Thyroid Nodules Group Research Articles

Gut Microbiome Lactobacillus acidophilus and its Relation to Thyroid Nodules and Thyroid Hormonal Profile

Abstract Background Thyroid nodules are a common clinical problem. Epidemiologic studies have shown that the prevalence of palpable thyroid nodules is approximately 5% in women and 1% in men living in iodine-sufficient parts of the world. It is well-known that any thyroid disease is closely related to thyroid hormone levels or the hormone functioning, which could influence the gut microbiomes composition. Lactobacillus is an important genus in the human gut which could improve the concentration of various trace elements in human cells. Aim of the Work To assess the relation between gut microbiome Lactobacillus acidophilus and its relation to thyroid nodules and thyroid hormonal profile. Patients and Methods This was a case control study that was conducted on 90 Egyptian subjects aged 16-60 years old that was divided into 3 groups, Group A that included 30 patients with benign thyroid nodule Group B that included 30 patients with Malignant thyroid nodule and Group C that included 30 healthy subjects as a control group, it was carried out at Endocrine outpatient clinic at Ain Shams University Hospital in Cairo, Egypt. It was conducted from September 2021 till September 2022. Systematic random sampling was performed. Results There was a significant increase in cycle threshold at which lactobacillus acidophilus PCR expressed (which indicate lower colony count of lactobacillus acidophilus) in group B (malignant thyroid nodules) than group C (control group) with P < 0.001 and there was a significant increase in cycle threshold at which lactobacillus acidophilus PCR expressed in group A (benign thyroid nodules) than group C (control group) with P value 0.003. Serum Selenium in Group (B) (malignant thyroid nodule) was lower than in Group (C) (healthy control) There was high statistically significant differences between groups (P-Value <0.001*). Serum Selenium in Group (A) (Benign thyroid nodule) was lower than in Group (C) (healthy control) There was high statistically significant differences between groups (P-Value <0.001*). Serum zinc was lower in Group (A) (benign thyroid nodule) than Group (C) (healthy control) There was high statistically significant differences between groups (P-Value <0.001*). Serum zinc was lower in Group (B) (Malignant thyroid nodule) than Group (C) (healthy control). There was high statistically significant differences between groups (P- Value <0.001*). Conclusion Stool Lactobacillus acidophilus count was significantly different between studied groups. Being lower in patients with thyroid cancer and patients with benign thyroid nodules than healthy group. This data may reflect the interaction between the gut microbiota lactobacillus acidophilus and the development of thyroid nodules and thyroid cancer.

Unveiling the link between ACR TI-RADS grading and Bethesda score of thyroid nodules in diabetic patients: A comprehensive analysis.

This study aimed to explores the factors influencing thyroid nodules (TNs) in individuals with type 2 diabetes mellitus (T2DM) and evaluates the consistency between different American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) grades and Bethesda scores. Total of 642 T2DM patients were divided into TN group (245) and control group (397) based on the presence or absence of TNs. TN patients were further categorized into ACR TI-RADS classification (TR) 1 to 4 and TR5 subgroups. Diabetes-related clinical and biochemical parameters were collected, and differences were analyzed using univariate analysis. Logistic regression analysis was utilized to pinpoint independent influencing factors for TN occurrence and different TN classifications. Consequently, age, body mass index (BMI), fasting plasma glucose level (FBGL), low density lipoprotein cholesterol (LDL-C), diabetic progression, and family history of TNs emerged as independent risk factors for TN development in T2DM patients. Additionally, glycosylated hemoglobin (HbA1c), nodule diameter, and family history of TNs were identified as independent risk factors for TR5 TN development in T2DM patients. All TR1 to 2 nodules had a Bethesda score of 2 and all showed benign pathological findings. In 97.10% of cases (67/69), nodules classified as TR3 exhibited a Bethesda score of 2, with all pathological results indicating benign findings, aligning with the Bethesda score. In addition, the concordance between TR4 nodules and Bethesda score was only 78.57% (88/112). In conclusion, TNs and their malignancy in T2DM patients are significantly linked to blood glucose and lipid metabolism indexes. TR3 classification in T2DM patients poses a low malignancy risk, suggesting caution when conducting fine needle aspiration cytology (FNAC) testing.

Saliva microbiome changes in thyroid cancer and thyroid nodules patients.

