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Thyroid Nodular Disease: Diagnostic Evaluation and Management

Wolfgang Raber, MD; Heinrich Vierhapper, MD
Arch Intern Med. 1997;157(5):575. doi:10.1001/archinte.1997.00440260143018.
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In a recent retrospective analysis of 2087 scintigraphically "cold" thyroid nodules, we found 18 of 91 thyroid malignancies to be smaller than 1 cm in diameter. These included 2 carcinomas (1 follicular and 1 medullary) with regional lymph node metastases.1 These findings make one wonder about the recommendation by Tan et al2 that thyroid nodules smaller than 1 cm in diameter should virtually be ignored. Even taking into account the logistic difficulty of performing sonography in every patient who is referred to a large thyroid outpatient clinic, one should still keep in mind the basic facts that each carcinoma must have been a very small nodule at one point and that no "incidentaloma," whether of adrenal or thyroid origin, will lose its malignant potential (which in the case of the thyroid is about 5.3%3) by being ignored. Surprisingly, only about 10% (194/1774) of Tan and colleagues' patients


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