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At least 127 records · Page 7Linked to original sources
PubMed2000

Thyroid nodules: rational management.

Thyroid nodules are the commonest disorder presenting to the endocrine surgeon. Most of the lesions are benign, but the principal problem facing the clinician is that of identifying the malignant nodule requiring surgery. Current diagnostic methods are reviewed, and the role of intraoperative frozen section in particular is examined in a series of 155 patients undergoing thyroidectomy for solitary thyroid nodule. It is concluded that when the fine-needle aspiration cytology (FNA) result is malignant intraoperative frozen section is unnecessary and contributes little to the management. Frozen section, however, is considered to be of value when the FNA result is reported as benign, suspicious, or inadequate. It permits identification of many malignant lesions that would otherwise require a second operation to complete a total thyroidectomy. Details of the indications for surgery and the operative strategy are discussed.

Biopsy, Needle↗
PubMed1999

Galectin-3 and CD44v6 isoforms in the preoperative evaluation of thyroid nodules.

PURPOSE: Thyroid cancer is the most frequently occurring endocrine malignancy; however, preoperative diagnosis of some lesions, in particular those with follicular histology, is difficult, and a consistent number of not otherwise-specified "follicular nodules" are surgically resected more for diagnosis than therapeutic purposes. In this study, we investigated whether the lectin-related molecules CD44v6 and galectin-3, the expression of which is altered during deregulated cell growth and malignant transformation, could be potential markers for improving the diagnostic accuracy of conventional cytology. MATERIALS AND METHODS: A comparative immuno-chemical and molecular analysis was performed on 157 thyroid specimens representative of normal, benign, and malignant tissues, and on 36 cytologic samples obtained preoperatively by fine-needle aspiration biopsy from nonselected patients with palpable thyroid nodules. RESULTS: Normal thyrocytes did not express galectin-3 nor CD44v6. Although the expression of CD44v6 isnegligible in thyroiditis, these molecules are variably detected in benign and malignant proliferative lesions. Interestingly, galectin-3 is never expressed in benign lesions, but it is invariably detected in cancers. A comparative evaluation of CD44v6 and galectin-3 expression in thyroid malignancies demonstrated that these molecules are coexpressed at the messenger RNA and protein level in almost all lesions. CONCLUSION: Our findings suggest that CD44v6 and galectin-3 could be potential markers to preoperatively identify malignant transformed thyrocytes. Immunodetection of these molecules on cytologic specimens obtained by fine-needle aspiration biopsy is an accurate and improved method for selecting, on a molecular basis, those nodular lesions of the thyroid gland that need to be surgically resected.

Adenoma↗
PubMed1995

Controversies in the management of cold, hot, and occult thyroid nodules.

Some aspects of thyroid nodule evaluation and management remain controversial. Radionuclide scanning provides functional information about nodules and differentiates cold from hot nodules. Although thyroid cancers are cold on scan, most cold nodules are benign. Ultrasonography visualizes the thyroid gland and nodules with remarkable clarity and provides structural information about location, number, size, and consistency of nodules. Widespread application of ultrasonography has resulted in the frequent discovery of incidental (occult) nodules in the general population. The clinical significance of these nodules remains unknown, and their management has created a dilemma for physicians. Current cost-effective evaluation of nodules does not include scanning or ultrasonography as routine frontline tests. In most centers, fine-needle aspiration biopsy has supplanted imaging studies as the routine initial procedure for differentiating benign from malignant nodules. Cytologic diagnosis is reliable and inexpensive, and it results in a better selection of patients for surgery. Limitations include false-negative diagnoses, nondiagnostic results, and indeterminate "suspicious" results. Laboratory test results are usually normal, but determination of serum thyrotropin may identify a hot nodule, and plasma calcitonin may help diagnose medullary thyroid carcinoma. Treatment of thyroid nodules is controversial. In some practices, benign colloid nodules are treated with suppressive doses of levothyroxine. Recent reports cast doubt on the efficacy of this approach, and it is no longer acceptable to select patients for surgical treatment on the basis of suppressive therapy. Furthermore, suppressive levothyroxine therapy may be associated with significant bone and cardiac side effects, especially in elderly patients and postmenopausal women. Our approach is observation for most patients, and we suggest a careful risk-benefit analysis when suppression is considered. Hot (autonomous) nodules can be treated with radioiodine, surgery, or ethanol injection. The use of sensitive thyrotropin assays has revealed that the "euthyroid" hot nodule is often associated with subclinical hyperthyroidism, warranting treatment if risks of osteoporosis are significant. Small (< 1.5 cm) occult nodules can be observed. Larger (> 1.5 cm) nodules can be selectively evaluated by ultrasonographically guided fine-needle aspiration. It is prudent to consider cost of care, risk-benefit analysis, and the low incidence of malignancy in thyroid nodules when diagnostic tests are selected and the treatment plan is outlined.

