Surgical Considerations and Emerging Non-Surgical Alternatives in the Diagnosis and Management of Hot and Cold Thyroid Nodules: A Comprehensive Review

Abstract: This text is a comprehensive review on thyroid nodules, discussing their characteristics, diagnostic challenges, and management strategies. It emphasizes the importance of careful evaluation of hyperfunctioning nodules due to their potential to cause hyperthyroidism. Risk factors like age, sex, and iodine intake influence the likelihood of malignancy, making the diagnostic approach challenging. Distinguishing between benign and malignant nodules remains a clinical challenge. Parameters such as clinical presentation, ultrasound findings, and thyroid stimulating hormone levels help improve diagnostic accuracy. Fine-needle aspiration biopsy guided by ultrasound is a pivotal tool for rapid and precise evaluation. Hot nodules, although less common, require unique diagnostic and therapeutic considerations. Somatic mutations are associated with hot nodules, which can manifest as euthyroid or hyperthyroid, requiring tailored management approaches like radioiodine therapy or percutaneous injection of ethanol. Non-surgical interventions offer promising alternatives for symptomatic nodules, especially in patients unfit for surgery. Techniques like percutaneous ethanol injection and radiofrequency ablation effectively reduce nodule volume and alleviate symptoms with minimal complications. Pediatric patients have distinct challenges, with a higher prevalence of malignant nodules requiring surgical intervention in autonomously functioning nodules. Incidental thyroid nodules pose a diagnostic dilemma, requiring differentiation between malignant and benign lesions through molecular testing and selective surgical excision. Non-surgical approaches like percutaneous microwave ablation, laser ablation, and high-intensity focused ultrasound ablation show promise in managing thyroid nodules with favorable outcomes and minimal complications. Tailored approaches are essential for optimizing patient outcomes.

کلیدواژه ها:

Cold Nodule ، Hot Nodule ، Thyroid