Background: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. Methods: The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Gr...

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2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.

Background: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the publication of the American Thyroid Association's guidelines for the management of these disorders was published in 2006, a large amount of new information has become available, prompting a revision of the guidelines. Methods: Relevant articles through December 2008 were reviewed by the task force and categorized by topic and level of evidence according to a modified schema used by the United States Preventative Services Task Force. Results: The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to optimal surgical management, radioiodine remnant ablation, a...

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Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer

The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications for the evidence-based use of therapeutic apheresis in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the Committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Seventh Edition of the JCA Special Issue continues to maintain this methodology and rigor to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Seventh Edition, like its predecessor, has consistently applied the category and grading system definitions in the fact sheets. The general layout and concept of a fact sheet that was used since the fourth edition has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis in a specific disease entity. The Seventh Edition discusses 87 fact sheets (14 new fact sheets since the Sixth Edition) for therapeutic apheresis diseases and medical conditions, with 179 indications, which are separately graded and categorized within the listed fact sheets. Several diseases that are Category IV which have been described in detail in previous editions and do not have significant new evidence since the last publication are summarized in a separate table. The Seventh Edition of the JCA Special Issue serves as a key resource that guides the utilization of therapeutic apheresis in the treatment of human disease. J. Clin. Apheresis 31:149-162, 2016. © 2016 Wiley Periodicals, Inc.

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice—Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Sixth Special Issue

Background Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition. Methods The American Thyroid Association (ATA) previously cosponsored guidelines for the management of thyrotoxicosis that were published in 2011. Considerable new literature has been published since then, and the ATA felt updated evidence-based guidelines were needed. The association assembled a task force of expert clinicians who authored this report. They examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to update the 2011 text and recommendations. The strength of the recommendations and the quality of evidence supporting them were rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. Results Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' orbitopathy; and management of other miscellaneous causes of thyrotoxicosis. New paradigms since publication of the 2011 guidelines are presented for the evaluation of the etiology of thyrotoxicosis, the management of Graves' hyperthyroidism with antithyroid drugs, the management of pregnant hyperthyroid patients, and the preparation of patients for thyroid surgery. The sections on less common causes of thyrotoxicosis have been expanded. Conclusions One hundred twenty-four evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.

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2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis

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Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists

Context: Although some endocrine surgeons administer Lugol solution to decrease thyroid gland vascularity, there is still not an agreement on its effectiveness. Objective: The aims of this clinical trial are to evaluate thyroid blood flow and microvessel density in patients with Graves’ disease who received Lugol solution treatment preoperatively. Design: This was a prospective clinical trial. Setting: This clinical trial took place at a tertiary referral center. Method: Thirty-six patients were randomly assigned to receive either preoperative treatment with Lugol solution (group 1, n = 17) or no preoperative treatment with Lugol solution (group 2, n = 19). Main Outcome Measures: Blood flow through the thyroid arteries of patients with Graves’ disease was measured by color flow Doppler ultrasonography. The microvessel density (MVD) was assessed by immunohistochemical and Western blot analysis of the level of expression of CD-34 in thyroid tissue. The weight and blood loss of the thyroid gland were measure...

Effect of lugol solution on thyroid gland blood flow and microvessel density in the patients with Graves' disease.

Background
The widespread use of ultrasound, computerized tomography, and magnetic resonance imaging has led to an increase in the number of incidental adrenal masses identified. Asymptomatic incidentally discovered adrenal masses may indicate that subclinical Cushing syndrome (SCS) is not uncommon. We aimed to evaluate the cardiovascular risk of patients with SCS before and after surgery.

Evaluation of the cardiovascular risk in patients with subclinical Cushing syndrome before and after surgery.

Objectives: Primary hyperparathyroidism (pHPT) is a common endocrine disease. The aim of this study was to assess the effect of the presence of thyroid nodules, adenoma weight, and ectopic localization on the sensitivity of different imaging studies in patients with hyperparathyroidism.



Study Design: A series of 125 patients with pHPT who underwent low-frequency ultrasonography, high-frequency ultrasonography, Thallium-Technetium scintigraphy, sestamibi scintigraphy, and combined technique was reviewed retrospectively. Patients were divided in two groups depending on the presence or absence of thyroid nodules.



