The role of surveillance in the management of indeterminate thyroid nodules: an evidence-based approach

OBJECTIVES: Following adequate evaluation of a thyroid nodule, there remains a group of patients for whom diagnostic surgical procedure is not an absolute indication, however they may not have a confirmed benign diagnosis. The majority of these nodules will ultimately be benign but there are few data in the literature for the appropriate length of surveillance. METHODS: Retrospective study from a high-volume tertiary referral centre. The Picture Archiving and Communications System Trust database was searched (1 January 2017 to 31 December 2021) and data from all U3 thyroid nodules extracted and analysed. RESULTS: Of the 1054 patients included, 70 (6.64 per cent) died during the follow-up period. Of those, only two deaths (0.2 per cent) were the result of thyroid cancer. Very few thyroid cancers were diagnosed after three-year follow-ups or three ultrasound scans. CONCLUSION: At the clinician's discretion, patients with an unconfirmed diagnosis in a U3 thyroid nodule, may be safely discharged after three-year surveillance.