ObjectiveThyroid disease has been reported to associate with gut microbiota, but the effects of thyroid cancer and thyroid nodules on the oral microbiota are still largely unknown. This study aimed to identify the variation in salivary microbiota and their potential association with thyroid cancer and thyroid nodules.MethodsWe used 16S rRNA high-throughput sequencing to examine the salivary microbiota of thyroid cancer patients (n = 14), thyroid nodules patients (n = 9), and healthy controls (n = 15).ResultsThe alpha-diversity indices Chao1 and ACE were found to be relatively higher in patients with thyroid cancer and thyroid nodules compared to healthy controls. The beta diversity in both the thyroid cancer and thyroid nodules groups was divergent from the healthy control group. The genera Alloprevotella, Anaeroglobus, Acinetobacter, unclassified Bacteroidales, and unclassified Cyanobacteriales were significantly enriched in the thyroid cancer group compared with the healthy control group. In contrast, the microbiome of the healthy controls was mainly composed of the genera Haemophilus, Lautropia, Allorhizobium Neorhizobium Pararhizobium Rhizobium, Escherichia Shigella, and unclassified Rhodobacteraceae. The thyroid nodules group was dominated by genre uncultured Candidatus Saccharibacteria bacterium, unclassified Clostridiales bacterium feline oral taxon 148, Treponema, unclassified Prevotellaceae, Mobiluncus, and Acholeplasma. In contrast, the genera unclassified Rhodobacteraceae and Aggregatibacter dominated the healthy control group. The study also found that clinical indicators were correlated with the saliva microbiome.ConclusionThe salivary microbiota variation may be connected with thyroid cancer and thyroid nodules.

Association of Helicobacter pylori Infection with Papillary Thyroid Carcinoma: A Case-control Study

Background: The thyroid nodules incidence has risen worldwide. Although factors such as increasing the use of imaging techniques and more rapid detection of small thyroid nodules have been implicated in the recent rise in thyroid cancer incidence, some environmental parameters such as infectious agents may be involved. Helicobacter pylori infection is an environmental risk factor, which may mimic the antigenic properties of membranes of thyrocytes. Objectives: This study aimed at evaluating the association of H. pylori infection with benign and malignant thyroid nodules in comparison with the control group. Methods: Patients with benign thyroid nodules, papillary thyroid cancer (PTC), and euthyroid healthy controls without thyroid nodules that had just been diagnosed were included in the study. All participants underwent clinical examination. Various biochemical parameters such as serum H. pylori Ab (IgG) and thyroid function tests were measured. Comparisons were made between groups. Results: Finally, 370 patients with benign thyroid nodules, 364 patients with PTC, and 360 healthy subjects without nodules participated as a control group. In the patients with PTC, the prevalence of H. pylori infection was 89.6%, while in the group of patients with benign thyroid nodules and the control group was 81.1% and 75%, respectively (P < 0.001). Helicobacter pylori antibody (Ab) titer was not significantly associated with any of the anthropometric and biochemical variables. Conclusions: Helicobacter pylori infection was significantly higher in patients with benign thyroid nodules and PTC than in the control group. Also, the rate of infection was significantly higher in the malignant nodule group than in the benign thyroid nodules group.

Clinical diagnostic value of American College of Radiology thyroid imaging report and data system in different kinds of thyroid nodules

BackgroundTo evaluate the diagnostic value of American College of Radiology (ACR) score and ACR Thyroid Imaging Report and Data System (TI-RADS) for benign nodules, medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) through comparing with Kwak TI-RADS.MethodsFive hundred nine patients diagnosed with PTC, MTC or benign thyroid nodules were included and classified into the benign thyroid nodules group (n = 264), the PTC group (n = 189) and the MTC group (n = 56). The area under the curve (AUC) values were analyzed and the receiver operator characteristic (ROC) curves were drawn to compare the diagnostic efficiencies of ACR score, ACR TI-RADS and KWAK TI-RADS on benign thyroid nodules, MTC and PTC.ResultsThe AUC values of ACR score, ACR TI-RADS and Kwak TI-RADS for distinguishing malignant nodules from benign nodules were 0.914 (95%CI: 0.886–0.937), 0.871 (95%CI: 0.839–0.899) and 0.885 (95%CI: 0.854–0.911), respectively. In distinguishing of patients with MTC from PTC, the AUC values of ACR score, ACR TI-RADS and Kwak TI-RADS were 0.650 (95%CI: 0.565–0.734), 0.596 (95%CI: 0.527–0.664), and 0.613 (95%CI: 0.545–0.681), respectively. The AUC values of ACR score, ACR TI-RADS and Kwak TI-RADS for the discrimination of patients with MTC, PTC or benign nodules from patients without MTC, PTC or benign nodules were 0.899 (95%CI: 0.882–0.915), 0.865 (95%CI: 0.846–0.885), and 0.873 (95%CI: 0.854–0.893), respectively.ConclusionThe ACR score performed the best, followed ex aequo by the ACR and Kwak TI-RADS in discriminating patients with malignant nodules from benign nodules and patients with MTC from PTC.

