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In this paper, we determined the rates of Bethesda IV thyroid nodules and calculated the malignancy rates of these nodules in a university hospital located in an endemic area for thyroid diseases. We aimed to define the predictive factors for malignancy to select patients who need surgery. We included in the study 221 patients who had a preoperative biopsy for follicular neoplasm or because of suspicion for follicular neoplasm and underwent thyroidectomy between January 2012 and December 2018. We evaluated the data about patient characteristics, preoperative ultrasound results, indications for operation and postoperative pathological valuation results and calculated ratio of Bethesda Category IV nodules and incidental malignancy rates. The malignancy rate of Bethesda Category IV nodules was 48.9 %, while the incidental malignancy rate was 30.7 %. There was no statistical difference between patients with benign and malignant pathology results in terms of gender, age, preoperative diagnosis, size of the index nodule, number and results of biopsies and the thyroidectomy performed. The most important risk factor among all parameters was hypoechogenicity of the nodule. The solid structure increases this risk. Ultrasonographic hypoechogenicity is the most important risk factor for preoperative malignancy risk assessment for Bethesda Category IV thyroid nodules. Centers should determine their malignancy rates with particular risk factors and surgical approaches in endemic regions.

Rationale and Objectives To evaluate the efficacy of microwave ablation (MWA) for benign thyroid nodules (BTNs) and compare trauma and complication rates between MWA and traditional thyroidectomy for BTNs. Materials and Methods 84 patients with BTNs were recruited and followed up at 1, 3, 6, and 12months. 56 and 28 patients chose to undergo MWA (group A) and traditional thyroidectomy (group B), respectively. Efficacy was assessed by volume reduction rate (VRR) and therapeutic success rate (TSR) at each follow-up. Trauma was compared using inflammation response parameters, visual analog scale (VAS) scores, quality of life (QOL) and thyroid function measures at 1, 3, and 6 months. Complications rates were also compared. Results The VRR was 80.70 ± 18.60%, and TSR was 91.70% at 6-months. Furthermore, the VRR increased to 90.45 ± 11.51%, and TSR increased to 100% at 12-months. C-reactive protein levels were significantly higher in group B on the first postoperative day (POD) (3.89 ± 0.86 mg/mL vs 3.39 ± 0.56 mg/mL, p = 0.002). Visual analog scale scores were significantly lower in group A on the first and second POD. Thyroid stimulating hormone levels were significantly lower in group A at three (1.71 ± 1.12uIU/mL vs 2.37 ± 1.24uIU/mL, p = 0.013) and 6-months (1.34 ± 0.70uIU/mL vs 1.97 ± 0.94uIU/mL, p = 0.002). There were no significant between-group differences in QOL and complication rates. Conclusion Microwave ablation shows acceptable and promising efficacy. Compared with thyroidectomy, MWA was associated with less trauma and comparable complication rates.

To assess the application of American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) guidelines and the potential reduction of unnecessary fine-needle aspirate (FNA) and cost savings through examination of cytopathological correlation.All ultrasound-guided thyroid FNA performed between December 2017 and July 2019 at our institution were included in this study. Prior to performing each FNA, the nodules were scored according to ACR-TIRADS criteria with subsequent cytology scored according to Bethesda criteria. FNA request forms and preceding diagnostic ultrasound reports were analysed for clinical rationale behind each FNA. Collected data were applied to ACR-TIRADS, American Thyroid Association (ATA) and Korean TIRADS (K-TIRADS) criteria. Rate of reduction of unnecessary thyroid FNA and associated costs were subsequently calculated.A total of 125 patients and 146 nodules were evaluated. A malignancy rate of 7.5% was obtained. Sensitivity and specificity for detection of malignancy were 75% and 41% for ACR-TIRADS, 91% and 26% for ATA and 92% and 19% for K-TIRADS. Reduction in the rate of unnecessary FNA was most superior for ACR-TIRADS at 54.8%. Based on Australian Medicare Benefits Schedule item codes, a total of $18 452.70 might have been saved over the study period had ACR-TIRADS guidelines been uniformly followed.This study highlights the strengths and limitations of guidelines in the investigative pathway of thyroid nodules, including superiority of ACR-TIRADS in reducing the rate of unnecessary FNA. Continued education is needed towards application of guidelines among radiologists and referring clinicians, given the potential to reduce unnecessary FNA and achieve economic savings.

BACKGROUND: Thermoablation is an attractive treatment of thyroid nodules for its minimal-invasiveness. It remains unclear whether results and morbidity meet the patients’ expectations. OBJECTIVE: The aim of the presented study is to show data obtained after microwave thyroid ablation from a patients’ perspective. METHODS: Indications and preoperative diagnosis were chosen according to international guidelines. Thermoablation was achieved using a CE certified microwave system. The procedures heeded the published recommendations of the European Federation of Societies for Ultrasound in Medicine and Biology. Follow-up included ultrasound, laboratory parameters and a standardized questionnaire. RESULTS: Thirty patients were enrolled into the study. All patients reported an improvement of complaints following the procedure. Scar formation occurred in 3 cases (10%) with 0.5 ± 1.3 mm length and 0.4 ± 1.0 mm width. No cosmetic, neurological, vocal or pharyngeal complication occurred. Energy required for non-functioning nodules (n= 15, 50%) was 2.56 ± 3.41 kJ/mL, for autonomous adenoma (n= 8, 27%) 0.96 kJ/mL (p< 0.05, t-test). CONCLUSION: The presented data summarize an initial experience in selected patients and resemble excellent patient reported outcome with minimal morbidity. These preliminary data indicate the majority of patients satisfied with the procedure. Further trials will be required to endorse these findings.

BACKGROUND Few studies have compared the features of thyroid cancer among races and ethnicities. We hypothesized that race and ethnicity may influence the frequency and features of thyroid malignancy in thyroid nodules. METHOD This was a retrospective chart review of patients between 2013 and 2020 who underwent thyroidectomy. RESULTS In the analysis of 2737 patients, thyroid cancer was less prevalent among Blacks (24.0% vs Whites 52.1%, Hispanics 58.7%, Asians 71.7%, and Others 57.9%, p

Introduction About 15% to 30% of thyroid fine-needle aspiration (FNA) nodules have indeterminate cytology. The Afirma (Veracyte Inc, South San Francisco, CA) Gene Expression Classifier (GEC)/Gene Sequencing Classifier (GSC) tests were designed to improve risk stratification of the indeterminate thyroid nodules. This study aimed to evaluate and compare the performance of the Afirma GEC and GSC tests in the indeterminate thyroid lesions. Methods Thyroid FNA cases with indeterminate cytology were searched in the pathology database and only those with available Afirma results were selected for this study. Each patient’s demographic, sonographic, cytologic, molecular, and subsequent surgical follow-up results were collected and analyzed. Results There were 100 cases with indeterminate thyroid FNA results, including 49 cases tested by GEC and 51 cases by GSC. In the GEC group, benign call rate (BCR) was 53% (26 of 49) and the calculated negative predictive value (NPV) and positive predictive value (PPV) were 88% and 47% respectively. In the GSC group, the BCR was 63% (32 of 51) and the calculated NPV and PPV were 100% and 64%, respectively. Whereas only 17% (1 of 6) of benign oncocytic lesions were tested benign by the GEC, 60% (3 of 5) of benign oncocytic nodules were tested benign by the GSC. Conclusion We demonstrated in this study that a little more than half of the indeterminate thyroid nodules had negative Afirma GEC/GSC results and the BCR using the Afirma GSC test was higher than GEC. The Afirma GSC showed higher NPV and PPV than GEC. In addition, the Afirma GSC appeared to be superior for differentiating benign and malignant oncocytic thyroid lesions.

Background The risk of malignancy from nodules with atypia of undetermined significance cytology is estimated between 5% and 15%, though more recent studies suggest rates upwards of 48%. This study sought to characterize preoperative predictors of malignancy to aid in clinical decision-making. Methods We performed a single institution retrospective review of all adult patients with unilateral thyroid nodules demonstrating atypia of undetermined significance cytology between March 1, 2013 and June 1, 2019 who underwent surgical resection (n = 266). Univariate and multivariate logistical analysis was performed using clinical and demographic variables to identify potential preoperative characteristics associated with malignant disease. Results Malignancy was identified on final pathology in 24.7% of patients with atypia of undetermined significance cytology. Age, sex, exposure to ionizing radiation, family history of thyroid cancer, Hashimoto’s disease, Afirma suspicious results, and smoking were not associated with malignancy on both univariate and multivariate analysis. Nodule size >4 cm was independently associated with malignancy risk on both univariate (odds ratio 2.44, 1.09–5.43, P Conclusion The results of this study demonstrate that nodules with atypia of undetermined significance cytology >4 cm are strongly associated with malignancy. We recommend strong consideration of surgery for all patients with thyroid nodules >4 cm and atypia of undetermined significance cytology.

Objective The purpose of this study was to develop a natural language processing (NLP) pipeline to identify incidental thyroid nodules (ITNs) meeting criteria for sonographic follow-up and to assess both adherence rates to white paper recommendations and downstream outcomes related to these incidental findings. Methods 21583 non-contrast chest CT reports from 2017 and 2018 were retrospectively evaluated to identify reports which included either an explicit recommendation for thyroid ultrasound, a description of a nodule ≥ 1.5 cm, or description of a nodule with suspicious features. Reports from 2018 were used to train an NLP algorithm called fastText for automated identification of such reports. Algorithm performance was then evaluated on the 2017 reports. Next, any patient from 2017 with a report meeting criteria for ultrasound follow-up was further evaluated with manual chart review to determine follow-up adherence rates and nodule-related outcomes. Results NLP identified reports with ITNs meeting criteria for sonographic follow-up with an accuracy of 96.5% (95% CI 96.2-96.7) and sensitivity of 92.1% (95% CI 89.8-94.3). In 10006 chest CTs from 2017, ITN follow-up ultrasound was indicated according to white paper criteria in 81 patients (0.8%), explicitly recommended in 46.9% (38/81) of patients, and obtained in less than half of patients in which it was appropriately recommended (17/35, 48.6%). Discussion NLP accurately identified chest CT reports meeting criteria for ITN ultrasound follow-up. Radiologist adherence to white paper guidelines and subsequent referrer adherence to radiologist recommendations showed room for improvement.

