Thyroid Nodules

Beano, Abdallah; Zmaili, Mohammad; Zayed, Ayman A.

doi:10.1056/nejmc1600493

Cited by 23 publications

(4 citation statements)

References 8 publications

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“…Lead (Pb) and cadmium (Cd) are inevitable environmental pollutants in daily life. They come from a variety of sources, such as leaded gasoline, mining wastes, smelting, electroplating, petroleum and lead paint, as well as the intensive use of consumer products, such as lead-acid batteries, make-up, pigments, plastic cooking tools and cigarettes 33–35. The biological half-life of Cd and Pb can be over 30 years.…”

Section: Discussionmentioning

confidence: 99%

“…They come from a variety of sources, such as leaded gasoline, mining wastes, smelting, electroplating, petroleum and lead paint, as well as the intensive use of consumer products, such as lead-acid batteries, make-up, pigments, plastic cooking tools and cigarettes. [33][34][35] The biological half-life of Cd and Pb can be over 30 years. Thus, exposure to Cd and Pb, even at environmentally low levels over time, is associated with a plethora of toxic effects on multiple systems and organs of the human body, 36 including endocrinedisrupting activities.…”

Section: Open Accessmentioning

confidence: 99%

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Are ethnic differences, urinary iodine status, lead and cadmium exposure associated with thyroid autoimmunity and hypothyroid status? A cross-sectional study

et al. 2022

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ObjectiveWe aimed to evaluate the effects of different ethnicities and potential environmental exposure on the prevalence of thyroid autoimmune status and hypothyroid status.DesignThe data were obtained from two cross-sectional studies.Participants2105 participants in Shanghai (Han) and 772 participants in Yunnan Honghe Prefecture (Han, Yi, Miao and Hani), aged 18–75 were enrolled.MethodsParticipants underwent several checkups, including urinary iodine concentration, blood lead (BPb) and blood cadmium (BCd), thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), thyroid stimulating hormone (TSH) as well as thyroid ultrasonography (US). Thyroid autoimmune status was defined as: antithyroid antibody positive (ATA+): TPOAb + or TgAb+; and ATA + and US+: TPOAb + or TgAb + together with characteristic US features.ResultsThe standardised prevalence of thyroid autoimmune positivity in Yunnan were higher than those in Shanghai (TPOAb+: 13.56% vs 8.27%, p<0.001; TgAb+: 9.28% vs 7.09%, p=0.045; ATA+: 16.96% vs 11.10%, p<0.001; ATA + and US+: 8.96% vs 6.64%, p=0.036). For urinary iodine-to-creatinine ratio (UI/Cr), compared with the level of 100.00–199.99 µg/g, the level of ≥300.00 µg/g had a 1.5-fold risk for ATA + and US+ (OR 1.455, p=0.041). The levels of 200.00–299.99 µg/g and ≥300.00 µg/g were positively associated with hypothyroid status (OR 1.509, p=0.002 and OR 1.338, p=0.043). Compared with the first quartiles, the fourth quartiles of BPb were positively associated with TPOAb+: (OR 1.637, p=0.006), ATA+ (OR 1.435, p=0.025), ATA + and US+ (OR 1.641, p=0.013), hypothyroid status (OR 1.467, p=0.013) and TSH levels (B 0.092, p=0.021). The fourth quartile of BCd was positively associated with the prevalence of ATA+ (OR 1.427, p=0.036).ConclusionsHigher levels of UI/Cr, BPb and BCd may be associated with thyroid autoimmunity and hypothyroid status.

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Section: Discussionmentioning

confidence: 99%

Section: Open Accessmentioning

confidence: 99%

Are ethnic differences, urinary iodine status, lead and cadmium exposure associated with thyroid autoimmunity and hypothyroid status? A cross-sectional study

et al. 2022

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“…For more than three decades, the cornerstones in the clinical management of patients with thyroid nodules have been ultrasound (US) and fine-needle aspiration cytology (FNA) ( 1 , 2 , 3 ). Robust evidence demonstrates that the risk of malignancy (primarily papillary cancer) in thyroid lesions is significantly correlated to the presence of specific US features, which include hypoechogenicity, microcalcifications, taller than wide shape, irregular margins, and extrathyroidal extension (ETE) ( 4 , 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

Considerable interobserver variation calls for unambiguous definitions of thyroid nodule ultrasound characteristics

