Benign Nodular Disease Research Articles

Follow‐Up After Surgery for Benign Nodular Thyroid Disease: Evidence‐Based Approach

There is no consensus on what constitutes appropriate methodology and timing for follow-up of patients after surgery for benign nodular disease. A systematic review of the medical literature using evidence-based criteria was used to address the following four issues: (1) How often should patients who have undergone thyroidectomy for the treatment of benign nodular goiter be followed, and what constitutes appropriate follow-up? (2) What is the most appropriate method for detecting recurrent nodular thyroid disease? (3) Does thyroid hormone administration prevent recurrent nodular thyroid disease? (4) Does iodine administration prevent recurrent nodular thyroid disease? Altogether, 742 articles were found in MEDLINE using a keyword search strategy; we then narrowed them to 23 articles. There were a total of four articles with Level I data, five articles with Level II data, one article with Level III data, and 13 articles with Level IV or retrospective data. Based on the available data, it is our recommendation that patients undergoing thyroid lobectomy for benign nodular thyroid disease should be followed with an annual physical examination, neck ultrasonography, and serum thyroid-stimulating hormone (TSH) measurement. Patients undergoing total thyroidectomy should be followed with an annual physical examination and a serum TSH measurement. Routine thyroxine and/or iodine supplementation may be useful for preventing recurrence in patients from iodine-deficient regions.

Triiodothyronine Levels in Athyreotic Individuals During Levothyroxine Therapy

Thyroidal production of triiodothyronine (T3) is absent in athyreotic patients, leading to the suggestion that T3 deficiency may be unavoidable during levothyroxine (LT4) therapy. However, trials evaluating therapy with combined LT4 and T3 have failed to demonstrate any consistent advantage of combination therapy. To determine whether T3 levels in patients treated with LT4 therapy were truly lower than in the same patients with native thyroid function. A prospective study conducted in the General Clinical Research Center, Georgetown University Medical Center, Washington, DC, between January 30, 2004, and June 20, 2007, of 50 euthyroid study participants aged 18 to 65 years who were scheduled for total thyroidectomy for goiter, benign nodular disease, suspected thyroid cancer, or known thyroid cancer. Following thyroidectomy, patients were prescribed LT4. Patients with benign thyroid disease and thyroid cancer were treated to achieve a normal and suppressed serum thyroid-stimulating hormone (TSH) level, respectively. The LT4 dose was adjusted as necessary postoperatively to achieve the desired TSH goal. Thyroxine (tetraiodothyronine [T4]), T3, and TSH levels were measured twice preoperatively and twice postoperatively. By the end of the study, there were no significant decreases in T3 concentrations in patients receiving LT4 therapy compared with their prethyroidectomy T3 levels (mean, 127.2 ng/dL; 95% confidence interval [CI], 119.5-134.9 ng/dL vs 129.3 ng/dL; 95% CI, 121.9-136.7 ng/dL; P = .64). However, free T4 concentrations were significantly higher in patients treated with LT(4) therapy (mean, 1.41 ng/dL; 95% CI, 1.33-1.49 ng/dL) compared with their native free T4 levels (1.05 ng/dL; 95% CI, 1.00-1.10 ng/dL; P < .001). Serum TSH values of 4.5 mIU/L or less were achieved in 94% of patients by the end of the study. The T3 concentrations were lower in the subgroup of patients whose therapy had not resulted in a TSH level of 4.5 mIU/L or less (P < .001). In our study, normal T3 levels were achieved with traditional LT4 therapy alone in patients who had undergone near-total or total thyroidectomy, which suggests that T3 administration is not necessary to maintain serum T3 values at their endogenous prethyroidectomy levels.

