Benign Nodular Disease Research Articles

Anxiety, depression and quality of life in patients undergoing total thyroidectomy: comparative analysis between differentiated thyroid cancer and benign nodular disease

Anxiety, depression and quality of life in patients undergoing total thyroidectomy: comparative analysis between differentiated thyroid cancer and benign nodular disease

Determination of Diagnostic Features of Serum Thyroid Hormones and Thyroglobulin Ratios in Normothyroid Differentiated Thyroid Carcinoma Cases.

Ultrasonography and fine-needle aspiration biopsy (FNAB) are the gold standard methods in the prediction of benign and malignant thyroid nodules. However, despite being easily applicable, FNAB is an invasive procedure. Less invasive biomarkers should be utilized in the diagnosis of thyroid malignancies. In this study, we aimed to determine the parameters that can be used in the diagnosis of differentiated thyroid cancer (DTC) based on the serum thyroid and thyroglobulin (TG) levels which are routinely checked in patients followed up for thyroid nodules. In the study, we evaluated patients who underwent thyroid surgery for nodular diseases between January 2015 and June 2022. Of the 1444 patients evaluated, 919 patients who met the inclusion criteria (normothyroid benign nodular disease or normothyroid DTC) were included in the study. Patients were divided into two groups as benign group (BG) and DTC group (DTCG). We compared patients' pre-operative serum thyroid and TG values and the diagnostic properties of their ratios. Of the 919 patients included, 517 (56.3%) were in BG and 402 (43.7%) were in DTCG. In DTCG, 318 patients were female and 84 patients were male. The mean age in the DTCG was 47.8 years. Comparison of DTCG and BG revealed a significant difference between T3/T4 ratio (p=0.002), T3/TSH ratio (p≤0.001), T4/TSH ratio (p≤0.001), TG/TSH ratio (p≤0.001), and TSH/TG ratio (p≤0.001). However, evaluation of the specified values by ROC analysis showed that the T3/T4 ratio did not make a significant difference between the two groups (p=0.1), whereas the other values displayed a significant difference (p≤0.001 for T3/TSH, p=0.001 for T4/TSH, p≤0.001 for TG/TSH, and p<0.001 for TSH/TG). T3/TSH (cutoff =2.183), T4/TSH (cutoff=0.6), and TG/TSH (cutoff=29.67) values were found to be significant tumor markers for the prediction of malignancy in thyroid nodules, and low values were found to be associated with malignancy. TSH/TG (cutoff=0.031) value was also significant in predicting malignancy while high values were found to be associated with malignancy. Thyroid hormone and TG ratios may alter the preferred treatment method for thyroid nodules.

Mendelian randomization to investigate the link between TSH and thyroid cancer

Evidence from observational studies suggests a positive association between serum thyroid-stimulating hormone (TSH) levels and differentiated thyroid carcinoma. However, the cause-effect relationship is poorly understood, and these studies are susceptible to bias and confounding. Using Mendelian randomization (MR) methodology, this study aimed to investigate the causal role of TSH in both benign thyroid nodules and thyroid cancer in up to 451,025 participants in the UK Biobank. Hospital Episode Statistics and Cancer Registry databases were used to identify 462 patients with differentiated thyroid carcinoma and 2031 patients with benign nodular thyroid disease. MR methods using genetic variants associated with serum TSH were used to test causal relationships between TSH and the two disease outcomes. We observed evidence of an inverse association between TSH levels and both thyroid cancer and benign nodular thyroid disease. Two-sample MR suggested that one standard deviation higher genetically instrumented TSH (approximately 0.8 mlU/L) resulted in an 80% reduction of risk of benign nodular disease (OR 0.20; 95% CI 0.10–0.41) and a 50% reduction of risk of thyroid cancer (OR 0.50; 95% CI 0.27–0.92). In keeping with other recently published studies, our results refute a causal role for TSH in both benign nodular thyroid disease and thyroid cancer, with increasing genetically instrumented TSH resulting in a lower risk of both diseases.

RETRACTION: Mendelian randomization supports a causative effect of TSH on thyroid carcinoma.

