scholarly journals Thyroid nodules and thyroid cancer in Graves’ disease

2014 ◽  
Vol 58 (9) ◽  
pp. 933-938 ◽  
Author(s):  
Abbas Ali Tam ◽  
Cafer Kaya ◽  
Fevzi Balkan Mehmet Kılıç ◽  
Reyhan Ersoy ◽  
Bekir Çakır
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Neck Region ◽  
External Irradiation ◽  
Graves Disease ◽  
Irradiation Treatment ◽  
Study Results ◽  
Iodine Treatment

Objective The frequency of thyroid nodules accompanying Graves’ disease and the risk of thyroid cancer in presence of accompanying nodules are controversial. The aim of this study was to evaluate the frequency of thyroid nodules and the risk of thyroid cancer in patients operated because of graves’ disease. Subjects and methods Five hundred and twenty-six patients in whom thyroidectomy was performed because of Graves’ disease between 2006 and 2013 were evaluated retrospectively. Patients who had received radioactive iodine treatment and external irradiation treatment in the neck region and who had had thyroid surgery previously were not included in the study. Results While accompanying thyroid nodule was present in 177 (33.6%) of 526 Graves’ patients, thyroid nodule was absent in 349 (66.4%) patients. Forty-two (8%) patients had thyroid cancer. The rate of thyroid cancer was 5.4% (n = 19) in the Graves’ patients who had no nodule, whereas it was 13% (n = 23) in the patients who had nodule. The risk of thyroid cancer increased significantly in presence of nodule (p = 0.003). Three patients had recurrence. No patient had distant metastasis. No patient died during the follow-up period. Conclusions Especially Graves’ patients who have been decided to be followed up should be evaluated carefully during the follow-up in terms of thyroid cancer which may accompany. Arq Bras Endocrinol Metab. 2014;58(9):933-8

scholarly journals Will Real Time Visualization of Needle in Target Thyroid Nodules Minimize False Negative FNA Results?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A904-A905
Author(s):  
Vijaykumar Sekar ◽  
Panadeekarn Panjawatanan ◽  
Sofia Junaid Syed
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
False Negative ◽  
Thyroid Ultrasound ◽  
Papillary Thyroid ◽  
Ultrasound Guided ◽  
Real Time Visualization ◽  
The Right

Abstract Introduction: Prevalence of thyroid nodules in the adult population based on detection by ultrasonography is about 20-76% of which only 5% account for thyroid cancer. All patients with a suspected thyroid nodule either on physical examination or noted incidentally on other imaging should be evaluated with thyroid ultrasound. Any thyroid nodule >= 1 cm on ultrasound should be investigated with FNAC. Ultrasound guided FNAC techniques are used to reduce false negative results. We present a patient with suspicious finding on initial thyroid ultrasound and subsequent negative FNAC presenting a few years later with papillary thyroid cancer. Case Presentation: A 32 y.o. female with history of thyroid nodule and thyroiditis presented to the endocrine clinic for follow-up of her thyroid nodule. 5 years ago, she was diagnosed with thyroid nodule, which was found on an ultrasound scan for workup of her dysphagia. The thyroid ultrasound then showed diffusely heterogeneous thyroid gland with an ill-defined area of decreased echogenicity in the right lobe and left superior lobe and possible nodule in the lower pole left thyroid. Blood work showed TSH of 1.71 (n 0.34-3.00 uIU/ml) and thyroid peroxidase antibody levels was 27.8 (n < 9.0 IU/ml). A CT scan of neck with contrast was done and no concerning mass was seen. The patient had a follow-up ultrasound after 8 months which showed small bilateral thyroid lesions, somewhat ill-defined. The patient had an FNA biopsy of the right thyroid nodule: the results were consistent with a benign follicular nodule. A follow-up thyroid ultrasound was done in a year, and the findings were unchanged. The patient came back 3 years later for follow-up with complaints of a new palpable nodule in the neck. Ultrasound showed unchanged right thyroid nodule and some new cervical adenopathy. The ultrasound showed a 2.2 cm heterogeneous lymph node with punctate echogenic foci along the right lateral margin of the right internal jugular vein at the level of the thyroid gland, Subsequently FNA biopsy of the right cervical node and right thyroid node were done. The cells from lymph nodes were positive for malignancy and cells from the right thyroid nodule were atypical. Overall the appearance was consistent with papillary thyroid carcinoma. Subsequently the patient underwent total thyroidectomy and right modified lymph node dissection and the pathology results came back as multifocal papillary thyroid cancer right side 1.2 cm and left side 0.4 cm, with metastasis to 2 lymph nodes. Conclusion: The reported false negative rate of ultrasound-guided FNAC is variable. Success of US-FNA depends on experience of operator and cyto-pathologist and the intrinsic nature of the nodule. Malignancy rates of only 1-2% are reported with repeat FNA in prior benign nodules. Good FNA techniques and real-time visualization of needle in target nodules can further decrease false negatives.

