Histologic Findings and Cytological Alterations in Thyroid Nodules After Radioactive Iodine Treatment for Graves’ Disease: A Diagnostic Dilemma

Unlike the well-documented relation between radiation to the neck and development of papillary thyroid carcinoma, a causal association between radioactive iodine treatment for Graves’ disease and development of thyroid malignancy is less defined. However, patients with a background of thyroid dysfunction presenting with clinically palpable thyroid nodules are followed more closely than the average population, and fine needle aspiration is recommended in such circumstances. Cytological examination of aspirates, and histologic examination of tissue provided from patients with a known history of Graves’ disease, managed by radioactive iodine therapy can create a diagnostic dilemma, as the distinction between radiation effect and a malignant primary thyroid neoplasm can be very challenging. Thus, pathologists should be aware of the existence of these changes in the setting of radiation therapy for Graves’ disease. Providing pathologists with appropriate clinical history of Graves’ disease treated with radioactive iodine is of paramount importance in order to prevent an overdiagnosis of malignancy.

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Management of Thyroid Nodules in Deceased Donors With Comparison Between Fine Needle Aspiration and Intraoperative Frozen Section in the Setting of Transplantation

Progress in Transplantation ◽

10.1177/1526924819873898 ◽

2019 ◽

Vol 29 (4) ◽

pp. 316-320 ◽

Cited By ~ 1

Author(s):

Albino Eccher ◽

Ilaria Girolami ◽

Antonia D’Errico ◽

Gianluigi Zaza ◽

Amedeo Carraro ◽

...

Keyword(s):

Fine Needle Aspiration ◽

Thyroid Nodules ◽

Frozen Section ◽

Clinical History ◽

Needle Aspiration ◽

Transmission Risk ◽

Fine Needle ◽

Intraoperative Frozen Section ◽

History Of ◽

Deceased Donors

Introduction: Newly discovered thyroid nodules in deceased donors are investigated to rule out cancer that can be transmitted, but there are no established protocols. The aim of the study was to compare fine needle aspiration versus intraoperative frozen section in the donor management with limited time. Methods: Data were extracted only from the records of Italian second opinion consultation service in the years 2016 to 2017 and included donor details, pathology diagnoses, complications, transmission risk profile, and impact on transplantation. Results: Among 31 deceased donors with thyroid nodules, we documented 4 with a clinical history of cancer and 27 with a newly discovered nodule. The latter was evaluated by thyroidectomy with frozen section in 22 and fine needle aspiration in 5. Among all donors, 7 had papillary thyroid carcinoma with negligible transmission risk, whereas 8 with unacceptable risk. Two donors presented major bleeding after thyroidectomy, with organ discard in 1 case. Transplantation was delayed in 4 cases that were evaluated with frozen section. Discussion: There was no uniform approach for the investigation of thyroid nodules. Our results showed that fine needle aspiration was more accurate and useful than frozen section. Fine needle aspiration had minor economic impact and a far less rate of bleeding/hemodynamic complications, potentially delaying and compromising organ recovery. Our results suggested considering fine needle aspiration as a first step in the evaluation of thyroid nodules in donors.

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Adherence to Guideline Recommendations in Patients with Thyroid Nodules

Kansas Journal of Medicine ◽

10.17161/kjm.v10i1.8639 ◽

2019 ◽

Vol 10 (1) ◽

pp. 1-2

Author(s):

Rudruidee Karnchanasorn ◽

Kristine Grdinovac ◽

Nichole Smith ◽

Bhairvi Jani ◽

G. John Chen

Keyword(s):

Thyroid Cancer ◽

Thyroid Nodules ◽

Retrospective Chart Review ◽

Standard Of Care ◽

Clinical History ◽

Daily Practice ◽

Needle Aspiration ◽

History Of ◽

Work Up ◽

Current Guidelines

Introduction. Thyroid nodules are common and fine-needleaspiration (FNA) biopsy is the standard of care for workupto exclude thyroid cancer. In this study, we examinedthe discrepancy between daily practice and recommendeddiagnostic approach for management of thyroid nodules,based on history taking, laboratory, and imaging studies. Methods. This was a retrospective chart review of 199 patientswho had ultrasound-guided fine needle aspiration(UGFNA) performed at a Midwest academic medicalcenter from January 2010 to December 2011. Thequality measures were selected based on recommended clinicalpractice guidelines, including family history, history of neckradiation, neck symptoms, TSH test, and thyroid ultrasound. Results. The majority of patients were Caucasian females. Familyhistory of thyroid cancer and childhood neck radiation exposurewere documented in 79 subjects (40%) and 76 subjects(38%), respectively. Neck symptoms were documented in mostsubjects, including dysphonia (56.8%), dysphagia (69.9%), anddyspnea (41.2%). Most subjects had a TSH measured and an ultrasoundperformed prior to biopsy (75% and 86%, respectively). Conclusions. It appears there is a gap between current patientcare and clinical practice guidelines for management of thyroidnodules. Clinical history and ultrasound features for risk stratificationof UGFNA were lacking, which could reflect physicians’unfamiliarity with the guidelines. As thyroid nodules are common,enhancing knowledge of the current guidelines could improveappropriate work-up. Further studies are needed to identifyfactors associated with the poor compliance with clinical guidelinesin management of thyroid nodules. KS J Med 2017;10(1):1-2.

