Hashimoto's Thyroiditis Does Not Affect Ultrasonographical, Cytological, and Histopathological Features in Patients with Papillary Thyroid Carcinoma

Impact of Hashimoto's thyroiditis on ultrasound diagnosis of papillary thyroid carcinoma: a retrospective study

Objective

To investigate the clinical features and ultrasonic manifestations of papillary thyroid carcinoma (PTC) with Hashimoto's thyroiditis (HT) and without HT. The characteristics were analyzed to improve the accuracy of diagnosing PTC with HT via ultrasound, potentially reducing overtreatment in certain cases.

Methods

The patients were retrospectively analyzed in the Second Hospital of Shandong University from December 2015 to January 2020. A total of 5732 patients had thyroid nodules on ultrasound. Among them, 553 patients (702 nodules) received surgical treatment and the histopathological results showed PTC with or without HT were enrolled. Univariate and multivariate analyses were conducted to evaluate the risk factors associated with HT influencing the ultrasound diagnosis of PTC. The nodules were categorized into two groups based on pathological results: PTC with HT and PTC without HT.

Results

Gender, nodule echo, posterior echo change, border, aspect ratio, and nodule invasion rate significantly differed between the two groups (P<0.05). Independent variables for the multivariate logistic regression model were selected from those that showed statistical significance (P<0.05) in the univariate analysis. The results showed that the model was statistically significant (χ2 = 4.717, P<0.001, R2 = 0.185). Being female and aspect ratio ≥1 were identified as the risk factors for the diagnosis of PTC with HT, and the values were higher in group A than in group B by 3.15 and 1.73, respectively (OR=3.15, 1.73, P<0.05). Moreover, HT was identified as the protective factor because PTC was less likely to invade the thyroid capsule than the control group (OR=0.47, P<0.05).

Conclusions

HT can affect the clinical and ultrasonographic features of PTC in distinct ways. It provides a protective effect on the capsule, significantly reducing capsular invasion, while female gender and an aspect ratio ≥1 are associated with an increased risk of PTC with HT diagnosis.

Papillary thyroid carcinoma with Hashimoto's thyroiditis: impact and correlation

Thyroid cancer is a malignant tumor of the endocrine system. Papillary thyroid carcinoma (PTC) is the most common form of thyroid cancer and has a comparatively better prognosis. An autoimmune disease called Hashimoto's thyroiditis (HT) affects the thyroid and can cause lymphocyte infiltration in the thyroid tissue as well as hypothyroidism, which is characterized by increased levels of a certain antibody. It is currently assumed that there is a connection between PTC and HT. HT may increase the incidence of PTC and improve its prognosis by regulating gene expression, participating in common signaling pathways, and creating a specific immune microenvironment. In this review, we summarized the relationship between HT and PTC as well as the effects of coexisting HT on PTC and the possible mechanisms, thereby providing new perspectives for future research.

Predicting central lymph node metastasis in papillary thyroid carcinoma combined with Hashimoto's thyroiditis: a preoperative study

BACKGROUND

Current studies have reported a high association between the Hashimoto's thyroiditis (HT) and papillary thyroid cancer (PTC). However, studies on the characteristics of central lymph node metastasis (CLNM) in PTC patients with HT are scarce. Therefore, this study aims to evaluate the risk factors of CLNM in PTC and HT patients.

METHODS

We retrospectively collected clinical data from 933 PTC patients with HT who underwent thyroid surgery. Of these, 653 patients were categorized into a training cohort for constructing the nomogram, and 280 patients formed a validation cohort to verify the performance of the model. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses were used to select risk factors. A nomogram model for predicting CLNM was developed and internally validated. We subsequently evaluated thyroid function within 3 years after surgery and estimated the prevalence and incidence of postoperative complications between the CLNM ( +) and CLNM (-) groups.

RESULTS

LASSO regression revealed that 19 nonzero variables were associated with CLNM. Multivariate logistic regression analysis revealed that younger, patients of low body mass index (BMI), drinking, intranodular hyperechoic (IH) status, diameter ≥ 1 cm, multifocality, extrathyroidal extension (ETE), enlarged central lymph nodes (ECLNs) and lateral lymph node metastasis (LLNM) were at higher risk of CLNM (P < 0.05). A nomogram to predict CLNM in PTC patients with HT was constructed and internally validated on the basis of risk factors. The areas under the ROC curve (AUCs) of nomogram were 0.768 (95% CI, 0.723-0.812) and 0.773 (95% CI, 0.705-0.841) in training and validation groups, respectively. Moreover, the nomogram data showed a good discrimination and calibration ability to training and validation groups. Postoperative follow-up revealed that TGAb levels and the incidence of hypothyroidism were significantly greater in CLNM ( +) group than CLNM (-) group, respectively.

CONCLUSIONS

Our nomogram schedule developed and validated with a comprehensive set of preoperative risk factors showed a high benefit in predicting CLNM in PTC patients with HT. Postoperative follow-up of thyroid function allow to clarify the trend, as well as prevalence and incidence of common thyroid complications.