Introduction Molecular testing has helped clinicians and cytopathologists to further categorize indeterminate thyroid fine needle aspiration (FNA) specimens. The purpose of the present study was to evaluate the accuracy of commercially available molecular tests, review their effects on patient treatment, and correlate the molecular alterations with the histologic findings. Materials and methods A pathology laboratory information system search identified thyroid FNAs performed at our institution between January 1, 2015 and June 30, 2020. The results of surgical follow-up and ancillary molecular testing were collected. We evaluated the accuracy of these tests and whether they could reduce the number of surgeries performed. Results Our laboratory information system search identified 510 cases reported as atypia of undetermined significance, 94 as suspicious for follicular neoplasm, and 44 as suspicious for follicular neoplasm, Hurthle cell type. Of the specimens, 343 had no ancillary molecular testing, 146 were sent for ThyGenX/ThyraMIR, and 136 were sent for ThyroSeq. Of the patients without molecular testing, 50.4% had undergone follow-up surgery compared with 30.8% after ThyGenX/ThyraMIR and 38.2% after ThyroSeq testing, resulting in 38.9% and 24.2% fewer surgeries and an odds ratio of 0.04 (95% confidence interval, 0.00-0.33) and 0.14 (95% confidence interval, 0.01-0.95), respectively. For ThyGenX/ThyraMIR testing, the risk of malignancy for high and moderate to high risk alterations was 80%, 28.6% for moderate and low to moderate risk alterations, and 23.1% for low risk alterations. For ThyroSeq, the risk of malignancy was 87.5% for high risk alterations, 36.8% for intermediate to high risk alterations, 27.3% for intermediate risk alterations, and 0% for low risk alterations. The areas under the curve for ThyGenX/ThyraMIR and ThyroSeq testing were 0.65 and 0.85, respectively. Conclusions These findings suggest that, at our institution, both ThygenX/ThyraMIR and ThyroSeq can be used to effectively stratify cytology specimens based on the risk of malignancy and reduce the number of surgeries performed at our institution.

Rationale and Objective This study is a dedicated 2D-shear wave elastography (2D-SWE) review aimed at systematically eliciting up-to-date evidence of its clinical value in differential diagnosis of benign and malignant thyroid nodules. Methods PubMed, Web of Science, and Scopus databases were searched for studies assessing the diagnostic value of 2D-SWE for thyroid malignancy risk stratification published until December 2016. The retrieved titles and abstracts were screened and evaluated according to the predefined inclusion and exclusion criteria. Methodological quality of the studies was assessed using the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review 2 (QUADAS-2) tool. Extracted 2D-SWE diagnostic performance data were meta-analyzed to assess the summary sensitivity, specificity, and area under the receiver operating characteristic curve. Results After stepwise review, 14 studies in which 2D-SWE was used to evaluate 2851 thyroid nodules (1092 malignant, 1759 benign) from 2139 patients were selected for the current study. Study quality on QUADAS-2 assessment was moderate to high. The summary sensitivity, specificity and area under the receiver operating characteristic curve of 2D-SWE for differential diagnosis of benign and malignant thyroid nodules were 0.66 (95% confidence interval [CI]: 0.64–0.69), 0.78 (CI: 0.76–0.80), and 0.851 (Q* = 0.85), respectively. The pooled diagnostic odds ratio, negative likelihood ratio, and positive likelihood ratio were 12.73 (CI: 8.80–18.43), 0.31 (CI: 0.22–0.44), and 3.87 (CI: 2.83–5.29), respectively. Conclusion Diagnostic performance of quantitative 2D-SWE for malignancy risk stratification of thyroid nodules is suboptimal with mediocre sensitivity and specificity, contrary to earlier reports of excellence.

In the setting of cancer pathology, molecular characterization of tumors providing diagnostic and predictive information is acquiring more and more relevance. Moreover, the advent of innovative technologies continuously improves the knowledge of the molecular landscape of tumors and strengthens the links between clinics, tumor pathology and molecular features. In the clinical management of patients with thyroid nodules and thyroid tumors, the aid of molecular testing is encouraged but still not strongly recommended by current guidelines. Also for this reason this field of study is attracting much interest. The nCounter system is a relatively new technology based on a direct hybridization of fluorescent probes to specific nucleic acid targets, followed by digital measurement of signals; the reaction is highly multiplexable and results are robust and reproducible. This review reports and discusses the available data related to the application of this specific technique to thyroid nodules and thyroid tumors samples. The available data indicate that nCounter system represents a solid approach for the research of relevant diagnostic and prognostic biomarkers in thyroid pathology.

Alterations in neck anatomy after thyroid surgery and post-operative fibrosis may be misleading by causing sonoelastographic changes in recurrent tissues in patients with recurrent nodular goiter and so may result in unnecessary biopsies or surgical procedures. Here, the aim was to examine thyroid sonoelastography values in patients developing a recurrence and presenting with recurrent nodular goiter with benign cytology after total or near-total thyroidectomy (T/N-TT). Twenty-nine nodules from 22 patients with a recurrence after T/N-TT whose biopsies were found to be benign constituted the patients, and 23 nodules from 23 participants among the non-operated patients having solitary or multiple thyroid nodules and with age, gender and body mass index values similar to those of the patients constituted our controls. Shear-wave velocity (SWV) values were measured. Average elapsed time after T/N-TT was 11.82 (4:25) y. No difference was detected between the groups in terms of localization and sonographic structures of the nodules. Nodule SWV values were higher in the operated recurrent nodular goiter group than in the controls (2.93 ± 0.87 m/s vs. 2.43 ± 0.33 m/s, respectively, p = 0.011). Because SWV values are high in operated recurrent nodular goiter patients, the utilization of reference sonoelastography values in those with unoperated goiter may yield misleading results in the differentiation of benign and malignant lesions.

Objective Radiofrequency ablation (RFA) is increasingly considered the prime option for treating symptomatic, benign, non-functioning thyroid nodules (NFTN). However, little is known about the degree of operator experience required to achieve optimal results. This study describes the RFA learning curve of a single-center team. Methods A retrospective cohort study of the first 103 patients receiving RFA treatment for a single, symptomatic, and benign NFTN, with a follow-up of at least 1 year. The primary outcome measure was technique efficacy, defined as the percentage of patients with a 6-month nodal volume reduction ratio (VRR) >50% after single-session RFA. Optimal treatment efficacy was defined as a 6-month VRR >50% achieved in at least 75% of patients. Secondary outcomes were complications of RFA and indications of secondary interventions. Results Median nodal volume at baseline was 12.0 mL (range 2.0–58.0 mL). A 6-month VRR >50% was achieved in 45% of the first 20 patients, 75% of the next 20, and 79% of the following 63 patients. Complications included minor bleeding (N = 4), transient hyperthyroidism (N = 4), and transient loss of voice (N = 1). Poor volume reduction or nodular regrowth led to diagnostic lobectomy in 11 patients and a second RFA in 5. Lobectomy revealed a follicular carcinoma (T2N0M0) in 2 patients. In 1 patient, nodule regrowth was caused by an intranodular solitary B-cell lymphoma. Conclusion About 40 procedures are required to achieve a 6-month VRR >50% in the majority of patients. Appropriate follow-up with re-evaluation is recommended for all patients with a VRR

BACKGROUND: This study aimed to investigate the ability of quantitative parameter-derived dual-source dual-energy computed tomography (DS-DECT) combined with machine learning to distinguish between benign and malignant thyroid nodules. METHODS: Patients with thyroid nodules and pathological surgical results who underwent preoperative DS-DECT were selected. Quantitative parameter-derived DS-DECT was applied to classify benign and malignant nodules. Then, machine learning and binary logistic regression analysis models were constructed using the DS-DECT quantitative parameters to distinguish between benign and malignant nodules. The receiver operating characteristic curve was used to assess the diagnostic performance. The DeLong test was used to compare the diagnostic efficacy. RESULTS: One hundred and thirty patients with 139 confirmed thyroid nodules were involved in the study. The malignant group had a significantly higher iodine concentration(nodule) (arterial phase) (P=0.001), normalized iodine concentration (arterial phase) (P=0.002), iodine concentration difference (P

Thyroid nodules are common in the general population, with higher prevalence in women and with advancing age. Approximately 5% of thyroid nodules are malignant; the majority of this subset represents papillary thyroid cancer. Ultrasonography is the standard technique to assess the underlying thyroid parenchyma, characterize the features of thyroid nodules, and evaluate for abnormal cervical lymphadenopathy. Various risk stratification systems exist to categorize the risk of malignancy based on the ultrasound appearance of a thyroid nodule. Nodules are selected for fine-needle aspiration biopsy on the basis of ultrasound features, size, and high-risk clinical history. Cytology results are classified by the Bethesda system into six categories ranging from benign to malignant. When cytology is indeterminate, molecular testing can further risk-stratify patients for observation or surgery. Surveillance is indicated for nodules with benign cytology, indeterminate cytology with reassuring molecular testing, or non-biopsied nodules without a benign sonographic appearance. Expected final online publication date for the Annual Review of Medicine, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

