The impact of the COVID-19 pandemic on thyroid nodular disease: a retrospective study in a single center in the western part of Romania.

Introduction: The COVID-19 pandemic had a significant impact on the healthcare system, leading to a prioritization of hospital admissions in many countries. Romania was no exception, and it had to restrict patient access to medical services in hospitals with chronic diseases and oncological pathology, including thyroid cancer. This study aimed to compare the clinical and pathological factors of patients with nodular thyroid disease diagnosed and surgically treated during the two years before and after the COVID-19 pandemic, in a single medical institution. Methods: The retrospective study included 1505 patients who were diagnosed and operated on for nodular thyroid disease between January 2018 and December 2021. The patients were divided into two groups: the "PRECOVID" group (January 2018 to February 2020), and the "POSTCOVID" group (March 2020 to December 2021). The analyzed parameters included patients' gender, age, preoperative diagnosis, type of surgical intervention, and pathological diagnosis. Results: A significant decrease was observed in the number of surgeries performed for thyroid nodular disease during the COVID-19 pandemic period (450 versus 1055 cases, p<0.00001). There was a significant decrease in the number of surgical reinterventions (0.9% in the POSTCOVID group versus 2.9% in the PRECOVID group, p=0.01) and a significant increase in the number of total thyroidectomies (84.9% in the POSTCOVID group versus 80.1% in the PRECOVID group, p=0.02). We also observed a higher incidence of malignant/borderline tumors in the POSTCOVID group compared to the PRECOVID group (p=0.04) and a significantly higher frequency of aggressive forms of thyroid cancer in the POSTCOVID group (p=0.0006). Discussion: The COVID-19 pandemic had a significant impact on the surgical management of nodular thyroid disease, resulting in a decrease in surgeries and a change in the type of surgical interventions performed. The higher incidence of malignant/borderline tumors diagnosed during the pandemic highlights the importance of timely diagnosis and treatment of thyroid nodules to prevent cancer progression.

Update on Calcitonin Screening for Medullary Thyroid Carcinoma and the Results of a Retrospective Analysis of 12,984 Patients with Thyroid Nodules.

BACKGROUND: We provide an update on calcitonin (Ctn) screening for the early detection of medullary thyroid carcinoma (MTC) and present the results of a large single-center analysis evaluating sex-specific cut-off-levels and long-term courses. METHODS: A total of 12,984 consecutive adult patients (20.1% male and 79.9% female) with thyroid nodules who had undergone routine Ctn measurement were retrospectively analyzed. Patients with confirmed suspicious Ctn values were referred for surgery. RESULTS: Ctn measurements were elevated in 207 (1.6%) patients, with values below twice the sex-specific reference limit in 82% of these cases. Further clarification was possible in 124/207 cases, of which MTC could be ruled out in 108 cases. Histopathological assessment confirmed MTC in 16/12,984 patients. CONCLUSIONS: Our extrapolated MTC prevalence of 0.14% is significantly lower than that described in early international screening studies. The stimulation test can usually be dispensable when using a decision-making concept based on sex-specific basal Ctn cut-off values. Ctn screening is recommended even in patients with very small thyroid nodules. High quality standards in pre-analytics, laboratory measurements, and the interpretation of data must be ensured, as well as close interdisciplinary cooperation between medical disciplines.

The crossroad between autoimmune disorder, tissue remodeling and cancer of the thyroid: The long pentraxin 3 (PTX3).

