Benign Nodular Thyroid Disease Research Articles

Uni- and Multivariate Analyses of Cancer Risk in Cytologically Indeterminate Thyroid Nodules: A Single-Center Experience.

Every year in Italy, about 60,000 new cases of nodular thyroid pathology are diagnosed, of which almost 30% are cytologically indeterminate (TIR3A/3B). The risk of malignancy reported in the literature on thyroid nodules ranges from 5% to 15% for TIR3A and from 15% to 30% for TIR3B. It is suspected that these percentages are higher in practice. We performed univariate and multivariate analyses of clinical risk factors. The medical records of 291 patients who underwent surgery for cytologically indeterminate nodular thyroid disease were retrospectively reviewed. Clinical parameters and preoperative serum markers were then compared between the benign nodular thyroid disease and thyroid cancer groups. For each patient, clinical characteristics, comorbidities, neck ultrasonographic features, and histological reports were statistically analyzed using Chi-squared and Fisher's exact tests. A total of 134 malignant neoplasms were found (46%), divided into 55 cases (35%) in the TIR3A group and 79 cases (59%) in the TIR3B group. Statistical analysis was not significant in both populations for both sex and age (TIR3A p-value = 0.5097 and p-value = 0.1430, TIR3B p-value = 0.5191 p-value = 0.3384), while it was statistically significant in patients with TIR3A nodules associated with thyroiditis (p-value = 0.0009). In addition, the patients with TIR3A and 3B nodules were stratified by ultrasound risk for the prediction of malignancy and it was significant (p = 0.0004 and p < 0.0001). In light of these results, it emerges that surgical treatment of nodular thyroid pathology with indeterminate cytology TIR3A should always be considered, and surgery for TIR3B is mandatory.

Natural course of benign thyroid nodular disease in a borderline iodine-sufficient area: 10-year retrospective follow-up data from a tertiary center

Natural course of benign thyroid nodular disease in a borderline iodine-sufficient area: 10-year retrospective follow-up data from a tertiary center

The relationship between papillary thyroid carcinoma and preoperative TSH level: A cross-sectional study from Syria

Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, and thyroid stimulating hormone (TSH) is the major growth factor for thyroid cells. It is also an available, inexpensive test and performed routinely while evaluating thyroid nodules. Yet the relationship between TSH levels and PTC is still controversial. Understanding the relationship between preoperative TSH levels and thyroid cancer helps to break new ground of current prevention, diagnosis, and management approaches of thyroid cancer. A cross-sectional retrospective study of patients underwent total thyroidectomy during 2019 at Al-Assad University Hospital, which included 305 individuals. All patients underwent thyroid ultrasonography and laboratory assessment of serum TSH levels prior to surgery, in addition to recording histological features of resected thyroid samples. The malignancy rate was 21.3%, PTC patients had higher TSH values across the entire study even when gender, age and number of thyroid nodules differed. A statistically significant increase in TSH levels was noticed by moving from the benign thyroid nodular disease (BTND) group to papillary thyroid microcarcinoma (PTMC) group, then to thyroid cancer of larger size (TCLS) group (P = .001). A statistically significant relationship was also found between high TSH levels and lymph node metastases (LNM) (P = .008). TSH concentrations were significantly higher in patients with PTC, and higher TSH values were associated with TCLS and LNM.

Thyroglobulin is a poor predictor of differentiated thyroid cancer in patients who undergo surgery for thyroid nodular diseases.

