High Prevalence Of Thyroid Nodules Research Articles

Associations between thyroid function, thyroid diseases, and primary aldosteronism.

Previous studies focusing on primary aldosteronism (PA) and thyroid diseases were controversial. Hence, this study aimed to examine associations between thyroid function, thyroid diseases, and PA and its subtypes. This was a cross-sectional study, which enrolled 1023 patients with PA and 6138 patients with essential hypertension (EH) admitted to Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region from August 2011 to June 2022. All patients with PA were accurately classified into aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) by adrenal vein sampling (AVS). Multivariate logistic regression analysis was used to assess the relationship of thyroid function, thyroid nodules, and PA and its subtypes. A total of 7161 patients (327 APA and 696 IHA, and 6138 EH) were included with a mean age of 48.20 ± 8.83 years. PA patients and PA subtypes showed lower FT4, FT3, TT4, TT3, and prevalence of positive TPOAb, meanwhile higher prevalence of thyroid nodules than EH patients (PA: 56.10%, IHA: 56.90%, APA: 54.80%, and EH: 48.90%, respectively). PA (adjusted OR: 1.290, 95% CI: 1.035-1.607, P = .02) and its subtype (IHA) (adjusted OR: 1.316, 95% CI: 1.005-1.724, P = .04) were significantly associated with thyroid nodules. Compared to patients with lower plasma aldosterone concentration (PAC) levels (<12 ng/dL), patients with PAC levels ≥ 12 ng/dL presented a higher prevalence of thyroid nodules. PA patients had lower thyroid function and higher prevalence of thyroid nodules compared to EH patients. Therefore, the screening of thyroid function and thyroid nodules may be indispensable for PA patients.

Lynch Syndrome and Thyroid Nodules: A Single Center Experience.

Lynch syndrome (LS) is a genetic disease with increased risk of colorectal cancer and other malignancies. There are few reported cases of thyroid cancer in LS patients. The aim of this study is to investigate the presence of thyroid nodules in LS patients and to explore their association with the genetic features of the disease. A retrospective and descriptive analysis was conducted to include all LS patients followed at the CEMAD (Centro Malattie Apparato Digerente) of Fondazione Policlinico Universitario A. Gemelli IRCCS. The characteristics of LS disease, gene mutations, and previous history of thyroid disease were evaluated. Majority of patients underwent thyroid ultrasound (US), and nodule cytology was performed when needed. Of a total of 139 patients with LS, 110 patients were included in the study. A total of 103 patients (74%) underwent thyroid ultrasound examinations, and 7 patients (5%) had a previous history of thyroid disease (cancer or multinodular goiter). The mean age was 51.9 years. Thyroid nodules were found in 62 patients (60%) who underwent US, and 9 of them (14%) had suspicious features of malignancy, inducing a fine-needle aspiration biopsy. A cytologic analysis classified 7 of 9 cases (78%) as TIR2 and 2 (22%) as TIR3a. Between patients with nodular thyroid disease (single nodule, multinodular goiter, and cancer), most of them (25 patients, 36% of total) were carriers of the MSH6 mutation, while 22 (32%), 17 (24%), and 5 (7%) had MSH2, MLH1, and PMS2 mutations, respectively. A high prevalence of thyroid nodules was found in patients with LS, especially in MSH6-carrying patients. Performing at least one thyroid ultrasound examination is suggested for the detection of nodular thyroid disease in LS patients. Systematic investigations are needed to estimate their prevalence, features, and risk of malignant transformation.

Sex-specific associations between the developmental alterations in the pituitary-thyroid hormone axis and thyroid nodules in Chinese euthyroid adults: a community-based cross-sectional study.

