Thyroid Ultrasound Examination Research Articles

P-69 Beneficial outcomes of hypothyroidism treatment in atrial fibrillation patient

Abstract Introduction It is well established that hyperthyroidism is a strong independent risk factor for atrial fibrillation (AF). However, the relationship between hypothyroidism and AF is complex and not fully understood. The abnormal thyroid hormone levels can disrupt the electrical signals that regulate heart rhythm, potentially leading to AF. Some symptoms of hypothyroidism, such as fatigue, weakness, and shortness of breath, can mimic the symptoms of AF. This can make it challenging to diagnose AF in individuals with underlying thyroid issues. Meanwhile the treatment of hypothyroidism in A patient with AF can significantly improve the symptoms. Clinical Case A 54 years old female was referred to the Therapy department with fatigue and palpitations. She was diagnosed one year ago with paroxysmal tachysystolic atrial fibrillation. CHADSVASK-1, EHRA-3. She experienced paroxysmal episodes four to five times a month for which she took propafenone. At presentation echocardiography (ECHO) showed LVEDD-50, LVEDS-35, IVS-12, LVPW-11, LA-42, EF-57%. The blood sample revealed TSH-8.41 (reference range 0.3-4 mIU/l), free T4-1.15 (reference range 10-25 pmol/l), free T3-3.76 (reference range 2.5-5.8 pmol/l), AbTPO-1040 (reference range 2.5-30 IU/ml). On thyroid ultrasound examination dimensions of right lobe were 18 *23 * 39 mm, left lobe were 22*20*38 mm, isthmus 3.8 mm, and no nodules were present. Total thyroid volume was 19.5 mL. The gland had heterogeneous echotexture and normal vascularity. Treatment with levothyroxine 50 mcg was started. After 6 weeks of treatment with levothyroxine TSH improved to 3.8 mIU/l and patient's fatigue and palpitation symptoms significantly improved, and no new paroxysms were detected. Conclusion: Managing hypothyroidism through thyroid hormone replacement therapy can often help control and sometimes even reverse AF if the arrhythmia was related to thyroid dysfunction. However, some individuals, as in this case, may continue to have AF even after their thyroid levels are normalized. In this case we emphasize the importance of understanding the effect of hypothyroidism on AF.

Utility of Colour Flow Doppler Ultrasonography to Differentiate Gestational Transient Thyrotoxicosis and Graves Disease in Pregnancy.

Accurate diagnosis of the etiology of thyrotoxicosis in pregnancy is important to guide appropriate treatment. The role of thyroid blood flow velocities by color Doppler to differentiate between Graves' disease (GD) in pregnancy and gestational transient thyrotoxicosis (GTT) is not well explored. This study evaluated inferior thyroid artery (ITA)-peak systolic velocity (PSV) as a marker for differential diagnosis of thyrotoxicosis in pregnancy. Fifty-six pregnant patients with thyrotoxicosis (30 with GTT and 26 with GD) along with 30 age-matched healthy euthyroid pregnant subjects were enrolled. Thyroid ultrasound examinations and color Doppler was performed by an ultrasound scanner. The studies of the right and left ITAs were performed with Doppler, and the PSV and End diastolic velocity (EDV) values were obtained from the right and left ITA. The mean total T4 value in GD and GTT were almost similar (25.04 ± 2.43 vs 23.25 ± 2.81, P value = 0.14). Beta HCG levels were significantly higher in cases of GTT as compared to GD (152946 ± 26694 vs 120608 ± 21244 mIU/ml, P < 0.0001). The ITA-PSV and EDV in patients with GTT were significantly lower than those of pregnant patients with GD (right: 22.5 ± 6.8 and 8.3 ± 2.3; left: 22.97 ± 6.3 and 8.13 ± 2.01; P < 0.001). receiver-operating-characteristic (ROC) curve demonstrated an optimal cutoff value of mean right ITA-PSV of 35 cm/sec to differentiate GTT from GD during pregnancy, with 84.6% and 93.3% sensitivity and specificity. Thyroid artery velocities can help to differentiate between GD and GTT. The cutoff point of mean ITA-PSV at 35 cm/s had an excellent value in differentiating between the two, with good sensitivity and specificity.

