Background Fine needle aspiration (FNA) is the standard to evaluate thyroid nodules for malignancy. The aim of this study was to determine the influence of patient age and gender on the rate of thyroid nodule malignancy by FNA. Methods A database of 3,981 consecutive patients who underwent thyroid FNA between 2002 and 2009 was reviewed. The percentages of benign, indeterminate, and malignant biopsies based on patient age and gender were determined. Statistical analysis was performed using SPSS. Results Our patient population included 2,766 women (mean age ± SD, 52 ± 15.2) and 964 men (mean age ± SD, 59 ± 13.8). Of the 3,722 (93.5%) patients with diagnostic FNAs, 196 (5.3%) had malignant FNA cytology. Malignant FNAs were twice as frequent in patients age ≤45 vs. those >45 (8.1% vs. 4.0%, p<0.001). Overall, men had more indeterminate (10.2% vs. 6.3%, p<0.001) and malignant (6.7% vs. 4.8%, p=0.034) FNAs than women. Malignant FNAs in men were greatest in patients over age 45 (6.0% vs. 3.2%, p=0.001). The incidence of malignant FNAs for women peaked in their 30s (10.4%) whereas the incidence of malignant FNAs for men peaked 10 years later in their 40s (12.1%). Both men and women had the lowest incidence of malignant FNAs in their 70s (2.3% and 1.9% respectively). Conclusion The typical 5% risk of thyroid nodule malignancy on FNA varies depending on patient age and gender. A patient’s age and gender should therefore be considered when counseling someone of their risk of thyroid cancer by FNA.

No abstract

Background Transaxillary thyroidectomy (TAT) has gained popularity in East Asian countries; however, to date there have been no attempts to evaluate the preferences regarding TAT in the United States population. The aim of this study is to assess the preferences and considerations associated with TAT in an American cohort. Methods Self-administered surveys were distributed to 966 adults at various locations in a single state. Questions assessed preferences for the surgical approach, acceptable risks and extra costs, and willingness to pursue TAT despite reduced cancer treatment efficacy. Results The response rate was 84% with a mean age of 40±17 years. The majority of respondents were female. Eighty-two percent of the respondents preferred TAT to a cervical thyroidectomy (CerT), all risks being equal. Fifty-one percent of the respondents were willing to accept a 4% complication rate with TAT. Sixteen percent of the respondents stated they would agree to pay up to an additional $5,000 for the TAT approach. When presented with thyroid cancer, 20% of all respondents still preferred TAT even if it would not cure their disease. Patients preferring TAT over CerT were younger, female, more willing to accept complications and spend additional money, and most significantly, preferred the TAT approach even if it was less likely to cure their cancer. Conclusions Although this survey presents a hypothetical question for people who do not have thyroid disease, the majority of respondents preferred TAT over CerT. Furthermore, a substantial number were willing to accept higher complication rates and increased costs for TAT.

With total thyroidectomy, formal compartmental neck dissection and radioactive iodine treatment, disease-free survival can be achieved in the majority of patients with PTC and synchronous lateral neck nodal metastases. A persistently elevated Tg post-operatively and a high ratio of metastatic nodes identify patients at increased risk of locoregional recurrence.

No abstract