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The Solitary Thyroid Nodule-Reply

Manfred Blum, MD; Martin Rothschild, MD
JAMA. 1980;244(22):2520. doi:10.1001/jama.1980.03310220021011.
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In Reply.—  There is no best way to ascertain clinically which solitary cold thyroid nodule is malignant. Mature judgment will lead to one or a combination of diagnostic tools. Our publication assessed prospectively the value in predicting cancer of the two following approaches that are commonly used and about which there are little hard data: (1) factors derived from the history and physical examination that are immediately available to the average primary physician without a consultant, and (2) the response to three months of suppressive therapy.Three fourths of our cancers came from the high-risk group, and in these patients neither suppressive therapy nor needle biopsy was needed to make an accurate diagnosis. Since 50% of this group had carcinoma and 30% adenoma, it is clear from our results that when there are high-risk factors a negative needle biopsy result should not deter surgery. The majority of the patients, those


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