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December 5, 1980

The Solitary Thyroid Nodule

JAMA. 1980;244(22):2519. doi:10.1001/jama.1980.03310220021010

To the Editor.—  The importance of preoperative identification of solitary thyroid nodules was stressed in the article by Blum and Rothschild. The program they chose included complete history and physical, routine laboratory tests, T3, T4, and thyrotropin (TSH) levels (done twice), echogram (done twice), thyroid scan, and three months of follow-up. In terms of cost-effectiveness, this program seems to be effective, but the cost must raise some questions.The simplicity, effectiveness, and economy of fine needle aspiration was dismissed because of "high incidence of false-negatives..., confusion between follicular adenoma and carcinoma, surgical complications, size constraints, and lack of sampling capsule or vessels by a limited core of tissue," and a lack of expertise.I have been carrying out direct puncture of thyroid masses with immediate reading and reporting for many years without the aforementioned difficulties. This is also the experience of the Swedish school.The following diagnoses can