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Background: The American Thyroid Association published revised guidelines in 2015 on the management of differentiated thyroid cancer in adults. One of the key changes introduced in the revision proposes that diagnostic biopsy be based on ultrasound findings (i.e. size and nodule characteristics). The overall effect of these changes results in fewer nodules requiring biopsy. This study was conducted to determine if the changes to the guidelines will result in overlooked thyroid cancers, specifically malignancies with aggressive characteristics measuring between 1 and 1.49 cm., Methods: Patients (n = 2083) with thyroid nodules who underwent total or subtotal/hemi thyroidectomy with or without neck dissection by a single surgeon between 2006 and 2016 were retrospectively enrolled. Demographic information and nodule characteristics were collected for all patients. Ultrasonography and final pathology reports were reviewed for patients with thyroid nodules between the sizes of 1-1.49 cm (n = 155)., Results: 45% (n = 70) of patients with nodules between 1 and 1.49 cm were "low suspicion" nodules according to ultrasound. 47 of these nodules contained malignancies on final histopathological examination, 100% of which were of the papillary subtype. 21% (n = 10) of these malignant nodules demonstrated extrathyroidal extension and 34% (n = 16) were associated with regional metastases., Conclusions: Reliance on sonographic patterns alone could result in missed cancer diagnoses in patients with thyroid nodules measuring between 1 and 1.49 cm. Moreover, a portion of these malignancies may be associated with aggressive features. The effect of this finding on long-term outcomes is unclear.

Background: The incidence of thyroid nodules is increasing among patients in North America. Few of these nodules harbour malignancy, thus further research is required to identify predictive markers of malignant thyroid disease. This study set out to understand the relationship between the levels of fT4 and fT3 and differentiated thyroid cancer., Methods: A case-control study was conducted with 142 cases and 86 controls from the McGill University Teaching Hospitals. All patients underwent thyroid surgery. Cases were defined as patients with malignant nodules confirmed on final pathology and controls were defined as patients with benign nodules. The serological levels of TSH, fT4 and fT3 were measured preoperatively. Odds ratios were determined for each parameter and logistic regressions were calculated between markers and probability of malignancy. Additionally, fT4 values were divided by fT3 values (fT4/fT3 quotient) for each patient and an odds ratio was calculated., Results: Amongst cases, the mean TSH was 2.25 ± 0.360U/mL, fT4 was 14.8 ± 0.689pmol/L, and fT3 was 4.65 ± 0.463pmol/L. Amongst controls, the mean TSH was 2.36 ± 1.68U/mL, fT4 was 14.3 ± 1.71pmol/L, and fT3 was 5.27 ± 0.957pmol/L. Patients in the control group were more likely to have low TSH, while patients in the case group would have high fT4 and patients in the control group were more likely to have a low fT4. The OR for patients with TSH >4.4U/mL was 2.13 (0.97, 4.65), and for patients with TSH <0.4U/mL was 0.46 (0.22, 0.95). The OR for patients with fT4 > 16pmol/L was 2.10 (1.09, 4.06), and for patients with fT4 < 10pmol/L was 0.45 (0.20, 0.98). The OR for patients with fT3 > 5.5pmol/L was 0.39 (0.14, 1.28). The OR for patients with fT3 < 3pmol/L was 1.83 (0.25, 13.69). The average fT4/fT3 was 3.39 ± 0.206 for cases and 2.93 ± 0.467 for controls. The fT4/fT3 quotient was considered high if it was >3.3 (OR =6.00 (2.94, 12.25))., Conclusion: In this study, a direct relationship between high levels of fT4 and malignancy was uncovered. Furthermore, low levels of TSH and fT4 increased the likelihood that a nodule was benign. In this study a fT4/fT3 ratio >3.3 increased the risk of malignancy by 3.6 times (p-value =0.0013).

Background: It has been reported that thyroglobulin antibody are more frequently elevated in patients with thyroid cancercompared to general population. This study aims at evaluating whether preoperative thyroglobulin antibody (TgAb) levels increase the likelihood that a thyroid nodule is malignant., Methods: A retrospective review of 586 patients who underwent thyroidectomy was conducted. Demographic data, TgAb levels, and final histopathology were recorded. Patients were divided into two groups: TgAb positive (defined as TgAb ≥ 30 IU/ml) and TgAb low/negative (defined as TgAb < 30)., Results: Preoperative TgAb levels were available in 405 patients. There were 353 (87 %) patients in the TgAblow/negative group (malignancy rate: 50.42 %) and 52 (13 %) patients in the TgAb positive group (malignancy rate: 65.38 %). The sensitivity, specificity, positive predictive value and negative predictive value of TgAb ≥ 30 IU/ml for thyroid malignancy were 16.04 %, 90.67 %, 65.38 % and 49.58 %, respectively. The relative risk of having a malignant thyroid nodule when the TgAb titers were≥30 IU/ml was 1.30 (CI1.04-1.62) and the odds ratio was 1.86 (CI 1.01-3.41). Both the Pearson chi-square test (p = 0.024) and Fisher's exact test (p = 0.017) yielded statistical significance between the two groups., Conclusions: In this study, patients with preoperative TgAb ≥ 30 IU/ml had a higher rate of malignancy when compared topatients with TgAb < 30 IU/ml. This suggests that an elevated TgAb level may indicate that a thyroid nodule is at an increased risk for malignancy.