The TIRADS is a scoring system used for the selection of nodules for FNA and classification of the risk of malignancy based on ultrasound characteristics. The BETHESDA is a standard reporting system used for the classification of FNA results based on six criteria with risks for malignancy. The objective of this study was to evaluate the relationship between TIRADS and BSRTC classifications in patients undergoing thyroid biopsy. A total of 350 consecutive patients were retrospectively evaluated using TIRADS and BETHESDA reporting systems for determining preoperative diagnosis of thyroid nodules. Patients' demographics, size, echogenicity and contour status of the nodules, TIRADS and BETHESDA scores were recorded and analyzed. Data obtained in this study were expressed as mean, standard deviation, frequency and percentage descriptive statistics. The mean age of the patients was 49.03 +/- 17.58 years. The mean nodule size was measured as 20.56 +/- 10.47 mm. TIRADS TR3 category was found in 165 (47.14%), TR4 in 154 (44%) and TR5 in 31 (8.86%) patients, while BETHESDA II category was found in 288 (82.28%), BETHESDA III category in 1 (0.29%), BETHESDA IV category in 19 (5.43%), BETHESDA V in 37 (10.57%) and BETHESDA VI in 5 (1.43%) patients. There was a general concordance between BETHESDA and TRIADS categories. The most significant concordance was found between BETHESDA IV and TR4 categories (84.21%). Combined use of TRIADS and BETHESDA can be efficiently used to provide the most accurate results for making preoperative diagnosis of thyroid nodules and to determine the risk of malignancy. WOS:000741857100001 35022917 Q3

Thyroid nodules present a serious problem, and mostly they do not carry neoplastic characteristics. Thus, they do not need to be surgically treated. The risk of malignancy varies from 5 to 15 %. Steps to diagnose malignancy should include a careful clinical evaluation, laboratory tests, a thyroid ultrasound exam and a fine-needle aspiration biopsy. Fine-needle aspiration biopsy (FNAB) is the most important diagnostic tool in the assessment of thyroid nodules. Today it is considered the gold standard for malignancy diagnosis in thyroid cancer. In this review we evaluate the role of FNAB and post-operative cytology in the evaluation of thyroid nodules. FNA results are classified as diagnostic (satisfactory) or nondiagnostic (unsatisfactory). Unsatisfactory smears (5–10 %) result from hypocellular specimens usually caused by cystic fluid, bloody smears, or suboptimal preparation. Diagnostic smears are conventionally subclassified into benign, indeterminate, or malignant categories. Benign cytology (60–70 %) is negative for malignancy, and includes cysts, colloid nodule, or Hashimoto thyroiditis. Malignant cytology (5 %) is almost always positive for malignancy, and includes primary thyroid tumors or nonthyroid metastatic cancers. Indeterminate or suspicious specimens (10–20 %) include atypical changes, Hurthle cells or follicular neoplasms. The new Bethesda Cytologic Classification has a 6-category classification, subdividing indeterminate further by risk factors. Considering the increasing worldwide incidence of thyroid microadenomas, recently it is recommended to undergo FNAB under ultrasound guidance even in small (< 1cm) nodules if they are correlated with suspicious ultrasonographic features or suspicious neck lymph nodes. FNAB is a cheap and reliable diagnostic tool that can be used in the selection candidates for surgery and pre-operative diagnosis of thyroid carcinomas. It was concluded that FNAB is the gold standard in the evaluation of thyroid nodules and can prevent many unnecessary surgeries. False-negative FNA cytology remains a concern for clinicians treating patients with thyroid nodules. Post-operative histology give the definitive diagnosis and studies confirm that it has a significant discordance between pre-operative cytology and post-operative histology in patients with thyroid nodule. Cytopathologists should strengthen their criteria for the identification of adenomatous hyperplasia, thyroiditis, cystic lesions or suspicious thyroid nodules to avoid misdiagnoses.

Background. The indicators of heart rate variability reflect the vital processes of managing the physiological functions of the body — autonomic balance and functional reserves of its management mechanisms, the adaptive capacity of the body, and stress resistance. At the expressed disturbances of autonomic nervous system homeostasis, the risk of emergence and progression of diseases increases. This is especially true for the elderly, who are characterized by comorbidity. The purpose of the study was to assess the state of adaptive capacity and autonomic regulation of the body in patients with precancerous conditions of the stomach with the thyroid gland pathology. Materials and methods. Seventy-two patients with chronic atrophic gastritis were divided into groups: group I consisted of 34 patients with nodules in the thyroid gland; group II included 23 patients with pathological changes of the thyroid gland and 15 patients of group III had a normal thyroid gland. The heart rate variability was assessed based on the results of PRECISE-diagnostics. To diagnose the functional state of the small intestinal microbiota, a hydrogen breath test was performed. Results. In 81.9 % of patients with chronic atrophic gastritis and thyroid pathology, an imbalance of the sympathetic and parasympathetic parts of the autonomic nervous system with a prevalence of vagotonia including the patients with thyroid nodules (64.7 %) and pathological changes in the thyroid gland (56.5 %) (р < 0.05). A significant violation of the body’s adaptive capacity was found in 63.2 % of patients with chronic atrophic gastritis. The frequency of reduced adaptive capacity of the organism was twice higher in patients with comorbid pathology (p < 0.05). 56.1 % of patients with chronic atrophic gastritis associated with thyroid pathology experienced a decrease in functional reserves of the body. In the spectrum of detected disorders, 68.8 % of patients presented with depletion of functional reserves of the body with increased central control and 31.2 % of patients — hormonal imbalance with a predominance of the humoral link with the inclusion of autonomous control (p < 0.05). The analysis of the stress index showed in half of the examined patients insufficient stress resistance with a probable increase in mean figures to (136.8 ± 7.4) m/s (p < 0.05). Correlations were found between the frequency of detection of excessive bacterial growth syndrome and maladaptation (r = 0.64; p < 0.05), imbalance of the sympathetic and parasympathetic parts of the autonomic nervous system (r = 0.59; p < 0.05). Conclusions. The course of chronic atrophic gastritis associated with thyroid pathology is associated with an imbalance of sympathetic and parasympathetic parts of the autonomic nervous system, depletion of adaptive mechanisms, reduced functional reserves of the body, and stress resistance. At the same time, disorders of the body’s adaptive potential and changes in autonomic balance are associated with the disorders of the small intestinal microbiota, which requires a multidisciplinary approach to the management of patients with comorbid pathology of the stomach and thyroid gland., Актуальність. Показники варіабельності серцевого ритму відображують життєво важливі процеси управління фізіологічними функціями організму — вегетативний баланс і функціональні резерви механізмів його управління, адаптаційні можливості організму та стресостійкість. При виражених порушеннях вегетативного гомеостазу підвищується ризик виникнення та прогресування захворювань. Особливо це стосується людей похилого віку, для яких характерна коморбідність. Мета дослідження: оцінити стан адаптаційних можливостей і вегетативної регуляції організму у хворих на передракові стани шлунка з патологією щитоподібної залози (ЩЗ). Матеріали та методи. 72 хворі на хронічний атрофічний гастрит були розподілені на групи: I групу становили 34 хворі з вузлами у ЩЗ; у II групу ввійшли 23 пацієнти з патологічними змінами ЩЗ і 15 пацієнтів III групи мали нормальну ЩЗ. Оцінку показників варіабельності серцевого ритму проводили за результатами PRECISE-діагностики. Для діагностики функціонального стану тонкокишкової мікробіоти проводили водневий дихальний тест. Результати. У 81,9 % хворих на хронічний атрофічний гастрит, поєднаний із патологією щитоподібної залози, виявлено дисбаланс симпатичної та парасимпатичної ланок вегетативної нервової системи з превалюванням частоти ваготонії за рахунок хворих з вузлами у ЩЗ (64,7 %) та з патологічними змінами ЩЗ (56,5 %) (p

Dang Luu Vu,1 Minh Thong Pham,1 Van Bang Nguyen,2 Thi My Le3 1Bach Mai Radiology Center, Bach Mai Hospital, Hanoi, Vietnam; 2Center of Endocrinology and Diabetes, Family Hospital, Da Nang, Vietnam; 3Radiology Department, Vinmec Times City International Hospital, Hanoi, VietnamCorrespondence: Thi My LeRadiology Department, Vinmec Times City International Hospital, Hanoi, VietnamTel +84 979600233Email v.mylt8@vinmec.comObjective: This study aims to evaluate the efficacy and safety of RFA in the AFTN treatment after 2 years of follow-up and to find the factors related to treatment responses through TSH level and VRR.Materials and Methods: This long-term prospective study was conducted from September 2017 to April 2021 on 17 AFTNs treated with RFA. Clinical evaluations, thyroid function tests, thyroid scintigraphy, and ultrasonography examinations were performed at 1 month, 3 months, 6 months, and 24 months after ablation. The primary endpoint was the success rate of RFA in restoring the euthyroidism stage after 24 months of follow-ups; secondary outcomes were VRR and improvements of US parameters, clinical examinations, and complications. The Spearman rank correlation test was used to determine related factors with treatment response variables.Results: At the 24 months after the procedure, symptom score, cosmetic score, vascularity grade, and nodule volume significantly decreased. The VRR reduced approximately 42.77%, 63.13%, 78.3%, and 95.65% after 1 month, 3 months, 6 months, and 24 months follow-up. All 17 patients were restored euthyroid state without taking ATDs. No major complications were collected. The last TSH level was significantly correlated with the age of patients (Spearman rho = − 0.637, p = 0.008). The VRR was significantly correlated with age of patients (Spearman rho = 0.566, p = 0.018) and initial TSH (Spearman rho = 0.485, p = 0.048).Conclusion: RFA was demonstrated as a safe and effective option for AFTN treatment in long-term follow-up. It can be used as an alternative treatment with encouraging results.Keywords: radiofrequency ablation, thyroid nodules, autonomously functioning thyroid nodule

To investigate the diagnostic accuracy of ultrasound microcalcifications for the detection of malignancy in thyroid nodules and determine the validity of the concept that ultrasound microcalcification reflects the presence of psammoma body calcification in thyroid nodules.The laboratory information system at University Hospital Galway, a tertiary referral hospital, was used to compile a list of patients who underwent thyroid lobectomy or complete thyroidectomy over a continuous 12-month period with both preoperative ultrasound and postoperative histology available (n=106) from January to December 2019. The haematoxylin and eosin-stained histology slides of each case were sourced and reviewed under light microscopy by a histopathologist to determine the presence of psammoma body calcification within both benign and malignant thyroid nodules. Two radiologists reviewed preoperative thyroid ultrasound images of each case independently and blindly, and reported on the presence of ultrasonographic microcalcification.There was a strong and significant relationship between the presence of preoperative ultrasound microcalcification and thyroid malignancy (p0.001). Ultrasound microcalcification had a high specificity (93%) and positive predictive value (75%) for thyroid malignancy, with a diagnostic accuracy of 76%. Negative predictive value was high at 76.7%, while sensitivity was low at 42.8%. There was a strong and significant association between the presence of preoperative ultrasound microcalcification in thyroid nodules and the presence of pathological psammoma bodies on histology (p0.001).Ultrasound microcalcification has a strong and significant association with malignancy in thyroid nodules. This study supported the theory that ultrasound microcalcification occurs secondary to the presence of psammoma bodies within thyroid nodules.

