过去的30年中，甲状腺结节的检测数量大幅增加。甲状腺结节通常没有症状，大多是偶然发现，一般对患者的风险影响很小。支持这些发现的数据显示，甲状腺结节和癌症的意外检测快速增加，但尽管接受治疗，对死亡率的影响很小。这些数据暗示了历史上对甲状腺结节和癌症的治疗方法可能有时包括不必要或过度的治疗。为了解决这个问题，过去的十年中，瘤样病变的管理越来越趋向保守，旨在个性化治疗，提供引导结果的最专注干预。良性结节可以通过最少的或长间隔的后续成像进行安全监测。分子检测应考虑用于细胞学未定性结节，因为它具有改善术前癌症风险确定和减少不必要手术的能力。活检证实为恶性结节的治疗变得越来越微妙，因为近乎全甲状腺切除的建议不再是常规。当手术干预得到支持时，现在常常考虑半甲状腺切除。一些体积小、孤立的癌性结节的患者可以通过积极监测来安全管理而不需要手术。总之，现代甲状腺结节疾病的管理策略旨在融合越来越多的可用诊断和预后数据，包括人口统计学、放射学、病理学和分子学的发现。一旦获得这些数据，就可以有效地制定个性化的管理计划。 Copyright © 2022 Elsevier Ltd. All rights reserved.

In the past 30 years, there has been a substantial rise in the detection of thyroid nodules. Largely asymptomatic, thyroid nodules are most often incidental findings that typically pose minimal risk. Data supporting these findings show a rapid rise in the incidental detection of thyroid nodules and cancer, but minimal effect on mortality rates, despite treatment. These data imply that historical approaches to thyroid nodule and cancer care might at times include unnecessary or excessive care. To address this issue, the past decade has witnessed an increasingly conservative approach to nodule management, seeking to individualise care and provide the most focused intervention that leads to favourable outcomes. Benign nodules can be safely monitored with minimal, or long-interval follow-up imaging. Molecular testing should be considered for cytologically indeterminate nodules because of its ability to improve preoperative cancer risk determination and reduce unnecessary surgery. The treatment of biopsy-proven malignant nodules has become increasingly nuanced, since recommendations for near-total thyroidectomy are no longer routine. Hemithyroidectomy is now commonly considered when operative intervention is favoured. Some patients with small volume, isolated cancerous nodules are safely managed non-operatively with active monitoring. In summary, modern management strategies for thyroid nodular disease seek to incorporate the growing amount of available diagnostic and prognostic data, inclusive of demographic, radiological, pathological and molecular findings. Once obtained, an individualised management plan can be effectively formulated.Copyright © 2022 Elsevier Ltd. All rights reserved.