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At least 19 recordsLinked to original sources
PubMed1999

Thyroid nodules, thyroid function and dietary iodine in the Marshall islands.

BACKGROUND: Thyroid nodules have been found to be common in the population of the Marshall Islands. This has been attributed to potential exposure of radioiodines from the nuclear weapons tests on Bikini and Eniwetok between 1946 and 1958. METHODS: In order to get a full picture of thyroid pathology in the Marshallese population potentially exposed to radioactive fallout we performed a large thyroid screening programme using palpation, high resolution ultrasound and fine needle biopsies of palpable nodules. In addition, various parameters of thyroid function (free T3, free T4, thyroid stimulating hormone [TSH]) and anti-thyroid antibodies were examined in large proportions of the total population at risk. Since dietary iodine deficiency is an established risk factor for thyroid nodules, iodine concentration in urine samples of 362 adults and 119 children was measured as well as the iodine content of selected staple food products. RESULTS: The expected high prevalence of thyroid nodules was confirmed. There was no indication of an increased rate of impaired thyroid function in the Marshallese population. A moderate degree of iodine deficiency was found which may be responsible for some of the increased prevalence of thyroid nodules in the Marshallese population. CONCLUSIONS: Studies on the relationship between exposure to radioiodines and thyroid nodules need to take dietary iodine deficiency into account in the interpretation of findings.

Adult↗
PubMed1994

[Malignancy markers in the cytodiagnosis of thyroid nodules. Thyroid peroxidase].

The enzyme thyroid-peroxidase (TPO) possesses in thyroid malignancy an immunological alteration disclosed by an anti-TPO monoclonal antibody termed MoAb47: a negative immunostaining with MoAb47 thus represent a marker of malignancy for thyroid tumors. The present work has been intended to investigate the ability of TPO immunodetection to assist the diagnosis of malignancy in fine-needle aspirates (FNA) of thyroid nodules. The study concerns 300 patients with histologically proven thyroid nodules. The results of TPO immunodetection have been compared to the final histological diagnosis and in 279 cases, to the results of standard cytological analysis. From 248 benign nodules, 215 yielded more than 80% positive cells. All malignant nodules had less than 80% positive cells and most of them less than 40%. According to these results, with 80% positive cells as the threshold between benign and suspicious or malignant results, the sensitivity of the method for the screening of malignancy is 100%, its specificity 86.7% and its overall accuracy 89%.

Antibodies, Monoclonal↗
PubMedDate not supplied

American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules.

Thyroid nodules are common and are frequently benign. Current data suggest that the prevalence of palpable thyroid nodules is 3% to 7% in North America; the prevalence is as high as 50% based on ultrasonography (US) or autopsy data. The introduction of sensitive thyrotropin (thyroid-stimulating hormone or TSH) assays, the widespread application of fine-needle aspiration (FNA) biopsy, and the availability of high-resolution US have substantially improved the management of thyroid nodules. This document was prepared as a collaborative effort between the American Association of Clinical Endocrinologists (AACE) and the Associazione Medici Endocrinologi (AME). Most Task Force members are members of AACE. We have used the AACE protocol for clinical practice guidelines, with rating of available evidence, linking the guidelines to the strength of recommendations. Key observations include the following. Although most patients with thyroid nodules are asymptomatic, occasionally patients complain of dysphagia, dysphonia, pressure, pain, or symptoms of hyperthyroidism or hypothyroidism. Absence of symptoms does not rule out a malignant lesion; thus, it is important to review risk factors for malignant disease. Thyroid US should not be performed as a screening test. All patients with a palpable thyroid nodule, however, should undergo US examination. US-guided FNA (US-FNA) is recommended for nodules > or = 10 mm; US-FNA is suggested for nodules < 10 mm only if clinical information or US features are suspicious. Thyroid FNA is reliable and safe, and smears should be interpreted by an experienced pathologist. Patients with benign thyroid nodules should undergo follow-up, and malignant or suspicious nodules should be treated surgically. A radioisotope scan of the thyroid is useful if the TSH level is low or suppressed. Measurement of serum TSH is the best initial laboratory test of thyroid function and should be followed by measurement of free thyroxine if the TSH value is low and of thyroid peroxidase antibody if the TSH value is high. Percutaneous ethanol injection is useful in the treatment of cystic thyroid lesions; large,symptomatic goiters may be treated surgically or with radioiodine. Routine measurement of serum calcitonin is not recommended. Suggestions for thyroid nodule management during pregnancy are presented. We believe that these guidelines will be useful to clinical endocrinologists, endocrine surgeons, pediatricians, and internists whose practices include management of patients with thyroid disorders. These guidelines are thorough and practical, and they offer reasoned and balanced recommendations based on the best available evidence.

