Improved nonoperative diagnosis of the solitary 'cold' thyroid nodule. Surgical selection based on risk factors and three months of suppression

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Abstract
The cancer-predictive value of a nonoperative, 2-stage prospective selection of solitary, cold, solid thyroid nodules that can be employed by the primary clinician was assessed. Patients [118] completed the protocol, all without adverse effect. The 1st stage identified for direct surgery 30 patients with a history of exposure to irradiation during youth, age < 20 yr, recent growth of a hard nodule or lymphadenopathy, revealing 15 cancers and 10 adenomas. In the 2nd stage, the remaining 83 patients were given liothyronine for 3 mo. Nodules [26] were excised because they failed to shrink 50% in diameter, disclosing 5 cancers and 19 adenomas. There were no cancers among 14 nodules excised for other reasons. Selection for surgery on the basis of clinical evaluation and risk factors alone can identify most of the cancers and lack of response to suppression a few more.