scholarly journals Should Mode of Presentation Influence Interpretation of Thyroid Nodule Ultrasounds?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A870-A871
Author(s):  
Lisa Stevens ◽  
Peter M Davoren
Keyword(s):  
Medical Records ◽  
Thyroid Nodules ◽  
Final Diagnosis ◽  
Gold Coast ◽  
University Hospital ◽  
Risk Of Malignancy ◽  
Neck Lump ◽  
Work Up ◽  
Patient Presentation ◽  
Unnecessary Testing

Abstract Background: The American College of Radiology (ACR) TI-RADS is a standardized scoring system for thyroid ultrasound reports providing recommendations on the need for fine needle aspirations (FNAs) independent of patient presentation. Aim: The aim of this audit was to determine if the initial presentation of the patient should be considered during the work-up of thyroid nodules. Methods: Data was collected from electronic medical records on 133 patients who underwent thyroid FNAs (165 FNAs in total) and 98 patients who had thyroid surgery for the management of thyroid nodules at Gold Coast University Hospital from Jan 1st 2019 – Dec 31st 2019. Patient presentation, adequacy of the ultrasound report and FNA results were recorded. These results were aligned with final diagnosis after surgery. Results: 98 patients underwent surgery and 29 (29.6%) were found to have malignant nodules, including 12 (12.2%) with microcarcinomas. Of the 29 malignancies, 16 patients presented with a palpable neck lump. Conclusions: Our data suggests a palpable neck lump is a significant factor in determining the risk of malignancy. It may be possible to adjust the current TI-RADS algorithm used to interpret thyroid ultrasounds to include patient presentation. This would reduce unnecessary testing and burden on the healthcare system.

scholarly journals Diagnosis delay of Duchenne Muscular Dystrophy

2004 ◽  
Vol 4 (2) ◽  
pp. 179-183 ◽  
Author(s):  
Alexandra Prufer de Queiroz Campos Araújo ◽  
Mariana Castro de Deco ◽  
Beatriz de Sá Klôh ◽  
Mariana Rangel da Costa ◽  
Fernanda Veiga de Góis ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Duchenne Muscular Dystrophy ◽  
Muscular Dystrophy ◽  
Clinical Features ◽  
Medical Records ◽  
Dystrophin Gene ◽  
Final Diagnosis ◽  
University Hospital ◽  
Diagnosis Delay ◽  
Diagnosis Age

OBJECTIVES: to study the clinical features of Duchenne Muscular Dystrophy with emphasis on diagnosis delay. METHODS: an observational descriptive retrospective study was performed using medical records of patients with diagnosis of Duchenne Muscular Dystrophy given in the period from 1989 to 2000 at the neuropediatric out-patient clinic of a University Hospital. RESULTS: immunohistochemical results or deletion on the dystrophin gene confirmed the diagnosis of the 78 boys included in this study. Parents had noticed the first symptoms since the median age of two years. The final diagnosis was reached at a median age of seven. CONCLUSIONS: diagnosis age is closer to the age of ambulation loss than that of the first symptoms. There is a marked delay for the diagnosis of this disease in our setting.

Incidental Thyroid Nodules Found During Acute Stroke Angiography: Prevalence, Outcomes, and Suggested Management Guidelines

2021 ◽  
pp. 875647932110184
Author(s):  
Diana M. Lin ◽  
Yurany A. Arevalo ◽  
Chen Lin
Keyword(s):  
Thyroid Cancer ◽  
Acute Stroke ◽  
Thyroid Nodules ◽  
Study Cohort ◽  
Stroke Work ◽  
Management Guidelines ◽  
Risk Of Malignancy ◽  
Thyroid Cancer Risk ◽  
Work Up

Objective: In stroke patients, extensive interventions for incidental thyroid nodules can be burdensome and costly. It appears that the risk of malignancy has not been reported in angiographically detected nodules and outcomes have not yet been described in patients, receiving acute stroke work-up. Materials and Methods: Incidental thyroid nodules were found on neck computerized tomography angiography or magnetic resonance angiography performed during inpatient stroke workup (January 2017 to September 2019). These patient cases were reviewed based on sonography reports, diagnosis, and follow-up care. Results: Of the 13 563 patients, 192 had incidental thyroid nodules (prevalence 1.4%). Twenty-six died from comorbidities and 22 received thyroid sonography. Twelve nodules from 10 patients had sonographic characteristics for biopsy: 10 benign, 1 indeterminate, and 1 papillary thyroid cancer (risk of malignancy: 8%). The cancer patient underwent hemithyroidectomy and is disease-free. Follow-up of the remaining patients showed no worsening or suspicious nodules. The American College of Radiology (ACR) guidelines would have prevented 8 unnecessary sonograms and 1 biopsy without missing malignancy. Conclusion: Although a small risk of malignancy was noted, 95% of patients undergoing additional diagnostic thyroid testing had clinically insignificant results. The ACR guidelines can prevent unnecessary interventions. Given the 14% mortality rate in the study cohort, it is proposed that a clinical evaluation of patients is important before undergoing further diagnostics, as comorbidities may be worse than a thyroid cancer.

