Clinicopathological Profile of Thyroid Carcinoma in Young Patients: An Indonesian Single-Center Study

Introduction. Thyroid cancer is the third most common cancer that occurs in children and adolescents. Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy. Although the mortality rate of thyroid malignancy in children is usually low, the disease recurrence is higher in children with more severe clinical presentation than in adults. This study aimed to determine the demographic and clinicopathological characteristics and outcome of pediatric and adolescent patients with thyroid malignancy in Indonesia. Methods. The retrospective study included all patients diagnosed with thyroid carcinoma aged <20 years, from January 1, 2015, to December 31, 2019. Twenty-nine subjects fulfilled the inclusion and exclusion criteria. We retrieved baseline characteristics, pathology features, TSH and fT4 status, radioactive iodine therapy data, and patients’ outcomes. Then, data were analyzed using the chi-square or Fisher’s exact method. Results. We identified 29 eligible subjects, including 3 boys and 26 girls. The most common type of thyroid carcinoma was PTC (96.5%), and follicular type (31%) was the predominant variant of PTC. Lymph node involvement occurred in 24% of patients, while distant metastasis occurred in 17.2% of patients with PTC. Twenty-four (82.7%) patients had stage 1 disease. Disease recurrence was recorded in 31% of patients during the study period with a median follow-up time of 24 months. Conclusion. PTC is the most frequent type of thyroid carcinoma among children and adolescents. This malignancy has a low mortality rate, but the recurrence rate remains high among younger patients than adults even during a short-term follow-up analysis. Distant metastasis and lymph node involvement are commonly found in this age group.

Association between multi nodular goitre and thyroid malignancy at a tertiary care centre

Background: Over the past few decades, the incidence of thyroid cancer has dramatically increased. Thyroid malignancy in multinodular goitre is considered to be high and these occult malignancies are detected only in post operative histopathological analysis. The study helps in finding association between multinodular goitre and thyroid malignancy. Objective was to find the association between multinodular goitre and thyroid malignancy in those who underwent total thyroidectomy.Methods: A cross sectional study conducted in department of general surgery, KIMS hospital, Bangalore. The 236 randomized cases of multinodular goitre who underwent total thyroidectomy were selected. Patients underwent thorough clinical examination pre operatively and were reassessed in post-operative period following surgery. Later, histopathology report on thyroidectomy specimen of the patients were obtained. This report was considered the gold standard for the diagnosis of thyroid malignancy.Results: Occult malignancies were commoner in middle aged females. Most of the patients in the study underwent total thyroidectomy. The prevalence of thyroid malignancy in our study was found to be 7.2%. In the study, 17 incidental malignancies were papillary carcinomas. It revealed a highly significant relation between the lymphocytic thyroiditis and occult malignancy (p<0.0001)Conclusions: The prevalence of malignancy in multinodular goitre is 7.2%. The only variant of incidental malignancy detected in histopathological examination of excised thyroid was papillary carcinoma. There is a statistically significant association between presence of thyroiditis in preoperative FNA and presence of occult malignancy carcinoma.

Secondary thyroid malignancy – a rare clinical finding?

Metastases to the thyroid gland, while rarely seen in clinical practice, can pose a diagnostic and therapeutic challenge. Most commonly, they originate from lung, renal, and breast cancer, and are generally a sign of multiorgan metastatic disease. In most cases, metastases to the thyroid gland are diagnosed incidentally on imaging studies, since they are rarely symptomatic and often do not influence thyroid function tests. Thyroid ultrasonography and fine-needle aspiration biopsy play a pivotal role in their evaluation, as both classic immunocytochemical features, and more novel molecular markers can help in the differential diagnosis. Prognosis mainly depends on the biology of the primary tumor and its extension. Communication between clinicians is essential in such patients, in order to ensure that the treatment options are carefully balanced, thus raising the need for multidisciplinary teams in their management.

A study of association between serum thyroid stimulating hormone concentration and thyroid cancer and also to assess whether serum thyroid stimulating hormone levels are of value in predicting malignancy in patients with thyroid swelling

Background: Thyroid neoplasm includes both benign and malignant tumors arising in the thyroid gland. Although thyroid cancer accounts for less than 1% of all cancers, the challenge to clinicians is to identify the minority of thyroid nodules that harbor malignancy. There are a number of well-established predictors of malignancy in thyroid nodules. More recently a few studies have suggested that higher concentration of thyroid stimulating hormone (TSH), even within the normal range are associated with subsequent diagnosis of thyroid cancer in patients with thyroid nodules and even higher serum TSH levels have been found associated with advanced stages of thyroid cancer. Methods: A prospective study was conducted on 220 cases without overt thyroid dysfunction attending Department of general surgery, Pushpagiri institute of medical science, Thiruvalla. Results: In our study incidence of malignancy of thyroid carcinoma was highest in patients with serum TSH concentrations, in range of 3.5 mIU/l-5.25 mIU/l, 55 patients out of 220 patients. Individually, incidence of papillary carcinoma (PC) (36/55 patients), follicular carcinoma (FC) (17/55 patients) and Hurthle cell carcinoma (HCC) (2/55 patients) were more in patients with higher TSH. So, from the study it can be clearly state that elevated TSH can be used as an independent predictor of thyroid malignancy. Higher TSH values are associated with papillary thyroid carcinoma.Conclusions: An elevated TSH can be used as an independent predictor of thyroid malignancy, especially for anticipating a probability of papillary carcinoma of thyroid.

