In a patient presenting with a swelling of the thyroid, the radionuclide scan showed a cold nodule and the ultrasound showed a non cystic solid mass. The management of this patient would be -

Ans is "B" i.e. Hemithyroidectomy A discrete solid swelling of the thyroid is mostly treated surgically by hemithyroidectomy. Biopsy of the resected segment is performed and if carcinoma found a total or near total thyroidectomy is done. A cystic swelling is treated by aspiration and surgery is performed only if it recurs (can be reaspirated upto 3 times) or cytology is suspicious of malignancy. most of the discrete thyroid swelling are non-neoplastic and benign, still surgery is the mainstay of treatment because of the risk of leaving a malignant nodule. Even though cold nodule ours malignancy only a very small percentage of them turn out to be malignant, so isotope scanning is of very little use in distinguishing between malignant and non-malignant swellings and is rather obsolete now. Eltroxin for TSH suppression is used only for a small number of cases. It is tried for 6 months. If the swelling regresses, well and good. If it does not surgery is performed.