Role of FNA in the medical management of minimally enlarged thyroid

Cytomorphological Spectrum of Thyroiditis: A Review of 110 Cases

Introduction

Different types of thyroiditis may share some parallel clinical and biochemical features. Timely intervention can significantly reduce morbidity and mortality.

Aim

Aim of this study is to find the frequency of various thyroiditis, study the cytomorphological features and correlate with clinical findings including radiological findings, thyroid function test, and anti-thyroid peroxidase antibodies (Anti-TPO antibodies).

Materials and Methods

The study included consecutive 110 cases of thyroiditis. Detailed cytomorphological features were studied and correlated with ultrasonography findings, thyroid function test, anti-thyroid peroxidase antibodies (anti-TPO) and histopathological features where thyroidectomy specimens were received for histopathological examination.

Results

The majority were Hashimoto's thyroiditis (n = 100) and females (n = 103). Other forms of thyroiditis were Hashimoto's thyroiditis with colloid goiter (n = 5), De Quervain's thyroiditis (n = 3), and one case each of postpartum thyroiditis and Hashimoto's thyroiditis with associated malignancy. The majority of patients were in the age group of 21-40 (n = 70) and the majority (n = 73) had diffuse enlargement of thyroid. The majority of patients were hypothyroid (n = 52). The serum anti-TPO antibodies were elevated in 47 patients out of 71 patients. In the 48 patients who underwent ultrasonography, 38 were diagnosed as having thyroiditis. The most consistent cytomorphological features seen in fine-needle aspiration smears of Hashimoto's thyroiditis were increased background lymphocytes, lymphocytic infiltration of thyroid follicular cell clusters, and Hurthle cells.

Conclusion

The diagnostic cytological features in Hashimoto's thyroiditis are increased background lymphocytes, lymphocytic infiltration of thyroid follicular cell clusters, and Hurthle cells. FNAC remains the "Gold Standard" for diagnosing Hashimoto's thyroiditis. Clinical history, thyroid function, and biochemical parameters are the key for diagnosis of other forms of thyroiditis.

Role of medical resource level in iodine deficiency disorder

BACKGROUND

Iodine deficiency disorders (IDDs) refer to a series of diseases caused by the human body's insufficient iodine intake. Edible salt became iodized in China in 1996, which yielded remarkable results. We have known that IDDs is associated with iodine in the human body, but it is not clear whether IDDs is related to medical resource level.

METHODS

We collected the number of IDDs cases and an index for the level of medical resource from 31 provinces, autonomous regions and municipalities directly under the central government in China. All data came from the China Statistical Yearbook of Health and Family Planning issued in 2013 by the Peking Union Medical College Publishing House. Data standardization and linear regression analysis were used.

RESULTS

The results showed that IDDs correlated with the number of beds in medical and health institutions, number of medical health personnel, number of medical and health institutions, total health expenditure, average health expenditure per capita, medical insurance for urban resident and new rural cooperative medical rural residents (P < 0.01). In a multiple linear regression, IDDs was most significantly associated with the number of beds in hospitals, the number of rural health personnel, the number of basic medical and health institutions and government health expenditure for these institutions.

CONCLUSION

Based on the experimental data, we concluded that IDDs had a positive connection with the medical resource level, and basic and rural areas had a more significant association with IDDs. This analysis provides new and explicit ideas for iodine prevention and control work in China.

Single lobe disease in cases of advanced endemic goiter: a new phenotype

OBJECTIVES

To report a new phenotype of advanced endemic goiter that affects only one lobe of the thyroid gland.

PATIENTS AND METHODS

This study included 60 patients from the west of Sudan with long-standing unilateral simple endemic goiter that required obectomy, with emphasis on the gross appearance, measurements and cytological features of the contralateral lobe.

RESULTS

Out of 60 patients with unilateral goiter, 50 (83%) were found to have the disease on the ipsilateral lobe only (monolobar goiter). The contralateral lobe in these 50 patients showed no nodularity, and its volume was within the normal limits. All patients with monolobar disease had total lobectomy on the affected side, and postoperatively they continued to have normal blood levels of T3, T4 and TSH.