Biopsy, Fine-Needle↗
PubMed2002

Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules.

Thyroid nodules are common. Evaluation of patients with thyroid nodules typically includes fine needle aspiration biopsy (FNA), an approach that has proven to be accurate for the detection of thyroid cancer. Although the majority of biopsies are adequate for a cytological diagnosis, up to 20% will be insufficient or nondiagnostic. Current opinion suggests that such aspirates should be repeated, although no systematic study has investigated the usefulness of this approach, especially when ultrasound guidance is used to direct the initial FNA. We sought to define the predictors and optimal follow-up strategy for initial nondiagnostic ultrasound-guided FNAs of thyroid nodules. Data were collected for all patients at the Brigham and Women's Hospital Thyroid Nodule Clinic between 1995-2000 who underwent ultrasound-guided FNA of a thyroid nodule. All patients with nondiagnostic cytology were advised to return for a repeat ultrasound-guided FNA. Patient age, gender, nodule size, cystic content, solitary vs. multinodular thyroid, and nodule location were documented and evaluated as possible predictors of a nondiagnostic biopsy in a multivariable model. The rate of diagnostic cytology obtained on repeat ultrasound-guided FNA was calculated. A total of 1128 patients with 1458 nodules were biopsied over a 6-yr period. A total of 1269 aspirations (950 patients) were diagnostic, and 189 (178 patients) were nondiagnostic. The cystic content of each nodule was the only significant independent predictor of nondiagnostic cytology (P < 0.001). The fraction of specimens with initial nondiagnostic cytology increased with greater cystic content (P < 0.001 for trend). A diagnostic ultrasound-guided FNA was obtained on the first repeat biopsy in 63% of nodules and was inversely related to increasing cystic content of each nodule (P = 0.03). One hundred and nineteen patients with 127 nodules returned for follow-up as advised, and malignancy was documented in 5%. Despite ultrasound-guided FNA, there remains a significant risk of initial nondiagnostic cytology, largely predicted by the cystic content of each nodule. Repeat aspiration is often successful and should be the standard approach to such nodules, given their risk of malignancy.

Adult↗
PubMed1998

Course of thyroid nodules.

Thyroid nodules are present in up to 30% of the German population. The causative role of iodine deficiency which is still endemic in this country has long been established. Recent progress has shed some light on the pathogenesis of nodular thyroid disease which still remains less well understood than goitrogenesis. Most thyroid nodules appear to be of clonal origin. Functional abnormalities have been related to alterations within the TSH signaling cascade, particularly mutations in the TSH receptor and stimulating G-protein-alpha-subunit. Proliferation which is dissociable from thyroid function has been linked to genetic differences of the thyroid cells themselves and growth factors being partly overexpressed by thyroid nodules. Data regarding the correlation of the molecular characteristics to the clinical behavior and growth potential have not yet been elucidated. On the other hand, there are only a few clinical studies that have addressed the long-term natural history of thyroid nodules. From these studies at least it appears that thyroid nodules tend to grow slowly and their increase in size may even by modern ultrasonography technique become apparent only after several years. Those in vitro and in vivo observations have important implications for the planning of therapeutical trials. Studies have focused so far mainly on short term effects of different therapeutic regimens such as iodine or levothyroxine. However, pathophysiological considerations and clinical observation would encourage studies over more prolonged periods of time.

Germany↗
PubMed2005

[Diagnosis and therapy of thyroid nodules].

Thyroid nodules and goitre can be diagnosed in up to 50% in populations living in iodine deficiency areas. Because of the necessity to exclude malignancy they therefore represent a significant diagnostic and economic problem. Sonography as well as TSH determination are the basic constituents of any thyroid diagnostic work up. Thyroid scintigraphy should be performed with any solitary thyroid nodule >10 mm if the scintigraphic result (together with the sonographic result) is likely to influence the treatment. Except of hot nodules any thyroid nodule should be evaluated by fine needle aspiration biopsy. Because of the lack of controlled studies including sufficient numbers of patients, there is a lack of evidence for some aspects of our everyday clinical practice. The aim of this article is therefore to summarize latest results on pathogenesis, diagnostic tools and recommendations concerning therapy and follow up.