Thyroid Cancer and Nodules in Graves’ Disease: A Single Center Experience

2020 ◽  
Vol 21 ◽  
Author(s):  
Claudio Casella ◽  
Riccardo Morandi ◽  
Apollonia Verrengia ◽  
Alessandro Galani ◽  
Sarah Molfino ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Nodules ◽  
Cancer Recurrence ◽  
Graves Disease ◽  
Common Complication ◽  
Single Center Experience ◽  
Operative Assessment ◽  
Risk Of Cancer ◽  
Us Scan

Background: The existence of a link between Graves’ Disease (GD) and Thyroid Cancer (TC) has long been investigated, however a clear pathogenic correlation has still to be found. Methods: In this study we analyzed retrospectively a cohort of 151 patients treated at our Clinic with total thyroidectomy between 2013 and 2018. All patients were symptomatic at the time of surgery, preoperatively ultrasonographic (US) study was performed to evaluate the presence of nodules and their distribution. All patients reached euthyroid state before surgery. Objective: We verified the presence of TC in patients submitted to surgery for GD, both with and without thyroid nodules (TN). Results: Nodules were detected in 53% of cases, above 60 y.o. at least one nodule was found, younger patients more frequently were nodules free. Bilateral diffusion of nodules appeared with increasing age. Cancer was found in 19 of 151 subjects (12.5%), all were papillary carcinomas, among them 93% were microcarcinomas. Among cancer-proven patients, 14 had thyroid nodules while 5 where nodule-free. During the follow up period no cancer recurrence was recorded. The most common complication after surgery was transient hypocalcemia (36%). Conclusions: Graves’ patients are burdened by major incidence of TC in the context of their TN. Pre-operative assessment in GD patients should consider the risk of cancer, US scan can help in rapid evaluation of nodules and new rising frontiers in molecular biomarkers analysis may help defining pathogenic basis of Graves’ neoplastic development.

scholarly journals What is New on Thyroid Cancer Biomarkers

2008 ◽  
Vol 3 ◽  
pp. BMI.S669 ◽  
Author(s):  
Rosaria M. Ruggeri ◽  
Alfredo Campennì ◽  
Sergio Baldari ◽  
Francesco Trimarchi ◽  
Maria Trovato
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Follicular Epithelium ◽  
Routine Practice ◽  
Appropriate Treatment ◽  
Follicular Lesions ◽  
Needle Aspiration Cytology ◽  
Well Differentiated

Thyroid cancer harbours in about 5% of thyroid nodules. The majority of them are well-differentiated cancers originating from the follicular epithelium, and are subdivided into papillary and follicular carcinomas. Undifferentiated carcinomas and medullary thyroid carcinomas arising from C cells are less common. Although most thyroid nodules are benign, distinguishing thyroid cancer from benign lesions is crucial for an appropriate treatment and follow-up. The fine needle aspiration cytology (FNAC) allows the diagnosis of nature of thyroid nodules in the majority of cases. However, FNAC has some limitations, particularly in the presence of follicular lesions which can appear dubious in rare instances even at histology. In an effort to improve diagnostic accuracy and offer new prognostic criteria, several immunohistochemical and molecular markers have been proposed. However, most of them have to be validated on large series before being used in routine practice.