Prevalence of thyroid diffuse goiter and its association with body mass index and the presence of cysts and nodules in children and adolescents: the Fukushima Health Management Survey.

The main cause of diffuse thyroid goiter is autoimmune chronic thyroiditis, otherwise known as Hashimoto's thyroiditis. Thyroid hormones play pivotal roles in growth and development during childhood. However, the prevalence of diffuse goiter and the relationships between diffuse goiter, thyroid volume, cysts and nodules, and anthropometric measurements in children are not well known. Among 789,459 participants who participated in thyroid ultrasound examinations, 320,206 participants (male: 161,728; female: 158,478) aged 1-23 years were analyzed. Logistic regression analyses were conducted to calculate the odds ratios of the standard deviation score of body mass index (BMI-SDS), the SDS of bilateral width multiplied thickness area (BWTAR-SDS) as a provisional determination of thyroid volume, and the presence of nodules or cysts for positive diffuse goiter compared with negative diffuse goiter after correction for sex and age. The prevalence of diffuse goiter increased in a female-dominant manner with aging. Compared with the absence of diffuse goiter, the age- and sex-adjusted odds ratios (95% confidence intervals) for BMI-SDS (1 SD), BWTAR-SDS (1 SD), cysts, and nodules were 1.24 (1.21-1.27), 3.21 (3.13-3.29), 0.53 (0.50-0.58), and 1.38 (1.17-1.64), respectively. The odds ratios of nodules for positive diffuse goiter were 4.18 (1.08-16.08), 1.76 (1.01-3.07), 1.80 (1.32-2.45), and 1.34 (1.08-1.67) in the age groups 1-7, 8-11, 12-15, and 16-23 years, respectively. The age-dependent increase in the prevalence of diffuse goiter was independently associated with increased BMI and positive prevalence of nodules in young individuals.

Analysis of the results of occupational health examination of radiation workers in Shaanxi Province

Objective: To analyze the results of occupational health examinations of radiation workers in Shaanxi Province, and to provide basis and reference for effectively conduct occupational health monitoring. Methods: From April 2016 to January 2022, a questionnaire survey was conducted to collect the basic information on occupational health examinations of qualified radiation workers in Shaanxi Province from 2016 to 2021. Based on the abnormal rate of occupational health among radiation workers, 1018 people were randomly selected using a cluster stratified sampling method to analyze the occupational health examination results of different positions, types of work, gender, length of service, and exposure doses. Results: The chromosomal aberration rates of peripheral blood lymphocytes among radiation workers in Shaanxi Province from 2016 to 2021 were 0.26% (10/3876), 0.77% (27/3512), 0.16% (16/10153), 0.09% (13/14769), 0.10% (13/13399), and 0.12% (20/16671), respectively. The abnormal rates of thyroid ultrasound examination were 32.33% (150/464), 24.46% (649/2653), 55.24% (786/1423), 32.89% (888/2700), 35.69% (1475/4133), and 42.51% (1993/4688), respectively. There was a statistically significant difference in the abnormal rates among different years (P<0.05). The abnormal rate of renal function examination in male radiation workers was higher than that in females (P<0.05). Compared with non medical users, the abnormal rates of renal function, thyroid function, and blood routine examination in medical radiation workers were higher (P<0.05), and the abnormal rates of renal function, thyroid function, and blood routine examination in medical applications were higher than those in radiation diagnosis, nuclear medicine, and radiation therapy (P<0.05). The abnormal rates of electrocardiogram, chest X-ray, blood pressure, thyroid function, and blood routine increased with the length of service (P<0.05). The abnormal rates of blood pressure, liver function, kidney function, thyroid function, and blood routine examination increased with the exposure dose (P<0.05) . Conclusion: The occupational health status of radiation workers is not optimistic. Occupational health monitoring should be strengthened, especially interventional radiation diagnosis occupational health examination, as well as changes in the indicators of sensitive organs such as eye lens and thyroid, so as to ensure the health of radiation workers.

Risk Stratification of Differentiated Thyroid Cancer: A Single-Center Study in Basrah.

