Summary and comments
54 colleagues have answered the questionnaire.
Does the RIGHT lobe have pathological nodule?
Distribution of answers
| Choice | Percentage | No |
| Yes. | 18.5 % | 10 |
| Probably yes. | 27.8 % | 15 |
| No. | 12.7 % | 7 |
| Probably no. | 40.7 % | 22 |
Expert commentary
The lesion fully corresponds to a more active foci of thyroiditis. There are several, tiny much smaller areas in the lobe. To raise the possibility of true nodule should be accepted but this lesion should not be regarded as an obvious pathological nodule.
Histopathology disclosed no nodule.
How to classify the largest lesion in the RIGHT lobe according to EU-TIRADS?
Distribution of answers
| Choice | Percentage | No |
| EU-TIRADS 3 | 24.07 % | 13 |
| EU-TIRADS 4 | 33.33 % | 18 |
| EU-TIRADS 5 | 42.59 % | 23 |
Expert commentary
The lesion is minimally/moderately hypoechoic and does not show any suspicious finding. So, this is an EU-TIRADS 4 lesion if we consider this as nodule.
Does the LEFT lobe have pathological nodule?
Distribution of answers
| Choice | Percentage | No |
| The RIGHT lobe has, the left lobe has not. | 5.56 % | 3 |
| The LEFT lobe has, right lobe has not. | 40.74 % | 22 |
| Both lobes have nodules. | 51.85 % | 28 |
| The thyroid does not have nodules. | 1.85 % | 1 |
Expert commentary
This lesion is much better circumscribed than the lesion in the right lobe and therefore it can be a true nodule with a much greater likelihood. But again, this is not an obvious pathological nodule. And one more consideration. If we consider the size of the lesion, it can be practically excluded that this would cause any harm to the patient later in her lifetime. In such cases, I would not burden the psyche of the patient with the term 'nodule'.
How to classify the lesion in the LEFT lobe (pointed with yellow arrow) according to EU-TIRADS?
Distribution of answers
| Choice | Percentage | No |
| EU-TIRADS 3 | 1.85 % | 1 |
| EU-TIRADS 4 | 48.15 % | 26 |
| EU-TIRADS 5 | 50 % | 27 |
Expert commentary
The lesion is minimally/moderately hypoechoic and does not show any suspicious finding. So, this is an EU-TIRADS 4 lesion if we consider this as nodule.
Is FNA indicated from any discrete lesions?
Distribution of answers
| Choice | Percentage | No |
| Yes, from the lesion in the RIGHT lobe. | 11.11 % | 6 |
| Yes, from the lesion in the LEFT lobe. | 18.52 % | 10 |
| Yes, from both lesions. | 20.37 % | 11 |
| No. | 50 % | 27 |
Expert commentary
The answer is obvious 'no' in both cases. We can consider FNA in subcentimeter lesion if it presents suspicious findings. But these lesions did not show any of these features.
Considering the previous FNA result, what would you suggest?
Distribution of answers
| Choice | Percentage | No |
| Repeat FNA. | 22.22 % | 12 |
| Surgery. | 29.63 % | 16 |
| Follow-up in 6 to 12 months. | 48.15 % | 26 |
Expert commentary
I think that the question cannot be clearly answered because there is no uniform solution. The first and third opportunities can be accepted depending on the psyche of the patient and the degree of anxiety caused by the previous report. In this case, I succeeded to calm down the patient and she accepted the suggested follow-up. I would not suggest surgery except for those patients whose anxiety remains in contrast to our efforts to eliminate it.
