Of 54 patients with solitary autonomous thyroid nodules (SAN), only one or perhaps two manifested signs or symptoms of hyperthyroidism. Eighteen of the 54 patients had nodules that were larger than 3 cm in diameter, but only one of these patients had possible thyrotoxicosis. Forty-eight of the 54 patients were followed up for 4 to 136 months (average, 24 months). The course of the disease was completely benign, and none of these subjects developed hyperthyroidism during the follow-up. Two of the 48 patients appeared to have a SAN that underwent degeneration during the study.
We think that euthyroid patients with SAN may be managed under most circumstances by periodic follow-up examinations and that they need to be subjected to surgical or radioactive iodine therapy only when and if they subsequently develop hyperthyroidism.
Burman KD, Earll JM, Johnson MC, Wartofsky L. Clinical Observations on the Solitary Autonomous Thyroid Nodule. Arch Intern Med. 1974;134(5):915-919. doi:10.1001/archinte.1974.00320230125024