Thyroglobulin, produced exclusively by thyroid follicular cells, serves as a specific tumor marker for the follow-up of differentiated thyroid cancer (DTC) patients after thyroidectomy. However, its role as a predictor of malignancy in patients with thyroid nodules is controversial. We assessed the potential role of preoperative serum thyroglobulin concentration to predict DTC in patients without a preoperative diagnosis of malignancy who underwent partial or total thyroidectomy. This retrospective study included patients with a preoperative diagnosis of benign multinodular goiter (MNG) or a thyroid nodule with indeterminate cytology (INC) (Bethesda system categories III/IV) who underwent partial or total thyroidectomy between January 2014 and May 2019. We compared the patients' demographic, clinical, imaging, and biochemical data according to their final diagnosis: DTC or benign thyroid nodular disease. Further statistical analysis included odds ratio calculation and receiver operating characteristic (ROC) curve analysis. Of 131 patients who met inclusion and exclusion criteria, the indication for surgery was benign MNG in 69 patients and a thyroid nodule with INC in 62 patients. A final diagnosis of DTC was reported in 18 of the 69 benign MNG patients (26%) and in 30 of the 62 thyroid nodule with INC patients (48%). The preoperative measurements of nodule diameter and serum thyroid-stimulating hormone and thyroglobulin concentrations did not significantly differ between patients with a final diagnosis of DTC and those with benign histology. Preoperative serum thyroglobulin alone is insufficient to differentiate between malignant and benign thyroid nodular disease.

A single-center multidisciplinary study analyzing thyroid nodule risk stratification by comparing the thyroid imaging reporting and data system (TI-RADS) and American thyroid association (ATA) risk of malignancy for thyroid nodules

ObjectivesThe thyroid imaging reporting and data system (TI-RADS) and 2015 American Thyroid Association (ATA) guidelines are two well-known risk stratification systems for classifying thyroid nodules based on cancer risk. This study aims to evaluate the diagnostic efficacy of these two systems in predicting malignancy in patients undergoing thyroid surgery. MethodsWe studied data on 120 individuals who were scheduled to undergo surgery for benign or malignant nodular diseases of the thyroid gland between October 2017 and October 2019. The TI-RADS category and ultrasound pattern based on ATA guidelines were assigned to dominant thyroid nodule categories by two experienced radiologists blinded to patients’ previous thyroid ultrasonography and fine-needle aspiration biopsy results. A pathologist with experience in thyroid diseases blinded to patients’ sonographic and clinical data reviewed the thyroidectomy specimens. ResultsA total of 120 patients, 88 women and 32 men, were included in our study. Final histopathological results were as follows: 50% (n=60) papillary thyroid carcinoma, 36.6% (n=44) benign nodular thyroid diseases, 4.1% (n=5) follicular adenoma, 2.5% (n=3) hurtle cell adenoma, 1.7% (n=2) follicular thyroid carcinoma, 1.7% (n=2) medullary thyroid carcinoma, 1.7% (n=2) hurtle cell carcinoma, and 1.7% (n=2) follicular tumor of uncertain malignancy potential. The sensitivity, specificity, positive predictive value, and negative predictive value for TI-RADS were 80%, 56%, 72%, and 67%, respectively, and that for ATA were 80%, 64%, 76%, and 69%, respectively. ConclusionThe TI-RADS and ATA showed similar rates of sensitivity, specificity, NPV, and PPV. Our observed risk of malignancy was higher than expected for the ACR TI-RADS 3–5 categories and the very low, low, and intermediate suspicion risk strata in the ATA guidelines. We found no difference between observed and expected malignancy risk for the ACR TI-RADS 2’s and ATA's high suspicion categories.

Possible factors of hypercalcitoninemia in a benign nodular thyroid disease

Possible factors of hypercalcitoninemia in a benign nodular thyroid disease

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.

\u201cThyroid nodular disease and PTEN mutation in a multicentre series of children with PTEN hamartoma tumor syndrome (PHTS)\u201d

