Clinical, sonographic and cytological evaluation of small versus large thyroid nodules.

OBJECTIVE To study the clinical presentation, thyroid function tests, ultrasound (US) features, cytology and surgical pathology results of patients undergoing fine needle aspiration (FNA) biopsy of thyroid nodules and to determine if a significant difference exists in the above variables between small (less than 1 cm) and large (1 cm or more) thyroid nodules. METHODS The study is a retrospective chart review study involving patients undergoing FNA of thyroid nodules at Marshall University Endocrine Clinic. Study data on patient demographics, clinical presentation, physical examination findings, thyroid function tests, US features, cytology and surgical pathology were collected and analyzed. RESULTS A total of 122 patients were included in the study including 18 patients with small and 104 patients with large thyroid nodules. Females were 88%. The overall mean age of patients was 56 +/- 15 years. Most of the patients (63%) were asymptomatic on presentation. Only 20% patients had their nodules reported to be palpable on physical examination. Solitary nodules as well as the dominant nodule in multi-nodular goiters in both groups were more frequently localized to the right lobe of thyroid gland. The mean US size was 0.7 +/- 0.15 cm for small and 2.4 +/- 1.2 cm for large nodules. Patients with small nodules presented at an earlier age (45 +/- 14 years Vs 58 +/- 15, years p = 0.008) and were more likely to have family history of thyroid cancer (p = 0.023), as compared to patients with large nodules. However, there was no other significant difference identified in clinical presentation, cytology results and prevalence rate of thyroid cancer between patients with small and large thyroid nodules. CONCLUSION In this study patients with small thyroid nodules presented at an earlier age and were more likely to have family history of thyroid cancer as compared to those with large nodules. There were no other significant differences in other study variables between small and large thyroid nodules. Further studies with large sample size in each group are needed to verify our results.