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Anesthesiology6 papers

Incidentaloma of thyroid gland

Last edited: 4/16/2026

Overview

Thyroid incidentalomas (TIs) are asymptomatic thyroid lesions discovered incidentally during unrelated diagnostic or therapeutic procedures. These lesions are frequently encountered by anesthesiologists and pain specialists due to increased neck imaging procedures 1.

Diagnosis

  • Ultrasonography (US): Preferred imaging modality for initial evaluation 1.
  • Cytology: Fine-needle aspiration biopsy (FNAB) recommended for suspicious lesions to assess for malignancy 1.
  • Grading: Lesions are typically classified based on US features (e.g., echogenicity, margins, calcifications) to guide further management 1.

    • Management

  • Observation: For small, non-suspicious TIs, regular monitoring with US is often sufficient 1.
  • Fine-needle aspiration biopsy (FNAB): Indicated for lesions with suspicious features to rule out malignancy 1.
  • Surgical Referral: Consider referral for surgical evaluation if malignancy is suspected or if there are growth changes 1.
  • Follow-up Imaging: Scheduled US follow-ups to monitor lesion stability or changes 1.

    • Special Populations

  • Pregnancy: Management strategies generally follow non-pregnant guidelines, with caution in biopsy timing and interpretation 1.
  • Elderly: Consider comorbidities and overall health status when deciding between observation and intervention 1.

    • Key Recommendations

  • Utilize ultrasonography as the primary imaging modality for evaluating thyroid incidentalomas 1 (Evidence: Strong).
  • Perform fine-needle aspiration biopsy for lesions with suspicious characteristics to assess for malignancy 1 (Evidence: Strong).
  • Implement regular follow-up ultrasonography for monitoring lesion stability in asymptomatic patients 1 (Evidence: Moderate).

    • References

    1 Narouze S, Souzdalnitski D. Management of thyroid incidentalomas encountered by anesthesiologists and pain physicians. Regional anesthesia and pain medicine 2013. link

    Original source

    1. [1]
      Management of thyroid incidentalomas encountered by anesthesiologists and pain physicians. — Narouze S, Souzdalnitski D Regional anesthesia and pain medicine (2013)
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