The impact of nodule size on malignancy risk in indeterminate thyroid nodules.

Background: The association between malignancy risk and nodule size in indeterminate thyroid nodules (ITNs) remains controversial. Thus, we aimed to explore the impact of nodule size as a predictor of cancer in patients with ITNs. Methods: This cross-sectional study assessed 113 patients who underwent surgical intervention for ITNs, comparing two groups based on nodule size (≥4 or <4 cm). The correlation between nodule size and malignancy risk was examined. Other variables of interest included demographics, thyroid-stimulating hormone (TSH) levels, type of surgery, and ultrasound features. Results: Of the 113 patients, 88.5% were aged <55 years, 76.1% were women, and 65.5% had nodules <4 cm. Mean nodule size was 3.4±2.3 cm. There was no significant correlation between malignancy risk and nodule size (P=0.55). An association was observed between <4 cm nodules and elevated TSH levels (P=0.03) and between ≥4 cm nodules and the presence of hypervascularity (P=0.04). Nodules <4 cm were more likely to have extrathyroidal extension, lymphovascular invasion, and positive margins than those ≥4 cm; however, this was not significant. Conclusions: Our findings showed no association between nodule size and malignancy risk, suggesting that size alone is not a predictor of cancer development. Further prospective studies are required to confirm these results.

Is the nodule location a predictive risk factor for cancer in AUS/FLUS thyroid nodules? A retrospective cohort study.

BACKGROUND: Atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is a heterogeneous category of thyroid nodules with uncertain cytology and controversial management. This study aimed to assess the association between nodule location and malignancy risk and whether the location can be used as a predictive risk factor for cancer in AUS/FLUS nodules. METHODS: A cohort of 102 patients (79 [77.5%] women, 23 [22.5%] men) was retrospectively analyzed. Only patients with a final histopathology of benign or well-differentiated thyroid cancer and an available nodule location were included. Sociodemographic, histopathological, and sonographic data were statistically evaluated and correlated. RESULTS: Based on pathology findings, 54 (52.9%) and 48 (47.1%) nodules were benign and malignant, respectively. Most nodules were right-sided (54.9%). Considering the nodule location, 41.2% of nodules occupied the whole lobe, 20.6% only the lower pole, 15.7% only the upper pole, and 2.9% the isthmus. Cases with nodules occupying only the upper, middle, or lower pole showed significant associations with cancer risk (odds ratio, [95% confidence interval]: 2.6, [1.1-5.7]; 2.0, [1.0-4.7]; and 1.9, [1.0-3.9], respectively). Male sex and the presence of a peripheral halo were significantly associated with malignancy risk (3.3, [1.2-9.1], P = 0.014; and 2.7, [1.0-9.5], P = 0.049, respectively). Isthmic nodules had the highest malignancy level (66.7%). CONCLUSIONS: Nodule location is a promising predictor of malignancy in AUS/FLUS nodules. Furthermore, isthmic nodules had the highest malignancy level, emphasizing the significance of careful evaluation of these nodules. Further large prospective studies are required to confirm these findings.

Weighty Matters: The Obesity-Thyroid Nodule Connection Unveiling the Impact of Obesity on Thyroid Cancer Risk.

Background and Objectives: The effect of obesity on the development/progression of thyroid nodules with uncertain cytology is unknown. Therefore, our objective was to assess the role of body mass index (BMI) in predicting malignancy in patients with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) nodules. Materials and Methods: We retrospectively analyzed 113 patients with available BMI data and final histopathology of benign or differentiated thyroid cancer. Patients were classified into four groups based on BMI: <18.5 (underweight), 18.5-24.9 (normal weight), 25-29.9 (overweight), and ≥30 (obesity) kg/m2. The association between risk of malignancy and BMI was examined for all data and subgroups based on nodule size, sex, and age. Results: Overall, 44.2% were obese, 36.3% were ≥45 years, and 75.4% were women. Final pathological results showed malignant nodules in 52 patients (46%) and benign nodules in 61 patients (54%) (mean age: 41 ± 11.6 vs. 39.9 ± 11.7 years; p = 0.62). Men had more malignant nodules than benign nodules (32.7% vs. 16.4%, p < 0.05). Overall, no significant correlation was identified between the risk of thyroid cancer and BMI, and the risk of malignancy was not significantly different between obese men and women (p = 0.4). However, in individuals with BMI < 30 kg/m2 (non-obese group), malignant nodules were more frequent in men than in women (71% vs. 41%, p = 0.04). No significant difference was observed in mean nodule size between the benign and malignant groups. Furthermore, BMI was not related to increased risk of malignancy in multiple logistic regression models using all data, even after controlling for confounding variables (odds ratio, 0.99, 95% confidence interval: 0.93-1.06, p = 0.87) or when stratifying by sex. Conclusions: Our study showed no correlation between obesity and thyroid cancer in patients with AUS/FLUS. Moreover, men had more malignant nodules than benign nodules. Further well-designed prospective studies are required to confirm our findings.

Recurrent laryngeal nerve injury after thyroidectomy: A national study from Saudi Arabia.

