Preoperative subclinical hyperthyroidism in patients with papillary thyroid carcinoma

Thyroid functional parameters and correlative autoantibodies as prognostic factors for differentiated thyroid cancers

To evaluate the effect of preoperative thyroid functional parameters and thyroid autoantibodies on aggressive clinicopathologic features and lymph node metastasis (LNM) of differentiated thyroid cancer patients. Four hundred twenty consecutive patients with initial surgery were enrolled from July 2010 to July 2015. The associations between aggressive clinicopathologic and LNM factors and thyroid functional & autoantibodies parameters were analyzed. Higher levels of TSH, TGAb or TMAb were found in patients with tumor size≥1 cm (all P<0.05), especially when TSH≥2.5 ulU/ml (P=0.03) and TGAb≥1 (P=0.01). Higher levels of TSH and TGAb and lower levels of T3 and T4 were found in patients with capsular invasion (all P<0.05), particularly when TSH≥2.5ulU/ml (P=0.03) and TGAb≥1 (P=0.005). The patients with multifocality had higher TAbs level (TAbs>1). Higher level of TSH was also found in patients with central LNM (P=0.001) and lateral LNM (P=0.002), especially with TSH≥2.5ulU/ml (P=0.003 and P=0.03). TGAb level was also found higher in patients with central LNM (P=0.02) and lateral LNM (P=0.01), especially with TGAb≥1 (P<0.05 and P=0.01). Higher level of TMAb was found in patients with lateral LNM (P<0.05). Moreover, multivariable analysis revealed that only TGAb was an independently predictive factor for primary tumor size≥1cm (P=0.01); and TSH level (P=0.01) and TGAb≥1 (P<0.05) were associated independently with central LNM. Thus, TSH level and TGAb≥1 were significantly independent predictors for central LNM, and might help make the decision of central neck dissection.

The Association of Thyrotropin and Autoimmune Thyroid Disease in Developing Papillary Thyroid Cancer

BACKGROUND

Papillary thyroid carcinoma (PTC) is the most common type of malignant thyroid neoplasm. However, the incidence of PTC with autoimmune thyroid disease (AITD) varies between studies. This study aims to investigate whether patients with AITD have increased incidence of PTC. We also analyzed the relationship of serum thyroid-stimulating hormone (TSH) levels and PTC in relation to AITD based on histopathological data.

METHODS

A total of 533 participants who underwent thyroidectomy were enrolled in this retrospective study based on clinicohistopathological data and known thyroid autoantibodies. Patients were divided into PTC and benign groups according to histopathologic diagnosis. Age, gender, body mass index, and serum TSH level before thyroidectomy were recorded.

RESULTS

Of the 533 enrolled patients, 159 (29.8%) were diagnosed with PTC, of which 38 (35.5%) had Hashimoto's thyroiditis (HT). More patients with HT were female, and patients with HT, Graves' disease, and thyroid nodules with higher TSH level had a higher incidence of PTC.

CONCLUSIONS

A high proportion of the patients with PTC had HT. There was a trend that a higher serum TSH level was associated with a greater risk of thyroid cancer.

Inappropriate Suppression of Thyrotropin Concentrations in Young Patients with Thyroid Nodules Including Thyroid Cancer: The Fukushima Health Management Survey

BACKGROUND

Serum thyroid hormone concentration is regulated through the hypothalamic-pituitary-thyroid axis. This study aimed to clarify the relationships between thyroid hormone regulation and ultrasonographic findings in subjects with thyroid nodules detected during thyroid ultrasound examination for the Fukushima Health Management Survey.

METHODS

As of October 31, 2014, a total of 296,253 subjects, who had been living in Fukushima Prefecture at the time of the Fukushima nuclear power plant accident and were aged ≤18 years on March 11, 2011, participated in two concurrent screening programs. In the primary screening, thyroid nodules were detected in 2241 subjects. A secondary confirmatory thyroid ultrasound examination and blood sampling for thyroid function tests were performed on 2004 subjects. The subjects were reassessed and classified into disease-free subjects (Group 1), subjects with cysts only (Group 2), subjects with nodules (Group 3), and subjects with malignancy or suspected malignancy (Group 4). Serum concentrations of free triiodothyronine (fT3), free thyroxine (fT4), thyrotropin (TSH), thyroglobulin, and the fT3/fT4 ratio were classified according to the diagnoses.