Comparison between sensitivity and specificity of thyroid elastography and fine needle aspiration cytology in differentiating the nature of thyroid nodules

Background Nodular goiter is the most frequent disease of the thyroid gland, it may affect up to 50% of adults and elderly people, Although malignancy only occurs in about 5% of thyroid nodules, the detection rate of papillary thyroid carcinoma has increased consistently both in women and men and in all ethnic groups Thus, the task of differentiating malignant from benign nodules is necessary. Ultrasound elastography (USE) is a non-invasive, completely painless for the patient and can be easily performed even during routine ultrasound examinations. It assesses lesion stiffness by evaluating tissue distortion in response to stress. Objective Study the role of strain elastography in the characterization of benign and malignant nature of the thyroid nodule Compare the sensitivity and specificity of ultrasound elastography (USE) and fineneedle aspiration cytology (FNAC) as preoperative predictor of malignancy in order to decrease the need for FNAC. Cytology report is the gold standard/ histopathology report if available. Patients and Methods Type of Study: Cross-sectional study. Study Setting: The study was conducted at Ain Shams University Hospitals. Patients: 32 patients, 16 benign, and 16 malignant Patients with thyroid nodules proven by FNAC referred to Ain Shams University Radiology Unit. Results After analysis of strain index (SI) and the elasto score with FNAC we found the cut of point for thyroid malignancy was &gt;1.4 and &gt;2 respectively. The sensitivity and specificity of strain index (SI) for thyroid malignancy diagnosis were 100% and 75%, respectively. The positive and negative predictive values were 80% and 100%, respectively its p-value was 0.000, being a highly significant test.The US-elastography score’s sensitivity and specificity for thyroid malignancy diagnosis both were 81.25%. The positive and negative predictive values both were 81.2%, its pvalue was 0.000, being a highly significant test. After the Postoperative histopathology which is done to only ten patients of the 32 patients with available results (31.3%), 4 of them were benign (12.5%), and six were malignant (18.8%), We conclude that the Elasto ratio is the most sensitive diagnostic test with NPP (negative predictive value) of 100 % being the best screening test while the FNAC is the most specific test with PPV(positive predictive value) of 100 % being the best diagnostic test while the elasto score’s p-value was 0.065, being a a non-significant test. Despite this good diagnostic performance, USE with SI assessment not yet meets all requirements for an optimal diagnostic tool as its specificity is only 75%, while that of FNAC is almost reaching 100% compared to the postoperative histopathology Conclusion Strain elastography was highlighted as a good tool for pre-operative differentiation of benign from malignant lesions showing high sensitivity and moderate specificity compared to other studies, thus further decreasing thyroid biopsies and surgeries. The most reliable tool in our study was the elasto ratio having the highest sensitivity. Ultrasound examination in combination with elastography is a well-tolerated, non-invasive, and cost-effective diagnostic tool in the pre-operative assessment of thyroid nodules, which is able to enhance the accuracy of assessing the risk of malignancy in thyroid nodules and for selecting nodules for FNAC, thus can be used to postpone the FNAC to decrease the amount of the unnecessary FNAC.

41Thyroid Cancers in Fukushima: Critical Review and Analysis of the 1st and 2nd Round Examination

Background After the Fukushima–Daiichi nuclear power plant (NPP) disaster, thyroid ultrasound examination (TUE) has been performed in subjects who were aged ≤18 years. Previous studies reported controversial results. Through critical review, three limitations were identified: arbitrary grouping of 59 municipalities, 2) usage of region as proxy of dose, and 3) separate analyse of the 1st and 2nd round data. Methods To overcome these limitations, this study examined the relationship between radiation dose and the number of participants with thyroid malignancy, using publicly available municipality level data (N = 59). To analyse two wave screening data, multi-level random-effect Poisson regression model was applied. The number of participants with thyroid malignancy was explained by dose estimates. Interaction between dose and screening round dummy (0 for the 1st and 1 for the 2nd) was also introduced to take into account latency. Results Interaction terms between external dose (Akahane et al. 2013) and screening round dummy were positive and significant (β = 0.681, z = 2.05). Similar results were obtained for UNSCEAR estimated thyroid dose (UNSCEAR 2013) (β = 0.128, z = 2.24) and re-estimated thyroid dose (Suzuki et al. 2018) (β = 0.215, z = 2.42). Conclusions These robust results are consistent with the conjecture that the 1st round TUE is the “baseline” that will not correlated with radiation level and the 2nd round TUE detected thyroid cancer caused by radiation from Fukushima NPP that distributed heterogeneously among regions. Key messages This was an ecological study at the municipality level, the results should be examined with individual level data.