THYROID SCREENING AND RELIABILITY OF RADIATION THYROID DOSES FOR THE BELARUSIAN IN UTERO COHORT.

OBJECTIVE: To describe the status and results of thyroid disease screening and assessment of reliability of radiationthyroid doses in the Belarusian in utero cohort of 2,965 individuals exposed to Chernobyl (Chornobyl) fallout. MATERIALS AND METHODS: Thyroid screening examinations are currently underway including thyroid palpation by anendocrinologist, ultrasonographic examination by an ultrasonographer and analysis of blood samples for diagnosisof hypo- and hyperthyroidism, autoimmune thyroiditis, thyroid function tests (thyroid-stimulating hormone [TSH],thyroxine [T4], thyroid peroxidase antibody [anti-TPO], and thyroglobulin antibodies [anti-TG]). Reliability of (i)information from 780 pairs of questionnaires obtained during the first and second interviews of the mothers and (ii)thyroid doses, which were calculated for the cohort members using this information, is evaluated. RESULTS: As of 15 August 2021, 1,267 in utero exposed study subjects had been screened. A single thyroid nodule wasdiagnosed in 167 persons (13.2 % of the total) and multiple thyroid nodules in 101 persons (8.0 %): 189 (14.9 %)persons had nodules detected for the first time at the screening while 79 (6.2 %) persons had nodules detected pre-viously (pre-screening nodules). Fifty-nine out of 268 subjects (22.0 %) with a suspicious thyroid nodule werereferred to fine needle aspiration biopsy, and among them 33 (55.9 %) were biopsied. Reasonable agreement wasobserved for modelqbased doses calculated for the Belarusian in utero cohort members using data from the two inter-views (Spearman's rank-correlation coefficient rs = 0.74, p < 0.001), while measurementqbased doses yielded almost per-fect agreement (rs = 0.99, p < 0.001). CONCLUSIONS: During the thyroid screening, at least one thyroid nodule was identified in 268 of 1,267 (21.2 %) inutero exposed cohort members. Seven thyroid cancer cases were identified in the cohort, including 5 pre-screeningcases and 2 cases detected during the screening. Ongoing research on this unique cohort will provide importantinformation on adverse health effects following prenatal and postnatal exposure to radioiodine and radiocesium iso-topes, for which available epidemiological data are scant.

Should Contralateral Nodules Be an Indication of Total or Completion Thyroidectomy for Patients With Unilateral Papillary Thyroid Carcinoma?

Objective: To determine whether papillary thyroid carcinoma (PTC) patients with benign or nonsuspicious nodules in the contralateral lobe have a higher rate of recurrence or worse survival after lobectomy compared to those without nodules in the contralateral lobe. Methods: Adult patients who underwent lobectomy and were diagnosed with unilateral PTC (2013-2015), were identified from an institutional database. Patients who previously had cytologically benign nodules or nonsuspicious nodules in the contralateral lobe comprised the contralateral nodule (CN) group. Patients who did not have nodules in the contralateral lobe comprised the unilateral nodule (UN) group. Results: 370 patients were included: 242 in the UN group and 128 in the CN group. After a median follow-up of 62 months (range, 16-85 months), recurrence was confirmed in 4.1% patients in the UN group and 5.5% patients in the CN group (p = 0.559). Clinical contralateral lobe PTC was detected in 2.9% (7/242) of patients from the UN group and 3.9% (5/128) of patients from the CN group (p = 0.601). The 5-year contralateral lobe recurrence-free survival (RFS) rates were 96.8% in the UN group and 97.4% in the CN group (p = 0.396). The 5-year loco-regional RFS rates were 98.4% in the UN group and 97.8% in the CN group (p = 0.690). The 5-year disease-specific survival rates were both 100%. Conclusion: PTC patients with benign or nonsuspicious CNs have similar recurrence and survival rates after lobectomy compared to those without CNs. CNs alone should not be an indication for total or completion thyroidectomy.

Does insulin resistance trigger thyroid nodule?