Preoperative platelet distribution width-to-platelet ratio combined with serum thyroglobulin may be objective and popularizable indicators in predicting papillary thyroid carcinoma.

ObjectivesThe incidence of papillary thyroid carcinoma (PTC) has increased more rapidly than that of any other cancer type in China. Early indicators with high sensitivity and specificity during diagnosis are required. To date, there has been a paucity of studies investigating the relationship between preoperative platelet distribution width‐to‐platelet count ratio (PPR) and PTC. This study thus aimed to assess the diagnostic value of PPR combined with serum thyroglobulin (Tg) in patients with PTC.MethodsA total of 1001 participants were included in our study. 876 patients who underwent surgery for nodular goiter were divided into the PTC group or benign thyroid nodule (BTN) group according to pathology reports, and 125 healthy controls (HCs) were included. Preoperative hemogram parameters and serum Tg levels were compared among three groups. Receiver operating characteristic (ROC) curve was used to evaluate the value of PPR combined with serum Tg for diagnosing PTC.ResultsPlatelet distribution width (PDW) and PPR levels were higher in the PTC group than in the BTN and HC groups (both p < 0.05) but did not significantly differ between the BTN and HC groups. PDW and PPR levels significantly differed in the presence/absence of lymph node metastasis, the presence/absence of capsule invasion (p = 0.005), and TNM stages (p < 0.001). Multivariable analyses indicated that high serum Tg levels [adjusted odds ratio (OR), 1.007; 95% confidence interval (CI), 1.004–1.009; p < 0.001], high neutrophil‐to‐lymphocyte ratio (NLR,adjusted OR, 1.928; 95% CI, 1.619–2.295; p < 0.001), and high PPR (adjusted OR, 1.378; 95% CI, 1.268–1.497; p < 0.001) were independent risk factors for PTC. In ROC analysis, the areas under the curves (AUCs) of serum Tg, PDW, PPR, and NLR for predicting PTC were 0.603, 0.610, 0.706, and 0.685, respectively. PPR combined with serum Tg (PPR + Tg) had a higher diagnostic value (AUC, 0.738; sensitivity, 60%; specificity, 74.7%) compared with PDW + Tg (AUC, 0.656; sensitivity, 64.4%; specificity, 59.9%) and NLR + Tg (AUC, 0.714; sensitivity, 61.6%; specificity, 71.1%).ConclusionsPreoperative PPR combined with serum Tg may be objective and popularizable indicators for effective predicting PTC.

Differences in Pre-Operative Mean Serum Concentration of Thyroid Stimulating Hormone (TSH) and Free Thyroxin (FT4) in Patients with Benign Thyroid Nodules and Thyroid Carcinoma at Sanglah General Hospital Denpasar

Background: Thyroid Stimulating Hormone (TSH) and Free Thyroxin (FT4) concentration are currently highlighted in their relation to thyroid carcinoma development in thyroid nodule patients. This study aimed to identify the difference in the pre-operative mean serum concentration of TSH and FT4 in patients with benign thyroid nodules and thyroid carcinoma at Sanglah General Hospital Denpasar.Methods: : This study was a case-control study that involved 110 patients with thyroid nodules who underwent thyroidectomy at Sanglah General Hospital from January until December 2019, whose specimens were examined histopathologically at the Anatomical Pathology Laboratory of Sanglah General Hospital. Cases were patients with thyroid carcinoma. Controls were patients with benign thyroid nodules. The data were collected from medical records. Results: Most subjects in the thyroid carcinoma group were female (72.7%). The thyroid carcinoma group had a higher mean age at the time of thyroidectomy (47.33 ± 13.4) compared to the benign thyroid nodule group (46.07 ± 12.5) (p = 0.61). Significant difference was found regarding the nodule size between the two groups (p &lt; 0.001). There were no significant differences in terms of nodule lateralization (p = 0.56) and the number of nodules (p = 0.58). Papillary thyroid carcinoma was the most common type of thyroid carcinoma (89.1%). A significantly higher pre-operative mean serum TSH concentration was found in cases (1.0 ± 0.23 IU/mL) compared to controls (0.8 ± 0.23 IU/mL) (p &lt; 0.001). The pre-operative mean serum FT4 concentration was significantly lower in cases (1.1 ± 0.25 IU/mL) compared to controls (1.2 ± 0.22 IU/mL) (p = 0.006). The optimal TSH and FT4 cut-off values for thyroid carcinoma were &gt; 1.0 IU/mL (61% sensitivity, 71% specificity) and &lt; 1.1 IU/mL (61% sensitivity, 51% specificity), respectively Conclusions: : Higher pre-operative mean TSH concentration and lower mean FT4 concentration were found in patients with thyroid carcinoma. There were statistically significant differences between patients with thyroid carcinoma and benign thyroid nodules in terms of these two laboratory parameters.

