Benign Nodular Thyroid Disease Research Articles

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 > 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.

Interstitial Laser Photocoagulation Using 980 nm Diode Laser in Benign Thyroid Nodule: A Feasibility Study

The aim of this study was to investigate the feasibility of using 980 nm diode laser for interstitial laser photocoagulation (ILP) before clinical application in benign thyroid nodule treatment. The bovine livers were cut into blocks to irradiate with 980 nm laser through the lumen of a 20-gauge spinal needle using a fiber optic guide. Laser irradiation was performed with the output power of 2 W and 3 W for 60, 120 and 180 seconds respectively. The liver blocks containing lesions were dissected along the axis of the fiber optic tracts and then cut transversely into slices. The thermal effect was evaluated by measuring the dimensions of the zone of coagulation necrosis. We present a case treated with 980 nm diode laser for the benign large thyroid nodule. All the irradiated areas zone measured in the gross specimens were 5.5 mm ± 1.4 mm (2 W, 60 s), 6.9 mm ± 1.4 mm (2 W, 120 s), 7.3 mm ± 0.5 mm (2 W, 180 s), 8.8 mm ± 2.2 mm (3 W, 60 s), 9.2 mm ± 0.8 mm (3 W, 120 s), 12.5 mm ± 4.1 mm (3 W, 180 s) respectively. The transverse diameter was as 5.1 mm ± 0.5 mm (2 W, 60 s), 6.1 mm ± 0.2 mm (2 W, 120 s), 9.9 mm ± 2.5 mm (2 W, 180 s), 6.2 mm ± 1.8 mm (3 W, 60 s), 7.7 mm ± 1.2 mm (3 W, 120 s), 8.8 mm ± 0.7 mm (3 W, 180 s) respectively. ILP was well tolerated and there was no complication. Interstitial laser photocoagulation with 980 nm diode laser induces well-defined tissue ablation correlated with energy parameters in bovine liver tissue and therefore, could be an efficient therapeutic tool in benign thyroid nodular disease.

Bradyarrhythmia as a presenting feature of subclinical hyperthyroidism

Subclinical hyperthyroidism appears to be a common disorder. It may be caused by exogenous or endogenous factors: excessive TSH suppressive therapy with L-thyroxine (L-T4) for benign thyroidnodular disease, differentiated thyroid cancer, or hormone over-replacement in patients withhypothyroidism are the most frequent causes. Consistent evidence indicates that subclinicalhyperthyroidism reduces the quality of life, affecting both the psycho and somatic components ofwell-being, and produces relevant signs and symptoms of excessive thyroid hormone action, oftenmimicking adrenergic overactivityJ MEDICINE January 2016; 17 (1) : 39-40

Demographic and Clinical Factors Associated With the Appropriate Target Thyroid-Stimulating Hormone Values in Patients With Primary Hypothyroidism Treated With Levothyroxine

Background: Hypothyroidism control is inadequate in up to 30-40% of patients. This study aimed to determine the control rate of primary hypothyroidism and the demographic and clinical factors associated with the hypothyroidism control. Methods: An observational and retrospective study was conducted between January 2014 and October 2015. Data were obtained from 174 medical records. Regarding hypothyroidism control analysis, patients were subdivided into two groups: the appropriate control group and the inappropriate control group. Autoimmune and post-surgical hypothyroidism secondary to benign nodular thyroid disease (BNTD) was classified as of benign etiology, and differentiated thyroid carcinoma (DTC) as of malignant origin. Results: The majority of patients consisted of women (93.68%), with a mean age of 55.53 ± 14.13 years old. The most common etiology was of autoimmune origin (41.95%). Adequate control of hypothyroidism was found in 55.17% of patients. Patients who had longer disease duration (P = 0.002), who kept using the same brand of levothyroxine (P = 0.001) and who were non-smokers (P = 0.004) had better control, and hypothyroidism from benign etiology also tended to be associated with better control (P = 0.08). Conclusions: Primary hypothyroidism still has a high percentage of poor control seen worldwide, despite its relatively simple treatment. In this study, almost 50% of the patients had inadequate control of hypothyroidism. The factors associated with good control, both of benign and malignant origin, were related to the use of the same brand of levothyroxine and to not smoking, and the benign etiology group tended to correlate with better treatment control. J Endocrinol Metab. 2016;6(4):109-115 doi: http://dx.doi.org/10.14740/jem367w

Thyroid Hormones, Autoantibodies, Ultrasonography, and Clinical Parameters for Predicting Thyroid Cancer.

