The role of complex diagnosis - follicular thyroid lesions

The role of complex diagnosis - follicular proliferation - Case 1.

Clinical data: a 40-year-old man visited us. Her wife watched a soap opera on TV, where a man was operated for thyroid cancer. It caused great anxiety because she was known having a thyroid nodule for years. She indicated an examination by herself and her husband. The man had no complaints.

Palpation: a nodule in the right lobe.

Functional state: euthyroidism with TSH-level 1.28 mIU/L.

Ultrasonography: there was an echonormal nodule presenting a halo sign and perinodular blood flow in the right lobe.

Cytological picture: follicular tumor.

We suggested follow-up examinations instead of surgery because taking the sonographic and the cytological picture into account, the risk of a follicular carcinoma was estimated less than 2%. The wife decided that her husband undergoes an operation.

Histopathology: revealed normofollicular adenoma.

Comment: this case illustrates the weakness of our strategy in thyroid nodules. The cytological pattern was clear, this is a follicular tumor. Based on the present protocol, such a patient had to be operated. However, the sonographic pattern was reassuring. Taken all circumstances into account, the risk of carcinoma was not greater than 2%. It would be a safe manner to follow such patients and to send to surgery only if the nodule later increases in size.

This case is enlisted among Follicular adenomas - case 7, too.