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Peng CCH, Lin YJ, Lee SY, Lin SM, Han C, Loh CH, Huang HK, Pearce EN. MACE and Hyperthyroidism Treated With Medication, Radioactive Iodine, or Thyroidectomy. JAMA Netw Open 2024; 7:e240904. [PMID: 38436957 PMCID: PMC10912964 DOI: 10.1001/jamanetworkopen.2024.0904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/11/2024] [Indexed: 03/05/2024] Open
Abstract
Importance Excessive thyroid hormones from hyperthyroidism increase cardiovascular risks. Among 3 available treatments for hyperthyroidism, comparisons of long-term outcomes associated with antithyroid drugs (ATDs), radioactive iodine (RAI), and surgery to treat newly diagnosed hyperthyroidism are lacking. Objective To compare risks of major adverse cardiovascular events (MACE) and all-cause mortality among patients with hyperthyroidism treated with ATDs, RAI, or surgery. Design, Setting, and Participants This nationwide cohort study used the Taiwan National Health Insurance Research Database. Patients aged 20 years or older with newly diagnosed hyperthyroidism between 2011 and 2020 were enrolled. Treatment groups were determined within 18 months from diagnosis, with follow-up until the development of MACE, death, or the end date of the database, whichever came first. Data were analyzed from October 2022 through December 2023. Exposures The ATD group received ATDs only. RAI and surgery groups could receive ATDs before treatment. Anyone who underwent thyroid surgery without RAI was classified into the surgery group and vice versa. Main Outcomes and Measures The primary outcomes included MACE (a composite outcome of acute myocardial infarction, stroke, heart failure, and cardiovascular mortality) and all-cause mortality. Results Among 114 062 patients with newly diagnosed hyperthyroidism (mean [SD] age, 44.1 [13.6] years; 83 505 female [73.2%]), 107 052 patients (93.9%) received ATDs alone, 1238 patients (1.1%) received RAI, and 5772 patients (5.1%) underwent surgery during a mean (SD) follow-up of 4.4 (2.5) years. Patients undergoing surgery had a significantly lower risk of MACE (hazard ratio [HR] = 0.76; 95% CI, 0.59-0.98; P = .04), all-cause mortality (HR = 0.53; 95% CI, 0.41-0.68; P < .001), heart failure (HR = 0.33; 95% CI, 0.18-0.59; P < .001), and cardiovascular mortality (HR = 0.45; 95% CI, 0.26-0.79; P = .005) compared with patients receiving ATDs. Compared with ATDs, RAI was associated with lower MACE risk (HR = 0.45; 95% CI, 0.22-0.93; P = .03). Risks for acute myocardial infarction and stroke did not significantly differ between treatment groups. Conclusions and Relevance In this study, surgery was associated with lower long-term risks of MACE and all-cause mortality, while RAI was associated with a lower MACE risk compared with ATDs.
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Affiliation(s)
- Carol Chiung-Hui Peng
- Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Diabetes Technology Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Jie Lin
- Health Information Center, Tzu Chi University, Hualien, Taiwan
| | - Sun Y. Lee
- Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Shu-Man Lin
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Physical Medicine and Rehabilitation, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Cheng Han
- Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Clinical Nutrition and Metabolism, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Ching-Hui Loh
- Diabetes Technology Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Center for Healthy Longevity, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Huei-Kai Huang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Elizabeth N. Pearce
- Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
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2
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Motofei IG. Biology of cancer; from cellular and molecular mechanisms to developmental processes and adaptation. Semin Cancer Biol 2022; 86:600-615. [PMID: 34695580 DOI: 10.1016/j.semcancer.2021.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/21/2021] [Accepted: 10/10/2021] [Indexed: 02/07/2023]
Abstract
Cancer research has been largely focused on the cellular and molecular levels of investigation. Recent data show that not only the cell but also the extracellular matrix plays a major role in the progression of malignancy. In this way, the cells and the extracellular matrix create a specific local microenvironment that supports malignant development. At the same time, cancer implies a systemic evolution which is closely related to developmental processes and adaptation. Consequently, there is currently a real gap between the local investigation of cancer at the microenvironmental level, and the pathophysiological approach to cancer as a systemic disease. In fact, the cells and the matrix are not only complementary structures but also interdependent components that act synergistically. Such relationships lead to cell-matrix integration, a supracellular form of biological organization that supports tissue development. The emergence of this supracellular level of organization, as a structure, leads to the emergence of the supracellular control of proliferation, as a supracellular function. In humans, proliferation is generally involved in developmental processes and adaptation. These processes suppose a specific configuration at the systemic level, which generates high-order guidance for local supracellular control of proliferation. In conclusion, the supracellular control of proliferation act as an interface between the downstream level of cell division and differentiation, and upstream level of developmental processes and adaptation. Understanding these processes and their disorders is useful not only to complete the big picture of malignancy as a systemic disease, but also to open new treatment perspectives in the form of etiopathogenic (supracellular or informational) therapies.