Our objective was to evaluate thyroid nodule malignancy prediction using thyroid function tests, autoantibodies, ultrasonographic imaging, and clinical data. We conducted a retrospective cohort study in 1400 patients with nodular thyroid disease (NTD). The thyroid stimulating hormone (TSH) concentration was significantly higher in patients with differentiated thyroid cancer (DTC) versus benign thyroid nodular disease (BTND) (p = 0.004). The receiver operating characteristic curve of TSH showed an AUC of 0.58 (95% CI 0.53–0.62, p = 0.001), sensitivity of 74%, and specificity of 57% at a cut-off of 1.59 mIU/L. There was an incremental increase in TSH concentration along with the increasing tumor size (p < 0.001). Thyroglobulin antibody (TgAb) concentration was associated with an increased risk of malignancy (p = 0.029), but this association was lost when the effect of TSH was taken into account (p = 0.11). Thyroid ultrasonographic characteristics, including fewer than three nodules, hypoechoic appearance, solid component, poorly defined margin, intranodular or peripheral-intranodular flow, and punctate calcification, can be used to predict the risk of thyroid cancer. In conclusion, our study suggests that preoperative serum TSH concentration, age, and ultrasonographic features can be used to predict the risk of malignancy in patients with NTD.

Nodular recurrence and hypothyroidism following partial thyroidectomy for benign nodular thyroid disease in children and adolescents

ObjectivesDiagnostic and therapeutic processing of a thyroid nodule in children and adolescents may require lobectomy–isthmusectomy (LI) or nodule-resection (NR). Very few data in the literature report the long-term evolution of the remaining thyroid lobe in a defined pediatric population. In this study, we aimed to answer the following questions: Does a nodule recurrence occur in the remainder lobe? Is a post-operative thyroxine treatment necessary? Material and methodsThis retrospective study describes 28 patients under 18 who underwent LI (22 cases) or NR (6 cases) from January 2004 to March 2012. Ten of them were lost to follow up, 18 could be assessed (4 NR (22%) and 14 LI (78%) - mean follow-up 45±31 months). All patients benefited of post-operative thyroid ultrasonography, and regular endocrinologic follow-up. The following data were analysed: emergence of new thyroid nodules, evolution of pre-existing nodules, occurrence of post-operative hypothyroidism and requirement for completion thyroidectomy. ResultsThe mean age at the time of surgery was 14.3±1.9 years. Two patients (11%) had pre-existing nodules in the remaining thyroid gland, none of which showed an increase in size after surgery. De novo nodules developed in five patients (27.8%). Three patients who underwent LI (21.4%) needed thyroxine treatment for post-operative hypothyroidism. One patient (5.5%) needed completion thyroidectomy. ConclusionsIn this children and adolescents population, after performing LI or NR, remaining thyroid tissue stays free of nodules in 72.2% of the cases. A post-operative thyroxin treatment is necessary in 21.4% of cases after LI.

Repeat FNA Significantly Lowers Number of False Negative Results in Patients with Benign Nodular Thyroid Disease and Features of Chronic Thyroiditis.