Thyroid is at the crossroads of immune dysregulation, tissue remodeling and oncogenesis. Autoimmune disorders, nodular disease and cancer of the thyroid affect a large amount of general population, mainly women. We wondered if there could be a common factor behind three processes (immune dysregulation, tissue remodeling and oncogenesis) that frequently affect, sometimes coexisting, the thyroid gland. The long pentraxin 3 (PTX3) is an essential component of the humoral arm of the innate immune system acting as soluble pattern recognition molecule. The protein is found expressed in a variety of cell types during tissue injury and stress. In addition, PTX3 is produced by neutrophils during maturation in the bone-marrow and is stored in lactoferrin-granules. PTX3 is a regulator of the complement cascade and orchestrates tissue remodeling and repair. Preclinical data and studies in human tumors indicate that PTX3 can act both as an extrinsic oncosuppressor by modulating complement-dependent tumor-promoting inflammation, or as a tumor-promoter molecule, regulating cell invasion and proliferation and epithelial to mesenchymal transition, thus suggesting that this molecule may have different functions on carcinogenesis. The involvement of PTX3 in the regulation of immune responses, tissue remodeling and oncosuppressive processes led us to explore its potential role in the development of thyroid disorders. In this review, we aimed to highlight what is known, at the state of the art, regarding the connection between the long pentraxin 3 and the main thyroid diseases i.e., nodular thyroid disease, thyroid cancer and autoimmune thyroid disorders.

Predicting the risk of nodular thyroid disease in coal miners based on different machine learning models.

Background: Nodular thyroid disease is by far the most common thyroid disease and is closely associated with the development of thyroid cancer. Coal miners with chronic coal dust exposure are at higher risk of developing nodular thyroid disease. There are few studies that use machine learning models to predict the occurrence of nodular thyroid disease in coal miners. The aim of this study was to predict the high risk of nodular thyroid disease in coal miners based on five different Machine learning (ML) models. Methods: This is a retrospective clinical study in which 1,708 coal miners who were examined at the Huaihe Energy Occupational Disease Control Hospital in Anhui Province in April 2021 were selected and their clinical physical examination data, including general information, laboratory tests and imaging findings, were collected. A synthetic minority oversampling technique (SMOTE) was used for sample balancing, and the data set was randomly split into a training and Test dataset in a ratio of 8:2. Lasso regression and correlation heat map were used to screen the predictors of the models, and five ML models, including Extreme Gradient Augmentation (XGBoost), Logistic Classification (LR), Gaussian Parsimonious Bayesian Classification (GNB), Neural Network Classification (MLP), and Complementary Parsimonious Bayesian Classification (CNB) for their predictive efficacy, and the model with the highest AUC was selected as the optimal model for predicting the occurrence of nodular thyroid disease in coal miners. Result: Lasso regression analysis showed Age, H-DLC, HCT, MCH, PLT, and GGT as predictor variables for the ML models; in addition, heat maps showed no significant correlation between the six variables. In the prediction of nodular thyroid disease, the AUC results of the five ML models, XGBoost (0.892), LR (0.577), GNB (0.603), MLP (0.601), and CNB (0.543), with the XGBoost model having the largest AUC, the model can be applied in clinical practice. Conclusion: In this research, all five ML models were found to predict the risk of nodular thyroid disease in coal miners, with the XGBoost model having the best overall predictive performance. The model can assist clinicians in quickly and accurately predicting the occurrence of nodular thyroid disease in coal miners, and in adopting individualized clinical prevention and treatment strategies.

Association of coal mine dust lung disease with Nodular thyroid disease in coal miners: A retrospective observational study in China.

Background: Coal dust is a major risk factor for the occupational health of coal miners, and underground workers with coal mine dust lung disease (Coal miners with coal mine dust lung disease (CMDLD) may have a higher risk of developing Nodular thyroid disease (NTD). The aim of this study was to investigate the relationship between coal mine dust lung disease and the development of Nodular thyroid disease in coal miners. Methods: This was a clinical retrospective observational study that included 955 male coal miners from 31 different coal mining companies in Huainan, Anhui Province, China, who were examined in April 2021 at the Huainan Occupational Disease Prevention and Control Hospital to collect all their clinical physical examination data, including general conditions, laboratory test indices and imaging indices. Based on the presence or absence of Nodular thyroid disease, 429 cases with Nodular thyroid disease were classified as the diseased group and 526 cases without Nodular thyroid disease were classified as the control group. Logistic regression was used to analyse the correlation between the occurrence of Nodular thyroid disease in coal miners, and further single- and multi-factor logistic regression was used to screen the risk exposure factors for Nodular thyroid disease in coal miners. Results: Age, coal mine dust lung disease (CMDLD), red blood cells (RBC), mean red blood cell volume (MCV), albumin (ALB), albumin/globulin (A/G), indirect bilirubin (IBIL), globulin (GLOB), total bilirubin (TBil) and myeloperoxidase (MPO) were associated with the development of Nodular thyroid disease in coal miners (p < 0.05) The results of univariate and multifactorial logistic regression analysis showed that CMDLD (OR:4.5,95%CI:2.79-7.51) had the highest OR and CMDLD was the strongest independent risk exposure factor for the development of Nodular thyroid disease in coal miners. Conclusions: There is a strong correlation between coal mine dust lung disease and Nodular thyroid disease in underground coal miners, and clinicians need to be highly aware of the high risk of NTD in coal miners with CMDLD and adopt individualized clinical prevention strategies.