PurposeTo report the incidence of 4–12% of differentiated thyroid cancer (DTC) and up to 50% of benign thyroid nodular disease and to describe nodular thyroid disease in a multicentre pediatric population with PTEN mutations. Methods: Retrospective data of pediatric patients with PTEN mutations collected from tertiary Departments of Pediatric Endocrinology of Turin, Milan and Genua, Italy, in the period 2010–2020.ResultsSeventeen children with PTEN mutations were recruited in the study. Thyroid involvement was present in 12/17 (70.6%) subjects, showing a multinodular struma in 6/17 (35.3%), nodules with benign ultrasound features in 5/17 (29.4%) and a follicular adenoma in 1/17 (6%). No correlation was found between thyroid disease and gender, puberty, vascular manifestations, delayed development, or brain MRI abnormalities, while multiple lipomas were associated with thyroid disease (p = 0.03), as was macrocephaly. Standard Deviation (SD) score head circumference was 4.35 ± 1.35 cm in subjects with thyroid disease, 3 ± 0.43 cm (p = 0.02) in the group without thyroid disease. Thyroid involvement was present in all subjects with mutations in exon 6 (4/4) and exon 8 (3/3) of the PTEN gene (p = 0.02).ConclusionIn the presented cohort, benign thyroid disorders were prevalent, with no evidence of DTC. A correlation was found between thyroid lesions and head circumference and the occurrence of multiple lipomas. Future studies in larger cohorts should assess whether risk stratification is needed when recommending surveillance strategies in children or young adolescents with PTEN hamartoma syndrome.

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.

Does Obesity Cause Thyroid Cancer? A Mendelian Randomization Study.

BackgroundThe incidence of thyroid cancer is rising, and relatively little is known about modifiable risk factors for the condition. Observational studies have suggested a link between adiposity and thyroid cancer; however, these are subject to confounding and reverse causality. Here, we used data from the UK Biobank and Mendelian randomization approaches to investigate whether adiposity causes benign nodular thyroid disease and differentiated thyroid cancer.MethodsWe analyzed data from 379 708 unrelated participants of European ancestry in the UK Biobank and identified 1812 participants with benign nodular thyroid disease and 425 with differentiated thyroid carcinoma. We tested observational associations with measures of adiposity and type 2 diabetes mellitus. One and 2-sample Mendelian randomization approaches were used to investigate causal relationships.ResultsObservationally, there were positive associations between higher body mass index (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.08-1.22), higher waist-hip ratio (OR, 1.16; 95% CI, 1.09-1.23), and benign nodular thyroid disease, but not thyroid cancer. Mendelian randomization did not support a causal link for obesity with benign nodular thyroid disease or thyroid cancer, although it did provide some evidence that individuals in the highest quartile for genetic liability of type 2 diabetes had higher odds of thyroid cancer than those in the lowest quartile (OR, 1.45; CI, 1.11-1.90).ConclusionsContrary to the findings of observational studies, our results do not confirm a causal role for obesity in benign nodular thyroid disease or thyroid cancer. They do, however, suggest a link between type 2 diabetes and thyroid cancer.

Management of Subclinical and Overt Hypothyroidism Following Hemithyroidectomy in Children and Adolescents: A Pilot Study.

Background: To reduce surgical complications and avoid lifelong thyroid hormone replacement, hemithyroidectomy is preferred in children and adolescents with benign nodular thyroid disease. However, hypothyroidism following hemithyroidectomy may occur, and postoperative thyroid hormone replacement for hypothyroidism following hemithyroidectomy is usually administered without a full understanding of the clinical characteristics of hypothyroidism.Methods: To investigate the incidence and risk factors of hypothyroidism after hemithyroidectomy in children and adolescents, and to identify whether postoperative thyroid hormone replacement is necessary, a retrospective review of 43 patients under 18 years of age who underwent hemithyroidectomy from January 2009 to October 2016 was conducted. All hypothyroid patients were retrospectively analyzed to determine the incidence and predisposing factor(s) of postoperative hypothyroidism. All patients were measured regarding age, sex, serum thyrotropin (TSH), anti-thyroid antibody, and histological evidence of lymphocytic infiltration. Hypothyroid patients were measured for symptoms, timing of diagnosis, and thyroid hormone replacement.Results: The mean age at the time of surgery was 13.65 ± 3.04 years. Of the cohort, 34 patients were female (79.07%), and the mean follow-up time was 28 ± 9 months. Hypothyroidism was diagnosed in 11 of the 43 patients. The mean postoperative TSH level was 7.17 ± 2.13 μIU/ml. The mean preoperative TSH level was 3.11 ± 0.59 μIU/ml in hypothyroid patients compared with 1.92 ± 0.72 μIU/ml in euthyroid patients (P < 0.05). A preoperative TSH level >2.2 μIU/l and lymphocytic infiltration graded 3 or 4 were found to be independent risk factors for the development of hypothyroidism. There were no significant differences between groups in terms of patient age or sex.Conclusions: In the pediatric and adolescent population, patients with elevated preoperative TSH levels or the presence of lymphocytic infiltration may increase the risk of risk of hypothyroidism. In our study, postoperative levothyroxine (L-T4) treatment was necessary in 16.28% of cases after hemithyroidectomy. Patients with mild postoperative hypothyroidism should be followed up, without the need for immediate L-T4 replacement, so as to expect patients to recover spontaneously.