The Correlation between Microalbuminuria and Thyroid Nodules in Type 2 Diabetic Mellitus.

Objective To investigate the correlation between thyroid nodules and microalbuminuria in type 2 diabetic mellitus. Methods A total of 270 patients with type 2 diabetes at Tongzhou Branch of Dongzhimen Hospital were enrolled in this retrospective study. Data were collected from the inpatient electronic files between January 2018 and January 2020. The laboratory indexes of the two groups (thyroid nodule group with 172 cases and control group including 98 cases without thyroid nodules) were statistically analyzed by binomial logistic regression analysis and Spearman correlation analysis. Results The proportion of microalbuminuria (MAU) in the thyroid nodule group was larger than that in the control group. Age, serum TT4, and FT4 in the thyroid nodule group were significantly higher compared with the control group. The binary logistic regression analysis indicated that age, sex, FT4, and MAU were the risk factors for thyroid nodule in T2DM patients. Spearman correlation analysis showed that the thyroid nodule was significantly positively correlated with MAU, age, FT4, and TT4. Conclusions MAU might be an independent risk factor for thyroid nodule in type 2 diabetic mellitus.

The Detection of Thyroid Nodules in Prediabetes Population and Analysis of Related Factors.

PurposeTo explore the detection of thyroid nodules (TN) and related influencing factors in the population of prediabetes (PreDM) in northwest China’s Gansu Province.Materials and MethodsA multi-stage stratified cluster random sampling method was used to select adult Han residents in Gansu Province for investigation, and recorded the clinical data of the subjects. The χ2 test was used to analyze the difference in TN detection rate of the PreDM population. Logistic regression analyzed the risk factors of TN in the PreDM population.ResultsThis study included 2659 people with normal glucose tolerance (NGT) and PreDM, of which 440 people were detected with TN. Among the PreDM population, the TN detection rate was higher than in the NGT population (24.48% vs 15.00%; P<0.05). The detection rate of TN in the impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and IFG+IGT group was also significantly higher than that in the NGT population (X2=4.117, X2=13.187, X2=13.016, all P<0.05), and of which, the IFG+IGT group was the highest (32.20%). The general trend of TN in the IFG, IGT and PreDM population all increased with age. General data showed that BMI, waist-to-height ratio, waist circumference, TG, TC, LDL-C, FPG, 2h PG, HbA1c and TSH indicators in the TN group were higher than those in the Non-TN group (P<0.05). The logistic regression suggested that the risk factors for TN in the PreDM population were female, age increase, high SP, high TSH, high FPG, high LDL-C, hypertension and family history of diabetes (all P<0.05).ConclusionThe detection rate of TN in the PreDM population is high, especially in the IFG+IGT population. Middle-aged and elderly people with hypertension and abnormal glucose and lipid metabolism should be treated reasonably and regularly, and their TN should be screened and followed up.

Ultrasonic Characteristics of Medullary Thyroid Carcinoma: Differential From Papillary Thyroid Carcinoma and Benign Thyroid Nodule.

