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An autonomous thyroid nodule or "hot nodule" is one that has thyroid function independent of the homeostatic control of the HPT axis (hypothalamic–pituitary–thyroid axis). According to a 1993 article, such nodules need to be treated only if they become toxic ; surgical excision ( thyroidectomy ), radioiodine therapy , or both may be used.
Although the correlation between thyroid nodule size and malignancy risk is limited, nodule size affects prognosis in malignant nodules. Small thyroid cancers (less than 2 cm) tend to have an indolent course, with favourable prognosis even if not treated. Less than 7% of the imaging-detected ITNs are seen in younger populations.
Most people with thyroid cancer do not have symptoms at the time of diagnosis and thyroid nodules and thyroid cancer is usually found incidentally on imaging of the neck. [ 10 ] [ 14 ] Up to 65% of adults have small nodules in their thyroids, but typically under 10% of these nodules are found to be cancerous. [ 15 ]
Treatment of a thyroid nodule depends on many things including size of the nodule, age of the patient, the type of thyroid cancer, and whether or not it has spread to other tissues in the body. If the nodule is benign, patients may receive thyroxine therapy to suppress thyroid-stimulating hormone and should be reevaluated in six months. [2]
Colloid nodules may be initially identified as an unspecified kind of thyroid nodule. Follow-up examinations typically include an ultrasound if it is unclear whether or not there really is a nodule present. Once the presence of a nodule has been confirmed, the determination of the kind of thyroid nodule is done by fine needle aspiration biopsy. [7]
Regular monitoring mainly consists of watching for changes in nodule size and symptoms, and repeat ultrasonography or needle aspiration biopsy if the nodule grows. [8] For patients with benign thyroid adenomata, thyroid lobectomy and isthmusectomy is a sufficient surgical treatment.
Since 2010, there is also a Bethesda system used for cytopathology of thyroid nodules, which is called The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC or BSRTC). Like TBS, it was the result of a conference sponsored by the NIH and is published in book editions (currently by Springer).
Solitary nodule in person younger than 35 years old Likely ultrasonography if at least 1 cm large in adults, or for any size in children. None needed if less than 1 cm in adults; Solitary nodule in person at least 35 years old Likely ultrasonography if at least 1.5 cm large; None needed if less than 1.5 cm