Single thyroid nodule with hot nodule on nuclear scan is less likely to be cancerous and can be treated with thyroxine (LT4) suppression therapy or nuclear therapy first. Cold nodules mostly require surgery. Any fast-developing, hard-textured single nodule, or accompanied by enlarged lymph nodes in the neck or single nodule in children should be operated at an early date because of the high possibility of malignancy.
2. Multinodular goiter (MNG)
Traditionally, it is believed that MNG has a lower chance of developing cancer than single nodules. However, using high-resolution ultrasound, it has been found that many of those diagnosed as solitary nodules are actually multinodular, and it is now believed that there is little difference in the incidence of cancer between the two. Therefore, the first step in the management of MNG is to rule out malignancy. If the sTSH is decreased, it is suggestive of hyperthyroidism. If the FNA cytologic diagnosis is malignant or suspected malignancy, surgery should be performed.
3. Cysts can be formed by benign or malignant degenerative
changes, pure thyroid cysts are rare, and any persistent or recurrent mixed mass should be removed.
4. Invisible nodules
In recent years, due to the development of ultrasound, CT and MRI, small invisible thyroid nodules can be accidentally found during other examinations. This situation is mostly seen in the elderly, usually there is no history of thyroid disease, no thyroid nodules, and no risk factors for thyroid cancer, the nodules are less than 1.5cm, only need to be followed up and observed, if the nodules are larger than 1.5cm, FNA can be done under the guidance of ultrasound, and then according to the cytology results, further processing.
5. Radiation nodules
Thyroid cancer is prone to occur in those who receive radiation therapy to the head and neck, as early as 5 years and as late as 30 years after radiation. Anyone who develops nodules in the thyroid after radiation therapy to the head and neck should have an FNA to confirm the diagnosis.