The management of the patient with a thyroid nodule remains a clinical challenge because of its risk of malignancy. This is a retrospective audit of 183 patients undergoing thyroidectomy for thyroid nodules at the Queen Elizabeth Hospital, Hong Kong, in 1994. The history, physical examination and investigations done were charted and analysed against the final histopathology of the specimens. Age, sex, symptom duration and nodularity were not associated with malignancy statistically, whereas a nodule hard in consistency was shown to be associated with malignancy (P <0.05). The sensitivity and specificity of ultrasonography, radionuclide scan and fine-needle aspiration cytology (FNAC) were 71% and 57%, 50% and 43%, and 93% and 60%, respectively. Hence, history and physical examination are unreliable for detecting malignant thyroid nodules and FNAC is mandatory. FNAC is superior to ultrasonography or radionuclide scan for evaluating thyroid nodules and should be used as the initial investigation.
Thyroid nodule is a common problem in surgical practice. In 1994, more than 350 thyroid operations were performed in our department, of which 183 were for thyroid nodules. Conventional preoperative assessment of a patient with a thyroid nodule, including history and physical examination, radionuclide scan and ultrasonography, has been shown to be relatively non-specific for diagnosing thyroid cancer.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.