Caracterización de los pacientes operados de afecciones nodulares de tiroides / Characterization of Patients Operated on for Nodular Thyroid Conditions

Introducción: Los nódulos tiroideos son un problema frecuente, deben ser estudiados, sobre todo por la posibilidad de que puedan ser malignos. Objetivo: Caracterizar el comportamiento de los pacientes con afecciones quirúrgicas del tiroides en la provincia de Cienfuegos desde el 1 de enero del 2015 al 31 de diciembre del 2017. Métodos: Se realizó un estudio descriptivo, retrospectivo de 225 pacientes con afecciones quirúrgicas del tiroides en el Servicio de Cirugía del Hospital General Universitario "Dr. Gustavo Aldereguía Lima" en la provincia Cienfuegos durante un trienio. Las variables analizadas fueron: edad, sexo, lóbulo afectado, características físicas y ecográficas de los nódulos, modalidades de biopsias utilizadas y su correlación, técnica quirúrgica, variedad histológica y complicaciones posoperatorias. Se empleó modelo recolector de datos con las variables de interés, presentándose en tablas de frecuencia, números y porciento. Resultados: Predominaron las féminas (87,1 por ciento), el grupo etareo 41 - 50 años (34,7 por ciento) y el lóbulo izquierdo (45,3 por ciento). Prevalecieron los nódulos únicos, móviles, renitentes y ecogénicos. Predominó el carcinoma papilar (59,6 por ciento) y el bocio multinodular (25,3 por ciento). La hemitiroidectomía, el procedimiento quirúrgico más empleado (44,9 por ciento) y la disfonía transitoria (4,9 por ciento) complicación más frecuente. Conclusiones: En la práctica clínica cotidiana de las afecciones del tiroides se evidencia la necesaria interrelación entre endocrinólogos, cirujanos, oncólogos, imaginólogos y patólogos, entre otros, para el abordaje multi e interdisciplinario en el diagnóstico y el tratamiento de estos pacientes(AU)

Introduction: Thyroid nodules are a frequent problem; they should be studied, especially because of the possibility that they may be malignant. Objective: To characterize patients with thyroid surgical conditions in Cienfuegos Province, from January 1, 2015 to December 31, 2017. Methods: A descriptive and retrospective study of 225 patients with thyroid surgical affections was carried out in the surgery service of Dr. Gustavo Aldereguía Lima General University Hospital, in Cienfuegos Province, during a three-year period. The variables analyzed were age, sex, affected lobe, physical and ultrasound nodular characteristics of nodules, used biopsy modalities and their correlation, surgical technique, histological variety and postoperative complications. A data collection model was used with the variables of interest, presented in tables of frequency, numbers and percentages. Results: Females predominated (87.1 percent), together with the age group 41-50 years (34.7 percent) and the left lobe (45.3 percent). Single, mobile, refractory and echogenic nodules prevailed. Papillary carcinoma (59.6 percent) and multinodular goiter (25.3 percent) predominated. Hemithyroidectomy was the most employed surgical procedure (44.9 percent) and transient dysphonia (4.9 percent) was the most frequent complication. Conclusions: The daily clinical practice of thyroid conditions evidences the necessary interrelation between endocrinologists, surgical doctors, oncologists, imaginologists and pathologists, among others, for the multi- and interdisciplinary approach in the diagnosis and managment of these patients(AU)