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Affiliation(s)
- Ion G Motofei
- Department of Oncology/ Surgery, Carol Davila University, St. Pantelimon Hospital, Dionisie Lupu Street, No. 37, Bucharest, 020021, Romania.
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Wang CL, Gao MZ, Gao XJ, Mu XY, Wang JQ, Gao DM, Qiao MQ. Mechanism Study on Chinese Medicine in Treatment of Nodular Goiter. Chin J Integr Med 2022; 29:566-576. [PMID: 36044118 DOI: 10.1007/s11655-022-3724-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/28/2022]
Abstract
Nodular goiter has become increasingly prevalent in recent years. Clinically, there has been a burgeoning interest in nodular goiter due to the risk of progression to thyroid cancer. This review aims to provide a comprehensive summary of the mechanisms underlying the therapeutic effect of Chinese medicine (CM) in nodular goiter. Articles were systematically retrieved from databases, including PubMed, Web of Science and China National Knowledge Infrastructure. New evidence showed that CM exhibited multi-pathway and multi-target characteristics in the treatment of nodular goiter, involving hypothalamus-pituitary-thyroid axis, oxidative stress, blood rheology, cell proliferation, apoptosis, and autophagy, especially inhibition of cell proliferation and promotion of cell apoptosis, involving multiple signal pathways and a variety of cytokines. This review provides a scientific basis for the therapeutic use of CM against nodular goiter. Nonetheless, future studies are warranted to identify more regulatory genes and pathways to provide new approaches for the treatment of nodular goiter.
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Affiliation(s)
- Chang-Lin Wang
- School of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.,Research and Innovation Team of Emotional Diseases and Syndromes of Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.,Key Laboratory of Traditional Chinese Medicine for Classical Theory, Ministry of Education, Jinan, 250355, China
| | - Ming-Zhou Gao
- School of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.,Research and Innovation Team of Emotional Diseases and Syndromes of Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.,Key Laboratory of Traditional Chinese Medicine for Classical Theory, Ministry of Education, Jinan, 250355, China
| | - Xiang-Ju Gao
- School of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.,Research and Innovation Team of Emotional Diseases and Syndromes of Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.,Key Laboratory of Traditional Chinese Medicine for Classical Theory, Ministry of Education, Jinan, 250355, China
| | - Xiang-Yu Mu
- School of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.,Research and Innovation Team of Emotional Diseases and Syndromes of Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.,Key Laboratory of Traditional Chinese Medicine for Classical Theory, Ministry of Education, Jinan, 250355, China
| | - Jie-Qiong Wang
- Research and Innovation Team of Emotional Diseases and Syndromes of Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.,Key Laboratory of Traditional Chinese Medicine for Classical Theory, Ministry of Education, Jinan, 250355, China.,School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.,Youth Research and Innovation Team of Pharmacology of Liver Viscera in Emotional Disease and Syndromes, Jinan, 250355, China
| | - Dong-Mei Gao
- School of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.,Research and Innovation Team of Emotional Diseases and Syndromes of Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.,Key Laboratory of Traditional Chinese Medicine for Classical Theory, Ministry of Education, Jinan, 250355, China
| | - Ming-Qi Qiao
- School of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China. .,Research and Innovation Team of Emotional Diseases and Syndromes of Shandong University of Traditional Chinese Medicine, Jinan, 250355, China. .,Key Laboratory of Traditional Chinese Medicine for Classical Theory, Ministry of Education, Jinan, 250355, China.