Background Differentiated thyroid cancer is a common endocrine cancer; most of it has an indolent course and favorable outcomes, with a subset of patients having the risk of disease recurrence, which can be assessed using the fixed American Thyroid Association (ATA) risk stratification system or the dynamic response to therapy risk stratification that can be modified during patients follow-up. Aim The aim of this article is to assess the risk stratification of patients having differentiated thyroid cancer. Methods This is aretrospective cross-sectional study in which we evaluated medical records of 75 patients having differentiated thyroid cancer to assess the baseline ATA risk of recurrence and compared it to the results of dynamic risk stratification in response to therapy at 6-12 months post-surgery and at the last visit. Thyroglobulin level, anti-thyroglobulin antibody, thyroid ultrasound, and cytopathological examination were used to determine dynamic response to therapy and divided subjects into four groups: excellent response (ER), biochemical incomplete response (BIR), structural incomplete response (SIR), and indeterminate response (IR). Results At baseline, 55 patients had low risk, 14 patients had intermediate risk, and six patients had high risk. At 6-12 months post-surgery, in the low-risk group, ER, BIR, and IR responses were observed in 56.4%, 5.5%, and 38.2% of patients, respectively, and none of them exhibited SIR. In the intermediate-risk group, ER, BIR, and IR responses were observed in 57.1%, 21.4%, and 21.4% of patients, respectively, and none exhibited SIR. Among the high-risk group, two patients had ER, two patients had BIR, one patient had IR, and one patient had SIR. At the last visit, ER, BIR, and IR were observed in 65.5%, 9.1%, and 25.5% of low-risk patients, respectively, and no patient developed SIR. In the intermediate-risk group, ER, BIR, and IR were observed in 50%, 21.4%, and 28.6% of patients, respectively, and no patients developed SIR. Among the high-risk group, three patients achieved ER, one had BIR, one had IR, and one had SIR. Conclusion Most of the differentiated thyroid cancers in this study are low-risk. Dynamic risk stratification appears to be an effective tool in the follow-up of this population of patients having differentiated thyroid cancer.

Risk factors of recurrent thyroid nodules after radiofrequency ablation.

To investigate the risk factors of thyroid nodule recurrence after radiofrequency ablation (RFA). METHODS The medical record information of 120 patients with thyroid nodules admitted to our hospital from June 2019 to April 2022 was retrospectively analysed. All participants received RFA treatment. According to the results of the postoperative thyroid ultrasound examination (USG), the patients were divided into the recurrence group (R, N=16) and the non-recurrence group (NR, N=104). Binary logistic regression analysis was performed to identify the independent risk factors of thyroid nodule recurrence after RFA. The receiver operating characteristic (ROC) curve was used to analyse the value of the forecast of each independent factor and combined model for thyroid nodule recurrence after RFA. During the follow-up period, 16 patients recurred, and the recurrence rate was 13.33%. Univariate regression analysis showed that whether the nodules are solitary (WNS), nodule diameter (ND), the degree of risk of nodular location (DRN), recurrent laryngeal nerve (RLN) injury were associated with thyroid nodule recurrence after RFA (P<0.05). Binary logistic regression analysis showed that WNS, ND, DRN and RLN injury were independent risk factors for the recurrence of thyroid nodules after RFA (P<0.05). ROC analysis of independent factors and combined model showed that solitary nodules, nodule diameter and nodule location risk degree had diagnostic value, while RLN injury had no predictive value. The combined model is more predictive than the independent factors. Conclusions: The risk factors of recurrent thyroid nodules after radiofrequency ablation are related to WNS, ND, DRN and so on, which should be paid attention to and preventive measures should be taken.

