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What is the strategy for sonographic follow-up of these nodules based upon nodule sonographic pattern?

waelhammad
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2022-11-18
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• A 42-year-old male with no active medical problem noticed a thyroid nodule 1 year back and was told by ENT specialist not to worry about it. Now he has come as he feels that the nodule is becoming more prominent. 

• Physical examination: 1 × 2 cm right lower pole nodule. There is also a lymph node which is hard and about 2 cm in size in the upper cervical chain in the right lateral neck region. An ultrasound is done which shows features of multinodular goiter. The FNA is done from the lymph node which showed metastatic papillary thyroid cancer. The patient was subjected to total thyroidectomy with radical neck dissection.

What is the strategy for sonographic follow-up of these nodules based upon nodule sonographic pattern?

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waelhammad
2022-11-18
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• Nodules with high suspicion US pattern: repeat US in 6–12 months.

• Nodules with sonographic features of low-to-intermediate suspicion US pattern: consider repeat US at 12–24 months.

• Nodules >1 cm with very low suspicion US pattern (including spongiform nodules) and pure cyst: the utility and time interval of surveillance US for risk of malignancy is not known. If US is repeated, it should be at >24 months.

• Nodules <1 cm with very low suspicion US pattern (including spongiform nodules) and pure cysts do not require routine sonographic follow-up.

• Nodules <5 mm without high suspicion US pattern do not require routine sonographic FU and if repeated, the US should be performed at 24 months or later.

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