Association between lifestyle and anthropometric parameters and thyroid nodule features.

PURPOSE: Thyroid nodularity has been associated with obesity, but data regarding associations of body composition parameters with specific ultrasound features of thyroid nodules are lacking. The aim of the present study was to assess associations between thyroid nodule ultrasound characteristics, lifestyle, and anthropometric parameters. SUBJECTS AND METHODS: This was a cross-sectional study in the general apparently healthy population of Northern Greece. Thyroid ultrasound data together with medical history, demographic, and anthropometric characteristics were individually recorded. Body composition was evaluated using bioelectrical impedance. RESULTS: Three hundred and six subjects [215 females (70.3%), aged 20-83 years] were included. Ultrasound revealed one or more thyroid nodules in 168 subjects (54.9%). Subjects with thyroid nodules were more frequently females (p = 0.033), older (p < 0.001) and had higher fat mass (p = 0.011), total body fat percentage (p < 0.001) and waist circumference (p = 0.045) than subjects without nodules. In logistic regression analyses, age and female gender were the only independent predictors of presence of thyroid nodules, as well as specific sonographic features. Additionally, total body fat percentage was positively correlated with nodule size (rho = 0.210, p = 0.006) and was the only independent predictor of hypoechoic thyroid nodule(s) and peripheral vascularity, while lack of exercise was predictive of internal vascularity. CONCLUSIONS: Body fat accumulation and lack of exercise, used as surrogate markers of sedentary lifestyle, influence thyroid nodule size and could predict some ultrasonographic characteristics, like hypoechoicity and internal vascularity. Therefore, routine thyroid examination of obese patients and promotion of active lifestyle may be warranted to prevent thyroid nodule formation and possibly progression to malignancy.

Breast Metastasis from Medullary Thyroid Carcinoma in a Male Patient: Case Report and Review of the Literature.

Medullary thyroid carcinoma (MTC) is a rare malignancy that may metastasize to liver, lungs and bones. Breast is an unusual metastatic site for MTC and only 20 female cases have been reported in the literature. We present a male patient in whom histological examination and immunohistochemistry of a breast mass were indicative of breast metastasis from MTC. A 67-year-old man with recent diagnosis of MTC and metastases to cervical and upper mediastinum lymph nodes was referred to our department for further treatment. At first evaluation, diagnostic imaging techniques showed lung and bone metastases and three months later the presence of liver metastases. Due to the extension of the disease, treatment with vandetanib was decided, but serious adverse events led to its interruption after two weeks. During follow-up, patient developed a painful swelling in the right breast. Ultrasound and mammography showed the presence of multiple masses to the right breast suspicious for malignancy. Core needle biopsy and histological examination of the specimen confirmed the presence of metastatic MTC. Palliative external beam irradiation was used to relieve local pain and, after one month, the patient died. Consequently, breast masses should be cautiously evaluated, mainly in the presence of a known primary malignancy. Histological and/or cytopathological examination are requisite diagnostic tools, while external beam irradiation and tyrosine kinase inhibitors may be used as palliative therapies in the concurrent presence of breast metastases from MTC.