Structural and functional differences in auto-antibody positive compared to auto-antibody negative hypothyroid patients with chronic thyroiditis

Most primary hypothyroidism in adults is caused by chronic thyroiditis. Autoantibodies such as anti-thyroglobulin antibody (TgAb) and anti-thyroid peroxidase antibody (TPOAb) are involved in the pathogenesis of chronic thyroiditis. On the other hand, the clinical features of antibody-negative hypothyroidism are not clear. In this study, we aimed to determine the prevalence of thyroid-related autoantibodies in patients with primary hypothyroidism and to evaluate the differences in thyroid structure between antibody-positive and antibody-negative hypothyroidism. Among 804 patients who attended Kawasaki Medical School Hospital for thyroid hormone abnormalities or thyroid gland enlargement between January 1, 2010 and December 31, 2021, 237 patients with primary hypothyroidism who underwent thyroid antibody measurement and thyroid ultrasound examination were included. Participants were divided into groups according to antibody positivity/negativity, and differences in antibody positivity and thyroid structure were evaluated. In this study, 34.6% of patients had antibody-negative hypothyroidism. The positive rate of each antibody was 62.0% for TgAb and 49.4% for TPOAb. The participants with antibody-positive hypothyroidism had significantly larger thyroid gland on thyroid ultrasound examination (p < 0.05). Thyroid-stimulating hormone was significantly higher in participants with antibody-positive compared to antibody-negative hypothyroidism. The present study reveals a positive rate of thyroid-related autoantibodies in patients with hypothyroidism and the differences in thyroid structure between patients with and without antibodies. This study clearly show that the prevalence of antibody-negative chronic thyroiditis is quite high among hypothyroid patients, although this point needs confirmation by further investigations. The data in this study would be useful for the treatment of antibody-negative hypothyroid patients.

No increase in translocated chromosomal aberrations, an indicator of ionizing radiation exposure, in childhood thyroid cancer in Fukushima Prefecture

To investigate the effects of radiation exposure due to the Fukushima nuclear power plant accident, following the disaster Fukushima Prefecture launched thyroid ultrasound examinations of residents who were generally younger than 18 years at the time of the earthquake. As the rate of pediatric thyroid cancer was higher than expected, we conducted biological dose assessment based on the frequency of translocated chromosome (Tr) aberrations using peripheral blood lymphocytes. Tr formation frequency was compared among the thyroid cancer (n = 38, median age 18 years, age range 12–26 years), thyroid-related disease (n = 30, median age 21 years, age range 15–28 years), and healthy controls (n = 31, median age 22 years, age range 20–23 years) groups. Tr aberration frequency was initially significantly higher in the thyroid cancer than in the other two groups; however, differences among the groups disappeared after adjusting for history of CT scan, as 92%, 67%, and 28% of those in the thyroid cancer, thyroid-related disease, and control groups, respectively, had undergone CT previously. Therefore, the significant difference in the initial number of Tr formations is presumably due to radiation exposure from CT. Accordingly, the effects of medical exposure on the chromosomes of children and adolescents should be noted.

Confounding factors and biases involved in regional differences in the detection rate of thyroid cancer in the second-round Thyroid Ultrasound Examination: the Fukushima Health Management Survey.

In response to concerns about health due to radiation exposure, the Fukushima Prefecture launched the Thyroid Ultrasound Examination program for residents aged 0-18years at the time of the earthquake. Herein, we considered the confounding factors involved in the regional differences in the development of thyroid cancer. In this study, the 242 065 individuals who participated in both first- and second-round surveys were classified into four groups by address according to their air radiation dose. The number of participants diagnosed as malignant or suspicious for malignancy by cytological examination were 17, 38, 10 and 4 with detection rates of 53.8, 27.8, 21.7 and 14.5 per 100 000 participants in Regions 1, 2, 3 and 4, respectively. Sex (P = 0.0400), age at the time of the primary examination (P < 0.0001) and interval between the first- and second-round surveys (P < 0.0001) were significantly different among the four regions, and these were suspected to be confounding factors affecting regional differences in malignant nodule detection rates. In addition, significant regional differences were observed in the participation rate in the confirmatory examination (P = 0.0037) and the fine needle aspiration cytology implementation rate (P = 0.0037), which could be potential biases. No significant regional differences in the detection of malignant nodules were found in the multivariate logistic regression analysis after adjusting for the survey interval alone or for sex, age and survey interval. The confounding factors and biases identified in this study that may have important impacts on thyroid cancer detection rate should be fully considered in future studies.

