Epidemiology, pathophysiology, guideline-adjusted diagnostics, and treatment of thyroid nodules]

Clinically relevant thyroid carcinomas can be found in 5-6% of nodular goiters which undergo surgery. Moreover, multinodular goiters fre- quently contain hot areas. Therefore, efficient and rational methods for the differential diagnosis and decision are required to identify those nodules with an increased cancer risk or those which are hot among the many thyroid nodules. Description of a newly revised and further guidelines and consensus statements as well as selected literature search. Already history, ultrasound and TSH (thyroid-stimulating hormone) determination do allow a first risk assessment for the further diagnostic work-up. Fine-needle biopsy (FNB) offers the best sensitivity and specificity for the distinction between benign and malignant thyroid nodules. The combination of several clinical and ultrasound criteria and laboratory determinations (calcitonin) can help with the selection of thyroid nodules with scintigraphically normal or decreased uptake > 1 cm for FNB. However, the efficiency of FNB requires sufficient training and experience of both the cytopathologist and the person performing FNB. Whereas solitary thyroid nodules with a suspicion for malignancy should be referred to the surgeon, euthyroid thyroid nodules without clinical ultrasound or cytological indicators of malignancy may be followed up - possibly under medication -, if surgery is not indicated by local complaints, tracheal or mediastinal involvement.