NO BENEFIT OF DEDICATED THYROID NODULE SCREENING IN PATIENTS WITH ACROMEGALY

2020 ◽  
Vol 26 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Ngan Betty Lai ◽  
Dave Garg ◽  
Anthony P. Heaney ◽  
Marvin Bergsneider ◽  
Angela M. Leung
Keyword(s):  
United States ◽  
Growth Hormone ◽  
Thyroid Cancer ◽  
Growth Factor ◽  
Thyroid Nodule ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Papillary Thyroid ◽  
Fine Needle

Objective: Acromegaly results from the excessive production of growth hormone and insulin-like growth factor-1. While there is up to a 2-fold increased prevalence of thyroid nodules in patients with acromegaly, the incidence of thyroid cancer in this population varies from 1.6 to 10.6% in several European studies. The goal of our study was to determine the prevalence of thyroid nodules and thyroid cancer among patients with acromegaly at a large urban academic medical center in the United States (U.S.). Methods: A retrospective chart review was performed of all patients with acromegaly between 2006–2015 within the University of California, Los Angeles health system. Data were collected regarding patient demographics, thyroid ultrasounds, thyroid nodule fine needle aspiration (FNA) biopsy cytology, and thyroid surgical pathology. Results: In this cohort (n = 221, 49.3% women, mean age 53.8 ± 15.2 [SD] years, 55.2% Caucasian), 102 patients (46.2%) underwent a thyroid ultrasound, from which 71 patients (52.1% women, mean age 52.9 ± 15.2 [SD] years, 56.3% Caucasian) were found to have a thyroid nodule. Seventeen patients underwent a thyroid nodule FNA biopsy and the results revealed 12 benign biopsies, 1 follicular neoplasm, 3 suspicious for malignancy, and 1 papillary thyroid cancer (PTC), from which 6 underwent thyroidectomy; PTC was confirmed by surgical pathology for all cases (8.5% of all nodules observed). Conclusion: In this sample, the prevalence of thyroid cancer in patients with acromegaly and coexisting thyroid nodules is similar to that reported in the general U.S. population with thyroid nodules (7 to 15%). These findings suggest that there is no benefit of dedicated thyroid nodule screening in patients newly diagnosed with acromegaly. Abbreviations: AACE = American Association of Clinical Endocrinologists; ATA = American Thyroid Association; DTC = differentiated thyroid cancer; FNA = fine needle aspiration; GH = growth hormone; IGF-1 = insulin-like growth factor-1; PTC = papillary thyroid cancer; U.S. = United States

scholarly journals Role of biomarkers in predicting the occurrence of thyroid neoplasms in radiation-exposed children

2018 ◽  
Vol 25 (4) ◽  
pp. 481-491
Author(s):  
Joseph M Shulan ◽  
Leonid Vydro ◽  
Arthur B Schneider ◽  
Dan V Mihailescu
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Nodules ◽  
Subsequent Development ◽  
Thyroid Neoplasms ◽  
Childhood Cancer Survivors ◽  
Malignant Neoplasms ◽  
Increased Risk ◽  
Need To Evaluate