Enfermedad nodular tiroidea en personas con diagnóstico de acromegalia / Nodular thyroid disease in people diagnosed with acromegaly

La aparición de nódulos tiroideos en las personas con acromegalia es una consecuencia de la elevación crónica de la hormona de crecimiento y el factor de crecimiento similar a la insulina tipo 1. Su naturaleza varía según la zona geográfica, suficiencia de yodo y antecedentes patológicos familiares, entre otros factores. No se han publicado estudios cubanos sobre la enfermedad nodular tiroidea en estas personas. Objetivos: Describir las características clínicas, bioquímicas y ultrasonográficas de la glándula tiroidea, según la presencia o no de la enfermedad nodular tiroidea. Métodos: Estudio observacional descriptivo, transversal, que incluyó 73 pacientes con acromegalia entre enero de 2003 y diciembre de 2017. Se estudiaron las variables: edad, sexo, color de la piel, antecedentes familiares de la enfermedad nodular tiroidea, niveles de la hormona de crecimiento, hormona estimulante del tiroides, T4 libre, anticuerpos contra la peroxidasa tiroidea y contra la tiroglobulina, volumen tiroideo, patrón ecográfico nodular y estudio citológico. Resultados: La enfermedad nodular tiroidea se presentó en el 75,3 por ciento de los casos, con predominio del bocio multinodular. La edad al diagnóstico fue menor en los pacientes con la enfermedad (43,53 ± 9,67), que en los que no la tenían (49,33 ± 6,96 años) (p = 0,02). La hormona de crecimiento al diagnóstico de acromegalia, resultó menor en los pacientes con este padecimiento (18,73 ± 11,33 µg/L vs. 35,91 ± 21,68 µg/L; (p = 0,00). El volumen tiroideo mostró diferencias significativas entre ambos grupos (14,2 ± 4,5 mL en los casos positivos de la enfermedad nodular tiroidea y 10,5 ± 2,8 mL en los casos negativos; p = 0,002), siendo el nódulo de baja sospecha de malignidad el más frecuente. El resto de las variables resultaron similares entre los pacientes con y sin la enfermedad. La citología se informó como benigna en el 75 por ciento en los nódulos únicos, el 80 por ciento de los bocios nodulares y el 90 por ciento de los bocios multinodulares (p = 0,51). Conclusiones: La enfermedad nodular tiroidea fue frecuente en los casos de acromegalia, y se asoció a la menor edad y los niveles inferiores de la hormona de crecimiento al diagnóstico. El bocio multinodular constituyó la forma clínica más frecuente y los parámetros hormonales y de autoinmunidad no se asociaron al tipo de la enfermedad nodular tiroidea(AU)

The appearance of thyroid nodules in people with acromegaly is a consequence of chronic elevation of growth hormone (GH) and insulin-like growth factor type 1 (IGF-1). Its nature varies according to the geographical area, the iodine sufficiency and family pathological history, among other factors. No Cuban studies on thyroid nodular disease (TND) in these people have been published. Objectives: Describe some clinical characteristics, as well as biochemical and ultrasonographic ones related to the thyroid gland, according to the presence or not of TND, and to identify the possible association of clinical, biochemical, ultrasonographic and cytological factors with the different types of TND in patients with acromegaly. Methods: A descriptive, cross-sectional observational study that included 73 patients with acromegaly between January 2003 and December 2017. The following variables were studied: age, sex, skin color, family history of TND, GH levels, thyroid stimulating hormone, free T4, antibodies against thyroid peroxidase and thyroglobulin, thyroid volume, nodular ultrasound pattern and cytological study. Results: TND occurred in 75.3 percent of cases, with a predominance of multinodular goiter. The age at diagnosis time was lower in patients with TND (43.53 ± 9.67) than in those who did not have it (49.33 ± 6.96 years) (p=0.02). GH at diagnosis time of acromegaly was lower in patients with TND (18.73±11.33µg/L vs 35.91±21.68µg/L; (p=0.00). The thyroid volume showed significant differences between both groups (14.2±4.5mL in positive cases of TND and 10.5±2.8mL in negative cases; p=0.002), being the most frequent the nodule with low suspicion of malignancy. The rest of the variables were similar between patients with and without TNDs. Cytology was reported as benign in 75 percent in single nodules, 80 percent of nodular goiters and 90 percent of multinodular goiters (p=0.51). Conclusions: TND was frequent in cases of acromegaly, and was associated with lower age and lower GH levels at diagnosis time. Multinodular goiter was the most frequent clinical form and hormonal and autoimmunity parameters were not associated with the type of TND(AU)

