A 50-year-old man presents with a solitary thyroid nodule. Fine-needle aspiration cytology is reported as Bethesda category IV (follicular neoplasm). What is the recommended management?
- A Diagnostic hemithyroidectomy (thyroid lobectomy) ✓
- B Radioiodine ablation
- C Total thyroidectomy with central neck dissection
- D Repeat FNAC in 6 months
Correct answer: A. Diagnostic hemithyroidectomy (thyroid lobectomy)
Explanation
Bethesda category IV (follicular neoplasm/suspicious for follicular neoplasm) carries a 25-40% malignancy risk. Cytology cannot distinguish follicular adenoma from follicular carcinoma because capsular and vascular invasion can only be assessed histologically. Hemithyroidectomy (lobectomy) is therefore the standard diagnostic and potentially curative procedure. Total thyroidectomy with central neck dissection is reserved for confirmed malignancy. Radioiodine is not a diagnostic tool for follicular lesions.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.