scholarly journals A case series and review on pediatric thyroid nodules

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Anju Sukumaran ◽  
Valiparambil B Praveen Kumar
Keyword(s):  
Primary Care ◽  
Thyroid Nodules ◽  
Case Series ◽  
Primary Care Providers ◽  
Close Monitoring ◽  
Care Providers ◽  
Long Term Follow Up ◽  
Risk Of Malignancy ◽  
Work Up

Thyroid nodules have a higher risk of malignancy in children and hence need close monitoring. Primary care providers often obtain the initial thyroid work up. Once there patients are referred to specialists, primary providers are unsure about subsequent management and follow up. We present here three cases of thyroid nodules with different initial presentation, diagnosis and management. This article provides a good brief summary about thyroid nodule and reiterates the importance of long term follow up of these patients by primary care provider and endocrinologists.

scholarly journals MULTINODULAR GOITER;

2013 ◽  
Vol 20 (06) ◽  
pp. 1035-1041
Author(s):  
ZULFIQAR ALI BHATTI, ◽  
JAVED AHMED PHULPOTO, ◽  
NOOR AHMED SHAIKH,
Keyword(s):  
Multinodular Goiter ◽  
Prospective Observational Study ◽  
Thyroid Nodules ◽  
Significant Risk ◽  
Nodular Goiter ◽  
University Hospital ◽  
Risk Of Malignancy ◽  
The Common ◽  
Thyroid Profile ◽  
Surgical Unit

Objective: The object of this study was to determine the frequency and type of thyroid carcinoma in Multi nodular goiter(MNG) after surgical resection on histopathological basis. Introduction: Multi nodular goiter (MNG) is one of the common presentationsof various thyroid diseases. Thyroid nodules have been reported to be found in 4% to 7% of the population on neck palpation. Although incomparison to solitary nodule, the risk of malignancy in MNG is low but certain studies are showing significant risk. Material andmethods: This prospective, observational study was carried out in the surgical unit I of Ghulam Mohammad Mahar Medical collegehospital sukkur from 2007 to 2012. 94 cases with clinical diagnosis of MNG were analyzed during this period. All the patients wereadmitted through opd with routine investigations plus investigations specific to thyroid including thyroid profile, thyroid scan, FNAC ofdominant nodule before being subjected to surgery. All FNACs were carried out at agha khan university hospital Karachi. Histopathologyof operated specimen was the main criteria for malignancy. Results: Among the 94 cases which were included in this study, 9 (9.5%)cases containing foci of malignancy. Incidence of malignancy commonly occurs in females, papillary carcinoma is being the commonestentity. Conclusions: The incidence of malignancy in MNG in this study is 9.5% that is quite high. So people should be educated andencouraged to attend the thyroid clinics for proper evaluation and early diagnosis of Malignancy.

scholarly journals Radiomics analysis improves 18FDG PET/CT-based risk stratification of cytologically indeterminate thyroid nodules

Endocrine ◽  
2021 ◽  
Author(s):  
Luca Giovanella ◽  
Lisa Milan ◽  
Arnoldo Piccardo ◽  
Gianluca Bottoni ◽  
Marco Cuzzocrea ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Predictive Performance ◽  
Final Diagnosis ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Lesion ◽  
Interpretation Criteria ◽  
18Fdg Pet ◽  
Pet Ct ◽  
Risk Of Malignancy ◽  
Fdg Pet Ct

Abstract Purpose As ~25% of cytologically indeterminate thyroid nodules harbour malignancy, diagnostic lobectomy is still performed in many cases. 18FDG PET/CT rules out malignancy in visually negative nodules; however, none of the currently available interpretation criteria differentiates malignant from benign 18FDG-avid nodules. We evaluated the ability of PET metrics and radiomics features (RFs) to predict final diagnosis of 18FDG-avid cytologically indeterminate thyroid nodules. Methods Seventy-eight patients were retrospectively included. After volumetric segmentation of each thyroid lesion, 4 PET metrics and 107 RFs were extracted. A logistic regression was performed including thyroid stimulating hormone, PET metrics, and RFs to assess their predictive performance. A linear combination of the resulting parameters generated a radiomics score (RS) that was matched with cytology classes (Bethesda III and IV) and compared with final diagnosis. Results Two RFs (shape_Sphericity and glcm_Autocorrelation) differentiated malignant from benign lesions. A predictive model integrating RS and cytology classes effectively stratified the risk of malignancy. The prevalence of thyroid cancer increased from 5 to 37% and 79% in accordance with the number (score 0, 1 or 2, respectively) of positive biomarkers. Conclusions Our multiparametric model may be useful for reducing the number of diagnostic lobectomies with advantages in terms of costs and quality of life for patients.