Introduction: It is not uncommon for patients with indeterminate thyroid nodules to undergo diagnostic hemithyroidectomy. When the final pathology determines that the nodule is in fact malignant, patients require counseling as to the whether a completion thyroidectomy is necessary., Objectives: 1. Determine the incidence of well differentiated thyroid cancer (WDTC) in the contralateral thyroid lobe in patients undergoing completion thyroidectomy. 2. Identify features of the malignant tumor in the initial resection that increase the likelihood of malignancy in the contralateral lobe., Methods: Retrospective chart review of 97 patients who underwent hemithyroidectomy and completion thyroidectomy in a university's teaching hospital network between 2006 and 2012. Pathology reports from both surgeries as well as patient and thyroid nodule characteristics were reviewed., Results: Of the 97 patients, 47 (48%) had a malignancy in the contralateral lobe. In the contralateral lobe, 42/47 (89%) of malignancies were papillary microcarcinomas (PMC) and 15/42 (36%) of the PMC were multifocal. Multifocal malignancies in the initial specimen had a 60% rate of contralateral malignancy and were found to be a predictor of bilateral disease (p = 0.04) with OR = 2.74 (95% CI: 1.11-6.79; p = 0.003) in WDTC and OR = 3.59 (95% CI:1.35 9.48; p = 0.01) in papillary cancer specifically. There was no statistical significant correlation established for the following variables: presence of positive cervical nodes, extrathyroidal extension, positive resection margins, size and angio-lymphatic invasion. Moreover, there was no statistical correlation between any of the variants of papillary thyroid cancer and bilateral disease, even though most aggressive subtypes were found to be bilateral., Conclusion: In this study, the rate of malignancy in the contralateral lobe was 48%. Multifocality and presence of an aggressive subtype of papillary thyroid cancer in the initial specimen were found to be more important variables to consider in decision-making regarding completion thyroidectomy than size of the initial tumor alone.

Background: Traditional teaching demonstrated that solitary thyroid nodules were more likely to be malignant. Newer studies show that there is no clear answer regarding the influence of the number or the distribution of nodules on the risk of malignancy., Objectives: The purpose of this study was to establish whether patients undergoing thyroid surgery and presenting with a solitary thyroid nodule show a greater rate of malignancy when compared to those presenting with multiple nodules. The secondary goal was to evaluate the impact of the distribution of the nodules (multiple unilateral nodules versus bilateral nodules) on the rate of malignancy in this population., Method: Retrospective review of the medical records of the 656 patients who underwent thyroidectomy at one of the hospitals of the McGill University Thyroid Cancer Centre between July 2006 and April 2011 was conducted., Results: There was no significant difference in the malignancy rate between patients with a solitary nodule and patients with two to six thyroid nodules at ultrasonography, between patients with unilateral nodule(s) and patients with bilateral nodules, or between patients with at least one nodule > 1.0 cm and patients without any nodules > 1.0 cm (p  =  .870, .578, and .361, respectively)., Conclusion: This study demonstrates that the likelihood of thyroid cancer is independent of the number of thyroid nodules. Moreover, our data show that the malignancy rate is not influenced by the distribution of the nodules or their size.

Thyroid cancer accounted for about 2.5% of all new cancers among Canadian females in the year 2000. The surgical management of well-differentiated thyroid cancer remains controversial. We reviewed 100 consecutive cases of total thyroidectomy for thyroid masses suspicious for malignancy done between 1998 and 1999. When feasible, a capsular dissection was performed using only the bipolar cautery for hemostasis. The accuracy of preoperative diagnosis and complications of surgery are evaluated. We suggest that total thyroidectomy can be performed, without excessive morbidity. If performed for all suspicious thyroid nodules, it will eliminate the need for completion thyroidectomies and high ablative does of 131I.

Objective:Papillary microcarcinoma of the thyroid has been described as either a normal variant or a serious malignancy. We describe our experience with papillary microcarcinoma and lymph node metastases.Method:A total of 685 consecutive total thyroidectomies with central compartment neck dissection were reviewed for papillary microcarcinoma. Association of central compartment lymph node metastases with age, gender, tumour multifocality, bilaterality and extrathyroidal extension was analysed.Results:Out of 170 papillary microcarcinoma cases, multifocality was found in 72 (42.4 per cent), bilaterality in 49 (28.8 per cent) and extrathyroidal extension in 16 (9.4 per cent). In all, 23 patients (13.5 per cent) had lymph node metastases. There was a significant association (p < 0.05) between extrathyroidal extension (but no other tumour characteristics) and lymph node metastases.Conclusion:In all, 13.5 per cent of papillary microcarcinomas in our series showed lymph node metastases. Lymph node metastases were associated with extrathyroidal invasion of the papillary microcarcinoma. [ABSTRACT FROM PUBLISHER]