Management of a Solitary Thyroid Nodule
25 Feb 1993-The New England Journal of Medicine (Massachusetts Medical Society)-Vol. 328, Iss: 8, pp 553-559
TL;DR: This review describes a strategy for the treatment of clinically euthyroid patients who have a solitary thyroid nodule that prevents unnecessary testing while identifying the few patients who require therapy.
Abstract: The solitary thyroid nodule, defined as a palpably discrete swelling within an otherwise apparently normal gland, is usually a benign lesion. However, patient and physician alike are typically concerned about the possibility of thyroid cancer. This review describes a strategy for the treatment of clinically euthyroid patients who have a solitary thyroid nodule that prevents unnecessary testing while identifying the few patients who require therapy. Management has changed in recent years, but important differences of opinion remain over which nodules should be surgically excised. Several recent reviews address these issues comprehensively1–3. Prevalence of Thyroid Nodules and Cancer The . . .
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TL;DR: In this article, the authors examined trends in thyroid cancer incidence, histology, size distribution, and mortality in the United States, concluding that the increasing incidence of thyroid cancer is primarily due to the increased detection of small papillary cancers.
Abstract: ContextIncreasing cancer incidence is typically interpreted as an increase in the true occurrence of disease but may also reflect changing pathological criteria or increased diagnostic scrutiny. Changes in the diagnostic approach to thyroid nodules may have resulted in an increase in the apparent incidence of thyroid cancer.ObjectiveTo examine trends in thyroid cancer incidence, histology, size distribution, and mortality in the United States.MethodsRetrospective cohort evaluation of patients with thyroid cancer, 1973-2002, using the Surveillance, Epidemiology, and End Results (SEER) program and data on thyroid cancer mortality from the National Vital Statistics System.Main Outcome MeasuresThyroid cancer incidence, histology, size distribution, and mortality.ResultsThe incidence of thyroid cancer increased from 3.6 per 100 000 in 1973 to 8.7 per 100 000 in 2002—a 2.4-fold increase (95% confidence interval [CI], 2.2-2.6; P .20 for trend). Virtually the entire increase is attributable to an increase in incidence of papillary thyroid cancer, which increased from 2.7 to 7.7 per 100 000—a 2.9-fold increase (95% CI, 2.6-3.2; P<.001 for trend). Between 1988 (the first year SEER collected data on tumor size) and 2002, 49% (95% CI, 47%-51%) of the increase consisted of cancers measuring 1 cm or smaller; 87% (95% CI, 85%-89%) consisted of cancers measuring 2 cm or smaller. Mortality from thyroid cancer was stable between 1973 and 2002 (approximately 0.5 deaths per 100 000).ConclusionsThe increasing incidence of thyroid cancer in the United States is predominantly due to the increased detection of small papillary cancers. These trends, combined with the known existence of a substantial reservoir of subclinical cancer and stable overall mortality, suggest that increasing incidence reflects increased detection of subclinical disease, not an increase in the true occurrence of thyroid cancer.
3,071 citations
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...Fine-needle aspiration allows for cytological assessment of a thyroid mass and can be performed quickly during an office visit.(21) It has largely replaced nuclear medicine scans, much more involved tests that required dietary restrictions prior to the test, took several hours to complete, and frequently produced indeterminate results....
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TL;DR: The rapid growth of knowledge in recent years concerning the physiology and biochemistry of the thyroid hormones and the pathogenesis and treatment of thyroid diseases has no doubt been responsible for the recent spate of books dealing with these subjects.
Abstract: The rapid growth of knowledge in recent years concerning the physiology and biochemistry of the thyroid hormones and the pathogenesis and treatment of thyroid diseases has no doubt been responsible for the recent spate of books dealing with these subjects. Among the most comprehensive and stimulating of these is The Thyroid Gland . This two volume presentation is comprised of 28 chapters by an international aggregation of 36 contributors, each an acknowledged authority in the field with which he deals. The books are edited by Rosalind Pitt-Rivers and W. R. Trotter, who are themselves distinguished authorities in basic and clinical thyroidology. This expertise and scholarship is reflected in the comprehensive manner in which the subjects are usually discussed and in the extensive bibliographies which accompany them. Volume 1 is concerned principally with the structure and function of the thyroid gland, the peripheral metabolism, and the metabolic effects of thyroid hormones.
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TL;DR: This work offers here another multifactorial system for the identification of low-risk patients who made up 89.4% of all patient seen between 1961 and 1980 and who have a death rate of only 1.8%.
942 citations
654 citations
TL;DR: The thyroid gland was removed en toto from each of 1,000 subjects undergoing routine consecutive postmortem examination in the Section of Patholo...
Abstract: BASIC and essential to reliable understanding of the disorders of anybodily organ or system is thorough knowledge of the minute gross and histologic anatomic characteristics of that organ. The pathologic findings observed must then be correlated with clinical observations under various circumstances of health, physiologic alterations and pathologic deviations. In reference to the thyroid gland, such basic pathologic data have been rather slow to accumulate because often the routine necropsy does not include removal of the entire gland. Even when the thyroid is removed, a systematic, minute study of the gland is rarely undertaken as part of the routine examination if the gland appears normal externally or when bisected. In order, then, to obtain additional basic pathologic data concerning the thyroid gland, the following study was undertaken. MATERIAL AND METHODS The thyroid gland was removed en toto from each of 1,000 subjects undergoing routine consecutive postmortem examination in the Section of Patholo...
645 citations
TL;DR: The incidence of malignant tumors and leukemia was analyzed in 829 patients with chronic lymphocytic thyroiditis and in 828 individually age-matched and sex-matched patients with colloid goiter.
Abstract: The incidence of malignant tumors and leukemia was analyzed in 829 patients with chronic lymphocytic thyroiditis and in 829 individually age-matched and sex-matched patients with colloid goiter. Diagnoses were based on cytologic studies of specimens obtained by fine-needle aspiration biopsy. The patients were examined between 1959 and 1978 and were followed in the Swedish Cancer Register between 1959 and 1981. There was no increased risk for the total number of tumors in the thyroiditis group (53 observed vs. 52.7 expected) or in the colloid-goiter group (40 vs. 53.2, respectively; P not significant). There were six lung cancers in the thyroiditis group (2.9 expected, P not significant), and one in the group with colloid goiter. Patients with thyroiditis had an increased risk of myeloproliferative and lymphoproliferative neoplasms (12 observed vs. 3.0 expected, P less than 0.001). The risk of malignant thyroid lymphoma was greatly increased, with an estimated relative risk of 67 (4 observed vs. 0.06 expected, P less than 0.000001). There was no increased risk for any type of tumor among patients with colloid goiter.
511 citations