Purpose. The aim of the study was to compare the risk of thyroid malignancy and efficacy of repeat FNA in patients with thyroid nodules diagnosed cytologically as benign lesion (BL) with features of chronic thyroiditis (BL-CT) and BL without CT features (BL-nCT). Methods. The analysis included 917 patients with BL-CT and 7046 with BL-nCT in the first FNA. Repeat biopsy was carried out in 787 patients of BL-CT and 5147 of BL-nCT; 218 patients of BL-CT and 2462 of BL-nCT were operated; in 88 cases of BL-CT and 563 of BL-nCT both ways of follow-up were available. Results. Outcome of repeat cytology implied surgery more frequently in patients with BL-CT than with BL-nCT—3.2% versus 1.9%, P < 0.05. Incidence of cancer (including incidentalomas) was higher in patients with BL-CT operated after one benign cytology than in patients with two benign FNA outcomes: 10.8% versus 1.6%, P < 0.05. In patients with BL-nCT that difference was not significant: 3.2% versus 2.6%. Conclusions. Patients with thyroid nodules diagnosed as BL with CT features have higher risk of malignancy than patients with BL without CT features. Repeat biopsy significantly lowers percentage of FN results in patients with BL-CT in the first FNA.

Hashimoto’s Thyroiditis as a Risk Factor of Papillary Thyroid Cancer May Improve Cancer Prognosis

Hashimoto's thyroiditis (HT) has been associated with an elevated risk of papillary thyroid cancer (PTC). To investigate the possible influence of HT on the prognosis of PTC patients, we assessed the related clinical factors linking these conditions, especially serum thyroid-stimulating hormone (TSH) concentration. Case-control study. The First Hospital of China Medical University. The demographic and histological characteristics of 2478 patients who underwent thyroidectomy at our center from 2004 to 2012 were analyzed. Compared with patients with benign thyroid nodular disease, patients with PTC showed a significantly higher prevalence of HT (18.8% vs 7.2%, P < .001), mean TSH concentrations (2.02 ± 1.76 vs 1.46 ± 1.21 mIU/L, P < .001), and positivity rates for anti-thyroglobulin antibodies (TGAB; 40.0% vs 20.4%, P < .001) and anti-thyroid peroxidase antibodies (24.8% vs 12.5%, P < .001). These differences remained after excluding all HT patients. The TSH concentrations were significantly higher in PTC patients with HT than in those without HT (2.54 ± 2.06 vs 1.90 ± 1.66 mIU/L, P = .001). Patients with PTC and HT were younger, with a female predominance, and had smaller sized tumors with less advanced TNM stage compared with those without HT, indicating a better prognosis. Multivariate analysis showed that HT, higher TSH concentration, male sex, and TGAB positivity were independent risk factors for PTC development. Histologically confirmed HT is associated with a significantly higher risk of PTC, due primarily to the higher serum TSH concentrations resulting from the tendency to hypothyroidism in HT. Autoimmunity is another independent risk factor for PTC but may be associated with a better prognosis.

Ultrasound-Guided Interstitial Laser Ablation for Thyroid Nodules Is Effective Only at High Total Amounts of Energy

According to cross-sectional surveys, the prevalence of nontoxic nodular goiter appears to be higher in the adult population. Surgical intervention is indicated for the following: (a) progressive goiter growth, (b) compression of organs such as the trachea and esophagus, and (c) significant aesthetic disfigurement. Ultrasound-guided laser photocoagulation for the treatment of benign thyroid nodules is a viable alternative to traditional surgery. However, studies that have appeared in literature since the introduction of ultrasound-guided laser photocoagulation for the treatment of benign thyroid nodules report contradictory data concerning the energy required for nodule ablation. The aim of the present trial was to evaluate retrospectively the efficacy of percutaneous laser thermal ablation in 2 groups of patients, one treated with low, and the other with high, total amount of energy. Forty euthyroid patients were treated with 1 session of percutaneous laser photocoagulation treatment at low (median = 71 J/mL; 20 patients) and high (median = 578 J/mL; 20 patients) energy. The volume of the nodules was measured by the same investigator, blinded for treatment, using the ellipsoid formula before treatment, at 2, 4, 8, and 30 weeks, and every 6 months for 3 years thereafter. Thyroid nodule ablation is effective over time only if a sufficient amount of energy (>400-500 J/mL for the nodular tissue to be treated) is given, although it incurs proportionate side effects. Percutaneous laser thermal ablation is a viable alternative to traditional surgery for the treatment of benign nodular thyroid disease only if a sufficient amount of energy is delivered.

