Meier C A
Division of Endocrinology and Diabetes, University Hospital Geneva, Geneva, CH-1211, Switzerland.
Baillieres Best Pract Res Clin Endocrinol Metab. 2000 Dec;14(4):559-75. doi: 10.1053/beem.2000.0103.
Thyroid nodules are very frequently found and their prevalence steadily increases with age. The discovery of such lesions by high-resolution radiological imaging procedures that have been performed for other indications raises the problem of how incidentally discovered thyroid nodules should be investigated in a cost-effective manner to identify the rare patient with a clinically significant malignancy. In this review the clinical criteria that prompt the evaluation of thyroid nodules are discussed, as is the currently recommended diagnostic approach, which principally relies on fine needle aspiration biopsy. The clinical implications of the different cytological diagnoses are discussed, with a special emphasis on the management of indeterminate, microfollicular lesions. Finally, the evidence for and against suppressive thyroid hormone therapy for benign thyroid nodules and multinodular goitres is discussed, with particular consideration of high-risk patients with prior external radiation therapy to the neck region.
甲状腺结节非常常见，其患病率随年龄增长而稳步上升。通过因其他指征而进行的高分辨率放射成像检查发现此类病变，引发了一个问题，即如何以具有成本效益的方式对偶然发现的甲状腺结节进行检查，以识别出患有具有临床意义恶性肿瘤的罕见患者。在本综述中，讨论了促使对甲状腺结节进行评估的临床标准，以及目前推荐的主要依赖细针穿刺活检的诊断方法。还讨论了不同细胞学诊断的临床意义，特别强调了不确定的微滤泡病变的处理。最后，讨论了支持和反对对良性甲状腺结节和多结节性甲状腺肿进行甲状腺激素抑制治疗的证据，尤其考虑了既往颈部接受过外照射治疗的高危患者。