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4
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ÇETİN Z, KÖSEOĞLU D, ÖZDEMİR BAŞER Ö. Clinical, sonographical and cytological comparison of toxic and non-toxic thyroid nodules. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1089028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: To compare patients with toxic and non-toxic nodular/multinodular goiter in terms of clinical, sonographical and cytological features.
Material and Method: The medical data of 326 patients were reviewed retrospectively. Clinical and sonographic features were examined. Four hundred and eighty-one nodules were compared sonographically and cytologically. One hundred twenty-four patients had toxic nodular goiter and 202 of them had non-toxic nodular goiter.
Results: The toxic nodular goiter group was older, they had more male sex, more multi-nodularity, larger thyroid glands and nodules with more sonographically suspicious features (p 40 mm in 13.9% of the nodules in the toxic group and 5.4% of those in the non-toxic group (p= 0.003). Central vascularization (p
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5
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Incidence and Risk Factors of Thyroid Malignancy in Patients with Toxic Nodular Goiter. Int J Surg Oncol 2022; 2022:1054297. [PMID: 35656410 PMCID: PMC9152398 DOI: 10.1155/2022/1054297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Although hyperfunctioning thyroid disorders were thought to be protective against malignancy, some recent studies reported a high incidence of incidentally discovered cancer in patients with hyperfunctioning benign thyroid disorders. We performed this study to estimate the incidence and predictors of malignant thyroid disease in patients with toxic nodular goiter (TNG). Patients and Methods. The data of 98 patients diagnosed with TNG were reviewed (including toxic multinodular goiter SMNG and single toxic nodule STN). The collected data included patients age, gender, systemic comorbidities, family history of thyroid malignancy, previous neck radiation, type of disease (multinodular or single), size of the dominant nodule by the US, operative time, and detection of significant lymph nodes during operation. Based on the histopathological analysis, the cases were allocated into benign and malignant groups. Results. Malignancy was detected in 21 patients (21.43%). Although age distribution was comparable between the two groups, males showed a significant increase in association with malignancy. Medical comorbidities and family history of cancer did not differ between the two groups. However, TMNG showed a statistically higher prevalence in the malignant group. Operative data, including operative time and lymph node detection, were comparable between the two groups. On regression analysis, both male gender and TMNG were significant predictors of malignancy. Conclusion. The presence of thyroid hyperfunction is not a protective factor against malignancy, as malignancy was detected in about 1/5 of cases. Male gender and TMNG were significant risk factors of malignancy in such patients.
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6
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Whitmer D, Phay JE, Holt S, O’Donnell B, Nguyen J, Joseph D, Chi A, Wu S, Hao Y, Huang J, Klopper JP, Kloos RT, Kennedy GC, Shin J. Risk of malignancy in cytologically indeterminate thyroid nodules harboring thyroid stimulating hormone receptor mutations. Front Endocrinol (Lausanne) 2022; 13:1073592. [PMID: 36619548 PMCID: PMC9815553 DOI: 10.3389/fendo.2022.1073592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To evaluate the frequency and risk of malignancy of TSHRpI568T mutations discovered in indeterminate thyroid nodules (ITN) within the Veracyte CLIA laboratory undergoing Afirma® Genomic Sequencing Classifier (GSC) testing, and to evaluate a broader cohort of TSHR variants and their categorization as Afirma GSC benign (GSC-B) or suspicious (GSC-S). Finally, we seek to assess the risk of malignancy (ROM) of this group of TSHR mutated ITN in the GSC-S category. METHODS ITN submitted to Veracyte for Afirma GSC testing between October 2017 and February 2022 were analyzed for TSHR variants and rates of GSC-B and GSC-S were calculated based upon BIII or IV cytology, by TSHR variant codon amino acid (AA) substitution, age, and gender. For GSC-S samples, surgical pathology reports were requested, and the rate of malignancy was calculated. RESULTS Five percent of the ITN samples harbored an isolated TSHR variant and 5% of those were classified as GSC-S. Among TSHRpI568T samples, 96% were GSC-B and of the GSC-S samples, 21% were malignant. Among an unselected group of TSHR, absent TSHRpI568T mutations, 16.3% of GSC-S samples were malignant, all but one with codon mutations in the transmembrane subdomains of the TSHR. This prompted a dedicated evaluation of transmembrane codons which revealed a malignancy rate of 10.7% among GSC-S nodules. In total, 13/85 (15.3%) TSHR mutated ITN with Afirma GSC-S results were found to be malignant. CONCLUSIONS TSHR variants are rare in ITN, and most are categorized as benign under Afirma GSC testing which carries a < 4% risk of malignancy. For GSC-S ITN with TSHR mutations, the risk of malignancy is ≥= 15%, which is clinically meaningful and may alter treatment or monitoring recommendations for patients.