Solymosi

Bonnema

Frasoldati³

et al. 2023

European Thyroid Journal

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OBJECTIVE: Thyroid nodule ultrasound characteristics are used as indication for FNA, usually as the basis for Thyroid Imaging Reporting and Data System (TIRADS) score calculation. Few studies on inter-observer variation are available, all of which are based on analysis of preselected still ultrasound images and often lack surgical confirmation. METHODS: After the blinded online evaluation of video-recordings of the ultrasound examinations of 47 consecutive malignant and 76 consecutive benign thyroid lesions, 7 experts from 7 thyroid centers answered 17 TIRADS-related questions. Surgical histology was the reference standard. Inter-observer variations of each ultrasound characteristic were compared using Gwet's AC1 inter-rater coefficients; higher values mean better concordance, the maximum being 1.0. RESULTS: On a scale from 0.0 to 1.0, the Gwet's AC1 values were 0.34, 0.53, 0.72, 0.79 for the four most important features in decision making, i.e. irregular margins, microcalcifications, echogenicity and extrathyroidal extension, respectively. The concordance in the discrimination between mildly/moderately and very hypoechogenic nodules was 0.17. The smaller the nodule size the better the agreement in echogenicity, and the larger the nodule size the better the agreement on the presence of microcalcifications. Extrathyroidal extension, was correctly identified in just 45.8% of the cases. CONCLUSIONS: Examination of video recordings, closely simulating the real-world situation, revealed substantial inter-observer variation in the interpretation of each of the four most important ultrasound characteristics. In view of the importance for management of thyroid nodules, unambiguous and widely accepted definitions of each nodule characteristic are warranted, although it remains to be investigated whether this diminishes observer-variation.

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“…Among all patients referred to our tertiary Endocrinology outpatient clinics for assessments of thyroid nodules between February 1, 2008, to February 1, 2018, we considered eligible all consecutive adult subjects (i.e., age > 18 years) for whom fine-needle aspiration (FNA) was indicated, and who provided a written informed consent. The real-life recommendation for a cytological examination was given combining several clinical and US parameters [ 4 , 16 ], as summarized in Table 1 of the supplementary materials. Non-diagnostic cytology and nodules with clinical or incomplete US assessments were not included in this study.…”

Section: Methodsmentioning

confidence: 99%

Choosing the best algorithm among five thyroid nodule ultrasound scores: from performance to cytology sparing—a single-center retrospective study in a large cohort

et al. 2021

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Objective Incidental diagnosis of thyroid nodules, and therefore of thyroid cancer, has definitely increased in recent years, but the mortality rate for thyroid malignancies remains very low. Within this landscape of overdiagnosis, several nodule ultrasound scores (NUS) have been proposed to reduce unnecessary diagnostic procedures. Our aim was to verify the suitability of five main NUS. Methods This single-center, retrospective, observational study analyzed a total number of 6474 valid cytologies. A full clinical and US description of the thyroid gland and nodules was performed. We retrospectively applied five available NUS: KTIRADS, ATA, AACE/ACE-AME, EUTIRADS, and ACRTIRADS. Thereafter, we calculated the sensitivity, specificity, PPV, and NPV, along with the number of possible fine-needle aspiration (FNA) sparing, according to each NUS algorithm and to clustering risk classes within three macro-groups (low, intermediate, and high risk). Results In a real-life setting of thyroid nodule management, available NUS scoring systems show good accuracy at ROC analysis (AUC up to 0.647) and higher NPV (up to 96%). The ability in FNA sparing ranges from 10 to 38% and reaches 44.2% of potential FNA economization in the low-risk macro-group. Considering our cohort, ACRTIRADS and AACE/ACE-AME scores provide the best compromise in terms of accuracy and spared cytology. Conclusions Despite several limitations, available NUS do appear to assist physicians in clinical practice. In the context of a common disease, such as thyroid nodules, higher accuracy and NPV are desirable NUS features. Further improvements in NUS sensitivity and specificity are attainable future goals to optimize nodule management. Key Points • Thyroid nodule ultrasound scores do assist clinicians in real practice. • Ultrasound scores reduce unnecessary diagnostic procedures, containing indolent thyroid microcarcinoma overdiagnosis. • The variable malignancy risk of the “indeterminate” category negatively influences score’s performance in real-life management of thyroid lesions.

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Thyroid Nodules

Cited by 23 publications

References 8 publications

Are ethnic differences, urinary iodine status, lead and cadmium exposure associated with thyroid autoimmunity and hypothyroid status? A cross-sectional study

Are ethnic differences, urinary iodine status, lead and cadmium exposure associated with thyroid autoimmunity and hypothyroid status? A cross-sectional study

Considerable interobserver variation calls for unambiguous definitions of thyroid nodule ultrasound characteristics

Choosing the best algorithm among five thyroid nodule ultrasound scores: from performance to cytology sparing—a single-center retrospective study in a large cohort

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