Purpose: A primary medical relevance of thyroid nodules consists of excluding thyroid cancer, present in approximately 5% of all thyroid nodules. Fine-needle aspiration biopsy (FNAB) has a paramount role in distinguishing benign from malignant thyroid nodules due to its availability and diagnostic performance. Nevertheless, intraoperative frozen section (iFS) is still advocated as a valuable tool for surgery planning, especially for indeterminate nodules. Methods: To compare the FNAB and iFS performances in thyroid cancer diagnosis among nodules in Bethesda Categories (BC) I to VI. The performance of FNAB and iFS tests were calculated using final histopathology results as the gold standard.Results: In total, 316 patients were included in the analysis. Both FNAB and iFS data were available for 272 patients (86.1%). The overall malignancy rate was 30.4%% (n=96). The FNAB sensitivity, specificity, and accuracy for benign (BC II) and malignant (BC V and VI) were 89.5%, 97.1%, and 94.1%, respectively. For all nodules evaluated, the iFS sensitivity, specificity, and accuracy were 80.9%, 100%, and 94.9%, respectively. For indeterminate nodules and follicular lesions (BC III and IV), the iFS sensitivity, specificity, and accuracy were 25%, 100%, and 88.7%, respectively. For BC I nodules, iFS had 95.2% of accuracy.Conclusion: Our results do not support routine iFS for indeterminate nodules or follicular neoplasms (BC III and IV) due to its low sensitivity. In these categories, iFS is not sufficiently accurate to guide the intraoperative management of thyroidectomies. iFS for BC I nodules could be a reasonable option and should be specifically investigated.

Dang Luu Vu,1 Minh Thong Pham,1 Van Bang Nguyen,2 Thi My Le3 1Bach Mai Radiology Center, Bach Mai Hospital, Hanoi, Vietnam; 2Center of Endocrinology and Diabetes, Family Hospital, Da Nang, Vietnam; 3Radiology Department, Vinmec Times City International Hospital, Hanoi, VietnamCorrespondence: Thi My LeRadiology Department, Vinmec Times City International Hospital, Hanoi, VietnamTel +84 979600233Email v.mylt8@vinmec.comObjective: This study aims to evaluate the efficacy and safety of RFA in the AFTN treatment after 2 years of follow-up and to find the factors related to treatment responses through TSH level and VRR.Materials and Methods: This long-term prospective study was conducted from September 2017 to April 2021 on 17 AFTNs treated with RFA. Clinical evaluations, thyroid function tests, thyroid scintigraphy, and ultrasonography examinations were performed at 1 month, 3 months, 6 months, and 24 months after ablation. The primary endpoint was the success rate of RFA in restoring the euthyroidism stage after 24 months of follow-ups; secondary outcomes were VRR and improvements of US parameters, clinical examinations, and complications. The Spearman rank correlation test was used to determine related factors with treatment response variables.Results: At the 24 months after the procedure, symptom score, cosmetic score, vascularity grade, and nodule volume significantly decreased. The VRR reduced approximately 42.77%, 63.13%, 78.3%, and 95.65% after 1 month, 3 months, 6 months, and 24 months follow-up. All 17 patients were restored euthyroid state without taking ATDs. No major complications were collected. The last TSH level was significantly correlated with the age of patients (Spearman rho = − 0.637, p = 0.008). The VRR was significantly correlated with age of patients (Spearman rho = 0.566, p = 0.018) and initial TSH (Spearman rho = 0.485, p = 0.048).Conclusion: RFA was demonstrated as a safe and effective option for AFTN treatment in long-term follow-up. It can be used as an alternative treatment with encouraging results.Keywords: radiofrequency ablation, thyroid nodules, autonomously functioning thyroid nodule

BACKGROUND: Radioiodine (131 I) is the treatment of choice for cats with hyperthyroidism. After 131 I, however, euthyroidism is not always achieved, with 5% to 10% of cats remaining persistently hyperthyroid and 20% to 50% developing iatrogenic hypothyroidism. OBJECTIVES: To identify pretreatment factors that may help predict persistent hyperthyroidism and iatrogenic hypothyroidism after treatment of cats using a novel 131 I dosing algorithm. ANIMALS: One thousand and four hundred hyperthyroid cats treated with 131 I. METHODS: Prospective, before-and-after study. Pretreatment predictors (clinical, laboratory, scintigraphic, 131 I dose, 131 I uptake measurements) of treatment failure or iatrogenic hypothyroidism were identified by multivariable logistic regression analysis. RESULTS: Cats that developed iatrogenic hypothyroidism were more likely to be older (odds ratio [OR] = 1.10; 95% confidence interval [CI], 1.04-1.17; P = .001), female (OR = 2.04; 95% CI, 1.54-2.70; P < .001), have detectable serum thyroid-stimulating hormone (TSH) concentrations (OR = 4.19; 95% CI, 2.0-8.81; P < .001), have bilateral thyroid nodules (OR = 1.57; 95% CI, 1.19-2.08; P < .001), have homogeneous, bilateral distribution of 99m Tc-pertechnetate uptake (OR = 2.93; 95% CI, 2.05-4.19; P < .001), have milder severity score (OR = 0.62; 95% CI, 0.49-0.79; P < .001), and have higher 131 I uptake (OR = 2.40; 95% CI, 1.75-3.28; P < .001). In contrast, cats remaining persistently hyperthyroid were more likely to be younger (OR = 0.81; 95% CI, 0.72-0.92; P < .001), have higher severity score (OR = 1.87; 95% CI, 1.51-2.31; P < .001), and have lower 131 I uptake (OR = 3.50; 95% CI, 1.8-6.80; P < .001). CONCLUSIONS AND CLINICAL IMPORTANCE: Age, sex, serum TSH concentration, bilateral and homogeneous 99m Tc-pertechnetate uptake on scintigraphy, severity score, and percent 131 I uptake are all factors that might help predict outcome of 131 I treatment in hyperthyroid cats. Cats with persistent hyperthyroidism had many predictive factors that directly contrasted those of cats that developed 131 I-induced hypothyroidism.

Purpose: Radiofrequency ablation (RFA) and ethanol ablation (EA) are effective and safe for benign symptomatic thyroid nodules (BSTNs). However, relatively little is known about the effects of these procedures on patients’ quality of life (QoL). This prospective, multicenter study evaluated the effects of RFA and EA on changes in thyroid-specific QoL in patients with BSTNs and assessed the volume reduction and safety of these procedures.Methods: Eighty-six consecutive patients with 86 BSTNs were prospectively included from two medical centers. RFA was performed for 55 BSTNs with solidity ≥50% and EA was performed for 31 BSTNs with solidity

Shear-wave elastography (SWE) has been shown to be predictive of malignancy in thyroid nodules.To determine, by SWE, the stiffness cutoff point with the highest specificity and sensitivity to detect thyroid nodules that require surgery.Cross-sectional study of ultrasonographically-evaluated patients for thyroid nodules over a period of three years; the TI-RADS classification system was used, and nodule stiffness was determined by SWE. Histopathological specimens were classified using the Bethesda system, and the stiffness cutoff point with the highest specificity and sensitivity was obtained using ROC curves.Forty-one percent of the nodules were classified as TI-RADS 5, and 59 %, as TI-RADS 1-4. In TI-RADS 5 nodules, median stiffness of those in Bethesda system IV-VI categories was 35.9 kPa; in nodules with TI-RADS 1-4, 21.6 kPa. In TI-RADS 5 nodules, a cutoff point32.5 kPa had a specificity of 75 % and sensitivity of 57 % to detect those requiring surgery; in TI-RADS 1 to 4 nodules, a cutoff point of 21.5 kPa had a specificity of 63 % and sensitivity of 51 %.SWE-determined stiffness is useful to detect nodules that require surgical evaluation.La elastografía por ondas de corte (SWE) ha demostrado ser predictiva de malignidad en nódulos tiroideos.Determinar mediante SWE, el punto de corte de la rigidez con mayor especificidad y sensibilidad para detectar nódulos tiroideos que requieren cirugía.Estudio transversal de pacientes con nódulos tiroideos evaluados ultrasonográficamente en un periodo de tres años; se empleó la clasificación TI-RADS y mediante SWE se determinó la rigidez de los nódulos. Con el sistema Bethesda se clasificaron las muestras histopatológicas y mediante curva ROC se obtuvo el punto de corte de la rigidez con mayor especificidad y sensibilidad.41 % de los nódulos fue TI-RADS 5 y 59 %, TI-RADS 1-4. En los TI-RADS 5, la mediana de rigidez de los nódulos con categoría IV-VI del sistema Bethesda fue de 35.9 kPa y en los nódulos con TI-RADS 1-4, 21.6 kPa. En los nódulos TI-RADS 5, la rigidez32.5 kPa tuvo especificidad de 75 % y sensibilidad de 57 % para detectar los que requieren cirugía; en los TI-RADS 1-4, el valor de corte de 21.5 kPa tuvo especificidad de 63 % y sensibilidad de 51 %.La rigidez determinada por SWE es útil para detectar nódulos que requerirán exploración quirúrgica.