The relationship between insulin resistance and thyroid nodules is not clearly understood. The purpose of this study is to investigate the relationship between insülin resistance and thyroid nodules in non-diabetic patients. 410 patients who applied to the Internal Medicine outpatient clinic from June 2018 to July 2019 were reviewed retrospectively. A total of 216 non-diabetic patients were divided into two groups. The relationship of 105 patients with thyroid nodules and 110 patients without thyroid nodules with insulin resistance was investigated. Homeostasis model assessment of insulin resistance value, serum triglycerides and total cholesterol level, and the ratio of women were higher in the group with thyroid nodules (p < 0.05). There was a positive and significant relationship between homeostasis model assessment of insulin resistance value and thyroid nodules (r + 0.29, p < 0.05). In non-diabetic thyroid nodule patients, a significant relationship was detected between nodule formation and insulin resistance. However, these data must be confirmed by other studies in the future.

Presence of Metabolic Syndrome and Thyroid Nodules in Subjects with Colorectal Polyps.

BACKGROUND Thyroid nodules (TNs) and metabolic syndrome (MS) have been individually associated with colorectal polyps. However, the potential joint relationship between them in relation to colorectal polyps has not been fully evaluated. This study aimed to validate the association of TNs/MS and colorectal polyps/adenomas and to determine the risk of colonic polyps in patients with TNs/MS. MATERIAL AND METHODS A retrospective study was conducted on patients undergoing routine health checks in the First Affiliated Hospital of Wenzhou Medical University from July 2014 to August 2017. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for colorectal polyps/adenomas after adjusting for confounding factors. Then patients were divided into 4 groups according to whether they had TNs or MS. Relative excess risks of interaction, attributable proportion, and synergy index were used to determine the additive interaction of TNs and MS on colorectal polyps/adenomas. RESULTS A total of 4514 eligible patients were included in this study. TNs and MS were confirmed to be independent risk factors for colorectal polyps/adenomas. Compared with the group of TNs(-)/MS(-), the odds ratios of TNs(+)/MS(+) in colorectal polyps (odds ratio [OR]: 3.031, 95% confidence interval [CI]: 2.262-4.062, P<0.05) or adenomas (OR: 2.894, 95% CI: 2.099-3.990, P<0.05) were significantly increased, and there was an interactive additive effect between TNs and MS. CONCLUSIONS TNs and MS have an associative and superimposing effect on the increased occurrence of colorectal adenomas. Colonoscopy screening should be advocated for patients with both of these diseases.

Papillary thyroid carcinoma in a hyper-functional thyroid nodule.

The authors reported the case of 69 years old woman presented with subclinical hyperthyroidism. 99m-Tc pertechnetate scan showed the abnormal focus of hot uptake in the left lobe, suggestive of a hyperfunctioning toxic thyroid nodule. Surgical treatment was advised because of the size of the nodule as a more applicable solution. Histological findings showed papillary thyroid carcinoma.

Exposure to the Chinese Great Famine in Early Life and Thyroid Function and Disorders in Adulthood: A Cross-Sectional Study.

Background: Malnutrition in early life may permanently change the structure and function of the body, which lead to a number of diseases in adulthood. The effect of famine exposure during the early life on thyroid function and disorders remains unclear. This study investigated the association between exposure to the Great Chinese Famine (1959-1961) in early life and thyroid function and disorders in adulthood. Methods: Nine thousand eight hundred eighty-one subjects with appropriate birth dates derived from the Thyroid disorders, Iodine status, and Diabetes Epidemiological survey were included. Thyroid function and disorders were defined by the test results of blood sample and ultrasonography of all participants. Associations between famine exposure in early life and thyroid function and disorders in adulthood were assessed with binary logistic regression and linear regression. Results: Participants exposed to the Great Chinese Famine during the fetal stage was associated with a higher thyrotropin (TSH) level in adulthood (ß = 0.024; p = 0.038), compared with the nonexposed participants. The association was significant among rural participants (ß = 0.039; p = 0.02) but not in urban participants (ß = 0.005; p = 0.77). Fetal-exposed group did not show a higher risk of thyroid disorders than the age-matched balanced control group, including overt hyperthyroidism, subclinical hyperthyroidism, overt hypothyroidism, subclinical hypothyroidism, autoimmune thyroiditis, and thyroid nodules (p > 0.05). Conclusions: Famine exposure during the fetal stage was associated with a higher TSH level in adulthood. The fetal stage could be the critical period for programming the pituitary-thyroid axis.