Thyroid Carcinoma (Tc) in Nodular Goitre

Objective: To study the incidence and pathology of thyroid malignancy in patients operated for presumably benign nodular thyroid disease (multi nodular goitre (MNG) & solitary thyroid nodule (STN)). Methods: A total of 175 patients who underwent surgery for presumably benign nodular thyroid disease between January 2004 and March 2012 were studied, prospectively. These patients underwent hemi, subtotal, total thyroidectomy. Results: 37 of the 175 patients (21%) had malignancy on final histopathological examination. The mean age of patients with benign disease was 46.4 years and that with malignancies was 50.6 years. Mean size of nodules was 4.28 +/- 1.48 cm in the benign group and 4.21 +/- 1.48 cm in the malignant group. All those with MNG, 14/14 (100%) were papillary carcinoma and those with STN, 22/23 (95.7%) were papillary carcinoma. Among the papillary carcinomas, follicular variant was 15 and the micropapillary variant was 3. Conclusions: The incidence of malignancy in nodular goiter is higher than what is usually reported. There was no significant difference in incidence of malignancy between MNG and STN (P value: 0.262). Papillary carcinoma was significantly higher in nodular goiter (97.3%). Papillary carcinoma was found in all patients who presented with MNG and all but one who presented with STN. Follicular variant of papillary carcinoma was more common than the micropapillary variant (40.5% and 8.1% respectively).

The epidemiology of thyroid disease

Thyroid disorders are prevalent and their manifestations are determined by the dietary iodine availability. Data from screening large population samples from USA and Europe. The most common cause of thyroid disorders worldwide is iodine deficiency, leading to goitre formation and hypothyroidism. In iodine-replete areas, most persons with thyroid disorders have autoimmune disease. Definition of thyroid disorders, selection criteria used, influence of age and sex, environmental factors and the different techniques used for assessment of thyroid function. Increasing incidence of well-differentiated thyroid cancer. Environmental iodine influences the epidemiology of non-malignant thyroid disease. Iodine supplementation of populations with mild-to-moderate iodine deficiency. An evidence-based strategy for the risk stratification, treatment and follow-up of benign nodular thyroid disease. Is there any benefit in screening adults for thyroid dysfunction?

LigaSure versus clamp-and-tie in thyroidectomy: a single-center experience

LigaSure (ValleyLab, CO, USA) is a bipolar diathermy system that seals vessels with reduced thermal spread. The device has been used successfully in abdominal surgery and has been introduced as a new method for hemostasis during thyroidectomy. This study compares the efficacy and advantages of LigaSure, when used for thyroidectomy in benign nodular thyroid disease, with the conventional clamp-and-tie technique. Between December 2003 and December 2008, 410 patients underwent thyroid surgery (333 with the conventional clamp-and-tie technique and 77 with LigaSure). Nine patients did not sign the ethical approval document and so were excluded from the study; the results of 68 LigaSure patients were evaluated. The main outcomes measured were age, sex, operating time, postoperative hypocalcemia, recurrent laryngeal nerve palsy, and drain use. Statistical analysis consisted of the chi-squared test and Student's t-test. The mean operating time was significantly shorter in the LigaSure group by 24.1+/-1.7 minutes for a total thyroidectomy (P<0.0001) and 7.6+/-0.1 minutes for one side total plus other side sub- total thyroidectomy (P<0.0001). Bleeding during surgery was significantly lower in the LigaSure group (P<0.0001). There were no significant differences between the study groups in terms of postoperative hypoparathyroidism, recurrent laryngeal nerve palsy, and postthyroidectomy hemorrhage. The LigaSure vessel sealer is a safe, effective alternative for thyroid surgery that reduces the overall operating time. However, its higher cost is a significant handicap for its use in surgery in developing countries.

