Management of a thyroid nodule / mass following FNAC or biopsy: Key points

  • The majority of thyroid nodules are benign and do not require surgery
  • Not all thyroid cancers require surgery
  • Most thyroid malignancies are indolent, slow growing papillary carcinomas which may be diagnosed on FNA
  • With follicular neoplasms, FNAC cannot distinguish benign (adenomas) and malignant (follicular or Hürthle cell carcinomas) as the latter two require histological evidence of vascular or capsular invasion
  • Some differentiated thyroid cancers may be observed with follow-up
  • Objectives of management
    • Avoid unnecessary surgery
    • Do appropriate surgery
    • Avoid doing harm e.g. causing hypocalcaemia and/or hypothyroidism in patients without access to monitoring and replacement therapy

Index: Clinical Practice Guidelines for Thyroid