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Prévot J, Potard G, Thuillier P, Roudaut N, Le Pennec R, Leclère JM, Mahéo C, Marianowski R, Leclère JC. Risk factors for hypothyroidism following hemithyroidectomy. ANNALES D'ENDOCRINOLOGIE 2023; 84:739-745. [PMID: 37517518 DOI: 10.1016/j.ando.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Hypothyroidism is the most common complication of hemithyroidectomy for thyroid nodules. This retrospective cohort study investigated the prognostic factors for hypothyroidism following hemithyroidectomy. METHODS We included patients who underwent hemithyroidectomy between 2016 and 2017, excluding those with history of preoperative hypothyroidism or malignancy on histopathological examination. The primary endpoint was development of hypothyroidism during follow-up (TSH≥2 above normal). RESULTS Twenty-six of the 128 included patients (20%) developed postoperative hypothyroidism. The following independent prognostic factors were found: preoperative TSH level>1.5 mIU/L (OR 2.11; P=0.013), and remaining thyroid volume adjusted for body surface area<4.0mL/m2 (OR 1.77; P=0.015). Twenty-one patients (81%) had first TSH values above the upper limit of normal. Postoperatively, first TSH level correlated significantly with the preoperative value (R=0.5779, P<0.001). Levothyroxine was prescribed to 16% of patients, with a mean dose of 0.92μg/kg/day. CONCLUSION Patients with TSH>1.5 mIU/or remaining thyroid volume adjusted for body surface area<4.0mL/m2 should have intensified clinical and biological follow-up in the first year after surgery.
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Affiliation(s)
- Julien Prévot
- Department of Head, Neck surgery, University Hospital of Brest, 4, avenue Foch, 29200 Brest, France
| | - Gaël Potard
- Department of Head, Neck surgery, University Hospital of Brest, 4, avenue Foch, 29200 Brest, France
| | - Philippe Thuillier
- Department of Endocrinology, University Hospital of Brest, Brest, France
| | - Nathalie Roudaut
- Department of Endocrinology, University Hospital of Brest, Brest, France
| | - Romain Le Pennec
- Department of Nuclear Medicine, University Hospital of Brest, Brest, France
| | - Jean-Michel Leclère
- Department of Head, Neck surgery, University Hospital of Brest, 4, avenue Foch, 29200 Brest, France; School of Medicine, University of Limerick, Limerick, Ireland
| | - Clémentine Mahéo
- Department of Head, Neck surgery, University Hospital of Brest, 4, avenue Foch, 29200 Brest, France
| | - Rémi Marianowski
- Department of Head, Neck surgery, University Hospital of Brest, 4, avenue Foch, 29200 Brest, France
| | - Jean-Christophe Leclère
- Department of Head, Neck surgery, University Hospital of Brest, 4, avenue Foch, 29200 Brest, France.
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Yan Y, Dong J, Li S, Yang G, Huang K, Tian W, Su J, Zhang Z. Risk factors associated with the prevalence of thyroid nodules in adults in Northeast China: a cross-sectional population-based study. BMJ Open 2023; 13:e069390. [PMID: 37907298 PMCID: PMC10619099 DOI: 10.1136/bmjopen-2022-069390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/18/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVES This study examined the association between anthropometric measurements, lifestyle factors and the prevalence of thyroid nodules among adults in Northeast China. DESIGN We employed a cross-sectional approach involving a questionnaire survey, which focused on participants' living habits, and a physical examination that included anthropometry and ultrasound imaging. SETTING The data were procured during multiple trips by medical teams from the first hospital of China Medical University to towns in Northeast China. PARTICIPANTS Of the 1092 participants, 489 did not have thyroid nodules (mean age: 54.02±11.49 years; 297 females (60.7%)), 99 had single thyroid nodules (mean age: 58.19±10.77 years; 59 females (59.6%)) and 504 had multiple thyroid nodules (mean age: 60.05±10.68 years; 394 females (78.2%)). Inclusion criteria mandated participants be over 20 years old without other medical conditions. We excluded individuals who had undergone surgical resection for thyroid nodules. RESULTS The prevalence of thyroid nodules was significantly associated with being female (OR 2.569, 95% CI 1.937 to 3.405, p<0.001) and increased age (OR 1.054, 95% CI 1.041 to 1.066, p<0.001). This association was more pronounced in those with multiple thyroid nodules. For males under 60, non-smoking was inversely correlated with the prevalence of multiple thyroid nodules (OR 0.321, 95%CI 0.149 to 0.69, p<0.05). For females under 60, diastolic blood pressure (DBP) was significantly linked with the prevalence of thyroid nodules (OR 0.978, 95% CI 2.614 to 2.705, p<0.05). CONCLUSIONS Besides gender and age, the prevalence of thyroid nodules in Northeast China correlates with smoking habits and DBP.