Background: Thyroid nodules are common, the majority benign. The small risk of malignancy leads to excessive workup. Thyroid ultrasound is essential for risk stratification and management guidance. Without an organised reporting guideline, reports do not add significant value to referring clinicians. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) was developed to aid ultrasound reporting, lessen excessive biopsies and diagnose thyroid cancers.Objectives: To standardise reporting of thyroid ultrasounds by utilising an organised reporting guideline based on ACR TI-RADS.Method: Thyroid ultrasound reports generated by radiology registrars at an academic hospital were studied in two phases. In Phase 1, the reports were generated as free text, and in Phase 2, using a guideline based on ACR TI-RADS. The percentages of reports that described the maximum size, the five ACR TI-RADS features and a management recommendation were compared.Results: A total of 130 reports were studied. Significant improvement was observed in the description of all five ACR TI-RADS categories (p < 0.0001) from Phase 1 to Phase 2. Of all the reports, 89% included a management recommendation. Reports including an ACR TI-RADSbased recommendation increased from 48% to 75% (p < 0.05). Recommendation for biopsy increased from 35.4% to 53.8% (p < 0.05).Conclusion: Introduction of an organised reporting guideline based on ACR TI-RADS, standardised reporting of thyroid ultrasounds by increasing description of thyroid nodule features and ensuring appropriate management recommendations. This, in future, will prevent underdiagnosis of thyroid cancer and unnecessary workup of benign nodules.

Objective: To describe the distribution profile of thyroidectomies in Brazil from 2010 to 2020 from a macro-regional perspective. Materials and methods: This is a retrospective, detailed and descriptive study built on secondary data obtained from the Hospital Information System of the Unified Health System (SIH/SUS). We organized the data in tables and grouped them according to the federative unit, macro-region, type of procedure, mortality rate, and year of performance. We performed statistical analysis using the χ2 test to assess the association between the variables, observing a P value of < 0.05 and a confidence interval of 95%. Results: From 2010 to 2020, 160 219 thyroidectomy surgeries were performed, of which 77 812 (48.56%) were total, 38 064 (23.76%) partial and 41 191 (25.70%) oncological.The Southeast was responsible for the largest share of procedures, with 70 745 (44.15%), followed by the Northeast with 43 887 (27.39%). In 2020, the procedure was less performed, with 9226 (5.75%) surgeries. The total mortality rate was 0.16% during the study period. Conclusion: We found that thyroidectomies are carried out mainly in the Southeastern, Northeastern, and Southern regions, and showed a downward trend in 2020, which may be related to the COVID-19 pandemic. In addition, total thyroidectomy is the most performed surgery, and the Northern region had the highest mortality rate.

Ziel: Ziel dieser Arbeit ist der Vergleich von Ultraschall-Elastographie und Schilddrüsenszintigraphie bei benignen und malignen Schilddrüsenknoten. Für diesen Vergleich werden sowohl Sensitivität und Spezifität der beiden Methoden als auch Vorteile und Limitationen der Ultraschall-Elastographie im Vergleich zur Schilddrüsenszintigraphie herangezogen. Methode: Für den Studienvergleich wurden für die Schilddrüsenszintigraphie und die Ultraschall-Elastographie jeweils sechs Studien ausgesucht. Mit Hilfe der SQ3R-Methode und diversen Ein- und Ausschlusskriterien wurden die Studien ausgewählt. Um die Studien zu vergleichen wurde die Sensitivität und Spezifität ausgearbeitet und jeweils der Median verwendet. Für die Vorteile und Limitationen der Ultraschall-Elastographie im Vergleich zur Schilddrüsenszintigraphie wurden die Information sowohl aus Studien, Artikeln und Fachliteratur als auch aus einer Expertenbefragung entnommen. Ergebnisse: Die Spezifität der Ultraschall-Elastographie beträgt 84,66%. Im Vergleich dazu beträgt die Spezifität der Schilddrüsenszintigraphie nur 46,75%. Die Sensitivität hingegen ist mit 81% bei der Ultraschall-Elastographie sehr ähnlich der Schilddrüsenszintigraphie, welche 80,5% beträgt. Im Vergleich zur Schilddrüsenszintigraphie ergeben sich einige Vorteile und Limitationen bei der Ultraschall-Elastographie. Der größte Vorteil besteht darin, dass keine Strahlung verwendet wird. Weitere Vorteile sind eine kürzere Untersuchungsdauer, eine kostengünstigere Untersuchung und das Bestimmen von Mikro-Knoten. Es ergeben sich jedoch mehr Limitationen als Vorteile. Dazu gehören die anwenderabhängige Kompression bei der Kompressionselastographie, womit folglich fast kein objektiver Vergleich möglich ist. Zusätzlich besteht eine längere Einschulungs- und Lernphase als bei der Schilddrüsenszintigraphie. Wird falsch komprimiert, besteht die Möglichkeit des Verrutschens eines Knotens. Auch Adipositas kann eine Ultraschall-Elastographie-Untersuchung limitieren. Eine zusätzliche Limitation stellt sich durch die Scherwellen dar. Diese breiten sich in einfachen Zysten nicht aus und können somit nicht gemessen und farblich gekennzeichnet werden. Auch die geringe Verfügbarkeit kann sich limitierend aus die Ultraschall-Elastographie auswirken. Diskussion: Beide Verfahren weisen diverse Vorteile und Limitationen auf. Im Vergleich weist die Ultraschall-Elastographie zurzeit noch mehr Limitationen auf. Es lässt sich sagen, dass beide Verfahren von Bedeutung sind und die Schilddrüsenszintigraphie nicht von der Ultraschall-Elastographie ersetzt werden kann. Die Schilddrüsenfunktion, welche bei der Schilddrüsenszintigraphie bestimmt werden kann, stellt einen wichtigen Faktor bei Schilddrüsenerkrankungen dar und ist somit nicht wegzudenken. Die Ultraschall-Elastographie hat jedoch die wichtigen Vorteile, dass sich damit Mikro-Knoten bestimmen lassen und dass keine Strahlung verwendet wird. Dadurch kann auch die Ultraschall-Elastographie von großem Nutzen. Aim: The aim of this paper is to compare ultrasound elastography and thyroid scintigraphy in benign and malignant thyroid nodules. The sensitivity and the specificity of both methods and the advantages and limitations of ultrasound elastography compared to thyroid scintigraphy are used for this comparison. Method: Six studies for thyroid scintigraphy and six studies for the ultrasound elastography were used for the study comparison. The studies were selected using the SQ3R method and various inclusion and exclusion criteria. To compare the studies, the sensitivity and specificity were worked out and the median was used in each case. For the advantages and limitations of ultrasound elastography compared to thyroid scintigraphy, information was taken from studies, articles, literature and from an expert survey. Results: The specificity of ultrasound elastography is 84.66%. In comparison, the specificity of thyroid scintigraphy is only 46.75%. The sensitivity of 81% for ultrasound elastography is very similar to that of thyroid scintigraphy, which is 80.5%. Compared to thyroid scintigraphy, there are some advantages and limitations of ultrasound elastography. The biggest advantage is that no radiation is used. Further advantages are a shorter examination time, a less expensive examination and the detection of micro-nodules. However, there are more limitations than advantages. These include the user-dependent compression in SE-elastography, which means that no objective comparison is possible. In addition, there is a longer training and learning phase than with thyroid scintigraphy. If the compression is incorrect, there is a possibility of a nodule slipping. Obesity can also limit an ultrasound elastography examination. An additional limitation is presented by the shear waves. These do not spread in simple cysts and therefore cannot be measured and color-coded. Low availability can also have a limiting effect on ultrasound elastography. Discussion: Both methods have various advantages and limitations. In comparison, ultrasound elastography currently has even more limitations. It can be said that both methods are important and thyroid scintigraphy cannot be replaced by ultrasound elastography. Thyroid function, which can be determined by thyroid scintigraphy, is an important factor in thyroid disease. However, ultrasound elastography has the important advantages that it can be used to determine micro-nodules and that no radiation is used. As a result, ultrasound elastography can also be of great benefit.

Background: The association between Graves’ disease (GD) and co-existing thyroid cancer is still controversial and most of the previously reported data have been based on surgically treated GD patients. This study investigated the clinicopathological findings and prognosis of concomitant thyroid cancer in GD patients in the era of widespread application of ultrasonography.Methods: Data of GD patients who underwent thyroidectomy for thyroid cancer between 2010 and 2019 in three tertiary hospitals in South Korea (Asan Medical Center, Chonnam National University Hwasun Hospital, and Pusan National University Hospital) were collected and analyzed retrospectively. In the subgroup analysis, aggressiveness and clinical outcomes of thyroid cancer were compared nodular GD and non-nodular GD groups according to the presence or absence of the thyroid nodules other than thyroid cancer (index nodules).Results: Of the 15,159 GD patients treated at the hospitals during the study period, 262 (1.7%) underwent thyroidectomy for coexisting thyroid cancer. Eleven patients (4.2%) were diagnosed with occult thyroid cancer and 182 patients (69.5%) had microcarcinomas. No differences in thyroid cancer aggressiveness, ultrasonographic findings, or prognosis were observed between the nodular GD and non-nodular GD groups except the cancer subtype. In the multivariate analysis, only lymph node (LN) metastasis was an independent prognostic factor for recurrent/persistent disease of thyroid cancer arising in GD (P=0.020).Conclusion: The prevalence of concomitant thyroid cancer in GD patients was considerably lower than in previous reports. The clinical outcomes of thyroid cancer in GD patients were also excellent but, more cautious follow-up is necessary for patients with LN metastasis in the same way as for thyroid cancer in non-GD patients.

Graves’ disease (GD) is the most common cause of pediatric hyperthyroidism. In children and adolescents the clinical GD course is different from this seen in adults, due to low remission rate and high prevalence of adverse events related to treatment with antithyroid drugs (ATDs). The majority of patients in this group require definitive therapy. As in adults, there are two treatment options – thyroid ablation with radioactive iodine (RAI) or surgery with preferred procedure of total thyroidectomy (TT). The choice of definitive therapy depends on many important factors such as children‘s age, effectiveness of the first- line ATD treatment, presence of ATDs side effects, presence of large goiter or thyroid nodules and concomitant diseases. The following paper provides the current guidelines on GD management in children and compares the efficacy of both definitive treatment methods as well as the acute and long-term complication rates, which must be taken into account to choose the optimal therapeutic option.

