Surgical Considerations and Emerging Non-Surgical Alternatives in the Diagnosis and Management of Hot and Cold Thyroid Nodules: A Comprehensive Review

Abstract: Thyroid nodules present a significant health concern worldwide, with varying risks of malignancy and associated symptoms. This comprehensive review delves into the diverse characteristics, diagnostic challenges, and management strategies for hot and cold thyroid nodules. Despite the rarity of malignancy in solitary hyperfunctioning nodules, their potential to cause subclinical or overt hyperthyroidism necessitates careful evaluation. Risk factors such as age, sex, and iodine intake influence the likelihood of malignancy, challenging clinicians in their diagnostic approach. Distinguishing between benign and malignant nodules remains a clinical challenge. Various parameters, including clinical presentation, ultrasound findings, and thyroid stimulating hormone levels, aid in improving diagnostic accuracy. Fine-needle aspiration biopsy guided by ultrasound has emerged as a pivotal tool, offering rapid and precise evaluation. Hot nodules, though less common, present unique diagnostic and therapeutic considerations. Associated with somatic mutations, hot nodules may manifest as clinically euthyroid or hyperthyroid, requiring tailored management approaches such as radioiodine therapy or percutaneous injection of ethanol. Advancements in non-surgical interventions offer promising alternatives for symptomatic nodules, especially in patients unfit for surgery. Techniques like percutaneous ethanol injection and radiofrequency ablation demonstrate efficacy in reducing nodule volume and alleviating symptoms, with minimal complications. Furthermore, the pediatric population poses distinct challenges, with a higher prevalence of malignant nodules and the recommendation for surgical intervention in autonomously functioning nodules. Incidental thyroid nodules also present a common diagnostic dilemma, with the imperative to differentiate between malignant and benign lesions through molecular testing and selective surgical excision. Novel non-surgical approaches, including percutaneous microwave ablation, laser ablation, and high-intensity focused ultrasound ablation, hold promise in the management of thyroid nodules, offering favorable outcomes with minimal complications. This review provides a comprehensive overview of the evolving diagnostic modalities and therapeutic interventions for hot and cold thyroid nodules, highlighting the importance of tailored approaches in optimizing patient outcomes.

Keywords:

cold nodule , Hot nodule , Thyroid nodule , Thyroid , malignancy