Incidental thyroid malignancy in Grave's thyrotoxicosis

SummaryAim: Thyroid nodules > 1 cm are observed in about 12% of unselected adult employees aged 18–65 years screened by ultrasound scan (40). While intensive ultrasound screening leads to early detection of thyroid diseases, the determination of benign or malignant behaviour remains uncertain and may trigger anxieties in many patients and their physicians. A considerable number of thyroid resections are consecutively performed due to suspicion of malignancy in the detected nodes. Fine needle aspiration biopsy (FNAB) has been recommended for the assessment of thyroid nodules to facilitate detection of thyroid carcinomas but also to rule out malignancy and thereby avoid unnecessary thyroid resections. However, cytology results are dependent on experience of the respective cytologist and unfortunately inconclusive in many cases. Methods: Molecular genetic markers are already used nowadays to enhance sensitivity and specificity of FNAB cytology in some centers in Germany. The most clinically relevant molecular genetic markers as pre-operative diagnostic tools and the clinical implications for the intraoperative and postoperative management were reviewed. Results: Molecular genetic markers predominantly focus on the preoperative detection of thyroid malignancies rather than the exclusion of thyroid carcinomas. While some centers routinely assess FNABs, other centers concentrate on FNABs with cytology results of follicular neoplasia or suspicion of thyroid carcinoma. Predominantly mutations of BRAF, RET/PTC, RAS, and PAX8/PPARγ or expression of miRNAs are analyzed. However, only the detection of BRAF mutations predicts the presence of (papillary) thyroid malignancy with almost 98% probability, indicating necessity of oncologic thyroid resections irrespective of the cytology result. Other genetic alterations are associated with thyroid malignancy with varying frequency and achieve less impact on the clinical management. Conclusion: Molecular genetic analysis of FNABs is increasingly performed in Germany. Standardization, quality controls, and validation of various methods need to be implemented in the near future to be able to compare the results. With increasing knowledge about the impact of genetic alterations on the prognosis of thyroid carcinomas, recommendations have to be defined that may lead to individually optimized treatment strategies.

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Thyroid malignancy concurrent with hyperthyroidism: variations with thyroid status and age

Endocrine Abstracts ◽

10.1530/endoabs.37.ep836 ◽

2015 ◽

Author(s):

Nadeesha Nawarathna ◽

Navam Kumarasinghe ◽

Deepthika Chandrasekara ◽

Shamali Balasooriya ◽

Aruna Shaminda ◽

...

Keyword(s):

Thyroid Malignancy ◽

Thyroid Status

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Thyroid malignancy rates according to the Bethesda reporting system in Israel - A multicenter study

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2021.03.237 ◽

2021 ◽

Author(s):

Ory Madgar ◽

Galit Avior ◽

Isaac Shochat ◽

Ben-Zion Joshua ◽

Lior Baraf ◽

...

Keyword(s):

Multicenter Study ◽

Reporting System ◽

Thyroid Malignancy

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Thy 3F and 3a malignancy rate, a multisite regional retrospective case series

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0103 ◽

2018 ◽

Vol 100 (7) ◽

pp. 545-550 ◽

Cited By ~ 2

Author(s):

V Alexander ◽

J Rudd ◽

D Walker ◽

G Wong ◽

A Lunt ◽

...

Keyword(s):

Thyroid Cancer ◽

Royal College ◽

Case Series ◽

Thyroid Malignancy ◽

Retrospective Case ◽

Retrospective Case Series ◽

Indeterminate Nodules ◽

The Uk ◽

Diagnosis Of Thyroid Cancer ◽

Benign Thyroid

Introduction The aim of this study was to ascertain the incidence of thyroid cancer for patients categorised as Thy3, 3a or 3f across four tertiary thyroid multidisciplinary centres in the UK. Material and methods This is a retrospective case series examining patients who presented with a thyroid nodule and diagnosed as Thy3, 3a or 3f according to the Royal College of Pathologists modified British Thyroid Association and Royal College of Physicians Thy system. Results In total, 395 patients were included in this study. Of these, 136 turned out to have benign thyroid disease and 24 had micropapillary thyroid carcinomas. The overall rate of thyroid malignancy was 28.8%. For each subcategory, the rate of malignancy was Thy3 24.7.7%, Thy3a 30.4% and Thy3f 29.2. However, the incidence of thyroid malignancy varied considerably between the four centres (Thy 3f 18-54%). Discussion The diagnosis of thyroid cancer is evolving but detection for malignancy for indeterminate nodules remains below 50% for most centres around the world. In 2014, the British Thyroid Association subdivided the original Thy3 category into Thy3a and Thy3f and recommended a more conservative approach to management for Thy3a nodules. Despite this, only two centres yielded a higher conversion rate of malignancy in the new higher graded Thy3f group compared with Thy3a. Conclusion It is debateable whether the new ‘Thy3’ subcategories are more useful than the original. Local thyroid malignancy rates may also be more useful than national averages to inform treatment decisions.

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Follow-up of Benign Thyroid Nodules—Can We Do Less?

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2018.10.001 ◽

2019 ◽

Vol 70 (1) ◽

pp. 62-67 ◽

Cited By ~ 1

Author(s):

Manijeh Mohammadi ◽

Carrie Betel ◽

Kirsteen Rennie Burton ◽

Kevin McLughlin Higgins ◽

Zeina Ghorab ◽

...

Keyword(s):

Fine Needle Aspiration ◽

Thyroid Nodules ◽

Descriptive Study ◽

Needle Aspiration ◽

Thyroid Malignancy ◽

Fine Needle ◽

Nodule Size ◽

Benign Thyroid Nodules ◽

Benign Thyroid

Objective To determine the incidence of malignancy, follow-up ultrasound (US), and repeat fine needle aspiration (FNA) in thyroid nodules that have been previously biopsied as benign. Methods This is a retrospective, descriptive study of benign thyroid nodules evaluated by US between 2010-2011. We determined the frequency of follow-up ultrasounds and FNAs, mean years of follow-up, interval between follow-up US, change in nodule size, reasons for repeat FNA (rFNA), frequency of thyroidectomy, and thyroid malignancy during 5 years of follow-up. Results A total of 733 benign thyroid nodules were reviewed in 615 patients. Mean years of US follow-up was 3.47 ± 1.65 years; 275 (37.5%) had no follow-up US; 109 (14.9%) had 1 follow-up US; 93 (12.7%) had 2 follow-up US; and 256 (34.9%) had 3 or more follow-up US. Assessment of thyroid nodule size showed that 215 (28.8%) nodules decreased in size, 145 (19.4%) increased in size by less than 50%, and 91 (12.1%) increased in size by more than 50%. Of the 733 nodules, 17 nodules (2.3%) underwent thyroidectomy for which the pathology result of 9 (1.2%) showed malignancy, and 65 (8.9%) thyroid nodules underwent rFNA. When applying the 2015 recommendations for repeat FNA, 35% were done unnecessarily. Conclusion In our sample of initially benign thyroid nodules, only 9 patients (1.2%) had pathology-proven malignancy after a mean follow-up of 3.5 years. Over 30% of patients had more than 3 rUSs. Decreased interval and frequency of rUS should be considered in future guidelines for thyroid management.

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