Sonographic characteristics and clinical characteristics combined with nomogram for predicting the aggressiveness of papillary thyroid carcinoma coexisted with Hashimoto's thyroiditis

OBJECTIVE

The association between Papillary Thyroid Carcinoma (PTC) and coexistent Hashimoto's Thyroiditis (HT) was controversial. The purpose of this study was to evaluate the presence of HT exerts any influence on the aggressiveness of PTC, and to establish a nomogram for predicting the possibility of aggressiveness in PTC.

METHODS

373 consecutive PTC patients with/without coexistent HT from January 2017 to December 2020 were retrospective reviewed. Patients' clinicopathologic and sonographic characteristics were collected for univariate and multivariate analyses. A nomogram was established based on the risk factors for aggressiveness in PTC.

RESULTS

Male (p = 0.001), tumor size >1.0 cm (p = 0.046) and lymph node metastasis (p = 0.018) were negatively associated with PTC coexisted with HT, while it was significantly positively associated with the frequence of multifocality (p = 0.010). Univariate and multivariate analyses suggested that age ≥55 years (p = 0.000), male (p = 0.027), HT (p = 0.017), tumor size >1.0 cm (p = 0.015), multifocality (p = 0.041), distance to capsular ≤0 cm (p = 0.050) and blood flow (Grade I: p = 0.044) were independent risk factors for predicting the aggressiveness in PTC. A nomogram according to these predictors was further developed and validated. The receiver operating characteristic curve (AUC = 0.734 and 0.809 for training and validation cohorts, respectively) and decision curve analyses indicated that the nomogram model was clinically useful. The calibration curve revealed that the nomogram exhibited an excellent consistency.

CONCLUSIONS

In this study, the coexistent HT might play a protective role in preventing the proliferation of PTC. Dispensable aggressive treatment may be reduced in PTC by pre-operative identification of sonographic and clinical characteristics and incorporating with the predicted nomogram model.

Hashimoto's thyroiditis is negatively associated with lymph node metastasis in PTMC

PURPOSE

The association between Hashimoto's thyroiditis (HT) and lymph node metastasis (LNM) of papillary thyroid microcarcinoma (PTMC) remains poorly understood. We aimed to elucidate the impact of HT on PTMC and its association with LNM.

METHODS

A retrospective cohort study was conducted at a single cancer referral center. Patients diagnosed with PTMC and complete clinicopathological results between January 2013 and June 2018 were included. Propensity score matching (PSM) and logistic regression analysis were performed to evaluate the difference in LNM characteristics between patients with and without HT.

RESULTS

Among the 9929 PTMC patients, 2389 (24.1%) were pathologically diagnosed with HT. After PSM using variables including age, sex, primary tumor size, central neck dissection, extrathyroidal extension (ETE), gross ETE, multifocality and bilaterality, we identified 2324 pairs of patients for analysis. Patients with HT had a significantly lower incidence of LNM in the central neck (40.9% vs 56.2%, P < 0.001) and lateral neck (11.6% vs 14.2%, P = 0.016), a lower incidence of extranodal extension (ENE) (10.1% vs 17.0%, P < 0.001), fewer positive lymph nodes (median [IQR], 0 [0 to 2] vs 1 [0 to 3], P < 0.001), and a lower lymph node ratio (median [IQR], 0.00 [0.00 to 0.15] vs 0.12 [0.00 to 0.33], P < 0.001) than those without HT. Logistic regression analysis indicated that patients with HT had a significantly reduced risk of CLNM and LLNM compared to those without HT.

CONCLUSIONS

Our study indicated a negative association between HT and LNM in PTMC.

Recommend with caution: A meta-analysis investigating papillary thyroid carcinoma tumor progression under active surveillance

BACKGROUND

Papillary thyroid carcinoma (PTC) is an indolent disease with favorable outcomes. The non-surgical treatment approach known as active surveillance (AS) has been introduced as an alternative treatment instead of the traditional thyroidectomy. However, 10-15 % of PTC tend to progress. We sought to determine factors predicting the progression of PTC under AS.

METHODS

A systematic search was performed in January 2022 using PubMed, Embase, Google Scholar, Web of Science, and ScienceDirect. PRISMA guidelines were used by multiple reviewers to extract study characteristics (author name, publication date, journal name, country, institution, and study design), as well as main outcomes and measures. A combination of utilization of thyroid replacement therapy, baseline tumor size and volume, follow-up tumor size and volume, and the presence of lymph node metastasis and its distribution, as well as surveillance duration, were the main measures of this study.

RESULTS

Nine studies with 4166 patients were included, of which 354 showed tumor progression during AS (15 %; 95%CI = 7 % - 23 %). The average follow-up period was 41.58 months. The mean tumor maximum diameter was 8.54 mm (95%CI = 7.04-10.03). Tumor progression was most commonly secondary to an increase in volume by ≥50 % (75 %; 95%CI = 68 % - 80 %), then increase in diameter by ≥3 mm (41 %; 95%CI = 13 % - 76 %), and finally the development of lymph node metastasis (13 %; 95%CI = 9 % - 19 %). Approximately only 2 % of all patients thus developed new lymph node metastasis. Patient age, sex, and tumor size were not associated with higher risks of tumor progression. 12 % of AS patients eventually underwent surgery, though only 40 % (95%CI = 27 % - 53 %) of these patients displayed tumor progression.