Assessment of the Adequacy of Thyroid Hormone Replacement Therapy in Hypothyroidism

Background: Recent studies identify a significant number of treated hypothyroid patients who express dissatisfaction with their therapy. At present there are sufficient measures of thyroid function to enable the clinician to establish a diagnosis of thyroid disease with a high degree of sensitivity and specificity. The purpose of this study was to quantitate the use of a new and novel assessment of clinically relevant hypothyroid symptoms in the management of patients with thyroid disease and to identify a tool that could help clinicians to assess adequacy of LT4 treatment.Methodology: Unselected outpatients of the Thyroid Clinic of the North Shore University Hospital at Manhasset completed a questionnaire asking them to rate their physical symptoms related to thyroid disease as part of their standard care. This questionnaire consisted of 10 signs and symptoms. The questionnaire was collected from 198 control subjects, 241 subjects with primary hypothyroidism (under treatment), 113 euthyroid subjects (benign nodular thyroid disease), 73 previously hyperthyroid subjects (previously treated), and 27 subjects with thyroid cancer. A repeat questionnaire was obtained from 48 subjects with primary hypothyroidism (20%), 19 euthyroid subjects (17%), and 17 subjects previously hyperthyroid (23%).Data Analysis: The mean score for the sum of the signs and symptoms in the primary hypothyroid group with no medication change was 9.62 ± 1.29 for the initial questionnaire, and 10.04 ± 1.32 for the follow up questionnaire (not significant). For the primary hypothyroid patients requiring a medication change, at the time of the initial questionnaire the mean serum TSH was 12.86 ± 2.75 mcU/ml. Concurrently with the normalization of TSH, a statistically significant improvement in the sum of signs and symptoms mean score for this group was noted (16.32 ± 1.93 initial vs. 10.32 ± 1.46 after treatment to normalize TSH).Conclusion: The proposed newly devised hypothyroid scale correctly identified subjects with TSH elevation and clinical/subclinical hypothyroidism based on their clinical signs and symptoms. In this particular subset of patients, the hypothyroid symptom scale showed a statistically significant improvement in the sum of the signs and symptoms with the normalization of the subjects' thyroid function.

The Impact of Post-thyroidectomy Paresis on Quality of Life in Patients with Nodular Thyroid Disease.

