Background: Thyroid cancer is increasing globally and is currently the most prevalent endocrine malignancy. Recent data show an increase in the incidence of thyroid cancer in the Kingdom of Saudi Arabia (KSA). Thyroid ultrasound and fine-needle aspiration cytology (FNAC) are the cornerstones in managing thyroid nodules. We conducted this study to evaluate the prevalence and the associated predictors for thyroid nodule Bethesda III–VI in eastern KSA. Methods: A retrospective study was conducted between January 2015 and 31 August 2021. The participants were recruited patients who received a thyroid ultrasound and ultrasound-guided thyroid FNAC, using the thyroid imaging reporting and data system (TI-RADS) and the Bethesda Classification, respectively. Result: Three hundred and ten patients who underwent thyroid FNAC were enrolled in the study. The median (interquartile, IQR) age was 47.0 (20.0) years, and 266 (85.8%) of them were females. The median (IQR) body mass index was 30.2 (7.6) kg/m2. Out of these participants, 64.8% were euthyroid, 27.4% had hypothyroidism and 7.7% had hyperthyroidism. The ACR TI-RADS-3, 4 and 5 were 51.3%, 46.1% and 2.6%, respectively. The Bethesda outcome of thyroid FNAC I–VI was 5.2%, 63.9%, 15.5%, 5.8%, 3.5% and 6.1%, respectively. The risk for malignancy (Bethesda III–VI) was documented in 31.0% and atypia of undetermined significance was most prevalent (15.5%). A higher ACR TI-RADS score was associated with a higher risk of malignancy: ACR TI-RADS-3 (20.8%), ACR TI-RADS-4 (39.2%) and ACR TI-RADS-5 (87.5%). In a multivariate analysis, only the ACR TI-RADS score was significantly associated with the outcome of thyroid FNAC: ACR TI-RADS-4 [OR = 2.59 (95% CI = 1.54–4.36)] and ACR TI-RADS-5 [OR = 29.03 (95% CI = 3.44–245.07)]. Conclusion: There was a high prevalence of Bethesda III–VI and atypia of undetermined significance was most prevalent. A thyroid ultrasound report for TI-RADS was significantly associated with the outcome of thyroid FNAC and is a reliable tool in the absence of molecular testing for thyroid cancer.

Vitamin D is an essential nutrient for the human body. Its deficiency is linked with many common chronic diseases, types of cancer and thyroid disorders. Recent data have shown high rates of vitamin D deficiency, thyroid nodules and an increase in the incidence of thyroid cancer in the Kingdom of Saudi Arabia (KSA). We conducted this study to evaluate the rates of vitamin D deficiency and associated risk factors in patients with thyroid nodules in the Eastern Region of the KSA. Methods: A retrospective study was conducted between 1 January 2015 and 31 December 2021. The recruited patients had documented thyroid nodules based on the American College of Radiology’s Thyroid Imaging Reporting and Data System (TI-RADS). Results: There were 391 patients with thyroid nodules enrolled in the study. The median (interquartile range [IQR]) age was 46.00 (20.0) years, and 332 (84.9%) of the participants were women. The patients’ median (IQR) body mass index was 30.26 (7.71) kg/m2, and the median (IQR) 25-hydroxyvitamin D (25[OH)]D) level was 14.50 (12.0) nmol/L. There was a high prevalence (89.8%) of vitamin D deficiency among patients with thyroid nodules. In the univariate analysis, there were significant associations between 25(OH)D level and age, hypertension, hyperthyroidism, thyroid-stimulating hormone level, free triiodothyronine level and thyroid ultrasound-based TI-RADS scores of 3 to 5. In the multivariate analysis, age, free thyroxine level, free triiodothyronine level and hyperthyroidism were not significantly associated with 25(OH)D level. However, there were significant associations between 25(OH)D level and hypertension (odds ratio [OR]=0.438, 95% confidence interval [CI] 0.210‒0.911) and higher TI-RADS scores (TI-RADS 4: OR=9.654 [95% CI 1.819‒51.226] and TI-RADS 5: OR=7.784 [95% CI 1.473‒41.135]). Conclusion: There was a high prevalence of vitamin D deficiency among patients with nodular thyroid disease. TI-RADS ultrasound scores of 4 and 5 and the presence of hypertension were significantly associated with lower levels of vitamin D.

