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PubMed1982

Solid thyroid nodules.

The management of solitary thyroid nodules remains controversial, A series of 120 patients having operation for a solitary thyroid nodule is retrospectively reviewed. Neoplasia rate was found to be 29.1 per cent and the malignancy rate, 11.7 percent. These are compared with other studies emphasizing the use of thyroid imaging with radioactive substances or ultrasonography and invasive techniques such as fine needle aspiration where the yields of neoplasia and malignancy are, respectively 18-65 per cent and 8-29 per cent. Current techniques allow identification of solitary nonfunctioning and solid nodules, and operation for these should increase the yield of cancer while reserving thyroid suppression and possibly fine needle aspiration for the management of other lesions.

Adenoma↗
PubMed2002

Diagnosis and management of patients with thyroid nodules.

Fewer than 5% of all adults will have a palpable thyroid nodule, but this is still a large number of individuals who require evaluation. Although most thyroid nodules are a result of a benign disease process (more than 95%), the possibility of thyroid cancer is always a consideration. Important aspects of history taking with a patient in whom a thyroid nodule has been noted include age, gender, family history of thyroid or endocrine disease, prior low dosage head and neck radiation, recent hoarseness, dysphagia, and symptoms of hypermetabolism. Key features of evaluation by physical examination are the size and location of the thyroid abnormality, the degree of firmness of the nodule, the presence of other nodules in the thyroid, palpable cervical lymph nodes, vocal cord paresis or paralysis, and tachycardia and/or tremor. The major categories of thyroid abnormality in such patients include cysts, adenomas, thyroiditis, and cancer. Although radionuclide scans, ultrasound examination and computer tomography have all been employed in the assessment of thyroid nodules, and thyroid stimulating hormone assay is useful for confirming a euthyroid state, fine needle aspiration biopsy (FNAB) has proved to be the most efficient diagnostic tool. The findings from FNAB allow avoidance of operative treatment for a large portion of these patients with palpable thyroid nodules, but a diagnosis of "follicular neoplasm" on FNAB usually requires operation, despite the fact that many such patients do ultimately prove to have a benign lesion. The extent of operation in patients undergoing surgery will depend on the diagnostic findings before operation, but unilateral thyroid lobectomy is the minimum procedure when surgery is required.

Adult↗
PubMed2003

[Cancer in thyroid nodules: evaluation of ultrasound and fine-needle aspiration biopsy].

BACKGROUND: Thyroid nodules are a very common clinical problem and fine-needle aspiration biopsy (FNAB) is its main diagnostic test. Recently, it has been shown that some ultrasonographic features are associated to an increased risk of cancer, but a comparison between FNAB and ultrasonography (US) or its combination is not available. The aim of this study was to evaluate FNAB and US performance, isolated or combined, for cancer diagnosis in thyroid nodules. METHODS: Eighty patients, with palpable solitary thyroid nodules or multinodular goiters, who were to undergo surgery, were selected among 289 patients seen in our clinic between March, 1995 and July, 1997. US and FNAB were performed by one of us. US was considered positive for cancer when microcalcifications, absent halo or hypoechogenicity were seen. FNAB was considered positive for cancer when it was either suspicious or compatible with malignancy. Both methods (FNAB and US) were evaluated in parallel combination (positive when FNAB or US was positive) and in serial combination (positive when both, FNAB and US, were positive). RESULTS: Sensitivity and specificity of FNAB and US for cancer diagnosis in thyroid nodules were, respectively, 87% and 62%, and 81% and 70%. Serial combination of FNA and US had sensitivity of 69% and specificity of 91%, and parallel combination resulted in sensitivity of 94% and specificity of 52%. CONCLUSION: The US had good accuracy in the evaluation of thyroid nodules, and can help us take some decisions in the clinical practice, supplementary to FNA. Nevertheless, the quality of the ultrasound examination depends on the experience of the examiner and on the characteristics of the equipment, so new studies are necessary to evaluate these factors to the current usage of ultrasonographic characteristics in the evaluation diagnostic of thyroid nodules.

Adenoma↗
PubMed2002

Implications of follicular neoplasms, atypia, and lesions suspicious for malignancy diagnosed by fine-needle aspiration of thyroid nodules.

