Enfrentamiento actual del nódulo tiroideo

Abstract

A thyroid nodule is a lesion structurally distinguishable from the thyroid parenchyma and is highly prevalent in the general population. Its detection has increased due to the widespread use of cervical ultrasonography. Although most nodules are benign, approximately 7–15% may correspond to cancer. The initial evaluation includes a detailed medical history, an assessment of risk factors, and a physical examination focused on signs of thyroid dysfunction or malignancy.

Thyroid ultrasound is the diagnostic method of choice due to its accuracy, safety, and low cost. Certain sonographic features allow estimation of malignancy risk, classified through systems such as TI-RADS. TSH measurement helps determine the functional status of the nodule.

Fine-needle aspiration biopsy (FNAB), guided by ultrasound, enables cytological analysis according to the Bethesda System (categories I–VI), which informs clinical management. For nodules with indeterminate cytology (Bethesda III and IV), molecular studies provide predictive value for malignancy.

Therapeutic decisions must consider the patient's age, comorbidities, the nodule's sonographic and cytological characteristics, and patient preferences. Management options range from ultrasound monitoring to surgical or ablative treatments.

In conclusion, the approach to thyroid nodules is based on an integrated and sequential strategy, guided by diagnostic tools and updated clinical guidelines, aimed at achieving personalized and safe decision-making.