Focal Lymphocytic Thyroiditis Nodules Share the Features of Papillary Thyroid Cancer on Ultrasound

Abstract

PurposeIt is often difficult to discriminate focal lymphocytic thyroiditis (FLT) or adenomatous hyperplasia (AH) from thyroid cancer if they both have suspicious ultrasound (US) findings. We aimed to make a predictive model of FLT from papillary thyroid cancer (PTC) in suspicious nodules with benign cytologic results.Materials and MethodsWe evaluated 214 patients who had undergone fine-needle aspiration biopsy (FNAB) and had shown thyroid nodules with suspicious US features. PTC was confirmed by surgical pathology. FLT and AH were confirmed through more than two separate FNABs. Clinical and biochemical findings, as well as US features, were evaluated.ResultsOf 214 patients, 100 patients were diagnosed with PTC, 55 patients with FLT, and 59 patients with AH. The proportion of elevated thyrotropin (TSH) levels (p=0.014) and thyroglobulin antibody (Tg-Ab) or thyroid peroxidase antibody (TPO-Ab) positivity (p<0.001) in the FLT group was significantly higher than that in the PTC group. Regarding US features, absence of calcification (p=0.006) and "diffuse thyroid disease" (DTD) pattern on US (p<0.001) were frequently seen in the FLT group. On multivariate analysis, Tg-Ab positivity, presence of a DTD pattern on US, and absence of calcification in nodules were associated with FLT with the best specificity of 99% and positive predictive value of 96%. In contrast, a taller than wide shape of nodules was the only variable significant for differentiating AH from PTC.ConclusionSuspicious thyroid nodules with cytologic benign results could be followed up with US rather than repeat FNAB, if patients exhibit Tg-Ab positivity, no calcifications in nodules, and a DTD pattern on US.

Diagnosis of Lymphocytic Thyroiditis Based on Grey Scale Evaluation in Correlation with Ultrasound Guided Fine Needle Aspiration Cytology

“…It was then observed that absence of calcification is sensitive for diagnosing lymphocytic thyroiditis in the study sample but less specific. Similar finding was observed by Sena hwang et al 10 in their study to differentiate focal lymphocytic thyroiditis from papillary carcinoma Conclusion  Lymphocytic thyroiditis was seen mostly in people with age group30-50.  The mean age of study sample with diagnosis as lymphocytic thyroiditis was 39 years.…”

Ectopic intrathyroidal thymus in children: Prevalence, imaging findings and evolution

“…1 Embryologically, the thymus migrates from the mandibular angle down to the superior mediastinum, the defects of which may cause the thymus to become ectopically located, either partly or totally, as seen mostly in the cervical region.² Focal lesions of the thyroid gland in children detected by US are mostly benign, rarely malignant thyroid nodules, though focal thyroiditis can be mistaken for thyroid nodules. 3,4 In our study, we depicted thyroid lesions resembling the above mentioned lesions and suggesting thymic tissue due to identical features observed with US. Intrathyroidal ectopic thymus (IET) is rarer than ectopic cervical thymus but more common than believed and frequently detected incidentally on neck US.…”

“…Increased vascularity on color power Doppler is more likely to be seen in focal thyroiditis. 4,16 Yildiz et al 15 found no lesions located in the upper pole of the thyroid gland, ten lesions in the mid portion (91%), and one lesion in the lower pole. In our study, the majority of the lesions were also located in mid portion (n=30, 83%).…”

Ultrasound Real-Time Tissue Elastography Improves the Diagnostic Performance of the ACR Thyroid Imaging Reporting and Data System in Differentiating Malignant from Benign Thyroid Nodules: A Summary of 1525 Thyroid Nodules

“…yroid nodule disease is common worldwide, and its incidence has grown rapidly over the past decade [1]. With the application of ultrasound (US) technology in thyroid scans, the number of thyroid nodules detected through nonpalpation has increased, reaching 20-67% of the general population [2].…”