OBJECTIVE: To break out subcategories of atypical and suspicious cytologic interpretations of thyroid aspirations and correlate those with final histologic diagnosis. SUMMARY BACKGROUND DATA: Fine-needle aspiration (FNA) of thyroid nodules has become the primary diagnostic tool in the initial evaluation of thyroid nodules. Management of thyroid nodules is based on statistical data correlating a specific cytologic reading with the probability of malignancy. Two particular cytologic readings that frustrate both cytopathologists and surgeons are follicular neoplasms and cells that show atypia. In most reported series, follicular neoplasms and cells showing atypia are included in a broad "suspicious" category, with reported overall malignancy rates generally between 20% and 30%. However, there is interest in determining whether these suspicious lesions can be subcategorized, allowing a more accurate assessment of the risk of malignancy. In addition, there is recent evidence that the incidence of follicular cancer may be declining in this country, possibly decreasing the probability that a "follicular neoplasm" will prove to be a follicular cancer. METHODS: From January 1994 through December 2000, 709 thyroid FNAs were performed at a single institution. Those interpreted as suspicious and the subsequent histologic reports were reviewed. From this set, four specific categories were defined, and the clinical records for patients whose cytology matched these categories form the subject of this study. These four categories are follicular neoplasms without atypia, follicular neoplasms with atypia, atypia, and suspicious for malignancy. In addition, lesions with nondiagnostic cytology were reviewed. Only lesions for which there was histologic follow-up were considered. RESULTS: Ninety-eight aspirates were categorized as follicular neoplasms without atypia, follicular neoplasms with atypia, or atypia alone. Of 74 follicular neoplasms without atypia, only 5 (6.8%) were malignant, and none of these were follicular thyroid cancers. Nine of the lesions were follicular neoplasms with atypia, and four (44.4%) of these were malignant, including two that were invasive follicular cancers. Of 15 lesions showing atypia alone, 3 (20%) were malignant, all of which were papillary thyroid cancers. Twenty-five additional patients had lesions highly suspicious for malignancy. Twenty-one (84%) of these lesions were malignant, the majority being papillary thyroid cancers. Only one was a follicular cancer. Fifty patients with nondiagnostic cytology had subsequent action taken. Thirty-one of these lesions were resected, with five (16.1%) proving to be malignant. CONCLUSIONS: Thyroid nodules whose FNA is diagnosed as highly suspicious for malignancy should be resected unless there are significant contraindications to a surgical procedure. The extremely low rate (2%) of invasive follicular cancers among all follicular neoplasms may reflect changing histologic criteria for follicular carcinoma, a true change in the disease frequency, or both. For thyroid nodules whose cytology shows a follicular neoplasm without atypia, malignancy rates of 8% or less may allow nonsurgical options, including reevaluation in selected populations. Continued efforts to correlate malignancy rates to specific cytologic criteria will allow patients to make more informed decisions regarding their medical care.

Adenocarcinoma, Follicular↗
PubMed1982

Needle biopsy in the assessment and management of hypofunctioning thyroid nodules.

Needle biopsy of hypofunctioning solitary thyroid nodules provides direct diagnostic information which would be otherwise obtainable only by surgery. The technique is safe and cost-effective. It provides a high diagnostic yield. It is also useful in planning surgery and reducing dependence on frozen-section diagnosis, which is often difficult with thyroid nodules. Technical and interpretative precautions are discussed. Of 192 patients undergoing this procedure, a satisfactory specimen was obtained in 95 percent. Needle aspiration biopsy (fine needle) was done in 110 patients with good cytologic correlations. Of 52 glands subsequently excised, carcinoma was present in 22 (42 percent). The preoperative diagnosis had been made in 19 (86 percent) of the latter group. This procedure is recommended for consideration in the assessment and management of hypofunctioning thyroid nodules.

Adenocarcinoma↗
PubMed1990

[New techniques of thyroid medical imaging. Value and limitations in the exploration of isolated thyroid nodules].