Evidence from observational studies suggests a positive association between serum thyroid stimulating hormone (TSH) levels and differentiated thyroid carcinoma. However, the cause-effect relationship is poorly understood and these studies are susceptible to bias and confounding. This study aimed to investigate the causal role of TSH in both benign thyroid nodules and thyroid cancer in up to 451,025 UK Biobank participants, using a genetic technique, known as Mendelian randomization (MR). Hospital Episode Statistics and Cancer Registry databases were used to identify 462 patients with differentiated thyroid carcinoma and 2031 patients with benign nodular thyroid disease. MR methods using genetic variants associated with serum TSH were used to test causal relationships between TSH and the two disease outcomes. Mendelian randomization provided evidence of a causal link between TSH and both thyroid cancer and benign nodular thyroid disease. 2-sample MR suggested that a one standard deviation higher genetically instrumented TSH (approximately 0.8 mlU/L) resulted in 4.96-fold higher odds of benign nodular disease (95% CI 2.46 - 9.99) and 2.00-fold higher odds of thyroid cancer (95% CI 1.09 - 3.70). Our results thus support a causal role for TSH in both benign nodular thyroid disease and thyroid cancer.

Mendelian randomization supports a causative effect of TSH on thyroid carcinoma.

Evidence from observational studies suggest a positive association between serum thyroid-stimulating hormone (TSH) levels and differentiated thyroid carcinoma. However, the cause–effect relationship is poorly understood and these studies are susceptible to bias and confounding. This study aimed to investigate the causal role of TSH in both benign thyroid nodules and thyroid cancer in up to 451,025 UK Biobank participants, using a genetic technique, known as Mendelian randomization (MR). Hospital Episode Statistics and Cancer Registry databases were used to identify 462 patients with differentiated thyroid carcinoma and 2031 patients with benign nodular thyroid disease. MR methods using genetic variants associated with serum TSH were used to test causal relationships between TSH and the two disease outcomes. Mendelian randomization provided evidence of a causal link between TSH and both thyroid cancer and benign nodular thyroid disease. Two-sample MR suggested that a 1 s.d. higher genetically instrumented TSH (approximately 0.8 mIU/L) resulted in 4.96-fold higher odds of benign nodular disease (95% CI 2.46–9.99) and 2.00-fold higher odds of thyroid cancer (95% CI 1.09–3.70). Our results thus support a causal role for TSH in both benign nodular thyroid disease and thyroid cancer.

Diagnostic performance of the American Thyroid Association ultrasound risk assessment of thyroid nodules in endocrinology (the ETIEN 3 study)

IntroductionNo study has been published to date in Spain about the value of the American Thyroid Association (ATA) ultrasound risk assessment of thyroid nodules applied by endocrinologists. ObjectivesTo assess the diagnostic performance of ATA thyroid nodule risk classification applied by endocrinologists with respect to histological results. MethodsA retrospective, observational study of 317 patients (mean age, 51.7±13.7 years; 83.3% women) with thyroid nodules (maximum diameter: 3.2±1.4cm) who underwent US-guided FNA in endocrinology between October 2015 and December 2018, were classified based on the ATA ultrasound risk assessment. Surgery was performed in all of them. Quality criteria of the ultrasound classification were assessed as compared to histological results. ResultsOverall, 61.2% of nodules assessed were classified as benign (n=3) and very low (n=60) or low suspicion (n=131), 11.7% as intermediate suspicion (n=37), and 27.1% as high suspicion (n=86). Benign nodular disease was found in 260 patients, and thyroid cancer in 57 patients. There were 14 incidental papillary microcarcinomas. Classification of thyroid nodules as high suspicion showed a high diagnostic performance to identify malignant nodules (87.7% sensitivity, 86.2% specificity, negative predictive value 97.0%), improving sensitivity (93.0%) and reducing specificity (73.1%) when considering high and intermediate suspicion nodules as a risk for thyroid cancer. ConclusionsApplication by endocrinologists of the ATA ultrasound risk assessment of thyroid nodules shows a high diagnostic performance to identify malignant thyroid nodules before surgery.

IGF Bioregulation System in Benign and Malignant Thyroid Nodular Disease: A Systematic Review.