Previous studies have revealed the sex-specific features of pituitary-thyroid hormone (TH) actions and the prevalence of thyroid nodules (TNs) in children and adolescents. However, it was unclear in adults. We aimed to investigate the features of pituitary-TH actions in women and men at different ages, and the associations of thyrotropin (TSH), THs, and central sensitivity to THs indices including the thyroid feedback quantile-based index by FT4 (TFQIFT4) and the thyroid feedback quantile-based index by FT3(TFQIFT3) with of TNs in Chinese euthyroid adults. 8771 euthyroid adults from the communities in China were involved. Demographic, behavioral, and anthropometric data were gathered through the questionnaires. Ultrasound was performed to evaluate the TNs. TSH and THs levels were measured. The multivariable logistic regression and multivariable ordinal logistic regression were conducted. TFQIFT3 among both genders, except women aged 43 to 59 years, where it increased slightly. Additionally, there was an age-related decline in TFQIFT4 levels in both women and men at ages < 50 and < 53, respectively, but a marked increase after that. Lower TSH levels were significantly associated with a higher prevalence and lower odds of having fewer TNs using multiple nodules as the base category in both men and women (both P for trend < 0.05). Additionally, lower TFQIFT3 and TFQIFT4 levels were significantly associated with a higher prevalence of TNs in women (both P for trend < 0.05), and lower TFQIFT3 levels were significantly associated with a higher prevalence of TNs in men. Both higher TFQIFT3 and TFQIFT4 levels were significantly associated with higher odds of having fewer TNs using multiple nodules as the base category in women. However, the relationships between TFQIFT4 and the prevalence or number of TNs in men were not found. The trends of THs, TSH, TFQIFT4, and TFQIFT3 at different ages were sex-dependent. Both TFQIFT4 and TFQIFT3 levels were negatively associated with the prevalence and number of TNs in women. The present results may lead to a better understanding of the sex-specific relationships between the development of the pituitary-TH axis and the formation of TNs.

EVALUATION OF THYROID FUNCTION AND THYROID DISEASES IN PATIENTS WITH PRIMARY ALDOSTERONISM

Objective: To explored the thyroid function and prevalence of thyroid diseases in primary aldosteronism (PA) and PA subtypes. Design and method: Patients with PA and Essential hypertension (EH) in our hypertension center between August 2011 to June 2022 were enrolled in this observational study. All PA patients underwent adrenal venous sampling (AVS), thus receiving the most accurate subtype diagnosis available. The differences of thyroid function and the prevalence of thyroid diseases between PA and EH patients were analyzed. Results: 7161 participants were included in the study with a mean age of 48.20±8.83 years and a mean BMI of 26.52±3.45 kg/m2. Two groups: PA patients showed lower FT4, FT3, TT4, TT3, positive TPOAb and higher prevalence of thyroid nodules (22.5%) than EH patients. PA was significantly associated with thyroid nodules (OR: 1.245, 95%CI: 1.052-1.473, P= 0.011). Three groups: statistical differences in FT4, FT3, TT4, TT3, and positive TPOAb levels were found in APA, IHA and EH. Thyroid nodules are most prevalent in APA (26.00%), followed by IHA (20.80%) and EH (17.80%). APA showed a significant association with thyroid nodules (OR: 1.345, 95%CI: 1.015-1.781, P=0.039). Additionally, it was found that FT4, FT3, TT4, and TT3 were negatively correlated with the PAC levels in patients. The stratification analysis showed that the prevalence of thyroid nodules was higher in subjects with PAC levels great than or equal to 12ng/dL. Conclusions: Compared to EH groups, PA patients had lower thyroid function and higher prevalence of thyroid nodules.

TO EXPLORED THE THYROID FUNCTION AND PREVALENCE OF THYROID DISEASES IN PRIMARY ALDOSTERONISM (PA) AND PA SUBTYPES

Objective: To explored the thyroid function and prevalence of thyroid diseases in primary aldosteronism (PA) and PA subtypes. Design and method: Patients with PA and Essential hypertension (EH) in our hypertension center between August 2011 to June 2022 were enrolled in this observational study. All PA patients underwent adrenal venous sampling (AVS), thus receiving the most accurate subtype diagnosis available. The differences of thyroid function and the prevalence of thyroid diseases between PA and EH patients were analyzed. Results: 7161 participants were included in the study with a mean age of 48.20±8.83 years and a mean BMI of 26.52±3.45 kg/m2. Two groups: PA patients showed lower FT4, FT3, TT4, TT3, positive TPOAb and higher prevalence of thyroid nodules (22.5%) than EH patients. PA was significantly associated with thyroid nodules (OR: 1.245, 95%CI: 1.052-1.473, P= 0.011). Three groups: statistical differences in FT4, FT3, TT4, TT3, and positive TPOAb levels were found in APA, IHA and EH. Thyroid nodules are most prevalent in APA (26.00%), followed by IHA (20.80%) and EH (17.80%). APA showed a significant association with thyroid nodules (OR: 1.345, 95%CI: 1.015-1.781, P=0.039). Additionally, it was found that FT4, FT3, TT4, and TT3 were negatively correlated with the PAC levels in patients. The stratification analysis showed that the prevalence of thyroid nodules was higher in subjects with PAC leve greater than or equal to 12ng/dL. Conclusions: Compared to EH groups, PA patients had lower thyroid function and higher prevalence of thyroid nodules.

