Lack of a Threshold Size for Autonomously Functioning Thyroid Nodules that Excludes Hyperthyroidism

Goundan, Poorani; Lee, Stephanie L.

doi:10.4158/ep-2019-0042

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…A retrospective study reported an increased risk of thyroid nodule malignancy associated with the elevation of ATG, ATPO, and TSH [ 21 ]. However, other studies have suggested that approximately 71% to 79% of individuals with thyroid nodules have TSH levels in the normal range [ 22 ]. In this present study, the serum ATPO and ATG of each enrolled participant was detected, and the thyroid morphology was checked by palpation and ultrasound.…”

Section: Discussionmentioning

confidence: 99%

Thyroid Hormone Reference Intervals among Healthy Individuals In Lanzhou, China

Lu¹,

Zhang²,

et al. 2023

Endocrinol Metab

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Background: The common reference intervals (RIs) for thyroid hormones currently used in China are provided by equipment manufacturers. This study aimed to establish thyroid hormone RIs in the population of Lanzhou, a city in the subplateau region of northwest China, and compare them with previous reports and manufacturer-provided values.Methods: In total, 3,123 individuals (1,680 men, 1,443 women) from Lanzhou, an iodine-adequate area of China, perceived as healthy were selected. The Abbott Architect analyzer was used to determine the serum concentration of thyroid hormones. The 95% RI was estimated using the 2.5th and 97.5th percentiles as the lower and upper reference limits, respectively.Results: The serum levels of thyroid-stimulating hormone (TSH), total triiodothyronine (TT3), antithyroglobulin (ATG) antibody, and antithyroid peroxidase (ATPO) antibody levels were significantly correlated with sex (P<0.05). TSH, total thyroxine (TT4), and ATPO levels were significantly correlated with age (P<0.05). The serum levels of TSH, ATG, and ATPO in men were significantly lower than in women; in contrast, the serum TT3 level was significantly higher in men than in women (P<0.05). Serum TSH, TT3, TT4, and ATG levels differed across age groups (P<0.05), but no such variation was observed for ATG levels (P>0.05). The established RIs of TSH, ATG, and ATPO in this study differed between sexes (P<0.05). The thyroid hormone RIs established herein were inconsistent with the manufacturer-provided values.Conclusion: The RIs of thyroid hormones in the healthy population of Lanzhou were inconsistent with those in the manufacturer’s manual. Validated sex-specific values are required for diagnosing thyroid diseases.

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Section: Discussionmentioning

confidence: 99%

Thyroid Hormone Reference Intervals among Healthy Individuals In Lanzhou, China

Lu¹,

Zhang²,

et al. 2023

Endocrinol Metab

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“…Indeed, several studies and one meta‐analysis have shown that TSH measurement, when used as a single tool, cannot be considered effective in detecting or excluding AFTN, since about one in two patients in whom AFTN is revealed by TS has a TSH value within normal reference values 14 . Moreover, the lack of a correlation between TSH and the size of the AFTN is reported in the literature 38 . Therefore, TS should be considered in patients with subnormal TSH or normal TSH in the presence of low‐ or intermediate‐risk nodules that meet criteria for FNA.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound systems for risk stratification of thyroid nodules prompt inappropriate biopsy in autonomously functioning thyroid nodules

Castellana

Virili

Paone

et al. 2020

Clinical Endocrinology

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Objective Ultrasound (US) risk stratification systems (RSSs) have been developed to reduce the number of unnecessary fine‐needle aspiration (FNA) biopsies in patients with thyroid nodules. Autonomously functioning thyroid nodules (AFTN) account for 5%‐10% of palpable lesions and are very rarely malignant. The present study was undertaken to investigate how RSSs classify AFTNs and whether RSSs are able to avoid unnecessary FNA biopsies in such cases. Methods Patients with AFTN who had undergone US, scintigraphy and thyroid function evaluation from December 2016 to December 2017 were selected. US images were retrospectively reviewed and AFTN reclassified according to AACE/ACE/AME, ACR‐TIRADS, ATA, BTA, EU‐TIRADS, K‐TIRADS and TIRADS. Risk class and indication for FNA were assessed. Results A number of 87 AFTNs from 85 consecutive patients were enrolled. A median diameter of 22 mm (range 10‐59) was found, with an ovoid isoechoic nodule being the most frequent US presentation. When AFTNs were reclassified according to US RSSs, the most common categories were low and intermediate risk. AFTNs were assessed as being at high risk/high suspicion/malignant in 1%‐9%, with good agreement among AACE/ACE/AME, ATA, EU‐TIRADS, K‐TIRADS and TIRADS. Remarkably, FNA was indicated in 27%‐90% of AFTNs. A statistically significant difference among the systems was found; 8% of cases were nonclassifiable by one or more US RSS. Conclusions Ultrasound RSSs prompt inappropriate FNA in a significant number of patients with AFTN.

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