Update on thyroid nodules: Characteristics and clinical management

Thyroid nodules (TNs) represent a highly widespread condition, usually destined to a positive outcome. Nevertheless, making a correct diagnosis is crucially important to ensure an appropriate and tailored strategy of follow up or treatment. Several different techniques allow to gradually characterize TNs by performing cytological and compositional analysis. In addition, collecting data of common risk factors together with recognized features - including microcalcifications, uneven margins, taller-than-wide form - may contribute to indicate a suspected malignancy. By combining all these information and proceeding step by step in the patients' investigation to achieve a diagnosis, physicians can optimize the diagnosis thus differentiating the small percentage of patients that need surgical intervention, without impacting on those patients with benign TNs. This may result helpful for improving the management of patients with TNs. Instead, in cases of benign TNs that no need neither surgical nor pharmacological treatments, dietary supplementations based on micronutrients involved in thyroid physiology, as iodine or myo-Inositol (myo-Ins), represent a useful tool. Even though evidence from literature sustains a correlation between iodine deficiency and TN occurrence, there are very few studies regarding a possible correlation between myo-ins deficiency and presence of TNs. Therefore, further investigations aimed to correlate myo-Ins levels with the severity of TNs may add new insights on this topic and improve the diagnostic process that aims to a tailored therapy for these patients. • Thyroid nodules (TNs) are a widespread condition, usually with a positive prognosis, but accurate diagnosis is crucial for tailored follow-up or treatment. • Different diagnostic techniques, including cytological and compositional analyses , support physicians in characterizing TNs. • Recording risk factors and ultrasound features (e.g., microcalcifications, irregular margins, taller-than-wide shape) assist in identifying suspected malignancies. • A step-by-step diagnostic approach helps optimize patient management, ensuring that only a small percentage undergo surgery while avoiding unnecessary interventions for benign TNs. • For benign TNs that do not require medical treatment, micronutrient supplementation (e.g., iodine, myo-inositol) may be beneficial for recovering thyroid functionality. • While iodine deficiency is a well-established risk factor for TNs, the link between myo-inositol deficiency and TNs remains largely unexplored. • Further studies on myo-inositol and TN severity could provide new insights and improve personalized treatment strategies.