Thyroid Ultrasound > Sonographic Features > Size/Multiplicity

Size and Multiplicity

Thyroid nodules become palpable when they reach approximately 1 cm in size. In nodules larger than 1 cm, no significant difference in the rate of malignancy in solid nodules is found by size, although higher rate of malignancy in nodules larger than 3 cm has been suggested. 

The recent Society of Radiologists in Ultrasound consensus statement suggests that, rather than a fixed size threshold, sonographic features should be used to guide nodule selection for FNA. More suspicious sonographic features should trigger biopsy at small nodule size, whereas nearly completely cystic nodules without other suspicious features probably do not require biopsy at any size. 

The presence of multiple nodules does not make thyroid carcinoma less likely, contrary to former teaching. In multinodular glands, each nodule should be scrutinized for suspicious features and selected for FNA on the basis of sonographic features, rather than size alone.

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