Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features.
01 May 2002-The Journal of Clinical Endocrinology and Metabolism (Endocrine Society)-Vol. 87, Iss: 5, pp 1941-1946
TL;DR: The aim of the study was to correlate the sonographic and color-Doppler findings with the results of US-guided fine needle aspiration biopsy and of pathologic staging of resected carcinomas to establish the relative importance of US features as risk factors of malignancy and a cost-effective management of nonpalpable thyroid nodules.
Abstract: The aim of the study was to correlate the sonographic [ultrasound (US)] and color-Doppler (CFD) findings with the results of US-guided fine needle aspiration biopsy (FNA) and of pathologic staging of resected carcinomas to establish: 1) the relative importance of US features as risk factors of malignancy; and 2) a cost-effective management of nonpalpable thyroid nodules. Four hundred ninety-four consecutive patients with nonpalpable thyroid nodules (8–15 mm) were evaluated by US, CFD, and US-FNA. Ninety-two patients with inadequate cytology were excluded from the study. All patients with suspicious or malignant cytology underwent surgery, whereas subjects with benign cytology had clinical and US control 6 months later. Thyroid malignancies were observed in 18 of 195 (9.2%) solitary thyroid nodules and in 13 of 207 (6.3%) multinodular goiters. Cancer prevalence was similar in nodules greater or smaller than 10 mm (9.1 vs. 7.0%). Extracapsular growth (pT4) was present in 35.5%, and nodal involvement in 19.4...
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University of Colorado Boulder1, Harvard University2, Mayo Clinic3, Boston University4, University of Pennsylvania5, University of Pittsburgh6, University of Siena7, University Health Network8, Institut Gustave Roussy9, Oregon Health & Science University10, University of Texas MD Anderson Cancer Center11, Duke University12, University of Cincinnati13, Memorial Sloan Kettering Cancer Center14, MedStar Washington Hospital Center15
TL;DR: Evidence-based recommendations are developed to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer and represent, in the authors' opinion, contemporary optimal care for patients with these disorders.
Abstract: 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...
10,501 citations
Cites background or methods from "Risk of malignancy in nonpalpable t..."
...Features with the highest specificities (median >90%) for thyroid cancer are microcalcifications, irregular margins, and tall shape, although the sensitivities are significantly lower for any single feature (70-77)....
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...Macrocalcifications within a nodule, if combined with microcalcifications, confer the same malignancy risk as microcalcifications alone (70;74)....
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...Patients with multiple thyroid nodules have the same risk of malignancy as those with solitary nodules (32;74)....
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...Two other studies and a meta-analaysis with higher proportions of FTC (10-22%) have shown that intranodular vascularity was correlated with malignancy (66;74;81)....
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...A diagnostic US should be performed to evaluate the sonographic prisk pattern of each nodule delineate the nodules, but if only the “dominant” or largest nodule is aspirated, the thyroid cancer may be missed (74)....
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Johns Hopkins University1, University of Michigan2, University of Colorado Denver3, Ohio State University4, Boston University5, University of Pennsylvania6, University of Florida7, Mayo Clinic8, University of Siena9, Institut Gustave Roussy10, University of Cincinnati11, Memorial Sloan Kettering Cancer Center12
TL;DR: Evidence-based recommendations in response to the appointment as an independent task force by the American Thyroid Association to assist in the clinical management of patients with thyroid nodules and differentiated thyroid cancer represent, in the authors' opinion, contemporary optimal care for patients with these disorders.
Abstract: 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...
7,525 citations
Cites background from "Risk of malignancy in nonpalpable t..."
...[A14] How should multinodular thyroid glands or multinodular goiters be evaluated for malignancy? Patients with multiple thyroid nodules have the same risk of malignancy as those with solitary nodules (18,44)....
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...A diagnostic US should be performed to delineate the nodules, but if only the ‘‘dominant’’ or largest nodule is aspirated, the thyroid cancer may be missed (44)....
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Brigham and Women's Hospital1, Boston University2, University of California, Los Angeles3, Boston Children's Hospital4, University of Alabama at Birmingham5, Stanford University6, Northwestern University7, Aalborg University8, Cardiff University9, University of Pennsylvania10, Erasmus University Rotterdam11, Medical University of South Carolina12
TL;DR: The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy and thyrotoxicosis in pregnancy.
Abstract: Background: Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2...
2,409 citations
Johns Hopkins University School of Medicine1, University of Michigan2, Anschutz Medical Campus3, Ohio State University4, Boston Medical Center5, University of Pennsylvania6, University of Florida7, Mayo Clinic8, University of Texas MD Anderson Cancer Center9, Memorial Sloan Kettering Cancer Center10
2,086 citations
Cites background from "Risk of malignancy in nonpalpable t..."
...Differentiated thyroid carcinoma (particularly papillary carcinoma) involves cervical lymph nodes in 20%–50% of patients in most series using standard pathologic techniques (75–79), and may be present even when the primary tumor is small and intrathyroidal (37,80)....
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...In one study investigating the value of routine reaspirations of benign nodules, the nodule grew in the three patients who were subsequently found to have thyroid cancer (37)....
