Thyroidectomy or radioiodine? The value of ultrasonography and cytology inthe assessment of nodular lesions in Graves' hyperthyroidism

Although diffuse toxic goiter is a classical feature of Graves' disease (GD ) nodular goiters are occasionally found in some patients. The aim of the p resent study was to investigate the ultrasonographic and corresponding cyto logical manifestations in GD patients with nodular lesions to decide on a t herapeutic strategy. Twenty-seven consecutive GD patients with nodular goit er were included in this study (21 women and six men, mean age 41.2 years, range 22-77 years). All underwent thyroid ultrasonography and fine-needle a spiration cytology. Of the 27 patients eight underwent surgical interventio n because papillary thyroid carcinoma or follicular neoplasm was diagnosed by cytology; five of these were shown to have papillary thyroid carcinomas. Ultrasonography revealed the malignant nodules to be hypoechogenic, hetero geneous, and with ill-defined margins in four of these five thyroid cancers , whereas the remaining sonogram showed a cystic change and cauliflower-lik e tumor formation with microcalcification. The volume and maximal diameter of cancerous nodules were significantly larger than those of benign nodules . In conclusion our results reveal that ultrasonography and fine-needle asp iration cytology are reliable and quick methods for diagnosing nodular goit ers in GD patients. If thyroid neoplasms are found ablative therapy with th yroidectomy is indicated instead of radioactive iodine.