Improved nonoperative diagnosis of the solitary 'cold' thyroid nodule. Surgical selection based on risk factors and three months of suppression.

We assessed the cancer-predictive value of a nonoperative, two-stage prospective selection of solitary, cold, solid thyroid nodules that can be employed by the primary clinician. One hundred eighteen patients completed the protocol, all without adverse effect. The first stage identified for direct surgery 30 patients with a history of exposure to irradiation during youth, age under 20 years, recent growth of a hard nodule or lymphadenopathy, revealing 15 cancers and ten adenomas. In the second stage, the remaining 83 patients were given liothyronine for three months. Twenty-six nodules were excised because they failed to shrink 50% in diameter, disclosing five cancers and 19 adenomas. There were no cancers among 14 nodules excised for other reasons. Selection for surgery on the basis of clinical evaluation and risk factors alone can identify most of the cancers and lack of response to suppression a few more.