Evaluation of dominant thyroid masses.

Controversy exists concerning the management of solitary thryoid nodules because of conflicting information converning the high clinical incidence of thyroid nodules, the varying incidence of cancer reported in those surgically excised and the infrequency of death from thyroid cancer. During the past several years, a plan for evaluating patients with dominant thyroid masses has evolved. The objective is to avoid unnecessary operations by identifying patients with a high risk of cancer. The criteria which are used are the age and sex of the patient, the duration of the mass, 125I or 99mTc scans, 75Selenomethionine scans, B-mode ultrasonography and the response of the mass to suppressive therapy. This is a report of the findings in 222 patients who have been studied employing this approach. Thirty per cent of the patients were operated upon. Forty per cent had neoplasms (well differentiated cancer--28.8%, adenoma--12.1%), 47.0%--nodular goiter, 6.1% cysts, and 6.1% chronic thyroiditis. The incidence of cancer in the 222 patients was 8.6% and adenoma 3.6%. Patients at greatest risk of having cancer are those with solid nonfunctioning nodules which fail to regress with suppressive therapy. This study indicates that the approach described above is effective in selecting for surgical excision those individuals at greatest risk of having thyroid cancer.