CONCLUSIONS

Our meta-analysis determined a tumor progression rate of 15 % in patients who underwent AS management, 13 % of which (2 % of all patients) developed lymph node metastasis. We found no protective or risk factors for tumor progression, and that almost half of all patients who underwent delayed surgery did so for reasons other than tumor progression. While not biopsying small (<1 cm) or very low suspicious nodules is already recommended, AS may be an appropriate treatment option in patients appropriately counseled, considering the low risk of advanced tumor progression but also the considerable patient population who fail to adhere to treatment. Alternatively, in aim of preventing overtreatment in patients who would rather take proactive measures against their low-risk carcinoma, minimally-invasive ablation techniques may be an attractive option.

Ultrasonographic, clinical, and pathological features of papillary thyroid carcinoma in children and adolescents with or without Hashimoto's thyroiditis

Objective

To compare the ultrasonographic, clinical, and pathological features of children and adolescents with papillary thyroid carcinoma (PTC) with and without Hashimoto's thyroiditis (HT).

Materials and methods

A total of 52 children and adolescent patients surgically diagnosed with PTC between 2017 and 2022 were included; 14 children and adolescent patients with PTC were diagnosed with HT via pathological examination. The preoperative ultrasonographic, postoperative histological, and molecular and clinical characteristics were retrospectively analyzed.

Results

The prevalence rate of PTC in patients with HT was 27%. Papillary thyroid microcarcinomas were found in 11 of 38 patients without HT, but none in patients with HT (p = 0.023). Extrathyroidal extension, capsular invasion, and lymph node metastases were more frequent in patients with PTC and HT than in patients with PTC alone (p < 0.05 for both). The ultrasonographic features of nodule composition, echogenicity, shape, margin, Thyroid Imaging Reporting and Data System categories, and total points were similar. The patterns of echogenic foci were more prominent in the nodules of patients with HT than in those of patients without HT (p = 0.016).

Conclusion

The frequency of papillary thyroid microcarcinomas in patients with PTC and HT was less, whereas that of extrathyroidal extension, capsular invasion, and lymph node metastasis was significantly higher in patients with PTC and HT than in those with PTC alone. The patterns of echogenic foci on ultrasonography may represent a risk for PTC.

Clinical and ultrasonic risk factors for high-volume central lymph node metastasis in cN0 papillary thyroid microcarcinoma: A retrospective study and meta-analysis

OBJECTIVE

Papillary thyroid microcarcinoma (PTMC) comprises more than 50% of all newly detected cases of papillary thyroid carcinoma (PTC). High-volume lymph node metastasis (involving >5 lymph nodes) (hv-LNM) is associated with PTMC recurrence. In half of the clinically node-negative (cN0) PTMC patients, central lymph node metastasis (CLNM) is pathologically present. However, clinical risk factors for high-volume CLNM (hv-CLNM) in cN0 PTMC have not been defined well. Therefore, we aimed to obtain evidence for hv-CLNM risk factors in cN0 PTMC.

DESIGN

Data on patients who visited our hospital between January 2020 and December 2021 were collected; a preoperative diagnosis of cN0 and a postoperative pathological confirmation of PTMC were obtained. After filtering by inclusion versus exclusion criteria, the obtained data (N = 2268) were included in the meta-analysis. Relevant studies published as of 10 April 2022, were identified from the Web of Science, PubMed, WANFANG, and CNKI databases. These eligible studies were included in the meta-analysis and the association between clinicopathological factors and hv-CLNM in cN0 PTMC was assessed. SPSS and MetaXL were used for statistical analyses.

RESULTS

The meta-analysis included 10 previous studies (11,734 patients) and 2268 patients enroled in our hospital for a total of 14,002 subjects. The results of which suggested that younger age (<40, odds ratio [OR] = 3.28, 95% confidence interval [CI] = 2.75-3.92, p < .001 or <45 odds ratio [OR] = 2.93, 95% CI = 2.31-3.72, p < .001), male sex (OR = 2.81, 95% CI = 2.25-3.52, p < .001), tumour size >5 mm (OR = 1.85, 95% CI = 1.39-2.47, p < .001), multifocality (OR = 1.88, 95% CI = 1.56-2.26, p < .001), extrathyroidal extension (OR = 2.58, 95% CI = 2.02-3.30, p < .001), capsule invasion (OR = 2.02, 95% CI = 1.46-2.78, p < .001), microcalcification (OR = 3.25, 95% CI = 2.42-4.36, p < .001) and rich blood flow (OR = 1.65, 95% CI = 1.21-2.25, p = .002) were the significant factors related to an elevated hv-CLNM risk in cN0 PTMC patients. Hashimoto thyroiditis (OR = 0.76, 95% CI = 0.55-1.07, p = .114), irregular margin (versus regular margin, OR = 0.96, 95% CI = 0.68-1.33, p = .787) and hypoechoic (versus nonhypoechoic, OR = 1.27, 95% CI = 0.84-1.92, p = .261) showed no significant association with hv-CLNM.

CONCLUSIONS

Younger age, tumour size >5 mm, males, extrathyroidal extension, multifocality, microcalcification, capsular invasion, and rich blood flow were the significant clinicopathological risk factors for hv-CLNM risk in cN0 PTMC patients. These predictors may compensate for the sensitivity of imaging diagnosis in the preoperative period, thus helping in the effective identification of PTMCs with an invasive phenotype.