The aim of this study was to evaluate the differences in ultrasonic features of patients with medullary thyroid carcinoma (MTC), papillary thyroid carcinoma (PTC), and benign thyroid nodules. This study included 53 cases of MTC, 151 cases of PTC, and 200 cases of benign thyroid nodule which were pathologically confirmed. There were no significant differences in sex and thyroid gland involvement among the MTC, PTC, and benign thyroid nodule groups. The age among the 3 groups was statistically different (P = 0.002). The TNM stage of MTC was significantly higher than that of PTC (P < 0.001). Compared with PTC, the lesion size, shape, margin, echogenicity, internal nodule component, and blood flow were significantly different in MTC (P < 0.001, P < 0.001, P < 0.001, P < 0.001, P = 0.045, P < 0.001). However, there were no differences in the form of calcification and cervical lymph node involvement between the 2 groups (P = 0.671, P = 0.128). Except for the lesion size and shape (P = 0.068, P = 0.444), MTC group have significant differences in the grade of Thyroid Imaging Reporting and Data System, lesion margin, echogenicity, internal nodule component, calcification, cervical lymph node, and blood flow compared with benign thyroid nodule group (P < 0.001, P = 0.014, P = 0.032, P < 0.001, P < 0.001, P < 0.001). Our data indicate that ultrasound have important value in preoperative diagnosis of MTC. The ultrasonic features of MTC include relatively large nodules, aspect ratio less than 1, smooth edge, solid hypoechoic, microcalcification, and rich blood flow. It is necessary to combine multiple ultrasonic features for the differential diagnosis of MTC, PTC, and benign thyroid nodules.

DNA double-strand breaks repair capacity and risk of differentiated thyroid cancer: a case-control study

Objective: To study the influencing factors of DNA double-strand breaks (DSB) repair capacity and relationship with differentiated thyroid cancer (DTC). Methods: A total of 140 patients with thyroid diseases admitted to the Henan Cancer Hospital from January 2020 to March 2020 were retrospectively analyzed, including 26 males and 114 females, aged from 18 to 78 years old. According to the pathological results, the patients were divided into DTC group (90 cases) and control group or benign thyroid nodules (BTN) group (50 cases). The DSB repair ability of peripheral blood T lymphocytes was measured by flow cytometry. The data of two groups were compared by Wilcoxon rank sum test to evaluate the relationship between DSB repair ability and the risk of DTC. According to the median repair ability of DSB in BTN group, the repair ability of DSB was divided into high and low categories, and the factors influencing the repair ability of DSB were analyzed by Logistic regression method. SPSS 22.0 software was used to analyze the data. Results: The DSB repair capacity was 27.87% in DTC group and 36.75% in BTN group, with significant difference (Z=-3.999,P<0.05). Logistic regression analysis suggested that patients with thyroid cancer had lower DSB repair capacity than patients without cancer (OR=2.245; 95%CI: 1.067-4.725; P=0.033), and patients with a history of radiation exposure had a reduced DSB repair capacity (OR=2.698; 95%CI: 1.271-5.725, P=0.010). Conclusion: The risk of DTC increases in patients with low DSB repair capacity. Radiation exposure is a risk factor for the reduction of DSB repair capacity.

Diagnostic value of circulating cell-free mtDNA in patients with suspected thyroid cancer: ND4/ND1 ratio as a new potential plasma marker

Thyroid cancer is the most common endocrine malignancy, and its incidence continues to rise. For clinicians with cancer patients, choosing and interpreting diagnostic laboratory studies has become increasingly important. Previously, changes in plasma free mitochondrial DNA levels have been found in colorectal, breast, lung, and urinary cancers, and have demonstrated diagnostic value. In this study, we investigated whether the occurrence and development of thyroid cancer might be predicted using mtDNA copy number (ND1), mtDNA integrity (ND4/ND1) and levels of cell-free nDNA (GAPDH). We analyzed ND1, ND4, and GAPDH levels in plasma and blood cells from 75 patients with thyroid cancer, 40 patients with nodular goiter, and 107 normal controls using real-time PCR. Although both the thyroid nodule and thyroid cancer patients had significantly increased ND1 levels, the ND4/ND1 ratio in the thyroid cancer group was higher than the thyroid nodule group (P < 0.05), and significantly higher than the normal control group (P < 0.01). Plasma levels of nuclear DNA (GAPDH) in the thyroid cancer group were also higher compared to normal (P < 0.05). These results indicate that increased intactness of plasma free mtDNA is associated with increased levels of plasma cell-free nDNA, and that the ND4/ND1 ratio has the potential to be a new detection indicator in thyroid cancer. Furthermore, we classified thyroid cancer patients according to clinical data including age, tumor size, and metastasis. We found significantly higher levels of GAPDH in malignant tissues. Because ND4/ND1 correlated with plasma GAPDH in the plasma studies, this also suggests a potential relationship between ND4 intactness and thyroid tumor tissue size. Taken together, our findings suggest a tumor-specific process involving increased release of intact mtDNA, detectable in the plasma, which differentiates normal patients from patients with thyroid cancer.