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Affiliation(s)
- Dorota Whitmer
- Department of Endocrinology, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, United States
- *Correspondence: Dorota Whitmer,
| | - John E. Phay
- Department of Surgery, The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Shelby Holt
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Benjamin O’Donnell
- Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Jay Nguyen
- Lake Cumberland Regional Hospital, Somerset, KY, United States
| | - Dennis Joseph
- Endocrinology Center of Lake Cumberland, Somerset, KY, United States
| | - Anthony Chi
- Department of Pathology, Mid-Atlantic Permanente Medical Group, Rockville, MD, United States
| | - Shuyang Wu
- 8Department of Research and Development, Veracyte, South San Francisco, CA, United States
| | - Yangyang Hao
- 8Department of Research and Development, Veracyte, South San Francisco, CA, United States
| | - Jing Huang
- 8Department of Research and Development, Veracyte, South San Francisco, CA, United States
| | - Joshua P. Klopper
- Department of Medical Affairs, Veracyte, South San Francisco, CA, United States
| | - Richard T. Kloos
- Department of Medical Affairs, Veracyte, South San Francisco, CA, United States
| | - Giulia C. Kennedy
- 8Department of Research and Development, Veracyte, South San Francisco, CA, United States
- Department of Medical Affairs, Veracyte, South San Francisco, CA, United States
- Department of Clinical Affairs, Veracyte, South San Francisco, CA, United States
| | - Joyce Shin
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, United States
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7
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He JL, Li GA, Zhu ZY, Hu MJ, Wu HB, Zhu JL, Zhao HH, Zhang HS, Huang F. Associations of exposure to multiple trace elements with the risk of goiter: A case-control study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 288:117739. [PMID: 34245984 DOI: 10.1016/j.envpol.2021.117739] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/16/2021] [Accepted: 07/04/2021] [Indexed: 06/13/2023]
Abstract
Goiter is one of common endocrine diseases, and its etiology has not been fully elucidated. The changes in trace elements' levels have an important impact on the thyroid. We designed a case-control study, which involved 383 goiter cases and 383 matched controls. We measured these elements in the urine of participants by inductively coupled plasma optical emission spectrometry (ICP-OES), graphite furnace atomic absorption spectrometry (GFAAS) and As3+-Ce4+ catalytic spectrophotometry. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to select the elements into multi-element models, conditional logistic regression models were applied to analyze the association between elements and goiter risk. Bayesian kernel machine regression (BKMR) model was used to depict elements' mixtures and evaluate their joint effects. Finally, 7 elements were included in the multi-element model. We found that the concentrations of lithium (Li), strontium (Sr) and barium (Ba) had a negative effect with goiter risk, and lead (Pb) and iodine (I) showed an extreme positive effect. Additionally, compared with the lowest levels, patients with highest quartiles of I and Pb were 6.49 and 1.94 times more likely to have goiter, respectively. On the contrary, in its second and third quartiles, arsenic (As) showed a negative effect (both OR<1). BKMR model showed a certain interaction among Pb, As, Sr and Li on goiter risk. Further large sample studies are needed to confirm these findings in the future.