Increased prevalence of nodular thyroid disease in patients with Klinefelter syndrome

PurposeThyroid dysfunction in patients with Klinefelter syndrome (KS) remains an unresolved issue. Although low free thyroxine (FT4) levels within the normal range and normal thyroid stimulating hormone (TSH) levels have been reported, there is currently no data on nodular thyroid disease in this population. This study aims to evaluate the results of thyroid ultrasound (US) examinations in KS patients compared with healthy controls.MethodsA cohort of 122 KS and 85 age-matched healthy male controls underwent thyroid US screening and thyroid hormone analysis. According to US risk-stratification systems, nodules ≥1 cm were examined by fine needle aspiration (FNA).ResultsThyroid US detected nodular thyroid disease in 31% of KS compared to 13% of controls. No statistical differences in the maximum diameter of the largest nodules and in moderate and highly suspicious nodules were found between patients and the control group. Six KS patients and two controls with nodules underwent FNA and were confirmed as cytologically benign. In line with published data, FT4 levels were found significantly near the lower limit of the normal range compared to controls, with no differences in TSH values between the two groups. Hashimoto’s thyroiditis was diagnosed in 9% of patients with KS.ConclusionsWe observed a significantly higher prevalence of nodular thyroid disease in KS compared to the control group. The increase in nodular thyroid disease is likely linked to low levels of FT4, inappropriate TSH secretion, and/or genetic instability.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

Prevalence of incidental thyroid abnormalities in patients with degenerative cervical spondylosis: a retrospective cross-sectional magnetic resonance imaging study.

Incidental thyroid abnormalities found on magnetic resonance imaging (MRI) of the neck are not uncommon. This study aimed to investigate the prevalence of incidental thyroid abnormalities in the cervical spine MRI of the degenerative cervical spondylosis (DCS) population indicated for surgery and to identify patients who require additional workup based on the recommendations of the American College of Radiology (ACR). All consecutive patients with DCS and indications for cervical spine surgery from October 2014 to May 2019 in the Affiliated Hospital of Xuzhou Medical University were reviewed. All MRI scans of the cervical spine routinely include the thyroid. Cervical spine MRI scans were retrospectively evaluated for the prevalence, size, morphologic characteristics, and location of incidental thyroid abnormalities. A total of 1,313 patients were included in the analysis, 98 (7.5%) of whom were found to have incidental thyroid abnormalities. The most frequent thyroid abnormality was thyroid nodules (5.3%), followed by goiters (1.4%). Other thyroid abnormalities included Hashimoto thyroiditis (0.4%) and thyroid cancer (0.5%). There was a statistically significant difference in age and sex between patients with DCS with and without incidental thyroid abnormalities (P=0.018 and P=0.007). Stratified by age, the results showed that the highest incidence of incidental thyroid abnormalities was found in patients aged 71 to 80 years (12.4%). Eighteen patients (1.4%) needed further ultrasound (US) and relevant workups. Incidental thyroid abnormalities are common in cervical MRI, with a prevalence of 7.5% identified in patients with DCS. Incidental thyroid abnormalities are large or have suspicious imaging features, and further evaluation with a dedicated thyroid US examination should be completed before cervical spine surgery is undertaken.

Automatic detection and diagnosis of thyroid ultrasound images based on attention mechanism

Incidents of thyroid cancer have dramatically increased in recent years; however, early ultrasound diagnosis can reduce morbidity and mortality. The work in clinical situations relies heavily on the subjective experience of the sonographer. Numerous computer-aided diagnostic techniques exist, but most consider how good the results are, ignoring the pre-image collecting and its usefulness in post-clinical practise. To address these issues, this study proposes a computer-aided diagnosis method based on an attentional mechanism. Due to its lightweight properties, the model can rapidly identify nodules and distinguish between benign and malignant ones without using much hardware. The model uses a bounding box to locate the thyroid nodule and determines whether it is benign or cancerous, and outputs the diagnostic result of the thyroid nodule ultrasound images. The latest attention mechanisms are used to get better results at a fraction of the cost. Additionally, ultrasound images with different features of benign and malignant thyroid nodules were collected following the Thyroid Imaging Reporting and Data System standards. The experimental results showed that the approach identifies and classifies thyroid nodules rapidly and effectively; the mAP value of the results reached 0.89, and the mAP value of malignant nodules reached 0.94, with detection rate of single image reached 7 ms. Young physicians and small hospitals with limited resources can benefit from using this method to assist with thyroid ultrasound examination diagnosis.