An analysis of the correlation between thyroid nodules and metabolic syndrome.

ObjectiveThe purpose of this study was to explore the prevalence of thyroid nodules (TN) and metabolic syndrome (MS) and to analyze the correlation between TN and the components of MS.MethodsA total of 1526 subjects were divided into two groups: a TN group and a non-thyroid nodules (NTN) group. The height, weight, blood pressure, fasting blood glucose level, fasting plasma insulin level, serum lipid profile, uric acid level, serum thyroid-stimulating hormone (TSH) level, free triiodothyronine (FT3) level, and free thyroxine (FT4) level of each patient were measured. Insulin resistance (IR) was estimated by homeostasis model assessment of insulin resistance (HOMA-IR). Fatty liver and TN were detected by color Doppler ultrasonography.Results(i) The overall prevalence of TN was 39.5%; it was significantly higher in women than in men (P < 0.01) and progressively increased with age in both sexes. (ii) The overall prevalence of MS was 25.6%; it was significantly higher in men than in women (P < 0.01) and progressively increased with age in both sexes. (iii) FT3 was significantly lower in the TN group than in the NTN group (P < 0.01). (iv) BMI, triglycerides, and HOMA-IR were higher in the TN group than in the NTN group (P < 0.05). (v) The existence of TN was significantly associated with overweight/obesity (OR = 1.03, 95% CI = 1.024–1.089), and with insulin resistance (IR) (OR = 1.98, 95% CI = 1.645–2.368), after adjusting for age and sex.ConclusionsThe prevalence of thyroid nodules and metabolic syndrome in the Nanchang area increases with age, and overweight/obesity and IR in patients are associated with thyroid nodules.

Markers of immune activation: novel biomarkers to predict the early-warning indicator of patients with papillary thyroid carcinoma

BackgroundPapillary thyroid carcinoma (PTC) is an indolent tumor that is exploding with increasing thyroid nodules (TN). Environmental carcinogens, lifestyle changes increased the incidence of thyroid carcinoma. With the development of B-ultrasound imaging, more and more thyroid cancer has been found. There has been a debate about whether thyroid cancer is overtreated.MethodsThe expression of T cell subsets and plasma cytokines in 191 patients, including 79 patients with PTC (PTC group), 58 patients with thyroid nodules (TN group) and 54 healthy individuals (HP group) were analyzed by flow cytometry.ResultsHigh levels of natural killer cells (NK) were detected in PTC and TN groups than in HP group. High activities of CD8+HLA-DR+ and CD8+CD38+ showed a gradual upward trend from HP group to PTC group. The rise in the levels of TNF-α in PTC patients’ was evident when compared with HP group. CD8+CD38+ showed a significant correlation with lymph node metastasis. CD8+CD38+ co-expression was higher in Nx stage than N0 stage, while the proportion of IL-10 was dramatically decreased in the Nx stage.ConclusionsThese results indicated that CD8+CD38+ might act as a biomarker of PTC lymph node metastasis. The combination of CD8+HLA-DR+, CD8+CD38+ and TNF-α can be used as useful biomarkers for the early-warning indicator of PTC.

Correlation analysis of metabolic syndrome and its components with thyroid nodules.

ObjectiveThis study aimed to analyze the relationship between the metabolic syndrome (MetS) and its components with the occurrence of thyroid nodules.MethodsA total of 2719 volunteers from some areas of Gansu Province, China, who participated in the national survey of thyroid diseases and iodine nutrition status (Tide) and diabetes prevalence, were selected. Their height, weight, waist circumference (WC), systolic blood pressure (SBP), and diastolic blood pressure were recorded. The fasting plasma glucose (FPG), 2-h plasma postprandial glucose (2hPG), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and glycosylated hemoglobin (HbA1C) levels were measured. The prevalence of MetS and thyroid nodules was evaluated, and the correlation between each component of MetS and thyroid nodules was studied.ResultsThe prevalence of MetS and thyroid nodules was 15.4% and 17.2%, respectively. WC, SBP, body mass index, FPG, 2hPG, TG, TC, and thyroid-stimulating hormone levels were significantly higher in the thyroid nodule group. The prevalence of thyroid nodules was significantly higher in the MetS group. A positive correlation was found between the degree of metabolic disorder and the occurrence of thyroid nodules. WC was found to be a risk factor for the occurrence of thyroid nodules. For WC≥90 cm, an increase in the independent variables led to a significant rise in the incidence of thyroid nodules.ConclusionThe prevalence of thyroid nodules was higher in the MetS group. The WC of the MetS components might be an independent risk factor for the occurrence of thyroid nodules.

