thyroid nodule has an increasing prevalence (3-8%). Although most nodules will be benign, the importance lies in differentiating benign nodules from cancer. Ultrasonography and cytological diagnosis by fine needle aspiration (FNA), using Bethesda classification (BTH) correctly classify the majority of lesions; however, when the result is indeterminate (BTH III-IV or V), patient undergoes diagnostic surgery.

retrospective review of thyroid surgeries performed in our center in last 5 years in which the indication was indeterminate nodule after FNA.

Of 1200 thyroid surgeries, cytological indeterminate FNAs were 174 BTH III, 83 BTH IV and 37 BTH V. Correlation with pathological diagnosis confirmed the presence of cancer in the resection specimens in 34.5% BTH III, 29.8% BTH IV and 83.7% BTH V. However, once incidental microcarcinoma cases were excluded, final results were 17.8% malignant BHT III, 25.3% BHT IV and 81% BHT V. Type of surgery performed was - BTH III: 60% total thyroidectomies (TT) (21% by totalization) and 40% hemithyroidectomies (HT). BTH IV: 66.7% TT (40% by totalization) and 33.3% HT. BHT V: 86.7% TT (3% by totalization) and HT 13.3%.

we highlight the higher percentage of cases of cancer in our series of indeterminate cytology compared to the literature, probably by continuous improvement of cytology methods and a closer follow-up with screening tests, which leads us to diagnose more and more cases of microcarcinoma. We tend to over-treat the tumor in the first stage or by later totalization, probably because patients' "cancerophobia" and lack of application of the latest guidelines recommendations.