With increasing numbers of childhood cancer survivors who were treated with radiation, there is a need to evaluate potential biomarkers that could signal an increased risk of developing thyroid cancer. We aimed to examine the relationships between thyrotropin and thyroglobulin levels and the risk of developing thyroid nodules and cancer in a cohort of radiation-exposed children. 764 subjects who were irradiated in the neck area as children were examined and followed for up to 25 years. All subjects underwent a clinical examination, measurements of thyrotropin, thyroglobulin levels and thyroid imaging. At baseline, 216 subjects had thyroid nodules and 548 did not. Of those with nodules, 176 underwent surgery with 55 confirmed thyroid cancers. During the follow-up, 147 subjects developed thyroid nodules including 22 with thyroid cancer. Thyroglobulin levels were higher in subjects with prevalent thyroid nodules (26.1 ng/mL vs 9.37 ng/mL; P < 0.001) and in those who had an initial normal examination but later developed thyroid nodules (11.2 ng/mL vs 8.87 ng/mL; P = 0.017). There was no relationship between baseline thyrotropin levels and the prevalent presence or absence of thyroid nodules, whether a prevalent neoplasm was benign or malignant, subsequent development of thyroid nodules during follow-up or whether an incident nodule was benign or malignant. In conclusion, in radiation-exposed children, higher thyroglobulin levels indicated an increased risk of developing thyroid nodules but did not differentiate between benign and malignant neoplasms. There was no association between the baseline TSH level and the risk of developing thyroid nodules or cancer.

scholarly journals Adrenal metastasis as the initial diagnosis of synchronous papillary and follicular thyroid cancer

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Xin He ◽  
Scott A. Soleimanpour ◽  
Gregory A. Clines
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Nodules ◽  
Follicular Thyroid Carcinoma ◽  
Distant Metastases ◽  
Needle Aspiration ◽  
Left Lobe ◽  
Adrenal Metastasis ◽  
Bethesda Classification ◽  
The Right

Abstract Background Differentiated thyroid cancer uncommonly presents with distant metastases. Adrenal metastasis from differentiated thyroid cancer presenting as the initial finding is even less common. Case Presentation A 71-year-old male was incidentally found on chest CT to have bilateral thyroid nodules, which were confirmed on ultrasound. Fine needle aspiration of the dominant right 3.3 cm nodule contained histologic features most consistent with Bethesda classification III, and repeat fine needle aspiration revealed pathology consistent with Bethesda classification II. Follow-up thyroid ultrasound showed 1% increase and 14% increase in nodule volume at one and two years, respectively, compared to baseline. Prior to the second annual thyroid ultrasound, the patient was incidentally found to have a 4.1 cm heterogeneously enhancing mass in the right adrenal gland on CT of the abdomen and pelvis. Biochemical evaluation was unremarkable with the exception of morning cortisol of 3.2 µg/dL after dexamethasone suppression. The patient then underwent laparoscopic right adrenal gland excision, which revealed metastatic follicular thyroid carcinoma. Total thyroidectomy was then performed, with pathology showing a 4.8 cm well-differentiated follicular thyroid carcinoma of the right lobe, a 0.5 cm noninvasive follicular thyroid neoplasm with papillary-like nuclear features of the left lobe, and a 0.1 cm papillary microcarcinoma of the left lobe. Thyrotropin-stimulated whole body scan showed normal physiologic uptake of the remnant thyroid tissue without evidence of other iodine avid disease. The patient then received radioactive iodine. At follow-up 14 months after total thyroidectomy, he remains free of recurrent disease. Conclusion Despite following the recommended protocol for evaluation and surveillance of thyroid nodules, thyroid cancer can be challenging to diagnose, and may not be diagnosed until distant metastases are identified.

LONG-TERM OUTCOMES OF RADIOIODINE THERAPY FOR JUVENILE GRAVES DISEASE WITH EMPHASIS ON SUBSEQUENTLY DETECTED THYROID NODULES: A SINGLE INSTITUTION EXPERIENCE FROM JAPAN

2020 ◽  
Vol 26 (7) ◽  
pp. 729-737 ◽  
Author(s):  
Tetsuya Mizokami ◽  
Katsuhiko Hamada ◽  
Tetsushi Maruta ◽  
Kiichiro Higashi ◽  
Junichi Tajiri
Keyword(s):  
Thyroid Gland ◽  
Thyroid Nodules ◽  
Radioiodine Therapy ◽  
Antithyroid Drug ◽  
Overt Hypothyroidism ◽  
Graves Disease ◽  
Outpatient Basis ◽  
Long Term Outcomes