Diagnosis, Differential↗
PubMed2006

Contemporary diagnostic approach to the thyroid nodule.

Thyroid nodules are common, with an estimated incidence of 5%-10% in the United States. The current gold standard for diagnosis is fine needle aspiration biopsy (FNAB). The incidence of indeterminate diagnoses varies from 10% to 25%. Surgical resection is usually indicated to exclude the diagnosis of cancer in these patients. However, only a minority (about 20%) of indeterminate thyroid nodules actually harbor a malignancy, resulting in surgery for diagnostic purposes alone in many patients. The increased detection of benign nodules and microcarcinomas reinforces the need for improved non-operative methods to differentiate benign from malignant disease and discriminate low-risk from high-risk cancers. In this article we present a current, rational diagnostic approach to the patient with a thyroid nodule, evaluate new advances including thyroid genomic and predictor models, and propose the development of prospective trials to incorporate these new additions into clinical decision making. Given how many questions still exist for patients with thyroid nodules, partnership and collaboration, or the "bench to bedside" concept should find its way into most every thyroid surgeon and endocrinologist's lexicon.

Algorithms↗
PubMed2006

Evaluation and management of incidentally discovered thyroid nodules.

Thyroid nodules are present in 4-10% of the adult population. However, less than 1% of all cancers occur in the thyroid gland. Thyroid nodules are usually an incidental finding in a routine clinical or an ultrasound examination of the neck performed for some other reason. Differentiating a benign nodule, which may require no specific treatment, from a malignant nodule presents a diagnostic dilemma. An individualized approach to a patient with history, risk factors and fine needle cytology is warranted. Molecular markers and immunohistochemical studies done on thyroid nodule cytology may help in differentiating benign from malignant. This article presents a review of the literature for the diagnosis and management of the thyroid nodule.

Adult↗
PubMed1993

[Comments on the ultrasonographic evaluation of thyroid nodules].

Thyroid ultrasonography does not allow establishing a positive diagnosis as to the benign or malignant nature of a thyroid nodule. However, the predictive value of this technique should be studied on the basis of recent technological progress. The great power of resolution of current sonographic systems allows a fine semiological analysis of the features of nodules. Presumption factors such as the solid, hypoechogenic nature, predictive of cancer in 35 to 63% of cases according to series, can be gathered. Thus ultrasonography can be placed in its right place for decision in the diagnostic strategy for a cold nodule; this place is better than that of radionuclide scanning, and close to that of cytology. This technological progress involves an increase in the prevalence of thyroid nodules. Multiple infraclinical micronodules, visible on ultrasonography but with uncertain pathological significance, are demonstrated. While ultrasonography has a disputable predictive value in such cases, it still is the technique of choice for the surveillance of such nodules. Sonographic guidance of cytological puncture of thyroid nodules, doppler studies of nodule vasculature and computer-supported analysis of its texture are interesting capabilities that may allow increasing the diagnostic efficiency of thyroid ultrasonography.

Humans↗
PubMedDate not supplied

Identification and evaluation of thyroid nodules.

Thyroid nodules are common, occurring in about 5% to 10% of people during their lifetimes. Primary care providers are often the first to recognize the nodules and to begin evaluation to rule out malignancy or other underlying disorder. Most nodules are benign, therefore the chance of diagnosing cancer is low but appreciable. The most cost-effective initial evaluation is the fine needle aspiration biopsy, performed and interpreted by skilled clinicians. Primary care providers are responsible for providing access to the "standard of care" in a community, which usually involves referral to an endocrinologist for evaluation of thyroid nodules. Therefore, most primary care providers are key participants in terms of thyroid nodule identification; appropriate and timely referral, and follow-up surveillance.

Adult↗
PubMed1975

The ultrasonic evaluation of nonfunctioning thyroid nodules.

Thyroid echography was carried out on 100 patients with thyroid abnormalities to evaluate the diagnostic accuracy of ultrasound in differentiating simple thyroid cysts from solid thyroid nodules. In all 46 proven cases, the ultrasonic diagnosis of the solid or cystic nature of thyroid nodules was correct.A proposed diagnostic workup of a hypofunctioning (cold) thyroid nodule is suggested with primary needle aspiration and cytologic examination of the cyst fluid being recommended if the nodule is shown to be entirely cystic by ultrasound.

