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Objectives:The aim of this study was to ascertain the relationship between Bethesda category and molecular mutation of thyroid nodules in patients undergoing thyroidectomy.Design: A retrospective cohort of patients who underwent thyroidectomy following needle biopsy and molecular profile testing was performed.Setting: Two tertiary care academic hospitals.Participants: Consecutive patients with a dominant thyroid nodule who underwent both USFNA and molecular profile testing followed by thyroidectomy were included in the study. Main Outcome and Measures:The main outcome was postoperative diagnosis of thyroid cancer and aggressivity of disease based on histopathological variants, nodal metastasis or extra-thyroidal extension. Associations between Bethesda category, molecular mutation and postoperative pathology was assessed using descriptive analysis and chi-square testing.Results: Four hundred fifty-one patients were included. 95.9% (93/97) of patients with a BRAFV600E mutation had a Bethesda category V or VI (p < .001), and all had confirmed thyroid cancer on postoperative pathology. Those with H, K or N RAS or EIF1AX mutations, gene expression profiling (GEP) or copy number alterations showed an association with Bethesda categories III and IV (p ≤ .01). Those with no identified molecular mutation had a lower incidence of aggressive thyroid cancer compared to those with an identified mutation (12.6% vs. 44.3%, p < .01). Conclusion:BRAFV600E mutations were associated with thyroid cancer subtypes known to be more aggressive whereas RAS and EIF1AX mutations, copy number alterations, and GEP were related to Bethesda categories III and IV. These findings may help thyroid specialists better identify aggressive thyroid nodules associated with indeterminate Bethesda categories.

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Hemoptysis is the expectoration of blood from the lower airway. A study in the United Kingdom showed that the annual incidence of hemoptysis in primary care is 0.1%. Between 5 and 15% of patients presenting with hemoptysis have a life-threatening hemoptysis   Approach to hemoptysis can be particularly perplexing for medical students considering the extensive list of differential diagnosis. It is important for physicians to be able to recognize and manage life-threatening hemoptysis as it is associated with high morbidity and mortality if untreated. Understanding when to further investigate patients at risk of lung cancer can help detect the disease at an earlier stage. This article begins with a brief introduction to life-threatening and nonlife-threatening hemoptysis and provides a detailed discussion of its management including diagnostic approaches followed by appropriate imaging modalities, laboratory findings, and clinical management. The target audience of this article are medical students at their preclinical or clinical phase.