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...

/pdf/2015-american-thyroid-association-management-guidelines-for-32kri8vrhd.pdf

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...

/pdf/revised-american-thyroid-association-management-guidelines-3i6bt8nj9c.pdf

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

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. As the population of patients recovering from COVID-19 grows, it is paramount to establish an understanding of the healthcare issues surrounding them. COVID-19 is now recognized as a multi-organ disease with a broad spectrum of manifestations. Similarly to post-acute viral syndromes described in survivors of other virulent coronavirus epidemics, there are increasing reports of persistent and prolonged effects after acute COVID-19. Patient advocacy groups, many members of which identify themselves as long haulers, have helped contribute to the recognition of post-acute COVID-19, a syndrome characterized by persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms. Here, we provide a comprehensive review of the current literature on post-acute COVID-19, its pathophysiology and its organ-specific sequelae. Finally, we discuss relevant considerations for the multidisciplinary care of COVID-19 survivors and propose a framework for the identification of those at high risk for post-acute COVID-19 and their coordinated management through dedicated COVID-19 clinics.

/pdf/post-acute-covid-19-syndrome-1bat2sg5js.pdf

Post-acute COVID-19 syndrome.

/pdf/management-guidelines-for-patients-with-thyroid-nodules-and-33wjxjfqag.pdf

Management guidelines for patients with thyroid nodules and differentiated thyroid cancer.

European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium Furio Pacini, Martin Schlumberger, Henning Dralle, Rossella Elisei, Johannes W A Smit, Wilmar Wiersinga and the European Thyroid Cancer Taskforce Section of Endocrinology and Metabolism, University of Siena, Via Bracci, 53100 Siena, Italy, Service de Medicine Nucleaire, Institut Gustave Roussy, Villejuif, France, Department of General, Visceral and Vascular Surgery, University of Halle, Germany, Department of Endocrinology, University of Pisa, Italy, Department of Endocrinology and Metabolic Disease, Leiden University Medical Center, The Netherlands and Department of Endocrinology and Metabolism, University of Amsterdam, The Netherlands

/pdf/european-consensus-for-the-management-of-patients-with-dske0use4g.pdf

European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium

Si definisce gozzo l’incremento diffuso o nodulare della ghiandola tiroidea. Il suo sviluppo e legato a fattori genetici e ambientali, di cui il piu importante e rappresentato dalla carenza iodica. L’inquadramento clinico prevede un’attenta valutazione dei sintomi, dei segni, dei risultati degli esami ormonali, delle caratteristiche ecografiche e citologiche. Il trattamento deve essere poi individualizzato tenendo conto della disponibilita di molteplici opzioni terapeutiche.

/pdf/il-gozzo-multinodulare-gpvqtkhyaf.pdf

Il gozzo multinodulare

The massive vaccination campaign against COVID-19 has granted a high level of protection against the severe forms of the disease at the price of some mild adverse events.To underline that COVID-19 vaccination can induce a transient enlargement of lymph-node metastases in differentiated thyroid cancer patients.We describe the clinical, laboratory, and imaging features of a 60-year-old woman affected by paratracheal lymph-node relapse of Hurtle Cell Carcinoma who came to our attention after full COVID-19 vaccination because of neck swelling and pain. In April 2021, after 5 years of stable structural disease, the patient presented an enlargement of the metastatic lymph node, associated with a rise of serum thyroglobulin (from 4.6 to 14.7 pg/mL). Anti-inflammatory treatment was started and pain and swelling remitted after 15 days. At the subsequent evaluation, at neck ultrasound, the right paratracheal lesion was smaller and thyroglobulin dropped to 3.9 pg/mL.We report the case of an enlargement of metastatic lymph node from differentiated thyroid cancer after COVID-19 vaccination. We warn clinicians to identify features of inflammatory response due to COVID-19 vaccination in order to prevent unwarranted surgical treatment. 

/pdf/enlargement-of-a-metastatic-lymph-node-from-differentiated-9adc07df.pdf

Enlargement of a metastatic lymph node from differentiated thyroid cancer after COVID-19 vaccination