OBJECTIVES: To determine the incidence and possible risk factors of recurrent laryngeal nerve injury, to provide a relevant literature review of studies from other centers in Saudi Arabia, and to present basic statistical data for future studies in our local community. METHODS: A retrospective study enrolled patients who were surgically treated for thyroid disease between January 2015 and December 2021. For concerns during the procedure, direct laryngoscopy was carried out before extubation to assess the vocal cords. Similarly, indirect laryngoscopy was carried out for patients who developed postoperative voice changes. All patients were evaluated clinically 2-3 weeks after surgery. Nerve monitors were not used in either case. RESULTS: The study examined 437 participants: 361 (82.6%) female and 76 (17.4%) male individuals. The incidence of recurrent laryngeal nerve injury was 1.1%. The demographic characteristics, pathology (benign vs. malignant), and extent of thyroidectomy were not significantly associated with the risk of recurrent laryngeal nerve injury. CONCLUSION: A recurrent laryngeal nerve injury is a serious complication, and further studies are required to determine the safest techniques for thyroidectomy. However, centralization of thyroid surgery in high-volume centers might reduce this risk.

Clinical and ultrasonographic features in cancer risk stratification of indeterminate thyroid nodules.

OBJECTIVES: To estimate the risk of malignancy in indeterminate thyroid nodules and to determine whether certain clinical or radiological parameters can predict the risk of malignancy. METHODS: This retrospective study enrolled all adult patients (age ≥14 years) with a cytological diagnosis of atypia/follicular lesion of undetermined significance and follicular neoplasm/suspicious for a follicular neoplasm between January 2014 and January 2020. Fifty patients with surgically treated primary thyroid nodules, documented final histological diagnosis, and ultrasound examination records were included. Thyroid nodules were evaluated radiologically using Thyroid Imaging Reporting and Data System introduced by the American College of Radiology (2017). RESULTS: Forty-two (84.0%) female and 8 (16.0%) male patients were enrolled in the study. The malignancy risks were 44.8% for Bethesda III and 28.6% for Bethesda IV. The malignancy risks for the Thyroid Imaging Reporting and Data System categories were 33.3% (TR2), 39.1% (TR3), 35.3% (TR4), and 50% (TR5). No significant associations were observed between age, gender, Bethesda category, and Thyroid Imaging Reporting and Data System and the risk of malignancy. CONCLUSION: None of the clinical or radiological characteristics evaluated in this study contributed to the cancer risk stratification of thyroid nodules with indeterminate cytology. A prospective multicenter study is needed to better understand cytologically indeterminate thyroid nodules.

Port-a-Cath Insertion in Pediatric Patients With Malignancy in Tabuk.

Objectives A port-a-cath has become the cornerstone of supportive care and therapy for most childhood malignancies. It is routinely used in children for recurrent blood sampling or intravenous therapies. This study aimed to investigate the complications of port-a-cath insertion in children, the reasons for its removal or reinsertion, and to compare open and percutaneous techniques of insertion in pediatric patients with cancer in the northwest region of Saudi Arabia. Materials and methods This is a retrospective observational study, which reviews pediatric cases that underwent port-a-cath insertion between 2008 and 2017. Their medical records were assessed for patient characteristics, indications for insertion, the nature of port use, their reasons for removing them, and port-related complications.  Results We included 64 patients who had a total of 79 port-a-cath insertions in this study. The median age at first insertion was 38 months (51.56% female, 48.44% male). The mean duration between the first insertion and the removal of the port-a-cath was 36 ± 17 months. The right internal jugular vein was used in most cases. The rate of complications at our institution was 9.38%. Conclusions In pediatric cancer patients, a port-a-cath can be safely used, is associated with minimal complications, and can be easily managed without serious complications. The most common complications were attributed to infections, followed by the malfunction and obstruction of ports.

Post-Thyroidectomy Hypocalcemia: A Single-Center Experience.

Introduction Thyroidectomy is a frequent operation performed worldwide. The most common complication following thyroid surgery is hypocalcemia, caused by transient or persistent hypoparathyroidism. This study aimed to investigate the prevalence of hypocalcemia after thyroidectomy and to identify potential risk factors. Methods All thyroidectomies performed at a single tertiary center between 2012 and 2017 were retrospectively analyzed. Post-thyroidectomy hypocalcemia was evaluated in relation to risk factors such as age, sex, procedure type, and type of thyroid disease. Data were extracted from patient medical records. Patients with pre-operative hypocalcemia were excluded. Results We enrolled 182 patients who underwent thyroidectomy. Female patients comprised 83% (n = 151) of the total patients. Of all patients, 116 (63.7%) had developed post-operative temporary hypocalcemia and three (1.6%) had persistent hypocalcemia. Remarkably, no cases of mortality were reported. There was no significant relationship between the occurrence of hypocalcemia and age, type of thyroid disease, and sex. Conversely, there was a significant relationship between the development of hypocalcemia and the type of procedure (P < 0.001). Conclusion Thyroidectomy is a safe surgery with few complications when performed by a skilled surgeon. These complications result in longer hospital stays and higher costs. The most common post-thyroidectomy complication was hypocalcemia. Furthermore, patients who underwent total thyroidectomy were at the greatest risk of developing post-thyroidectomy hypocalcemia.