Objective: To investigate the long-term outcomes of radioiodine therapy (RIT) for juvenile Graves disease (GD) and the ultrasonographic changes of the thyroid gland. Methods: All of 117 juvenile patients (25 males and 92 females, aged 10 to 18 [median 16] years) who had undergone RIT for GD at our clinic between 1999 and 2018 were retrospectively reviewed. Each RIT session was delivered on an outpatient basis. The maximum 131I dose per treatment was 13.0 mCi, and the total 131I dose per patient was 3.6 to 29.8 mCi (median, 13.0 mCi). 131I administration was performed once in 89 patients, twice in 26, and three times in 2 patients. Ultrasonography of the thyroid gland was regularly performed after RIT. The duration of follow-up after the initial RIT ranged from 4 to 226 (median 95) months. Results: At the latest follow-up more than 12 months after RIT (n = 111), the patients' thyroid functions were overt hypothyroidism (91%), subclinical hypothyroidism (2%), normal (5%), or subclinical hyperthyroidism (2%). New thyroid nodules were detected in 9 patients, 4 to 17 years after initial RIT. Patients with newly detected thyroid nodules underwent RIT with lower doses of 131I and had larger residual thyroid volumes than those without nodules. None of the patients were diagnosed with thyroid cancer or other malignancies during the follow-up period. Conclusion: Over a median follow-up period of 95 months (range, 4 to 226 months), RIT was found to be effective and safe in juvenile GD. However, cumulative evidence from further studies is required to confirm the long-term safety of RIT for juvenile GD. Abbreviations: ATD = antithyroid drug; GD = Graves disease; KI = potassium iodide; LT4 = levothyroxine; MMI = methimazole; PTU = propylthiouracil; RAIU = radio-active iodine uptake; RIT = radioiodine therapy; 99mTc = technetium-99m; TSH = thyrotropin

Prospective Evaluation of Semiquantitative Strain Ratio and Quantitative 2D Ultrasound Shear Wave Elastography (SWE) in Association with TIRADS Classification for Thyroid Nodule Characterization

2019 ◽  
Vol 40 (04) ◽  
pp. 495-503 ◽  
Author(s):  
Vito Cantisani ◽  
Emanuele David ◽  
Hektor Grazhdani ◽  
Antonello Rubini ◽  
Maija Radzina ◽  
...  
Keyword(s):  
Thyroid Nodule ◽  
Shear Wave ◽  
Diagnostic Performance ◽  
Thyroid Nodules ◽  
Shear Wave Elastography ◽  
Strain Ratio ◽  
Ultrasound Elastography ◽  
Prospective Evaluation ◽  
2D Ultrasound

Abstract Purpose To evaluate the diagnostic performance of strain ratio elastography (SRE) and shear wave elastography (SWE) alone and in combination with Thyroid Imaging Reporting and Data System (TIRADS) classification parameters to improve differentiation between benign and malignant thyroid nodules. Materials and Methods In this prospective study benign (n = 191) and malignant (n = 52) thyroid nodules were examined with high-resolution ultrasound (US) features using the TIRADS lexicon and SRE semiquantitative and SWE quantitative findings using histology or cytology as the gold standard with a 12-month follow-up. Sensitivity (Se), specificity (Sp) and the area under the ROC curve (AUROC) were used to evaluate the diagnostic performance of each feature and combinations of the methods. Results TIRADS score showed a sensitivity of 59.6 %, a specificity of 83.8 % with an AUROC of 0.717, a PPV of 50.0 % and an NPV of 88.4 %. SRE yielded the highest performance with a sensitivity of 82.7 %, a specificity of 92.7 % with AUROC of 0.877, a PPV 75.4 % and an NPV of 95.2 %. SWE (kPa) had a sensitivity and specificity of 67.3 % and 82.7 %, respectively, with an AUROC of 0.750, a PPV of 51.5 % and an NPV of 90.3 %. Differences were significant for SRE only but not for SWE. Conclusion Ultrasound elastography may improve thyroid nodule discrimination. In particular, SRE has a better performance than TIRADS classification, while their combination improves sensitivity.