Diagnostic accuracy of routine calcitonin measurement for the detection of medullary thyroid carcinoma in the management of patients with nodular thyroid disease: a meta-analysis.

OBJECTIVE: The usefulness of routine calcitonin measurement for early detection of medullary thyroid carcinoma (MTC) in patients with nodular thyroid disease (NTD) has been investigated in various studies. Recently, a Cochrane review has been published on this issue, but a meta-analysis is lacking yet. Therefore, we performed this meta-analysis. METHODS: We performed an electronic search using PubMed/Medline, Embase and the Cochrane Library. Studies assessing the diagnostic accuracy of routine calcitonin measurement for detecting MTC in patients with NDT were selected. Statistics were performed by using Stata software, risk of bias was assessed using Review Manager version 5.3. RESULTS: Seventeen studies, involving 74,407 patients were included in the study. Meta-analysis, using the bivariate random effects model and the hierarchical summary receiver operating characteristic (HSROC) curve revealed the following pooled estimates: sensitivity 0.99 (95% CI, 0.81-1.00), specificity 0.99 (95% CI, 0.97-0.99), positive likelihood ratio (L+) 72.4 (95% CI, 32.3-162.1), and negative likelihood ratio (L-) 0.01 (95% CI, 0.00-0.23). Meta-regression analysis showed that the threshold of basal calcitonin is an independent factor, but in particular performing stimulation test is not an independent factor. CONCLUSIONS: We showed that routine basal serum calcitonin measurement in the management of patients with thyroid nodules is valuable for the detection of MTC. However, the published cut-off values should be considered and, if applicable, the patients monitored in a wait-and-see strategy by experienced physicians to avoid overtreatment.

TSH Level and Risk of Malignancy in Patients with Bethesda Category IV Thyroid Nodules.

Fine needle aspiration biopsy does not permit to distinguish between benign and malignant follicular thyroid lesions (category IV in the Bethesda Cytopathology System). Some reports have suggested an association between increased serum TSH levels and thyroid cancer, so the aim of this study was to investigate the association between TSH levels and malignancy in patients with follicular thyroid nodules. Therefore, we conducted a retrospective study of all subjects who underwent surgical treatment for Bethesda IV thyroid nodules in a single center (years 2012-2017). A total of 127 patients were analyzed, and malignancy was present in 38.6% of the patients. Using ROC analysis, the best TSH cut-off point to differentiate benign from malignant disease was 2.1 mU/l and the age cut-off with better sensitivity and specificity was 47 years. The proportion of subjects with TSH ≥ 2.1 mU/l was greater among subjects with cancer than in those with benign diseases (65.3 vs 44.9%, P = 0.029). The concurrence of both cut-off points (TSH ≥ 2.1 mU/l and age ≥ 47 years) showed a higher diagnostic accuracy than either of the two variables separately. Therefore, the present study supports an association between serum concentrations of TSH and risk of malignancy among subjects with Bethesda IV thyroid nodules. TSH levels could modify the diagnostic and therapeutic approach of patients with Bethesda IV nodules.