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Affiliation(s)
- Yudie Yan
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Junhe Dong
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shufeng Li
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Guochun Yang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Kunbo Huang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wen Tian
- Department of Geriatric, the First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China
| | - Jingtong Su
- Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Zhen Zhang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Brigante G, Monzani ML, Locaso M, Gnarini VL, Graziadei L, Kaleci S, De Santis MC, Tagliavini S, Simoni M, Rochira V, Madeo B. De novo Lesions Frequently Develop in Adult Normal Thyroid Over Almost Six Years. Front Endocrinol (Lausanne) 2020; 11:18. [PMID: 32082257 PMCID: PMC7001274 DOI: 10.3389/fendo.2020.00018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/10/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: In order to understand how thyroid abnormalities emerge over time in adults, we evaluated incidence of thyroid diseases in healthy subjects, after almost 6 years from a previous negative ultrasound. Methods: Anamnestic and physical data were collected. Ultrasound neck evaluation was performed by an experienced endocrinologist, recording detailed thyroid and nodules characteristics. Nodules were classified according to American Thyroid Association classification for prediction of cancer risk. Serum samples were collected for subsequent evaluations (TSH, free thyroid hormones, calcitonin, anti-thyroid antibodies). Anamnestic, clinical, sonographic, and serological characteristics were analyzed with logistic regression analysis for subjects with nodules vs. those without. Results: One hundred and eleven subjects were enrolled (43M, 68F). Half of them developed nodules, mainly smaller than 1 cm and without suspicious characteristics. Ninety-seven percent were euthyroid. Only 4% had serological diagnosis of thyroiditis. Incidence of thyroid diseases was higher in women, especially nulliparous. Comparing clinical characteristics of subjects with and without nodules, the only statistically significant difference concerned thyroid volume adjusted for body weight or surface (p < 0.05), but not residual volume excluding nodules. Multivariate logistic regression analysis showed that female gender, higher BMI-adjusted thyroid volume and residual thyroid volume excluding nodules, nulliparity, age, and fT3 increase the risk of developing nodules. Conclusions: These results demonstrate that adult thyroid tissue undergoes changes that are already detectable by US after almost 6 years. Half of the enrolled subjects developed de novo nodules or colloid cysts of poor clinical relevance.
