Is there a correlation between thyroiditis and thyroid cancer?

BACKGROUND: In the past few decades, the incidence of thyroid cancer has increased significantly all over the world. In the same period, there also seems to have been an increase in the incidence of Hashimoto's Thyroiditis-the most common inflammatory autoimmune thyroid disease. Several studies have linked thyroiditis to thyroid cancer. METHODS: In our study, we examined 2304 cases of thyroid surgery collected over a 12-year period starting from 2004. In 2090 cases (90.7%) out of our sample, it has been possible to compare the presence, or lack thereof, of thyroiditis by means of a histological diagnosis post-surgery; 214 (9.3%) cases were excluded from our study due to insufficient data. We then divided the different histological classifications into two groups. Group A included all the benign histological classifications and Group B included all the malignant histological classifications. In each group, we then assessed the presence, or lack thereof, of thyroiditis in order to evaluate if thyroiditis can be linked to a higher incidence of thyroid cancer. RESULTS: Data analysis showed a higher incidence of thyroiditis in Group B, 36.4% (malignant pathology report), than in Group A, 32.4% (benign pathology report), but no statistically significant difference emerged between those two groups (P > 0.05). CONCLUSIONS: Our conclusion was that a correlation between thyroiditis and a higher incidence of thyroid cancer is still undefined.

The surgical approach to nodule Thyr 3-4 after the 2.2014 NCCN and 2015 ATA guidelines.

BACKGROUND: The incidence of palpables thyroid nodules in general population is 5% and the prevalence of non -palpable nodules is higher (35-60%) in the endemic goiter area. In the last years the new guidelines and new classification related to thyroid nodule have changed the indication to treat it. MATERIAL AND METHOD: We analyzed the patients treated from January 2013 to June 2016 for Thyr 3 and Thyr 4 thyroid nodule sec. Bethesda system. We have divided in I and II period related to the 2.2014 and 2015 ATA guidelines and we have evaluated the indication to treat, the type of surgical procedure, the incidence of thyroid carcinoma and the adverse events. RESULTS: We selected from 909 cases, 252 cases surgically treated with preoperative diagnosis of Thyr 3(80 cases) and Thyr 4(172 cases); carcinoma was found in 21/80 (26.2%) and in 62/172 (26.05%). The period was divided from January 2013 to December 2014 and from January 2015 to june 2016 (first and second period). In II period we found carcinoma in 8/40 Thyr3 and in 26/88 Thyr 4. The incidence of lobectomy in II period was higher than I period (p < 0.0001) sec.guidelines indications. No difference in adverse events. The number of cancer is lower in patients treated with lobectomy than those who underwent total thyroidectomy (12,5%vs 21,8% in Thyr 3; 15,3% vs 32% in Thyr 4). CONCLUSIONS: The indications to treat related to Thyr 3 and Thyr4 are changed in the two periods. The number of cancer is lower in patients treated with lobectomy. The new guidelines have changed the surgical approach to thyroid nodule.

Thyroid micro-carcinoma: only a diagnostic epidemic?

BACKGROUND: The incidence of thyroid carcinoma ranges from 0.5 to 10 cases every 100,000, depending on the country, the context and purpose of the study. The high incidence of differentiated thyroid tumor is continuously growing. While most malignant pathologies affect the adults, a proportion of 1-2% of pediatric population is affected by solitary nodule, of which some are malignant cancers. Studying thyroid malignant cancer, the most sensitive and accurate imaging technique is color Doppler ultrasonography. Fine needle aspiration cytology (FNAC), if correctly performed, is the key to a correct diagnosis. METHODS: This prospective study analyzes 1726 cases of total thyroidectomy and lobectomy performed between January 2004 and December 2013. The cytology sampling has been done following standard FNAC or capillary aspiration. Results have been classified in five classes, following the Italian SIAPEC-AIT system (2008). Sensibility, specificity, accuracy, negative predictive value and positive for the evaluation of FNAC technique are the statistical parameters considered. RESULTS: The outcome is aligned with what already known in literature, that FNAC has sensibility between 60-98% and specificity between 72-100%. Considering Tir3 as a low malignancy risk category therefore not suitable for surgery, those values decrease. CONCLUSIONS: Micro-carcinoma is a more represented entity than apparently suspected. Nowadays, cytology is the most precise diagnostic support to the therapeutic management of thyroid node, yet it is still charged with false negatives. The evaluation of data records, combined with some molecular biology techniques and applied to cytology, could help in giving more appropriate surgical indication, allowing the surgery to be therapeutic more than diagnostic.