A Rare Case of Systemic Sarcoidosis in a Middle-Aged Female with a Solitary Thyroid Nodule

Sarcoidosis is a multisystem inflammatory disease characterized by the presence of noncaseating granulomas. Sarcoidosis can affect any organ of the body, the lung being the most affected. Sarcoidosis rarely affects the thyroid gland, and only a few cases of thyroid-related sarcoidosis have been reported in the literature. Herein, we report a case of systemic sarcoidosis with multiple organ involvement in a patient with a solitary left thyroid nodule and benign Fine Needle Aspiration (FNA) findings. The patient was eventually diagnosed with thyroid sarcoidosis using a core needle biopsy of the thyroid nodule. With this case report, we highlight the limitations of the FNA. This case report has the objective to encourage clinicians to include thyroid sarcoidosis in the differential diagnosis of thyroid nodules in patients with systemic sarcoidosis even with unremarkable FNA findings.

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Comparison of surgeon-performed ultrasound-guided fine needle aspiration cytology with histopathological diagnosis of thyroid nodules

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.4.537 ◽

2019 ◽

Vol 35 (4) ◽

Cited By ~ 2

Author(s):

Muhammad Ayoob Jat

Keyword(s):

Thyroid Nodule ◽

Fine Needle Aspiration ◽

Thyroid Nodules ◽

Needle Aspiration ◽

Histopathological Diagnosis ◽

Ultrasound Guided ◽

Aspiration Cytology ◽

Fine Needle ◽

Solitary Thyroid Nodule ◽

Needle Aspiration Cytology

Objective: To assess the Solitary thyroid nodules by surgeon-performed ultrasound-guided FNAC and evaluate with the histopathological findings. Methods: This study includes 100 Consecutive patients of a solitary thyroid nodule which were presented to the Outpatients Department of Surgery during the period of two years from September 2016 to August 2018. Exclusion criteria were patients with extra-thyroid swelling, diffuse goiter and multinodular goiter. All patients with a solitary thyroid nodule underwent Surgeon –performed ultrasound-guided FNAC in the department of Radiology. After thyroid surgery, thyroid specimens were sent for histopathology and evaluate with FNAC findings. Results: The study included hundred patients with solitary thyroid nodule, 75(75%) female and 25 (25%) male with a ratio of F 3:1M. The age of the patients ranged from 15-75 years with a mean age of 35 years. The result of 100 cases of Surgeon –performed Ultrasound –guide FNAC of a solitary thyroid nodule were inconclusive in 10 cases (10%), Non-neoplastic in 60 cases (60%) and Neoplastic lesions in 30 cases (30%). After evaluation of findings from FNAC and histopathology, four cases with benign FNAC (adenomatous/colloid Goiter) turnout as neoplastic (papillary carcinoma) on histopathology and six cases with neoplastic FNAC (papillary carcinoma), just two cases turnout as benign (nodular colloid goiter with cystic degeneration) on histopathology. In present study Surgeon – performed Us FNAC has found to be 87.5% sensitive, 95.3% specific and 92.0% diagnostic accuracy. Conclusion: Surgeon – performed Ultrasound-guided FNAC is a safe, simple and accurate technique in the diagnosis of solitary thyroid nodule. doi: https://doi.org/10.12669/pjms.35.4.537 How to cite this:Jat MA. Comparison of surgeon-performed ultrasound-guided fine needle aspiration cytology with histopathological diagnosis of thyroid nodules. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.537 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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FNAC IN THE MANAGEMENT OF SOLITARY THYROID NODULE

The Professional Medical Journal ◽

10.29309/tpmj/2006.13.04.4934 ◽

2006 ◽

Vol 13 (04) ◽

pp. 596-603

Author(s):

SOHAIL RAZA ◽

HAMAD RAZA ◽

ZAHID SAEED ◽

Mubasher Ahmed

Keyword(s):