The exploration of thyroid nodules deals mainly with the problem of detection of malignancy. Except in the cases of characteristic clinical situations which suggest at once malignancy, classical investigations offer mostly an insufficient approach including erroneous conclusions. Scintigraphy, whose morphological definition remains limited, can miss non- or hypofixing lesions. Pharmacological tests of nodule reduction by suppression of thyreostimulin do not provide specific informations. Fine needle- biopsy cannot absolutely exclude malignancy, depending too much of the sites of punction and of the difficulties of cytological analysis. Echography brings an important progress in the precision of thyroid volume, nodules counting and gross connections. The liquid or solid characterization is an important echographic information as well. Tomodensitometry provides useful data in the retrosternal and retrotracheal areas. The connections with aerodigestive tract are more clearly pointed out and the presence of metastatic nodes as well. Magnetic resonance imaging gives further information because of the ability of multiple longitudinal slices, and of the trial of a tissular characterization from signal analysis and ultrastructural macroanatomic study. Additive precisions will be likely in the future by a more accurate determination of criteria of malignancy. The complementarity of magnetic resonance imagery and fine needle-biopsy should lead to a more frequent use of these investigations before the decision of surgical removal.

Diagnostic Imaging↗
PubMed2004

Increased incidence of thyroid carcinoma in france: a true epidemic or thyroid nodule management effects? Report from the French Thyroid Cancer Committee.

Thyroid cancer (TC) incidence, in France, has dramatically increased over the last two decades. In order to try and account for this observation, the French Department of Health requested the Public Health Agency to coordinate a multidisciplinary Thyroid Cancer Committee (TCC). The TCC analysed the temporal incidence trend in France, evaluated the contribution of changes in diagnostic practices of thyroid diseases to the observed increase of TC, and set up guidelines to improve the national surveillance system of TC. The increased incidence of TC is real (8.1% and 6.2% per year in women and in men, respectively), mainly due to papillary type with an epidemic of microcarcinomas (43% of operated cancers, period 1998-2001) associated to the extensiveness of thyroidectomies. Multicentric studies showed a significant increase, from 1980 to 2000, in ultrasonographic (3 to 84.8%) and cytological procedures (8 to 36% of patients with thyroid nodules) as well as a significant association between the increase in TC prevalence among operated patients (12.5 to 37%) and the spread of fine needle aspiration. Epidemiological evidence does not favour any link with the Chernobyl accident. The TCC recommended a national registry dedicated to thyroid cancer of the youths ( <18 years old). For adults, in addition with the strengthening of the French regional registries, a continuous registration of incident cases through the National Hospital Discharge Survey that covers all the territories is proposed. Such system, matched with pathological data derived from a national standardized collection, will provide a relevant model for epidemiological surveys of TC.

Carcinoma, Papillary↗
PubMed1995

[Thyroid nodule in Basedow-Graves disease and thyroid cancer: experience in 6 patients].

Traditionally, Basedow-Graves disease was considered a protection against thyroid cancer. However, recent reports suggest that cancer occurs with a higher frequency than expected and is more aggressive in this disease. We report six patients with hyperthyroidism due to a Basedow Graves disease that presented a palpable thyroid nodule, which was cold in the scintiscan and solid in the ultrasound examination. Fine needle cytology disclosed cancer in five cases (two with cytological features of greater aggressiveness) and a nodular hyperplasia in one. The diagnosis was confirmed in the surgical piece in all patients. We conclude that Basedow-Graves disease and thyroid cancer, which can have an increased aggressiveness, may coexist.

Adolescent↗
PubMed1977

[Diagnosis of cold thyroid nodules by 201T1 scientigraphy].

Fifty two patients with cold thyroid nodule demonstrated on the thyroid scan were imaged with 201Tl which were given intravenously as thallium chloride in dose of 2 mCi. Thirty nine of 52 patients were confirmed and investigated whether 201Tl concentrated or not. Fourteen of 15 (93 percent) thyroid carcinomas, 5 of 17 (29 percent) thyroid adenomas, 1 of 2 adenomatous goiters and all of 5 of chronic thyroiditis were visualized as positive with 201 Tl. One thyroid carcinoma did not concentrate 201Tl which was confirmed to have cystic degeneration. Of the 19 benign cold thyroid nodules except chronic thyroiditis 6 were positively visualized with 201Tl. However, 201Tl did not accumulate in the other 13 benign nodules, 11 out of which were confirmed to have cystic degeneration. The data suggests that if the thyroid nodule is found to have negative accumulation of 201Tl, malignancy can be ruled out except a small microscopical lesion.

