Context The impact of Hashimoto thyroiditis (HT) on the risk of thyroid cancer and its accurate detection remains unclear. The presence of a chronic lymphocytic infiltration imparts a logical mechanism potentially altering neoplastic transformation, while also influencing the accuracy of diagnostic evaluation. Methods We performed a prospective, cohort analysis of 9851 consecutive patients with 21,397 nodules ≥1 cm who underwent nodule evaluation between 1995 and 2017. The definition of HT included (i) elevated thyroid peroxidase antibody (TPOAb) level and/or (ii) findings of diffuse heterogeneity on ultrasound, and/or (iii) the finding of diffuse lymphocytic thyroiditis on histopathology. The impact of HT on the distribution of cytology and, ultimately, on malignancy risk was determined. Results A total of 2651 patients (27%) were diagnosed with HT, and 3895 HT nodules and 10,168 non-HT nodules were biopsied. The prevalence of indeterminate and malignant cytology was higher in the HT vs non-HT group (indeterminate: 26.3% vs 21.8%, respectively, P < 0.001; malignant: 10.0% vs 6.4%, respectively, P < 0.001). Ultimately, the risk of any nodule proving malignant was significantly elevated in the setting of HT (relative risk, 1.6; 95% CI, 1.44 to 1.79; P < 0.001), and was maintained when patients with solitary or multiple nodules were analyzed separately (HT vs non-HT: 24.5% vs 16.3% solitary; 22.1% vs 15.4% multinodular; P < 0.01). Conclusion HT increases the risk of thyroid malignancy in any patient presenting for nodule evaluation. Diffuse sonographic heterogeneity and/or TPOAb positivity should be used for risk assessment at time of evaluation.

Objective To investigate the concordance of serologic and sonographic evidence of Hashimoto’s thyroiditis with its gold standard histopathologic identification. Design We performed a retrospective analysis on a cohort of 825 consecutive patients in whom TPOAb and thyroid ultrasound were performed, and in whom thyroid nodule evaluation led to surgical and histopathologic analysis. The presence or absence of Hashimoto’s thyroiditis on histopathology was correlated with serologic and sonographic markers. We further assessed the impact of low versus high titers of TPOAb upon this concordance. Results Of 825 patients, 277 (33.5%) had histologic confirmation of Hashimoto’s thyroiditis, 235 patients (28.4%) had elevated serum levels of TPOAb, and 197 (23.8%) had sonographic evidence of diffuse heterogeneity. Of those with histopathologic evidence, only 64% had elevated TPOAb (sensitivity: 63.9%; specificity: 89.4%), while only 49% were sonographically diffusely heterogeneous (sensitivity: 49.1%; specificity: 88.9%). A subset of only 102 of 277 (37%) with histologically proven Hashimoto’s thyroiditis was positive for both TPOAb and diffusely heterogeneous. Concordance analysis demonstrated that TPOAb and histopathology had higher agreement (κ = 0.55) than did ultrasound and histopathology (κ = 0.40) for the diagnosis of Hashimoto’s thyroiditis. Higher titers of TPOAb correlated with a higher likelihood of Hashimoto’s thyroiditis, with a best cutoff of 2.11-fold the upper normal level of TPOAb. Conclusion Only moderate concordance exists between serological evidence of Hashimoto’s thyroiditis and histopathologic findings, though it increases with higher TPOAb concentration. Diffuse heterogeneity on ultrasound is a less-sensitive diagnostic tool than elevated TPOAb.

Does not collect accurate historical data Relies exclusively on secondary sources or documentation of others Is disrespectful in interactions with patients Disregards patient privacy and autonomy Fails to recognize patient's central problem Does not consider patient's privacy and comfort during exams Incorrectly performs basic physical exam maneuvers Key Functions with Related Competencies Obtain a complete and accurate history in an organized fashion PC2 Demonstrate patient-centered interview skills ICS1 ICS7 P1 P3 P5 Demonstrate clinical reasoning in gathering focused information relevant to a patient's care KP1 Perform a clinically relevant, appropriately thorough physical exam pertinent to the setting and purpose of the patient visit PC2 Gather a history and perform a physical exam EPA 1 EPA 1: Gather a History and Perform a Physical Examination Underlying entrustability for all EPAs are trustworthy habits, including truthfulness, conscientiousness, and discernment. An EPA: A unit of observable, measurable professional practice requiring integration of competencies Barron, B, Orlander, P, Schwartz, ML. Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014. This schematic depicts development of proficiency in the Core EPAs. It is not intended for use as an assessment instrument. Entrustment decisions should be made after EPAs have been observed in multiple settings with varying context, acuity, and complexity and with varying patient characteristics. PATIENT CARE (PC):Provide patient-centered care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health 1.1 Perform all medical, diagnostic, and surgical procedures considered essential for the area of practice 1.2 Gather essential and accurate information about patients and their condition through historytaking, physical examination, and the use of laboratory data, imaging, and other tests 1.3 Organize and prioritize responsibilities to provide care that is safe, effective, and efficient 1.4 Interpret laboratory data, imaging studies, and other tests required for the area of practice 1.5 Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment 1.6 Develop and carry out patient management plans 1.7 Counsel and educate patients and their families to empower them to participate in their care and enable shared decision making 1.8 Provide appropriate referral of patients, including ensuring continuity of care throughout transitions between providers or settings and following up on patient progress and outcomes 1.9 Provide health care services to patients, families, and communities aimed at preventing health problems or maintaining health 1.10 Provide appropriate role modeling 1.11 Perform supervisory responsibilities commensurate wi...