Detection of Papillary Thyroid Carcinoma With Serum Protein Profile Analysis

To determine the sensitivity and specificity of surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS) for papillary thyroid carcinoma (PTC) detection. The SELDI-TOF-MS protein profiles of patients with PTC, patients with benign nodular disease (BND), and healthy controls were analyzed to determine the sensitivity and specificity of SELDI-TOF-MS assay for PTC detection. Data analysis was performed to process the spectral data and classify the disease status of the patients. Academic tertiary care hospital. Serum samples were collected prospectively from 7 patients with PTC, 8 patients with BND, and 7 healthy control volunteers. All patients diagnosed as having PTC or BND underwent thyroidectomy from October 21, 2004, to January 31, 2006. Twenty-two serum samples were analyzed. Most protein peaks resolved by the SELDI-TOF-MS assay were in the range of 1 to 20 kDa. Classification tree analysis based on peak expression distinguished patients with PTC from those with BND with 85.7% sensitivity and 100% specificity. Serum samples from patients with PTC differed most significantly from those of patients with BND by the underexpression of a protein peak at 11 101 Da. This pilot study demonstrates that proteomic analysis of serum protein profiles distinguishes patients with PTC from patients with BND with a high degree of sensitivity and specificity. Further investigation into the clinical utility of this technology in PTC biomarker detection and surveillance is warranted.

The meaning and predictivity of Hürthle cells in fine needle aspiration cytology for thyroid nodular disease

Aims. The significance of Hürthle cells in thyroid nodule fine needle aspiration cytology (FNAC) samples remains uncertain. This study aims to clarify the meaning and the predictivity of this kind of cells. Methods. One hundred and ten patients with Hürthle cells in FNAC of thyroid nodules were reviewed. Histopathology was correlated with cytological findings. Results. The density of Hürthle cells in FNACs ranged from 20 to 100%. Eighty-nine patients had benign nodular disease (Hürthle cell or follicular adenoma), and 21 patients had malignant tumours. The presence of more than 50% Hürthle cells in FNAC correlated with benign or malignant Hürthle cell neoplasm. Hürthle cell carcinomas displayed more than 90% Hürthle cells in FNAC. Conclusions. Surgery is indicated for all nodular lesions with more than 50% Hürthle cells in FNAC.

Thyroid suppression therapy: risks and indications

Thyroid hormone suppression therapy has long been used to treat benign and malignant thyroid disorders. Significant side effects are increasingly recognized, including cardiac dysfunction, osteoporosis, and symptomatic thyrotoxicosis. These risks may be reduced with more selective use, less aggressive suppression, adjunctive medical therapy, and involvement of an endocrinologist. Currently, thyroid hormone suppression therapy is widely recommended after initial therapy for well-differentiated thyroid cancer. In contrast, routine thyroid hormone suppression therapy is increasingly discouraged for benign thyroid disorders because of side effects. In diffuse, sporadic, nontoxic goiter, thyroid hormone suppression therapy may reduce thyroid volume for certain patients, but goiter recurs after cessation of therapy. For patients with endemic goiter, iodide is safer than thyroid hormone suppression therapy and equally effective. After partial thyroidectomy, thyroid hormone suppression therapy may prevent goiter recurrence in selected patients with evidence of remnant growth. In sum, thyroid hormone suppression therapy is rarely indicated for benign nodular disease but may reduce nodule volume and prevent new nodule formation for a minority of patients.

Value of re-aspirations in benign nodular thyroid disease.

