Definition – Solitary Nodule: Most of these swellings are simple nodular goitre formed by inactive colloid or apparently localized manifestations of simple multinodular goitre. This group also includes the neoplastic group, either benign or malignant; cysts and localised chronic lymphocytic thyroiditis.
A clinically solitary nodule is often a cluster of nodules of non-toxic goitre usually between 1 and 4 cms in total size.
The patient complains mainly of the localised swelling in the neck which moves on deglutition.
On palpation, it is a smooth, softish swelling, which has a very definite margin.
- Thyroid Function Tests – Are not very useful as diagnostic tests since most patients with thyroid cancer and benign thyroid swelling are euthyroid.
- Radioactive Scan – Helpful in differentiating ‘hot’ from ‘cold’ nodules.
- Realtime Ultrasonic Scanning – Determines the physical characteristic of the swelling and cysts or the areas of cyst formation are reliably differentiated from solid swellings.
- Aspiration of Fluid – In case of cystic swelling for treatment, as well as for cytology is helpful.
- Needle Biopsy – Particularly in solid group.
Treatment of simple nodular goitre becomes mainly cosmetic as the estimated risk of malignancy is about 5-30%. Moreover not infrequently, such goitres turn toxic.
The treatment is excision of the solitary nodule along with a margin of normal thyroid tissue all around.
Reference: A Handbook of Surgery by Dr Mansi Sharma