Recommendations for management of cystic thyroid disease

Background. Thyroidectomy has been advocated for cystic nodules that recur after 2 fine-needle aspiration biopsies (FNABs) because of concern for mali gnancy. Methods. A review of patients with nodular thyroid disease was completed to determine the frequency of cystic nodules, significance of the color and v olume of aspirated fluid, frequency and factors predictive of cyst resoluti on, and incidence of carcinoma in cystic nodules. Results, Thyroid nodules were cystic In 70 (18%) of 389 patients. FNAB was diagnostic in 50 (71%) patients with no false-negative results. Cyst resolu tion occurred in 10 (14%) patients. The mean volume of fluid aspirated from cysts that resolved was 14 +/- 12 mL compared with 8 +/- 18 mL from recurr ent cysts (P > .05). Thyroidectomy was performed in 28 (40%) patients becau se of an abnormal or persistently nondiagnostic FNAB or compressive symptom s. Six patients (8.6%) had cancer, with a mean nodule size of 3.8 +/- 2.3 c m compared with 3.7 +/- 2.6 cm in patients with benign cysts (P > .05). Hem orrhagic fluid was aspirated in 4 patients with and 36 without cancer (P > .05). Conclusions, FNAB of cystic thyroid nodules is rarely therapeutic and is a common cause of nondiagnostic rather than false-negative results. Recommend ations for thyroidectomy should be based on FNAB rather than on size, fluid color, or failure of cyst resolution alone.