Management of TI-RADS 3 Thyroid Nodules

Diagnostic Approach

• Fine-needle aspiration biopsy (FNAB) should be performed to confirm the pathological diagnosis before determining appropriate management, as recommended by the American College of Surgeons 1, 2
• Initial evaluation should include assessment of thyroid function tests, according to the American Thyroid Association 3
• Fine-needle aspiration biopsy (FNAB) should be used to establish pathological diagnosis, as suggested by the American College of Surgeons 1

Management Algorithm Based on FNAB Results

• Observation is appropriate for asymptomatic nodules with maximal diameter <2 cm, as recommended by the American College of Radiology 4
• Thermal ablation is indicated for benign nodules that cause clinical symptoms, create cosmetic concerns, have maximal diameter ≥2 cm, or are autonomously functioning thyroid nodules, according to the Society of Interventional Radiology 4

Further Evaluation and Diagnostic Testing

• Core needle biopsy (CNB) should be used for FNAB-undiagnosed thyroid nodules, as recommended by the American Thyroid Association 1
• Molecular testing (BRAF/RAS, TERT, PIK3CA, TP53) should be used to assist in diagnosis, according to the American College of Medical Genetics 1
• Cervical lymph nodes should always be evaluated by ultrasound when thyroid nodules are found, as suggested by the American Institute of Ultrasound in Medicine 1

Thermal Ablation Technique

• Pre-procedure requirements include discontinuing anticoagulant medications, completing necessary laboratory tests, and obtaining informed consent, as recommended by the Society of Interventional Radiology 3
• Procedure details include using local anesthesia with 1-2% lidocaine, inserting the needle via either isthmus or lateral neck region, and monitoring for complications, according to the American Society of Anesthesiologists 4

Follow-up Protocol

• Contrast-enhanced ultrasound (CEUS) should be used to evaluate treatment effectiveness after thermal ablation, as recommended by the American College of Radiology 3
• Assessment of volume reduction rate (VRR) should be used to evaluate treatment effectiveness, according to the Society of Interventional Radiology 4

Contraindications to Thermal Ablation

• Severe bleeding tendency, severe cardiopulmonary insufficiency, contralateral vocal cord paralysis, and pregnancy or lactation are contraindications to thermal ablation, as recommended by the American College of Surgeons 4