MANAGEMENT OF A SOLITARY THYROID-NODULE - A PARADIGM OF A CLINICAL-PRACTICE GUIDE LINE

The solitary thyroid nodule is frequently observed and many strategies are proposed for the diagnosis of the etiology and for the choice of treatment. Despite many discussions no clear consensus has been so for reached. The french groups concerned by this problem set up a Clinica l Practice Guide line with the methodological help of Agence Nationale pour le Developpement de l'Evaluation Medicale. Based upon the critic al review of the litterature a consensus was obtained concerning the n atural history of the nodules and the diagnosis value of the complemen tary explorations. The clinical approache alone completed by a TSH det ermination gives the therapeutical choice in about 30 % of the patient without any other explorations. In the remaining cases 3 methods (iso tope scan, echography, cytoponction) can be used alone or in a combine d sequence. So far no strategy can be privilegiated. It is necessary t o set up a systematic comparison between the possible strategies and t his will be made by the french thyroid specialists after this first st ep of delimitation of a clinical practise guide line.