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Affiliation(s)
- Jia-Liu He
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Guo-Ao Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Zhen-Yu Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Ming-Jun Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Hua-Bing Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Jin-Liang Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Huan-Huan Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Han-Shuang Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Fen Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China.
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8
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Goonoo MS, Arshad MF, Tahir F, Balasubramanian SP. Toxic adenoma: to biopsy or not to biopsy? Ann R Coll Surg Engl 2021; 103:e319-e323. [PMID: 34435917 DOI: 10.1308/rcsann.2021.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Toxic adenoma nodules rarely harbour cancer. Fine-needle aspiration (FNA) is often not done because of the rarity of these lesions being cancer, the difficulty in interpreting cytology in hyperthyroid patients and the rare precipitation of thyrotoxicosis. We present two young, Caucasian female patients aged 29 and 13 years who were each diagnosed with a toxic nodule categorised as benign and indeterminate respectively. They underwent hemithyroidectomy after being rendered euthyroid, however their histology unexpectedly revealed differentiated follicular cancer. Despite thyroid cancer being rare in patients with toxic adenomas, it should be considered when planning treatment, especially if there are risk factors for cancer, or suspicious features on ultrasound examination. A review of the literature shows that compared with adenomas in euthyroid patients, patients in this group are generally younger and predominately female. If an FNA is considered, it should be performed after the patient is rendered euthyroid.
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Affiliation(s)
- M S Goonoo
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - M F Arshad
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - F Tahir
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
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9
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Osorio C, Ballestas J, Barrios D, Arévalo A, Montaño S, Pérez N, Guardo Y, Oviedo H, Zambrano V, Redondo K, Herrera F. Clinical characteristics associated with the finding of thyroid cancer originating from hot nodules in patients with hyperthyroidism: a case report and systematic review of the literature. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Coexistence between thyroid cancer and hyperthyroidism is rare, and most of the nodular lesions from which a malignant tumor is documented in this group of patients correspond to cold nodules. Justified by the increasing number of reports in the literature about malignant tumors diagnosed from hot nodules, a systematic review was carried out to determine possible factors associated with the diagnosis of thyroid cancer from hot nodules in patients with hyperthyroidism. The results suggest that the clinical diagnosis of toxic nodular goiter, nodular lesions of diameter > 10 mm and a histological type compatible with a follicular carcinoma, are factors that on their own increase the risk of making the diagnosis of cancer from a hot nodule.
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Bonati E, Bettoni S, Loderer T, Del Rio P. Can we still consider thyroid hyperfunction a protective condition for the onset of thyroid cancer? Gland Surg 2021; 10:1359-1367. [PMID: 33968687 DOI: 10.21037/gs-20-688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Thyroid cancer is the ninth most commonly diagnosed cancer in the world, and the most common endocrine carcinoma. It was originally believed to be a rare event in patients with thyroid hyperfunction and it was reported that hyperthyroidism had a protective role against thyroid neoplasms. However, in recent years, several studies have hypothesized that differentiated thyroid carcinomas and hyperthyroidism may coexist. Our study aims therefore to evaluate the incidence of differentiated thyroid carcinomas on definitive histological examination, in patients undergoing total thyroidectomy or hemithyroidectomy with coexisting hyperfunctioning thyroid disease, to understand whether hyperthyroidism can be considered a protective condition against the onset of thyroid neoplasms. Methods The study involved 1,449 patients underwent to thyroid surgery from 2010 to 2018 at the General Surgery Unit, Department of Surgery, University Hospital of Parma, Parma, Italy, presenting thyroid cancer at postoperative histological exam. Patients were divided in two groups based on the presence (Group A) or absence (Group B) of hyperfunction. All data were collected in a dedicated database and include demographic data, such as age and sex, preoperative cytology, date and type of surgery, postoperative diagnosis, characteristics of aggressiveness of the neoplasm and postoperative complications. For data analysis, a P value of less than 0.05 was considered statistically significant. Results The incidence of thyroid carcinomas was lower in patients suffering from hyperfunction compared to the incidence found in non-hyperthyroid patients, both in preoperative cytological examination and in postoperative diagnosis through histological examination. Furthermore, the tumors that have developed in patients with hyperfunction had a comparable degree of aggression and invasiveness in the two groups studied. However, we have found an equal incidence of microcarcinomas and occult carcinomas on postoperative histological examination. Postoperative complications in patients with cancer were similar, regardless of the presence or absence of hyperfunctioning thyroid disease. Conclusions Our study confirms that hyperthyroidism is a protective condition against thyroid carcinoma, but the finding of an equivalent incidence of occult carcinomas in the two groups stresses the need to perform a cytological examination in case of a nodular pathology in a hyperthyroid patient before performing a treatment.
