Management Of Solitary Thyroid Nodule Research Articles

Thyroid nodulectomy: A promising approach to the management of solitary thyroid nodules

Thyroid nodulectomy: A promising approach to the management of solitary thyroid nodules

AMERICAN COLLEGE OF RADIOLOGY THYROID IMAGING REPORTING AND DATA SYSTEM IN SOLITARY THYROID NODULES – A COMMUNITY-BASED SINGLE CENTRE REAL WORLD EXPERIENCE

Introduction: A solitary thyroid nodule (STN) is a palpable enlargement in a normally functioning thyroid. Diagnosing and treating STN requires a holistic approach. Ultrasonography (USG) is a standard screening tool to identify high-risk nodules that may require fine needle aspiration cytology (FNAC) (benign/malignant). Hence, the current analysis aimed to access the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) with the malignancy and the management of STN in routine clinical practice. Methods: The study was a retrospective analysis of STN patients electronic medical records (EMR) database and USG recorded from 2014 to 2022. We queried a single-center EMR database with the search terms “solitary thyroid nodule”, “autonomously functioning thyroid nodule” and “nontoxic multinodular goiter”. A total of 213 records were identified with STN diagnosis, 161 records have one USG report, and of which a 5-year follow-up of 88 records having at least 2 USG reports with at least 1-year time interval of follow-up data. To better identify benign and malignant nodules and optimize clinical management, ACR-TIRADS and The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was adapted in clinic from 2017. Descriptive statistics was used to report the statistical analysis of data. Results: A total of 213 patients were identified with STN. The mean (SD) age is 45.2 (13.8) years. Of these, majority were female, 158 (75%) than male, 54 (25%). Of the total of 160 patients who had ACR TIRADs, 2 (1%) patients had score of 1, 97 (67%) had score 2, 46 (26%) had score 3, 16 (10%) had score 4, 3 (2%) had score 5. Ninety six (45%) patients had Bethesda categorization of nodule and it is observed in 3 (3%), 82 (82%), 8 (8%), 2 (2%), 1 (1%) belonged to class 1, 2, 3, 4, 5, respectively. At follow-up, 67 (76%) patients had no change in the ACR TIRAD nodule score, in 14 (16%) patients score decreased and in 7 (8%) patients increase in score. At baseline the mean (median) nodular volume is 24.2 (8.2) and at follow up 22.2 (6.7), percent change in the nodule volume is -17.7% (-16.0%). Further, of the 88 patients, 7 (9%) of patients had shown >50% increase in the nodular volume. Conclusion: In this real-world data analysis of STN, we observed that the majority of the nodules are benign and nonprogressive, and very few patients had the risk of malignancy, indicating better treatment approaches to control the progression of this condition.

A Study on Clinicopathological Corelation and Management of Solitary Thyroid Nodule

Background: A solitary nodule is a goiter which, on clinical examination appears to be a single nodule in one lobe of the thyroid with no palpable abnormality elsewhere in the gland. The incidence of solitary nodule in general population in South India is 9%. This study aims to assess the presence of malignancy in patients presenting with solitary thyroid nodule and to evaluate and compare results of various investigative modalities used to diagnose a solitary thyroid nodule and the outcome of management modalities in solitary thyroid nodule. Methods: The present study on clinicopathological correlation and management of solitary thyroid nodule has been conducted on cases admitted and managed in the Department of Surgery at KIMS medical college, Hubli. Prospective analysis of 50 cases of solitary nodule thyroid in the specified period was done. These cases were selected by random sampling method and studied in detail clinically and recorded as per the proforma. Routine investigations and specific investigations including FNAC of the nodule, Thyroid profile, IDL, Plain X-ray neck, USG neck were done in all cases. Special investigations like radio-isotope scanning were not performed as the facilities were not available. All the patients were managed by surgery and diagnosis was confirmed by histo- pathological examination. The patients were grouped according to different variables like age, sex, size of the nodule, site of the nodule, functional thyroid status, FNAC reports and histo-pathological examination reports, then analyzed and compared with the previous similar studies conducted elsewhere. Results: Total of 50 cases of solitary nodule of thyroid studied. The mean age of presentation is 38.5 years. Cases in 3rd to 5th decades constitutes 72% of the cases studied. Out of 50 cases studied 46 were females and 4 were males, and the ratio comes to M:F = 1 : 11.5. Out of 50 cases along with swelling in front of the neck, 3 cases had pain, 3 cases had discomfort .....

