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6.2.4: 4. How to Manage a Thyroid Nodule After FNAC and/or Ultrasound

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    • The majority of thyroid nodules are benign and do not require surgery
    • Not all thyroid cancers require surgery
    • Most thyroid malignancies are indolent, slow growing papillary carcinomas which may be diagnosed on FNA
    • With follicular neoplasms, FNAC cannot distinguish benign (adenomas) and malignant (follicular or Hürthle cell carcinomas) as the latter two require histological evidence of vascular or capsular invasion
    • Some differentiated thyroid cancers may be observed with follow-up
    • Objectives of management
      • Avoid unnecessary surgery
      • Do appropriate surgery
      • Avoid doing harm e.g. causing hypocalcaemia and/or hypothyroidism in patients without access to monitoring and replacement therapy
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