Adenocarcinoma↗
PubMed1997

Efficacy of fine-needle aspiration biopsy of thyroid nodules: experience of a Mexican institution.

In most centers only selected patients with high risk thyroid nodules undergo thyroid surgery, and fine needle aspiration biopsy (FNA) is used to select patients for surgical treatment. The aim of the present study was to evaluate the impact of FNA on the management of thyroid nodules at our institution. A total of 872 patients who underwent FNA over a period of 7 years were retrospectively analyzed. There were 66 men and 806 women with a mean age of 40 +/- 15 years. Altogether 549 patients presented with a thyroid nodule and 323 with multinodular disease. The sensitivity and specificity of FNA were 90.0% and 99.8%, respectively. The positive and negative predictive values were 98% and 99%, respectively, and the accuracy was 99%. Our results are in agreement with those of other reports establishing that FNA of the thyroid is safe, reliable, and effective for differentiating benign from malignant nodules.

Adolescent↗
PubMed2003

Intra-thyroid thyroglossal duct cyst as a differential diagnosis of thyroid nodule.

An intra-thyroid thyroglossal duct cyst (ITTDC) presented as a congenital anterior neck mass in a 10-year-old male. Diagnosis, work-up, management approach, and differential diagnosis of thyroid nodules are discussed, as well as distinguishing features between thyroglossal duct cyst (TDC) and branchial cleft cyst (BCC). This is the fourth case of ITTDC reported in the pediatric population, and ITTDC should remain in the differential diagnosis of pediatric neck mass.

Biopsy, Needle↗
PubMed1993

Percutaneous ultrasound-guided ethanol injection: a new treatment of toxic autonomously functioning thyroid nodules?

Twenty autonomously functioning thyroid nodules were treated with ultrasound-guided percutaneous ethanol injection (PEI) and followed for 12 months. PEI was performed on symptomatic and biochemically proven thyrotoxic patients by injecting 2.0-4.0 mL sterile ethanol and was repeated 3-8 times, depending on nodule size. Serum thyroglobulin increased immediately after PEI, peaked at 6-10 h, and declined thereafter. Free T4 progressed slowly during the first 24 h. Free T3 showed a delayed and not significant increase. By the end of the treatment (4 weeks), PEI had produced clinical improvement and hormonal normalization. Three months later, serum TSH was detectable and responsive to TRH in 17 of the 20 patients. All nodules had a significant shrinkage at ultrasound evaluation. The previous hot thyroid areas manifested hypofunction at technetium-99 m-pertechnetate scintiscan, and the surrounding parenchyma returned to normal function in all but the 3 cases with still suppressed TSH. The histological features of a nodule that had been operated upon and the fine needle aspiration biopsy patterns obtained after PEI showed coagulative necrosis, with scanty follicles, some fibroblasts, but no lymphocytic infiltration. The procedure was generally well tolerated, but in 1 case it induced temporary dysphonia, and in another patient, it caused a transient exacerbation of thyrotoxicosis.

Adult↗
PubMed1999

The role of fine-needle aspiration biopsy in the management of thyroid nodules in children, adolescents, and young adults: a multi-institutional study.