Thyroid Nodule ◽

Thyroid Nodules ◽

Fine Needle Aspiration Biopsy ◽

Cost Effective ◽

Needle Aspiration ◽

Military Hospital ◽

Solitary Thyroid Nodule ◽

Benign Nodules ◽

Histopathological Results

Objective: To determine the significant role of FNAC upon other diagnosticmodalities in pre-operative investigations of patients presenting with solitary thyroid nodules and to compare the postoperative histopathological results with the results of FNAC. Design: A Comparative study. Place and Duration ofStudy: Department of Surgery Combined Military Hospital Quetta and Combined Military Hospital Rawalpindi fromDecember 1999 to December 2001. Patients and Methods: In this study 46 patients with solitary thyroid nodule werestudied. Only 2 patients were toxic while remaining 44 were with euthyroid. In this study only one case was suspectedto be malignant clinically out of 5 malignant cases. All 46 patients under went thyroid scanning, ultrasound examinationand fine needle aspiration biopsy and the diagnostic accuracy was assessed. Results: 36 patients (78.26%) wereoperated while 10(21.73%) were managed conservatively. There were 5(10.86%) malignant nodules while 41(89.13%)were benign. All the 5 cases with malignancy were with ‘cold’ nodules on scan as most of others, while ‘solid’ onultrasound examination and so were most of other benign nodules. All cases diagnosed malignant pre-operatively onFNAC, proved to be malignant on histopathology after surgery and the others diagnosed as benign on FNAC provedto be benign. Conclusion: This study shows that conventional investigations for evaluation of solitary thyroid nodulesare inaccurate in identifying the malignant from the benign nodules and their routine use in such patients should beabandoned, while the use of FNAC should be encouraged more in our hospitals as this technique is with high degreeof sensitivity and specificity, cost effective and safe.

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Technetium scintigraphy as a predictive tool of thyroid malignancy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20171183 ◽

2017 ◽

Vol 3 (2) ◽

pp. 308

Author(s):

Sanjeev Mohanty ◽

Sreenivas . ◽

Vinay Raj T. ◽

Devipriya . ◽

Vinoth M.

Keyword(s):

Thyroid Nodule ◽

Fine Needle Aspiration ◽

Fine Needle Aspiration Cytology ◽

Thyroid Nodules ◽

Needle Aspiration ◽

Aspiration Cytology ◽

Fine Needle ◽

Solitary Thyroid Nodule ◽

Needle Aspiration Cytology ◽

Cold Nodule

Background: Thyromegaly is a common cause of physician consultation. Solitary thyroid nodules are conventionally viewed with suspicion. Clinical examination cannot reliably distinguish between a solitary thyroid nodule and a dominant nodule in multinodular goiter. Ultrasonographical examination has its own pitfalls. Technetium 99 is a commonly used modality for the functional assessment of solitary thyroid nodule detection. It has the advantage of low cost with lower radiation dose to the exposed patients. On literature search, studies on technetium 99 scintigraphy for thyroid in context to the Indian scenario do not yield much information and very few studies are notable. This study was conducted to correlate and qualify thyroid cold nodule as detected by Technetium 99 pertechnetate thyroid scan. This study was conducted to correlate, qualify and compare the predictive value of Technetium 99 pertechnetate scintigraphy on solitary thyroid nodule via fine needle aspiration cytology and to countercheck with histopathological examination. Methods: A prospective cohort study in a NABH, NAAC and JCI accredited tertiary care teaching university hospital was conducted over a period of 36 months. All the subjects underwent clinical assessment of the neck included standard examination techniques to segregate solitary thyroid nodules. They were then subjected to Technetium 99 pertechnate scintigraphy using the standard protocol. All the patients with solitary cold nodule underwent FNAC followed by nodule excision or hemi-thyroidectomy under general anaesthesia. All the specimens underwent histo-pathological examination by an experienced histopathologist. The results were statistically analysed using pearson chi-square test. Results: Cold nodules as detected by Technetium 99 pertechnetate thyroid scan is a reasonable indicator of probable malignancy via fine needle aspiration cytology. Occurrence of cold nodules is highest in 3rd to 5th decade of life (21-50 year age group). Occurrence of cold nodules is higher in females (83%) whereas occurrence of malignancy in cold nodules is higher in males (85%). Occurrence of malignancy in cold nodules is higher in subjects less than 21 and above 50 years. Conclusions: Technetium 99m pertechnetate thyroid scintigraphy is an important preoperative tool in management of thyroid nodules and its routine use in all such patients is recommended especially to rule out cold nodules.