Comparison of Various Ultrasound-Based Malignant Risk Stratification Systems on an Occasion for Assessing Thyroid Nodules in Hashimoto's Thyroiditis

Purpose

To compare the diagnostic performance and unnecessary ultrasound-guided fine-needle aspiration (US-FNA) biopsy rate of the 2015 American Thyroid Association (ATA), 2016 Korean Society of Thyroid Radiology (KSThR), and 2017 American College of Radiology (ACR) guidelines for patients with and without Hashimoto's thyroiditis (HT).

Patients and Methods

This retrospective study included 716 nodules from 696 consecutive patients, which were classified using the categories defined by the three guidelines: ATA, KSThR, and ACR. The malignancy risk in each category was calculated and the diagnostic performance and unnecessary fine-needle aspiration (FNA) rates of the three guidelines were compared.

Results

In total, 426 malignant and 290 benign nodules were identified. Patients with malignant nodules had lower total thyroxine levels and higher thyroid-stimulating hormone, thyroid peroxidase antibody, and thyroglobulin antibody levels than those without malignant nodules (all P<0.01). The margin difference was significant in non-HT patients (P<0.01), but comparable in HT patients (P=0.55). The calculated malignancy risks of high and intermediate suspicion nodules in the ATA and KSThR guidelines and moderately suspicious nodules in the ACR guidelines were significantly lower in non-HT patients compared with HT patients (P<0.05). The ACR guidelines showed the lowest sensitivity, highest specificity, and lowest unnecessary FNA rates in patients with and without HT. Compared to non-HT patients, HT patients had significantly lower unnecessary FNA rates (P<0.01).

Conclusion

HT was associated with a higher malignancy rate of thyroid nodules with intermediate suspicion according to the ATA, KSThR, and ACR guidelines. The three guidelines, especially ACR, were likely to be more effective and could allow a greater reduction in the percentage of benign nodules biopsied in patients with HT.

Prognostic value of the preoperative and early trends in postoperative serum thyroglobulin antibody levels among patients with papillary thyroid carcinoma and concomitant Hashimoto's thyroiditis

BACKGROUND

Thyroglobulin antibody(TgAb) was generally used as a prognostic marker of papillary thyroid cancer(PTC) only after total thyroidectomy, but its value in PTC patients with concomitant Hashimoto's thyroiditis(HT) is unclear. We aimed to assess the prognostic significance of the serum TgAb in these patients.

METHODS

This retrospective cohort study included PTC patients and pathologically proven HT from 2007-2016. The Cox proportional hazards model with restricted cubic spline was used to analyze the association between TgAb and structural recurrence, and then survival analysis was performed.

RESULTS

Of 839 patients enrolled, 48 recurrences were identified during a median follow-up of 64 months. Macrocarcinoma and lymph node metastasis were significantly associated with higher TgAb (P = 0.006, 0.002), but no significant difference was found for any other characteristics. An increasing preoperative TgAb level up to 2000 IU/ml was associated with shorter recurrence-free survival(RFS) (P < 0.001), and the 5-year RFS rates in patients with TgAb ≤400, 400-800 and >800 IU/ml were 97.3%, 93.2% and 85.8%, respectively (P < 0.05). The difference was found even after adjusting for potential risk factors (P < 0.001). Of 337 PTC patients who were treated with lobectomy and had available TgAb data at the first year after surgery, a significant decrease (≥50%) in postoperative TgAb was achieved in 41.8% patients, who had a favorable prognosis compared with others (5-year RFS rate 98.5% vs. 92.0%, P = 0.008).

CONCLUSIONS

The preoperative serum TgAb seem to effectively stratify PTC patients with concomitant HT who had high risk for recurrence, and the early postoperative trends of TgAb was a good prognostic marker for these patients who treated with lobectomy.

Ultrasound gray scale ratio for differential diagnosis of papillary thyroid microcarcinoma from benign micronodule in patients with Hashimoto's thyroiditis

BACKGROUND

To investigate the diagnostic value of ultrasound gray scale ratio (UGSR) in differentiating papillary thyroid microcarcinomas (PTMCs) from benign micronodules (BMNs) in patients with Hashimoto's thyroiditis (HT).

METHODS

The ultrasound images of 285 PTMCs (from 247 patients) and 173 BMNs (from 140 patients) in the HT group, as well as 461 PTMCs (from 417 patients) and 234 BMNs (from 197 patients) in the non-HT group were retrospectively analyzed. The diagnosis of all cases was confirmed by histopathological examinations. The gray scale values of the nodules and surrounding thyroid tissues were measured and subsequently the UGSRs were calculated. Receiver operating characteristic curve analysis was used to determine the area under the curve (AUC), optimal UGSR threshold, sensitivity and specificity in differentiating PTMCs and BMNs in the two groups.

RESULTS

The UGSR of PTMC and BMN was 0.52 ± 0.12 and 0.85 ± 0.24 in the HT group (P < 0.001), and 0.57 ± 0.13 and 0.87 ± 0.20 in the non-HT group (P < 0.001), respectively. The difference in PTMC-UGSR was significant between the two groups (P < 0.001), whereas BMN-UGSR did not differ between the two groups (P = 0.416). The AUC, optimal UGSR threshold, sensitivity and specificity of UGSR for differentiating PTMC and BMN in the HT and non-HT group were 0.890 versus 0.901, 0.68 versus 0.72, 91.23% versus 90.67%, and 77.46% versus 82.05%, respectively.