A survey of patients with thyroid diseases who migrated from inland to coastal of Cangzhou City Hebei Province and their urinary iodine levels / 中华地方病学杂志

Objective To investigate the prevalence of common thyroid diseases and urinary iodine levels in the population migrated from inland to coastal areas and to evaluate the epidemiological trend of thyroid disease in Heibei Cangzhou. Methods A retrospective analysis method was adopted. All the persons who were employees of enterprises and institutions,were divided into three groups:the migrated group,who migrated from Cangzhou City and the west counties of Cangzhou City to the Port of Huanghua where they had settled permanently because of the job; the inland group, who lived in Cangzhou City all the time and the seaport group, who lived in the Port of Huanghua for a long-term. Migrated groups were divided into stable occupants and intermittent occupants. During 2010 - 2016, a follow-up survey was conducted in the three groups at Examination Center of Cangzhou Central Hospital Physical. We compared the cumulative incidences of thyroid diseases including: chronic lymphocytic thyroiditis (CLT), nodular thyroid disease and Graves's disease (GD). In migrated group, 28 persons who occasionally lived in the Port of Huanghua were detected urinary iodine levels intermittently.We compared the two parts of urinary iodine level changes for three times by collecting a urine sample,including one part from people who lived in the Port of Huanghua continuously for more than a month,and another part of people who lived in Cangzhou or Hejian County for more than half a month then returned to Port of Huanghua. Results In 2010 - 2016, a total of 7 180 residents were surveyed, of which 2 012 were in the migrated group, 2 858 were in the inland group and 2 310 in the seaport group. The incidences of CLT and nodular thyroid disease were 2.29% (46/2 012)and 8.60% (173/2 012)in the migrated group,which were much higher than that of the inland group and the seaport group [1.05% (30/2 858), 5.42% (155/2 858); 1.47% (34/2 310), 6.88% (159/2 310), P < 0.01 or < 0.05]. At the same time,the incidences of GD was 0.45%(9/2 012) in the migrated group, which was higher than that of the inland group [0.10% (3/2 858), P < 0.05]. In migrated group, there were 1 503 residencies, including 482 stable occupants and 1 021 intermittent residents. The incidences of CLT and nodular thyroid disease in intermittent residents were 3.23% (33/1 021) and 9.89% (101/1 021), which were much higher than that of stable occupants [1.45% (7/482), 6.64% (32/482), P < 0.05]. The urinary iodine levels in the persons who lived in the Port of Huanghua occasionally (464.6 μg/L) were much higher than that of the persons who lived in Cangzhou for a long time(301.4 μg/L, U = 4.648, P < 0.01).There was a marked fluctuation of the median of urinary iodine determined 6 times which were 485.7,285.2,431.7,310.6,470.3 and 304.4 μg/L,respectively.Conclusions The incidence of many thyroid diseases of people migrated from inland to coastal areas has increased, which is not only higher than that of inland people,but also higher than that of coastal people.Large fluctuations in iodine intake due to migration flow and residential instability may be part of the reason for the high incidence of thyroid diseases. In the future, we should pay more attention to thyroid diseases of migratory population.

Are large thyroid nodules classified as benign on fine needle aspiration more likely to harbor cancer?

INTRODUCTION: Our aim was to investigate whether benign thyroid nodules ≥ 4 cm have a higher malignancy rate. METHODS: A retrospective review of patients with a nodule and a benign FNAB who underwent thyroidectomy was completed. Patients were divided into two groups; nodule size: < 4 cm or ≥4 cm, and clinical factors, nodule size and rates of malignancy were compared. RESULTS: 337 patients underwent thyroidectomy: 99 had nodules <4 cm (2.8 ± 0.58 cm) and 238 had nodules ≥ 4 cm (5.9 ± 1.97 cm). Seven (2.1%) patients had cancer, 2 (2.0%) with a nodule < 4 cm and 5 (2.1%) with a nodule ≥ 4 cm (p = 0.962). There was no difference in clinical factors between groups (p > 0.05). CONCLUSION: There is no difference in rates of malignancy for nodules < 4 cm or ≥ 4 cm. Thus, thyroidectomy should not be recommended based solely on nodule size.