Cysts↗
PubMed2003

Endocrine tumors: evaluation of the thyroid nodule.

Thyroid nodules are found in 4 to 7% of the population, and with the increased use of radiographic methods, incidental nodules are becoming more prevalent. Only 5% of all nodules will be malignant, and thyroid cancer accounts for only 0.4% of all cancer deaths. The preferred diagnostic approach is early referral, avoidance of numerous radiologic evaluations, and early performance fine-needle aspiration. This article reviews the literature of the last 12 months and discusses some of the new molecular, genetic, and immunostaining techniques in the evaluation of thyroid nodules.

Diagnostic Imaging↗
PubMedDate not supplied

[Thyroid nodules].

Thyroid nodules are commonly encountered in clinical practice. They are present in 4 to 7% of the population by neck palpation and 30 to 50% by ultrasonography. Most are benign and could be neglected by the clinician and his patient. However, 5% of nodules are malignant, requiring surgical treatment; therefore, an exhaustive evaluation is needed. The diagnostic approach includes physical examination, laboratory analysis, ultrasonography, radioisotope imaging, and fine needle aspiration. This article, based on the literature and the authors'experience, provides recommandations for thyroid nodule management.

Humans↗
PubMed2000

[Management of thyroid nodule].

Thyroid nodules are often encountered in clinical practice. Although the vast majority are benign lesions, about 5% may actually be cancerous. The main problem raised by a solitary nodule of the thyroid gland is therefore the diagnosis of neoplasia. Several diagnostic techniques have been proposed to distinguish benign nodules from malignant nodules. These techniques vary in reliability. History taking, physical examination, laboratory studies and diagnostic imaging may help the physician to categorise the nodule but only fine-needle aspiration biopsy provide sensitive and specific results in the diagnostic process. The reliability of this technique is largely dependent on the experience of the person performing the biopsy and that of the cytopathologist interpreting it.

Algorithms↗
PubMed1993

[Is it appropriate to treat thyroid nodules with thyroid hormone?].

The appropriateness of treating thyroid nodules with thyroid hormone is being debated: in fact, the development of nodules is not caused by an iodothyronine deficiency or a desuppression of TSH, and T4 seems to be able to regain control on cell proliferation. A very great number of authors have reported their experience with suppression of thyroid nodules with thyroid hormone, but treatment efficacy has been variably appreciated (9 to 69% regression). On the other hand, the four randomized prospective studies available at present, which analyze the evolution of nodules, especially on ultrasonography, have not demonstrated that hormone therapy is more effective than a placebo. The methodology of these studies is not free from criticism, and other prospective surveys are required, especially to establish whether this treatment is innocuous and whether some varieties of nodules may be more amenable to hormone therapy than others.

Humans↗
PubMed1993

[Management of the cold thyroid nodule and thyroid malignancy].

The evaluation and management especially of cold thyroid nodules remains an area of controversy. The past decade has witnessed two important advances. The increased availability of fine-needle aspiration of thyroid nodules has altered the clinician's approach to this disease, and provides for the single most precise method for selecting appropriate patients for surgery. The introduction of high-resolution thyroid ultrasonography provides for anatomic definition that is clearly superior to thyroid scintigraphy. However, radionuclide imaging remains critical for determining the functional status of abnormal thyroid tissue. This review attempts to provide a practical approach to the evaluation and management of the thyroid nodule. Only rare data exists concerning the therapeutic approach of cold thyroid nodules and non-toxic nodular goitre. There seems to be a size-reducing effect by thyroxin-treatment, but no data are reported from iodine deficient areas. Concerning the treatment of differentiated thyroid carcinoma total thyroidectomy combined with eradication of remaining thyroid tissue with iodine 131 is usually preferred. In case of smaller or occult carcinoma various modes of uni- or bilateral subtotal resection are used. Chemotherapy is of little use in treating differentiated thyroid carcinoma and remains as a last possibility if usual approaches are no longer effective. To control local-invasive growth of anaplastic thyroid carcinoma combined treatment with mitoxantrone and hyperfractionated irradiation seems to be a successful approach.

Biopsy, Needle↗