The associated factors for spontaneous intranodular hemorrhage of partially cystic thyroid nodules: A retrospective study of 101 thyroid nodules.

ABSTRACT: Spontaneous intranodular hemorrhaging in benign partially cystic thyroid nodules was reported to cause neck swelling, difficulty swallowing, and other oppressive symptoms attributed to their growing progressively at high rates. In our study, the risk factors for hemorrhaging in these nodules were investigated.We retrospectively analyzed benign partial cystic thyroid nodules from September 2017 to December 2019, and divided them into 2 groups according to the occurrence of intranodular hemorrhage. Age, gender, follow-up time nodules initial maximum diameter, blood supply, spongiform content, nodules solid components, and internal solid portion were compared between the 2 groups at the first ultrasound examination. Chi-Squared and multivariate analysis were performed to evaluate the association of hemorrhage with clinical and ultrasonographic characteristics. ROC analysis was performed to evaluate the utility of factors in predicting hemorrhage.There were 59 occurrences of intranodular hemorrhage, which were associated with abundant blood supply, spongiform contents, and unsmooth margin of the internal solid portion. After multivariate analysis, abundant blood supply, and spongiform content were independent predictors for hemorrhage. In ROC analysis integrating these predictors, the sensitivity was 62.7% and specificity was 95.2% with the AUC 0.881.Partially cystic thyroid nodules with abundant blood supply, non-smooth margin of the internal solid portion and a spongiform internal content were apt to spontaneous intranodular hemorrhaging, which can be recognized as soon as possible by ultrasound.

Determinación de las características funcionales de los nódulos tiroideos mediante imágenes de medicina nuclear en pacientes que acudieron al Instituto de Investigaciones en Ciencias de la Salud - UNA, en el periodo 2016-2019 / Determination of the functional characteristics of thyroid nodules through nuclear medicine images in patients, who attended the Instituto de Investigaciones en Ciencias de la Salud - UNA, in the period 2016-2019

nuclear permiten visualizar la estructura y función de un órgano, tejido, hueso o sistema dentro del cuerpo, entre ellos la glándula tiroidea, la cual puede presentar un nódulo tiroideo y este es importante diagnosticar por su potencial malignidad. Objetivo: Determinar las características funcionales de los nódulos tiroideos en 183 pacientes que asistieron al Servicio de Medicina Nuclear del Instituto de Investigaciones en Ciencias de la Salud - UNA durante el período de noviembre del 2016 - noviembre del 2019. Metodología: Fue utilizada la gammacámara SPECT doble cabezal, siguiendo protocolo estandarizado, con administración de pertecnetato de sodio. Resultados: Se observó que la gran mayoría de los pacientes corresponden al sexo femenino 89%, así como que el 64% provienen de la capital y del departamento central; las patologías detectadas corresponden a bocio en 82%, 15% a nódulos (hipercaptantes, hipocaptantes y autónomos) y casos particulares de tiroiditis, tiroides ectópica y adenoma tóxico. La medicina nuclear está directamente involucrada tanto en el diagnóstico como en el tratamiento de la enfermedad tiroidea, por lo que se requiere una comprensión de la fisiopatología y el manejo de los trastornos de la tiroides, de manera a que las políticas de salud pública sean implementadas para el fortalecimiento de la lucha contra estas enfermedades. Conclusión: El trabajo de investigación realizado comprobó que un mayoritario porcentaje de participantes de sexo femenino (89%), con enfermedades tiroideas asistieron al IICS/UNA, y que la frecuencia de bocio entre la totalidad de pacientes que participaron de este estudio fué de 151/183 (82%), los pacientes provenían en su mayoría de hospitales de referencia del departamento Central y coinciden con la localización geográfica de los domicilios de los pacientes, quienes provenían principalmente del mismo departamento Central 118/183 (64%), no obstante también participaron del trabajo de investigación pacientes provenientes de otros departamentos del país. Palabras claves: Diagnóstico, medicina nuclear, tiroides, tecnología nuclear en salud, SPECT

