Chronic Lymphocytic Thyroiditis May Lower Accuracy of AUS/FLUS Cytopathology in Surgical Patients

Mulder, Michelle B.; Khazeni, Kristina; Sussman, Matthew S.; Lew, John I.; Farrá, Josefina C.

doi:10.1016/j.jss.2019.07.068

Cited by 13 publications

(10 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Chronic lymphocytic thyroiditis (CLT), also known as Hashimoto's thyroiditis, is an autoimmune disease characterized by diffuse goiter infiltrated by lymphocytes and is the leading cause of hypothyroidism in iodine-sufficient regions of the world [ 1 , 2 ]. The disease develops slowly and its clinical manifestations are not specific.…”

Section: Introductionmentioning

confidence: 99%

Clinical Observation of Levothyroxine Sodium Combined with Selenium in the Treatment of Patients with Chronic Lymphocytic Thyroiditis and Hypothyroidism and the Effects on Thyroid Function, Mood, and Inflammatory Factors

Sun

Zhu

et al. 2021

Evidence-Based Complementary and Alternative Medicine

View full text Add to dashboard Cite

The purpose of this study was to investigate the therapeutic effects of levothyroxine sodium combined with selenium treatment and single levothyroxine sodium treatment on patients with chronic lymphocytic thyroiditis and hypothyroidism and to analyze the effects of different treatment regimens on patients’ thyroid function, mood, and inflammatory factors, with the aim of providing a reference for clinical treatment. The subjects of the current study were 138 chronic lymphocytic thyroiditis (CLT) patients with hypothyroidism admitted to our hospital from May 2016 to September 2019 and were randomly divided into a control group taking levothyroxine sodium (LT4) treatment and a combined group of LT4 combined with selenium treatment, with 69 cases each. Patients in both groups were evaluated for efficacy after 3 months of treatment, and their thyroid function was observed by total triiodothyronine (TT3), total thyroxine (TT4), thyroid stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), and thyroid globulin antibody (TGAb), and their mood changes were observed by Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores. The levels of inflammatory factors such as interleukin-2 (IL-2), interleukin-10 (IL-10), and tumor necrosis factor-α (TNF-α) were measured, and the occurrence of adverse drug reactions during the treatment period was observed and recorded in all patients. The results showed that the total effective rate of the combined group was significantly higher than that of the control group. The levels of TT3, TT4, TSH, TgAb, and TPOAb, SAS and SDS scores, and levels of inflammatory factors such as IL-2, IL-10, and TNF-α were significantly improved in both groups after treatment. Compared with the control group, TGAb, TPOAb, IL-2, TNF-α levels, and SAS and SDS scores decreased more and IL-10 levels increased more in the combined group, while the differences of other indexes were not statistically significant. This suggests that LT4 has certain efficacy in treating CLT with hypothyroidism, and the combined selenium treatment can improve the therapeutic effect of LT4 and can play a greater role in improving patients’ mood and immune and inflammatory responses.

show abstract

Section: Introductionmentioning

confidence: 99%

Clinical Observation of Levothyroxine Sodium Combined with Selenium in the Treatment of Patients with Chronic Lymphocytic Thyroiditis and Hypothyroidism and the Effects on Thyroid Function, Mood, and Inflammatory Factors

Sun

Zhu

et al. 2021

Evidence-Based Complementary and Alternative Medicine

View full text Add to dashboard Cite

show abstract

“…Mulder et al. ( 10 ) reported a lower rate of malignancy in AUS/FLUS cytology coexisting with CLT (44%, 32/73 nodules) than without CLT (60%, 131/220 nodules) in the US population (P = 0.02). The authors suggested that atypia due to CLT may falsely increase the diagnosis of AUS/FLUS; thus, AUS/FLUS cytology with a CLT background shows a lower prevalence of thyroid malignancy.…”

Section: Discussionmentioning

confidence: 96%

“…CLT caused by HT is characterized by epithelial changes and variable atypia ( 19 ). Microscopic findings of early CLT include enlarged nuclei, lymphocytic and plasma cell infiltration, atrophic follicles with abundant oncocytes, and atypical epithelium ( 10 ). The microscopic features of progressed CLT include fibrosis and nodularity or atrophic parenchyma, which are distinct from AUS/FLUS ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Malignancy Rate of Bethesda Class III Thyroid Nodules Based on the Presence of Chronic Lymphocytic Thyroiditis in Surgical Patients