Thyroid nodules in children are extremely uncommon and in most cases present as asymptomatic neck masses. The significance of a thyroid nodule in a child involves the underlying risk of malignancy. The purpose of this study was to assess the validity of results of fine-needle aspiration biopsy (FNAB) of thyroid nodules in the pediatric population and its usefulness in pediatric patient management. FNAB was performed on a total of 57 thyroid nodules from 57 patients between 1992 and 1997. The patients included 46 females and 11 males ranging in age from 9 to 20 years (average 16.5 years). Surgical and/or clinical follow up was available in all patients. FNAB diagnoses included papillary thyroid carcinoma (PTC) (12.3% [7/57]), follicular neoplasm (FN) (15.8% [9/57]), atypical cytology (8.8% [5/57]) and nonneoplastic thyroid (63.2% [36/57]). Surgical follow-up available in all patients with cytological diagnoses of PTC, FN, and atypical cytology revealed malignancy in 13 cases. Of the 36 patients with nonneoplastic cytological diagnosis, surgical excision was performed in 3 patients and the rest were followed up clinically. Surgical excision in these 3 patients revealed follicular carcinoma (FC) (1 case) and multinodular goiter (2 cases). Overall, 14 patients (24.6%) had malignant thyroid lesions, including 11 PTC and 3 FC. In conclusion, the majority of pediatric thyroid nodules are benign. The prevalence of malignancy in pediatric patients with thyroid nodules in our series was 24.6%. High diagnostic accuracy of thyroid FNAB improves selection of pediatric patients requiring surgery.

Adenoma↗
PubMed2002

A comparison of total thyroidectomy and lobectomy in the treatment of dominant thyroid nodules.

Patients with a clinically concerning dominant thyroid nodule have been managed by lobectomy or total thyroidectomy at our institution. We determined the complications associated with both approaches and the ability of thyroid lobectomy to avoid the need for thyroid hormone replacement therapy. Records of all patients with a dominant thyroid nodule managed with surgery from August 1993 through December 2000 were reviewed for demographics, history of head and neck radiation, indication for surgery, preoperative fine-needle aspirate results, final pathologic evaluation, perioperative complications, determinations of need for subsequent thyroid surgery after lobectomy, and need for thyroid hormone replacement therapy after surgery. Patients with a preoperative diagnosis of malignancy or bilateral or diffuse disease were excluded because these conditions would uniformly be managed by bilateral thyroidectomy. The complications for the lobectomy group (n = 131) compared with the total thyroidectomy group (n = 84) were: recurrent laryngeal nerve paresis (4.6% vs 2.4%), recurrent laryngeal nerve injury (0.8% vs 0), and transient hypoparathyroidism (1.5% vs 9.5%; P = 0.007). No permanent hypoparathyroidism was identified in either group. Postoperative thyroid hormone replacement was required in 64 of 131 lobectomy patients (48.8%). Complications associated with either surgery were low. Total thyroidectomy was not associated with clinically significant additive morbidity. Patients treated by lobectomy should be aware of a nearly 50 per cent chance of requiring thyroid hormone replacement. Total thyroidectomy avoids future thyroid surgery; lobectomy patients remain at risk. When complications can be minimized total thyroidectomy should be considered an option in the management for patients with dominant thyroid nodules that require surgery.

Adenocarcinoma↗
PubMed2000

Multicentre study of thyroid nodules in patients with Graves' disease.

BACKGROUND: The association of Graves' disease with thyroid nodules and thyroid carcinoma is rarely reported. The incidence seems to be increasing according to recent literature. The aim of this multicentre study was to review patients who had surgery for Graves' disease associated with thyroid nodules, and to evaluate the risk of thyroid carcinoma. METHODS: A retrospective study was made of 557 consecutive patients who underwent operation for Graves' disease between 1991 and 1997 in five endocrine surgery departments. Each patient underwent clinical, biochemical, ultrasonographic and scintigraphic evaluation. None of the patients had had previous radioactive iodine therapy or external irradiation. Surgery consisted of either a subtotal or total thyroidectomy. RESULTS: Nodules were observed before operation in 140 patients (25.1 per cent). Thyroid carcinoma was diagnosed in 21 patients (15.0 per cent), always inside a nodule. The incidence of thyroid carcinoma associated with Graves' disease was 3.8 per cent (21 of 557 patients): 20 papillary and one follicular carcinoma. The carcinoma was multifocal in two patients. Tumour diameter ranged from 2 to 25 mm. A nodule was palpable in four patients. CONCLUSION: This multicentre study of patients having thyroidectomy for Graves' disease showed that 3.8 per cent had a carcinoma; the rate of carcinoma in cold nodules was 15.0 per cent. Surgery should be advised in any patient with Graves' disease and a thyroid nodule; the operation should be total thyroidectomy.

Adolescent↗