[When and how to manage thyroid nodules?].

Thyroid nodules are a very frequent finding in particular within the feminine population. Their prevalence increases with age and the vast majority (>95%) are benign and without dangerous consequences. A true cancer of the thyroid is rare. Following the discovery of a thyroid nodule by the patient himself or by the doctor, a relatively simple strategy should exclude the rare event of an underlying cancer. Thyroid ultrasound will confirm that the nodule is of thyroid origin. Furthermore, the ultrasound will measure the size of the nodule and reveal if other nodules or if suspicious lymph nodes are present. The next step is to measure the TSH level. If the TSH is normal, a fine needle aspiration is indicated for nodules larger than 1.0-1.5 centimetres. The choice between clinical follow up and a surgical thyroidectomy will be based upon the cytological analysis (hence the key role of an experimented pathologist in thyroid cytology). A thyroid scan is useless (except in case of hyperthyroidism with a low TSH).