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...Sonographic characteristics are superior to nodule size for identifying nodules that are more likely to be malignant (37,38) and include the presence of microcalcifications, hypoechogenicity (darker than the surrounding thyroid parenchyma) of a solid nodule, and intranodular hypervascularity (37,38)....
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...Patients with multiple thyroid nodules have the same risk of malignancy as those with solitary nodules (14,37)....
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01 Jan 2011
TL;DR: Pregnancy is a stress test for the thyroid, resulting in hypothyroidism in women with limited thyroidal reserve or iodine deficiency, and postpartum thyroiditis inWomen with underlying Hashimoto’s disease who were euthyroid prior to conception.
Abstract: Pregnancy has a profound impact on the thyroid gland and thyroid function. The gland increases 10% in size during pregnancy in iodine-replete countries and by 20%– 40% in areas of iodine deficiency. Production of thyroxine (T4) and triiodothyronine (T3) increases by 50%, along with a 50% increase in the daily iodine requirement. These physiological changes may result in hypothyroidism in the later stages of pregnancy in iodine-deficient women who were euthyroid in the first trimester. The range of thyrotropin (TSH), under the impact of placental human chorionic gonadotropin (hCG), is decreased throughout pregnancy with the lower normal TSH level in the first trimester being poorly defined and an upper limit of 2.5 mIU/L. Ten percent to 20% of all pregnant women in the first trimester of pregnancy are thyroid peroxidase (TPO) or thyroglobulin (Tg) antibody positive and euthyroid. Sixteen percent of the women who are euthyroid and positive for TPO or Tg antibody in the first trimester will develop a TSH that exceeds 4.0 mIU/L by the third trimester, and 33%–50% of women who are positive for TPO or Tg antibody in the first trimester will develop postpartum thyroiditis. In essence, pregnancy is a stress test for the thyroid, resulting in hypothyroidism in women with limited thyroidal reserve or iodine deficiency, and postpartum thyroiditis in women with underlying Hashimoto’s disease who were euthyroid prior to conception. Knowledge regarding the interaction between the thyroid and pregnancy/the postpartum period is advancing at a rapid pace. Only recently has a TSH of 2.5 mIU/L been accepted as the upper limit of normal for TSH in the first trimester. This has important implications in regards to interpretation of the literature as well as a critical impact for the clinical diagnosis of hypothyroidism. Although it is well accepted that overt hypothyroidism and overt hyperthyroidism have a deleterious impact on pregnancy, studies are now focusing on the potential impact of subclinical hypothyroidism and subclinical hyperthyroidism on maternal and
1,464 citations
Cites background from "Risk of malignancy in nonpalpable t..."
...The presence of two or more suspicious sonographic criteria reliably identifies most neoplastic lesions of the thyroid gland (87%– 93% of cases) (229)....
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References
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TL;DR: Treatment of recurrences is based mainly on surgery and 131I treatment, and the recent availability of recombinant human thyroid stimulating hormone has greatly improved the quality of the patient's life during follow-up.
Abstract: Papillary and follicular thyroid carcinomas are among the most curable of all cancers. However, some patients are at high risk of recurrence or even death from their cancer. Most of these patients can be identified at the time of diagnosis using well-established prognostic indicators. The extent of initial treatment and follow-up should therefore be individualized. The early discovery of persistent and recurrent disease is based on the combined use of serum thyroglobulin determination and of total body scanning with 131I. The recent availability of recombinant human thyroid stimulating hormone has greatly improved the quality of the patient's life during follow-up. Treatment of recurrences is based mainly on surgery and 131I treatment.
1,500 citations
TL;DR: The frequency and clinical significance of incidentally discovered, nonpalpable thyroid nodules are reviewed and a practical approach to their treatment is offered and the recommendations for treating thyroid incidentalomas are offered.
Abstract: Background: The introduction of highly sensitive imaging techniques has made it possible to detect many nonpalpable nodules, or “incidentalomas,” in the thyroid. Discovery of these lesions raises c...
960 citations
TL;DR: More than 99% of papillary thyroid microcarcinoma patients are not at risk of distant spread or cancer mortality, and RRA after BLR did not improve postoperative outcome.
819 citations
TL;DR: The data indicate that thyroid abnormalities are very common incidental findings, emphasizing the need for a conservative approach when such lesions are encountered incidentally.
Abstract: Background: Thyroid nodules are commonly identified on autopsy examination. There are relatively few descriptions, however, of the frequency with which thyroid nodules are encountered incidentally during the course of other investigations. Method: Prospective study to examine the prevalence of thyroid nodules in asymptomatic North American subjects, with palpation findings compared with findings on high-resolution ultrasonography. Results: Palpable nodules were identified in 21 (21%) of 100 subjects, with nine solitary nodules (9%) and 12 multiple nodules (12%). In comparison, only 33 subjects were found to be free of any nodules by ultrasonography. Of the 67 subjects with abnormal ultrasound findings, 22 had solitary nodules (22%) and 45 had multiple nodules (45%). The prevalence of nodules was greater in women (72%) than in men (41%) ( P Conclusions: The data indicate that thyroid abnormalities are very common incidental findings, emphasizing the need for a conservative approach when such lesions are encountered incidentally. (Arch Intern Med. 1994;154:1838-1840)
740 citations