Surgery in simple goiter |
|
|
Score 3 | citology indicative for maligancy |
obstructive symptoms with goiter of volume < 40 ml | |
Score 2 | citology suggestive for follicular neoplasm or Hurtle |
cells (numerous) | |
Score 1 | thoracic goiter |
volumetric increase by US (increase < 5 mm or 50% of precedent volume) during suppressive therapy |
|
regional lymph node enlargement | |
history of neck irradiation (6) | |
airways obstruction (x-ray documented) | |
intolerance to thyroxine | |
clinical clues suggestive for malignancy | |
Score -1 | age < 80 |
high surgical risk | |
good response to previously instituted suppressive therapy |
1 | malignant neoplasms papillary | 11 |
malignant neoplasms follicular | 3 | |
malignant neoplasms medullary | 3 | |
malignant neoplasms Hurtle cells | 2 | |
malignant neoplasms anaplastic | 1 | |
2 | diffuse goiter with foci of occult papillary carcinoma | 3 |
3 | follicular adenomas | 4 |
4 | lymphocytic thyroiditis | 20 |
5 | simple cysts | 12 |
6 | micro-macro follicular goiter | 84 |
The follow-up of the 269 not operated subjects (12-112 months) did not reveal any diagnostic failure (6 were lost to the follow-up).
Thirty-two were reevaluated by fine needle aspiration cytology with results confirming the precedent examination.
The described approach can be proposed as a useful diagnostic tool to evaluate simultaneously multiple factors in order to take appropriate diagnostic decisions.