Introduction: The images obtained by nuclear medicine allow to visualize the structure and function of an organ, tissue, bone or system inside the body, including the thyroid gland, which can present a thyroid nodule and this is important to diagnose for its potential malignancy. Objective: To determine the functional characteristics of the thyroid nodules were determined in 183 patients, who attended the Nuclear Medicine Service at the Instituto de Investigaciones en Ciencias de la Salud during the period of November 2016 - November 2019. Methodology: It was used the dual head SPECT gamma camera following a standardized protocol with administration of sodium pertechnetate. Result: It was observed that most of the patients corresponded to the female sex 89 %, as well as that 64% came from the capital and the central department. The pathologies detected corresponded to goiter in 82%, 15% to nodules (hypercaptant, hypocaptant and autonoms) and particular cases of thyroiditis, ectopic thyroid and toxic adenoma. Nuclear medicine is directly involved both in the diagnosis and in the treatment of thyroid disease, therefore it requires an understanding of the pathophysiology and management of thyroid disorders in order that public health policies are implemented for strengthening the fight against these diseases. Conclusion: The research carried out showed that a majority percentage of female participants (89%), with thyroid diseases attended IICS / UNA, and the frequency of goiter among all patients who participated in this study was 151/183 ( 82%), the patients mostly they came the reference hospitals in the Central department and coincide with the geographic location of the patients' homes, who tested mainly from the same Central department 118/183 (64%), also participate in the research work patients from other departments of the country. Keywords: Diagnosis, nuclear medicine, thyroid, health technology, SPECT.

A model of the cost of delaying treatment of Hashimotos thyroiditis: thyroid cancer initiation and growth.

Hashimoto's thyroiditis (HT) is an autoimmune disorder that drives the function of thyroid gland to the sequential clinical states:euthyroidism (normal condition), subclinical hypothyroidism (asymptomatic period) and overt hypothyroidism (symptomatic period). In this disease, serum thyroidstimulating hormone (TSH) levels increase monotonically, stimulating the thyroid follicular cells chronically and initiating benign (non-cancerous) thyroid nodules at various sites of the thyroid gland. This process can also encourage growth of papillary thyroid microcarcinoma. Due to prolonged TSH stimulation, thyroid nodules may grow and become clinically relevant without the administration of treatment by thyroid hormone replacement. Papillary thyroid cancer (80% of thyroid cancer) whose incidence is increasing worldwide, is associated with Hashimoto's thyroiditis. A stochastic model is developed here to produce the statistical distribution of thyroid nodule sizes and growth by taking serum TSH value as the continuous input to the model using TSH values from the output of the patientspecific deterministic model developed for the clinical progression of Hashimoto's thyroiditis.

Localization and characterization of thyroid microcalcifications: A histopathological study.

Thyroid calcification is frequent in thyroid nodules. The aim of our study was to evaluate the prevalence of calcifications in thyroid tissue samples of patients with various thyroid diseases, and to identify their composition according to their localization. Among 50 thyroid samples included, 56% were malignant (papillary carcinoma) and 44% were benign (adenoma, multinodular goiter, Graves' disease, sarcoidosis). Calcifications were found in 95% of samples using polarised light microscopy, whereas only 12% were described in initial pathological reports. Three types were individualised and analyzed by infrared spectrometry (µFTIR): colloid calcifications composed of calcium oxalate, capsular calcifications and psammoma bodies, both composed of calcium phosphate. Of notice, psammoma bodies characterized by FE-SEM were composed of concentric structure suggesting a slow process for crystal deposition. Calcium phosphates were found only in malignant samples whereas calcium oxalate was not associated with a define pathology. Proliferation assessed by KI67 staining was high (33% of positive follicles), and RUNX2, OPN, and CD44 positive staining were detected in thyrocytes with a broad variation between samples. However, thyrocyte proliferation and differentiation markers were not associated with the number of crystals. TRPV5 and CaSR expression was also detected in thyrocytes. mRNA transcripts expression was confirmed in a subgroup of 10 patients, altogether with other calcium transporters such as PMCA1 or Cav1.3. Interestingly, TRPV5 mRNA expression was significantly associated with number of colloid calcifications (rho = -0.72; p = 0.02). The high prevalence of calcium oxalate crystals within colloid gel raises intriguing issues upon follicle physiology for calcium and oxalate transport.