CONCLUSIONS

The USGR of the HT group was lower than that of the non-HT group. Moreover, UGSR exhibited important diagnostic value in differentiating PTMC from BMN in both HT and non-HT groups.

The Value of Thyroid Ultrasound Computer-Aided Diagnosis System in the Evaluation of Thyroid Nodules With Concurrent Hashimoto's Thyroiditis

OBJECTIVE

To investigate the value of computer-aided diagnosis (CAD) system in assessing thyroid nodules concurrent with Hashimoto's thyroiditis (HT).

METHODS

Totally 148 patients with 193 thyroid nodules were enrolled. A radiologist assessed the nodules using a thyroid ultrasound CAD system. Additionally, the nodules were evaluated by one experienced radiologist alone, and one training radiologist without and with CAD assistance. The diagnostic performance was compared between the CAD system and the experienced radiologist, and the training radiologist without and with CAD assistance.

RESULTS

The CAD system demonstrated a similar sensitivity to that of the experienced radiologist in diagnosing thyroid cancers (89.8% versus 92.4%, P > .05). The specificity and accuracy of the CAD system were lower than that of the experienced radiologist in assessing the nodules with diffusedly altered glands (specificity, 60.0% versus 81.7%, P = .007; accuracy, 77.5% versus 88.1%, P = .011). With CAD assistance, the training radiologist had improved sensitivity and accuracy that increased to 87.9% and 86.8% in classifying nodules with sonographically evident HT (both P = .012).

CONCLUSION

The CAD system has comparable sensitivity, but lower specificity compared with the experienced radiologist in diagnosing thyroid malignancies concurrent with HT. For a radiologist with less experience, the CAD system can help improve the diagnostic performance by increasing sensitivity and accuracy in assessing thyroid nodules with diffusely altered parenchyma.

The value of ultrasound grayscale ratio in the diagnosis of papillary thyroid microcarcinomas and benign micronodules in patients with Hashimoto's thyroiditis: A two-center controlled study

OBJECTIVE

The value of ultrasound grayscale ratio (UGSR) in the diagnosis of papillary thyroid microcarcinomas (PTMCs) and benign micronodules (BMNs) has been recognized by some authors, but studies have not examined these aspects in patients with Hashimoto's thyroiditis (HT). This retrospective study investigated the value of UGSR in the diagnosis of PTMCs and BMNs in patients with HT using data from two medical centers.

METHODS

Ultrasound images of 428 PTMCs in 368 patients with HT and 225 BMNs in 181 patients with HT in center A were retrospectively analyzed and compared to the ultrasound images of 412 PTMCs in 324 patients with HT and 315 BMNs in 229 patients with HT in medical center B. All of the cases were surgically confirmed. The UGSR was calculated as the ratio of the grayscale value of lesions to the surrounding normal thyroid tissues. The optimal UGSR thresholds for the PTMCs and BMNs in patients with HT from the two medical centers were determined using a receiver operating characteristic (ROC) curve. Furthermore, other statistics, including the area under the curve (AUC), the optimal UGSR threshold, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of the two medical centers, were pair analyzed in this study.

RESULTS

The UGSR of PTMCs and BMNs in patients with HT from medical center A were 0.513 (0.442, 0.592) and 0.857 (0.677, 0.977) (Z = -15.564, p = 0), and those from medical center B were 0.514 (0.431, 0.625) and 0.917 (0.705, 1.131) (Z = -15.564, p = 0). For both medical centers A and B, the AUC, optimal UGSR threshold, sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the UGSR in differentiating between PTMCs and BMNs in patients with HT were 0.870 and 0.889, 0.68 and 0.70, 0.921 and 0.898, 0.747 and 0.759, 0.874 and 0.829, 0.832 and 0.848, and 0.861 and 0.836, respectively. There were no significant differences in the UGSR for the PTMCs between patients from the two medical centers (Z = -0.815, p = 0.415), while there was a significant difference in the UGSR of the BMNs between patients from the two medical centers (Z = -3.637, p = 0).

CONCLUSION

In the context of HT, UGSR still has high sensitivity, accuracy, and stability in differentiating between PTMCs and BMNs, making it a complementary differentiator of thyroid imaging reporting and data systems. However, due to its low specificity, a comprehensive analysis of other ultrasound signs is required.

Validation of Four Thyroid Ultrasound Risk Stratification Systems in Patients with Hashimoto's Thyroiditis; Impact of Changes in the Threshold for Nodule's Shape Criterion

Simple Summary

Thyroid Imaging Reporting and Data Systems (TIRADS) optimize the selection of thyroid nodules for cytological examination. There is a question: is the effectiveness of these systems affected by morphological changes to thyroid parenchyma that are visible in the course of Hashimoto’s thyroiditis (HT)? This question is very important because of the increased risk of malignancy in thyroid nodules in patients with HT. We investigated widely accepted ultrasound malignancy risk features with a special consideration of the suspected nodule’s shape in patients with and without HT. We also validated EU-TIRADS, K-TIRADS, ACR-TIRADS, and ATA guidelines in both groups and evaluated the impact of changes in the threshold for nodule’s shape criterion on the diagnostic value of these TIRADS. The presence of Hashimoto’s thyroiditis did not exert any significant adverse implications for the efficiency of examined TIRADS. The impact of changes in the threshold for nodule’s shape criterion was the highest for EU-TIRADS.

