Management of a solitary thyroid nodule. A paradigm of a clinical practice guide line

The solitary thyroid nodule is frequently observed and many strategies are proposed for the diagnosis of the etiology and for the choice of treatment. Despite many discussions no clear consensus has been so for reached. The french groups concerned by this problem set up a Clinical Practice Guide line with the methodological help of Agence Nationale pour le Developpement de l'Evaluation Medicale. Based upon the critical review of the litterature a consensus was obtained concerning the natural history of the nodules and the diagnosis value of the complementary explorations. The clinical approache alone completed by a TSH determination gives the therapeutical choice in about 30 % of the patient without any other explorations. In the remaining cases 3 methods (isotope scan, echography, cytoponction) can be used alone or in a combined sequence. So far no strategy can be privilegiated. It is necessary to set up a systematic comparison between the possible strategies and this will be made by the french thyroid specialists after this first step of delimitation of a clinical practise guide line.