Safety and Efficacy of Radiofrequency Ablation for Nonfunctioning Benign Thyroid Nodules in Children and Adolescents in 14 Patients over a 10-Year Period.

PURPOSE: To evaluate the efficacy and safety of radiofrequency (RF) ablation for nonfunctioning benign thyroid nodules in children and adolescents. MATERIALS AND METHODS: Fourteen pediatric patients (10 female, 4 male; mean age 15.7 ± 2.3 years, range 12-19 years) with nonfunctioning benign thyroid nodules (mean longest diameter 3.7 ± 1.1 cm, range 2.0-5.6 cm) treated with the use of RF ablation from 2005 to 2015 were evaluated. The inclusion criteria for RF ablation therapy were (i) age <20 years, (ii) benign cytological confirmation by ≥2 separate fine-needle aspiration or core needle biopsies, (iii) pressure symptoms or cosmetic problems caused by thyroid nodules, (iv) absence of any suspicious feature as determined with the use of ultrasound (US), (v) normal serum levels of thyroid hormone and thyrotropin, and (vi) follow-up of >6 months. RF ablation was performed with the use of an RF generator and an 18-gauge internally cooled electrode. RF ablation was performed under local anesthesia without conscious sedation or general anesthesia. Changes in nodules on follow-up US, changes in symptomatic and cosmetic scores, and complications arising during or after RF ablation were evaluated. RESULTS: Mean follow-up period was 36.9 ± 21.7 months (range 6-69 months). At last follow-up visits, mean longest nodule diameter and volume had decreased significantly (3.7 ± 1.1 cm vs 1.4 ± 0.9 cm and 14.6 ± 13.3 mL vs 1.7 ± 4.4 mL; P < 0.001). Both cosmetic and compressive symptoms significantly improved (3.8 ± 0.6 vs 1.4 ± 0.6 and 3.4 ± 1.0 vs 0.1 ± 0.4; P < 0.001). The mean number of ablation sessions was 2.1 ± 1.2 (range 1-5 sessions) and no major complication was encountered during or after RF ablation. CONCLUSIONS: RF ablation might be a safe and effective treatment modality for nonfunctioning benign thyroid nodules in children and adolescents.

Dysbiosis of the gut microbiome is associated with thyroid cancer and thyroid nodules and correlated with clinical index of thyroid function.

PURPOSE: Thyroid cancer and thyroid nodules are the most prevalent form of thyroid endocrine disorder. The balance of gut microbiome is highly crucial for a healthy human body, especially for the immune and endocrine system. However, the relationship between gut microbiome and the thyroid endocrine disorders such as thyroid cancer and thyroid nodules has not been reported yet. METHODS: A cohort of 74 patients was recruited for this study. Among them, 20 patients had thyroid cancer, 18 patients had thyroid nodules, and 36 were matched healthy controls. Gut microbiome composition was analyzed by 16S rRNA (16S ribosomal RNA) gene-based sequencing protocol. RESULTS: We compared the gut microbiome results of 74 subjects and established the correlation between gut microbiome and thyroid endocrine function for both thyroid cancer and thyroid nodules. The results inferred that alpha and beta diversity were different for patients with thyroid tumor than the healthy controls (p < 0.01). In comparison to healthy controls, the relative abundance of Neisseria (p < 0.001) and Streptococcus (p < 0.001) was significantly higher for thyroid cancer and thyroid nodules. Butyricimonas (p < 0.001) and Lactobacillus (p < 0.001) displayed notably lower relative abundance for thyroid cancer and thyroid nodules, respectively. It was also found that the clinical indexes were correlated with gut microbiome. CONCLUSION: Our results indicate that both thyroid cancer and thyroid nodules are associated with the composition of gut microbiome. These results may support further clinical diagnosis to a great extent and help in developing potential probiotics to facilitate the treatment of thyroid cancer and thyroid nodules.

