Solitary Thyroid Nodule: Comparison Between Palpation and Ultrasonography

doi:10.1001/archinte.1995.00430220076008

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Vol. 155 No. 22, 11 DECEMBER 1995

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Solitary Thyroid Nodule

Comparison Between Palpation and Ultrasonography

Gerry H. Tan, MD; Hossein Gharib, MD; Carl C. Reading, MD

Arch Intern Med. 1995;155(22):2418-2423.

Abstract

Objective
To determine the accuracy of clinical palpation in the diagnosisof solitary thyroid nodule in comparison with ultrasonographicfindings.

Methods
From a computerized database of 1774 patients with the diagnosisof nodular thyroid disease made from January 1990 through December1991 at our institution, we retrieved and reviewed the medicalrecords of the 193 patients who underwent ultrasonography ofthe thyroid (42 patients with multinodular glands on palpationwere excluded). Nodules were categorized as "solitary" or "dominantnodule of a multinodular gland." Concordance rates were measuredbetween results of palpation and ultrasonographic findings.

Results
Of 151 patients included in the study, 78 had solitary noduleson ultrasonography and 73 had multiple nodules. Of those withmultiple nodules, 49 had two nodules and 24 had three or morenodules. Of clinically palpable nodules, 89% were 1 cm or greaterin diameter. In 72% of the patients with multiple nodules, theother nodules not identified on palpation were less than 1 cmin diameter. The overall concordance rate between the size ofthe solitary nodule or the dominant nodule in a multinodulargland estimated with clinical palpation and the actual sizeseen on ultrasonography was 72%. The relationship between multiplenodules and malignancy was not statistically significant.

Conclusions
Our results suggest that (1) a palpable solitary nodule representsa multinodular gland in about 50% of patients, (2) clinicalpalpation is less sensitive than thyroid ultrasonography inidentifying multiple nodules, and (3) palpation is reliableonly if a nodule is at least 1 cm in diameter. We recommendthat small, occult (impalpable) thyroid nodules not be consideredclinically important; they do not warrant further evaluationunless ultrasonographic features suggest malignancy or the noduleincreases in size.

(Arch Intern Med. 1995;155:2418-2423)

Author Affiliations

From the Division of Endocrinology/Metabolism and Internal Medicine (Drs Tan and Gharib) and the Department of Diagnostic Radiology (Dr Reading), Mayo Clinic and Mayo Foundation, Rochester, Minn.

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