Prevalence of Malignancy in Solitary Thyroid Nodule-A Retrospective Study

Background: Solitary thyroid nodule is defined as discrete mass palpable in an otherwise apparently normal thyroid gland. Solitary nodule is the common presentation of thyroid disorders.
 Objective: This study aimed to look into the prevalence of malignancy in clinico-radiologically detected solitary thyroid nodule and to correlate the findings in pre-operative fine needle aspiration cytology(FNAC) and post-operative histopathological examination(HPE).
 Materials and Methods: A retrospective study was carried out in our Institute for a period of 6 months using the data obtained between 2018-2020 of patients who were clinically and radiologically diagnosed as solitary thyroid nodule in the Department of General Surgery.
 Results: Out of 30 cases of clinically detected solitary thyroid nodule 7(23.3%)cases was found to be malignant. The mean age of presentation was 41.2 years with male female ratio of 1:9. 25(83.3%)cases was reported as benign nodules according to pre-operative FNAC out of these 2(6.6%)cases turned out to be malignant on post-operative histopathological examination.
 Conclusion: It is concluded that from the present study the prevalence of malignancy in clinically detected solitary thyroid nodule is 23.3%. FNAC being sensitive, cost effective and reliable tool in the preoperative assessment of solitary thyroid nodules and HPE in post operative evaluation of clinical specimen both playing a vital role in management of solitary thyroid nodule thus helping in early diagnosis and proper surgical intervention.

Ultrasonography Guided Fine Needle Aspiration Cytology as a Valuable Tool for Management of Solitary Thyroid Nodule

Ultrasonography Guided Fine Needle Aspiration Cytology as a Valuable Tool for Management of Solitary Thyroid Nodule

Comparative study between cytological and histopathological analysis results of hemithyroidectomy in treatment of solitary thyroid nodule

Aim:The aim of this study was to compare the outcome results of cytological examination by fine-needle aspiration cytology to histopathological examination by hemithyroidectomy in patients with solitary thyroid nodule.Patients and methods:We prospectively reviewed 30 consecutive patients had primary hemithyroidectomy for management of solitary thyroid nodule, carried out over a year (from January 2017 to January 2018) at Assiut University Hospital Surgical Department.Results:There were 24 women and six men with a mean age 34.67 years (range, 19–70 years). Preoperative findings of fine-needle aspiration cytology of these were: 17 (56.7%) patients had colloid nodule, 10 (33.3%) follicular neoplasm, and three3 (10%) hyperplastic nodule. Biopsied lesions were found to be malignant on pathological evaluation in two (6.6%) patients with follicular neoplasm, hemithyroidectomy was adequate definitive treatment in 28 of 30 (93.3%) patients.Conclusion:In a review of the experience at Assiut University Hospital Surgical Department, hemithyroidectomy was the optimal initial and definitive surgical approach for most patients with benign and indeterminate cytology and had undergone thyroid surgery for suspicion of cancer.

Role of fine-needle aspiration cytology & ultrasound in the management of solitary thyroid nodule

