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The role of ultrasound in the management of nodular thyroid disease

¹ Diagnostic & Therapeutic Neurological Imaging Service (WA), Sir Charles Gairdner Hospital, Perth, Western Australia, Australia, ² Department of Diagnostic Imaging, Bart's and The London NHS Trust, Queen Elizabeth II Wing, St Bartholomew's Hospital, London EC1A 7BE, ³ Department of Neuroradiology, Atkinson Morley Wing, St Georges' Hospital, Blackshaw Road, London SW17 0QT, UK

• The incidence of sub-clinical thyroid nodules inthe general population is high.
  
• Thyroid carcinoma is rare and has a good prognosis.
  
• Clinical assessment can reduce the number of ultrasounds requested.
  
• Ultrasound and FNAc can detect the majority of neoplasms requiring treatment.
  
• Management strategies should minimize the risks, cost and anxiety of unnecessary surgery.
  

Benign nodular thyroid disease is common, and biologically significant thyroid cancers (10 mm in size, or associated with lymphadenopathy) are rare. By comparison, papillary microcarcinomas (<10 mm) are quite common but the majority are thought to be clinically insignificant . The investigation and management of thyroid nodules is controversial; the ideal diagnostic pathway is a balance between missing carcinomas of potential clinical aggressiveness and reducing the number of unnecessary operations whilst keeping an eye on the cost. This article reviews some of the ultrasonographic features of thyroid nodular disease, and discusses the role of ultrasound and fine-needle aspiration in the assessment of thyroid nodules.