Current State of Molecular Cytology in Thyroid Nodules: Platforms and Their Diagnostic and Theranostic Utility.

The high prevalence of thyroid nodules and increased availability of neck ultrasound have led to an increased incidence of diagnostic thyroid fine needle aspirations, with approximately 20% yielding indeterminate results. The recent availability of molecular tests has helped guide the clinical management of these cases. This paper aims to review and compare three main commercially available molecular cytology platforms in the U.S.-Afirma GSC, Thyroseq GC, and ThyGeNEXT + ThyraMIR. Sequential improvements of the Afirma GSC and Thyroseq GC tests have increased positive and negative predictive values, sensitivity, and specificity. Comparative studies revealed similar diagnostic performance between these tests, with considerations for factors such as cost and processing time. Thyroseq GC provides detailed genomic information and specific management recommendations. ThyGeNEXT + ThyraMIR, though less studied, presents promising results, particularly in miRNA analysis for weak driver mutations. Challenges in interpreting results include variations in reporting and the evolving nature of testing platforms. Questions persist regarding cost-effectiveness and the utility of ultrasound characteristics in selecting candidates for molecular testing. While molecular testing has primarily served diagnostic purposes, advancements in understanding genetic alterations now offer therapeutic implications. FDA-approved options target specific genetic alterations, signaling a promising future for tailored treatments.

THU587 High Prevalence Of Primary Aldosteronism Diagnosis In Patients With Papillary Thyroid Cancer And Hypertension: A Cross-sectional Case-control Study

Abstract Disclosure: A.W. Maciel: None. T. Freitas: None. D.L. Danilovic: None. G.F. Fagundes: None. F. Freitas-Castro: None. L. Santana: None. A. Guimaraes: None. A. Pio-Abreu: None. J. V. Silveira: None. F. Consolim-Colombo: None. L. Bortolotto: None. M.C. Fragoso: None. A. Latronico: None. L. Drager: None. B.B. Mendonca: None. A.O. Hoff: None. M.Q. Almeida: None. Introduction: Aldosterone excess can cause oxidative stress leading to DNA damage in vitro and in vivo. Single case reports demonstrated a coincidence of primary aldosteronism (PA) with different malignancies. A higher prevalence of thyroid nodules and non-toxic multinodular goiter was described in patients with PA compared to those with essential hypertension (HT). A single study showed an association between PA and papillary thyroid cancer (PTC), but without a paired control group. Objective: To assess PA prevalence in a transversal cohort of patients with PTC and HT compared to a paired control group with HT. Methods: In this cross-sectional case-control study, PA was investigated in all patients with PTC and HT (n= 114), regardless of HT severity, under active surveillance at a cancer institute from 2019 to 2022. The control group included 228 (2:1) age-, sex- and body mass index (BMI)-matched individuals from a retrospective cohort of HT previously investigated for PA from 2011 to 2022. Serum aldosterone and plasma direct renin concentrations were measured by a chemiluminescent immunoassay. A positive PA screening was defined by aldosterone ≥10 ng/dL and aldosterone to renin ratio ≥2 ng/dL/μUI/mL. Results: Age, sex and BMI were not statistically different between PTC and control groups, respectively (age 59.8 ± 12 vs. 58.9 ± 12.3 yrs, p= 0.67; 79% vs. 81% women, p= 0.67; BMI 30.7 ± 5.8 vs. 30.8 ± 6.5 Kg/m2, p= 0.98). PA was diagnosed in 35 out of 114 PTC patients with HT. The prevalence of PA in the PTC group (30.5%, confidence interval (IC) 22.6%-40.1%) was significantly higher when compared to the paired control group with HT (11.84%, CI 8.08%-16.93%; p&amp;lt; 0.0001). Although PA prevalence was higher in the PTC group, only 20.2% had stage 3/resistant HT (vs. 38% in the control group, p= 0.003). The number of anti-hypertensive medications was lower in the PTC group compared to controls (2 drugs, 1 to 3 vs. 4 drugs, 3 to 5, respectively; p&amp;lt; 0.001). When analyzing only PA patients in both groups, frequency of stage 3/resistant HT and number of medications were lower in the PTC group (p&amp;lt; 0.001 and p&amp;lt; 0.001, respectively). Although HT was more severe in PA patients without PTC, aldosterone and renin levels were not different in PA patients from PTC and control groups, respectively (p= 0.15 and p= 0.34). Conclusion: PA prevalence was strikingly high among patients with PTC and HT, supporting the recommendation of PA screening in this patient group, regardless of HT severity. Presentation: Thursday, June 15, 2023