Fine-needle aspiration cytology (FNAC) is the most useful procedure for the evaluation of thyroid nodules. The requirement for repeated aspirations in the follow-up of benign nodular thyroid disease, however, is controversial. To determine the value of re-aspirations in benign nodular thyroid disease, we studied 457 fine-needle reaspirations performed on 216 patients (197 female, 19 male) aged 42.9+/-12 years with uninodular (n = 65) and multinodular (n = 151) thyroid disease. Two hundred fifty-seven of these were second, 137 were third, 46 were fourth, and 17 were fifth re-aspirations of the same nodule, performed in a mean follow-up time of 43.9+/-31 (3-156) months. FNAC results were benign in 407 (89%), insufficient for diagnosis in 31 (6.8%), suspicious in 16 (3.5%), and papillary carcinoma (PC) in 3 (0.7%). An initial benign diagnosis did not change after multiple aspirations in 213 (98.61%) of the cases. Three patients with initial aspirations read as benign had a diagnosis of PC from their second biopsies, (diagnosis confirmed at surgery). Re-examination of the initial FNAC revealed atypical features in 1 of the 3 patients. These 3 patients likely represent a false-negative result of the initial FNAC rather than benign nodular disease transformed to a malignant one during the follow-up period. In conclusion, a second aspiration of clinically suspicious nodules may correct a few initial false-negative results, but routine additional re-aspirations are not useful for clinically stable disease.

Thyroid Nodularity and Cancer among Chernobyl Cleanup Workers from Estonia

Thyroid examinations, including palpation, ultrasound and, selectively, fine-needle aspiration biopsy, were conducted on nearly 2,000 Chernobyl cleanup workers from Estonia to evaluate the occurrence of thyroid cancer and nodular thyroid disease among men with protracted exposure to ionizing radiation. The examinations were conducted in four cities in Estonia during March-April 1995, 9 years after the reactor accident. The study population was selected from a predefined cohort of 4,833 cleanup workers from Estonia under surveillance for cancer incidence. These men had been sent to Chernobyl between 1986 and 1991 to entomb the damaged reactor, remove radioactive debris and perform related cleanup activities. A total of 2,997 men were invited for thyroid screening and 1,984 (66%) were examined. Estimates of radiation dose from external sources were obtained from military or other institutional records, and details about service dates and types of work performed while at Chernobyl were obtained from a self-administered questionnaire. Blood samples were collected for assay of chromosomal translocations in circulating lymphocytes and loss of expression of the glycophorin A (GPA) gene in erythrocytes. The primary outcome measure was the presence or absence of thyroid nodules as determined by the ultrasound examination. Of the screened workers, 1,247 (63%) were sent to Chernobyl in 1986, including 603 (30%) sent in April or May, soon after the accident. Workers served at Chernobyl for an average of 3 months. The average age was 32 years at the time of arrival at Chernobyl and 40 years at the time of thyroid examination. The mean documented radiation dose from external sources was 10.8 cGy. Biological indicators of exposure showed low correlations with documented dose, but did not indicate that the mean dose for the population was higher than the average documented dose. Ultrasound examinations revealed thyroid nodules in 201 individuals (10.2%). The prevalence of nodules increased with age at examination, but no significant associations were observed with recorded dose, date of first duty at Chernobyl, duration of service at Chernobyl, building the sarcophagus or working on the roof of neighboring buildings or close to the damaged reactor. Nodularity showed a nonsignificant (p(1) = 0.10) positive association with the proportion of lymphocytes with chromosome translocations, but associations with the frequency of variant erythrocytes in the GPA assay were weak and unstable (p(1) > or = 0.46). The majority of fine-needle biopsies taken on 77 study participants indicated benign nodular disease. However, two cases of papillary carcinoma and three benign follicular neoplasms were identified and referred for treatment. Both men with thyroid cancer had been sent to Chernobyl in May of 1986, when the potential for exposure to radioactive iodines was greatest. Chernobyl cleanup workers from Estonia did not experience a markedly increased risk of nodular thyroid disease associated with exposure to external radiation. Possible reasons for the apparent absence of effect include low radiation doses, the protracted nature of the exposure, errors in dose measurement, low sensitivity of the adult thyroid gland or the insufficient passage of time for a radiation effect to be expressed.

Clinical review 66: Thyroxine suppression therapy for benign nodular disease.

Clinical review 66: Thyroxine suppression therapy for benign nodular disease.

Clinical review 66: Thyroxine suppression therapy for benign nodular disease

Clinical review 66: Thyroxine suppression therapy for benign nodular disease