Thyroid Nodular Disease: Diagnostic Evaluation and Management-Reply

The recommendations made by Raber and Vierhapper are neither accurate nor cost-effective. Their concerns were based on retrospective analysis of 2087 scintigraphically cold nodules, done as part of nodule evaluation. We agree that thyroid cancer can be found in small nodules, but the prevalence of occult thyroid cancer is small, with a mean (±SD) prevalence estimated to be 3.9%±4.1%.¹ Performing thyroid ultrasonography as an initial tool will only confuse the issue by the discovery of other nodules that, according to the recommendation of Raber and Vierhapper, will need further evaluation. There are no data to support this. To our knowledge, there is no study that prospectively examines these impalpable thyroid nodules. Autopsy studies have shown these nodules to be benign.² At the same time, in Japanese subjects, who have the highest prevalence of occult cancers, the death rate is very low, since the majority of these cancers are