Incidental thyroid nodules in a randomly selected cohort – the effects of screening

Abstract Introduction Incidental thyroid nodules (ITN) are common findings, but they cause a dilemma for both clinicians and radiologists. Should all nodules be mentioned in the radiology report and is a follow-up ultrasound always necessary? Method We prospectively performed a thyroid ultrasound screening of 542 randomly selected individuals, 50-65 years old, participating in the Swedish CardioPulmonary bioImage Study (SCAPIS). For those with thyroid nodules demanding further work-up (according to TIRADS), follow-up ultrasound and fine needle aspiration cytology (FNA) was performed. Result In the screened cohort, 14% had thyroid nodules measuring ≥1 cm and 8% underwent FNA whereof six had Bethesda category III-VI and subsequently underwent surgery, with benign histopathology results in five patients and one case of follicular tumor of uncertain malignant potential (FT-UMP). Discussion In conclusion, when screening an unselected Swedish cohort, 50-65 years of age, with thyroid ultrasound, we found ≥1 cm nodules in 14%. Thyroid malignancy was extremely rare but the amount of required follow-up is not negligible, even when applying TIRADS to discriminate which nodules must undergo FNA.