Thyroid Diseases
Thyroid Nodule
TIRADS classification, fine-needle biopsy, follow-up vs surgery decision.
Is every thyroid nodule dangerous?
No. 50–65% of adults have a thyroid nodule on ultrasound; only 5–10% are cancer. Risk is evaluated with ultrasound: the TIRADS (Thyroid Imaging Reporting and Data System) score guides follow-up vs FNA biopsy. TIRADS 1–2: benign, follow-up sufficient. TIRADS 3: mild suspicion, 1–2 year ultrasound surveillance. TIRADS 4–5: suspicious / highly suspicious, FNA biopsy required. Biopsy results are categorised on the Bethesda system; III/IV (grey zone) cases may have molecular testing or repeat FNA. V/VI cases proceed to surgery.
Active surveillance — an emerging option
In the classical approach, all "suspicious" cytology nodules went to surgery. In the last decade, "active surveillance" gained acceptance for small (≤1 cm) low-risk papillary microcarcinoma: 6-monthly ultrasound instead of surgery, with surgery on growth or new feature. Miyauchi's Japan series showed 10+ year safe outcomes.
The decision is shared: patient + surgeon + endocrinologist together evaluate "operate or observe". Ideal active-surveillance candidate: ≤1 cm tumour, no extrathyroidal extension, no high-risk feature, patient motivated for long-term follow-up.
Frequently Asked Questions
- No. Selection is by TIRADS score; typically the most suspicious-looking and largest nodules go to biopsy. Not all nodules in multinodular goitre need biopsy.
- No, performed under local anaesthesia; most patients describe mild pressure. 5–10 minutes; normal activity immediately after.
- Insufficient cell collection. Repeat FNA is recommended. If repeat is also insufficient, surgery may be considered based on ultrasound features.
- For some benign thyroid nodules, RFA is an option. Not for suspected cancer. RFA is not yet widespread in Türkiye; surgery is standard.
- TIRADS 3 nodules: 1–2 year ultrasound. If stable, intervals extend to 2–3 years. Growth or change triggers repeat FNA.
References
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