Of 54 patients with solitary autonomous thyroid nodules (SAN), only one or perhaps two manifested signs or symptoms of hyperthyroidism. Eighteen of the 54 patients had nodules that were larger than 3 cm in diameter, but only one of these patients had possible thyrotoxicosis. Forty-eight of the 54 patients were followed up for 4 to 136 months (average, 24 months). The course of the disease was completely benign, and none of these subjects developed hyperthyroidism during the follow-up. Two of the 48 patients appeared to have a SAN that underwent degeneration during the study.
We think that euthyroid patients with SAN may be managed under most circumstances by periodic follow-up examinations and that they need to be subjected to surgical or radioactive iodine therapy only when and if they subsequently develop hyperthyroidism.