Abstract

The aim of the study was to validate thyroid US malignancy features, especially the nodule’s shape, and selected Thyroid Imaging Reporting and Data Systems (EU-TIRADS; K-TIRADS; ACR-TIRADS, ATA guidelines) in patients with or without Hashimoto’s thyroiditis (HT and non-HT groups). The study included 1188 nodules (HT: 358, non-HT: 830) with known final diagnoses. We found that the strongest indications of nodule’s malignancy were microcalcifications (OR: 22.7) in HT group and irregular margins (OR:13.8) in non-HT group. Solid echostructure and macrocalcifications were ineffective in patients with HT. The highest accuracy of nodule’s shape criterion was noted on transverse section, with the cut-off value of anteroposterior to transverse dimension ratio (AP/T) close to 1.15 in both groups. When round nodules were regarded as suspicious in patients with HT (the cut-off value of AP/T set to ≥1), it led to a three-fold increase in sensitivity of this feature, with a disproportionally lower decrease in specificity and similar accuracy. Such a modification was effective also for cancers other than PTC. The diagnostic effectiveness of analyzed TIRADS in patients with HT and without HT was similar. Changes in the threshold for AP/T ratio influenced the number of nodules classified into the category of the highest risk, especially in the case of EU-TIRADS.

Clinicopathological characterization and prognostic implication of FOXP3 and CK19 expression in papillary thyroid carcinoma and concomitant Hashimoto's thyroiditis

Papillary thyroid carcinoma (PTC) is considered the most prevalent thyroid malignancy. The association between Hashimoto's thyroiditis (HT) and PTC is still unclear. We aimed to examine the clinicopathological impact of immunohistochemical staining of FOXP3 and Cytokeratin 19 in PTC and concomitant HT and their correlation with patients' outcome and survival. Eighty thyroid biopsies obtained from patients with PTC were immunostained by FOXP3 and CK19.The patients were treated by radioactive iodine (I131) and followed up. FOXP3 and CK19 expression were detected in 45% and 80% studied cases of PTC respectively. 16.7% of PTC with associated HT showed FOXP3+ lymphocytes in lymphocytic infiltrate of HT, while most of PTC associated HT express cytoplasmic CK19 positive Hurtle cells. FOXP3 was more expressed in PTC female patients more than 45 years with higher stage, lymph node, and distant metastasis, extracapsular extension, number of I131doses, and cumulative radioiodine doses with a highly statistically significant difference (p < 0.001). The relation was significant between CK19 immunostaining as regard 10-year Overall Survival and death (p value = 0.027 and 0.036, respectively). HT represents a step in the process of autoimmune inflammatory disease ending by the evolution of PTC with better prognosis, therefore appropriate follow up of these cases is needed. FOXP3 tends to be more expressed in PTC cases with worse prognostic variables and is predictable to become a recent prognostic and targeted therapy for PTC. There was a significant relation between CK19 immunostaining and 10 year overall survival.

The impact of concurrent Hashimoto thyroiditis on thyroid nodule cytopathology assessed by ultrasound-guided fine-needle aspiration cytology

Objective: Thyroid nodules are highly prevalent and a common clinical problem worldwide. How to identify the nature of a nodule is a major concern of clinicians. Fine needle aspiration cytology (FNAC) has an established role and is well-utilized in nodule management. However, the unsatisfactory nondiagnostic and indeterminate rates limit its usage and lead to some unnecessary surgery. Hashimoto thyroiditis (HT) is prevalently found concurrent with thyroid nodules. Whether HT can influence the accuracy of cytopathological diagnosis of nodules is still controversial. Methods: We collected medical records of 1,063 patients with thyroid nodules who had done FNAC in our hospital from 2015 to 2016. Thyroid function, anti-thyroid autoantibody levels, thyroid ultrasound records, and cytological and histopathological results of nodules were reviewed to analyze the impact of HT on FNAC outcome. Results: A total of 1,063 patients with an average age of 44 ± 13 years old were retrospectively reviewed for pathological and clinical data. Patients with different cytological diagnoses had comparable positive rates of anti-thyroid autoantibodies. One hundred patients were confirmed to have concurrent HT by histopathology after surgery. The overall nondiagnostic and indeterminate cytology rates were 11.9% and 25% respectively. No statistical difference was found either in the rate of a nondiagnostic cytology results or in the rate of indeterminate cytology results between patients with positive anti-thyroid autoantibodies and patients with negative test for anti-thyroid autoantibodies (P > 0.05). The same was true between patients with histopathologically confirmed HT and HT-negative ones (P > 0.05). Conclusions: The presence of concurrent HT, whether clinically implied with positive anti-thyroid autoantibodies or pathologically confirmed, is unlikely to predispose an FNAC diagnosis of thyroid nodules to be non-diagnostic or indeterminate.