The insulin-like growth factor bioregulation system is implicated in cancer biology. Herein, we aim to review the evidence on the expression of the insulin-like growth factor 1 and 2 (IGF1 and IGF2), their receptors (IGF-Rs) and IGF-binding proteins (IGFBPs) in thyroid tissue and their possible association with benign and malignant thyroid nodular diseases. We systematically reviewed Pubmed and Scopus databases up to May 2020. A total of 375 articles were retrieved and analyzed. Among 375 articles, 45 were included in this systematic review study. IGF1 was investigated in 31 studies, IGF2 in 1, IGF1 receptor in 15 and IGF-binding proteins in 13 articles. IGF1 expression in humans was dependent on the number and compound of benign nodules as well as the method of measurement. In differentiated thyroid carcinoma, a positive correlation between IGF1 and immunohistological stage was documented in some studies while in others only a positive trend was observed. IGF-1R and IGFBPs expression was higher in malignant rather than benign lesions. There was only a positive trend for increased IGF2 expression in malignancy, while IGFBPs were in most studies statistically increased in various cancer types compared to benign nodular disease. The present data demonstrate that in most studies there is statistically positive expression of IGF-1 and less of IGF-2 in thyroid cancer compared to normal thyroid tissue.

Rendimiento diagnóstico del sistema de evaluación de riesgo ecográfico del nódulo tiroideo de la American Thyroid Association en endocrinología (estudio ETIEN 3)

IntroductionNo study has been published to date in Spain about the value of the American Thyroid Association (ATA) ultrasound risk assessment of thyroid nodules applied by endocrinologists. ObjectivesTo assess the diagnostic performance of ATA thyroid nodule risk classification applied by endocrinologists with respect to histological results. MethodsA retrospective, observational study of 317 patients (mean age, 51.7±13.7 years; 83.3% women) with thyroid nodules (maximum diameter: 3.2±1.4cm) who underwent US-guided FNA in endocrinology between October 2015 and December 2018, were classified based on the ATA ultrasound risk assessment. Surgery was performed in all of them. Quality criteria of the ultrasound classification were assessed as compared to histological results. ResultsOverall, 61.2% of nodules assessed were classified as benign (n=3) and very low (n=60) or low suspicion (n=131), 11.7% as intermediate suspicion (n=37), and 27.1% as high suspicion (n=86). Benign nodular disease was found in 260 patients, and thyroid cancer in 57 patients. There were 14 incidental papillary microcarcinomas. Classification of thyroid nodules as high suspicion showed a high diagnostic performance to identify malignant nodules (87.7% sensitivity, 86.2% specificity, negative predictive value 97.0%), improving sensitivity (93.0%) and reducing specificity (73.1%) when considering high and intermediate suspicion nodules as a risk for thyroid cancer. ConclusionsApplication by endocrinologists of the ATA ultrasound risk assessment of thyroid nodules shows a high diagnostic performance to identify malignant thyroid nodules before surgery.

Association between preoperative thyrotrophin and clinicopathological and aggressive features of papillary thyroid cancer.

We aimed to investigate the relation between preoperative serum thyrotrophin (TSH) and clinicopathological features in patients with papillary thyroid carcinoma (PTC) and microcarcinoma (PTMC). Patients who underwent thyroidectomy and diagnosed to have benign nodular disease or PTC/PTMC in our clinic were evaluated retrospectively. Patients with a previous history of thyroid surgery, patients using antithyroid medications or thyroid hormone and patients with tumors known to be unresponsive to TSH were excluded. Data of 1632 patients were analyzed. Histopathological diagnosis was benign in 969 (59.4%) and malignant in 663 (40.6%) patients. Preoperative median serum TSH was significantly higher in malignant compared to benign group (1.41 IU/dL vs. 0.98 IU/dL, p < 0.001). Malignancy risk increased gradually as going from hyperthyroidism to euthyroidism and hypothyroidism (20, 40.6, and 59.1%, respectively, p < 0.05). Serum TSH was lowest in benign nodular disease, higher in PTMC and highest in PTC (p < 0.001). This was also true when patients with positive antithyroid peroxidase/antithyroglobulin and with lymphocytic thyroiditis were excluded from the analysis (p < 0.001). Serum TSH was higher in patients with bilateral tumor, capsular invasion and lymph node metastasis (LNM) compared to patients with unilateral tumor, without capsule invasion and without LNM, respectively (p = 0.036, p = 0.002, and p = 0.001, respectively). Patients with aggressive variant PTC had higher serum TSH than nonaggressive ones (p < 0.05). Preoperative serum TSH is associated with PTMC, PTC and LNM. Serum TSH seems to be related with thyroid cancer regardless of autoimmunity. With the present study, for the first time, we showed an association between serum TSH and aggressive variants of PTC.

