Prevalence of normal <scp>TSH</scp> value among patients with autonomously functioning thyroid nodule

Treglia, Giorgio; Trimboli, Pierpaolo; Verburg, Frederik A.; Luster, Markus; Giovanella, Luca

doi:10.1111/eci.12456

Cited by 66 publications

(48 citation statements)

References 34 publications

(65 reference statements)

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“…If the 99m Tc thyroid scan identifies a cold nodule, the patient will undergo thyroid FNA, while if the 99m Tc thyroid scan identifies a hot nodule, the patient will not undergo FNA. This approach is largely approved in the literature [18][19][20][21][22][23][24] and is justified by the fact that most functional thyroid nodules are follicular adenomas and hyperplasia, and in these cases FNA is often not conclusive. This could be used as a first tool to reduce the number of FNAs with a TIR-3 diagnosis, which is the most controversial and clinically complex FNA category.…”

Section: Discussionmentioning

confidence: 99%

When Is Thyroidectomy the Right Choice? Comparison between Fine-Needle Aspiration and Final Histology in a Single Institution Experience

et al. 2016

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Objectives: The aim of this study was to compare SIAPEC-IAP-based cytological reports with their corresponding histological diagnoses to establish when thyroidectomy is the right choice in the management of thyroid diseases. Study Design: This is a retrospective review of all the consecutive thyroidectomies/lobectomies performed at Maria Vittoria Hospital during the 10-year period between January 2005 and December 2015. Patients who underwent both fine-needle aspiration (FNA) and surgical procedures in our institution were included in the study. Results: A total of 260 patients underwent both FNA and a thyroid surgical procedure at Maria Vittoria Hospital; 111 (42.69%) had a malignant histological report. The final cytological diagnosis was nondiagnostic (TIR-1) in 19 cases (7.31%), benign (TIR-2) in 83 cases (31.92%), indeterminate (TIR-3) in 96 cases (36.92%), suspicious for malignancy (TIR-4) in 22 cases (8.46%), and diagnostic for malignancy (TIR-5) in 40 cases (15.38%). Among the 96 cases with TIR-3 cytology, after the review, 44 (16.92%) were classified as TIR-3A and 52 (20%) as TIR-3B. The prevalence of malignancy among TIR-3A cases was 20.45% (9/44) and among TIR-3B cases 53.85% (28/52). The difference was statistically significant (p = 0.0007). Conclusions: Our data suggest that follow-up alone is not sufficient in TIR-3A patients given the high prevalence of malignancy within that diagnostic category (20.45%) and the low sensitivity (75.68%) and specificity (59.32%) in the distinction between TIR-3A and TIR-3B. Regarding patients with a multinodular goiter and TIR-2 at FNA, the surgical approach should not be excluded.

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Section: Discussionmentioning

confidence: 99%

When Is Thyroidectomy the Right Choice? Comparison between Fine-Needle Aspiration and Final Histology in a Single Institution Experience

et al. 2016

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“…All patients were evaluated by US, while additional imaging including whole body scintigraphy, magnetic resonance imaging, computed tomography, and positron emission tomography/computed tomography was used when needed. This approach was based on our previous experience spanning more than a decade and is also supported by the most recent literature …”

Section: Methodsmentioning

confidence: 98%

Can ultrasound systems for risk stratification of thyroid nodules identify follicular carcinoma?

Castellana

Piccardo

Virili

et al. 2020

Cancer Cytopathology

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BACKGROUND: Ultrasound (US) risk stratification systems (RSSs) have been developed to reduce the number of unnecessary fine needle aspirations (FNAs) of thyroid nodules. These systems were designed primarily to identify papillary thyroid carcinomas, thus their performance on follicular thyroid carcinoma (FTC) is debatable. The present study was undertaken to investigate the accuracy of RSSs in selecting FTCs for FNA. METHODS: Patients with FTC who underwent US examinations between 2012 and 2018 in 2 institutions were selected. US images were reviewed retrospectively, and FTCs were reclassified according and Thyroid Imaging Reporting and Data System (TIRADS). Risk class and indication for FNA were assessed. RESULTS:Forty-five FTCs from 45 consecutive patients were included in the study. The median tumor diameter was 32 mm (range, 11-100), and ovoid isoechoic nodule with or without lobulated margins was the most frequent presentation. When FTCs were classified according to RSSs, the most common categories were intermediate and high risk, though 1 case in 3 was not classifiable. FTCs were classified as high risk/high suspicion/malignant in 11% to 74% of cases, with a statistically significant difference among the systems. FNA was indicated in 69% to 100% of cases, with good agreement among AACE/ACE/AME, ACR-TIRADS, and TIRADS. CONCLUSION: Current RSSs show high performance in selecting FTCs for FNA. This result is mainly due to the dimensional RSSs cutoffs indicating FNA. On the contrary, given the reported unsuspicious echo-structural presentation of FTC and the recognized limitation of cytological assessment to detect it, caution is advised when using US to manage cytologically indeterminate nodules. Cancer Cytopathol 2020;128:250-259.

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“…Furthermore, the EANM believes that thyroid scintigraphy still has its place in the diagnostic workup of nodular thyroid disease, especially in regions, including a number of EANM member countries, with a known or recently alleviated iodine deficiency. In such populations a normal TSH level cannot rule out thyroid autonomy [8][9][10][11]. In their retrospective study, Chami et al [9] found that 49 % of patients with an autonomously functioning focal thyroid nodule had a normal TSH level.…”

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confidence: 99%

Why the European Association of Nuclear Medicine has declined to endorse the 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer

Verburg

Aktolun²,

Chiti

et al. 2016

Eur J Nucl Med Mol Imaging

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Recently the American Thyroid Association (ATA) released the third version of one of the most cited differentiated thyroid cancer (DTC) guidelines under the title B2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer^ [1]. Compared to the earlier versions [2,3], these guidelines are a major departure, as the volume of the text, the number of recommendations and the number of references have increased considerably.We fully understand the effort involving many hours of work that must have been required for the rigorous screening of the literature to produce the evidence tables and the eventual definitions of the recommendations. The document consists of roughly 73,000 words which make up the 101 recommendations and the explanatory text and comments. In the current ATA guidelines, most of the text appears eminently sensible and represents a significant advance from previous DTC-related guidelines published by the ATA as well as other societies, including the 2008 European Association of Nuclear Medicine (EANM) guidelines on 131 I therapy of DTC [4][5][6][7]. For instance, we welcome the clear division of indications for initial 131 I treatment of DTC patients after total thyroidectomy into ablation, adjuvant therapy and therapy. Furthermore, this change in terminology which we strongly support much more clearly delineates the role of 131 I in the care of patients with DTC in other disciplines, especially medical oncology. Considering all the factors that have to be weighed in formulating recommendations this is a huge dedicated effort that has come to fruition.

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Prevalence of normal TSH value among patients with autonomously functioning thyroid nodule

Cited by 66 publications

References 34 publications

When Is Thyroidectomy the Right Choice? Comparison between Fine-Needle Aspiration and Final Histology in a Single Institution Experience

When Is Thyroidectomy the Right Choice? Comparison between Fine-Needle Aspiration and Final Histology in a Single Institution Experience

Can ultrasound systems for risk stratification of thyroid nodules identify follicular carcinoma?

Why the European Association of Nuclear Medicine has declined to endorse the 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer

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