Upregulation Of Protein Tyrosine Phosphatase Receptor Type C Associates To The Combination Of Hashimoto's Thyroiditis And Papillary Thyroid Carcinoma And Is Predictive Of A Poor Prognosis

Introduction

PTC is not generally considered a lethal disease, but prone to recurrence as the prognosis. Hashimoto’s thyroiditis (HT) is an important factor that affects the prognosis of papillary thyroid carcinoma (PTC). It is crucial to find biomarkers to identify the combination of HT with PTC and to predict the prognosis.

Methods

RNASeq data from the Cancer Genome Atlas (TCGA) database was used to screen differentially expressed genes (DEGs) of PTC with HT via the edgeR package of R software version 3.3.0. Also, the DEGs were applied to the DAVID web-based tool to determine the enrichment of gene functions via Gene Ontology (GO) analysis and to identify associated pathways in the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. By constructing protein interaction networks within Cytoscape software, we screened candidate genes and explored possible relationships with the clinical phenotype of PTC. Finally, additional thyroid tissue samples were collected to verify the results above.

Results

After analyzing the RNA-Seq data of PTC patients from the Cancer Genomic Atlas, 497 differentially expressed PTC genes were found to be associated with HT, of which protein tyrosine phosphatase receptor type C (PTPRC), KIT, and COL1A1 were associated with tumor size and lymph node metastasis (p < 0.05). Verification of these results with another 30 thyroid tissues of clinical PTC patients revealed that the expression level of PTPRC in the PTC with HT group was higher than that in the PTC without HT group (p < 0.05) and the ROC curve showed a good discrimination (area under the curve = 0.846). However, the correlation with the clinical phenotype was not statistically significant (p > 0.05).

Discussion

These data suggest that upregulation of PTPRC enhances the incidence of HT associated with PTC and is also predictive of a poor prognosis.

Changes in glucose-lipid metabolism, insulin resistance, and inflammatory factors in patients with autoimmune thyroid disease

Background

Autoimmune thyroid disease (AITD) is a common organ‐specific autoimmune disorder, and genetic, environmental, and endogenous factors are responsible for initiation of thyroid autoimmunity. Some AITD patients suffer from a certain degree of glucose‐lipid metabolism disorder. This study aims to explore the changes in glucose‐lipid metabolism, insulin resistance, and inflammatory factors in patients with AITD.

Methods

A total of 91 patients with Hashimoto's thyroiditis were retrospectively analyzed and divided into hypothyroidism group (n = 42) and normal thyroid group (n = 49), while 50 healthy people were selected as control group. The changes in glucose‐lipid metabolism, insulin resistance, and inflammatory factors in each group were compared, and their correlations with the thyroid function were analyzed.

Results

The levels of serum interleukin‐6 (IL‐6), tumor necrosis factor‐α (TNF‐α), IL‐12, IL‐10, (FINS), and homeostasis model assessment of insulin resistance (HOMA‐IR) were gradually declined in sequence of hypothyroidism group, normal thyroid group, and control group (P < 0.05). In hypothyroidism group, the levels of serum‐free triiodothyronine (FT3), free thyroxine (FT4), (TC), triglyceride (TG), and low‐density lipoprotein cholesterol (LDL‐C) were significantly lower than those in normal thyroid group (P < 0.05), while the level of serum thyroid stimulating hormone (TSH) was significantly higher than that in normal thyroid group (P < 0.05). However, the fasting blood glucose and 2‐hour postprandial blood glucose levels had no statistically significant differences among the three groups (P > 0.05).

Conclusion

Autoimmune thyroid disease patients are prone to fat metabolism disorder, and the serum thyroid hormone level has a close correlation with blood lipid metabolism, insulin metabolism, and inflammatory factors.

The Impact of Hashimoto Thyroiditis on Thyroid Nodule Cytology and Risk of Thyroid Cancer

Context

The impact of Hashimoto thyroiditis (HT) on the risk of thyroid cancer and its accurate detection remains unclear. The presence of a chronic lymphocytic infiltration imparts a logical mechanism potentially altering neoplastic transformation, while also influencing the accuracy of diagnostic evaluation.

Methods

We performed a prospective, cohort analysis of 9851 consecutive patients with 21,397 nodules ≥1 cm who underwent nodule evaluation between 1995 and 2017. The definition of HT included (i) elevated thyroid peroxidase antibody (TPOAb) level and/or (ii) findings of diffuse heterogeneity on ultrasound, and/or (iii) the finding of diffuse lymphocytic thyroiditis on histopathology. The impact of HT on the distribution of cytology and, ultimately, on malignancy risk was determined.

Results

A total of 2651 patients (27%) were diagnosed with HT, and 3895 HT nodules and 10,168 non-HT nodules were biopsied. The prevalence of indeterminate and malignant cytology was higher in the HT vs non-HT group (indeterminate: 26.3% vs 21.8%, respectively, P < 0.001; malignant: 10.0% vs 6.4%, respectively, P < 0.001). Ultimately, the risk of any nodule proving malignant was significantly elevated in the setting of HT (relative risk, 1.6; 95% CI, 1.44 to 1.79; P < 0.001), and was maintained when patients with solitary or multiple nodules were analyzed separately (HT vs non-HT: 24.5% vs 16.3% solitary; 22.1% vs 15.4% multinodular; P < 0.01).

Conclusion

HT increases the risk of thyroid malignancy in any patient presenting for nodule evaluation. Diffuse sonographic heterogeneity and/or TPOAb positivity should be used for risk assessment at time of evaluation.