Preoperative TSH level and risk of thyroid cancer in patients with nodular thyroid disease: nodule size contribution.

BACKGROUND: Many reports have supported the relationship between high preoperative TSH levels and risk of thyroid cancer in nodular thyroid disease (NTD). OBJECTIVES: We investigated whether TSH levels are related to the risk of differentiated thyroid carcinoma (DTC) in patients who have undergone total thyroidectomy for NTD. The relationship between TSH and size of malignant nodule was investigated. Finally, we assessed whether TSH levels are related to DTC and presence of additional benign nodules. PATIENTS AND METHODS: A retrospective study of 980 patients was conducted. Variables included age at diagnosis, TSH level, nodule size, gender, final histology (benign versus DTC), and type of malignancy. RESULTS: Malignancy was present in 261 (26.6%) patients. These patients had higher median TSH levels as compared to those with no malignancy (1.61 mU/L (0.9-2.5) versus 0.9 mU/L (0.3-1.6); p-value<0.001). TSH was higher in patients with DTC in whom the largest nodule was malignant than in patients in whom the largest nodule was benign (1.80 mU/L (1.1-2.6) versus 1.38 mU/L (0.7-2.1) respectively; p-value=0.025). A significant correlation was seen between malignant nodule size and TSH level, but not between TSH levels and size of the largest benign nodule. CONCLUSIONS: Our study supported an association between preoperative TSH levels and risk of DTC in patients with NTD. There was also a direct relationship between malignant nodule size and TSH levels. By contrast, no relationship was found between the size of benign nodules and TSH levels.

Correlation between polymorphisms of transforming growth factor-β1, tumor necrosis factor-related apoptosis-inducing ligand genes and nodular thyroid disease / 中华地方病学杂志

Objective To study the correlation between individual gene polymorphisms of transforming growth factor (TGF)-β1 + 869 T/C,tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) + 1525 G/A genes and nodular thyroid disease.Methods From September 2007 to December 2009,a total of 544 patients with nodular thyroid disease diagnosed in the Department of Endocrinology,The First Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology were selected,including 136 cases of nodular goiter patients (node group),132 cases of thyroid tumor (adenoma group),146 cases of Graves patients (GD group),and 130 cases of Hashimoto's thyroiditis (HT group).One hundred and thirty-five healthy subjects were enrolled as control group.Two milliliters of fasting venous blood of all subjects were collected.Polymorphisms of the TGF-β1 + 869 T/C and the TRAIL 1525 A/G genes were identified by the polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) and the restriction fragment length polymorphism (PCR-RFLP) methods.Results TGF-β1 + 869 T/C:The CC genotypes and C allele frequencies of nodular goiter group [47.0％(64/136),63.2％(172/ 272)] were significantly higher than those of normal control group [18.0％(22/135),45.2％ (122/270); x2 =30.76,17.79,all P ＜ 0.05].The genotypes and allele frequencies of adenoma group[42.4％ (56/132),59.1％ (156/264)] were significantly higher than those of the normal control group (x2 =24.40,10.34,all P ＜ 0.05).The risk of population carrying the C allele suffering from nodular goiter was 2.086 times of those carrying the T allele (OR =2.086; 95％ CI:1.480-2.943).The risk of population carrying the C allele suffering from adenoma was 1.752 times of those carrying the T allele (OR =1.752,95％ CI:1.244-2.469).TRAIL + 1525 G/A:the genotypes and allele frequencies of nodular goiter group [40.4％ (55/136),62.9％ (171/272)] were significantly higher than those of normal control group [12.0％ (16/135),48.5％ (131/270); x2 =9.176,11.307,all P ＜ 0.05].The genotypes and allele frequencies of adenoma group[53.3％ (70/132),73.1％ (193/264)] were significantly higher than those of the normal control group (x2 =9.806,33.82,all P ＜ 0.05).The risk of population carrying the G allele suffering from nodular goiter was 1.796 times of those carrying the A allele (OR =1.796,95％ CI:1.275-2.531).The risk of population carrying the G allele suffering from adenoma was 2.884 times of those carrying the A allele (OR =2.884,95％ CI:2.009-4.142).Conclusions TGF-β1 + 869 T/C and TRAIL + 1525 G/A gene polymorphisms may be related to the incidence of nodular thyroid diseases; G allele of TRAIL and C allele of TGF-β1 may be predisposing genes of patients with nodular goiter.