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Affiliation(s)
- Giulia Brigante
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Maria Laura Monzani
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Michela Locaso
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Valentina Luisa Gnarini
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Graziadei
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Shaniko Kaleci
- Department of Diagnostic Medicine, Clinics and Public Health, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Maria Cristina De Santis
- Department of Laboratory Medicine and Pathology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Simonetta Tagliavini
- Department of Laboratory Medicine and Pathology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Manuela Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Bruno Madeo
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- *Correspondence: Bruno Madeo
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Zatelli MC, Lamartina L, Meringolo D, Arvat E, Damiani L, Grani G, Nervo A, Durante C, Giacomelli L. Thyroid nodule recurrence following lobo-isthmectomy: incidence, patient's characteristics, and risk factors. J Endocrinol Invest 2018; 41:1469-1475. [PMID: 30182360 DOI: 10.1007/s40618-018-0946-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/11/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE This study was aimed at assessing the incidence and timing of thyroid nodules recurrence, defined as appearance of new benign or malignant nodules in contralateral lobe in patients with benign thyroid nodules or thyroid microcarcinoma treated with lobo-isthmectomy. Patient's characteristics and risk factors associated with this phenomenon were also investigated. METHODS A retrospective study was performed by evaluating 413 patients undergoing lobo-isthmectomy with a minimum follow-up of 1 year. Clinical characteristics, surgical interventions and complications, histological diagnosis, and thyroid function at last follow-up were collected. RESULTS Single or multiple thyroid nodule recurrence equally occurred in 80 patients (23%) with a median time to relapse of ~ 5 years (range 0.3-34.5 years) after lobo-isthmectomy. Recurrence was significantly associated with younger age (< 46 years) and number of pregnancies in women. Development of hypothyroidism was not rare either (~ 10%) and appeared in 3-19 months; a preoperative TSH level > 2.43 mIU/L was associated with the need of l-thyroxin replacement therapy after surgery. The most frequent surgical complication was transient hypoparathyroidism (4.6%), while the rate of permanent hypoparathyroidism significantly increased in patients submitted to completion thyroidectomy (5.3%). CONCLUSIONS Thyroid nodules recurrence following lobo-isthmectomy is not a rare event and occurs within 5 years after surgery, more frequently in younger patients with family history of nodular goiter and in women with multiple pregnancies. Pre-surgical TSH levels may predict the development of post-surgical hypothyroidism, possibly improving the management of patients addressed to surgery.
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Affiliation(s)
- M C Zatelli
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
| | - L Lamartina
- Department of Internal Medicine and Medical Specialties, University of Rome 'Sapienza', Rome, Italy
| | - D Meringolo
- Endocrinology Unit, AUSL Bologna-Bentivoglio Hospital, Bologna, Italy
| | - E Arvat
- Division of Oncological Endocrinology, Department of Medical Sciences, Azienda Ospedaliera Città DELLA Salute E Della Scienza, Turin, Italy
| | - L Damiani
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - G Grani
- Department of Internal Medicine and Medical Specialties, University of Rome 'Sapienza', Rome, Italy
| | - A Nervo
- Division of Oncological Endocrinology, Department of Medical Sciences, Azienda Ospedaliera Città DELLA Salute E Della Scienza, Turin, Italy
| | - C Durante
- Department of Internal Medicine and Medical Specialties, University of Rome 'Sapienza', Rome, Italy
| | - L Giacomelli
- Department of Surgical Sciences, University of Rome 'Sapienza', Rome, Italy
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Grani G, Lamartina L, Biffoni M, Giacomelli L, Maranghi M, Falcone R, Ramundo V, Cantisani V, Filetti S, Durante C. Sonographically Estimated Risks of Malignancy for Thyroid Nodules Computed with Five Standard Classification Systems: Changes over Time and Their Relation to Malignancy. Thyroid 2018; 28:1190-1197. [PMID: 30105949 DOI: 10.1089/thy.2018.0178] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Over 50% of newly diagnosed thyroid nodules are either cytologically benign or presumed to be benign on the basis of low-suspicion sonographic findings. The strategies used for their long-term surveillance are based mainly on the estimated residual risk of malignancy calculated with various ultrasonographic classification systems (e.g., Thyroid Image Reporting and Data Systems [TIRADS]). We conducted a longitudinal study to evaluate the temporal stability of the initial risk estimates computed with five widely used systems and to determine whether risk class increases during follow-up are indeed predictive of malignancy. METHODS We re-analyzed data prospectively collected at a single academic referral center on 232 patients (age: 54.1 ± 13.7 years) with 432 asymptomatic, sonographically or cytologically benign thyroid nodules at baseline (T0) and 122 new nodules that were present five years later (T5). At both time points, the sonographically estimated risk of malignancy was calculated as recommended by the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi, the American College of Radiologists' TIRADS, the American Thyroid Association's 2015 practice guidelines, the European Thyroid Association's TIRADS (EU-TIRADS), and the TIRADS of the Korean Society of Thyroid Radiology (K-TIRADS). RESULTS For 57 to 127 (13.2-29.4%) of the original nodules, depending on the system used, the estimated malignancy risk increased over the 5-year interval. Of the nodules whose baseline risk had not warranted cytological assessment, very few (6.3-8.3%) met the criteria for cytology at the 5-year evaluation. Biopsy was indicated for only 4 to 8 (3.3-6.6%) of the new nodules based on T5 risk estimates. Despite these changes, none of the 232 patients was ever diagnosed with a cancer. CONCLUSIONS Ultrasound-based risk classes of presumably benign thyroid nodules remain fairly stable over time, and changes warranting biopsy are rare indeed. The appearance of new nodules is a frequent event, but very few (<5%) are classified as high risk, and only the 3-7% meet the criteria for cytological assessment. Collectively, these findings support the view that patients with presumably benign thyroid nodules can be safely followed with less intensive protocols.