Biopsy, Needle↗
PubMed1996

Thyroid nodules and the detection of thyroid cancer.

Although thyroid nodules are common and cause concern about possible malignancy, relatively few are thyroid cancers, and relatively few thyroid cancers are lethal. These considerations justify a selective approach in recommending surgical excision of nodules. Selection of patients should be based on assessment of cancer risk factors in the history and physical examination, and most importantly on fine-needle aspiration biopsy of the thyroid with cytologic examination. Other testing in most cases should be limited to serum thyroid-stimulating hormone and antithyroid antibodies and a thyroid sonogram. With the results of this evaluation a recommendation can be made for either immediate surgery or observation. This approach should reduce the number of operations for benign thyroid nodules and avoid excessive diagnostic testing.

Adult↗
PubMed1982

The thyroid nodule.

Solitary cold thyroid nodules occur in approximately 4% to 7% of adults. The diagnostic workup should be designed to predict the likelihood of malignancy. The presence of risk factors for carcinoma raises the index of suspicion and should prompt consideration of surgical excision of the nodule. An orderly sequence of diagnostic tests should be performed in every patient with a thyroid nodule, and additional special tests may be needed under specified clinical circumstances. With careful selection high risk patients can be referred for neck exploration and low risk patients can be followed without operation.

Adenocarcinoma↗
PubMed1993

Influence of frequency of previous pregnancies on the prevalence of thyroid nodules in women without clinical evidence of thyroid disease.

In a region with insufficient alimentary iodine supply (Kiel, Northern Germany) the prevalence of thyroid nodules was studied by means of ultrasonography in 212 healthy women (36-50 years old) in four groups of 53 women each with 0, 1, 2, and 3-5 previous pregnancies. Goiters were found in 28.3% (15 of 53) of the women without children and in 28.9% (46 of 159) of the women with children. There was no significant increase of goiter prevalence according to the number of pregnancies. We detected thyroid nodules in 21.2% (45 of 212). Only 9.4% (5 of 53) of the women without previous pregnancies had thyroid nodules, but 25.1% (40 of 159) of the women with pregnancies in the past had nodules, the difference being statistically significant (p < 0.05). We observed nodules in 11 of 53 women with 1 child (20.7%), in 11 of 53 women with 2 children (20.7%), and in 18 of 53 women with 3-5 previous pregnancies (33.9%). We propose that, in regions with borderline or insufficient alimentary iodine supply, accentuated iodine deficiency during pregnancies due to increase of iodine requirement is a probable cause for the higher prevalence of thyroid nodules in women with previous pregnancies.

Adult↗
PubMedDate not supplied

Thyroid hormones homeostasis and TSH in autonomic thyroid nodule.