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Survey of management of solitary thyroid nodules in Germany

Nuklearmedizin ◽

10.3413/nukmed-0136 ◽

2008 ◽

Vol 47 (03) ◽

pp. 87-96

Author(s):

K. Wegscheider ◽

R. Vaupel ◽

M. Schmidt ◽

H. Schicha ◽

M. Dietlein

Keyword(s):

Thyroid Nodule ◽

Thyroid Nodules ◽

Radioiodine Therapy ◽

Needle Aspiration ◽

Test Cases ◽

Standard Procedures ◽

Solitary Thyroid Nodule ◽

Differences Of Opinion ◽

Needle Aspiration Cytology ◽

Different Levels

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

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Clinicopathological study of solitary thyroid nodule in Kolhan belt of Jharkhand

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212115 ◽

2021 ◽

Vol 7 (6) ◽

pp. 959

Author(s):

Rajeev Saxena ◽

Shiwani Kanth ◽

Rohit Kumar Jha ◽

Devandra Jee

Keyword(s):

Diagnostic Accuracy ◽

Thyroid Nodule ◽

Predictive Value ◽

Thyroid Nodules ◽

Histopathological Examination ◽

Follicular Adenoma ◽

Daily Practice ◽

Needle Aspiration ◽

Age Group ◽

Solitary Thyroid Nodule

Background: Thyroid disorders are commonly encountered in our daily practice and specially in countries like India and Nepal (foothill areas). There are variety of lesions that can arise within thyroid gland. In such scenario it is important to diagnose neoplastic and non-neoplastic conditions accurately with minimum complications so that proper management can be done as early as possible. The aim of the study was to know clinical spectrum of solitary thyroid nodules and diagnostic accuracy of fine needle aspiration cytology as compared to histopathological examination.Methods: We conducted our study over a period of 21 months from July 2018 to March 2020. 74 patients who gave consent and presented with solitary thyroid swelling were included in the study. Results: In our study, cases mostly presented in the age group of 31-40 years with a female preponderance. Colloid goiter was the most common pathology which presented as solitary thyroid nodule. Among neoplastic lesions, follicular adenoma was the most common benign neoplasia with papillary thyroid carcinoma being the most common malignancy. FNAC had sensitivity of 78%, specificity-100%, positive predictive value-100%, negative predictive value-88% and diagnostic accuracy-92%.Conclusions: Majority of solitary thyroid nodules are found in females of middle age group. In our study we found FNAC as valuable diagnostic tool specially in benign cases.

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Correlation of Fine Needle Aspiration Cytology with Histopathology in the Diagnosis of Solitary Thyroid Nodule

Journal of Thyroid Research ◽

10.4061/2010/379051 ◽

2010 ◽

Vol 2010 ◽

pp. 1-5 ◽

Cited By ~ 30

Author(s):

Manoj Gupta ◽

Savita Gupta ◽

Ved Bhushan Gupta

Keyword(s):

