Thyroid nodules: Global, economic, and personal burdens

Abstract

Thyroid nodules have garnered attention due to changes in population surveillance systems and rising concerns about the associated financial burden on healthcare systems, payers, and patients. In this review, we find that prevalence rates vary widely based on method of detection and may particularly pronounced in asymptomatic patients undergoing routine screening. Incidence rates may be particularly rising in lower-income and middle-income countries and may be declining in higher-income countries. Despite high incidence rates, survival rates continue to be as high as 97% for papillary thyroid cancer. Over the last few decades, thyroid nodule workup and management has grown more sophisticated with the advent of fine-needle aspiration biopsy, specialized biomarkers, and molecular testing. However, gaps remain in risk stratification that can lead to substantial costs of care. Certain molecular tests, such as the Afirma Gene Sequencing Classifier can lead to a cost per diagnosis of $17,873 while achieving only mild decreases in diagnostic lobectomies for patients (11.6% to 9.7% in one study). Out-of-pocket costs associated with thyroid nodule management continue to drive significant financial toxicity for patients, especially for individuals with thyroid cancer. Financial toxicity has been defined as a term that describes how direct and indirect medical costs of cancer care strain patients and households via decreased income, assets, and spending on basic necessities. Recent studies suggest that such toxicity can lead to adverse financial outcomes, such as foreclosure and bankruptcy. Additional cost-effectiveness analyses are needed to improve existing thyroid nodule management systems and new clinical tools are needed to avoid unnecessary workup and management.

Defining thein vivorole of mTORC1 in thyrocytes by studying the TSC2 conditional knockout mouse model

“…The lack of in vivo models for investigating mTORC1’s role in thyrocyte physiology outside the context of thyroid cancer led to the generation of TPO-TSC2 KO mice. It is well-established that mTORC1, a sensor of nutrients and growth factors, plays a crucial role in promoting cell growth and proliferation [7, 8]. Consequently, it is not surprising that TPO-TSC2 KO mice exhibit thyrocyte growth and proliferation.…”

“…A total of $2.1-4.3 billion was spent on treatment for thyroid dysfunction among adult women [6]. Cost-effectiveness analyses have estimated that the screening and management of all thyroid nodules in the United States would incur $25.1 billion in costs [7]. For nodules representing malignant disease, the costs of well-differentiated thyroid cancer care in the United States are projected to exceed $3.5 billion by 2030 [5, 7].…”

Financial toxicity in thyroid cancer survivors

“…The prevalence and increasing incidence of thyroid cancer has translated to an enormous financial burden in the United States. The overall national cost of well differentiated thyroid cancer in 2013 for all US patients diagnosed after 1985 was estimated at $1.6 billion [48 ▪ ,49]. Further, with an increasing incidence, the estimated cost is projected to exceed $3.5 billion by 2030 [49].…”

“…Patients who experience the greatest financial toxicity file for bankruptcy protection within the first year of diagnosis, and this correlates with high up-front costs of care [26]. With diagnosis early in life, long-term surveillance costs can reach over $900 000 for office visits, lab work, and radiographic studies [48 ▪ ].…”

A Review of Thyroid Cancer

“…Approximately one-fourth of people worldwide have thyroid nodules, but only 10% to 15% of these nodules are malignant . Therefore, when screening for thyroid malignancy in clinical practice, it is important to consider procedure invasiveness, diagnostic accuracy, and cost …”