Xingyu Chang,1,2,&ast; Yaqi Wang,1,2,&ast; Songbo Fu,1,2 Xulei Tang,1,2 Jingfang Liu,1,2 Nan Zhao,1,2 Gaojing Jing,1,2 Qianglong Niu,1,2 Lihua Ma,1,2 Weiping Teng,3 Zhongyan Shan3 1Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China; 2Gansu Provincial Endocrine Disease Clinical Medicine Research Center, Gansu, 730000, People’s Republic of China; 3Department of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, 101100, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Songbo FuDepartment of Endocrinology, First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of ChinaTel +86-13993122257Email fusb@lzu.edu.cnPurpose: To explore the detection of thyroid nodules (TN) and related influencing factors in the population of prediabetes (PreDM) in northwest China’s Gansu Province.Materials and Methods: A multi-stage stratified cluster random sampling method was used to select adult Han residents in Gansu Province for investigation, and recorded the clinical data of the subjects. The χ2 test was used to analyze the difference in TN detection rate of the PreDM population. Logistic regression analyzed the risk factors of TN in the PreDM population.Results: This study included 2659 people with normal glucose tolerance (NGT) and PreDM, of which 440 people were detected with TN. Among the PreDM population, the TN detection rate was higher than in the NGT population (24.48% vs 15.00%; P< 0.05). The detection rate of TN in the impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and IFG+IGT group was also significantly higher than that in the NGT population (X2=4.117, X2=13.187, X2=13.016, all P< 0.05), and of which, the IFG+IGT group was the highest (32.20%). The general trend of TN in the IFG, IGT and PreDM population all increased with age. General data showed that BMI, waist-to-height ratio, waist circumference, TG, TC, LDL-C, FPG, 2h PG, HbA1c and TSH indicators in the TN group were higher than those in the Non-TN group (P< 0.05). The logistic regression suggested that the risk factors for TN in the PreDM population were female, age increase, high SP, high TSH, high FPG, high LDL-C, hypertension and family history of diabetes (all P< 0.05).Conclusion: The detection rate of TN in the PreDM population is high, especially in the IFG+IGT population. Middle-aged and elderly people with hypertension and abnormal glucose and lipid metabolism should be treated reasonably and regularly, and their TN should be screened and followed up.Keywords: prediabetes, thyroid nodules, risk factors

Xingyu Chang,1,2,&ast; Yaqi Wang,1,2,&ast; Songbo Fu,1,2 Xulei Tang,1,2 Jingfang Liu,1,2 Nan Zhao,1,2 Gaojing Jing,1,2 Qianglong Niu,1,2 Lihua Ma,1,2 Weiping Teng,3 Zhongyan Shan3 1Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China; 2Gansu Provincial Endocrine Disease Clinical Medicine Research Center, Gansu, 730000, People’s Republic of China; 3Department of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, 101100, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Songbo FuDepartment of Endocrinology, First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of ChinaTel +86-13993122257Email fusb@lzu.edu.cnPurpose: To explore the detection of thyroid nodules (TN) and related influencing factors in the population of prediabetes (PreDM) in northwest China’s Gansu Province.Materials and Methods: A multi-stage stratified cluster random sampling method was used to select adult Han residents in Gansu Province for investigation, and recorded the clinical data of the subjects. The χ2 test was used to analyze the difference in TN detection rate of the PreDM population. Logistic regression analyzed the risk factors of TN in the PreDM population.Results: This study included 2659 people with normal glucose tolerance (NGT) and PreDM, of which 440 people were detected with TN. Among the PreDM population, the TN detection rate was higher than in the NGT population (24.48% vs 15.00%; P< 0.05). The detection rate of TN in the impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and IFG+IGT group was also significantly higher than that in the NGT population (X2=4.117, X2=13.187, X2=13.016, all P< 0.05), and of which, the IFG+IGT group was the highest (32.20%). The general trend of TN in the IFG, IGT and PreDM population all increased with age. General data showed that BMI, waist-to-height ratio, waist circumference, TG, TC, LDL-C, FPG, 2h PG, HbA1c and TSH indicators in the TN group were higher than those in the Non-TN group (P< 0.05). The logistic regression suggested that the risk factors for TN in the PreDM population were female, age increase, high SP, high TSH, high FPG, high LDL-C, hypertension and family history of diabetes (all P< 0.05).Conclusion: The detection rate of TN in the PreDM population is high, especially in the IFG+IGT population. Middle-aged and elderly people with hypertension and abnormal glucose and lipid metabolism should be treated reasonably and regularly, and their TN should be screened and followed up.Keywords: prediabetes, thyroid nodules, risk factors

Rationale and Objectives This study aims to evaluate the diagnostic accuracy, inter-reader, and intra-reader variability of the ACR Thyroid Imaging Reporting and Data System (TI-RADS) for risk-stratification of indeterminate thyroid nodules using next generation genetic sequencing and tissue histology as a reference standard. Materials and Methods Retrospective chart review was performed on all patients who underwent thyroid ultrasound for a nodule with subsequent fine-needle aspiration ± surgical resection from January 2017 to August 2018. Four radiologists with expertise in thyroid ultrasound assessed imaging twice, ≥1 month apart. Results of cytology and next generation genetic sequencing were used as a reference standard for high versus low risk of malignancy in each nodule. Inter-reader reliability between readers and intra-reader reliability between replicate self-reads for TI-RADS categorization were assessed. Univariate analysis, kappa statistics, and receiver operating characteristic curve were calculated. Results One hundred and thirty six nodules across 121 patients met inclusion criteria. 84.6% of patients were female and average age was 55.8 ± 14.1 years. One hundred and eighteen of 135 nodules (87%) had indeterminate cytology (Bethesda III or IV). One of 23 high-risk mutations was identified in 30.1% (42) of the nodules. Of the 52 patients who had surgery, 24 (47.1%) had confirmed malignant disease on surgical pathology. Inter-reader reliability between the four radiologists was marginal, κ = 0.293. Intra-reader reliability ranged from marginal to good, κ = 0.337 to κ = 0.560, respectively. The area under the receiver operating characteristic curve was 0.509, and no optimal TI-RADS Level for identifying high-risk nodules existed. Conclusion The ACR TI-RADS classification system performs with low inter-reader and intra-reader reliability when assessing the genetic risk of nodules with indeterminate cytology.

Resumen: Objetivo. Evaluar retrospectivamente la capacidad diagnóstica de la elastografía cuantitativa para determinar la posibilidad de malignidad o benignidad de los nódulos tiroideos benignos y malignos, y determinar su utilidad para así decidir qué nódulos deberán ser sometidos a punción aspirativa con aguja fina (PAAF). Pacientes y métodos. Se analizaron 203 nódulos tiroideos de 195 pacientes remitidos por el Servicio de Endocrinología para estudio citológico durante el año 2018. A todos ellos se les realizó ecografía convencional, elastografía cuantitativa y PAAF. Se realizó un análisis estadístico mediante regresión logística, que pone en relación la probabilidad de que un nódulo sea sospecho de malignidad y el valor de la elasticidad medido en kilopascales (kPa) y el ratio elastográfico. Resultados. Existe una relación significativa y positiva entre el resultado citológico de Bethesda V/VI y los kPas/ratio elastográfico. Se recomienda realizar PAAF a aquellos nódulos con valores superiores a 25kPa y/o ratio elastográfico superior a 1,5. Conclusión. La elastografía cuantitativa es una herramienta útil que, junto a otros parámetros ecográficos, ayudaría a predecir o sospechar la malignidad de un nódulo tiroideo y a una mejor selección para la PAAF. Abstract: Objective. To retrospectively assess the diagnostic capacity of quantitative elastography to determine the odds between benign and malignant thyroid nodules, and determine its usefulness in deciding which nodules should be subjected to fine needle aspiration puncture (FNA). Patients and methods. 203 thyroid nodules from 195 patients referred by the Endocrinology Service for cytological study during the year 2018 were analyzed. All of them underwent conventional ultrasound, quantitative elastography and FNA. A statistical analysis was performed using logistic regression that relates the probability that a nodule is suspected of malignancy and the elasticity value measured inkilopascals (kPa) and the elastographic ratio. Results. There is a significant and positive relationship between the cytological result of Bethesda V / VI and the kPas / elastographic ratio. FNA is recommended for those nodules with values greater than 25kPa and / or elastographic ratio greater than 1.5. Conclusion. Quantitative elastography is a useful tool that, together with other ultrasound parameters, would help to predict the malignancy of a thyroid nodule and to better select for FNA.

Background The Bethesda System for Reporting Thyroid Cytopathology has 6 diagnostic categories, each with an implied cancer risk of malignancy (ROM). Bethesda III, defined as atypia or follicular lesions of undetermined significance (AUS/FLUS) on fine needle aspiration (FNA), has an indeterminate ROM. This study investigates the utility of Afirma Gene Expression Classifier (GEC) and Thyroid Sequencing (ThyroSeq) molecular testing to predict malignancy in AUS/FLUS thyroid nodules. Methods A retrospective review of prospectively collected data of 1457 patients with index thyroid nodules who underwent FNA and thyroidectomy at a single academic institution was performed. Use of GEC or ThyroSeq for AUS/FLUS thyroid nodules was examined. GEC testing was reported benign or suspicious for malignancy whereas ThyroSeq testing was reported on a spectrum of low, intermediate or high ROM. Descriptive statistics were utilized to compare the ROM among AUS/FLUS thyroid nodules. Results Of 1457 patients with FNA thyroid cytology, 359 (25%) corresponded to AUS/FLUS results. There were 132 (37%) patients with GEC testing and 88 (24%) had ThyroSeq testing. ROM without GEC or ThyroSeq testing was 49%, whereas ROM with suspicious GEC was 55%. ROM with positive ThyroSeq was 73%. Among ThyroSeq patients, 43 had intermediate-risk mutations with 60% malignancy, and 23 had high-risk mutations with 96% malignancy (P Conclusion Surgical patients with AUS/FLUS thyroid nodules have a high ROM. High-risk ThyroSeq testing may have some utility in predicting malignancy, but GEC and intermediate-risk TGC results have limited value. Surgeons should carefully consider the utility of molecular tests to determine surgical resection.

