Evaluation of thyroid nodules by shear wave elastography: a review of current knowledge.

PURPOSE: Shear wave elastography (SWE), as a tool for diagnosing thyroid malignancy, has gathered considerable attention during the past decade. Diverging results exist regarding the diagnostic performance of thyroid SWE. METHODS: A comprehensive literature review of thyroid SWE was conducted using the terms "Thyroid" and "shear wave elastography" in PubMed. RESULTS: The majority of studies found SWE promising for differentiating malignant and benign thyroid nodules on a group level, whereas results are less convincing on the individual level due to huge overlap in elasticity indices. Further, there is lack of consensus on the optimum outcome reflecting nodule elasticity and the cut-off point predicting thyroid malignancy. While heterogeneity between studies hinders a clinically meaningful meta-analysis, the results are discussed in a clinical perspective with regard to applicability in clinical practice as well as methodological advantages and pitfalls of this technology. CONCLUSION: Technological as well as biological hindrances seem to exist for SWE to be clinically reliable in assessing benign and malignant thyroid nodules. Structural heterogeneity of thyroid nodules in combination with operator-dependent factors such as pre-compression and selection of scanning plane are likely explanations for these findings. Standardization and consensus on the SWE acquisition process applied in future studies are needed for SWE to be considered a clinically reliable diagnostic tool for detection of thyroid cancer.

Serum thyroxine and age--rather than thyroid volume and serum TSH--are determinants of the thyroid radioiodine uptake in patients with nodular goiter.

BACKGROUND: Radioiodine (131I) therapy is widely used for treatment of non-toxic goiters. A limitation for this treatment is a low thyroid radioiodine uptake (RAIU), often encountered in these patients. AIM: To estimate the impact of various factors on the thyroid RAIU. METHODS: We examined prospectively 170 patients (146 females; age range: 22-87 yrs) with nodular goiter (median 64 ml, range: 20-464 ml) selected for 131I therapy. Serum TSH was sub-normal in 42.4%. None were treated with anti-thyroid drugs. The thyroid RAIU was determined at 24h and 96 h. The goiter volume was measured by ultrasound (no.=127), or by magnetic resonance imaging (no.=43). RESULTS: The 24h and the 96 h RAIU were 34.2 ± 9.8(SD)% (range: 11.4-66.0%) and 34.0 ± 10.0% (range: 10.5-60.9%), respectively. Sixty-one patients had a 24h RAIU <30% and these individuals were older than patients with a 24h RAIU ≥ 30% (median 58 vs 51 yrs, p=0.02). These two subgroups did not differ significantly in other variables. Overall, the 24h RAIU was positively correlated to the serum (s) free T4-index (r=0.20, p=0.01), and negatively to age (r=-0.18, p=0.02), but not significantly related to serum TSH or thyroid volume. Age correlated positively with thyroid volume (r=0.31, p < 0.001). In a regression analysis, s-free T4-index and age remained as the only determinants of the 24h and the 96 h RAIU. CONCLUSIONS: In patients with a symptomatic nodular goiter, serum T4 and age are the major determinants of the thyroid RAIU. A sub-normal serum TSH is not a marker of a compromised thyroid RAIU but reflects that the iodine is confined to a few 'hot spots'.

External dose rates in radioiodine treatment of benign goitre: estimation versus direct measurement.

OBJECTIVE: According to European recommendations, the external dose rate (ED) in radioiodine-treated goitre patients can be determined by estimating from calculation of the residual activity (RA) in the patient based on radioiodine uptake measurements or by measuring ED directly. In the European guidelines, "Radiation Protection 97", it is assumed that an RA of 600 MBq (131)I causes an ED of 30 microSv/h at a distance of 1 m. This implies a slope of 0.05 microSv/h/MBq for the ratio ED/RA relationship, but, theoretically, this ratio is higher, at 0.07, a difference that is due to measurement in air versus in a scattering medium. We sought to investigate what the true ratio might be. MATERIAL AND METHODS: Sixty-six patients scheduled for radioiodine treatment of benign goitre (mean size 102 mL, range 20-440), who received (131)I orally (mean 984 MBq, range 173-3700) were examined. After 24 h and 96 h iodine uptake percentage we examined 7269 patients scheduled for radioiodine treatment of benign goitre (mean size 1042 mL, range 20-440) who received (131)I orally (mean 101,100 MBq, range 180-3700). After 24 h and 96 h, the iodine uptake was determined, RA calculated and ED measured using a hand-held dosimeter. RESULTS: At 24 and 96 h, we observed a slope ratio of 0.103 microSv/h/MBq (95 % CI: 0.09564-0.111) and 0.101 microSv/h/MBq (95 % CI: 0.0915-0.11107), respectively, for the ED/RA relationship. None of the confidence intervals included the value 0.05 microSv/h/MBq, reflecting that the observed slopes differed significantly from the expected slope (p < 0.001). Consequently, an RA of 600 MBq typically causes an ED of 60 and not 30 microSv/h, and therefore dose rates based on radioiodine uptake measurements and established assumptions were only about half as high as the directly measured values. We noticed that with an RA roughly below 450 MBq, the anticipated slope of 0.05 microSv/h/MBq is within the prediction interval of our claimed ratio, therefore we cannot rebut the anticipated slope for lower doses. CONCLUSIONS: Dose-rate estimates based on radioiodine uptake measurements and established assumptions were only about half as high as the directly measured values in patients receiving doses higher than the widely accepted limits for outpatient treatment. This finding may have substantial implications for us, in that it makes a considerable difference whether the radiation precautions are taken to limit doses to the patient's surroundings and for deciding if a patient may or may not be regarded as an outpatient, as well as for the safe discharge of an inpatient from hospital.

[Laryngeal tuberculosis. A rare, but important differential diagnosis to chronic laryngitis]. / Tuberkulose i larynx. En sjaelden, men vigtig differentialdiagnose til kronisk laryngitis.

A middle-aged native Danish man became aphonic with chronic laryngitis. The symptoms persisted despite antibiotic treatment, and chest X-ray disclosed a central pulmonary infiltrate. Histopathology on specimens from the larynx and lung and microscopy and culture of the sputum revealed primary lung tuberculosis with spread to the larynx. At presentation, laryngeal tuberculosis often mimics non-specific chronic laryngitis or laryngeal carcinoma. It should be suspected when the clinical course is unusual. Tuberculosis may develop in the absence of risk factors.