Management of benign cystic thyroid nodules in euthyroid patients

FNAB: fine-needle aspiration biopsy; RFA: radiofrequency ablation; US: ultrasound.

* In some nodules, fluid reaccumulation is a slow process, and patients may prefer periodic aspiration rather than more definitive therapy.

¶ Choice depends on patient preference and advantages and disadvantages of the procedures, some of which are listed below.

• Surgery advantages – Immediate definitive management.
• Surgery disadvantages – Inpatient (although in some centers, lobectomy is performed as an outpatient procedure), high cost, risk of hypothyroidism and surgical complications (eg, vocal cord paralysis, hypoparathyroidism) dependent on extent of resection but generally low with lobectomy.
• US-guided ablation advantages – Reduction in nodule volume (60 to 85%), outpatient, avoidance of scars.
• US-guided ablation disadvantages – Risk of chemical or thermal injury (eg, recurrent laryngeal nerve), risk of recurrence requiring more than one treatment, continued long-term monitoring with thyroid US.

Δ Thyroid nodules are selected for FNAB based on suspicious ultrasonographic characteristics and size. Refer to UpToDate content on selecting nodules for FNAB.

◊ Thyroid lobectomy is sufficient for definitive treatment of a predominately cystic nodule, but the extent of surgery may be influenced by the presence of contralateral thyroid nodules.

§ For predominantly cystic nodules, a combination of ethanol ablation followed by RFA of the solid component is also an option.