Trends in thyroid function testing, neck ultrasound, thyroid fine needle aspiration, and thyroidectomies in North-eastern Italy

Abstract

Purpose Evidence of an increased diagnostic pressure on thyroid has emerged over the past decades. This study aimed to provide estimates of a wide spectrum of surveillance indicators for thyroid dysfunctions and diseases in Italy. Methods A population-based study was conducted in North-eastern Italy, including 11.7 million residents (20% of the total Italian population). Prescriptions for TSH testing, neck ultrasound or thyroid fine needle aspiration (FNA), surgical procedures, and drugs for hypo- or hyperthyroidism were extracted from regional health databases. Proportions and rates of selected examinations were calculated from 2010 to 2017, overall and by sex, calendar years, age, and region. Results Between 2010 and 2017 in North-eastern Italy, 24.5% of women and 9.8% of men received at least one TSH test yearly. In 2017, 7.1% of women and 1.5% of men were prescribed drugs for thyroid dysfunction, 94.6% of whom for hypothyroidism. Neck ultrasound examinations were performed yearly in 6.9% of women and 4.6% of men, with a nearly two-fold variation between areas. Thyroid FNA and thyroidectomies were three-fold more frequent in women (394 and 85 per 100,000) than in men (128 and 29 per 100,000) with a marked variation between areas. Both procedures decreased consistently after 2013. Conclusions The results of this population-based study describe recent variations over time and between surrounding areas of indicators of ‘diagnostic pressure’ on thyroid in North-eastern Italy. These results emphasize the need to harmonize practices and to reduce some procedures (e.g., neck ultrasound and total thyroidectomies) in certain areas.

Cancer and Pregnancy: Estimates in Italy from Record-Linkage Procedures between Cancer Registries and the Hospital Discharge Database

“…PAC were more frequent in the case of cancers of the breast, thyroid, and other endocrine glands; as concerning breast cancer, our finding is consistent with the literature, as concerning thyroid cancer, the high frequency is probably related to the diagnostic pressure in Italy [27]. Differences in the cancer ranking concerning the general female population aged 15-49 were also due to the different age composition of the two groups (women with PAC are younger); melanoma was the third cancer in the general female population, while it was the fifth among women with PAC [28].…”

Trends in radioactive iodine treatment after total thyroidectomy in Italy, 2001–2018

“…This trend is unlikely to be a consequence of an increasing proportion of very low-risk differentiated thyroid cancer due to widespread overdiagnosis. Declines in diagnostic pressure, namely fine-needle aspiration biopsies of thyroid nodules, were reported at the population level in some Italian areas after 2014 ( 24 ). Meanwhile, the growth in thyroid cancer surgery previously registered in Italy leveled off after 2013–2014 at the national level ( 11 ); recent data show a relative increase in the recourse to lobectomy among overall thyroid surgeries in Italy, after a decade of marked decline ( 24 ).…”

Autoimmune Thyroid Disease and Differentiated Thyroid Carcinoma: A Review of the Mechanisms That Explain an Intriguing and Exciting Relationship

“…These aspects have made it difficult to establish "causality" in the continuum of the pathogenesis between AITD and DTC; furthermore, the relationship could also be argued to be non-causal, and that what really happens is the coexistence between two independent and highly prevalent entities, with enormous ease of early identification through laboratory tests, thyroid ultrasound, and thyroid cytology [97][98][99].…”

“…Accordingly, it must be considered that the over-screening of thyroid functional evaluation (or imaging evaluation) and for TC can be potential confounders when evaluating the possible association between AITD and DTC (a phenomenon of overestimation of the association, with overdiagnosis and, potentially, overtreatment) [97][98][99][100][101].…”