Nodular disease and parafollicular C-cell distribution: results from a prospective and retrospective clinico-pathological study on the thyroid isthmus

The isthmus represents a peculiar, as yet partially unexplored, thyroid gland area. To assess i) the prevalence and clinico-pathological features of solitary thyroid isthmic nodules (STIN); ii) the frequency of medullary thyroid carcinoma (MTC) arising from the isthmus; and iii) the C-cell distribution in the isthmus of patients with MTC and benign nodular thyroid disease (NTD). Patients referred from 2006 to 2008 for STIN were prospectively recruited, and underwent serum calcitonin (C(t)) measurement and fine needle aspiration cytology (FNAC). MTCs diagnosed from 1993 to 2005 were retrospectively searched. Immunohistochemistry was performed using anti-C(t) antibodies on lateral lobes and isthmi of 50 benign NTD and 50 MTC cases. From 1993 to 2005, 150 patients underwent surgery for MTC. All patients had the neoplasm located in lateral thyroid lobes, none in the isthmus. In the 3 years following, 192 STIN patients (40 (21%) males, 152 (79%) females; mean age: 46.2+/-7.1 years; 6.4% of NTD subjects) were recruited. All had normal C(t) concentrations. FNAC was malignant or suspicious for malignancy in 14 (7.3%) patients. Histology found malignancy in 17 (9%) cases, MTC in none. C cells were disclosed in lateral thyroid lobes of 100% MTC and 77% benign NTD patients; isthmi were free of C cells in either group. STINs are significantly less likely to be MTC in patients presenting with sporadic disease. Therefore, C(t) screening is not warranted in these subjects. Nonetheless, STINs are more likely to be neoplastic and deserve equal attention as those of the lateral lobes.

A new nonsurgical therapy option for benign thyroid nodules?

Despite the increasing implementation of iodization programs, benign nodular thyroid disease will remain a prevalent therapeutic concern for decades. recent research suggests that nonsurgical therapy, including radioactive iodine, radiofrequency thermal ablation and percutaneous laser ablation, might have a role in the treatment of symptomatic patients.

Lower levels of TSH are associated with a lower risk of papillary thyroid cancer in patients with thyroid nodular disease: thyroid autonomy may play a protective role

Higher TSH values, even within normal ranges, have been associated with a greater risk of thyroid malignancy. The relationship between TSH and papillary thyroid cancer (PTC) has been analyzed in 10 178 patients submitted to fine needle aspiration of thyroid nodules with a cytology of PTC (n=497) or benign thyroid nodular disease (BTND, n=9681). In 942 patients, submitted to surgery (521 from BTND and 421 from PTC), the histological diagnosis confirmed an elevated specificity (99.6%) and sensitivity (98.1%) of cytology. TSH levels were significantly higher in PTC than in BTND both in the cytological and histological series and also in patients with a clinical diagnosis of multinodular goiter (MNG) and single/isolate nodule (S/I). A significant age-dependent development of thyroid autonomy (TSH <0.4 microU/ml) was observed in patients with benign thyroid disease, but not in those with PTC, diagnosed both on cytology and histology. In patients with MNG, the frequency of thyroid autonomy was higher and the risk of PTC was lower compared to those with S/I. In all patients, the presence of thyroid auto-antibodies (TAb) was associated with a significant increase of TSH. However, both in TAb positive and TAb negative patients TSH levels were significantly higher in PTC than in BTND. Our data confirm a direct relationship between TSH levels and risk of PTC in patients with nodular thyroid diseases. Thyroid autonomy conceivably protects against the risk of PTC, while thyroid autoimmunity does not play a significant role.

Two Patients with Highly Aggressive Macrofollicular Variant of Papillary Thyroid Carcinoma

