Thy3 cytology: what to do next?

Abstract

The correct management of patients with Thy3 lesions is challenging. The work-up of any patient requires full and appropriate clinical evaluation, which may include biochemical tests, thyroid auto-antibodies, ultrasound, radioisotope scan and/or other imaging before deciding on an appropriate management plan. The majority of the lesions in the Thy3 category are follicular neoplasms and the majority are likely to be recommended to undergo diagnostic hemithyroidectomy. One of the themes of the paper by Lakhani et al is the difficulty in decision making when dealing with this subgroup. Lakhani et al have summarised the British Thyroid Association guidelines introduced in 2007 and the American Thyroid Association guidelines for the management of the thyroid nodules and lumps. However, they have not mentioned the recent guidance on the reporting of thyroid cytology specimens from the Royal College of Pathologists published in 2009.1 This subdivides the Thy3 category into Thy3f (follicular) and Thy3a (atypia) instead of Thy3(i) and Thy3(ii). Use of the ‘f’ or ‘a’ suffix is intuitively easier to understand rather than the arbitrary ‘i’ or ‘ii’ and if incorporated into regular clinical use may help lessen the decision making burden that Lakhani and colleagues describe.