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[The thyroid nodule. A retrospective study of 200 cases].

We analysed 200 cases of thyroid nodules collected in 2 units of the Laennec Hospital. The results of clinical examination, complementary investigations per and post-operative histology and medical follow up were analysed and compared with those in the literature. The malignancy rate was 18%. With the exception of 5 cases, a rigorous medical examination revealed at least one suspicious clinical sign in these patients. Thyroid isotope scan, which was cold in 82% of cases was of no value in distinguishing between benign and malignant nodules. The authors were not in agreement on the policy to be followed when faced with an isolated cold nodule. Fine needle aspiration is the only method which allows diagnosis but it is of low reliability. Ultrasound may be reassuring when it demonstrates fine walled, small diameter cysts only, but this situation is rare. We analysed the limits and pitfalls of these various methods. It is difficult to submit a patient to regular follow up for several years with antagonist treatment, where appropriate, and in addition malignant transformation may not be recognized. With knowledge of the good prognosis of cancers operated on at the microscopic intracapsular stage and the significant number of microscopic carcinomas discovered fortuitously in the course of surgery, it would appear reasonable to at least perform a cervicotomy with extemporaneous histological examination of any cold or isofixing nodule. Lobo-isthmectomy is in practice the solution adopted and its complications are rare and minimal.