The macrofollicular variant of papillary thyroid carcinoma (MFV-PTC) is an unusual type of thyroid carcinoma with histological features that can be confused with nodular goiter or follicular adenoma. It generally has a good prognosis and low incidence of metastases. We report two patients with highly aggressive MFV-PTC including bone metastases, one of whom died of their disease. The first patient was a 59-year-old woman with an occipital mass diagnosed histologically as papillary thyroid carcinoma (PTC), follicular variant. There were multiple bone lesions on computed tomography. Ten years earlier a biopsy of a thyroid nodule had been negative for malignant cells. Thyroidectomy showed a 3-cm nodule in the thyroid, diagnosed as MFV-PTC. Iodine 131 whole body scan showed uptake in the skull, ribs, thoracic and lumbar spine, and pelvic bones. The second patient was an 81-year-old man with a history of right thyroid nodule treated by total thyroidectomy with a postoperative diagnosis of adenomatous goiter. Three years later he developed a right shoulder mass, histologically diagnosed as follicular variant of PTC. The original thyroidectomy specimen was reviewed and reclassified as MFV-PTC. The patient developed new bone and lung metastases. Three treatments with (131)I were not effective. He died of metastatic thyroid cancer. To our knowledge these are the first cases of MFV-PTC reported with bone metastasis. Although MFV-PTC usually has a good prognosis these cases highlight the importance of careful histopathological examination for MFV-PTC in thyroidectomy specimens that may appear to be seemingly benign nodular thyroid disease.

Scintigraphie thyroïdienne quantifiée (123I) du nodule thyroïdien : une nouvelle imagerie moléculaire

Thyroid nodules are a common clinical finding which often indicates, aside from cancer, a more diffuse disease, such as multinodular goiter, auto-immune thyroid disease or thyroid autonomy. Recent reports suggest that the overall prognosis of thyroid autonomy compares with that of pT2/pT3 thyroid cancer, even in patients with low to normal TSH levels. The thyroid scan (I123) can be quantified, thus offering a powerful tool to diagnose thyroid hyperfunction when local uptake measurements appear innappropriately high as regards to TSH levels. Finally, correlation with ultrasound reduces the number of FNA to suspicious nodules only and optimizes follow-up and specific treatment (lT4, I131) of most benign nodular thyroid diseases.

Multiplex analysis of cytokines as biomarkers that differentiate benign and malignant thyroid diseases

Thyroid cancer incidence is increasing, and its diagnosis can be challenging. Fine needle biopsy, the principal clinical tool to make a tissue diagnosis, leads to inconclusive diagnoses in up to 30% of the cases, leading to surgery. Advances in proteomics are improving abilities to diagnose malignant conditions using small samples of tissue or body fluids. We hypothesized that analysis of serum growth factors would uncover diagnostically informative differences between benign and malignant thyroid conditions. Using xMAP profiling, we evaluated concentrations of 19 cytokines, chemokines, and growth factors. We used sera from 23 patients with cancer (Malignant group), 24 patients with benign nodular thyroid disease (Benign group), and 23 healthy subjects (Normal group). In univariate analysis, five factors (epithelial growth factor, hepatocyte growth factor, Interleukins-5 and -8, and regulated upon activation, normally T-expressed and presumably secreted (RANTES) distinguished subjects with thyroid disease from the Normal group. In multivariate analysis, the set {Interleukin-8, hepatocyte growth factor, monocyte-induced γ interferon, interleukin-12 p40} achieved noteworthy discrimination between Benign and Malignant groups (area under the receiver operating characteristics curve was 0.81 (95% confidence interval: 0.65-0.90)). Multiplex panels of serum biomarkers may be promising tools to diagnose cancer in patients presenting with evidence of nodular thyroid disease.

Risk factors for well-differentiated thyroid carcinoma in patients with thyroid nodular disease

Evaluate current accepted risk factors for well-differentiated thyroid carcinoma, and develop a predictive model to determine one's risk of malignancy given a thyroid nodule. Retrospective analysis of 600 patients. Patients with benign thyroid nodular disease and with well-differentiated thyroid cancer were randomly selected. Patient, clinical, and investigational data were compared by means of univariate and multivariate regression analyses. Age, regional lymphadenopathy, ipsilateral vocal cord palsy, solid and/or calcified nodules, and an aspiration biopsy being malignant or suspicious predicted for cancer (P < 0.05). Regional lymphadenopathy and vocal cord palsy are perfect predictors of malignancy. Multivariate analysis indicated age, solid and/or calcified nodules, and all fine-needle aspiration biopsy results to be significant in assessing risk (P < 0.05). Taking individual risk factors in isolation is not always reliable. Using a predictive model, one can anticipate a patient's risk of malignancy when the diagnosis is unclear.