Objectives To evaluate the effectiveness of fine-needle aspiration cytology (FNAC) & ultrasound scanning (US) in the diagnosis and management of solitary thyroid nodules. Materials & Methods A retrospective study was carried out on 63 patients who were euthyroid and had a clinically palpable solitary thyroid nodule, who underwent either total or hemi-thyroidectomy, during a period of two years (January 2018 to December 2019) in the ENT unit of a tertiary care hospital in Sri Lanka. All patients with FNAC of Bethesda ≥5 underwent total thyroidectomy. Diagnostic hemi-thyroidectomy was performed only in patients with a FNAC of Bethesda ≤4, irrespective of US suspicious features. Results Mean age was 46.9 years (±13.2). 53(84.1%) patients were females and 10 (15.9%) of them were male. 28(44.4%) patients had histologically proven malignancy while the other 35(55.6%) had benign histology. Sensitivity, specificity, positive predictive values and negative predictive values for FNAC and ultrasound were calculated. Out of 34 patients who underwent diagnostic hemi-thyroidectomy, 12(35%) had to undergo completion surgery due to malignant histology. 58% who underwent completion surgery had suspicious features of malignancy in their pre-op US. Conclusion Both ultrasonography and FNAC are cost-effective, minimally invasive investigations in the diagnosis of malignancy in patients with solitary thyroid nodules. However, there is a notable false negative rate in FNAC; hence it is best to incorporate US findings with FNAC in the decision making process in management of solitary thyroid nodules.

Clinical Approach to Management of Solitary Thyroid Nodule, A Concrete Plan in 42 Patients, in a Tertiary Centre

Clinical Approach to Management of Solitary Thyroid Nodule, A Concrete Plan in 42 Patients, in a Tertiary Centre

Evaluation and management of solitary thyroid nodule in a tertiary care hospital, Andhra Pradesh – A study

Evaluation and management of solitary thyroid nodule in a tertiary care hospital, Andhra Pradesh – A study

Management of solitary thyroid nodule by USG guided FNAC

Management of solitary thyroid nodule by USG guided FNAC

Cytological and histological correlation of solitary Thyroid Nodule

Objective: To assess the role of fine needle aspiration cytology (FNAc) in the management of solitary thyroid nodule and to correlate the FNA cytodiagnosis with histopathological results of surgically excised specimens of thyroid. Design: It was a retrospective study. Place and duration of study: This study was carried out at Jinnah Hospital Lahore in the year 2006. Patients and methods: In this period patients files and slides were retrieved from record. Both FNA cytolodiagnosis and histopathological results were correlated. Results: Out of these 64 cases, 5 cases were diagnosed malignant on histology. These were 2 cases of papillary carcinoma, 2 cases of Non Hodgkin`s lymphoma (NHL) and I case of follicular carcinoma. I case of NHL and 2 cases of papillary carcinoma were correctly diagnosed on FNA. 1 case of NHL was misdiagnosed as benign cystic lesion of thyroid on FNA and I case in which cytodiagnosis of hyperplastic colloid nodule/follicular neoplasm was made, tumed to be follicular carcinoma on histology. In the remaining 59 benign cases, a wide range of overlap was seen among benign thyroid lesions. Conclusion: Despite, the overlap of the spectrum of cytological features of different thyroid lesions, FNA cytological examination of solitary thyroid nodules is strongly recommended.

Fine needle aspiration cytology and ultrasonography in the management of solitary thyroid nodule

fine needle aspiration cytology and ultrasonography in the management of solitary thyroid nodule

Survey of management of solitary thyroid nodules in Germany

To compare the opinions of practitioners in primary care with those of thyroid specialists in Germany on the management of solitary thyroid nodules (Papillon 2005). Questionnaires were filled in by 2,191 practitioners and 297 thyroid specialists between June 1 and September 30, 2005. The test cases and their modifications described a solitary thyroid nodule of 2-3 cm with different levels of thyroid function and a hypoechogenic nodule of 1 cm in diameter. TSH determination and sonography were found to be standard procedures, followed by scintigraphy (selected by 84.7% of practitioners and 95.1% of specialists, p < 0.001) and fine needle aspiration cytology (54.5% of practitioners, 57.4% of specialists). For a hypoechogenic nodule calcitonin determination was advocated by 54.0% of endocrinologists and by 32.2% of nuclear medicine physicians (p < 0.001). A euthyroid solitary thyroid nodule would be treated medically by 77.8% of practitioners and by 85.7% of specialists, the combination of levothyroxine and iodine being clearly preferred (60.9% of practitioners and 67.1% of specialists). For a hyperfunctioning nodule the preference of radioiodine therapy was significantly higher in the specialist group (88.8%) than among the practitioners (52.2%). The main differences of opinion between practitioners and specialists focused on calcitonin screening and referral to radioiodine therapy.