Background Diabetes mellitus (DM) and thyroid nodules (TNs) with the risk of malignancy are increasing globally. Hence, we conducted this study to evaluate the prevalence and the associated predictors for DM among adult patients with TNs in Royal Commission Hospital, Kingdom of Saudi Arabia (KSA). Methods A retrospective study was conducted between January 1, 2015 and December 31, 2021. Patients with documented TNs based on the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) were recruited. Then the prevalence and associated risk factors for DM were assessed. Result Three hundred ninety-one patients who had TNs were recruited. The median (interquartile range (IQR)) age was 46.00 (20.0) years, and 332 (84.9%) of the patients were females. There was a high prevalence of DM (24.0%) among adult patients with TNs. In the univariate analysis, there were significant associations between diagnosed DM among adult patients with TNs and age, gender, 25-hydroxyvitamin D (25(OH)D) level, hypertension, bronchial asthma, free triiodothyronine (FT3), white blood cell count, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglycerides. In the multivariate analysis, there were significant associations between diagnosed DM among adult patients with TNs and age (odds ratio (OR) 1.037 (95% confidence interval (CI) 1.012 - 1.062)), hypertension (OR 0.374 (95% CI 0.203 - 0.689)), FT3 level (OR 0.635 (95% CI 0.412 - 0.980)), LDL (OR 0.643 (95% CI 0.456 - 0.907)) and HDL (OR 0.654 (95% CI 0.465 - 0.919)). Conclusion There was a high prevalence of DM among patients with TNs. Age, hypertension, FT3, LDL and HDL were significantly associated with DM and TNs.

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BACKGROUND: The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) classified and predicted the risk of thyroid nodule malignancy with ultrasound scan scoring system. AIM: Hence, we aimed to investigate the value of the combined use of ultrasound ACR TI-RADS scoring and ultrasound-guided thyroid fine needle aspiration cytology (FNAC) based on the Bethesda System for Reporting Thyroid Cytology (TBSRTC) for assessing the accuracy tests of diagnosing low and high-risk thyroid nodules of ACR TI-RADS. METHODS: We enrolled 392 patients with thyroid nodules who underwent ultrasound scanning and scoring using the ACR TI-RADS classification along with ultrasound-guided thyroid FNAC and scoring with TBSRTC. The two methods were grouped as low and high risk of malignancy to evaluate the accuracy of ACR TI-RADS. RESULTS: Three hundred and ninety-two patients were enrolled in the study. The mean (Standard deviation [SD]) age was 46.03 (13.96) years, 332 (84.7%) were females and the mean (SD) of body mass index was 31.90 (22.32) kg/m2 and Vitamin D 17.65 (11.15) nmol/L. The mean (SD) for thyroid function test was 5.37 (44.16) mmol/L for thyroid-stimulating hormone, 1.48 (1.49) ng/dL for free thyroxine (FT4), and 2.69 (0.70) nmol/L for free triiodothyronine (FT3). Most of the participants were euthyroid (63.8%), but 28.6% had hypothyroidism and 7.7% had hyperthyroidism. The accuracy tests of ACR TI-RADS in relation to TBSRTC, were sensitivity (87.8%), specificity (65.2%), positive predictive value (29.8%), and negative predictive value (97%). The area under the curve = 0.590, 95% CI = 0.530–0.650, p ˂ 0.006. CONCLUSION: ACR TI-RADS is a simple, practical, and reliable scoring system for assessing thyroid nodule; it has a better overall diagnostic performance and the ability to exclude unnecessary FNAC with high negative predictive value.