Abstract Fine-Needle Aspiration Biopsy (FNAB) guides surgical treatment of thyroid nodules which, according to the Italian classification, are classified as TIR 1/1C, TIR 2, TIR 3A, TIR3B, TIR4 or TIR5, which correspond to Thy I, Thy II, Thy III, Thy IV, Thy V and Thy VI categories of the Bethesda System. TIR 3 identifies the follicular pattern, which is typical of both benign and malignant lesions. Surgery is usually recommended for TIR 3B, TIR 4 and TIR 5 nodules. The latest histopathological classifications of thyroid cancers have introduced significant changes. While the follicular (FV-PTC) and classical variants (CV-PTC) of papillary thyroid carcinoma and the minimally invasive follicular thyroid carcinoma (FTC) are characterized by a good prognosis and require a less aggressive treatment, the poorly differentiated thyroid carcinoma (PDTC), the anaplastic thyroid carcinoma (ATC), the tall cell (TC-PTC) and the solid variants (SV-PTC) and other variants have a worse prognosis. In addition, thyroid ultrasound often identifies thyroid nodules <1 cm, which are usually characterized by an indolent behavior and active surveillance may be advised. We retrospectively analyzed consecutive histopathological records of 1117 patients (for a total of 1668 nodules, of which 650 malignant) who underwent surgery in 2017, and who had previously undergone FNAB and thyroid ultrasound (available for 390 nodules), in order to characterize echographic and cytological features useful to identified aggressive variants among TIR4-5 nodules and malignant lesions among TIR3B nodules. Of the 566 PTC, 18.7% were TIR3A, 20.7% TIR 3B and 51.6% TIR4-5, while of 50 FTC 42.0% were TIR3A, 42.0% TIR3B and 6.0% TIR4-5. Of the 11 PDTC 54.5% had been diagnosed as TIR 3B. Of the 249 classic variant of PTC, 0.8% had resulted TIR3A, 14.1% TIR3B and 79.9% TIR4-5. Among 49 tall cell variant, none had resulted TIR3A, 2% had been diagnosed as TIR3B and 95.9% as TIR4-5. Of the 219 follicular variant of PTC 42.0% had resulted TIR3A, 39.7% TIR3B and 12,3% TIR4-5. Among 34 SV-PTC, 32.4% had been diagnosed as TIR3A, 41.2% TIR3B and 0.6% TIR4-5. Blurred margins were the only feature associated with malignancy (p=0.034) in TIR3B nodules. The coexistence of hypoechogenicity and blurred margins in absence of microcalcifications were more common in tall cell variant (7/28) compared to classic variant (10/120) of PTC (p= 0.021). A significant number of PDTC and SV-PTC were diagnosed as TIR3. Among TIR3B nodules, irregular margins correlate with malignancy. Coexistence of irregular margins with a hypoechoic pattern in absence of microcalcifications is helpful in identifying TIR4/TIR5 nodule which turn out TC-PTC. In conclusion, among TIR3B, TIR4 and TIR5 nodules, ultrasound helps to identify aggressive variants and therefore to choose the extent of surgical treatment and, when <1 cm, to confidently advise active surveillance. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

/pdf/psat382-characterization-of-ultrasound-and-cytological-268gb593.pdf

PSAT382 Characterization of Ultrasound and Cytological Features Identifying Thyroid Nodules with Aggressive Behavior: From Histology to Clinic

Abstract Background Destructive thyroiditis is the most common endocrine immune related adverse event (iRAEs) in patients treated with anti-PD1/PD-L1 agents. Given its self-limited course, current guidelines recommend no treatment for this iRAE. Nevertheless in patients with enlarged thyroid volume and a poor performance status, thyrotoxicosis may be particularly severe and harmful. Aim of the study is to evaluate if steroid treatment might be useful in improving thyrotoxicosis in subjects with a poor performance status. Methods We conducted a case-control study, comparing the course of thyrotoxicosis of 4 patients treated with oral prednisone at the dosage of 25 mg/d (tapered to discontinuation in three weeks) and an enlarged thyroid volume to that of 8 patients with similar thyroid volume who were left untreated. Results No difference was found between the two groups at the onset of thyrotoxicosis (time 0) in demographic characteristics and in the levels of thyroid hormones. The levels of thyroid hormones were lower in subjects treated with prednisone compared to those untreated at time 7, 14, 21, 28, 35, 42, 60 and 90 days (P<0.05 at each time). The median time to remission of thyrotoxicosis was 24 days in patients treated with steroids and 92 days in untreated patients (P<0.001). At 6 months, the rate of evolution to hypothyroidism was similar in the 2 groups (4/4 in steroid group vs 7/8 in untreated group, P=0.74) and no difference was found in tumor progression (Progression free survival in treated group 5.1 months vs 5.0 months in untreated patients, P=0.89). Conclusion A short period of prednisone therapy is useful to restore more quickly euthyroidism in patients with a poor performance status and a severe destructive thyrotoxicosis induced by PD-1 blockade. This treatment does not impair the efficacy of immunotherapy. Presentation: Sunday, June 12, 2022 11:30 a.m. - 11:45 a.m.

/pdf/or11-3-steroid-treatment-in-the-management-of-destructive-s5frwgl0.pdf

OR11-3 Steroid Treatment in the Management of Destructive Thyrotoxicosis Induced by PD1 Blockade

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online) 

Francesco Latrofa

Papers

Il gozzo multinodulare

Enlargement of a metastatic lymph node from differentiated thyroid cancer after COVID-19 vaccination

PSAT382 Characterization of Ultrasound and Cytological Features Identifying Thyroid Nodules with Aggressive Behavior: From Histology to Clinic

OR11-3 Steroid Treatment in the Management of Destructive Thyrotoxicosis Induced by PD1 Blockade

Ultrasound and cytological features of thyroid nodules with aggressive behavior: from histology to clinic