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DOCTOREndocrine & Metabolic DiseasesThyroid nodulesDiagnosisTreatment Planning

Current Diagnostic Approach and Therapy Selection for Thyroid Nodules

A 20-slide presentation covering thyroid-nodule diagnosis, molecular testing, ablative treatment, and surgical approaches.

Presented by Dr. dr. Bob Andinata, Sp.B., Subsp. Onk(K) · Published: Source: Original presentation supplied for the 19 September 2026 thyroid-nodule seminarManagement of Thyroid Nodules — How to Make a Good Diagnosis? · 19 September 2026
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Slide 01

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MANAGEMENT OF THYROID NODULES : HOW TO MAKE A GOOD DIAGNOSIS ? 
Live Webinar, September 19th 2026
Current Diagnostic 
Approach and 
Therapy Selection 
for Thyroid Nodules
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Slide 02

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MANAGEMENT OF THYROID NODULES : 
HOW TO MAKE A GOOD DIAGNOSIS ? 
Live Webinar, September 19th 2026
Benign or Malignant ??
?
 B
M
 M
 M
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Slide 03

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MANAGEMENT OF THYROID NODULES : 
HOW TO MAKE A GOOD DIAGNOSIS ? 
Live Webinar, September 19th 2026
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Slide 04

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MANAGEMENT OF THYROID NODULES : 
HOW TO MAKE A GOOD DIAGNOSIS ? 
Live Webinar, September 19th 2026
World no.6
 Asia no.4
Incidence, Both sexes, in 2024
Dharmais
 
no.4
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Slide 05

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Diagnostic
Physical Examination
MANAGEMENT OF THYROID NODULES : 
HOW TO MAKE A GOOD DIAGNOSIS ? 
Live Webinar, September 19th 2026
FNAB → 
Bethesda 
Imaging : 
Ultrasound
→ TIRADS 
 LAB :
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Slide 06

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MANAGEMENT OF THYROID NODULES : 
HOW TO MAKE A GOOD DIAGNOSIS ? 
Live Webinar, September 19th 2026
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Slide 07

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MANAGEMENT OF THYROID NODULES : 
HOW TO MAKE A GOOD DIAGNOSIS ? 
Live Webinar, September 19th 2026
Risk of Malignancy
• Bethesda VI Estimated = 97%
• Bethesda V = 74%
• Bethesda IV = 30%
Bethesda III & IV → need to 
Molecular Analysis to get 
diagnosis Benign or Malignant
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Slide 08

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MANAGEMENT OF THYROID NODULES : 
HOW TO MAKE A GOOD DIAGNOSIS ? 
Live Webinar, September 19th 2026
Molecular T esting
• ThyroSeq v3 is also based on next-
generation sequencing of DNA and 
RNA. 
• Expanded to analyze 112 genes, 
• Providing information on >12,000 
mutation hotspots and >150 gene 
fusion 
• 1st time lauched on april 2007 in 
Pittsburg University 
Dharmais begins 
by NGS in trial 2026 
(Nikiforova MN et al. 2018).
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Slide 09

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MANAGEMENT OF THYROID NODULES : 
HOW TO MAKE A GOOD DIAGNOSIS ? 
Live Webinar, September 19th 2026
Surgery : Open / 
Endoscopic / Robotic
Ablative 
Treatment
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Slide 10

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MANAGEMENT OF THYROID NODULES : 
HOW TO MAKE A GOOD DIAGNOSIS ? 
Live Webinar, September 19th 2026
• Conservative : < 10 mm, TIRADS 1-2
• Surgery : Open, Endoscopic or Robotic
• Non-Surgery (Ablative therapy) : Percutaneous 
Ethanol Ablation, Microwave, RFA & HIFU 
Benign Tiroid Nodule
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Slide 11

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Percutaneous 
Ethanol Ablation
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Slide 12

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RFA
radiofrequency ablation
MANAGEMENT OF THYROID NODULES : 
HOW TO MAKE A GOOD DIAGNOSIS ? 
Live Webinar, September 19th 2026
First
-
line 
treatment option 
for benign nodule
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Slide 13

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MANAGEMENT OF THYROID NODULES : 
HOW TO MAKE A GOOD DIAGNOSIS ? 
Live Webinar, September 19th 2026
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Slide 14

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MANAGEMENT OF THYROID NODULES : 
HOW TO MAKE A GOOD DIAGNOSIS ? 
Live Webinar, September 19th 2026
Well Differentiated Carcinoma Thyroid
• Surgery : Endoscopic or Robotic (Low Risk) & 
Open (High Risk) Thyroidectomy, RND
• Internal Radiation / Radioablation with I131
• Medication : Levothyroxin 100 – 300 mcgr
• Targeted Therapy : Lenvatinib
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Slide 15

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ENDOSCOPIC THYROIDECTOMY
TOETV A
MANAGEMENT OF THYROID NODULES : 
HOW TO MAKE A GOOD DIAGNOSIS ? 
Live Webinar, September 19th 2026
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Slide 16

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MANAGEMENT OF THYROID NODULES : 
HOW TO MAKE A GOOD DIAGNOSIS ? 
Live Webinar, September 19th 2026
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Slide 17

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MANAGEMENT OF THYROID NODULES : 
HOW TO MAKE A GOOD DIAGNOSIS ? 
Live Webinar, September 19th 2026
TORT
 Trans Oral
Robotic Thyroidectomy
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Slide 18

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MANAGEMENT OF THYROID NODULES : 
HOW TO MAKE A GOOD DIAGNOSIS ? 
Live Webinar, September 19th 2026
TORT Trans Oral
Robotic Thyroidectomy
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Slide 19

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MANAGEMENT OF THYROID NODULES : 
HOW TO MAKE A GOOD DIAGNOSIS ? 
Live Webinar, September 19th 2026
Poor Differentiated Carcinoma Thyroid
• Surgery : Total Thyroidectomy, debulking
• External Radiation
• Chemoterapy
• Targeted therapy
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Slide 20

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MANAGEMENT OF THYROID NODULES : HOW TO MAKE A GOOD DIAGNOSIS ? 
Live Webinar, September 19th 2026
1
st
 
TORT in Indonesia : March 30
th
 
2026
If you fail, try 
again once more.
And If you fail 
again, try 10 
times more.
Bob Andinata
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