Background. Gitelman syndrome (GS) is an inherited salt-losing renal tubulopathy characterized by hypokalemic metabolic alkalosis with hypomagnesemia and hypocalciuria. Patients can be asymptomatic until late adolescence or adulthood, and hence may be discovered incidentally during presentation with other illnesses. GS has been described in association with thyroid disorders and should be considered in patients with hyperthyroidism and persistent hypokalemia, especially in those with associated hypomagnesemia and hypocalciuria. Case summary. In this report, we describe an 18-year-old female who presented with hyperemesis gravidarum and thyrotoxicosis, and was incidentally found to have GS, confirmed by the sequence analysis of SLC12A3. Conclusions. Thyroid dysfunctions, such as hypothyroidism, thyrotoxicosis, and thyroid nodules, may develop during pregnancy. A structural homology between the beta-human chorionic gonadotropin and thyroid stimulating hormone molecules, as well as their receptors is probably the basis for the transient thyrotoxicosis crisis during pregnancy. Since hyperemesis in pregnancy can also lead to hypokalemia and alkalosis, a high index of suspicion for GS during pregnancy is required for timely diagnosis and management.

To report a new feature of contrast-enhanced ultrasound (CEUS) and its diagnostic performance for the prediction of papillary thyroid carcinoma (PTC).This retrospective study was conducted from October 2018 to March 2019, including 276 patients with 308 thyroid nodules who underwent CEUS examinations prior to surgery (90 patients, 122 nodules) or fine needle aspiration (186 patients, 186 nodules). Quantitative analysis of CEUS features was performed using time-intensity curves. After surgery, tissue sections stained with HE and an anti-CD34 primary antibody were used to characterize the cell number and microvessel density. The nodules were divided into retention and non-retention groups.There were 168 malignant nodules and 140 benign nodules. The contrast-agent retention (CAR) feature was only observed in 52 papillary carcinomas. The CAR feature showed the sensitivity of 30.9% albeit the high specificity of 100%, for the diagnosis of thyroid cancers. The maximum slope coefficient of the washout index was significantly lower in the retention group than in the non-retention group (P 0.001). The enhancement intensity during the late stage of enhancement index was significantly higher in the retention group than in the non-retention group (P 0.001). The cell number and microvessel density in nodules with CAR features were higher (P 0.001, P = 0.004).The combination of the retention pattern of the CEUS observed herein with other CEUS features may be a useful tool to improve the diagnostic of the PTC.

Our objective was to provide the various sonographic characteristics of clinically atypical subacute thyroiditis (CAST) in distinguishing CAST from papillary thyroid carcinomas (PTCs) by using conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS). Forty-six CAST patients and 50 PTC patients were enrolled in this study. We evaluated the size, shape, margin, echogenicity, calcification, vascularity and CEUS parameters for each nodule. The final diagnosis of CAST was confirmed via fine-needle aspiration (FNA) or surgery. Of the 46 CASTs, 13 (28.3%) were confirmed by surgery to be benign, and 33 (71.7%) were proven by FNA to be benign. Univariate analysis indicated that compared with PTCs, CAST lesions more frequently had wider-than-taller shapes, blurred margins, the absence of microcalcifications, peripheral high echogenicity, the absence of internal vascularity, hypo-enhancement, centrifugal perfusion and a peak intensity index

Although nearly half of thyroid nodules with Bethesda V cytology (suspicious for malignancy) may be benign or harbor low-grade neoplasms that can be sufficiently treated with lobectomy, many patients with Bethesda V cytology continue to be treated with total thyroidectomy. The objectives of this study were to establish whether cytomorphologic and ultrasonographic features can determine appropriate surgery for thyroid nodules with Bethesda V cytology and how often patients are overtreated with total instead of partial thyroidectomy.Utilizing a 10-y prospective database starting January 1, 2004, cytomorphologic and ultrasonographic features of thyroid nodules with Bethesda V cytology were reviewed. Overtreatment was defined as total thyroidectomy when histopathology revealed benign nodule, noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) or a unilateral4 cm low risk cancer.Sixty-three patients were included in the study. Seventeen (27%) had benign, 14 (22%) NIFTP, and 32 (51%) malignant nodules. On cytology, nuclear pseudoinclusions, and on ultrasound, taller-than-wide configuration, were more common in malignant than benign or NIFTP nodules. Among 56 patients who underwent total thyroidectomy, 14 and 11 had a benign or NIFTP nodule, respectively, and 13 had a unilateral4 cm low risk cancer, suggesting that 68% (38/56) were overtreated.Total thyroidectomy for Bethesda V thyroid nodules may result in overtreatment in more than half of the patients. Although certain cytomorphologic and ultarsonographic features may be helpful in determining appropriate surgery for Bethesda V thyroid nodules, additional characteristics are needed to reduce overtreatment of these nodules.

Background: A globus sensation is one of the most common complaints in otolaryngological practice. Patients with no associated abnormalities detected during the usual examinations performed in ENT clinics, are being diagnosed with globus sensation. Cervical ultrasonography is usually not performed in ENT clinics; however, it is useful in screening diseases of the subcutaneous tissue/organs, whose detection is not possible with the routine ENT examinations. The purpose of our study was to elucidate whether cervical ultrasound examination identifies abnormalities in patients with globus sensation. Methods: A single-centre retrospective cohort study. Cervical ultrasonographic examinations were performed on patients with globus sensation at the Department of Otolaryngology, Head and Neck Surgery of Tottori university hospital, a tertiary care centre, from January 2013 to September 2017. The subjects were 74 patients who complained of globus sensation with no abnormality in general otolaryngological examination including laryngoscopy. Results: Ultrasonography detected structural abnormalities in 60.8% of the patients with globus sensation: thyroid disorders in 41 patients, including: 35 patients with thyroid nodules, 4 patients with Hashimoto’s disease, 1 patient with Grave’s disease, and 1 patient with subacute thyroiditis; Sjögren syndrome in 2 patients; and cervical lipoma in 1 patient. Furthermore, 2 patients with thyroid disorders had concomitant esophageal cancer. Conclusion: Cervical ultrasonography identified thyroid disorders in patients with globus sensation, despite the normal ENT status. Therefore, it would be appropriate to adopt cervical ultrasonography as a routine examination at ENT clinics for patients with globus sensation.

In an assessment of risk for differentiated thyroid cancer (DTC) in individuals with human papillary thyroid cancer (PTC) and thyroid nodules a cohort prospective study was undertaken to establish the significance of preoperative thyroid-stimulating hormone (TSH) levels. Confirmed histologically PTC cases in one tertiary care center, and matched healthy individuals were tested for TSH, T3, T4 and T4 free total. The ORs and 95% confidence intervals have been calculated using conditional logistic regression models (CI). The blood TSH levels were related to the higher risk of PTC for men (OR,0,09; 95% Ci, 04–0,21, 95% CI and women) compared with the middle tertile of the TSH levels in the normal range (OR,0,07; 95 percent CI, 0,04–0,1). Over the normal range of TSH levels, an elevated PTC risks were connected amongst women (OR 0,09; 95% CI, 0,04–0,21) but not amongst men (OR,0,07; 95% CI, 0,04–0,1). With an increase in TSH level in the normal range between men and women, the risk for PTC reduced (Ptrend=0.041 and 0.0001). The risk of PTC related to TSH levels has been dramatically elevated above the normal range for men and TSH values below the normal range for women.

Background The Thyroid Imaging Reporting and Data System (TIRADS) was created to assess risk of thyroid nodules through ultrasound. Plenty classifications methods for thyroid nodules have already been created, but none of them have yet achieved global utilization. This study analyzed the performance of the American College of Radiology (ACR) TIRADS, its reproducibility and the impact of its utilization as a screening method in a large Cancer Center cohort. Methods Thyroid nodules which underwent fine-needle aspiration (FNA) in a 1-year period were selected, with their ultrasound images retrospectively classified according to the ACR TI-RADS. Cytological evaluation of the nodules and final histology (whenever available) was used to assess risk of neoplasm (RON) and risk of malignancy (ROM) associated to each ACR-TIRADS category. Further analyses were also carried out according to recommendation or not of FNA by the ACR-TIRADS and nodule size. Inter-observer agreement for the system was also assessed. Results A total of 1112 thyroid nodules were included. RON for each category according to final cytological diagnosis was 0% for TR1 and TR2, 2.1% for TR3; 15.6% for TR4 and 68.9% for TR5. No significant difference was observed between the RON of the categories for cases above or below 1.0 cm. Nodules that met the criteria for FNA had 3 times greater chance of a positive outcome. Substantial agreement (kappa 0.77) was seen between two different observers. Conclusions ACR TI-RADS scoring system has demonstrated to be an accurate method to stratify thyroid nodules in a Cancer Center, with a high reproducibility.

Background A number of ultrasound risk stratification systems (RSSs) of thyroid nodule, often labeled as TIRADS (Thyroid Imaging Reporting and Data System), have been proposed. As a consequence, an increasing number of studies have been published on this topic. This systematic review was undertaken to answer specific questions in this field: how many articles and what type of studies have been published, which TIRADSs/RSSs have preferably been discussed, and what is the geographic distribution of the publications. Methods The study was conducted according to PRISMA. A specific search algorithm was used. Defined selection criteria were applied. Results 502 studies were finally included. The number of publications about TIRADSs/RSSs has increased over the time, being the Horvath TIRADS the most evaluated one. The first author of the article was from China in one fourth of cases. Conclusions The number of scientific articles focused on TIRADSs/RSSs is high and it has been importantly increased over the time.