scholarly journals Radiomics analysis improves 18FDG PET/CT-based risk stratification of cytologically indeterminate thyroid nodules

2021 ◽  
Author(s):  
Luca Giovanella ◽  
Lisa Milan ◽  
Arnoldo Piccardo ◽  
Gianluca Bottoni ◽  
Marco Cuzzocrea ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Predictive Performance ◽  
Final Diagnosis ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Lesion ◽  
Interpretation Criteria ◽  
18Fdg Pet ◽  
Pet Ct ◽  
Risk Of Malignancy ◽  
Fdg Pet Ct

Abstract Purpose As ~ 25% of cytologically indeterminate thyroid nodules harbour malignancy, diagnostic lobectomy is still performed in many cases. 18FDG PET/CT rules out malignancy in visually negative nodules; however, none of the currently available interpretation criteria differentiates malignant from benign 18FDG-avid nodules. We evaluated the ability of PET metrics and radiomics features (RFs) to predict final diagnosis of 18FDG-avid cytologically indeterminate thyroid nodules. Methods 78 patients were retrospectively included. After volumetric segmentation of each thyroid lesion, 4 PET metrics and 107 RFs were extracted. A logistic regression was performed including thyroid stimulating hormone, PET metrics and RFs to assess their predictive performance. A linear combination of the resulting parameters generated a radiomics score (RS) that was matched with cytology classes (Bethesda III and IV) and compared with final diagnosis. Results Two RFs (shape_Sphericity and glcm_Autocorrelation) differentiated malignant from benign lesions. A predictive model integrating RS and cytology classes effectively stratified the risk of malignancy. The prevalence of thyroid cancer increased from 5–37% and 79% in accordance with the number (score 0, 1 or 2, respectively) of positive biomarkers. Conclusion Our multiparametric model may be useful for reducing the number of diagnostic lobectomies with advantages in terms of costs and quality of life for patients.

scholarly journals Predictors of Malignancy in Patients With Thyroid Nodule(s)

2017 ◽  
Vol 8 (1) ◽  
pp. 1
Author(s):  
Islam Alatiar ◽  
Hassam Elfol ◽  
Tarek Rageh
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Surgery ◽  
Large Scale ◽  
Thyroid Nodules ◽  
Nodular Goiter ◽  
Fine Needle Biopsy ◽  
Needle Aspiration ◽  
University Hospital ◽  
Fine Needle ◽  
Risk Of Malignancy

Purpose: To detect the predictors of malignancy in patients with thyroid nodule(s). Background: Thyroid nodules are common surgical problem with 5-10% risk of malignancy. Thyroid surgery is a major operation with many complications. So, it is important to search for the predictors of malignancy in thyroid nodules to spare more benign lesions from surgery. Patients and methods: This prospective study includes 150 patients with thyroid nodule(s), all were admitted for thyroidectomy at Menoufia University Hospital. Demographic and clinical data, ultrasound, fine needle aspiration reports and final histopathology were recorded and analyzed. Patients with previous thyroid surgery or previous neck biopsy were excluded. Results: About 20% of the studied population proved to have malignant nodules on final histopathology reports. Out of 150 cases, there were 83 with multi-nodular goiter and 67 with solitary thyroid nodules. There were higher incidence of malignancy in male patients. The incidence also was higher in solitary nodules than in multinodular goiter. There were statistically significant ultrasound features differences such as; micro-calcifications, ill-defined edges, solid consistency, hypo-echoic pattern, intra-nodular vascularity and size below 2cm. Regarding fine needle biopsy, there were a significant increase in incidence of malignancy from Bethesda(II) – Bethesda(VI) with highest incidence in Bethesda(VI). Conclusion: Predictors of malignancy detected were; male gender, solitary nodules, micro-calcifications, hypo-echoic pattern, ill-defined edges, intra-nodular vascularity, solid nodules, size below 2 cm and Bethesda VI. Large scale multi center studies are needed for more solid statistical result.

scholarly journals Early recognition of PIMS-TS: a single centre retrospective review