Thyroid Nodule ◽

Fine Needle Aspiration ◽

Fine Needle Aspiration Cytology ◽

Thyroid Nodules ◽

Cost Effective ◽

Needle Aspiration ◽

Aspiration Cytology ◽

Fine Needle ◽

Solitary Thyroid Nodule ◽

Needle Aspiration Cytology

Background. Fine needle aspiration cytology is considered the gold standard diagnostic test for the diagnosis of thyroid nodules. Fine needle aspiration cytology is a cost effective procedure that provides specific diagnosis rapidly with minimal complications. Based on the cytology findings, patients can be followed in cases of benign diagnosis and subjected to surgery in cases of malignant diagnosis thereby decreasing the rate of unnecessary surgery. Purpose of the present study was to correlate the fine needle aspiration cytology findings with histopathology of excised specimens.Material and Methods. This was a prospective study conducted on 75 consecutive patients between January 2003 and December 2005. All patients with clinically diagnosed solitary thyroid nodule who were clinically and biochemically euthyroid were included for study. Patients with multinodular goitre and who were hypothyroid or hyperthyroid were excluded from the study.Results. The sensitivity, specificity, accuracy, false positive rate, false negative rate, positive predictive value, and negative predictive value of FNAC for the diagnosis of neoplastic solitary thyroid nodules were 80%, 86.6%, 13.3%, 20%, 80%, and 86.6%, respectively. Commonest malignancy detected was papillary carcinoma in 12 patients.Conclusions. Fine needle aspiration cytology is a simple, easy to perform, cost effective, and easily repeated procedure for the diagnosis of thyroid cancer. It is recommended as the first line investigation for the diagnosis of solitary thyroid nodule.

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Role of Midkine in Predicting Malignancy in Patient with Solitary Thyroid Nodule

Journal of Cancer and Tumor International ◽

10.9734/jcti/2019/v9i230102 ◽

2019 ◽

pp. 1-10

Author(s):

Nesma A. Ibrahim ◽

Ahmed M. Hamam

Keyword(s):

Thyroid Nodule ◽

Thyroid Nodules ◽

Clinical Problem ◽

Needle Aspiration ◽

Heparin Binding ◽

Significant Difference ◽

Solitary Thyroid Nodule ◽

Needle Aspiration Cytology ◽

Benign Nodules

Background: Solitary thyroid nodules are a common clinical problem. None of sonographic features is sufficient to discard or detect malignancy efficiently. Midkine is a novel heparin-binding growth factor, plays critical roles in carcinogenesis. In this study, we aimed to evaluate serum midkine levels in patients with solitary thyroid nodules to predict malignancy. Methods: A total of 100 patients who had solitary thyroid nodules were enrolled in the study. Serum midkine levels were measured. Fine needle aspiration cytology was done to all nodules (25 suspicious/ malignant and 75 benign). Results: Serum midkine levels were significantly higher in patients who had nodules with the following sonographic features; hypoechoic nodules compared to isoechoic and hyperechoic nodules (P=0.024), nodules with microcalcification compared to nodules with macrocalcification or without calcification (P = 0.011), nodules with irregular borders compared to nodules with regular borders (P = 0.014) and nodules more than 2 cm in length than shorter ones (P = 0.011). Serum midkine levels were also higher in nodules with absent halo compared to those with clear halo but with no significant difference (P = 0.660). Also, levels of serum medikine were significantly higher in suspicious/ malignant nodules than in benign nodules (P < 0.001). Conclusion: Serum midkine can predict malignancy in solitary thyroid nodule and also well correlated with sonographic features of thyroid nodules. We suggest that midkine levels may serve as a novel biochemarker in association with sonographic features in evaluation of solitary thyroid nodules.

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Factors to consider when comparing the diagnostic performance of fine-needle aspiration and core-needle biopsy for thyroid nodules

Endocrine ◽

10.1007/s12020-020-02562-4 ◽

2021 ◽

Author(s):

Dong Gyu Na

Keyword(s):

Fine Needle Aspiration ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Diagnostic Performance ◽

Thyroid Nodules ◽

Needle Aspiration ◽

Core Needle ◽

Fine Needle

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Choosing the best algorithm among five thyroid nodule ultrasound scores: from performance to cytology sparing—a single-center retrospective study in a large cohort

European Radiology ◽

10.1007/s00330-021-07703-5 ◽

2021 ◽

Author(s):

Clotilde Sparano ◽

Valentina Verdiani ◽

Cinzia Pupilli ◽

Giuliano Perigli ◽

Benedetta Badii ◽

...