Influence of metabolic syndrome and lifestyle factors on thyroid nodules in Chinese adult men: a cross-sectional study.

Given the high prevalence of thyroid nodules and the potential for malignancy, it is imperative to understand the various factors that contribute to their development. This study aimed to explore the relationship between metabolic syndrome, lifestyle, and thyroid nodules in adult men in southern China. This study enrolled a total of 183,990 subjects at a medical examination center in a general hospital in southern China between January 1, 2015, and December 31, 2020. Multivariate logistic regression analysis was utilized to evaluate the relationship between metabolic syndrome, lifestyle factors, and thyroid nodules. Furthermore, structural equation modeling elucidated the intricate relationships among these variables. The prevalence of thyroid nodules among Chinese adult males was 14.9%. Several factors were identified as risk factors for thyroid nodules, including advanced age, irregular meal time, smoking or quitting smoking, quitting drinking, heavy manual labor, hypertension, diabetes, dyslipidemia and centripetal obesity, and those belonging to ethnic minorities and drinking alcohol were found to be protective factors against thyroid nodules. Structural equation modeling highlighted metabolic syndrome's mediating role amidst lifestyle influences on thyroid nodules. The prevalence of thyroid nodules in Chinese adult males is relatively moderate to low. The factors identified in this study can help clinicians identify high-risk patients and develop targeted screening strategies for the timely detection of thyroid nodules. However, further mechanistic research and longitudinal studies are necessary to explore the underlying causes and establish causal relationships.

Fully automated thyroid ultrasound screening utilizing multi-modality image and anatomical prior

There is a high prevalence of thyroid nodules in the general population. Early detection is essential for the treatment of malignant thyroid nodules. Ultrasound has the advantage of being non-invasive and radiation-free, and is sufficient for early diagnosis of malignant nodules. However, ultrasound image acquisition relies on manual manipulation of the probe by the sonographer, making it difficult to screen populations for malignant thyroid nodules. Robotic ultrasound systems (RUS) are expected to replace sonographers in ultrasound scanning and improve the standardization and reproducibility of ultrasound examinations. However, there is currently no RUS that can fully autonomously screen for thyroid nodules. In this paper, we propose a fully automated two-step search method that mimics a physician's thyroid scanning protocol. First, using the body surface structure observed by the RGBD camera, we use a bimodal detection network for the initial localization of the human neck. The bimodal detection network achieves an average accuracy of 0.986. Second, we designed a tracking strategy based on the anatomical prior of the human neck to navigate the probe for thyroid ultrasound acquisition. An network-based visual servoing method enables shadow prevention and target tracking to be performed uniformly. In vitro experiments demonstrated the effectiveness of the protocol.

Prevalence of Thyroid Nodules and Associated Clinical Characteristics: Findings from a Large Sample of People Undergoing Health Checkups at a University Hospital in Vietnam.