The diagnostic accuracy of ultrasound guided fine-needle aspiration biopsy and intraoperative frozen section examination in nodular thyroid disease / Journal of the ASEAN Federation of Endocrine Societies

OBJECTIVES:To determine the diagnostic accuracy of combined ultrasound-guided fine needle aspiration biopsy (USG-FNAB) and intraoperative frozen section examinationin (FSE) in diagnosing malignant thyroid nodules.METHODOLOGY:Retrospective review of patients undergoing thyroidectomy with intraoperative frozen section examination following ultrasound guided fine-needle aspiration biopsy. Sensitivity, specificity, positive and negative predictive values and accuracy were calculated with respect to final histology.RESULTS: A total of 2,239 nodules were subjected to USG-FNAB at the Diabetes, Thyroid and Endocrine Center, St. Luke's Medical Center between January 2007 and December 2009. Two hundred fifty-one nodules were surgically excised following USG-FNAB. Frozen section examinations were taken from 90 of 251 nodules. The USG-FNAB yielded 90.3% (n=1,721) adequate specimens and 9.7% (n=185) inadequate specimens. The histologic examination of the 251 surgically excised nodules revealed 182 (73%) benign and 69 (27%) malignant nodules. The sensitivity, specificity, positive and negative predictive values and accuracy rate of USG-FNAB cytology are 70.3%, 92.8%, 76.5%, 90.4% and 87.2%, respectively. The diagnosis by frozen section was benign in 56 cases (62%), malignant in 10 cases (11%) and deferred in 24 cases (27%). By FSE, the sensitivity, specificity, positive and negative predictive values and accuracy rate are 83.3%, 100%, 100%, 96.4% and 96.7%, respectively. A diagnostic accuracy of up to 97.2% was achieved when USG-FNAB and FSE were combined and when their findings were concordant. When USG-FNAB and FSE diagnoses were discordant, the FSE showed superior accuracy (83.3%) than cytology (16.7%). In the group of nodules with indeterminate or inadequate cytology, the diagnostic accuracy of frozen section is 100%.CONCLUSION:Ultrasound guided fine-needle aspiration biopsy is an accurate preoperative test for the evaluation of nodular thyroid disease. It helps to distinguish malignant from benign lesions. The intraoperative frozen section is a valuable test for confirming the cytologic diagnosis. It is especially important in identifying malignant thyroid nodule in cases with indeterminate cytology. The combination of USG-FNAB and FSE greatly improves the accuracy rate in thyroid cancer detection.

Ultrasonography: Its role in nodular thyroid disease.

OBJECTIVE: The objective was to correlate the number, size and extent of the nodules as determined during the preoperative clinical examination of the thyroid gland, USG, intra-operative examination and histopathology. Also, FNAC (with or without USG guidance) and USG findings suggestive of malignancy were correlated with the final histopathology. SETTING: Tertiary referral centre PATIENTS: A retrospective chart review was done for 106 patients who underwent surgery for benign or malignant nodular thyroid disease in our center, between Jan 2004-Dec 2006. RESULTS: USG has 7 times higher predictive value than clinical examination in detecting number of nodules and determining size of nodules. USG guided FNAC has a sensitivity of 85.71% and specificity of 90.0% in detecting malignancy in nodular thyroid disease. However for predicting malignancy in thryoid nodules, this study shows that USG has a sensitivity of 20.0% and specificity of 97.67%. CONCLUSION: In patients with nodular thyroid disease, USG can accurately determine the number and the size of the nodules. It is extremely useful in guiding FNAC; However its role in predicting malignancy is doubtful. We therefore recommend that USG guided FNAC be carried out as a routine in the evaluation of thyroid nodules.