Association of Body Mass Index and Risk Stratification of Thyroid Nodules in a Multi-center Healthy Population

Objective To investigate the relationship between body mass index(BMI)and risk levels of thyroid nodules in a multi-center healthy population. Methods A total of 6070 subjects were enrolled from five medical physical examination centers in China from January 2015 to December 2017. All the participants'general information and parameters were recorded. Thyroid nodules were detected by color Doppler ultrasonography. All ultrasound doctors received uniform training before study. Results Among all the subjects,5773(95.1%;with 4274 nodules identified in 2833 subjects)were from northern China and 297(4.9%,with 183 nodules identified in 158 subjects)from central China(χ2=1.923,P=0.092). The nodules were single in 1479 of 2991 subjects(49.4%)and multiple in 1512 subjects(50.6%). Nodules larger than 1 cm accounted for 13.3% and nodules smaller than 1 cm accounted for 86.7%. Compared with the non-thyroid nodule group,the thyroid nodule group had significantly more women(χ2=156.36,P=0.000),older age(t=-18.768,P=0.000),and higher fasting blood glucose(FBG) level(t=-3.808,P=0.000). Among all the nodules,the prevalence rates of benign,very-low-risk,low-risk,moderate risk,and high risk were 4.5%,6.6%,85.0%,0.1%,and 3.7%,respectively,according to the ATA guidelines. Notably,there were 4291 nodules at moderate or lower risks and 166 nodules at high risk. Compared with the former,patients with high-risk nodules had significantly lower BMI(χ2=25.161,P=0.000)and high FBG(t=3.357,P=0.000). Multivariate non-conditional Logistic regression showed low BMI(OR=2.900,95%CI:1.461-5.783,P=0.002)and high FBG level(OR=0.803,95%CI:0.675-0.955,P=0.013)were independent risk factors for high-risk nodules. Compared with subjects with normal weight or obese populations,subjects with low BMI had significantly higher detection rate of high-risk nodules(χ2=25.16,P=0.000). In ≥55 year-old group,significantly more high-risk nodules were detected in low BMI group(χ2=44.868,P=0.000). Conclusion Low weight is associated with high-risk thyroid nodules among people ≥55 years old.

Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules

ObjectiveUltrasound-guided fine-needle aspiration biopsy (US-FNAB) is a safe and effective method of screening malignant thyroid nodules such as papillary thyroid carcinoma. However, not much data are available regarding the diagnostic efficacy of US-FNAB for papillary thyroid microcarcinoma (≤10 mm in diameter). We aim to compare the diagnostic efficacy of US-FNAB on thyroid nodules between two groups divided by a diameter of 10 mm by correlating the cytological results of US-FNAB with the histopathologic diagnoses in selected patients.Patients and methodsEight hundred twenty-two thyroid nodules (Group A: diameter ≤10 mm, n=620; Group B: diameter >10 mm, n=202) from 797 patients treated between March 2014 and June 2017 were retrospectively evaluated. Only nodules with Thyroid Imaging Reporting and Data System (TIRADS) categories 4–6 were enrolled and sampled by US-FNAB, followed by surgical resection.ResultsAccording to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) diagnostic categories, 94 thyroid nodules were classified as I, III and IV, and were excluded from the analysis. The resultant 728 thyroid nodules from 721 patients were analyzed. The malignant tendency (TBSRTC V and VI) rates on US-FNAB were 88.2% and 84.6% (P=0.202) in Group A and Group B, respectively, and the malignant rates were 89.5% and 86.9% (P=0.330), respectively, on histopathology. There was a high concordance between cytology and histopathology diagnoses (kappa value =0.797), and no statistical difference in terms of US-FNAB accuracy was found between the two groups (P=0.533).ConclusionFor thyroid nodules of TIRADS category 4–6, the diagnostic efficacy of US-FNAB is similar for thyroid nodules either smaller or greater than 10 mm in their maximum diameter.

