Recommandations de la Société française d’endocrinologie pour la prise en charge des nodules thyroïdiens

doi:10.1016/j.lpm.2011.05.001

Cited by 19 publications

(4 citation statements)

References 180 publications

(271 reference statements)

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“…Thyroid nodules are widespread, up to 50% of patients older than 50 years among the European population [2–4]. The majority of thyroid nodules are benign, with thyroid cancer accounting for only 5% of nodules [5–8]. Fine‐needle aspiration (FNA) is the most cost‐effective and accurate preoperative diagnostic modality to evaluate thyroid nodules routinely [7, 9].…”

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Preoperative Role of RAS or BRAF K601E in the Guidance of Surgery for Indeterminate Thyroid Nodules

et al. 2020

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Background RAS and K601E BRAF mutations are not a reliable indicator of malignancy in fine‐needle aspirations (FNA) of thyroid indeterminate cytologic nodules. We aimed to evaluate the histologic characteristics, the risk of malignancy associated with such mutations in FNA and their potential interest for preoperative clinical management of nodules. Methods We evaluated 69 indeterminate thyroid nodules with RAS or K601E BRAF mutations with available histopathologic follow‐up. All FNA specimens were indeterminate according to the thyroid Bethesda system. Diagnosis of malignant, benign or indolent neoplasms was classified according to 2017 WHO classification. Carcinoma, NIFTP (noninvasive follicular thyroid neoplasm with papillary‐like features) and WDTUMP (well‐differentiated tumor of uncertain malignant potential) were considered “surgical,” as they require surgical excision. Adenoma was considered “non‐surgical.” The risk of malignancy and the risk of “surgical disease” were evaluated. Results Pathologic evaluation of the 69 mutated nodules demonstrated benign, indolent and malignant histology in 17 cases (25%), 21 cases (30%) and 31 cases (45%), respectively. The risk of malignancy was 45%, and the risk of surgical disease was 75%. The majority of carcinomas were a follicular variant of papillary thyroid carcinoma. On follow‐up, there have been no recurrences to date. Conclusion Preoperative RAS or BRAF K601E mutations detection in cytologic indeterminate thyroid nodules carries a high risk of surgical disease and may benefit from surgical management. Most surgical lesions harboring those mutations are low‐risk tumors, which may be in favor of an initial lobectomy.

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Preoperative Role of RAS or BRAF K601E in the Guidance of Surgery for Indeterminate Thyroid Nodules

et al. 2020

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“…The incidence of thyroid nodules and thyroid cancer in children not only appears to be steadily increasing but also demonstrates a worse prognosis. According to some studies recently published, the risk of malignancy of pediatric thyroid nodules varies from 9 to 50% with an average risk of 26% (2)(3)(4), far higher than the expected value in the adult population (5%) (2)(3)(4)(5).…”

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confidence: 93%

Pediatric thyroid surgery: Retrospective analysis on the first 25 pediatric thyroidectomies performed in a reference center for adult thyroid diseases

et al. 2023

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IntroductionPediatric thyroid carcinoma represents about 4-5% of all pediatric carcinoma with an incidence of 0.5 cases/100,000, compared to 2-10/100000 cases in the adult population. The aim of this study is to present the experience of a reference adult endocrine surgery unit in charge of the treatment of pediatric thyroid diseases.Materials and methodsFrom January 2019 to September 2022, 25 patients, aged 5-17, underwent thyroid surgery. We analysed indications for surgery, use of intraoperative nerve monitoring (IONM), definitive histological examination, postoperative outcomes and risk factors related.ResultsSurgical indication was performed for Graves’ disease (27%) and for nodular pathology (73%): of these, four were malignant lesions (TIR4/TIR5), eight with indeterminate characteristics (TIR3A/TIR3B) and four characterized as benign (TIR1/TIR2). Total thyroidectomy (TT) was performed in 76% of cases, three of which were prophylactic for the activation of the RET gene mutation in MEN 2A. IONM was used in eight cases (32%), all patients aged 11 years or less. FNA’s accuracy was 100% for lesions typified as benign and malignant (TIR1/TIR2 and TIR4/TIR5). The overall malignancy rate achieved was 40% and in the final histological examination 75% of the TIR 3B lesions were malignant. Six patients (24%) developed hypoparathyroidism in the first postoperative day, with normalization of calcium values within thirty days in 5 patients.ConclusionsPediatric thyroid nodules are rare and distinguished from adult thyroid disease by a worse prognosis and higher malignancy rates. Our work reports a much higher malignancy rate among indeterminate TIR 3B lesions than observed in the adult population and the three patients who underwent prophylactic total thyroidectomy for activating RET gene mutation had all a definitive histological diagnosis of medullary carcinoma. Post-surgical hypoparathyroidism is a common finding in these patients: in most cases the condition is transient and it benefits from supportive therapy. Intraoperative finding of a thinner recurrent laryngeal nerve in younger patients makes nerve isolation more difficult than in adult surgery: IONM is recommended in patients under 12. Pediatric thyroid surgery is challenging, we sustain it requires referral thyroid Centers for thyroid disease with highly skilled general endocrine surgeons.

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“…Ce dépistage a été prôné et largement réalisé par les européens [24], mais non recommandé par les américains dans un premier temps [17]. De nouvelles recommandations américano-européennes [25] et françaises viennent d'être éditées [26]. Les principaux arguments en faveur ou contre ce dépistage systématique sont regroupés dans le tableau I.…”

Section: Maladie Nodulaire Thyroïdienneunclassified

“…Pour ces taux de bCT, la valeur prédictive positive de CMT est faible [24]. Devant un taux modérément augmenté de CT (> 15 pg/mL pour les femmes et > 30 pg/mL pour les hommes), conformé-ment aux recommandations françaises de prise en charge des nodules thyroïdiens [26], il est conseillé de contrôler (trois à 12 mois plus tard) la valeur de bCT. La chirurgie est envisagée s'il est constaté une progression du taux de bCT et/ou si la concentration est supérieure à 50 pg/mL.…”

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Dosages de la calcitonine : indications et interprétation

d’Herbomez

2011

La Presse Médicale

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Recommandations de la Société française d’endocrinologie pour la prise en charge des nodules thyroïdiens

Cited by 19 publications

References 180 publications

Preoperative Role of RAS or BRAF K601E in the Guidance of Surgery for Indeterminate Thyroid Nodules

Preoperative Role of RAS or BRAF K601E in the Guidance of Surgery for Indeterminate Thyroid Nodules

Pediatric thyroid surgery: Retrospective analysis on the first 25 pediatric thyroidectomies performed in a reference center for adult thyroid diseases

Dosages de la calcitonine : indications et interprétation

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