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Oral steroid prophylaxis for Graves’ orbitopathy after radioactive iodine treatment for Graves’ disease is not only effective, but also safe

Journal of Endocrinological Investigation ◽

10.1007/s40618-019-01126-2 ◽

2019 ◽

Vol 43 (3) ◽

pp. 381-383 ◽

Cited By ~ 2

Author(s):

S. Rosetti ◽

M. L. Tanda ◽

G. Veronesi ◽

E. Masiello ◽

P. Premoli ◽

...

Keyword(s):

Radioactive Iodine ◽

Oral Steroid ◽

Graves Disease ◽

Graves Orbitopathy ◽

Iodine Treatment

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Contemporary Management of Thyroid Nodules

Annual Review of Medicine ◽

10.1146/annurev-med-042220-015032 ◽

2021 ◽

Vol 73 (1) ◽

Author(s):

Kristen Kobaly ◽

Caroline S. Kim ◽

Susan J. Mandel

Keyword(s):

Thyroid Nodules ◽

Cervical Lymphadenopathy ◽

Standard Technique ◽

Clinical History ◽

Needle Aspiration ◽

Annual Review ◽

Publication Date ◽

Molecular Testing ◽

Risk Of Malignancy ◽

Indeterminate Cytology

Thyroid nodules are common in the general population, with higher prevalence in women and with advancing age. Approximately 5% of thyroid nodules are malignant; the majority of this subset represents papillary thyroid cancer. Ultrasonography is the standard technique to assess the underlying thyroid parenchyma, characterize the features of thyroid nodules, and evaluate for abnormal cervical lymphadenopathy. Various risk stratification systems exist to categorize the risk of malignancy based on the ultrasound appearance of a thyroid nodule. Nodules are selected for fine-needle aspiration biopsy on the basis of ultrasound features, size, and high-risk clinical history. Cytology results are classified by the Bethesda system into six categories ranging from benign to malignant. When cytology is indeterminate, molecular testing can further risk-stratify patients for observation or surgery. Surveillance is indicated for nodules with benign cytology, indeterminate cytology with reassuring molecular testing, or non-biopsied nodules without a benign sonographic appearance. Expected final online publication date for the Annual Review of Medicine, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

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Quality of Life Is Worse at 6-10 Years after Radioactive Iodine Treatment of Graves’ Disease as Compared with Antithyroid Drugs or Surgery

Clinical Thyroidology ◽

10.1089/ct.2019;31.144-147 ◽

2019 ◽

Vol 31 (4) ◽

pp. 144-147

Author(s):

Sun Y. Lee

Keyword(s):

Quality Of Life ◽

Radioactive Iodine ◽

Antithyroid Drugs ◽

Graves Disease ◽

Iodine Treatment

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When thyroid labs do not add up, physicians should ask patients about biotin supplements

BMJ Case Reports ◽

10.1136/bcr-2019-231337 ◽

2020 ◽

Vol 13 (3) ◽

pp. e231337

Author(s):

Michael S Lundin ◽

Ahmad Alratroot ◽

Fawzi Abu Rous ◽

Saleh Aldasouqi

Keyword(s):

Thyroid Function ◽

Dose Adjustment ◽

Radioactive Iodine ◽

Graves Disease ◽

Thyroid Function Tests ◽

Medication List ◽

Function Tests ◽

Extensive Evaluation ◽

History Of ◽

Radioactive Iodine Ablation

A 69-year-old woman with a remote history of Graves’ disease treated with radioactive iodine ablation, who was maintained on a stable dose of levothyroxine for 15 years, presented with abnormal and fluctuating thyroid function tests which were confusing. After extensive evaluation, no diagnosis could be made, and it became difficult to optimise the levothyroxine dose, until we became aware of the recently recognised biotin-induced lab interference. It was then noticed that her medication list included biotin 10 mg two times per day. After holding the biotin and repeating the thyroid function tests, the labs made more sense, and the patient was easily made euthyroid with appropriate dose adjustment. We also investigated our own laboratory, and identified the thyroid labs that are performed with biotin-containing assays and developed strategies to increase the awareness about this lab artefact in our clinics.

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A SWOLLEN MIDDLE FINGER IN A MIDDLE-AGED FARMER

Hand Surgery ◽

10.1142/s0218810412720112 ◽

2012 ◽

Vol 17 (01) ◽

pp. 121-123 ◽

Cited By ~ 1

Author(s):

Somprakas Basu ◽

Shilpi Bhadani ◽

Vijay Kumar Shukla

Keyword(s):

Proximal Phalanx ◽

Middle Finger ◽

Needle Aspiration ◽

Excision Biopsy ◽

Middle Aged ◽

Cytological Examination ◽

Diagnostic Dilemma ◽

X Ray ◽

The Right ◽

Bony Erosion

Hand tumors are not common and a swollen finger poses considerable diagnostic dilemma. We present a case of a middle-aged farmer who had presented with a painless swelling of the middle finger of the right hand without any neurovascular deficit or evidence of metastasis. An X-ray of the finger showed cortical expansion and bony erosion of the proximal phalanx. A fine needle aspiration cytological examination was inconclusive. He underwent a digit amputation in view of subsequent morbidity and chances of recurrence following local excision. Biopsy proved it to be a giant cell tumor of the proximal phalanx. Following six months of treatment he is doing well. We herein highlight an unusual tumor of the finger and its diagnostic and treatment challenges.

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