Thirty patients with autonomic thyroid nodules were studied. Thyroid scintigram, iodine uptake at 2 and 24 hrs, PBI, total thyroxine, serum T3(RIA), basal TSH and 30 minutes after TRH administration were performed. A lack of concordance was found between the clinical signs and the laboratory data. According to the data obtained the patients were grouped into 3 categories: having 1) autonomic thyroid nodules with normal PBI, T4t, T3 values and absent or diminished TSH response to TRH; 2) autonomic thyroid nodules with increased T3 secretion and no response to TRH despite a normal T4 and iodine uptake, 3) hyperfunctional autonomic nodules in which PBI, T4t, T3 and iodine uptake are increased. TSH response to TRH is the most sensitive test for hyperthyroidism, more sensitive than the circulating thyroid hormones assay, and best fitted for adequate therapeutic management. Serum triiodothyronine was found to be increased in 95% of the patients. Thus, there is a T3 thyreotoxicosis in most of the autonomic nodules. TRH test and serum T3 assay being essential elements in starting the treatment, they have to be included among the tests used in autonomic thyroid nodules investigation.

Adenoma↗
PubMed1999

Increased thyroid epithelial cell proliferation in toxic thyroid nodules.

Most toxic thyroid nodules (TTN) result from clonal expansion of a single cell caused by a somatic mutation in the thyrotropin (TSH) receptor, the Gsalpha protein, or yet unknown proteins. Expanding a single cell into a TTN with thousands of cells suggests a prolonged increase in proliferation compared to nonaffected surrounding cells. To test this hypothesis, we evaluated cell proliferation in TTN. Tissue from 20 TTN and their surrounding normal thyroid tissue was studied for the occurrence of the proliferating cell nuclear antigen (PCNA) and Ki-67 epitope as markers for cell proliferation. The labeling index (number of labeled cells versus total cell number) for nodular and surrounding tissue was calculated. Nineteen samples were evaluated for PCNA immunohistochemistry. In 16 TTN, a significant (p< or =0.05%) up to 3-fold increase in the labeling index for PCNA was detectable. In only 3 toxic nodules (2 without a detectable TSH receptor or Gsalpha protein mutation), we found no significant difference in the labeling index compared to the surrounding tissue. Because labeling for KI-67 was much lower, only 16 toxic thyroid nodules were quantified. Twelve of these showed significantly (p< or =0.05%) increased labeling indices. The increase of the labeling index for both markers was similar for histologically defined adenoma versus adenomatous nodule or nodules with or without TSH receptor mutation or clonal versus polyclonal origin of toxic nodules studied. These findings are evidence that an increased thyroid epithelial cell proliferation is a uniform feature common to most TTNs, independent of their histopathological or molecular characteristics. Although increased proliferation in many TTNs is very likely the result of TSH receptor mutations, the cause of increased proliferation in TTN without a mutation is unknown.

Cell Division↗
PubMed1997

[Thyroid nodules--differential diagnosis guidelines].

Thyroid nodules are common. The vast majority of those represent hyperplastic or adenomatous nodules, true follicular adenomas, or malignant tumours. Due to the clinical relevance, the main task of the pathologist is thus to exclude or demonstrate malignancy preoperatively by fine needle aspiration (FNA) cytology, intraoperatively by frozen section diagnosis, and postoperatively by conventional histological examination. In this paper guidelines for the diagnosis and differential diagnosis of thyroid nodules are formulated. Features for the diagnosis of thyroid carcinomas include papillary structures, the characteristic cytological changes of papillary carcinoma, vascular invasion and/or capsular invasion. However, the evaluation of thyroid nodules still depends on routine cytological or histological specimens since no modern techniques are currently available to distinguish in particular benign from malignant nodules.

Biopsy, Needle↗
PubMed1980

Suppressive therapy for postirradiation thyroid nodules.

From the thyroid screening program at the Roswell Park Memorial Institute in Buffalo, New York, 85 patients with thyroid nodules who had received previous irradiation to the head and neck were identified. The diagnosis was confirmed microscopically by needle aspiration cytology and the patients were treated with thyroid replacement therapy. In 24 patients, the nodules disappeared completely; a partial response (more than 50% reduction in size) was seen in 26; 11 patients were improved (20% to 50% reduction in size); 14 had stable disease (less than 20% reduction in nodule size) and in 10 the condition progressed (an increase of more than 20% in nodule size). Six of 21 patients who underwent operation had well differentiated tumours. The number of cases of Hashimoto's thyroiditis (14) was high. Suppressive therapy will separate those patients whose nodules will disappear completely and who will thus be spared operation. Continued follow-up of such patients is essential. All other patients should be offered operation since thyroid nodules are malignant in 30% of cases.