Achievements and Current Status of the Fukushima Health Management Survey.

The Fukushima Health Management Survey (FHMS) was established in response to the Fukushima Daiichi Nuclear Power Plant accident on March 11, 2011. The primary objectives of the study are to monitor residents' long-term health and promote their future well-being, and to determine the health effects of long-term low-dose radiation exposure. This special issue summarizes the results and current status of the FHMS and discusses the challenges and future directions of the FHMS. The FHMS, a cohort study of all people who were residents in Fukushima Prefecture at the time of the accident, consists of a Basic Survey, Thyroid Ultrasound Examination, Comprehensive Health Check, Mental Health and Lifestyle Survey, and Pregnancy and Birth Survey. The radiation exposure was estimated based on the behavioral records examined using the Basic Survey. Although the response rate was low in the Basic Survey, the representativeness of the radiation exposure data was confirmed using additional surveys. There appears to be no relationship between the radiation exposure and risk of thyroid cancer, although more thyroid cancer cases were detected than initially expected. The ongoing Comprehensive Health Check and Mental Health and Lifestyle Survey have provided evidence of worsening physical and mental health status. The Pregnancy and Birth Survey showed rates of preterm delivery, low birth weight, and congenital abnormalities similar to the national average. Considering the above evidence, the Fukushima Prefectural Government decided to end the Pregnancy and Birth Survey at the end of March 2021, as recommended by the Prefectural Oversight Committee. The framework of the FHMS has not changed, but the FHMS needs to adapt according to the survey results and the changing needs of the eligible residents and municipalities.

Revisiting the Geographical Distribution of Thyroid Cancer Incidence in Fukushima Prefecture: Analysis of Data From the Second- and Third-round Thyroid Ultrasound Examination.

After the first-round (Preliminary Baseline Survey) ultrasound-based examination for thyroid cancer in response to the accident at the Fukushima Daiichi Nuclear Power Plant in 2011, two rounds of surveys (Full-scale Survey) have been carried out in Fukushima Prefecture. Using the data from these surveys, the geographical distribution of thyroid cancer incidence over 6 or 7 years after the disaster was examined. Children and adolescents who underwent the ultrasound-based examinations in the second- and/or third-round (Full-scale) survey in addition to the first-round survey were included. With a discrete survival model, we computed age, sex, and body mass index standardized incidence ratios (SIRs) for municipalities. Then, we employed spatial statistics to assess geographic clustering tendency in SIRs and Poisson regression to assess the association of SIRs with the municipal average absorbed dose to the thyroid gland at the 59-municipality level. Throughout the second- and third-round surveys, 99 thyroid cancer cases were diagnosed in the study population of 252,502 individuals. Both flexibly shaped spatial scan statistics and maximized excess events test did not detect statistically significant spatial clustering (P = 0.17 and 0.54, respectively). Poisson regression showed no significant dose-response relationship: the estimated relative risks of lowest, middle-low, middle-high, and highest areas were 1.16 (95% confidence interval [CI], 0.52-2.59), 0.55 (95% CI, 0.31-0.97), 1.05 (95% CI, 0.79-1.40), and 1.24 (95% CI, 0.89-1.74). There was no statistical support for geographic clustering or regional association with radiation dose measures of the thyroid cancer incidence in the cohort followed up to the third-round survey (fiscal years 2016-2017) in Fukushima Prefecture.

Age-specific serum thyrotropin reference range for the diagnosis of subclinical hypothyroidism and its association with lipid profiles in the elderly population

