U/S indications for diagnostic thyroid surgery in absence of FNAC

U/S can be used to risk-stratify using the Thyroid Imaging Reporting and Data System (TI-RADS) (http://tiradscalculator.com/)

Solid nodule

  • With suspicious sonographic  features                                     >1.0 cm
  • Without suspicious sonographic features                                >1.5 cm

Mixed cystic-solid nodule

  • With suspicious sonographic  features: hypoechoic,            Solid component >1.0 cm
    microcalcifications, infiltrative margins, taller than
    wide in transverse plane
  • Without suspicious sonographic features: Spongiform       Solid component >1.5 cm
    nodules, isoechoic of hyper echoic solid nodules, mixed
    solid-cystic nodules without above suspicious features

Spongiform nodule (multiple microcystic components               >2.0 cm
in >50% of volume of nodule

Suspicious cervical lymph node: May consider biopsy of lymph node

Above criteria are general guidelines: With high risk clinical features, evaluation of smaller nodules may be indicated based on clinical concerns e.g. prior thyroid cancer, radiation exposure, 1st degree relative with thyroid cancer of MEN2, FDG avid on PET scan, thyroid cancer associated history e.g. familial adenomatous polyposis, Carney complex, Cowden syndrome

Index: Clinical Practice Guidelines for Thyroid