Study on HRQOL and Cost-effectiveness Analysis in Management of Patients With <2cm Thyroid Nodules
Study on HRQOL and Cost-effectiveness Analysis in Management of Patients With <2cm Thyroid Nodules
Ideally randomized controlled trials should be carried out to compare the cost-effectiveness
 between FNAC and watchful waiting but such studies are very difficult to conduct in practice
 because they require following up very large number of subjects for a long period of time.

 The aims are to determine the health-related quality of life (HRQOL) and HRQOL preference
 (utility) of patients undergoing watchful observation (no FNAC) and routine FNAC, and to
 determine the cost-effectiveness of two strategies in managing small incidental thyroid
 nodules for the Chinese population in Hong Kong.
Inclusion Criteria:

 -  Aged 18 or above

 -  Have life expectancy of at least 6 months

 -  Have an incidental nodule which measures between 1.0 to 2.0cm in the largest dimension
 on ultrasound guidance (USG) and has benign ultrasonographic features such as
 spongiform or honeycomb appearance, purely-cystic, egg shell type calcification,
 iso-echoic or hyper-echoic in relation to the rest of the thyroid tissue and
 peripheral vascularity on Doppler USG. For subjects with more than one nodule on USG,
 provided that the other nodules are not >2.0cm or have suspicious features (see
 below), they will still be eligible.

 -  Normal thyroid function (both serum thyroid-stimulating hormone (TSH) and free T4
 levels within normal range)

 -  Given consent to take part in the study

 Exclusion Criteria:

 -  Have suspicious ultrasonographic features such as microcalcifications, marked
 hypoechogenicity, irregular margins and / or taller than wide and intranodular
 vascularity on transverse view on Doppler USG that warrant a FNAC

 -  Nodule size > 2.0cm

 -  Insisting or refusing FNAC or surgical intervention despite medical reassurance

 -  Inability to understand or communicate in Cantonese or Chinese

 -  Significant cognitive impairment judged by the doctor to be unable to answer the
 questionnaire

 -  Too ill to carry out interview

 -  Refusal to give consent