Introduction: DICER1 syndrome is characterized by increased susceptibility to malignancies, mostly occurring in childhood. The range of phenotypic effects of DICER1 variants is under investigation, and the syndrome’s phenotypic spectrum is steadily widening. We report on three Italian families showing heterogeneous clinical presentation and reduced penetrance in family members. Case descriptions: Patient 1 is a 10-year-old girl with a Sertoli-Leydig cell tumor. Although family history was unremarkable, genetic testing identified a DICER1 germline variant, inherited from her healthy father. Benign thyroid nodules were subsequently diagnosed in both the proband and her father. Patient 2 is an 8-month-old boy with type 1 pleuropulmonary blastoma. His sister developed a nephroblastoma at age 2 years. A DICER1 novel variant was identified in both siblings and their healthy father. Patient 3 is a 22-year-old man who developed a spinal extramedullary intradural mass diagnosed as rhabdomyosarcoma with a peculiar tubular, gland-like component. Tumor testing revealed two pathogenic DICER1 variants, one of which was confirmed to be germline and identified in his 17-year-old healthy brother and in his father, who showed multiple thyroid nodules. Conclusions: Among our patients, three developed tumors most frequently associated with DICER1 syndrome (i.e. pleuropulmonary blastoma, nephroblastoma, and Sertoli-Leydig cell tumor). One developed a peculiar sarcoma of the spinal cord not previously described in DICER1 syndrome. Genetic testing in relatives highlighted the paternal origin and reduced penetrance in all families, with thyroid benign lesions as the most common features in otherwise unaffected individuals.

Introduction and objective: The present review work aims to assess the mutual influence that pregnancy may have on the progression of differentiated thyroid carcinoma as well as the influence that differentiated thyroid carcinoma may have on pregnancy. Synthesis: Thyroid cancer appears frequently in women at reproductive age and during pregnancy. Since the most common presentation is as a thyroid nodule, proper management of this condition constitutes a priority while pregnancy. Thyroid ultrasound and ultrasound-guided FNA are fundamental tools for both correct diagnosis and monitoring thyroid nodules. Also, differentiated thyroid carcinoma can happen during pregnancy in at least three different settings (newly diagnosed, papillary thyroid microcarcinoma under active surveillance, and differentiated thyroid carcinoma previously treated before pregnancy) that must be approached in different ways. Usually, pregnancy does not present any additional risk for the prognosis of differentiated thyroid carcinomas. Furthermore, differentiated thyroid carcinoma does not appear to have a negative influence on the progression of pregnancy for either the mother or the fetus. The treatment of choice for new-onset carcinomas is surgery, which should be postponed after delivery whenever possible or carried out in the second trimester in the most aggressive cases. Papillary microcarcinomas do not appear to be significantly influenced by pregnancy and do not require special monitoring during gestation. For previously treated carcinomas, pregnancy does not worsen the prognosis in most cases either. Only those classified as having an incomplete structural response require special attention in their follow-up. Treatment with the appropriate doses of levothyroxine to achieve the most appropriate TSH levels for the risk situation is another of the fundamental cornerstones in the management of differentiated thyroid carcinoma. Finally, treatment with I-131, if necessary, is formally contraindicated during pregnancy and lactation. Introducción y objetivo: el presente trabajo de revisión pretende valorar la influencia mutua que puedan tener la gestación sobre la progresión del carcinoma diferenciado de tiroides, así como la influencia que el carcinoma diferenciado de tiroides pueda tener sobre la gestación. Síntesis: El cáncer de tiroides aparece con frecuencia en mujeres en edad reproductiva y durante el embarazo. Dado que la presentación más común es en forma de nódulo tiroideo, el manejo adecuado de esta patología constituye una prioridad durante la gestación. La ecografía tiroidea y la PAAF guiada por ecografía son herramientas fundamentales tanto para el correcto diagnóstico como para el seguimiento de los nódulos tiroideos. Además, el carcinoma diferenciado de tiroides puede presentarse durante el embarazo en al menos tres escenarios diferentes (recién diagnosticado, microcarcinoma papilar de tiroides bajo vigilancia activa y carcinoma diferenciado de tiroides tratado previamente antes del embarazo) que deben abordarse de distintas maneras. Por lo general, el embarazo no presenta ningún riesgo adicional para el pronóstico de los carcinomas diferenciados de tiroides. Además, el carcinoma diferenciado de tiroides no parece tener una influencia negativa en la progresión del embarazo ni para la madre ni para el feto. El tratamiento de elección de los carcinomas de nueva aparición es la cirugía, que debe posponerse hasta después del parto siempre que sea posible o realizarse en el segundo trimestre en los casos más agresivos. Los microcarcinomas papilares no parecen estar significativamente influenciados por el embarazo y no requieren un seguimiento especial durante la gestación. Para los carcinomas tratados previamente, el embarazo tampoco empeora el pronóstico en la mayoría de los casos. Solo aquellos clasificados como de respuesta estructural incompleta requieren especial atención en su seguimiento. El tratamiento con las dosis correctas de levotiroxina para conseguir los niveles de TSH más adecuados a la situación de riesgo, constituye otro de los pilares fundamentales en el manejo del carcinoma diferenciado de tiroides. Finalmente, el tratamiento con I-131, si fuera necesario, está formalmente contraindicado durante el embarazo y la lactancia.

Background and Objective: Thyroid imaging reporting and data system (TI-RADS) is developed to determine the risk of malignancy in patients with thyroid nodules. The aim of this study was to determine the diagnostic accuracy of TI-RADS classification for diagnosing malignant thyroid nodules taking Fine needle aspiration cytology (FNAC) as a gold standard in the local population. Methods: In this cross-sectional validation study, 201 patients presenting with thyroid nodules at the Department of Radiology, Bakhtawar Amin Hospital Multan, Pakistan from July 2020 to December 2020 were included. In all patients, thyroid nodules were evaluated on grey scale (B-mode) modality. TI-RADS score was calculated for each patient. Patients with TI-RADS score 4 and 5 were labelled as having malignant nodules. After that FNAC samples were taken and sent for histopathologic evaluation of thyroid nodules. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TI-RADS taking FNAC as a gold standard were determined. Results: The mean age of the patients was 47.8 ± 4.5 years; there were 129 (67.2%) women and 72 (35.82%) men. There were 42 patients who tested true positive and 36 patients tested false positive and 12 patients were false negative and 111 patients true negative. The TIRADS sensitivity was 77.8%, specificity was 75.5%, PPV was 53.8%, and NPV 90.2%. the diagnostic accuracy was 76.1%. Conclusion: Differentiating benign thyroid nodules from malignant using the TI-RADS score has a high diagnostic accuracy. Our study results support the TIRADS as a first-line imaging evaluation for diagnosis of thyroid malignancy.

Background: Thyroid fine needle aspiration (T-FNA) is a mainstay in management of thyroid nodules. However, the preparation of T-FNA specimens varies across institutions. Prior studies have compared diagnostic rates between different specimen preparations of T-FNA specimens and their associated advantages and disadvantages. However, few have compared the rates of all diagnostic categories of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) between liquid-based preparations (LBPs) and a combination of LBP and conventional smear (CS) preparations. Our study compares TBSRTC diagnostic rates between these 2 cohorts and correlates cytologic diagnoses with subsequent thyroid resections to evaluate rates of neoplasia (RON) and malignancy (ROM). Methods: 584 consecutive thyroid FNA specimens were collected and stratified by preparation type (ThinPrep [TP] vs. CS & TP). Diagnostic rates for each TBSRTC diagnostic category were calculated. The institution’s electronic medical records database was searched for histologic diagnoses of previously sampled thyroid nodules to evaluate the RON and ROM. Results: Of 584 thyroid FNA specimens, 73 (12.5%) and 511 (87.5%) were evaluated by TP only and CS & TP, respectively, reflecting the predominance of rapid on-site evaluation (ROSE) with CS for T-FNAs at our institution. Of the TP only and CS & TP cohorts, 29 (39.7%) and 98 (19.2%) had subsequent resections, respectively. The frequency of non-diagnostic cases was lower in the CS & TP cohort (12.7% vs. 26%). While the diagnostic rate of follicular lesion of undetermined significance was similar for both cohorts, SFN categorization was only utilized in the CS & TP cohort (1.5% vs. 0%). Although RON and ROM were similar between cohorts in many of the TBSRTC categories, there was a higher RON associated with non-diagnostic specimens in the TP only cohort when the denominator included all non-diagnostic cases. Conclusion: The combination of CS and LBP may potentially decrease the non-diagnostic rate of T-FNA specimens as well as the number of passes required for diagnosis, particularly with ROSE. Evaluation of morphologic features highlighted in conventional smears may facilitate diagnostic categorization in the “suspicious for follicular neoplasm” category.

To report the results of a multicenter retrospective evaluation of the clinical outcomes of thermal ablation (TA) in a large series of autonomously functioning thyroid nodules (AFTN) with a follow-up protracted up to 3 years.Patients treated with single TA for an AFTN in Italy were included. Changes in nodule volume, TSH values, and ongoing anti-thyroid therapy were assessed at the 2-, 6-, 12-, 24-, and 36-month follow-up controls. Complications and need of any additional therapy after TA were also registered.A total of 361 patients (244 females, 117 males, median age 58 years, IQR 46-70 years) were included. Nodule volume was significantly reduced at all time points (p 0.001) (median volume reduction 58% at 6-month and 60% at 12-month). Serum TSH values increased significantly at all time points. After TA, anti-thyroid therapy was withdrawn in 32.5% of patients at 2 months, in 38.9% at 6 months, and in 41.3% at 12 months. A significant difference in the rate of patients who withdrawn medical therapy at 12 months was registered between small ( 10 mL) (74%), medium (49%), or large ( 30 mL) nodules (19%). A single major complication occurred (0.25%). Additional treatments were needed in 34/361 (9.4%) of cases including 4 (1.1%) surgical treatment.Image-guided thermal ablation offers a further safe and effective therapeutic option in patients with AFTN. Clinical outcomes are significantly more favorable in small than in large size AFTN.• Thermal ablations (TA) can be safely and effectively used in patients with autonomously functioning thyroid nodules (AFTN). • TA results in a clinically significant nodule volume reduction that is paralleled by TSH level normalization and anti-thyroid drug therapy discontinuation (after TA anti-thyroid therapy was withdrawn in 41.3% at 12 months). • Clinical outcomes after TA are more favorable in small nodules, and when a large amount of thyroid nodule tissue is ablated.