Management of Thyroid Nodules 1cm or Large
      “Management of Thyroid Nodules Detected at US:
           Society of Radiologists in Ultrasound Consensus Conference Statement1 
        Mary C. Frates”  Radiology 2005;237:794-800

Recommendations for Thyroid Nodules 1 cm or Larger in Maximum Diameter

US Feature

Recommendation

SOLITARY NODULES

 

  • Microcalcifications

Strongly consider US-guided FNA if >1 cm

  • Solid (or almost entirely solid) or coarse calcifications

Strongly consider US-guided FNA if >1.5 cm

  • Mixed solid and cystic or almost entirely cystic with solid mural component

Consider US-guided FNA if >2cm

  • None of the above but substantial growth since prior US examination

Consider US-guided FNA

  • Almost entirely cystic and none of the above and no substantial growth       (or no prior US)

US-guided FNA probably unnecessary

MULTIPLE NODULES

Consider US-guided FNA of one or more nodules, with selection prioritized on basis of criteria (in order listed) for solitary nodule*


Note.—FNA is likely unnecessary in diffusively enlarged gland with multiple nodules of similar US appearance without intervening parenchyma. Presence of abnormal lymph nodes overrides US features of thyroid nodule(s) and should prompt US-guided FNA or biopsy of lymph node and/or ipsilateral nodule.

* Panel had two opinions regarding selection of nodules for FNA. The majority opinion is stated here.