Thyroid nodule is a common disorder normally detected by ultrasound. However, little is known about the population prevalence of thyroid nodules in a Vietnamese population. This study aimed to estimate the prevalence of thyroid nodules, its characteristics, and associated factors in a large number of people undergoing annual health checkups. A retrospective, cross-sectional descriptive study was conducted, based on electronic medical records of people undergoing health checkups at the Health Checkup Department, University Medical Center at Ho Chi Minh City. All of the participants underwent thyroid ultrasonography, anthropometric measurements, and serum examinations. A total of 16,784 participants (mean age: 40.4 ± 12.7 years, 45.1% female) were included in this study. The overall prevalence of thyroid nodules was 48.4%. The mean diameter of nodules was 7.2 ± 5.8 mm. The prevalence of nodules with malignant characteristics was 36.9%. Women had a significantly higher prevalence of thyroid nodules than men (55.2% vs 42.9%, p<0.001). Advanced age, hypertension, and hyperglycemia were significantly associated with thyroid nodules in both genders. In men, significant factors also included increased body mass index. In women, these included increased total cholesterol and LDLc, hypertriglyceridemia, and hyperuricemia. This study showed a high prevalence of TNs in Vietnamese people undergoing general health checkups. Importantly, the proportion of TNs with malignant risk was quite high. Therefore, screening for TNs should be added to annual health checkups to improve early detection of TNs, targeting those who have a high-risk profile based on factors identified in this study.

Evaluation of thyroid nodules by ultrasonography with cytological and histopathological correlation

Background: Nodular thyroid is a common clinical entity. The optimum diagnostic strategy for the patient with nodular thyroid is still a matter of debate. A thyroid nodule is a well-defined discrete lesion, sonographically distinct from the surrounding thyroid parenchyma. Thyroid nodules occur with relatively high frequency in the general population with prevalence of 4–7% by palpation alone, 13%–67% by sonographic evaluation, and 50% at autopsy. It is estimated that 4–8% of adult women and 1–2% of adult men have thyroid nodules that can be felt on clinical examination. However, in contrast to high prevalence of thyroid nodules, the prevalence of thyroid malignancy is low. &lt;7% of thyroid nodules are malignant. Aims and Objectives: The present study was undertaken to evaluate the diagnostic efficacy of ultrasonography (USG) and color Doppler in differentiating benign and malignant thyroid nodules and in comparing the findings with results of fine needle aspiration cytology (FNAC). Materials and Methods: A prospective study was carried out on 65 patients from 11–80 years age group of both sexes, presenting with thyroid nodules. All patients were evaluated by gray scale USG and color Doppler and then subjected to FNAC. Histopathology was done whenever required. The results of FNAC were compared with that of USG and color Doppler. Results: The majority of the cases presented were females between the age group of 21–50 years. Swelling in the anterior neck was the presenting complaint in all 65 cases (100%). The most of thyroid nodules were benign in nature. The sensitivity and specificity of US in diagnosing malignant lesions were 80% and 86%, respectively. The most common presentation was from the females in the age group of 21–50 years, with swelling in the anterior neck. Conclusion: USG with color Doppler is a safe, reliable, and cost-effective diagnostic modality with a high sensitivity and specificity and is the single best radiological investigation for non-invasive evaluation of thyroid nodules. However, a combination of FNAC and USG gives optimum results and can avoid unnecessary surgery.

Investigation of Clinical Features and Surgical Results in Patients with Thyroid Nodules Referred to the Endocrinology Clinic in Hamadan City

Background and Objective: Considering the high prevalence of thyroid nodules and the increased incidence of malignancy of this gland, the present study aimed to assess the clinical characteristics and pathology results following surgery in patients with nodular goiter and referred to the endocrinology clinic in Hamadan, Iran. Materials and Methods: This study was conducted as case series from 2011 to 2021. All patients diagnosed with thyroid nodules who underwent thyroidectomy according to the indication and whose pathology was benign or malignant were included in the study. The patients' information was collected by reviewing the files, which included demographic, clinical, and pathology results. The data was analyzed in SPSS software (version 26), and the significance level was considered less than 0.05. Results: Among the 507 patients studied, 88.2% were female, and 11.8% were male. The mean age of the patients was 41.93 years. Pathology result was malignant in 57% of cases and benign in 43% of subjects. Most patients with malignant pathology were under 35 years of age, and those with benign pathology were older (P&lt;0.001). Most patients were in stage I of the disease; nonetheless, males compared to females were significantly in more advanced stages of the disease (P&lt;0.001). Conclusion: Thyroid nodules are very common, and their incidence is increasing. Considering the nature of malignancy, the good prognosis of these nodules, and effective treatment, early diagnosis of malignancy assumes critical importance.

