The management of thyroid nodules poses several diagnostic dilemmas. The vast majority of thyroid nodules are asymptomatic and impalpable, such that only 4% to 7% of the adult US population has palpable thyroid nodules.1 However, neck ultrasonography reveals a large reservoir of clinically silent impalpable nodules, termed incidentalomas, the prevalence of which (both benign and malignant) ranges from 30% to 60% in autopsy studies and from 19% to 67% in prospective clinical studies.2 Thyroid nodules increase in prevalence with advancing age and are more prevalent in women. An ultrasound screening study of 96 278 German employees aged 18 to 65 years found that the presence of a thyroid nodule was 13% in women and 9% in men aged 26 to 35 years, increasing to almost 45% in women and 32% in men aged 55 years and older.3 Moreover, thyroid cancer, which is relatively rare, is found in approximately 4% of fine-needle aspiration biopsy (FNAB) cytology specimens, will account for 30 000 new cases in the United States in 2006,2 and, while usually associated with a good prognosis, will cause about 1500 deaths this year.4
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