RESULTS

Inverse relationships between age and log TSH values (Spearman's correlation r = -0.311, p = 0.015), serum fT3 concentration (r = -0.688, p < 0.001), and the fT3/fT4 ratio (r = -0.520, p < 0.001) were observed in Group 1. When analysis of covariance with Bonferroni post hoc comparisons was used in the four groups, the log TSH values were significantly lower in both Group 3 and Group 4 compared with Group 1 and Group 2 after correcting for age (p < 0.001; Group 1 vs. Group 3, p = 0.016; Group 1 vs. Group 4, p = 0.022; Group 2 vs. Group 3, p = 0.001; Group 2 vs. Group 4, p = 0.008). However, no significant differences were observed between the four groups regarding levels of fT3, fT4, fT3/fT4 ratio, and thyroglobulin (p = 0.304, 0.340, 0.208, and 0.583, respectively).

CONCLUSION

TSH suppression can be present in response to illness, including thyroid nodules, in young subjects. Low TSH levels may be associated with the finding of papillary thyroid cancer as well as with thyroid nodules in children and adolescents.

Thyroid nodules with repeat nondiagnostic cytologic results: the role of clinical and ultrasonographic findings

OBJECTIVES

Ultrasound-guided fine-needle aspiration (FNA) is the most valuable procedure in the diagnosis of thyroid nodules. One possible result of FNA of thyroid nodules, however, is "nondiagnostic" cytology. In these cases, consensus guidelines suggest repeating FNA with ultrasound guidance, but the results obtained may continue to be nondiagnostic. These results cause confusion due to the fact that there exist conflicting potential treatment modalities, such as performing diagnostic surgery or recommending follow-up. Hence, the present study aimed to establish a protocol for performing diagnostic operations for thyroid nodules with repeat nondiagnostic cytology.

MATERIALS AND METHODS

This study was performed on patients who underwent ultrasound-guided FNA and molecular testing for BRAF gene mutation. Out of 1,203 patients, 84 had nondiagnostic cytology and were BRAF negative, and ultrasound-guided FNA was repeated on these patients. Out of this group, 54 patients once again had nondiagnostic cytology, and 51 of these underwent diagnostic surgery. We analyzed the characteristics and ultrasonographic findings of the group of patients with repeat nondiagnostic cytology.

RESULTS

On the initial ultrasound-guided FNA, the percentage of patients with nondiagnostic cytology was 6.98 %, and on repeat ultrasound-guided FNA, the percentage of patients with nondiagnostic cytology was 67.5 %. The majority of these patients underwent diagnostic surgery, and 36 (70.6 %) patients were diagnosed as having a malignant thyroid nodule, while15 (29.4 %) patients were diagnosed with a benign nodule. Univariate analysis showed a significant difference in the size of the nodule, hypoechogenicity, and microcalcification in the ultrasonography findings. Multivariate analysis revealed only hypoechogenicity as a factor that showed a significant difference (p value 0.017, 95 % confidence interval 1.494-62.426).The diagnostic accuracy of the ultrasonography was 76.5 %.

CONCLUSIONS

Hypoechogenicity on ultrasonography represents an excellent parameter for the selection of those who should be referred for diagnostic operation among patients with thyroid nodules and repeat nondiagnostic cytology.

The prevalence of thyroid cancer in patients with hyperthyroidism

OBJECTIVES

To determine the prevalence of thyroid cancer in patients with hyperthyroidism.

METHODS

This is a retrospective observational study using the data of 71 Omani patients with a diagnosis of hyperthyroidism due to Grave's disease, toxic multinodular goiter, and solitary toxic adenoma. These patients underwent thyroidectomy at the Royal Hospital (RH), Muscat, Oman, and were followed up at the National Diabetes and Endocrine Center (NDEC) between 2007 and 2013. The details were collected from the medical records of both the RH and the NDEC. Patients who underwent thyroidectomy for other reasons like non-toxic goiter and hypothyroidism with cancer were excluded from the study.

RESULTS

Thyroid cancer was identified in 32.8% (n=23) of patients with hyperthyroidism. Half of these patients 52.1% (n=12) had papillary micro-cancer (intra-thyroidal), and 3 patients with Grave's disease (13%) had lymph nodes metastasis (loco-regional infiltration. The cancer preponderance was higher in young (n=21, 91.3%) and female patients (n=18, 73.9%). Most patients with thyroid cancer had abnormal ultrasound neck findings and thyroid scintigraphy (99 mTc uptake).

CONCLUSION

Many patients with hyperthyroidism in Muscat, Oman, especially those with Grave's disease, show malignancy, and hence a proper initial evaluation of these patients is required as part of long-term management.