The severity of a cystic nodule in the bilateral lobes of the thyroid gland is determined by the size as well as the nature of the thyroid nodule. If the thyroid nodules are large and compress the trachea, cervical nerves, blood vessels, or esophagus, and the patient has clinical manifestations such as dyspnea or difficulty breathing, hoarseness, choking on water, or flushing and discomfort swallowing, or if there are no symptoms of compression but it affects the aesthetics, surgery is required.
If the nodule is small, asymptomatic, and clearly benign, you can consider observation and annual review of the thyroid ultrasound. In general, cystic nodules are more likely to be benign, but there are a few that can become malignant. If the ultrasound reveals nodules with unclear borders, irregular shape, crab foot or burr sign, obvious internal gravel-like calcification, abundant blood flow, and aspect ratio greater than 1, it is a typical sign of malignancy. Further surgical treatment is required.
If there are no particularly obvious typical signs of malignancy, but when malignancy is not excluded, that is, when the ultrasound grading is grade 4, a fine needle aspiration biopsy for cytologic pathologic diagnosis may be considered to clarify the nature. Therefore, the severity cannot be determined based on the description of cystic nodules in the bilateral lobes of the thyroid alone.