Epidemiology of Thyroid Cancer.

Epidemiology of Thyroid Cancer.

Prevalence of thyroid nodules and its association with water iodine among Chinese men and women

BackgroundBecause of the large change in iodine nutrition and other lifestyle in China, there is concern that thyroid nodules (TNs) may become epidemic. However, few data are currently available on the national prevalence of TNs. In addition, whether excess iodine in drinking water is associated with an increased risk of TNs, following universal salt iodization, has been less studied. We aim to estimate a national prevalence of TNs and its association with drinking water iodine. MethodsWe conducted a national survey of 9,381,032 adults, aged 18 years or older, from 30 provinces and municipalities in China, who underwent a thyroid ultrasound test from January 2018 to December 2018. Crude and standardized prevalence of TNs were estimated. We further evaluated the ecological association between province- or city-specific iodine levels in drinking water and the prevalence of TNs using linear regression. ResultsThe age-standardized prevalence of TNs in men, women, and both sexes were 29.8%, 44.7%, and 37.1%, respectively. The prevalence increased with age from 22.7% (18–30 years) to 71.5% (≥70 years), and body mass index from 26.1% (<18.5 kg/m2) to 40.8% (≥28 kg/m2). Participants living in the eastern, northern, and northeastern regions had a higher prevalence of TNs (ranged from 38.7% to 43.7%) than those in other regions (ranged from 30.1% to 35.5%). The coastal residents (40.1%) had a higher prevalence of TNs than those in inlanders (35.4%). Higher levels of iodine in drinking water were linearly associated with increased prevalence of TNs, with Pearson correlation coefficients of 0.47 (P < 0.01) in men, 0.40 (P = 0.03) in women, and 0.46 (P = 0.01) in overall participants. ConclusionThis was a nationwide prevalence study of TNs in China, showing that TNs were common health problems, and increased concentration of iodine in drinking water was associated with a higher prevalence of TNs.

Six Air Pollutants Associated With Increased Risk of Thyroid Nodules: A Study of 4.9 Million Chinese Adults.

BackgroundThyroid nodules has become a significant public health issue worldwide with a rapidly increasing prevalence. However, its association with outdoor air pollution remains poorly understood. We aim to investigate the relationship between six outdoor air pollutants (PM2.5, PM10, NO2, SO2, CO, and O3) and the risk of thyroid nodules.MethodsWe utilized a database including 4,920,536 participants who attended the annual physical examinations in the Meinian HealthCare Screening Center in 157 Chinese cities in 2017. City-specific concentrations of six pollutants (PM2.5, PM10, NO2, SO2, CO, and O3) from 2015 to 2017 were estimated based on the China’s National Urban Air Quality Real Time Publishing Platform. Thyroid nodule was measured with ultrasound. Multivariable Logistic regression was used to examine the associations between air pollutants and thyroid nodules with adjustment for age, sex, education, smoking, body mass index, fasting blood glucose, triglyceride, low density lipoprotein cholesterol, high density lipoprotein cholesterol, urine iodine, gross domestic product, and thyroid stimulating hormone. We conducted stratified analyses to investigate potential effect modification by sex, age, and urine iodine groups.ResultsApproximately 38% of the participants (1,869,742) were diagnosed with thyroid nodules. Each of the six air pollutants was significantly and linearly associated with the risk for thyroid nodules. The adjusted odds ratios [95% CI] for every increase of 10 μg/m3 for PM2.5, PM10, NO2, SO2, and O3 were 1.062 [1.061, 1.064], 1.04 [1.03, 1.04], 1.10 [1.09, 1.10], 1.11 [1.11, 1.12], and 1.151 [1.149, 1.154], respectively; The odds ratio for each increase of 1 mg/m3 for CO was 1.50 [1.49 to 1.52]. Furthermore, these associations were significantly higher in the participants who were men, younger, or having lower urine iodine level (p <0.001).ConclusionThe six air pollutants may contribute to the high prevalence of thyroid nodules in China.