The overdiagnosis of subclinical hypothyroidism (SCH) in the elderly has driven researchers to establish age-specific thyroid stimulating hormone (TSH) intervals to precisely evaluate the prevalence of SCH. Moreover, abnormal lipid profiles, an insidious manifestation of SCH, show various impacts on different age groups. This study aimed to establish an age-specific TSH reference range to clarify the spectrum of SCH in the elderly. The prevalence of dyslipidemia and the age-specific association between TSH and lipid profiles were analyzed to elucidate the relationship between SCH and dyslipidemia. This cross-sectional study enrolled 2460 participants aged ≥ 65 years via cluster sampling. All participants received physical, laboratory tests and thyroid ultrasound examination and completed the questionnaire. The chi-square test was used to analyze variations of dyslipidemia prevalence among different groups. The Cochran-Armitage trend test was applied for testing the linear trends of age-specific prevalence of dyslipidemia among different TSH intervals in each age group. After adjusting for confounding factors, the age-specific association between TSH and lipid profiles was identified using multi-variate linear regression analysis. The TSH reference ranges in the 65–70 age group, 71–80 age group and > 80 age group were 0.65–5.51 mIU/L, 0.85–5.89 mIU/L and 0.78–6.70 mIU/L, respectively. Using these age-specific reference ranges, the prevalence of SCH in the whole population was 3.74%, which was significantly lower than the prevalence based on the laboratory reference range (10.28%). In the 65–70 age group, only the prevalence of high total cholesterol (TC) increased significantly with the age-specific TSH intervals, and TSH was positively associated with TC and low-density lipoprotein cholesterol (LDL-C). In the 71–80 and > 80 age groups, the prevalence of high TC, high triglycerides (TGs), and high LDL-C increased significantly with elevated TSH reference ranges. The levels of TC, TGs, and LDL-C were also positively associated with TSH level in 71–80 age group. However, such an association disappeared in > 80 age group. An age-specific reference range for TSH can effectively prevent the overdiagnosis of SCH in the elderly. Aging could somewhat attenuate the impact of TSH on lipid profiles.

LBSAT291 Familial Papillary Thyroid Carcinoma

Abstract Introduction Familial papillary thyroid carcinoma is a rare entity; however, it must be considered if a strong family history of non medullary thyroid carcinoma is noted. As this cancer presents earlier and with more aggressive features with each subsequent generation, a targeted diagnostic and management approach should be utilized. Case Presentation A 26 year old female presented to the PCP after sustaining head trauma while kickboxing. During the visit, she requested for thyroid evaluation due to a strong family history of thyroid cancer in her mother, maternal aunt, maternal uncle and maternal grandfather. She reported that her mother was diagnosed with thyroid cancer at the age of 40 years; however, she was unaware of further details. She denied any personal history of cancer or exposure to radiation. An extensive review of systems was negative. TSH was within the normal range 2.65 uIU/ml (0.40 - 4. 0). Thyroid ultrasound showed a 1.1 cm nodule in the right thyroid lobe with microcalcifications suspicious for malignancy. Fine needle aspiration cytology of the nodule confirmed papillary thyroid carcinoma. A preoperative CT neck and soft tissue was negative for cervical lymphadenopathy per size criteria. She underwent a total thyroidectomy with neck dissection. Surgical pathology report showed 1.8 cm right thyroid lobe papillary carcinoma and 13 lymph nodes positive for metastatic carcinoma, the largest measuring 0.4 cm. Post-operatively, she underwent radio-active iodide therapy and was started on Levothyroxine supplementation. She was closely monitored with serial thyroid function tests, thyroglobulin levels and thyroid ultrasound examinations. Tempus XT positive for BRAF and FOXP1. Approximately one year after the surgery, serum thyroglobulin levels started to plateau. A surveillance thyroid ultrasound was concerning for left lobe thyroid tissue remnant/cancer. Thus, a radio-active iodine total body scan was planned to locate the remnant thyroid tissue followed by biopsy and excision in case of recurrent cancer. Discussion Papillary thyroid cancer runs in families and becomes more aggressive with each subsequent generation. The American Thyroid Association guidelines detail that screening with thyroid ultrasound should be considered in families with three or more family members affected by familial non medullary thyroid cancer. In addition, certain mutations such as the BRAF mutation are associated with aggressive clinicopathological characteristics and high tumor recurrence. There is limited data available on the FOXP1; however, it may also be linked to an aggressive course. Therefore, screening ultrasound should be offered in such patients and FNAC samples should be sent for genetic analysis to help formulate an appropriate treatment plan. These patients benefit from receiving early screening, more intensive management and frequent follow up. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Possible Association Between Thyroid Nodule Formation and Developmental Alterations in the Pituitary-Thyroid Hormone Axis in Children and Adolescents: The Fukushima Health Management Survey.

