Follow-up of large thyroid nodules without surgery: Patient selection and long-term outcomes

Background: The management of large thyroid nodules remains controversial. Mandatory resection is recommended by some authors. Methods: All patients with thyroid nodules ≥3 cm between January 2009 and January 2013 were followed until August 2017. Follow-up data were collected using an integrated hospital-community system. Results: A total of 141 nodules were included. Of these, 37/141 (26%) nodules were initially referred to surgery, resulting in a 32% malignancy rate (12/37). The remaining 104/141 (74%) were referred to follow-up. During the follow-up period, 24 additional operations were done, resulting in a 4% malignancy rate (1/24). An indication of nonbenign cytology was significantly associated with malignancy compared with other indications. Median follow-up was 53.5 months. No patient developed regional or distal diseases. The mean change in nodule size during the follow-up period was a 7% reduction, with no significant trend of change over time. Conclusion: Careful patient selection based on clinical, sonographic, and cytologic features can reduce diagnostic surgery allowing for safe follow-up of large thyroid nodules without surgery.