Prevalence and associated metabolic factors for thyroid nodules: a cross-sectional study in Southwest of China with more than 120 thousand populations

ObjectiveTo explore the prevalence and its associated metabolic factors of thyroid nodules (TNs) among subjects who participated in the physical examinations in Chongqing, China.MethodsThe participants from the Health Management Center of JinShan Hospital of Chongqing Medical University, between September 2015 and May 2020, were included in this study. All of the participants underwent thyroid ultrasonography, anthropometric measurements, and serum examinations. Differences in the TNs prevalence were compared with the chi-square test or Wilcoxon rang-sum test. Multivariable logistic regression analyses were used to estimate the metabolic factors associated with TNs and multiple thyroid nodules (MTNs).ResultsOf the included 121,702 participants, 41,547 had TNs, and 20,899 had MTNs, with the prevalence of 34.1 and 17.0 %, respectively. Women had a significantly higher prevalence of TNs than men (40.6 % vs. 29.8 %; χ2 = 1517.33, P < 0.001), and TNs prevalence was gradually increased with age (P for trend < 0.001). Female gender, advanced age, and metabolic factors including central obesity, hypertension, diabetes and fatty liver were positively associated with TNs; BMI, hyperlipoidemia and hyperuricemia were not independent risk factors of TNs. While female gender, advanced age, central obesity, hypertension and diabetes were independent risk factors of MTNs.ConclusionsThe prevalence of thyroid nodules was relatively high. The associated factors identified in this study could help the clinicians to detect the high-risk patients and make targeted screening strategies for the preventing of the occurrence of TNs.

Differences in Clinicopathological Characteristics of Papillary Thyroid Carcinoma between Symptomatic and Asymptomatic Patients with Primary Hyperparathyroidism.

Background Popularization of cervical ultrasound led to higher detection of papillary thyroid carcinoma (PTC) and primary hyperparathyroidism (PHPT), as well as increasing percentage of asymptomatic PHPT in China. Although the coexistence of PTC and PHPT has been reported, it is unknown whether the clinicopathological features of PTC differ between asymptomatic and symptomatic PHPT patients. Methods We retrospectively reviewed the medical records of 304 PHPT patients treated in our hospital between January 2009 and July 2020, including 217 females and 87 males with the average age of 53.27 ± 13.54 years. Of the 304 patients, 181 were symptomatic PHPT patients and 123 were asymptomatic PHPT patients. We analyzed the laboratory results, postoperative pathology, and the TNM stage of PTC between asymptomatic and symptomatic PHPT patients. Results Concurrent thyroid nodules were found in 61.51% of PHPT patients, and the prevalence of PTC in thyroidectomized PHPT patients was 29.89% in our cohort. Lower serum parathyroid hormone (PTH) (p < 0.05) and calcium (p < 0.05) were found in PHPT patients with PTC compared to patients with benign thyroid lesion. Compared with the symptomatic PHPT patients, the asymptomatic PHPT patients showed lower serum calcium (p < 0.05), serum chlorine (p < 0.05), alkaline phosphatase (p < 0.05), PTH (p < 0.05), and bone turnover markers (p < 0.05) but higher prevalence of thyroid nodules (70.73% versus 55.24%, p < 0.05) and PTC (15.44% versus 3.87%, p < 0.05). All the PTC in symptomatic PHPT patients were papillary microcarcinoma limited to the thyroid, while 68.42% and 15.78% of the PTC in asymptomatic PHPT patients showed microscopic extrathyroidal extension and lymph node metastases, respectively. Moreover, 36.84% (7/19) of the PTC patients in asymptomatic group showed multifocality, which was much higher than 14.29% (1/7) in the symptomatic group; however, no statistical significance was found (p=0.24). Conclusions The concomitant PTC in asymptomatic PHPT patients showed a higher rate of microscopic extrathyroidal invasion when compared to symptomatic PHPT patients. So the FNA is essential to the asymptomatic PHPT patients with suspicious thyroid nodules and once the PTC is confirmed, concurrent parathyroidectomy should be performed with thyroidectomy in asymptomatic PHPT patients.

