save the thyroid gland
Prof. Bojan Kovacevic MD, PhD - general and endocrine surgeon
The sacuvajstitastu.com was created to provide patients with clear, reliable, and up-to-date information about minimally invasive treatments for thyroid nodules.
The main advantage of these modern techniques, compared to traditional surgery, is that they preserve healthy thyroid tissue, avoid the need for general anesthesia, and leave no visible scar on the neck.
Thyroid hormones affect the function of every cell in the human body. Unfortunately, many patients, and even some doctors, choose to remove this vital gland too quickly, sometimes when it is not truly necessary.
The goal of sacuvajstitastu.com is to explain thyroid conditions in simple way so patients can take an active role in making treatment decisions.
We hope the information you find here helps you understand your condition from a new perspective and, whenever possible, preserve the precious tissue of your thyroid gland.
Important: The final decision and treatment plan can only be made after a direct consultation with your doctor.
Thyroid nodules
Basic information
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A nodule is any change in the thyroid gland that looks different from the surrounding tissue on an ultrasound exam.
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Thyroid nodules are very common and ultrasound can detect them in nearly 60% of people.
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The main goal of further testing when a new thyroid nodule is found is to rule out cancer, which is present in about 10–15% of patients.
Nodule in the thyroid gland - what's next?
The first step in preserving the thyroid gland
After your neck ultrasound, you were told that you have a thyroid nodule.
To avoid unnecessary surgery, while still making sure cancer is not missed, it’s important to follow a straightforward evaluation process.
This is the first step where you have the chance to preserve your thyroid gland.
To decide on the best next move for a newly discovered thyroid nodule, your doctor usually needs just a few key pieces of information:
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TSH (thyroid-stimulating hormone) level
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Size of the nodule
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Ultrasound assessment of how suspicious the nodule looks for cancer
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Calcitonin level (if the result is normal, it usually does not need to be repeated)
Initial diagnostics
TSH (thyroid stimulating hormone)
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TSH (thyroid stimulating hormone) is a hormone produced by the pituitary gland and stimulates thyroid function.
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Elevated TSH levels are slightly more common in cases of malignancy, but this finding does not definitively indicate cancer.
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Low TSH levels are seen when the thyroid is overactive; if a nodule is also present, a thyroid scintigraphy should be performed.
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A toxic adenoma, or a hyperfunctioning nodule identified on scintigraphy, is almost always benign, and a biopsy is rarely needed.
Nodule dimensions
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Nodules smaller than 1 cm usually do not require further diagnostic testing and the decision is made by the treating physician.
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Nodules larger than 2 cm are almost always biopsied.
Nodules suspicious for malignancy
When a nodule is detected in the thyroid on ultrasound, it is important to assess its suspicion for malignancy. Certain ultrasound features are more commonly seen in malignant tumors:
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Hypoechoic nodule
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Microcalcifications
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“Taller-than-wide” shape in the transverse view
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Irregular margins
No single feature alone can definitively confirm that a nodule is malignant. However, the more of these features are present at the same time, the higher the likelihood that the nodule is cancerous.
Tumor markers for thyroid cancer
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Calcitonin is the only tumor marker used in preoperative diagnostics for thyroid nodules.
Elevated levels are specifically significant for the diagnosis of medullary thyroid carcinoma, a rare form of thyroid cancer.
Fine needle aspiration biopsy (FNAB)
The second step in preserving the thyroid gland
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After the initial evaluation and identification of suspicious nodules, a decision is made to perform a nodule biopsy.
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The procedure is carried out under ultrasound guidance and is practically painless.
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If the biopsy confirms that an asymptomatic nodule is benign, surgery is not necessary.
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Biopsy should be an essential part of the preoperative assessment for any solitary thyroid nodule.
Interpretation of cytological findings
The cytology results from a thyroid biopsy are classified using the Bethesda system:
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Bethesda I – Inadequate sample; biopsy usually needs to be repeated
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Bethesda II – Benign
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Bethesda III and IV – Surgery may be considered
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Bethesda V and VI – Surgical treatment is recommended
Surgical treatment
If the evaluation of a newly discovered thyroid nodule follows the procedure described above, most patients will not require surgery.
Surgical treatment is recommended in the following cases:
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Biopsy results of Bethesda III, IV, V, or VI
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Nodules that, due to their size or location, cause health or cosmetic problems
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Hyperfunctioning nodules
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Cytologically benign nodules (Bethesda II) that cause symptoms or cosmetic concerns due to their size or position; in these cases, minimally invasive procedures under local anesthesia may be an alternative treatment option.
Minimally invasive treatment of thyroid nodules
Ultrasound guided ethanol ablation of thyroid nodules
Cysts and predominantly cystic nodules are benign changes in the thyroid that can cause cosmetic concerns or symptoms due to their size or location, such as difficulty swallowing, neck pain or pressure, breathing difficulties, or coughing.
Surgical treatment involves removing the cyst along with the affected thyroid lobe.
These tumors can also be successfully treated with nodule sclerotherapy using ethanol, performed under local anesthesia.
Advantages of sclerotherapy:
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Performed under local anesthesia
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Preserves healthy thyroid tissue
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No scar on the neck
Microwave (MW) and Radiofrequency ablation of thyroid nodules (RFA)
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This procedure has been used for nearly 20 years and has recently gained increasing popularity due to its effectiveness and safety.
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Ideal candidates are patients with a single benign nodule causing symptoms or cosmetic concerns.
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It can also be used as an alternative treatment for hyperfunctioning nodules.
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According to the latest 2025 ATA guidelines, it can be selectively applied in the treatment of certain thyroid cancers smaller than 1 cm and metastases in the neck lymph nodes.
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The procedure is performed on an outpatient basis under local anesthesia.
It usually takes about 30 minutes and is carried out using a special needle guided by ultrasound. -
The tip of the needle emits microwaves or radiofrequency waves, causing necrosis of the nodule while preserving the surrounding healthy thyroid tissue.
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Advantages: Preservation of healthy thyroid tissue, avoidance of general anesthesia, no visible scar on the neck
Contact
If you already have the necessary lab tests and a recent neck ultrasound (not older than three months), you can schedule a free consultation by sending your documents to: konsultacije@sacuvajstitastu.com
If this is your first examination or you haven’t had a check-up for a long time, please book your appointment by phone.
+381 64 195 64 12
(+381) 641956412