Keyword(s):

Thyroid Nodule ◽

Thyroid Nodules ◽

Real Life ◽

Scoring Systems ◽

Diagnostic Procedures ◽

Needle Aspiration ◽

Common Disease ◽

Single Center ◽

Thyroid Microcarcinoma ◽

Thyroid Malignancies

Abstract Objective Incidental diagnosis of thyroid nodules, and therefore of thyroid cancer, has definitely increased in recent years, but the mortality rate for thyroid malignancies remains very low. Within this landscape of overdiagnosis, several nodule ultrasound scores (NUS) have been proposed to reduce unnecessary diagnostic procedures. Our aim was to verify the suitability of five main NUS. Methods This single-center, retrospective, observational study analyzed a total number of 6474 valid cytologies. A full clinical and US description of the thyroid gland and nodules was performed. We retrospectively applied five available NUS: KTIRADS, ATA, AACE/ACE-AME, EUTIRADS, and ACRTIRADS. Thereafter, we calculated the sensitivity, specificity, PPV, and NPV, along with the number of possible fine-needle aspiration (FNA) sparing, according to each NUS algorithm and to clustering risk classes within three macro-groups (low, intermediate, and high risk). Results In a real-life setting of thyroid nodule management, available NUS scoring systems show good accuracy at ROC analysis (AUC up to 0.647) and higher NPV (up to 96%). The ability in FNA sparing ranges from 10 to 38% and reaches 44.2% of potential FNA economization in the low-risk macro-group. Considering our cohort, ACRTIRADS and AACE/ACE-AME scores provide the best compromise in terms of accuracy and spared cytology. Conclusions Despite several limitations, available NUS do appear to assist physicians in clinical practice. In the context of a common disease, such as thyroid nodules, higher accuracy and NPV are desirable NUS features. Further improvements in NUS sensitivity and specificity are attainable future goals to optimize nodule management. Key Points • Thyroid nodule ultrasound scores do assist clinicians in real practice. • Ultrasound scores reduce unnecessary diagnostic procedures, containing indolent thyroid microcarcinoma overdiagnosis. • The variable malignancy risk of the “indeterminate” category negatively influences score’s performance in real-life management of thyroid lesions.

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Can sonographic features of microcalcification predict thyroid nodule malignancy? a prospective observational study

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00498-x ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Mehrdad Nabahati ◽

Rahele Mehraeen ◽

Zoleika Moazezi ◽

Naser Ghaemian

Keyword(s):

Thyroid Nodule ◽

Roc Analysis ◽

Thyroid Nodules ◽

Area Under The Curve ◽

Positive Association ◽

Needle Aspiration ◽

Northern Iran ◽

Significant Positive Association ◽

Irregular Margin ◽

Benign Nodules

Abstract Background The aim of this study was to investigate the diagnostic accuracy of microcalcification, as well as its associated sonographic features, for prediction of thyroid nodule malignancy. We prospectively assessed the patients with thyroid nodule, who underwent ultrasound-guided fine-needle aspiration during 2017–2020 in Babol, northern Iran. The ultrasonographic characteristics of the nodules, as well as their cytological results, were recorded. We used regression analysis to evaluate the relation between sonographic findings and nodule malignancy. A receiver operator characteristics (ROC) analysis was also used to estimate the ability of ultrasound to predict the characteristic features of malignancy, as estimated by the area under the curve (AUC). Results Overall, 1129 thyroid nodules were finally included in the study, of which 452 (40%) had microcalcification. A significant positive association was found between nodule malignancy and microcalcification in both univariate (OR=3.626, 95% CI 2.258–5.822) and multivariable regression analyses (OR=1.878, 95% CI 1.095–3.219). In the nodules with microcalcification, significant positive relations were seen between malignancy and hypoechogenicity (OR=3.833, 95% CI 1.032–14.238), >5 microcalcification number (OR=3.045, 95% CI 1.328–6.982), irregular margin (OR=3.341, 95% CI 1.078–10.352), and lobulated margin (OR=5.727, 95% CI 1.934–16.959). The ROC analysis indicated that AUC for hypoechogenicity, >5 microcalcification number, irregular margin, and lobulated margin were 60%, 62%, 55%, and 60%, respectively, in predicting malignant thyroid nodules. Conclusion The findings indicated that microcalcification can be a potential predictor of thyroid nodule malignancy. Also, the presence of irregular or lobulated margins, multiple intranodular microcalcification (>5 microcalcifications), and/or hypoechogenicity can improve the ability of microcalcification in distinguishing malignant from benign nodules.

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