To investigate the impact of postoperative paresis on disease-specific quality of life (DSQoL) after thyroidectomy in patients with benign nodular thyroid disease. Observational study. University hospital. Patients were evaluated before and 3 weeks and 6 months after surgery in an individual prospective cohort study using videolaryngostroboscopy (VLS), voice range profile, voice handicap index (VHI), multidimensional voice program, maximum phonation time (MPT), and auditory perceptual evaluation. Changes in DSQoL were assessed by the Thyroid-specific Patient-Reported Outcome measure. Cohen's effect size was used to evaluate changes. Sixty-two patients were included, 55 of whom completed all examinations. Three weeks after surgery, a blinded VLS examination showed signs of paresis of either the recurrent laryngeal nerve or the external branch of the superior laryngeal nerve (RLN/EBSLN) in 13 patients (24%). A paresis corresponded to a 12 ± 28 point increase in VHI (P = .002) and was associated with a significant 4.3 ± 7.5 semitone decrease in the maximum fundamental frequency (P < .001) and a 5.3 ± 8.2 dB reduction in maximum intensity. Further, it was associated with a 4.5 ± 11.2 second reduction in MPT (P = .001) and an increase of 0.40 ± 1.19 in grade, 0.42 ± 1.41 in roughness, and 0.36 ± 1.11 in breathiness. Signs of postoperative RLN/EBSLN paresis correlated with an 11.0-point (P = .02) poorer improvement in goiter symptoms at both 3 weeks and 6 months after surgery. Signs of RLN/EBSLN paresis after thyroidectomy were associated with less pronounced improvement in goiter symptoms in patients with thyroid nodular disease. However, thyroidectomy was associated with an overall improved DSQoL by 6 months after surgery.

MON-620 Autoimmune Thyroiditis, Benign Nodular Thyroid Disease and Adipokines Levels

Introduction: The interrelationship between autoimmune thyroiditis, benign nodular thyroid disease and plasma adipokines levels remains elusive. We aimed to compare the levels of adipokines in patients with autoimmune thyroiditis with and without benign nodular thyroid disease. Subjects and Methods: We recorded thyroid function tests, BMI, the levels of total cholesterol(TC), HDL, LDL-cholesterol, triglycerides(TG), apolipoprotein B(ApoB), ApoA1, lipoprotein(a)(Lp[a]), homocysteine, CRP(C-reactive protein), folic acid, vitamin B12 levels,adiponectin, resistin and plasminogen activator inhibitor-1 (PAI-1) in 98 patients with autoimmune thyroid disease, 75.9% woman, with a mean age of 46.7±15.3 years. An ultrasound scan of the thyroid gland was performed in all patients. Patients were divided according to thyroid function (euthyroidism, hypothyroidism or hyperthyroidism) and presence of benign nodular thyroid disease (unimodular goitre [UNG], multinodular goitre [MNG]). Results: Patients with hyperthyroidism showed higher levels of resistin comparing with those with hypothyroidism (28.3±14.7 vs 20.7±22.6 ng/ml, p<0.01), PAI-1 (27.3±25.1 vs 12.7±10.9 ng/ml, <0.01) and lower levels of adiponectin (21.0±13.3 vs 28.3±14.7 μg/ml, p<0.01). In both hypothyroidism and hyperthyroidism, adiponectin, resistin and PAI-1 were not correlated with BMI. Among patients with hypothyroidism, the group with MNG presented lower adiponectin levels than the group without nodules (12.9±6.3 vs 23.7±14.4 μg/ml, p<0.01). The group with UNG had significantly higher resistin levels than patients with MNG (34.2±40.18 vs 7.2±2.5 ng/ml, p<0.01). On the other hand, among patients with normal thyroid function, those with MNG presented significantly higher levels of resistin comparing with those with UNG (16.2±15.3 vs 8.0±7.8 ng/ml, p<0.05). Regarding the group with hyperthyroidism, patients with MNG had significantly higher levels of PAI-1 comparing with the group with UNG (30.2±27.4 vs 18.8±15.8 ng/ml, p<0.05). Conclusions: We found significant associations between benign nodular thyroid disease and adipokines levels among patients with AIT. This relationship seems to be modulated by thyroid function. Our results suggest that adipokines may have an important role in the pathogenesis of benign nodular thyroid disease among patients with AIT.

Long-term sequelae of the less than total thyroidectomy procedures for benign thyroid nodular disease.