Results: The overall sensitivity of low-frequency ultrasonography, high-frequency ultrasonography, Thallium-Technetium scintigraphy, sestamibi scintigraphy, and combined technique was 69%, 89%, 71%, 86%, and 98%, respectively. The sensitivity of these imaging studies was 94%, 100%, 94%, 96%, and 100%, respectively, in our patients with no thyroid nodules but decreased to 54%, 84%, 54%, 81%, and 79%, respectively, in the presence of thyroid nodules. The parathyroid adenoma weight in true-positive imaging studies was significantly higher than those in false-positive and false-negative imaging studies. The numbers of ectopic parathyroid adenomas were found to be higher in the group of parathyroid adenomas undetected with ultrasonography when compared with ultrasonographically detected adenomas.



Conclusion: In patients with parathyroid adenoma, the sensitivity of imaging studies correlates with the presence of thyroid nodules, adenoma weight, and ectopic localization.

Impact of gland morphology and concomitant thyroid nodules on preoperative localization of parathyroid adenomas.

Objectives: To evaluate the incidence and risk factors of recurrent laryngeal nerve palsy and hypoparathyroidism following thyroidectomy.



Design:  Retrospective case–control study.



Setting:  Tertiary clinic.



Participants:  From September 1990 to September 2005, 3250 consecutive patients who had a thyroidectomy for treatment of various thyroid diseases.



Main outcome measures:  The rates of nerve palsy and hypoparathyroidism were evaluated based on thyroid pathology, the choice of operative procedure, whether the nerve was identified, and the experience of the surgeon.



Results:  Overall, the rate of nerve palsy was 1.8% and that of hypoparathyroidism was 6.6%. On univariate analysis the rates of complications were siginificantly higher in the patients who had an extended thyroidectomy, identification of the recurrent laryngeal nerve during surgery, repeat surgery and patients older than 50 years of age. Complications were no commoner in operations performed by trainees under supervision than experienced surgeons. On multivariate analysis extended thyroidectomy had a 12 fold (95% CI 1.7, 92) increased risk of nerve palsy. Repeat surgery had a 3 fold (95% CI 2.1, 4.7) increased risk of postoperative hypoparathyroidism.



Conclusion:  Extentended thyroidectomy and repeat surgery had a significant effect on the incidence of recurrent laryngeal nerve palsy and postoperative hyperparathyroidism respectively following thyroid surgery.

Predictive factors for recurrent laryngeal nerve palsy and hypoparathyroidism after thyroid surgery

This study was done to determine mammographic, sonographic and magnetic resonance imaging (MRI) appearances of idiopathic granulomatous mastitis, an entity clinically and radiographically resembling breast carcinoma. A total of 36 women (mean age 37 years, range 21–51 years) with histopathological diagnosis of idiopathic granulomatous mastitis were enrolled in the study. The Breast Imaging Reporting and Data System (BI-RADS) was used to categorise the levels of suspicion of malignancy on mammography. Mammography findings were classified also according to density, margin, architectural distortion and number of lesions. Lesions were classified according to number, heterogeneity and echogenic features on sonography. Dynamic MRI findings were categorised as enhancing mass lesion, nonmass lesion or both mass lesions and nonmass lesions together. Subclassification criteria for MRI included lesion shape, margin, border and internal enhancement pattern. The most common mammographic finding was either focal or diffuse asymmetric density (n=15, 44%). The most common sonographic findings were solitary or multiple circumscribed heterogeneous hypoechoic masses (n=19, 52%). Among other sonographic findings were diffuse abscess formation with fistulae and massive parenchymal heterogeneity and hypoechogenicity in 12 (33%) and five (13%) women, respectively. On MRI, enhancing mass lesions were detected in 24 patients, whereas enhancing nonmass lesions were observed in 28. Sixteen patients had both enhancing mass lesions and nonmass lesions together. Although not characteristic for this entity, asymmetric density on mammography, solitary or multiple clustered heterogeneous hypoechogenicity with a tubular configuration on sonography and round, smooth-contoured masslike lesion with rim enhancement or segmental non-mass-like lesion on MRI are the most common features of the disease.

Artur Salmaslioglu

Papers

Effect of lugol solution on thyroid gland blood flow and microvessel density in the patients with Graves' disease.

Evaluation of the cardiovascular risk in patients with subclinical Cushing syndrome before and after surgery.

Impact of gland morphology and concomitant thyroid nodules on preoperative localization of parathyroid adenomas.

Predictive factors for recurrent laryngeal nerve palsy and hypoparathyroidism after thyroid surgery

Multimodality imaging features of idiopathic granulomatous mastitis: outcome of 12 years of experience