Thyroid Nodule: Approach and Management

Mittal, Madhukar; Ganakumar, Vanishri; Shukla, Ravindra; Garg, Mahendra Kumar

doi:10.5772/intechopen.91627

Cited by 7 publications

(33 citation statements)

References 40 publications

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“…Different clinical features have been described as predictors of malignancy in thyroid nodules. These include the history of hoarseness of voice, history of the rapid growth of the nodule, fixation to surrounding structures, hard consistency of the nodule, and the illdefined surface of the nodule [21,22] . Furthermore, old age, male sex, solitary nodule, and larger size of the nodule are thought to be associated with increased risk of malignancy [9,23] .…”

Section: Discussionmentioning

confidence: 99%

Rate and Clinical Predictors of Malignancy in Thyroid Nodules with Indeterminate Cytology

Tefera

2021

CSRC

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Background: Fine needle aspiration cytology (FNAC) cannot differentiate between benign and malignant conditions in cytologically indeterminate thyroid lesions. Therefore, a minimum of diagnostic lobectomy is required for definitive diagnosis. The objective of this study is to identify the rate of malignancy and clinical features that may possibly predict malignancy in patients with these lesions, in Ethiopian hospitals. Methods: This was a retrospective review of the medical records of patients who underwent surgery for cytologically indeterminate thyroid lesions in three referral hospitals between September 2015 and September 2020. Results: Of 85 patients with indeterminate cytology findings, 56 (63.5%) were follicular, and 29 (34.1%) were reported to be hurthle cell neoplasms. Follicular lesions of undetermined significance (FLUS) and suspicious for follicular neoplasm were each reported in single cases (1.7%). Malignant disease was diagnosed in 19 (22.4%) of patients. A follicular variant of papillary cancer was detected in 7 (11.5%) patients. Hard nodule consistency was reported in 9 of 11 malignant lesions and 5 of 66 benign lesions. In multivariate binary logistic regression, hard nodule consistency was found to be associated with malignancy (P = 0.012, AOR = 7.28 (1.5, 34.54) 95% CI ). The ill-defined surface of a nodule was found to be associated with malignancy though the association was not statistically significant (P = 0.088, AOR = 0.162 (0.020, 1.313) 95% CI. Ultrasound evaluation of thyroid nodule was performed only in 41 (47.7%) of patients. Conclusion: The rate of malignancy in thyroid nodules with indeterminate cytology was 22.4%. The risk of malignancy was higher in patients with hard thyroid nodule consistency and ill-defined surface. Despite the established benefits of ultrasound for the evaluation of thyroid nodules, the current practice of its use in our setup is suboptimal. Keywords: Follicular; hurthle cell; indeterminate cytology; predictors of malignancy

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Section: Discussionmentioning

confidence: 99%

Rate and Clinical Predictors of Malignancy in Thyroid Nodules with Indeterminate Cytology

Tefera

2021

CSRC

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“…This analysis has a sensitivity of 92%, specificity of 48-53%, negative predictive value (NPV) of 93%, but low PPV thus being used as a rule out test to identify benign nodules. 1 Molecular testing is only applicable when combined with clinical and US malignancy features. Study by Kim et al [15] showed that suspicious of malignant cell (SMC) from repeat FNA or BRAFV600E mutation in cytopathologic specimen should be a trustworthy surrogate for malignancy and can be considered to proceed with surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasonography (US) reported can detect the nodule as high as 67%. [1][2][3] Fine needle aspiration (FNA) is the most valuable, cost effective and accurate method in the evaluation of thyroid nodule. The sensitivity was reported 65-98% and specificity 72-100%.…”

Section: Introductionmentioning

confidence: 99%

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Management of Atypia of Undetermined Significant Thyroid Nodule

Mayangsari¹,

Moulanda²

2021

Advances in Health Sciences Research

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Thyroid nodules are one of frequent clinical problem with prevalence of 5% palpable nodules. Results of atypia of undetermined significance (AUS) can be found with risk of 5-15% malignancy rates. Management of AUS is still challenging and complex including observation until surgical approach. We present two cases of nodule thyroid. The 1st case of 44-year-old female with nodule of left thyroid lobe for 1 year. Ultrasonography (USG) examination showed TIRADS 4 at left lobe yet the Fine needle aspiration (FNA) resulted as AUS. The 2 nd case was 44-year-old male with nodule at left thyroid lobe for 3 years. USG showed TIRADS 5 of left lobe and TIRADS 4 of right lobe meanwhile FNA resulted as AUS. Left hemithyroidectomy was performed for the 1 st patient and histopathology examinations showed as struma adenomatous with focus of thyroid papillary carcinoma with follicular variant. Completion thyroidectomy then performed 2 months after the first procedure. Observation was chosen for the 2 nd case. Patient has been asymptomatic with close thyroid function and USG follow up. Hemithyroidectomy was performed 6 months afterwards since the mass getting bigger, and histopathology showed papillary carcinoma thus proceed with total thyroidectomy. Management of AUS is still debatable. It can present as heterogeneous lesions with different sub classifications according to cytomorphologic and molecular findings. Considerations of clinical risk stratification, USG findings and FNAB should be combined altogether for the best management and treatment outcome.

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“…Los nódulos tiroideos son lesiones glandulares con características radiológicamente distintas al tejido circundante. Son hallazgos que se pueden presentar en más de la mitad de los pacientes sanos, sin embargo, generan preocupación tanto en el paciente como en el médico (1,2). Si bien la mayoría de los casos resultan ser nódulos benignos, su desafío clínico radica precisamente en identificar los que no lo son, mediante una historia clínica y un examen físico orientado a encontrar factores de riesgo personales y familiares, indagar la presencia de síntomas compresivos y explorar ganglios linfáticos cervicales (3,4).…”

Section: Introductionunclassified

Nódulo tiroideo: un enfoque integral

Leal

2022

Rev.méd.sinerg.

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Los nódulos tiroideos son causa frecuente de consulta y preocupación entre los pacientes, el uso generalizado de estudios de imagen ha provocado un aumento en la incidencia de esta entidad, a pesar de su bajo riesgo de malignidad significa un reto diagnóstico detectar los nódulos potencialmente malignos, para ello, se realiza una anamnesis y examen físico orientados dirigidos a detectar factores de riesgo en la historia personal y familiar, además de signos físicos sugestivos de un proceso infiltrativo. Dentro del abordaje inicial está indicada la medición de niveles séricos de tirotropina (TSH) y ultrasonido de tiroides, asimismo, se cuenta con otros estudios diagnósticos como la gammagrafía, la citología y las pruebas moleculares que ayudan a determinar la funcionalidad y la naturaleza del nódulo. El tratamiento de los nódulos puede ser médico o quirúrgico, mientras que algunos solo requieren observación en el tiempo. La alta prevalencia de nódulos tiroideos requiere estrategias costo efectivas y basadas en evidencia para realizar la estratificación de riesgo, diagnóstico, tratamiento y seguimiento de esta patología.

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Thyroid Nodule: Approach and Management

Cited by 7 publications

References 40 publications

Rate and Clinical Predictors of Malignancy in Thyroid Nodules with Indeterminate Cytology

Rate and Clinical Predictors of Malignancy in Thyroid Nodules with Indeterminate Cytology

Management of Atypia of Undetermined Significant Thyroid Nodule

Nódulo tiroideo: un enfoque integral

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