THYROID
NODULES IN PATIENTS WITH GRAVES DISEASE
Thyroid
nodules may be observed in patients with Graves disease (GD). Thyroid nodules
larger than 1 cm should be evaluated before selecting non-surgical therapy
(antithyroid drugs or radioiodine therapy). If a scan is performed, any
nonfunctioning or hypofunctioning nodules should be considered for fine-needle
aspiration cytology, because they are associated with a higher risk of
underlying malignancy. Surgery is indicated when cytopathology is suspicious or
diagnostic of malignancy or in the presence of indeterminate cytology. However,
thyroid cancer is observed in a very small percentage of patients with GD (≤ 2 %). Long-term prognosis is excellent in this subgroup of patients
(20-yr disease-free survival ~ 99 % after thyroidectomy for microscopic
papillary thyroid cancer (< 1 cm) associated with GD.
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