Nodular thyroid disease

doi:10.1136/bmj.323.7322.1184

BMJ 2001;323:1184 ( 17 November )

Letters

Nodular thyroid disease

Abnormal thyroid function may be positive discriminator for malignancy

Author's reply

Abnormal thyroid function may be positive discriminator for malignancy

The first 150 words of the full text of this article appear below.

EDITOR $---$ Keston Jones states that testing of thyroid function is still one of the cornerstones of investigation in nodular thyroiddisease.¹ He also states that overt thyroid dysfunction effectivelyrules out the possibility ofmalignancy.

Thyroid function tests will not help in the discrimination of a nodule as they give no description of the nodule. In addition,malignancy may occur in patients with hyperthyroidism and a palpablethyroid nodule. Kraimps et al report that in patients with a coldnodule and Graves' disease the incidence of malignancy is as highas 15%, and that malignancy should be taken as an indication fortotal thyroidectomy, although in this group the nodules were mainlynon-palpable.²

More impressively, Carnell and Valente report that 19% of palpable cold nodules were malignant in a retrospective review of468 patients with Graves' disease.³ Thus in some instancesabnormal thyroid function seems to be a positive discriminator. . . [Full text of this article]