Characterization of thyroid tissue using infrared spectroscopy

Introduction: In recent years, the number of surgical procedures involving the thyroid gland has increased worldwide; however, no increase in mortality rate has been observed. The Fourier Transform Infrared (FTIR) spectroscopy technique presents evidence in the characterization of multiple tissues, such as the thyroid gland, with the advantage of being rapid and preserving the tissue analyzed. Objectives: Characterize both healthy and pathological thyroid tissues by FTIR spectroscopy. Methods: Patients were selected at the Head and Neck Surgery Service of the Hospital das Clínicas, Ribeirão Preto Medical School, University of Sao Paulo - USP, Ribeirão Preto-SP, Brazil, from 2014 to 2015. The sample consisted of 44 patients with reference for thyroidectomy. The analysis was performed by defining the areas of each band using the OriginPro 8.6.0 software. The band was then normalized to 1240 cm-1. The mean area was calculated using the Student’s t-test with p<0.05. After calculation of the means, the second-order derivative of the spectrum was evaluated to show the positions of each absorption band. Results: The infrared spectrum of each piece was obtained and expressed as a function of absorbance and wave numbers in the mean IR (4000-900 cm-1). The present study demonstrated that, in the analysis of thyroid tissue by FTIR spectroscopy, it is possible to differentiate benign nodules from healthy tissue with significant difference in the area of the B-band between healthy tissue and goiter, which corresponds to 1452.90 cm-1 in healthy tissue (proteins and lipids) and 1069.80 cm-1 in goiter (DNA), as well as significant difference in width between normal thyroid tissue and carcinoma of the C band. Conclusions: FTIR spectroscopy is able to differentiate pathologically altered thyroid tissues from the thyroid gland compared with findings in healthy thyroid tissues. In patients with benign nodular disease of the thyroid gland, it is possible to differentiate healthy goiter tissue with statistical significance, as well as malignant nodules from healthy tissue through FTIR spectroscopy.

Cytopathologic Features in Papillary Thyroid Cancer Arising From Benign Nodular Disease

The presence of papillary thyroid carcinoma (PTC) arising from benign nodular disease (PTCAB) is a rare condition. Our study evaluates the clinicopathologic features of PTCAB. PTCAB is extremely rare, and its characteristics have not been well described. From April 2007 through March 2014, 323 patients with PTC were treated at Kangdong Sacred Heart Hospital. During this period, 10 cases of PTCAB were found. We also randomly selected 15 cases each of benign and papillary thyroid microcarcinoma (PTMC) for controls. We reviewed the medical records and the cytomorphologic features of fine-needle aspiration cytology and postoperative specimens. There was a significant difference in the rates of capsular invasion (P = 0.003) and lymphovascular invasion (P = 0.040) between the PTCAB and PTMC groups. Hashimoto's thyroiditis was more prevalent in the PTCAB group (62.5%, P = 0.026). The PTCAB group had a more even and variable distribution from category II to VI by the Bethesda Systems for Reporting Thyroid Cytopathology (P &amp;lt; 0.001). The most common cytomorphologic features of PTCAB were nuclear grooves (90%), pale chromatin (90%), and follicles (60%). Moderate to high cellularity and anisonucleosis were absent in 90% and 80%, respectively, of PTCAB cases. The only cytomorphologic feature significantly different between PTCAB and PTMC group was cellularity. Clinical characteristics were similar between PTCAB and PTMC. PTCAB has an overlapping pattern of cytomorphologic features between benign nodules and PTMC. However, most PTCAB cases contained a nuclear groove, pale chromatin, numerous follicles, and low cellularity, and these features help to establish a new diagnostic point for PTCAB.

