Thyroid nodules: Rational management

Thyroid nodules are the commonest disorder presenting to the endocrine surg eon, Most of the lesions are benign, but the principal problem facing the c linician is that of identifying the malignant nodule requiring surgery. Cur rent diagnostic methods are reviewed, and the role of intraoperative frozen section in particular is examined in a series of 155 patients undergoing t hyroidectomy for solitary thyroid nodule, It is concluded that when the fin e-needle aspiration cytology (FNA) result is malignant intraoperative froze n section is unnecessary and contributes little to the management. Frozen s ection, however, is considered to be of value when the FNA result is report ed as benign, suspicious, or inadequate. It permits identification of many malignant lesions that would otherwise require a second operation to comple te a total thyroidectomy. Details of the indications for surgery and the op erative strategy are discussed.