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Affiliation(s)
- Elena Bonati
- General Surgery Unit, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
| | - Stefania Bettoni
- General Surgery Unit, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
| | - Tommaso Loderer
- General Surgery Unit, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
| | - Paolo Del Rio
- General Surgery Unit, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
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Lau LW, Ghaznavi S, Frolkis AD, Stephenson A, Robertson HL, Rabi DM, Paschke R. Malignancy risk of hyperfunctioning thyroid nodules compared with non-toxic nodules: systematic review and a meta-analysis. Thyroid Res 2021; 14:3. [PMID: 33632297 PMCID: PMC7905613 DOI: 10.1186/s13044-021-00094-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/01/2021] [Indexed: 02/07/2023] Open
Abstract
Background Hyperfunctioning or hot nodules are thought to be rarely malignant. As such, current guidelines recommend that hot nodules be excluded from further malignancy risk stratification. The objective of this systematic review and meta-analysis is to compare the malignancy risk in hot nodules and non-toxic nodules in observational studies. Methods Ovid MEDLINE Daily and Ovid MEDLINE, EMBASE, Scopus, and Web of Science databases were searched. Observational studies which met all of the following were included: (1) use thyroid scintigraphy for nodule assessment, (2) inclusion of both hyperfunctioning and non-functioning nodules based on scintigraphy, (3) available postoperative histopathologic nodule results, (4) published up to November 12, 2020 in either English or French. The following data was extracted: malignancy outcomes include malignancy rate, mapping of the carcinoma within the hot nodule, inclusion of microcarcinomas, and presence of gene mutations. Results Among the seven included studies, overall incidence of malignancy in all hot thyroid nodules ranged from 5 to 100% in comparison with non-toxic nodules, 3.8–46%. Odds of malignancy were also compared between hot and non-toxic thyroid nodules, separated into solitary nodules, multiple nodules and combination of the two. Pooled odds ratio (OR) of solitary thyroid nodules revealed a single hot nodule OR of 0.38 (95% confidence interval (CI) 0.25, 0.59), toxic multinodular goiter OR of 0.51 (95% CI 0.34, 0.75), and a combined hot nodule OR of 0.45 (95% CI 0.31, 0.65). The odds of malignancy are reduced by 55% in hot nodules; however, the incidence was not zero. Conclusions Odds of malignancy of hot nodules is reduced compared with non-toxic nodules; however, the incidence of malignancy reported in hot nodules was higher than expected. These findings highlight the need for further studies into the malignancy risk of hot nodules. Supplementary Information The online version contains supplementary material available at 10.1186/s13044-021-00094-1.
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Affiliation(s)
- Lorraine W Lau
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Section of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Sana Ghaznavi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Section of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Alexandra D Frolkis
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Alexandra Stephenson
- Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Helen Lee Robertson
- Clinical Medicine. Health Sciences Library, University of Calgary, Calgary, Canada
| | - Doreen M Rabi
- Section of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ralf Paschke
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. .,Section of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. .,Departments of Oncology, Pathology, and Laboratory Medicine, Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Canada.