Thyroid lobectomy is an effective option for unilateral benign nodular disease.

The use of thyroid lobectomy in the treatment of unilateral, benign nodules is limited by the potential of nodular recurrence in the remaining lobe. This study aimed to assess the rate and clinical impact of nodular recurrence in the contralateral lobe after thyroid lobectomy and to identify predictive factors of recurrence. Single-centre retrospective study. Records of patients that underwent lobectomy for unilateral thyroid nodules between 1991 and 2010 were reviewed and 270 patients were included. Exclusion criteria were: presence of contralateral nodule(s) ≥5mm on preoperative ultrasound, diagnosis of cancer necessitating completion thyroidectomy or pseudonodules. Recurrence was defined as the occurrence of nodule(s) ≥5mm in the remaining lobe on at least one postoperative ultrasound. A set of clinical, imaging, histological and biochemical parameters was tested as predictors of recurrence using logistic regression. After a median follow-up of 78months (range, 12-277months), the global recurrence rate was 42% and recurrence of nodules of a size ≥1cm occurred in 19%. Reoperation rate was 1·1%. 90% of patients were treated postoperatively by levothyroxine. Median time to nodular recurrence was 4years. Preoperative contralateral lobe volume and resected thyroid weight were identified as significant predictors of recurrence (P=0·045 and P=0·03 respectively). Thyroid lobectomy is an effective therapeutic strategy for unilateral, benign nodules, resulting in a low rate of clinically relevant nodular relapse in a mildly iodine-deficient area. Patients with uninodular disease and a contralateral lobe of normal size are particularly good candidates for lobectomy.

Histological Study of Nodular Outgrowths of the skin in Patients from a tertiary care Hospital, Hyderabad

Background: Pathological studies have documented the extent of spread of various skin lesions and have made significant contribution to the understanding of etiology and pathogenesis; Pathologic studies have played an important role in the diagnosis of various skin lesions. Objective: To study of Nodular Outgrowths of the skin in Patients from a tertiary care Hospital, Hyderabad. Methods: Histopathological study of benign nodular lesions of the skin, studied during the period of October 2010-September 2012 at Department of Pathology, Owaisi Hospital and Research Centre and Princess Esra Hospital. Skin biopsies were received from the Outpatient department of Dermatology. For this study, Clinico-pathologic details were recorded. During this period a total of 67 cases of benign nodular skin disease were studied. The patients were selected, irrespective of age, sex, socioeconomic status and residence. Cases were taken up for study after appropriate consent. All the skin biopsies either Punch or Incisional, were stained with Hematoxylin & Eosin, and examined. Special stains like AFB, PAS etc. were done in required cases. Results: Maximum number of cases was seen in the age group of 31-50 years. Male to female ratio was 1.16:1 showed male preponderance. Out of 23, syringoma were found in 9 (39.13%), trichoepithelioma in (26.08%), syringocystandenoma papilliferum in 4 (17.39%), sebaceous adenoma in 3 (13.04%), and pilar cyst in 1 (4.34%). Females (65.21%) outnumbered males (34.78%) in our study population. Conclusion: The present study has emphasized the role of histopathologic examination in cutaneous disorders and disease. Key words: Nodular Outgrowths, Histopathological study, Cutaneous disorders

Insulin Resistance in Patients with Benign Thyroid Nodules.

Recently, it has been questioned whether insulin resistance is associated with thyroid nodules. The aim of this study was to examine insulin resistance prevalence in a case-control study of patients with benign thyroid nodules in an iodine-sufficient area. This was a single-center, case-control study on euthyroid patients with benign nodular diseases. Thirty newly diagnosed patients with benign thyroid nodules according to fine needle aspiration cytology were investigated for insulin resistance. As a control group, 30 euthyroid control subjects with normal thyroid sonography without nodule were recruited from the general population. The participants were matched in pairs by age, gender, and body mass index. The diagnosis of insulin resistance was made when the homeostasis model assessment of insulin resistance (HOMA-IR) index was more than 2.5. The mean of HOMA-IR value was significantly higher in patients compared to controls (1.32 ± 0.65 vs. 0.76 ± 0.36, P-value < 0.001). Insulin resistance was seen in two subjects with thyroid nodules (6.7%), but none in the control group. There was a positive significant correlation between HOMA-IR and thyroid nodule size (r-value: +0.38, P < 0.03). Patients with thyroid nodules have higher HOMA-IR value. There is an association between insulin resistance and benign thyroid nodules. More investigations are required to define the role of this factor in thyroid nodule formation.