Adenocarcinoma↗
PubMed1992

Thyroid nodules in pregnancy.

Thyroid nodules are common in pregnant women. Most of them are benign. Toxic autonomous nodules may be seen infrequently, and the diagnosis is supported by elevated free thyroid hormone levels and undetectable levels of TSH. The most common and most important problem is the diagnosis of thyroid cancer. FNB is the most reliable diagnostic tool. FNB findings also can be used to indicate the urgency for surgery and the appropriate extent of the operation when surgery is indicated. Best use of FNB data requires that the cytopathologist provide tissue diagnoses and that there has been enough experience to permit reasonable inferences of cancer probability for each diagnosis.

Adenocarcinoma↗
PubMed2003

The clinical significance of an isofunctioning thyroid nodule.

The management of an "isofunctioning" thyroid nodule--defined by radioiodine uptake equivalent to normal thyroid tissue--is often a dilemma. Our goal was to determine the percentage of thyroid nodules that were isofunctioning and the frequency with which carcinoma occurred in an isofunctioning nodule. Patients referred for evaluation of a thyroid nodule from 1990 to 2002 were reviewed and those with an iodine-123 thyroid scintiscan were identified. Nodule size, serum thyrotropin, fine-needle aspiration biopsy, pathology, and follow-up were determined for patients with an isofunctioning, hypofunctioning, or hyperfunctioning thyroid nodule. Of the 562 patients with a thyroid nodule 273 (49%) had a thyroid scan. Nodules were hypofunctioning in 232 (85%), isofunctioning in 29 (11%), and hyperfunctioning in 12 (4%) patients. Mean nodule size and serum thyrotropin level were respectively 2.49 +/- 0.23 cm and 1.73 +/- 0.26 microIU/mL for isofunctioning, 2.47 +/- 0.31 cm and 0.83 +/- 0.21 microIU/mL for hyperfunctioning, and 3.94 +/- 0.13 cm and 1.86 +/- 0.28 pIU/mL for hypofunctioning nodules. Seventeen patients with an isofunctioning nodule underwent thyroidectomy and 12 patients were followed for a mean 27 months without an increase in nodule size. No patient with a hyperfunctioning nodule, six patients (21%) with an isofunctioning nodule, and 44 patients (19%) with a hypofunctioning nodule had a carcinoma. We conclude that the risk of malignancy in an isofunctioning nodule is similar to that of a hypofunctioning nodule and therefore the management should be based on routine fine-needle aspiration biopsy.

Algorithms↗
PubMed1996

[Management of a thyroid nodule].

Whenever a thyroid nodule is detected, the crucial question is whether it is benign or malignant. Apart from surgery, the most accurate assessment is provided by cytologic result. Provided the limitations and constraints of the procedure are understood, especially the need to repeat fine needle aspiration biopsy with time and to have the specimens read by highly experienced cytologists a significant number of surgical operations can be avoided according to circumstances. Except in some special cases, scintigraphy may be discarded because echography is more accessible, lest costly and more discriminating with regard to the surrounding parenchyma. Also, it is not necessary to prescribe hormonal therapy either before or after surgery, if the gland remains under euthyroid conditions; the epidemiological data available are not conclusive enough to justify such a prescription.

Biopsy, Needle↗
PubMed1995

Thyroid nodules in the elderly.

Thyroid nodules in the elderly are more frequent and more frequently malignant. Fine needle aspiration is the first step to diagnose these type of nodules, and thyroid scans and ultrasounds may be obtained in special cases. Thyroid suppression is frequently not effective in decreasing the size of the nodule and may cause subclinical or clinical thyrotoxicosis. It is not uncommon to discover that what initially was thought to be a solitary nodule is only the dominant nodule of a multinodular goiter.

Aged↗