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Necessity of follow-up sonography in patients with multinodular goiter

National Naval Medical Center Bethesda, MD 20889

We are frequently asked by our endocrinologists to do routine follow-up sonography on all patients with multinodular goiter, often at 6-month intervals. The rationale offered is to document the stability of all lesions. The endocrinologists specifically want to evaluate any interval increase in size that would then mandate biopsy because the increase in size may indicate a malignant change. I have yet to see a positive result from this type of follow-up and am interested in learning the opinion of your consultant.

Answer

University of Alabama at Birmingham Birmingham, AL 35233

I would tend to agree that such close follow-up is unwarranted. Although growth is often used as a predictor of malignancy, a significant proportion of benign nodules can enlarge over time. Using sonography, Alexander et al. [1] documented an increase in volume of 15% or greater in 129 of 330 benign nodules followed up for a mean interval of 20 months. Interpreting sonograms of patients with multinodular goiter is particularly challenging because it can be extremely difficult to distinguish dominant nodules from background multinodularity [2].

Practice patterns vary widely, however. This fall, the Society of Radiologists in Ultrasound will convene a panel of radiologists, endocrinologists, and other experts to reach consensus on guidelines for the management of thyroid nodules [3]. The results of the conference will be presented at the Society's annual meeting and will subsequently be published in the literature.

References

1. Alexander EK, Hurwitz S, Heering JP, et al. Natural history of benign solid and cystic thyroid nodules. Ann Intern Med 2003;138:315 -318[Abstract/Free Full Text]
2. Tessler FN, Tublin ME. Thyroid sonography: current applications and future directions. AJR1999; 173:437 -443[Free Full Text]
3. SRU annual meeting. Society of Radiologists in Ultrasound Web site. Available at: www.sru.org. Accessed July 12, 2004

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Jewell, E. W. Articles by Tessler, F. N. Search for Related Content PubMed Articles by Jewell, E. W. Articles by Tessler, F. N. Social Bookmarking                      What's this?