The Effect of Inflammation on the Formation of Thyroid Nodules.

Background Some studies have demonstrated that inflammation is highly associated with the prevalence of thyroid nodules (TNs). However, more confounders, such as metabolic diseases, should be adjusted. Methods A clinical study collecting 2722 subjects was conducted to confirm the association between inflammation and TNs. The underlying mechanism was investigated in combination with bioinformatics analysis. Results In the clinical study, propensity score matching was used to match metabolic parameters and other confounders, and it is observed that subjects with high inflammation had a higher prevalence of TNs and thyroid-stimulating hormone (TSH) than those with low inflammation. After further matching TNs, it is found that inflammation was positively associated with TSH, which was also demonstrated in a population without TNs. In bioinformatics study, inflammation did not promote TNs formation directly. Instead, it inhibited the synthesis of thyroid hormone, which might be the cause of the elevated TSH coexisting with inflammation. Conclusion Inflammation promotes the development of TNs disease, probably due to its indirect effect through inhibiting the synthesis of thyroid hormone, which results in the elevation of TSH.

Thyroid tumor surveillance using ultrasound in childhood cancer survivors.

The optimal method for thyroid cancer screening in childhood cancer survivors (CCSs) who received radiation involving the thyroid gland is still debated. We describe a case series of ultrasound surveillance for thyroid tumor in CCSs in our institute. We conducted thyroid tumor surveillance for CCSs with a history of radiation therapy involving the thyroid. The basic screening method was palpation. Thyroid ultrasound was also performed for patients who agreed after its benefits and risks were explained to them. We surveyed CCSs who visited the long-term follow-up outpatient clinic in our institution between October 2014 and September 2018. Of 82 CCSs who visited our institution during the study period, 44 were eligible for inclusion. None had a mass identified by palpation. Thyroid ultrasound was performed in 39 CCSs, and we identified thyroid nodules in 27. Four patients had a nodule with malignant echo features. Two of these cases received biopsies, and one patient was ultimately diagnosed with an early stage thyroid carcinoma. Childhood cancer survivors irradiated in the thyroid had a higher prevalence of thyroid nodules than the general population. Ultrasound screening contributed to early detection of impalpable thyroid cancer and enabled us to perform minimal surgery. Thus, ultrasound appears to be a useful option for secondary thyroid cancer screening. The thyroid tumor surveillance modality should be considered according to the individual case, and the patient must receive a clear explanation of the benefits and risks. These results could help doctors consider how to screen for secondary thyroid cancer.

A Mechanism Exploration of Metabolic Syndrome Causing Nodular Thyroid Disease.

Background Metabolic syndrome (MS) and its components have been demonstrated to facilitate the prevalence of thyroid nodules (TNs). The underlying pathogenesis needs to be elucidated. Methods A total of 2722 subjects, who underwent health checkup in our institute from December 2014 to November 2018, were retrospectively and randomly collected. After exclusion, 2068 subjects were chosen, and their anthropic and clinical data were collected. Results After matching age, gender, uric acid (UA), and creatinine (Cr) by propensity score matching (PSM), subjects with MS had higher prevalence of TNs than those without MS, as well as higher thyroid-stimulating hormone (TSH) and inflammatory levels, indicated by the higher white blood cell (WBC), lymphocyte (LY), and monocyte/high-density lipoprotein (Mo/HDL). After matching age, gender, UA, Cr, TSH, free triiodothyronine (FT3), thyroxine (FT4), WBC, NE, LY, Mo, NE/LY, LY/Mo, and Mo/HDL by PSM, no significant difference of the prevalence of TNs was found between MS and non-MS groups. Step logistic regression suggested glucose intolerance (GI), among all the components of MS, was an independent impact factor of TNs and was considered to contribute most to the formation of TNs. The prevalence of TNs was higher in the GI group after matching age, gender, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood sugar (FBS), UA, Cr, triglyceride (TG), cholesterol (CHOL), HDL, and low-density lipoprotein (LDL). Conclusions Patients with MS have a higher prevalence of TNs, probably due to the elevated TSH and inflammatory levels in vivo. Among the components of MS, glucose intolerance contributes most to the development of TNs.