Nodular goiter is the most common disorder of the thyroid gland. Less than total thyroidectomy procedures are considered the gold standard in the surgical management of nodular thyroid disease despite its propensity for recurrence. The aim of the study was to assess long-term sequelae of the less than total thyroidectomy procedures. In this single-center retrospective study, records of 154 patients that underwent less than total thyroidectomy, for nodular disease and/or hyperthyroidism between 1998 and 2013, were reviewed. Patients with malignant findings in the histology report and a follow-up of less than 5 years were excluded. The mean age of the recorded patients was 65.1 ± 12.91 years of which 132 were females. Subtotal thyroidectomy was performed in 45.5% of the study population, 22.1% underwent partial thyroidectomy, while the remaining 32.5% underwent lobectomy. Long-term thyroxine supplementation was administered in 138 patients (89.6%). Recurrence of clinically important nodules (>1 cm) was observed in 68.2% of patients but only 11% of the population underwent completion thyroidectomy. In the univariate analysis, the duration of follow-up (p = 0.00005, C.I.: 0.903-0.965) as well as the type of operation (p = 0.035, C.I.: 1.031-2.348) appeared to have a significant correlation with nodular recurrence. The multivariate analysis identified the duration of follow-up (p = 0.0005, C.I.: 0.908-0.973) as the only significant predictive factor of nodular recurrence. This is the first study with such a long duration of post-operative follow-up. The high rate of nodular recurrence in less than total thyroidectomy procedures along with the lifelong need for thyroxine supplementation suggest that a more conservative surgical approach is needed. When surgery is recommended, we suggest total thyroidectomy as the treatment of choice to avoid the recurrence of disease, the high cost associated with frequent follow-ups by means of sonography as well as thyroxine replacement therapy.

Significance of BRAF V600E Mutation and Cytomorphological Features for the Optimization of Papillary Thyroid Cancer Diagnostics in Cytologically Indeterminate Thyroid Nodules.

Ultrasound guided fine needle aspiration biopsy with cytologic analysis is an initial step in diagnostic of thyroid nodules. Unfortunately, up to 30% of biopsies are indeterminate and diagnostic surgery is required. The aim of this study was to estimate the diagnostic value of BRAF V600E mutation status combined with cytomorphological features for diagnosis of papillary thyroid cancer (PTC) in cytologically indeterminate thyroid nodules. A prospective study analyzed patients who had ultrasound suspicious thyroid nodules, underwent fine needle aspiration and cytological examination, and were classified according to the Bethesda system. Patients from indeterminate diagnostic categories were examined for BRAF V600E mutation and 22 cytomorphological features, and underwent thyroid surgery. A binary logistic regression model was used to evaluate the diagnostic utility. A total of 219 patients met study criteria. After histological examination, 77 (35.2%) patients were diagnosed with PTC and 142 (64.8%) with benign nodular thyroid disease. According to logistic regression model, significant features for PTC diagnosis were: liquid colloid consistency, papillary structures, eosinophilic colloid bodies, and BRAF V600E mutation. Risk groups classified by this model have sensitivity of 80.5% (95% CI: 69.9 to 88.7), specificity of 99.3% (95% CI: 96.1 to 100), positive predictive value of 98.4% (95% CI: 89.8 to 99.8), negative predictive value of 90.4% (95% CI: 85.7 to 93.7), and accuracy of 92.7% (95% CI: 88.4 to 95.8) for PTC diagnosis. Evaluation of BRAF V600E mutation status combined with cytomorphological features for diagnosis of PTC in cytologically indeterminate thyroid nodules can significantly improve diagnostic accuracy and reduce the number of diagnostic operations (calculator available at www.ptc-calc.we2host.lt).