Prevalencia y malignidad asociada de las citologías de categoría Bethesda III de nódulos tiroideos según el grupo «atipia citológica» o «atipia arquitectónica» / Prevalence and associated malignancy of Bethesda category III cytologies of thyroid nodules assigned to the "cytological atypia" or "architectural atypia" groups

Objetivo: Conocer la prevalencia de citologías de categoría Bethesda III, su tasa de malignidad y analizar si existen diferencias en la segunda citología, tasa de malignidad, tipo de carcinoma y estadio TNM entre los grupos atipia citológica (AC) y atipia arquitectónica (AA). Pacientes y método: Estudio retrospectivo de 973 citologías. Las de categoría Bethesda III se agruparon en AC cuando se apreció atipia nuclear pero no diagnóstica o sospechosa de malignidad, y en AA cuando se trató de extensiones con poca celularidad, pero con un patrón predominantemente microfolicular y con coloide mínimo o ausente. Se correlacionaron los resultados citológicos y anatomopatológicos. Resultados: Hallamos 87 (8,9%) citologías de categoría Bethesda III (34 AC, 53 AA). Se realizó una segunda citología en 23 casos (16 AC, 7 AA) con resultado benigno en el 68,7% de los AC y 71,4% de los AA. Fueron intervenidos quirúrgicamente 64 casos (23 AC, 41 AA) y 15 (23,4%) resultaron malignos: 39,1% AC vs 14,6% AA (p=0,029). Hubo un falso negativo en la segunda citología. El carcinoma papilar variante folicular fue el más frecuente (60%). No hubo diferencias entre AC y AA respecto al tipo de neoplasia ni estadio TNM. Conclusiones: Nuestra prevalencia de citologías de categoría Bethesda III está dentro de lo recomendado. La tasa de malignidad es significativamente superior en el grupo AC, pero sin diferencias en el resultado de la segunda citología, tipo de carcinoma hallado ni estadio TNM. La división de la categoría Bethesda III es útil para proporcionar una mejor estratificación del riesgo de malignidad

Objective: To ascertain the prevalence of Bethesda category III cytologies and their malignancy rate, and to analyze differences in the second cytology, malignancy rate, type of carcinoma, and TNM stage between the cytological atypia (CA) and architectural atypia (AA) groups. Patients and method: A retrospective study of 973 biopsies. Bethesda category III cytologies were classified as CA when nuclear atypia was seen but they were not diagnostic or suspicious of malignancy, and as AA when smears had few cells but had a predominantly microfollicular pattern and minimal or absent colloid. The cytological and pathological results were correlated. Results: There were 87 (8.9%) Bethesda category III cytologies (34 CC, 53 AA). Second cytologies were performed in 23 patients (16 with CA, 7 with AA), and a benign result was found in 68.7% of CA and 71.4% of the AA group. Sixty-four patients (23 CA, 41 AA) underwent surgery and 15 of these (23.4%) had a malignant disease: 39.1% CA vs 14.6% AA (P=.029). There was a false negative result in the CA group. The follicular variant of papillary thyroid carcinoma was the most common malignancy (60%). There were no differences in type of carcinoma or TNM stage between CA and AA patients. Conclusions: The reported prevalence of Bethesda category III cytologies was as expected. The malignancy rate was significantly higher in the CA group, but there were no differences in the result of the second cytology, type of carcinoma found, or TNM stage. The division of Bethesda category III cytologies is useful to provide a better stratification of the risk of malignancy

The diagnostic value of elastography score and strain index for the evaluation of thyroid micronodules

Background/aim: In the general population, the frequency of thyroid micronodules is increasing, and the prevalence of malignancy is higher for such nodules. Ultrasonography findings of these nodules are neither specific nor sensitive. The aim of this study was to investigate the diagnostic value of elastography in patients with thyroid micronodules. Materials and methods: A total of 224 patients with thyroid micronodules were recruited in this prospective study. All patients underwent a thyroid fine-needle aspiration biopsy. Elastography scores (ESs) and strain indexes (SIs) were measured with real-time ultrasound elastography. Results: Malignant micronodules had higher ES and SI values than those of benign micronodules (P < 0.001). When ES was used to diagnose malignancy, scores of >3 showed sensitivity of 79.4% and specificity of 98.1%. The area under the curve (AUC) for ES was 0.888 (P < 0.001). The optimal SI cutoff value that differentiated benign from malignant micronodules was 3.06 (98% sensitivity; 91% specificity). The AUC for SI was 0.970 (P < 0.001). Conclusions: ES and SI are beneficial markers for detecting malignant thyroid micronodules. We showed that SI is better than ES when assessing the malignancy of thyroid micronodules.

