Navigating the Debate on Large (4+cm) Thyroid Nodules: Local Insight on a Persisting Problem

Abstract Background: Thyroid nodules are a common clinical finding, however discordant practice guidelines for managing large may result in unnecessary surgeries and excess costs. Recent data suggest similar false negative rates fine needle aspiration (FNA) biopsies between small (<4cm) (4+ cm) nodules, indicating that monitoring rather than surgery be appropriate nodules. Evaluating current management strategies reveal insights regarding surgeries, costs opportunities improvement. Objectives: The goal of this project was to describe the patients at our institution with thyroid determine proportion potentially associated predictors. Methods: This retrospective cohort study included who received FNA nodule (s) ≥4cm 11/1/2014 10/31/2019 tertiary care institution. Patient demographics, sonographic size, cytology, molecular testing results, final surgical pathology, history neck irradiation, family cancer, presence compressive symptoms or toxic multinodular goiter, were compared had those did not. A considered inappropriate if benign absence any following: suspicious on testing, symptoms, cancer first degree relative, goiter substernal extension. Continuous variables evaluated using Wilcoxon rank-sum test while categorical tested chi-square Fisher’s exact test. Results: total 177 4+ cm during timeframe. Half (54.2%)with surgery. Patients underwent significantly younger (51.5 years vs 62 years; P<0.001), more likely report obstructive (34.4% 12.1%; P=0.001) have larger size (5.0 4.7 cm; P=0.26) not Forty-one (Bethesda II) results went All 41 found surgery, yielding rate 0.0% cohort. Twenty-three (24.0%) overall 13% (23/177) 4+cm median charge these $13,183. Conclusion: Approximately half especially younger, sizes. Overall revealing improving