Abstract
Thyroid nodules (TNs) assigned to the Bethesda System categories III and IV include numerous clinical characteristics, which increase or decrease the risk of malignancy. However, there are very few data regarding the influence of TSH non-suppressive thyroid hormone therapy (NSTHT) on the risk of malignancy in patients in the aforementioned categories. We assessed the number of patients with thyroid nodules assigned to categories III and IV who take TSH NSTHT and if thyroid hormone therapy is associated with a rate of malignancy. We retrospectively analyzed the medical records of 4,716 individuals and selected 532 (11.28%) patients with Bethesda System category III and IV thyroid nodules. All participants underwent surgery, and histopathological verification was obtained in all cases. In all, 33.1% of individuals with category III and IV thyroid nodules took TSH NSTHT. In patients with category III nodules, application of NSTHT was associated with a lower rate of thyroid cancer (TC), though this observation was not significant (OR = 0.55, p = 0.381). In patients with category IV nodules, we demonstrated a significantly lower rate of TC when NSTHT was applied (OR = 0.44, p = 0.005). In conclusion, the prevalence of patients with Bethesda System category III and IV thyroid nodules who take NSTHT is high. TSH NSTHT significantly decreases a rate of malignancy in category IV, but not category III patients.
Highlights
Since 2009, the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has had a well-established role in the diagnosis of thyroid nodules (TNs)[1,2]
The question is, how does this therapy influence the risk of malignancy for Thyroid nodules (TNs) in the categories of AUS/FLUS and FN/SFN? Currently, it is estimated that, for differentiated thyroid cancers, surgery with subsequent radioiodine therapy followed by thyroid hormone supplementation in suppressive doses is the established treatment procedure
The first question is, “Which nodules assigned to the AUS/FLUS and FN/SFN categories should be considered for surgical treatment and which can be safely observed?” The second question is, “Is thyroid hormone therapy for patients with category III and IV nodules safe? If yes, does the safety extend to both categories?” In our previous study, we presented a description of the clinical features of TNs classified in the AUS/FLUS category and suggested that these lesions had malignant potential
Summary
Since 2009, the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has had a well-established role in the diagnosis of thyroid nodules (TNs)[1,2]. It was suggested that thyroid hormone therapy in non-suppressive doses reduced or stabilized the size of thyroid nodules[12] This approach to management is still controversial and not accepted by some researchers[9,10,11]. This hesitancy is in part due to a certain amount of “unpredictable and uncertain” cytological diagnoses of TNs in AUS/FLUS and FN/SFN categories It cannot be predicted if TNs assigned to Bethesda System categories III or IV will remain clinically silent or manifest as malignant lesions. The first question is, “Which nodules assigned to the AUS/FLUS and FN/SFN categories should be considered for surgical treatment and which can be safely observed?” The second question is, “Is thyroid hormone therapy for patients with category III and IV nodules safe? We did not investigate the influence of TSH NSTHT on the risk of malignancy
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