Non-contrast agent based small vessel imaging of human thyroid using motion corrected power Doppler imaging.

Singular value based spatiotemporal clutter filtering (SVD-STF) can significantly improve the sensitivity of blood flow imaging in small vessels without using contrast agents. However, despite effective clutter filtering, large physiological motion in thyroid imaging can impact coherent integration of the Doppler signal and degrade the visualization of the underlying vasculature. In this study, we hypothesize that motion correction of the clutter filtered Doppler ensemble, prior to the power Doppler estimation, can considerably improve the visualization of smalls vessels in suspicious thyroid nodules. We corroborated this hypothesis by conducting in vivo experiments on 10 female patients in the age group 44-82 yrs, with at least one thyroid nodule suspicious of malignancy, with recommendation for fine needle aspiration biopsy. Ultrasound images were acquired using a clinical ultrasound scanner, implemented with compounded plane wave imaging. Axial and lateral displacements associated with the thyroid nodules were estimated using 2D normalized cross-correlation. Subsequently, the tissue clutter associated with the Doppler ensemble was suppressed using SVD-STF. Motion correction of the clutter-filtered Doppler ensemble was achieved using a spline based sub-pixel interpolation. The results demonstrated that power Doppler images of thyroid nodules were noticeably degraded due to large physiological motion of the pulsating carotid artery in the proximity. The resultant power Doppler images were corrupted with signal distortion, motion blurring and occurrence of artificial shadow vessels and displayed visibly low signal-to-background contrast. In contrast, the power Doppler images obtained from the motion corrected ultrasound data addressed the issue and considerabley improved the visualization of blood flow. The signal-to-noise ratio and the contrast-to-noise ratio increased by up to 15.2 dB and 12.1 dB, respectively. Across the ten subjects, the highest improvement was observed for the nodule with the largest motion. These preliminary results show the ability of using motion correction to improve the visualization of small vessel blood flow in thyroid, without using any contrast agents. The results of this feasibility study were encouraging, and warrant further development and more in vivo validation in moving tissues and organs.

An assessment of the relationship between thyroid nodule characteristics, insulin resistance and arterial stiffness in euthyroid nodular goiter.

OBJECTIVES: Publications suggesting that thyroid nodule might be associated with insulin resistance and metabolic syndrome are quite interesting. There is a need for studies assessing the relationship between nodule presence and cardiovascular risk in individuals with non-functioning nodular goiter. The purpose of the present study is to reveal whether or not insulin resistance, nodule presence, and nodule stiffness affect arterial stiffness, which is a reliable and valid cardiovascular risk indicator, in individuals with euthyroid nodular goiter using the pulse wave analysis (PWA). MATERIALS AND METHODS: 50 patients with euthyroid nodular goiter and 50 healthy volunteers were included in the study. All participants were examined by B-mode thyroid ultrasound, and the participants in the nodular goiter group were also examined by strain elastography (SE). The strain index of nodules was calculated according to the Rago scoring. Also, fasting plasma glucose (FPG) and insulin levels were measured, and HOMA-IR. Arterial stiffness measurements of the participants were performed using a PWA device which employs a cuff-based oscillometric method from the brachial artery. RESULTS: PWV was found to be significantly higher in the euthyroid nodular goiter group (p < 0.001). PWV was found to be positively correlated with FPG and waist circumference. Fasting plasma glucose was found to be higher in the group with nodular goiter (p = 0.03). However, no difference was found between the groups in terms of HOMA-IR and insulin level. HOMA-IR was not correlated with thyroid volume, nodule volume, and nodule count. Also, HOMA-IR was not correlated with strain index value and PWA data. CONCLUSION: We found that PWV was significantly higher in patients with euthyroid nodular goiter. This result suggests that these patients may be at risk for cardiovascular disease.

