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