Abstract
Simple SummaryElderly patients have a high prevalence of thyroid nodules, and their management should consider the presence of comorbidities, which are frequent in this age group. In this retrospective monocentric study, we analyzed data of more than 13,000 nodules in order to highlight differences between the elderly and the general population in terms of cytological and histological diagnoses. Thyroid nodules in the elderly are more often benign than in younger patients. Nevertheless, in case of malignancy, follicular-derived well-differentiated tumors are almost always diagnosed in younger patients. Instead, elderly patients more often have tumors with aggressive histotypes. In addition, even in presence of well-differentiated tumors, elderly patients present a higher rate of high-risk pathological features.Background. The prevalence of thyroid nodules increases with age. Their management takes into account the presence of co-morbidities, which are frequent among the elderly. We sought to highlight the differences between the elderly and the general population in cytological and histological diagnoses. Methods. In this retrospective cohort study, we gathered 13,747 nodule data and compared cytological and histological diagnoses between patients aged over 65 years and a control group. Results. Elderly patients had a higher prevalence of cytologically benign nodules and, consequently, they were less frequently subject to surgery. However, there were no differences in terms of malignancy-risk after surgery. At histology, elderly patients often presented aggressive histology such as medullary thyroid carcinoma, poorly-differentiated and anaplastic cancer, tall cell variant of papillary thyroid carcinoma and Hürthle cell carcinoma. Even in presence of well-differentiated cancer, older patients had higher rates of local invasiveness, lateral lymph node involvement and vascular invasion. Conclusion. Thyroid nodules in elderly patients represent a challenging entity since they are very often benign, but, in case of malignancy, aggressive histotypes and high-risk features are more frequent. Therefore, presurgical characterization of nodules in older patients is crucial and might require strict monitoring.
Highlights
Introduction distributed under the terms andThe prevalence of thyroid nodules in the adult population is growing, with reported ranges between 26 and 67% [1]
Several authors have reported that the rate of benign cytology in patients older than 65 years could be higher than usual [5,6]; on the other hand, it is well known that advanced age is one of the factors that negatively influences thyroid cancer prognosis [7]
This study describes a large series of thyroid nodules from elderly patients referring to a single institution
Summary
Introduction distributed under the terms andThe prevalence of thyroid nodules in the adult population is growing, with reported ranges between 26 and 67% [1]. Several authors have reported that the rate of benign cytology in patients older than 65 years could be higher than usual [5,6]; on the other hand, it is well known that advanced age is one of the factors that negatively influences thyroid cancer prognosis [7]. The surgical rate for cytologically suspicious and malignant nodules in the elderly can be affected by the presence of other co-morbidities that are more frequent than in other age groups. In these elderly patients, a conservative approach might be preferred, whenever possible, to avoid risks and complications associated with surgery [8]. Presurgical characterization of nodules in older patients is crucial and might require strict monitoring
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