High Serum Thyrotropin Concentrations within the Reference Range: A Predictor of Malignancy in Nodular Thyroid Disease

Objective: This study assessed whether or not a simple biochemical parameter, serum thyrotropin (TSH), within the reference range can predict the likelihood of thyroid malignancy in subjects undergoing fine-needle aspiration biopsy (FNAB) for thyroid nodules. Subjects and Methods: This cross-sectional study evaluated 236 patients without overt thyroid dysfunction who were not on levothyroxine therapy. They underwent FNAB of the thyroid nodules at the Clementino Fraga Filho University Hospital between 2011 and 2012. The reference range and serum TSH quartiles were determined according to age-specific values for serum TSH and then compared between the cases with benign thyroid nodular disease and differentiated thyroid carcinoma (DTC) based on surgical pathology reports. Results: Of the 236 patients, 201 (85.1%) underwent a surgical procedure (thyroidectomy) and 89/236 (44.3%) had DTC. The mean TSH concentrations were 2.09 ± 1.15 mU/L in benign patients versus 2.73 ± 1.33 mU/L in cases of DTC (p < 0.01). As TSH increased from quartiles 1 to 4, the frequency of a malignant diagnosis also increased progressively from 22% in quartile 1 to 65% in the last quartile (p ≤ 0.001). Conclusion: Thyrotropin levels were positively associated with the diagnosis of DTC in thyroid nodules.

Da li postoje varijacije u odnosu neutrofila i limfocita, srednjeg volumena trombocita i broja trombocita između papilarnog tiroidnog karcinoma i benignog nodularnog poremećaja štitne žlezde?

Objective: Neutrophil lymphocyte ratio (N/L) and mean platelet (Plt) volume (MPV), the markers of systemic inflammatory response, has been investigated in many cancers, but data for the head and neck cancers and thyroid carcinoma are limited. It had been purposed to study N/L, MPV, and Plt levels in papillary thyroid carcinoma (PTC) as a diagnostic marker. Material and Methods: A total of 104 patients, had undergone ultrasonography guided fine needle aspiration (FNA) and thyroidectomy, for the indicated cases, between April 2010 and August 2013, were enrolled in the study. The laboratory tests, regarding N/L, MPV, and Plt, of the cases had been collected retrospectively. Results: No difference was found between PTC and benign nodular thyroid diseases (BNTD) in terms of age, gender, size of the nodule, N/L, MPV, and Plt (p &gt; 0.05). Conclusion: The preoperative inflammatory hematological parameters, in terms of N/L, MPV, and Plt, may not be useful as a predictive diagnostic marker of the thyroid malignancy, PTC.

Are total thyroidectomy and loboisthmectomy effective and safe in benign thyroid diseases? An analysis of 420 patients

Objective. Ideal thyroid surgery is still a debated issue due to preoperative pathology and varying rates of postoperative incidental carcinoma and complications. In our clinic loboisthmectomy and bilateral total thyroidectomy are the treatment of choice in benign nodular thyroid diseases. The objective of this study was to analyse effectiveness and safety of bilateral total thyroidectomy and loboisthmectomy for treating benign thyroid diseases. Methods. Patient charts of the subjects that have undergone thyroid surgery due to benign thyroid diseases between 2009-2015 were evaluated retrospectively. We extracted data including number of patients, type of surgery, preoperative and postoperative pathologies and postoperative complications from departments medical records. Results. Four hundred and twenty patients including 98 (23.3%) male and 322 (76.7%) females aged between 14-80 years (mean; 47.3 ± 12.5) were included into the study. Bilateral total thyroidectomy was performed in 348 (82.9%) patients and loboisthmectomy was performed in 72 (17.1%). Mean duration of follow-up was 41 (range: 15-70) months. Incidental thyroid carcinoma rate was 24.5% (n = 103) in postoperative pathological examination. Temporary and permanent hypocalcemia was seen in 53 (15.2%) patients and 8 (2.3%), respectively. Permanent and transient recurrent laryngeal nerve palsy rate were 2.6% and 2.1%, respectively. Postoperative hematoma was observed in 7 (1.7%) patients. Conclusions. Incidental thyroid carcinoma is frequent in patients who had surgical operation for benign thyroid diseases. When revision surgeries and additional complications due to revision surgery in the remaining cases are kept in mind, bilateral total thyroidectomy or loboisthmectomy at the minimum can be considered as the ideal surgical approach for benign thyroid diseases.