Diagnostic performance of ATA, BTA and TIRADS sonographic patterns in the prediction of malignancy in histologically proven thyroid nodules.

INTRODUCTION: We aimed to compare the malignancy risk stratification of histologically proven thyroid nodules using the 2015 American Thyroid Association (ATA) Management Guidelines, 2014 British Thyroid Association (BTA) Guidelines for the Management of Thyroid Cancer and the Thyroid Imaging Reporting and Data System (TIRADS). METHODS: Thyroid nodules measuring > 1 cm resected over 5.5 years were retrospectively studied. Demographic information as well as cytology and histopathology results were collected. Static ultrasonography (US) images and radiologists' reports of each resected nodules were reviewed and classified based on the above risk classification systems. RESULTS: A total of 167 thyroid nodules from 150 patients were examined. More malignant nodules were solid (78.4% vs. 62.5%; p = 0.049) or hypoechoic (70.6% vs. 28.6%; p < 0.001), and had irregular margins (35.3% vs. 8.0%; p < 0.001), taller-than-wide morphology (9.8% vs. 2.7%; p = 0.031), microcalcifications (33.3% vs. 8.0%; p < 0.001), disrupted rim calcifications (9.8% vs. 0.9%; p = 0.012) or associated abnormal cervical lymphadenopathy (13.7% vs. 0.9%; p = 0.001) compared with benign nodules. The guidelines' diagnostic performance was: ATA - sensitivity 98.0%, specificity 17.3%, positive predictive value (PPV) 35.0%, negative predictive value (NPV) 95.0%; BTA - sensitivity 90%, specificity 50.9%, PPV 45.5%, NPV 91.8%; and TIRADS - sensitivity 94.0%, specificity 28.2%, PPV 37.3%%, NPV 91.2%. CONCLUSION: Sonographic patterns outlined by the three guidelines displayed high sensitivity and NPV. Although isolated suspicious US features cannot predict malignancy risk, they should be considered when risk stratifying nodules that do not fit into particular sonographic patterns based on current guidelines.

Predictive quantitative sonographic features on classification of hot and cold thyroid nodules.

PURPOSE: This study investigated the potentiality of ultrasound imaging to classify hot and cold thyroid nodules on the basis of textural and morphological analysis. METHODS: In this research, 42 hypo (hot) and 42 hyper-function (cold) thyroid nodules were evaluated through the proposed method of computer aided diagnosis (CAD) system. To discover the difference between hot and cold nodules, 49 sonographic features (9 morphological, 40 textural) were extracted. A support vector machine classifier was utilized for the classification of LNs based on their extracted features. RESULTS: In the training set data, a combination of morphological and textural features represented the best performance with area under the receiver operating characteristic curve (AUC) of 0.992. Upon testing the data set, the proposed model could classify the hot and cold thyroid nodules with an AUC of 0.948. CONCLUSIONS: CAD method based on textural and morphological features is capable of distinguishing between hot from cold nodules via 2-Dimensional sonography. Therefore, it can be used as a supplementary technique in daily clinical practices to improve the radiologists' understanding of conventional ultrasound imaging for nodules characterization.

[Medical Treatment of Thyroid Nodule]. / Medikamentöse Therapie des Schilddrüsenknotens.

Whereas in regions with sufficient iodide intake treatment of thyroid nodules with levothyroxine has been almost completely abandoned and is also not further recommended by guidelines, medical treatment may be still indicated in Germany as recently demonstrated by randomized, placebo-controlled LISA study.A major reason for this is mild iodide deficiency in patients with thyroid nodules. In LISA study a combined therapy of levothyroxine and iodide resulted in an at least 50 % reduction of nodular volume in 21,6 % of treated patient compared to in only 5,2 % of placebo-treated patients.To avoid TSH suppression levothyroxine dose must be adjusted that TSH is in the lower reference range, since subclinical hyperthyroidism may result in cardiac adverse events as arrythmias.In the elderly the cardiac risk has to be considered and levothyroxine dose has frequently to be reduced or therapy even to be stopped.