Risk Factors for Perioperative Airway Difficulty and Evaluation of Intubation Approaches Among Patients With Benign Goiter

The objective was to determine patient and gland characteristics associated with difficult intubation in patients undergoing thyroidectomy for goiter and to assess different methods of intubation in these patients. This study was an IRB-approved, retrospective chart review of 112 consecutive patients undergoing hemithyroidectomy or total thyroidectomy for thyroid goiter from 2009-2012 at an academic tertiary care facility in Bronx, New York. Patient demographics, thyroid gland characteristics (gland weight and nodule size), presence of preoperative symptoms (dyspnea, dysphagia, and hoarseness), and radiographical findings (tracheal compression, tracheal deviation, and substernal extension of the thyroid gland) were recorded. Anesthesia records were reviewed for method of intubation, as well as success or failure of intubation attempts. Nineteen patients (17.0%) were men and 93 (83.0%) were women. The age of the patients included in the study ranged from 14 to 86 years with a mean ± SD age of 53.5 ± 14.7 years. Difficult intubation was noted with 13 (11.6%) patients. Only patient age was significantly associated with difficult intubation. The mean age of patients with airway difficulty was 60.7 ± 3.7 years compared to 52.1 ± 1.5 years in those who did not experience airway difficulty (P = .04). No other reviewed risk factors were found to be significantly associated with difficult intubation. Fiberoptic intubation (FOI) was used in 38 patients and difficult intubation occurred in 18.4% (7/38). Direct laryngoscopy with transoral intubation (LTOI) was used in 58 patients, in whom 3.4% (2/58) experienced a difficult intubation. FOI was aborted 6 times and LTOI was subsequently successful in each of these cases. Our results suggest that benign nodular goiter disease does not pose significant challenges to intubation in our patient cohort. The technique of intubation deviated from the initial plan several times in the FOI group, whereas LTOI was ultimately successful in every case. Our data suggest that the role of fiberoptic intubation for patients with large goiters should be further refined.

65 Organotypic regeneration after interstitial laser irradiation for the treatment of benign nodular diseases of the thyroid gland and breast

65 Organotypic regeneration after interstitial laser irradiation for the treatment of benign nodular diseases of the thyroid gland and breast

Thyroid surgery for elderly patients: are they at increased operative risks?

An increasing elderly population, a rising incidence of differentiated thyroid carcinoma (DTC), and a rising incidence of benign nodular disease with age are all contributing to a rise in thyroid operations for the elderly. Literature review on the outcome and safety of thyroid surgery in elderly patients has been filled with conflicting results and this subject remains controversial. Although most single-institution studies conducted by high-volume surgeons did not find significant differences of complication rates in elderly when compared with younger cohorts, they often lacked the power necessary to identify subtle differences and suffered from various selection and referral biases. Recent evidence from large population-based studies concluded that thyroid surgery in the elderly was associated with higher complication rates. One of the major contributing factors for the increased complication rate was because most elderly patients suffered from many preexisting comorbidities. Therefore, elderly patients who have abnormal thyroid findings should complete a thorough preoperative workup and better postoperative care after undergoing any thyroid surgery. Furthermore, these high-risk patients would benefit if they could be referred to high-volume, specialized surgical units early. In this systemic review, we aimed to evaluate different issues and controversies in thyroidectomy for elderly patients.