Management of solitary thyroid nodule

Management of solitary thyroid nodule

Management of solitary thyroid nodules in rural Africa

To review a simple protocol for the management of solitary thyroid nodules and to document the spectrum of pathological diagnoses associated with this condition. A retrospective review of all solitary solid thyroid nodules excised over a three-year period from 1st January 1999 to 31st December 2001. A rural church-based hospital in Kenya. All patients undergoing thyroidectomy for solitary solid thyroid nodule over a three-year period at Kijabe Hospital. A simple protocol was used to manage this condition involving history, clinical examination, needle aspiration of the lesion, and excision when clinically indicated. Clinical diagnosis, tribe, operation performed, pathology, and complications of surgery. Eighty-one operations were performed for a solitary thyroid nodule. The most common operations were lobectomy and isthmusectomy. There were two complications--a neck haematoma that required surgery and one recurrent laryngeal nerve injury. The commonest pathological diagnosis was multinodular goitre (42%). There was a 16% malignancy rate with eight papillary carcinomas, five follicular carcinomas, and one hurthle cell carcinoma. The simple protocol described gives good results in a rural African hospital. Solitary solid thyroid nodules should be routinely excised due to the 16% malignancy rate in this condition. There is a possibility that there is a shift in the ratio of papillary to follicular carcinomas compared to older African studies and this would be an interesting area for further study.

A comparative study of fine needle aspiration cytology, ultrasonography and radionuclide scan in the management of solitary thyroid nodule : A prospective analysis of fifty cases

Solitary thyroid nodule is a common clinical entity encountered by the otorhinolaryngologist and physcians. The optimum diagnostic strategy for the euthyroid patient with a soilitary thyroid nodule is still a matter of debate. The goal of diagnostic workup now is to select those patients for surgery who have a high likelihood of harbouring malignancy in the solitary thyroid nodule. The present study was undertaken to evaluate the utility of FANC in the preoperative diagnosis of solitary thyroid nodule and to evaluate the efficacy of FNAC, VSG and RNS in differentiating between benign and malignant nodules. It was found that FNAC is a safe, reliable and cost effective diagnostic modality with a high sensitivity of 83.3% and specificity of 100% and is the single best investigation for preoperative evaluation of solitary thyroid nodules to differentiate between benign and malignant nodules.

IMPACT OF FINE NEEDLE ASPIRATION CYTOLOGY ON THE MANAGEMENT OF SOLITARY THYROID NODULES

To evaluate the impact of the routine use of fine needle aspiration cytology (FNAC) on the management of solitary thyroid nodules, 102 consecutive patients were assessed in regard to the proportion of patients being subjected to surgery and the corresponding yield of malignancy. This cohort was compared with a historical control where FNAC was not routinely applied as a diagnostic selection criterion. The percentage of patients operated on had decreased from 95% to 60% (P less than 0.001) without any significant decrease in the field of malignancy: 18.6% vs 17.6% (P = 0.97). The yield of malignancy of patients operated on had increased from 18.4% to 26.2%. Of those not subjected to surgery, 14 patients or 14% of the original cohort experienced spontaneous complete resolution of their nodules after a mean follow-up period of 5.5 months (s.d. = 3.5) (non-resected group). In the retrospective evaluation of diagnostic discriminants to maximize yield of malignancy while minimizing unnecessary surgery for thyroid nodules, the use of combined parameters of clinical suspicion, positive FNAC and age greater than or equal to 50 years detected 100% of malignancies with only 50% of patients requiring surgery. This was superior to other modalities including clinical parameters and expensive investigations of radionuclide scans and ultrasonography. In conclusion, the use of FNAC in the evaluation of solitary thyroid nodules has resulted in a decreased proportion of patients requiring surgery and cost saving while maintaining the yield of malignancy.