CONCLUSION

We report a new phenotype of advanced endemic goiter that affects only one lobe of the thyroid gland, and in the presence of a structurally and functionally normal contralateral lobe.

Comparison of fine needle aspiration cytology and thyroid scan in solitary thyroid nodule

Objective. This was a comparative study between FNAC and thyroid scan used to diagnose the solitary thyroid nodule and histopathology was used as gold standard to compare the results of both modalities. We hypothesized that Fine needle aspiration cytology and thyroid scan diagnose solitary thyroid nodule (STN) as accurately as histopathology. Materials and Methods. This study comprised of 50 patients with solitary thyroid nodules (STN) presented to OPD. After clinical examination these patients were referred to Centre for Nuclear Medicine, Mayo Hospital Lahore for thyroid function tests and thyroid scan (TS). These patients underwent FNAC in the department of Pathology and surgery in Mayo Hospital. The cases were operated and evaluated for histopathological changes. Results. On thyroid scan, 40 patients (80%) having cold nodule were labeled as suspicious 10 patients (20%) had hot nodule. On FNAC 23 patients (46%) had benign lesion, 22 patients (44%) had indeterminate lesion and 5 patients (10%) had malignant lesions. On histopathology, 45 patients (90%) were confirmed to have benign lesions and 5 patients (10%), malignant lesions. After comparison of results of thyroid scan and FNAC with histopathology, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of thyroid scan were 80%, 20%, 10%, 90% and 26%, respectively whereas those of FNAC were 80%, 97.7%, 80%, 97.7% and 96%, respectively. Conclusion. Fine needle aspiration was a significantly better predictor of malignancy than thyroid scan and resulted in a smaller proportion of excisions for benign nodules.

Increased annual frequency of Hashimoto's thyroiditis between years 1988 and 2007 at a cytological unit of Sicily

Like other auto-immune diseases, Hashimoto's thyroiditis (HT) results from the interaction of genetic with environmental factors. Only few studies have evaluated the year-to-year change in frequency of HT over a wide period of time. The endocrine division of our Hospital has reported a great increase in the annual frequency of HT between 1975 and 2005, and a progressive decrease in both age at presentation and female to male (F/M) ratio starting in the mid-1990s. Between years 1988 and 2007, we have collected 8397 adequate examinations by fine needle aspiration cytology (FNAC) on 8397 persons referred for the evaluation of a solitary or dominant thyroid nodule (total FNAC and persons=8520) with a 14-fold increase in 2007 over 1988. In this 20-year period, cases of HT, De Quervain's thyroiditis (DQT) and Riedel's thyroiditis (RT) were 490, 36 and two, respectively. HT cases were one in 1988 but 90 in 2007, with a significant upward temporal trend (r=0.919, P<0.001) and significant downward trend for age at FNAC (r=-0.466, P<0.05). In contrast, DQT cases were zero and one, respectively, with no significant temporal trend (r=0.29, P=0.21). The HT increase in frequency started in 1996 (+350% over 1995). Until 1995 there was only one man, but there were 22 men in 2005-2007. These FNAC data provide independent confirmation to the data from the endocrine division of the same hospital, further supporting the conclusion that only environmental modifications can explain these marked changes that have occurred in such a relatively short period of time.

Role of fine needle aspiration cytology in thyroiditis

Fine needle aspiration (FNA) of thyroid is a cost-effective, simple, diagnostic tool in the initial screening of patients with thyroid lesions. Its role in a minimally enlarged thyroid in a symptomatic patient suspected of thyroid dysfunction is now well known. It plays an important role in the medical management of all nonpalpable/minimally enlarged thyroid (goiter) in patients suspect for thyroid pathology and/or in combination with thyroid-stimulating hormone, T3 and T4 levels by diagnosing early cases of thyroiditis. FNA may be of assistance in the early detection of subclinical hypothyroidism, which is of utmost importance in pregnant women, and further makes possible the availability of baseline values for future reference. With the implementation of this protocol of FNA thyroid with/without imaging, we affirm that the practice of cytology has differed in different geographic areas and from country to country, depending on economy and availability of infrastructure.