scholarly journals Papillary Thyroid Carcinoma With Cystic Changes in a Patient With Prior History of Toxic Nodule

2020 ◽  
Vol 8 ◽  
pp. 232470962094267
Author(s):  
Gliceida Maria Galarza Fortuna ◽  
Paola Rios ◽  
Ailyn Rivero ◽  
Gabriela Zuniga ◽  
Kathrin Dvir ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Molecular Testing ◽  
Papillary Thyroid ◽  
Thyroid Lobectomy ◽  
Cystic Changes ◽  
History Of

Thyroid nodules are palpable on up to 7% of asymptomatic patients. Cancer is present in 8% to 16% of those patients with previously identified thyroid nodules. Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, accounting for approximately 85% of thyroid cancers. Although most appear as solid nodules on ultrasound imaging, a subset of 2.5% to 6% has cystic components. The presence of cystic changes within thyroid nodules decreases the accuracy of fine needle aspiration (FNA) in the diagnosis of thyroid cancer, given the difficulty of obtaining appropriate cellular content. This becomes a diagnostic and therapeutic challenge. We present a case of a 31-year-old female with a 1-month history of palpitations, fatigue, and night sweats, who underwent evaluation, and was diagnosed with subclinical hyperthyroidism. She presented 4 years later with compressive symptoms leading to repeat FNA, showing Bethesda III-atypia of undetermined significance and negative molecular testing. Thyroid lobectomy revealed PTC with cystic changes. This case is a reminder that patients with hyperfunctioning thyroid nodule should have closer follow-up. It poses the diagnostic dilemma of how much is good enough in the evaluation and management of a thyroid nodule. Early detection and action should be the standard of care.

THE RISK OF THYROID CANCER IN PATIENTS WITH THYROID NODULE 3 CM OR LARGER

2020 ◽  
Vol 26 (11) ◽  
pp. 1286-1290
Author(s):  
Edy Kornelius ◽  
Shih-Chang Lo ◽  
Chien-Ning Huang ◽  
Yi-Sun Yang
Keyword(s):  
Thyroid Cancer ◽  
Positive Predictive Value ◽  
Thyroid Carcinoma ◽  
Thyroid Nodule ◽  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Fine Needle

Objective: There are conflicting data on the risk of thyroid cancer in thyroid nodules 3 cm or larger, and few such studies on this issue have been conducted in Asia. This study aimed to examine the risk of thyroid cancer in patients with thyroid nodules 3 cm or larger. Methods: This was a 7-year retrospective study conducted in a tertiary referral hospital in Taiwan. All patients with a thyroid nodule measuring ≥3 cm who underwent thyroid operation with or without fine-needle aspiration biopsy (FNAB) were included. The prevalence rate of thyroid cancer, as well as the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and false-negative rate of FNAB for thyroid nodule ≥3 cm were also examined. Results: A total of 132 patients were included in this study. Thyroid cancer was detected in 19 of 132 (14.4%) thyroid nodules measuring ≥3 cm. The performance of FNAB for detecting cancer in nodules 3 cm or larger without considering other ultrasonography parameters was relatively poor with a sensitivity of 50%, but the specificity (100%), PPV (100 %), and NPV (93.4 %) were excellent. Conclusion: The risk of thyroid cancer for thyroid nodules ≥3 cm in this study was low. The PPV and NPV of FNAB were high for the detection of cancer in large nodules. The decision to perform thyroidectomy should not be solely based on nodule size and should include other factors, such as ultrasound characteristics and surgical risk. Abbreviations: ATA = American Thyroid Association; FNAB = fine-needle aspiration biopsy; mPTC = micropapillary thyroid carcinoma; NPV = negative predictive value; PPV = positive predictive value; PTC = papillary thyroid carcinoma

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