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Affiliation(s)
- Giorgio Grani
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
| | - Livia Lamartina
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
| | - Marco Biffoni
- 2 Dipartimento di Scienze Chirurgiche, and Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
| | - Laura Giacomelli
- 2 Dipartimento di Scienze Chirurgiche, and Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
| | - Marianna Maranghi
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
| | - Rosa Falcone
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
| | - Valeria Ramundo
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
| | - Vito Cantisani
- 3 Unitá Operativa Semplice Innovazioni Diagnostiche e Ultrasonografiche, Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
| | - Sebastiano Filetti
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
| | - Cosimo Durante
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
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Grani G, Lamartina L, Cantisani V, Maranghi M, Lucia P, Durante C. Interobserver agreement of various thyroid imaging reporting and data systems. Endocr Connect 2018; 7:1-7. [PMID: 29196301 PMCID: PMC5744624 DOI: 10.1530/ec-17-0336] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 11/09/2017] [Indexed: 12/29/2022]
Abstract
Ultrasonography is the best available tool for the initial work-up of thyroid nodules. Substantial interobserver variability has been documented in the recognition and reporting of some of the lesion characteristics. A number of classification systems have been developed to estimate the likelihood of malignancy: several of them have been endorsed by scientific societies, but their reproducibility is yet to be assessed. We evaluated the interobserver variability of the AACE/ACE/AME, ACR, ATA, EU-TIRADS and K-TIRADS classification systems and the interobserver concordance in the indication to FNA biopsy. Two raters independently evaluated 1055 ultrasound images of thyroid nodules identified in 265 patients at multiple time points, in two separate sets (501 and 554 images). After the first set of nodules, a joint reading was performed to reach a consensus in the feature definitions. The interobserver agreement (Krippendorff alpha) in the first set of nodules was 0.47, 0.49, 0.49, 0.61 and 0.53, for AACE/ACE/AME, ACR, ATA, EU-TIRADS and K-TIRADS systems, respectively. The agreement for the indication to biopsy was substantial to near-perfect, being 0.73, 0.61, 0.75, 0.68 and 0.82, respectively (Cohen's kappa). For all systems, agreement on the nodules of the second set increased. Despite the wide variability in the description of single ultrasonographic features, the classification systems may improve the interobserver agreement that further ameliorates after a specific training. When selecting nodules to be submitted to FNA biopsy, that is main purpose of these classifications, the interobserver agreement is substantial to almost perfect.
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Affiliation(s)
- Giorgio Grani
- Department of Internal Medicine and Medical Specialties'Sapienza' University of Rome, Rome, Italy
| | - Livia Lamartina
- Department of Internal Medicine and Medical Specialties'Sapienza' University of Rome, Rome, Italy
| | - Vito Cantisani
- UOS Innovazioni Diagnostiche e UltrasonograficheAzienda Ospedaliera Universitaria Policlinico Umberto I, 'Sapienza' University of Rome, Rome, Italy
| | - Marianna Maranghi
- Department of Internal Medicine and Medical Specialties'Sapienza' University of Rome, Rome, Italy
| | - Piernatale Lucia
- Department of Internal Medicine and Medical Specialties'Sapienza' University of Rome, Rome, Italy
| | - Cosimo Durante
- Department of Internal Medicine and Medical Specialties'Sapienza' University of Rome, Rome, Italy
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