Assessment of serum midkine level in benign and malignant thyroid nodules. Can midkine be a marker of thyroid malignancy?

Background: Thyroid nodules are a common clinical problem. The prevalence of malignancy in thyroid nodules is currently about 5%–15%. Fine-needle aspiration biopsy (FNAB) has improved the preoperative prediction of malignancy, but still has disadvantages including operator variability and nondiagnostic reports. Midkine (MK) is a novel heparin-binding growth factor; MK levels have been proposed as indicative of malignancy in numerous tumors. MK overexpression in thyroid cancer has been reported to be in correlation with clinicopathological features of the tumor, hypothesizing that MK might play a role as a biomarker for diagnosis and more aggressive behavior of thyroid cancer. Aim: The aim of this study is to evaluate the value of serum MK (SMK) as a marker of malignancy in patients with nodular thyroid disease. Patients and Methods: The current study included 75 individuals with age ranging from 25 to 80 years divided into 25 with malignant thyroid nodule (Group A), 25 with benign thyroid nodule (Group B), and 25 healthy individuals as a control group (Group C). Free triiodothyronine, free thyroxin, thyroid-stimulating hormone, and SMK levels were assessed. Individuals with thyroid nodules were submitted for neck ultrasonography and FNAB. Results: On comparing the three studied groups, a high statistically significant difference in plasma MK levels was found (P Conclusions: SMK might be the indicator of malignant thyroid cytopathology, suggesting that MK might serve as a novel biomarker in the assessment of thyroid nodules. The present study explored the usefulness of MK as a biomarker in the differentiation between benign and malignant thyroid nodules in samples from serum.

MEAN PLATELET VOLUME: AN OVERLOOKED HERALD OF MALIGNANT THYROID NODULES.

SUMMARYPhysicians and surgeons pay much attention to evaluating thyroid nodules due to the malignant potential of these growths. Inflammation has a crucial role in the development of cancer. Increase in the mean platelet volume (MPV) has been described in various inflammatory conditions. Since some of thyroid nodules are malignant, we aimed to compare MPV values between patients with malignant and benign thyroid nodules after precise pathologic diagnosis. We retrospectively analyzed hemograms of patients having undergone thyroid surgery for thyroid nodule between January 2013 and January 2015, and compared them to those recorded in healthy subjects. MPV was higher in the malignant thyroid nodule group than in the benign nodule group (9.1±1 fL vs. 7.8±0.8 fL). The difference was statistically significant (p<0.001). Increased MPV should be considered as an assistive diagnostic tool in differentiating malignant and benign thyroid nodules. However, further prospective studies are required to confirm its usefulness in this population.

Value of ultrasonography in the diagnosis of primary hepatic carcinoma and thyroid carcinoma.

The present study explored the value of ultrasonography in the diagnosis of primary hepatic carcinoma (PHC) and thyroid carcinoma (TC) by assessing their sonographic features. A total of 426 patients diagnosed with liver space-occupying lesions by ultrasonic examination admitted to Liaocheng People's Hospital from March 2014 to October 2017 were enrolled in this study. These patients were divided into two groups: A total of 226 patients with 237 foci in the PHC group and 200 patients with 216 foci in the benign liver lesion group. During the same period, 367 patients diagnosed with thyroid nodules (382 nodules) by ultrasonic examination were also enrolled in this study. These patients were divided into further two groups: A total of 193 patients with 203 nodules in the TC group and 174 patients with 179 nodules in the benign thyroid nodule group. Two-dimensional and color Doppler ultrasonography were performed on all the patients in the four groups. Differences in the sonographic features such as focus morphology, focus size, internal echo, halo and blood flow distribution were statistically significant between patients in the PHC and the benign liver lesion group (p<0.001). Differences in the sonographic features such as nodule boundary, nodule size, internal echo, microcalcification, lymph node status and blood flow were statistically significant between patients in the TC and the benign thyroid nodule group (p<0.01). PHC can be differentiated from benign liver lesions by evaluation of focus morphology, focus size, internal echo, halo, and blood flow. TC can be differentiated from benign thyroid nodules by evaluation of nodule boundary, nodule size, internal echo, microcalcification, lymph node status, and blood flow. Ultrasonic diagnosis of PHC and TC is not only accurate, but also convenient, fast, cost-efficient and non-invasive. Thus, application of ultrasonography in the diagnosis of PHC and TC should be expanded for the benefits of patients.