Thyroid incidentaloma: next to be neglected or investigated?

Abstract

In modern clinical practice, thyroid incidentaloma is an unpalpated node in the thyroid gland, which is detected accidentally by technical means of imaging when examining a patient for other, non-thyroid diseases. Its dimensions are limited to 10 mm, the limit above which it can already be palpated by a qualified professional. In the author’s view, such a definition narrows the concept of incidentaloma, primarily from a nosological point of view. Under the definition of the node can be micro- or macrofollicular nodular goiter, tumor, benign (adenoma) or malignant (carcinoma), the focus of thyroiditis, cyst, inflammatory focus (infiltrate, abscess), calcifications. When enumerating the me­thods of detection by incidental, the palpation method is excluded and the nodes in the thyroid gland detected with its help are not only up to 10 mm in size but also larger, which should also be called incidental. The same can be said about the nodes that are accidentally found on the neck during operations for diseases of the trachea, cervical esophagus, salivary glands. Speaking of incidentalomas, which are detected at autopsy, it should be noted that some of them are larger than 10 mm. All these positions do not fit into the definition of thyroid incidentaloma only as an unpalpated node in the thyroid gland up to 10 mm, which is determined by instrumental imaging methods. Therefore, the concept of thyroid incidentaloma is broader and more capacious than formulated by its modern definition. Incidental thyroid disease should be considered any additional formation in it, regardless of its size, detected by any non-target method of research. Unpalpated and, as a rule, clinically “dumb” nodes up to 10 mm, determined by instrumental methods, can be considered as one of the subspecies of the incidentaloma. The frequency of their detection has increased sharply in recent years, some are malignant neoplasms with an unpredictable course, tactical approaches to them have not been finalized.

Keywords

• thyroid, nodular goiter, incidentaloma, diagnosis, treatment