2021 ◽  
Vol 5 (1) ◽  
pp. e001011
Author(s):  
Roshni Mistry ◽  
Nicola Scanlon ◽  
James Hibberd ◽  
Fionnghuala Fuller
Keyword(s):  
Early Recognition ◽  
Febrile Illness ◽  
Final Diagnosis ◽  
University Hospital ◽  
Single Centre ◽  
Retrospective Case ◽  
Reactive Protein ◽  
Review Reports ◽  
Specific Symptoms

IntroductionResearch into paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) has focused on tertiary level management. This review reports on symptoms and investigations at presentation.MethodsSingle centre retrospective case note analysis of patients fulfilling PIMS-TS diagnostic criteria from March to May 2020 in a London district level university hospital.ResultsSix patients presented in the week prior to their final diagnosis with fever and non-specific symptoms. Raised C-reactive protein (CRP), lymphopenia and hyponatraemia were noted. Kawasaki-like symptoms were under-represented in all patients.InterpretationThe results suggest that a proportion of children with early PIMS-TS present with a non-specific febrile illness and abnormal blood results. Further research is needed to determine the most appropriate identification and follow-up of these children.

scholarly journals Endoscopic retrograde cholangiopancreatography in infants and children

2021 ◽  
Vol 09 (03) ◽  
pp. E292-E296
Author(s):  
Tone Lise Åvitsland ◽  
Lars Aabakken
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Medical Records ◽  
Pediatric Patients ◽  
Biliary Stricture ◽  
Infants And Children ◽  
University Hospital ◽  
Older Children ◽  
Endoscopic Retrograde ◽  
Procedure Codes ◽  
In Infants And Children

Abstract Background and study aims Previous reports have suggested that endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients are safe. However, the total number of cases presented in the literature remains small. We present results regarding safety and outcomes in pediatric patients undergoing ERCP at Oslo University Hospital. Patients and methods Patients < 18 years who underwent ERCP between April 1999 and November 2017 were identified using procedure codes. Medical records were examined for age, gender, diagnosis, indications, type of sedation, findings, interventions, and complications. Results A total of 244 procedures were performed in 158 patients. Fifty-six of these were in 53 infants (age ≤ 1 year). Mean age was 8.8 years. The youngest patient was 8 days old. Mean weight was 5.0 kg in infants, the smallest weighing 2.9 kg. Cannulation failed in 19 (7.8 %). The main indication in infants was suspicion of biliary atresia (n = 38). Six of the procedures (10.7 %) were therapeutic. In children the main indications were biliary stricture (n = 64) and investigation of primary sclerosing cholangitis (PSC) (n = 45). 119 (63.2 %) of these procedures were therapeutic.Complications were uncommon in infants; only two episodes of infection were registered. In children (> 1 year) post-ERCP pancreatitis were seen in 10.4 %. Conclusions Our retrospective series of ERCP procedures includes 56 procedures in infants, which is one of the largest series presented. Complications in infants are rare and post-ERCP pancreatitis was not seen. In older children 10.4 % experienced post-ERCP pancreatitis. In expert hands, ERCP was shown to be acceptably feasible and safe in infants and children.

scholarly journals A retrospective study on the usefulness of the JJ risk engine for predicting the incidence rate of coronary heart disease in type 2 diabetes patients

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Yasunari Yamashita ◽  
Rina Kitajima ◽  
Kiyoshi Matsubara ◽  
Gaku Inoue ◽  
Hajime Matsubara
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Medical Records ◽  
Low Frequency ◽  
University Hospital ◽  
Diabetes Treatment ◽  
C Statistic ◽  
Risk Engine

Abstract Objective In 2018, we conducted a retrospective survey using the medical records of 484 patients with type 2 diabetes. The observed value of coronary heart disease (CHD) incidence after 5 years and the predicted value by the JJ risk engine as of 2013 were compared and verified using the discrimination and calibration values. Results Among the total cases analyzed, the C-statistic was 0.588, and the calibration was p < 0.05; thus, the JJ risk engine could not correctly predict the risk of CHD. However, in the group expected to have a low frequency of hypoglycemia, the C-statistic was 0.646; the predictability of the JJ risk engine was relatively accurate. Therefore, it is difficult to accurately predict the complication rate of patients using the JJ risk engine based on the diabetes treatment policy after the Kumamoto Declaration 2013. The JJ risk engine has several input items (variables), and it is difficult to satisfy them all unless the environment is well-equipped with testing facilities, such as a university hospital. Therefore, it is necessary to create a new risk engine that requires fewer input items than the JJ risk engine and is applicable to several patients.

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