Short term effects of levothyroxine treatment in thyroid multinodular disease

The levothyroxine suppressive efficacy in benign thyroid nodules treatment is well described in uninodular non-toxic goiter, whereas only few controlled trials enrolled patients with multinodular disease. The aim of the present study is to evaluate the short term effects of levothyroxine treatment in never treated, pre-menopausal women affected by thyroid multinodular disease. Seventy-one pre-menopausal women with thyroid multinodular disease, still presenting normal TSH levels, from Latina area were randomly assigned to a levothyroxine treated or control group. Biochemical and ultrasonography evaluations of thyroid were monitored at the enrollment and after 6, 12 and 24 months of treatment. In the levothyroxine treated group, after 1 year of treatment, thyroid and dominant nodule volume and number of nodules >0.5 mL significantly decreased from a median of 12.0 to 9.8 mL (p <0.001), from 1.0 to 0.5 mL (p <0.001) and from 0.5 to 0, respectively. Conversely, in the control group significant augmented values of these parameters were observed (p =0.007, p <0.001 and p <0.001, respectively). Furthermore, these observations were also confirmed by results obtained after a 24 months follow-up period. Our data support previous observations on the clinical usefulness of L-T(4) treatment in preventing thyroid and nodule volume and nodule numbers growth. These findings confirm the tendency of benign nodular disease toward progression and the efficacy of TSH suppression in preventing its evolution by means of removing the major growth factor for thyroid nodules still responsive to physiological stimuli.

Levothyroxine therapy in preventing nodular recurrence after hemithyroidectomy: A retrospective study

To determine the effect of levothyroxine (L-T4) therapy on the recurrence rate of nodular disease in patients previously treated with lobectomy for benign nodular goiter. Two hundred and thirty-tree patients (38 males, 195 females; age 49.9+/-13.1 yr) with no post-surgical evidence of nodular disease in the remnant, were followed- up yearly with serum TSH and ultrasound (US). Nodular recurrence was defined as a lesion of at least 5 mm at US. Patients were divided in 2 groups based on whether or not they had been treated with L-T4 after surgery: Group 1 (45 patients) who did not receive any L-T4, and Group 2 (188 patients) treated with L-T4. Group 2 was further subdivided in Group 2a (123 patients) receiving L-T4 substitutive therapy (TSH>or=0.5 and <or=3 mUI/l) and Group 2b (65 patients) receiving L-T4 at TSH-suppressive dose (TSH<0.5 mUI/l). Mean observation period was 5.8+/-4.7 yr. Overall, 71 out of 233 (30.5%) patients experienced recurrence of thyroid nodular disease: 29 patients (64.4%) in Group 1, 24 (19.5%) patients in Group 2a, and 18 (27.7%) patients in Group 2b. The recurrence rate was significantly lower (p<0.001) in Group 2 compared with Group 1, but no significant difference was observed between Groups 2a and 2b. In patients who have undergone hemithyroidectomy for benign monolobar nodular disease, L-T4 therapy may prevent recurrence of nodular disease. TSH suppression may not be required for prevention of recurrence in the remnant thyroid tissue.

Thyroidectomies from patients with history of therapeutic radiation during childhood and adolescence have a unique mutational profile

Radiation in childhood is a known risk factor for thyroid carcinoma, but may also be related to benign nodular hyperplasias. Recent evidence from comparative genomic hybridization indicates that radiation can induce clonal DNA damage in cultured rat thyrocytes. We used a loss of heterozygosity analysis for the loci identified by comparative genomic hybridization to study human thyroids. Thyroids from patients with a history of radiation, patients who had recent therapeutic external beam radiation for laryngeal carcinoma, and patients who had no radiation and underwent incidental thyroidectomy with laryngectomy for laryngeal carcinoma were included. PCR was performed for 18 different genetic loci defined by prior reported comparative genomic hybridization study. A semiquantitative capillary electrophoresis analysis was used and frequency of allelic loss was calculated from the number of losses/the number of informative loci. A total of 40 cases of thyroids from patients with childhood radiation, 12 cases of recently radiated thyroids, and 15 cases of nonradiated thyroids were included. In the nonradiated and recently radiated thyroids, the mean frequency of allelic loss was 2.3%. In the thyroids from patients radiated as children, the mean frequency of allelic loss was 39%. Losses were seen at every locus with a range of 7–100% of the cases analyzed (mean 49.6%). Radiation in childhood was associated with both benign nodular disease and carcinomas of the thyroid. The frequency of allelic loss was very high in all lesions in these patients, as compared to control thyroid glands. These data from human thyroids support prior cell culture experiments and show that radiation induces genetic mutational damage even in benign proliferative processes in these thyroids.