The increasing prevalence of chronic lymphocytic thyroiditis in papillary microcarcinoma

Although the incidence of some malignancy has decreased over the recent years, this is not the case of papillary thyroid microcarcinoma (PTMC), whose incidence has increased worldwide. Most PTMC are found incidentally after histological examination of specimens from surgery for benign thyroid disease. Hashimoto's thyroiditis, whose incidence has also increased, coexists in about one in three PTMC patients. Three different mechanisms have been proposed to clarify the association between chronic lymphocytic thyroiditis and PTMC, namely tumor development/growth by: (i) TSH stimulation, (ii) expression of certain proto-oncogenes, (iii) chemokines and other molecules produced by the lymphocytic infiltrate. Whether Hashimoto's thyroiditis protects against lymph node metastasis is debated. Overall, autommune thyroiditis seems to contribute to the favorable prognosis of PTMC. Major limitations of the studies so far performed include: (i) retrospective design, (ii) limited statistical power, (iii) high risk of selection bias, (iv) and predominant Asian ethnicity of patients. Full genetic profiling of both diseases and identification of environmental factors capable to trigger them, as well as well-powered prospective studies on different ethnical groups, may help understand their causal association and why their frequencies are continuing raising.

Risk factors associated with intrathyroid extension of thyroid microcarcinomas

PURPOSE

The aims of this study were to investigate the rate of intrathyroid extension of papillary thyroid microcarcinoma (PTMC) in patients operated for benign thyroid disease and to identify independent risk factors associated with it.

METHODS

A retrospective study of 301 patients operated for benign thyroid diseases (hyperthyroid diseases, multinodular goitre, Hashimoto thyroiditis and benign thyroid tumours) was performed at a high-volume endocrine surgery unit of a tertiary referral academic hospital, in a 5-year period. These patients had a PTMC incidentally discovered on definite histopathological findings following total or near-total thyroidectomy. Since distinguishing between intrathyroid extension of PTMC as the result of intrathyroid dissemination or as the result of multicentricity is challenging, we observed them together as multifocality. In statistical analysis, we used standard descriptive statistics and univariate and multivariate logistic regression analysis to determine independent risk factors associated with multifocality.

RESULTS

In our study, there were 85.4% females and 14.6% males with a median age of 54 years. A multinodular goitre (32.5%) was the most common indication for an operation. Most patients (68.4%) had a PTMC that was 5 mm or smaller. The most frequent histological variants of PTMC were the follicular variant (52.8%), followed by the papillary variant (22.6%) and the mixed follicular-papillary variant (18.6%). A multifocal PTMC was present in 26.6% of cases. An independent protective factor for multifocality of PTMC was a thyroid gland that weighed more than 38 g (OR 0.55, 95% CI 0.31-0.97, p = 0.039). Size of PTMC greater than 5 mm was an independent risk factor for a multifocal PTMC (OR 3.26, 95% CI 1.85-5.75, p = 0.000). Finally, the mixed follicular-papillary variant of PTMC represents an independent risk factor for a multifocal PTMC (OR 2.42, 95% CI 1.09-5.36, p = 0.030).

CONCLUSIONS

Intrathyroid extension is present in more than a quarter of PTMCs found in patients operated for benign thyroid disease. Independent risk factors for intrathyroid extension are size of PTMC greater than 5 mm and the mixed follicular-papillary variant of PTMC, while a large thyroid gland is an independent protective factor.

Malignancy is associated with microcalcification and higher AP/T ratio in ultrasonography, but not with Hashimoto's thyroiditis in histopathology in patients with thyroid nodules evaluated as Bethesda Category III (AUS/FLUS) in cytology

The predictors of malignancy are important for the decision of appropriate management in nodules with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS). Our aim was to determine the ultrasonographical, clinical, and biochemical predictors of malignancy in these patients. A total of 427 patients with cytologically Bethesda Category III (AUS/FLUS) thyroid nodules were included in this retrospective study. We divided the nodules into two subgroups according to the histopathology as benign and malignant, and compared the preoperative ultrasonographical, clinical, and biochemical findings. In overall, 427 patients with 449 AUS/FLUS nodules who had undergone surgery, the rate of malignancy was 23.4 % (105/449). When evaluated separately, the rate of malignancy was 25.8 % in nodules with AUS (82/318) and 17.6 % in nodules with FLUS (23/131) (p = 0.061). The vast majority of malignant specimens in histopathology consisted of papillary thyroid carcinoma (PTC) (n = 91, 86.7 %). Preoperative ultrasonographic features of 105 malignant nodules in histopathology were compared with the 344 benign nodules in histopathology. Anteroposterior/Transverse (AP/T) ratio was significantly higher in malignant group compared to benign group (p = 0.013). In multiple logistic analysis, we found that higher AP/T ratio and microcalcification were independently associated with malignancy (p < 0.05). The malignancy-associated cut-off value of AP/T ratio at maximum sensitivity and specificity was ≥0.81. We did not find any correlation between malignancy and Hashimoto's thyroiditis in histopathology in multivariate analysis (p > 0.05). In Bethesda Category III nodules with higher AP/T ratio and microcalcification, surgery might be considered as a first therapeutic option instead of repeat fine-needle aspiration biopsy or observation.