Haber R S
Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029-6574, USA.
Mt Sinai J Med. 1996 Jan;63(1):10-5.
Although thyroid nodules are common and cause concern about possible malignancy, relatively few are thyroid cancers, and relatively few thyroid cancers are lethal. These considerations justify a selective approach in recommending surgical excision of nodules. Selection of patients should be based on assessment of cancer risk factors in the history and physical examination, and most importantly on fine-needle aspiration biopsy of the thyroid with cytologic examination. Other testing in most cases should be limited to serum thyroid-stimulating hormone and antithyroid antibodies and a thyroid sonogram. With the results of this evaluation a recommendation can be made for either immediate surgery or observation. This approach should reduce the number of operations for benign thyroid nodules and avoid excessive diagnostic testing.
尽管甲状腺结节很常见，且会引发对可能恶变的担忧，但真正的甲状腺癌相对较少，而致命性甲状腺癌更是为数不多。基于这些考量，在推荐甲状腺结节手术切除时应采取选择性策略。患者的选择应基于病史和体格检查中对癌症风险因素的评估，最重要的是基于甲状腺细针穿刺活检及细胞学检查。在大多数情况下，其他检查应限于血清促甲状腺激素、抗甲状腺抗体以及甲状腺超声检查。根据这些评估结果，可做出立即手术或观察的建议。这种方法应能减少良性甲状腺结节的手术数量，并避免过度的诊断性检查。