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12
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Rosario PW, de Castro Nicolau T. The value of ultrasonography for the indication of fine-needle aspiration in autonomous thyroid nodules. Diagn Cytopathol 2020; 49:363-366. [PMID: 33152168 DOI: 10.1002/dc.24659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/09/2020] [Accepted: 10/26/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The risk of malignancy in autonomous thyroid nodules is considered to be very low in adults and fine-needle aspiration (FNA) is not recommended in these cases; however, some studies contest this. Just as ultrasonography (US) has been used to select nonautonomous nodules with initial benign cytology that deserve FNA repetition, this method may also be useful to select autonomous nodules that are candidates for FNA. METHODS In this prospective study, FNA was obtained in 48 adults patients with autonomous solitary nodules >1 cm with suspicious US features (at least two of the following findings: hypoechogenicity, microcalcification, irregular margins, taller than wider shape, predominantly or exclusively central vascularization). RESULTS Cytology was benign in 28 patients (58.3%). Six patients (12.5%) had nondiagnostic cytology and histology revealed benign nodules in these cases. Cytology was indeterminate in nine other patients (18.5%). Of these, seven were adenomas and two were follicular carcinomas on histology. Finally, cytology suspicious for malignancy or malignant cytology was detected in five patients (10.4%), all of them confirmed histologically to be papillary carcinomas (the follicular variant in three). Thus, the frequency of malignancy was 14.6% (two follicular carcinomas and five papillary carcinomas), 8.3% in nodules with two suspicious findings vs 33.3% in nodules with ≥3 suspicious findings (P = .055). CONCLUSION The results suggest that the presence of ultrasonographic findings suspicious for malignancy in autonomous thyroid nodules >1 cm is a criterion for the indication of FNA.
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Affiliation(s)
- Pedro Weslley Rosario
- Santa Casa de Belo Horizonte (Endocrinology Department), Belo Horizonte, Minas Gerais, Brazil
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13
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Bilginer MC, Ozdemir D, Seyrek FNC, Yildirim N, Yazgan AK, Kilic M, Ersoy R, Cakir B. Evaluation of ultrasonographical and cytological features of thyroid nodules in patients treated with radioactive iodine for hyperthyroidism. Diagn Cytopathol 2019; 48:3-9. [PMID: 31674156 DOI: 10.1002/dc.24319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND In this study, we aimed to evaluate ultrasonographical and cytological features of thyroid nodules in patients who were treated with radioactive iodine (RAI) for hyperthyroidism years ago. METHODS Patients who had a history of RAI treatment for hyperthyroidism and had thyroid nodules that were evaluated with fine-needle aspiration biopsy (FNAB) were included in the study. RESULTS There were 27 patients (22 female and 5 male) with a mean age of 59.3 ± 13.5. The indication for RAI treatment was Graves in 5 (18.6%), toxic nodular or multinodular goiter in 16 (69.2%), and unknown in 6 (22.2%) patients. A total of 48 thyroid nodules were evaluated with FNAB and cytological diagnosis were benign in 24 (50.0%), nondiagnostic in 15 (31.2%), atypia of undetermined significance in 5 (10.4%), suspicous for malignancy in 2 (4.2%), and malignant in 2 (4.2%) nodules. Thyroidectomy was performed in 10 patients, 5 were benign (50.0%), and 5 (50.0%) were malignant histopathologically. Ultrasonography features of 31 cytologically/histopathologically benign and five cytologically/histopathologically malignant nodules were compared. Prevalence of isoechoic nodules was higher in benign nodules (P = .025). Macrocalcification was observed in 4 (80.0%) of malignant and 10 (32.3%) of benign nodules (P = .042). CONCLUSION In patients with a history of RAI treatment for hyperthyroidism, thyroid nodules with suspicious ultrasonography features, particulary hypoechoic appearence and macrocalcification, should be evaluated with FNAB irrespective of the time elapsed after RAI treatment.
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Affiliation(s)
- Muhammet C Bilginer
- Department of Endocrinology and Metabolism, SBU Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Didem Ozdemir
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Fatma N C Seyrek
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Nilufer Yildirim
- Department of Nuclear Medicine, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Aylin K Yazgan
- Department of Pathology Ankara, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Kilic
- Department of General Surgery, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
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