Background: We previously found low thyrotropin (TSH) levels in children and adolescents with thyroid nodules, including papillary thyroid cancer, although it is generally accepted that high TSH levels are a risk factor for formation and growth of thyroid nodules in adults. To clarify the reasons for the discrepancy, we precisely analyzed the features of pituitary-thyroid hormone (TH) actions in children and adolescents with or without nodules at different ages. Methods: Among the 4955 participants who participated in a second screening by thyroid ultrasound examination in the Fukushima Health Management Survey, 721 and 2849 euthyroid participants aged 6-20 years without or with nodules, including thyroid cancer, were selected for evaluation of TH regulation. The responsivity of TSH to THs was assessed by two thyroid feedback quantile-based indices (T4FQI and T3FQI). Logistic regression analyses were conducted to calculate the odds ratios (ORs) of serum concentrations related to thyroid functions for positive thyroid nodules compared with negative nodules. Results: The feedback indices declined in a sex-specific manner with aging. In particular, T3FQI, the index for TSH response to free triiodothyronine (fT3), started to decline after ∼10 and 15 years of age in female and male participants, respectively. Compared with the absence of nodules, the age- and sex-adjusted ORs (confidence intervals) for logTSH, free thyroxine (fT4), fT3, T4FQI, T3FQI, and thyroglobulin levels were 0.586 (0.501-0.685), 1.036 (0.595-1.805), 1.059 (0.842-1.332), 0.569 (0.454-0.715), 0.564 (0.443-0.719), and 1.01 (1.005-1.014), respectively. Associations between the presence of nodules and either low logTSH or low feedback indices were observed in participants aged between 12 and 17 years among the total cohort. Conclusions: The relationships between the levels of TSH and THs changed in a sex-dependent manner in children and adolescents. The age-dependent shift in the pituitary-TH set point may be associated with age-dependent nodule formation during restricted periods of growth and maturation in both young female and male participants.

Combination of thyroid ultrasound examination (TIRADS) and survivin gene mRNA expression to determine the type of thyroid nodule

Background: Ultrasound plays a significant role in determining the diagnosis of thyroid nodules. The thyroid ultrasound examination is operator dependent, so the Thyroid Imaging Reporting and Data System (TIRADS) method were developed. However, until now TIRADS has not been able to replace the Fine Needle Aspiration (FNA) examination in determining the type of benign or malignant thyroid nodule, so it is necessary to find alternative biomarkers that can be used to increase the sensitivity and specificity of TIRADS. In this study, the mRNA expression of the survivin gene in thyroid nodules was examined in combination with TIRADS so that it is expected to increase the diagnostic value. Method: This study is a diagnostic test with a cross sectional design on 51 patients with thyroid nodules in 5 hospitals on the island of Lombok. Subjects who met the inclusion and exclusion criteria were subjected to TIRADS examination using an ultrasound machine and mRNA expression of the survivin gene using cubital vein blood samples with polymerase chain reaction (PCR). Result: The characteristics of the research subjects were dominated by female sex with age 40 years, TIRADS 3 and histology of benign thyroid nodules. Analysis using the ROC curve obtained TIRADS has a sensitivity of 94.4%, specificity 39.4%, accuracy 58.82%, Positive Predictive Value (PPV) 45.9%, Negative Predictive Value (NPV) 92.9%. While Survivin has 100% sensitivity, 60.6% specificity, 58.1% accuracy, 58.1% PPV, 100% NPV. In the serial combination of TIRADS and survivin, there was an increase in the diagnostic value, namely sensitivity 94.4%, specificity 75.8%, accuracy 82.35%, PPV 68%, NPV 96.2%. Conclusion: The combination of TIRADS and survivin can increase the diagnostic value in determining the type of thyroid nodule

Is Chinese Thyroid Imaging Reporting and Data Systems superior to American College of Radiology or American Thyroid Association guidelines for consistency and efficacy in the diagnosis of thyroid cancer?

Is Chinese Thyroid Imaging Reporting and Data Systems superior to American College of Radiology or American Thyroid Association guidelines for consistency and efficacy in the diagnosis of thyroid cancer?