Influence of Incidental Pulmonary Nodules on Surgical Decision-Making in Thyroid Cancer: a Nationwide Survey

Background and Objectives:The clinical significance of incidental pulmonary nodules detected during thyroid cancer evaluation remains unclear.This study aimed to investigate how such findings affect surgical decisionmaking and whether management differs by physician characteristics.Materials and Methods: A web-based survey was distributed to 722 active members of the Korean Thyroid Association in March 2025.Eligible participants included board-certified endocrinologists, endocrine surgeons, and otolaryngologists actively treating thyroid cancer.The questionnaire included clinical scenarios featuring incidental lung nodules found during thyroid cancer work-up, with respondents asked to choose preferred surgical extent (thyroid lobectomy vs. total thyroidectomy) and management approaches.Results: Out of 72 physicians who completed the survey, half (n=36, 50.0%) of the respondents answered that the presence of incidental lung nodules could influence their decision on thyroidectomy extent.Among those influenced by lung nodules, 86.1% recommended total thyroidectomy in patients with high-or intermediate-risk thyroid cancer, while 11.1% would do so for all thyroid cancer patients.Endocrinologists, compared to surgeons, were more likely to choose total thyroidectomy in patients with preoperative incidental lung nodules (78.3% vs. 36.7%,p=0.001).Conclusion: Incidental lung nodules may influence surgical planning in clinicians due to the risk of micrometastasis from thyroid cancer.Endocrinologists tend to favor a more extensive surgical approach compared to surgeons, reflecting greater concern for potential metastatic disease.These findings underscore the need for multidisciplinary consensus guidelines for the management of incidental pulmonary nodules in thyroid cancer patients.