Diagnostic accuracy of fine-needle aspiration biopsy versus frozen section in solitary thyroid nodules

Fine-needle aspiration biopsy is widely used in the diagnosis and management of the solitary thyroid nodule. It is the most accurate tool available and decreases the need for ultrasonography and thyroid scanning. In those patients who are selected for surgical treatment by fine-needle aspiration biopsy, it has been advocated as a guide to determining the extent of operation. Frozen section, which usually serves as the surgeon's guide, and fine-needle aspiration biopsy both have varying accuracy rates. Few direct comparisons have been made. We studied 198 aspirates in 198 patients who presented with a solitary nodule and had surgical excision. Fine-needle aspiration biopsy (198 cases) and frozen section (182 cases) were compared with the final histologic diagnosis. Accuracy rates for fine-needle aspiration biopsy and frozen section were 90 percent and 95 percent, respectively. Fineneedle aspiration biopsy detected 43 percent of the cancers and frozen section, 64 percent. There were no false-positive diagnoses with frozen section, but three cases with fine-needle aspiration biopsy. The false-negative diagnosis rate was 5 percent for frozen section and 8.5 percent for fine-needle aspiration biopsy. When the “other” diagnosis category was grouped with the “positive” diagnosis category and a single expert cytopathologist was used to read the cytology report, the sensitivity was increased to 80 percent whereas the accuracy was maintained at 83 percent. We believe that since there were no false-positive diagnoses using frozen section, it can reliably be used as a guide when it reveals malignancy. When the fine-needle aspiration biopsy diagnosis is “positive” or “other,” it can guide operation, but only after carefully assessing the wording of the cytology report and the clinical situation. Each modality can provide information missed by the other. We continue to use them as complementary tools in the diagnosis and management of solitary thyroid nodules.

The Use of Ultrasound and Fine Needle Aspiration in the Management of Solitary Thyroid Nodules

International Journal of Clinical PracticeVolume 36, Issue 6 p. 227-228 Clinical Studies The Use of Ultrasound and Fine Needle Aspiration in the Management of Solitary Thyroid Nodules Timothy J. Archer FRCS, Timothy J. Archer FRCS Royal Free Hospital, Pond Street, London, NW3Search for more papers by this authorLeslie A. Berger FRCR, FRACP, Leslie A. Berger FRCR, FRACP Royal Free Hospital, Pond Street, London, NW3Search for more papers by this authorLionel R. H. Gracey FRCS, Lionel R. H. Gracey FRCS Royal Free Hospital, Pond Street, London, NW3Search for more papers by this author Timothy J. Archer FRCS, Timothy J. Archer FRCS Royal Free Hospital, Pond Street, London, NW3Search for more papers by this authorLeslie A. Berger FRCR, FRACP, Leslie A. Berger FRCR, FRACP Royal Free Hospital, Pond Street, London, NW3Search for more papers by this authorLionel R. H. Gracey FRCS, Lionel R. H. Gracey FRCS Royal Free Hospital, Pond Street, London, NW3Search for more papers by this author First published: 01 June 1982 https://doi.org/10.1111/j.1742-1241.1982.tb08397.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume36, Issue6June 1982Pages 227-228 RelatedInformation

Evaluation of dominant thyroid masses.

Controversy exists concerning the management of solitary thryoid nodules because of conflicting information converning the high clinical incidence of thyroid nodules, the varying incidence of cancer reported in those surgically excised and the infrequency of death from thyroid cancer. During the past several years, a plan for evaluating patients with dominant thyroid masses has evolved. The objective is to avoid unnecessary operations by identifying patients with a high risk of cancer. The criteria which are used are the age and sex of the patient, the duration of the mass, 125I or 99mTc scans, 75Selenomethionine scans, B-mode ultrasonography and the response of the mass to suppressive therapy. This is a report of the findings in 222 patients who have been studied employing this approach. Thirty per cent of the patients were operated upon. Forty per cent had neoplasms (well differentiated cancer--28.8%, adenoma--12.1%), 47.0%--nodular goiter, 6.1% cysts, and 6.1% chronic thyroiditis. The incidence of cancer in the 222 patients was 8.6% and adenoma 3.6%. Patients at greatest risk of having cancer are those with solid nonfunctioning nodules which fail to regress with suppressive therapy. This study indicates that the approach described above is effective in selecting for surgical excision those individuals at greatest risk of having thyroid cancer.