2021

View full text Add to dashboard Cite

BackgroundHashimoto’s thyroiditis (HT), also known as chronic lymphocytic thyroiditis (CLT), may interfere with the accurate cytological diagnosis of thyroid nodules. Recently, HT has been considered a premalignant condition for thyroid cancer development. The diagnosis of atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS) thyroid nodules is challenging and evidence for the malignancy risk of AUS/FLUS thyroid nodules coexisting with CLT is scarce. Therefore, we assessed the malignancy risk of AUS/FLUS thyroid nodules according to the presence of background CLT.MethodsThis study included 357 surgically resected thyroid nodules with AUS/FLUS cytology. Cases with concomitant malignant nodules were excluded. CLT was defined based on the pathologic report after thyroid surgery.ResultsAmong 357 tumors, 130 tumors (36%) were confirmed to have coexisting CLT, and 170 tumors (48%) were determined to be malignant after thyroidectomy. Malignancy rates were similar in both groups (48% in each) regardless of background CLT (62/130 with CLT vs. 108/227 without CLT). In the group with CLT, thyroiditis was more frequent in the final pathology (12% with CLT vs. 1% without CLT, P = 0.003). In multivariate analysis, positive BRAFV600E mutation, highly suspicious sonographic features (K-TIRADS 5), and smaller thyroid nodules were significant factors for thyroid malignancies.ConclusionThe malignancy rate of thyroid nodules with AUS/FLUS cytology was comparable irrespective of the presence of underlying CLT.

show abstract

“…Molecular analysis of cytological samples may provide more insights into the pre-operative characterization of indeterminate thyroid nodules (11,12,13), but although molecular testing was encouraged by ATA guidelines for thyroid nodules and cancer (3), its routine use in clinical settings remains limited. Some evidence would support the notion that the diagnostic accuracy of fine-needle aspiration cytology (FNAC) for thyroid nodules might be reduced by a concomitant chronic autoimmune thyroiditis (CAT) (14,15) due to the thyroiditis-related cell atypia. The possibility that CAT might represent a confounding factor by increasing the rate of indeterminate cytology results was investigated by several studies, but the results were discrepant (15,16,17).…”

Section: Introductionmentioning

confidence: 99%

The diagnostic accuracy of fine-needle aspiration cytology for thyroid nodules is not affected by coexistent chronic autoimmune thyroiditis: results from a cyto-histological series of patients with indeterminate cytology

Rotondi

Molteni

Cappelli

et al. 2021

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective Indeterminate cytological result at Fine-needle-aspiration-cytology (FNAC) remains a clinical challenge for endocrinologists. Aim of the present study was to evaluate whether a coexistent Chronic-Autoimmune-Thyroiditis (CAT) might affect the diagnostic accuracy of fine-needle aspiration cytology for thyroid nodules. Design and Methods A retrospective cohort study was designed including all nodules receiving an indeterminate cytology result (TIR3A or TIR3B) undergoing thyroid surgery and subsequent histological confirmation. Patients were stratified in two groups according to the presence or absence of CAT. The hypothesis to be tested was whether follicular cell alterations induced by CAT might increase the rate of indeterminate cytological results in histologically benign thyroid nodules. Additional control groups were represented by nodules with determinate cytology, either benign (TIR 2) or malignant (TIR5). Results: One-hundred-eighty-nine indeterminate thyroid nodules were included (67 TIR3A and 122 TIR3B). At post-surgical histology 46 nodules (24.3%) were malignant. No significant differences were observed in the rate of histologically proven malignancy between patients without CAT and patients with CAT in the TIR3B (29.4% vs 32.4%; p=0.843) nor TIR3A (13.0% vs 11.4%; p=1.000) nodules. The rate of coexistent CAT was similar between TIR3B and TIR5 nodules harboring PTC at histology (30.4% vs 39.4%, p=0.491) and between indeterminate nodules and a control group of TIR2 nodules (39.2% vs 37.0%; p=0.720). Conclusions: The similar rates of histologically proven malignancy found in cytologically indeterminate nodules in the presence or absence of concomitant CAT, would not support that CAT itself affects the diagnostic accuracy of fine-needle aspiration cytology.

show abstract

Chronic Lymphocytic Thyroiditis May Lower Accuracy of AUS/FLUS Cytopathology in Surgical Patients

Cited by 13 publications

References 22 publications

Clinical Observation of Levothyroxine Sodium Combined with Selenium in the Treatment of Patients with Chronic Lymphocytic Thyroiditis and Hypothyroidism and the Effects on Thyroid Function, Mood, and Inflammatory Factors

Clinical Observation of Levothyroxine Sodium Combined with Selenium in the Treatment of Patients with Chronic Lymphocytic Thyroiditis and Hypothyroidism and the Effects on Thyroid Function, Mood, and Inflammatory Factors

Malignancy Rate of Bethesda Class III Thyroid Nodules Based on the Presence of Chronic Lymphocytic Thyroiditis in Surgical Patients

The diagnostic accuracy of fine-needle aspiration cytology for thyroid nodules is not affected by coexistent chronic autoimmune thyroiditis: results from a cyto-histological series of patients with indeterminate cytology

Contact Info

Product

Resources

About