Studen Katica Bajuk, Domagała Bartosz, Gaberšček Simona, Zaletel Katja, Hubalewska-Dydejczyk Alicja
Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Division of Nuclear Medicine, University Medical Centre, Ljubljana, Slovenia.
Endocrine. 2025 Jan;87(1):39-47. doi: 10.1007/s12020-024-04015-8. Epub 2024 Aug 31.
Due to the frequent diagnosis of benign thyroid nodules, it is necessary to deviate from the traditional paradigm based on frequent surgical treatment. This article highlights the evolution of diagnosis and treatment in recent years, beginning from standardization of ultrasound assessment of nodules and cytology results to minimally invasive techniques to reduce the size of symptomatic thyroid nodules. These achievements reduce the number of surgeries, enable more individualized care for patients with benign thyroid disease, reduce long-term complications, and promote cost-effectiveness within healthcare systems. Furthermore, although the use of minimally invasive techniques significantly decreases thyroid nodule volume, the thyroid nodule usually does not disappear and the challenges in this field are discussed (the efficacy of thermal ablation, a variable part of thyroid nodules that remains viable after thermal ablation, some of the nodules treated with thermal ablation may require a second treatment over time and the efficacy of thermal ablation in nodules with different phenotypes). However, although surgery still represents the "gold standard" for establishing the final histopathologic diagnosis, it is associated with lifelong thyroid hormone substitution need and serious complications in rare cases. Therefore, it should represent the ultima ratio only after a detailed diagnostic procedure. In the future, artificial intelligence-assisted programs for the evaluation and management of nodules are expected.
由于甲状腺良性结节的诊断较为频繁，有必要偏离基于频繁手术治疗的传统模式。本文重点介绍了近年来诊断和治疗的演变，从结节超声评估和细胞学结果的标准化到减少有症状甲状腺结节大小的微创技术。这些成果减少了手术数量，使甲状腺良性疾病患者能够获得更个性化的护理，减少长期并发症，并提高医疗系统内的成本效益。此外，尽管使用微创技术可显著减小甲状腺结节体积，但甲状腺结节通常不会消失，本文还讨论了该领域的挑战（热消融的疗效、热消融后仍存活的甲状腺结节可变部分、部分接受热消融治疗的结节可能需要二次治疗以及热消融在不同表型结节中的疗效）。然而，尽管手术仍是确立最终组织病理学诊断的“金标准”，但它与终身甲状腺激素替代需求相关，且在罕见情况下会引发严重并发症。因此，只有在经过详细诊断程序后，手术才应作为最后的手段。未来，预计会出现人工智能辅助的结节评估和管理程序。
