-
The Journal of Clinical Endocrinology... Sep 2020Approximately 60% of adults harbor 1 or more thyroid nodules. The possibility of cancer is the overriding concern, but only about 5% prove to be malignant. The... (Review)
Review
CONTEXT
Approximately 60% of adults harbor 1 or more thyroid nodules. The possibility of cancer is the overriding concern, but only about 5% prove to be malignant. The widespread use of diagnostic imaging and improved access to health care favor the discovery of small, subclinical nodules and small papillary cancers. Overdiagnosis and overtreatment is associated with potentially excessive costs and nonnegligible morbidity for patients.
EVIDENCE ACQUISITION
We conducted a PubMed search for the recent English-language articles dealing with thyroid nodule management.
EVIDENCE SYNTHESIS
The initial assessment includes an evaluation of clinical risk factors and sonographic examination of the neck. Sonographic risk-stratification systems (e.g., Thyroid Imaging Reporting and Data Systems) can be used to estimate the risk of malignancy and the need for biopsy based on nodule features and size. When cytology findings are indeterminate, molecular analysis of the aspirate may obviate the need for diagnostic surgery. Many nodules will not require biopsy. These nodules and those that are cytologically benign can be managed with long-term follow-up alone. If malignancy is suspected, options include surgery (increasingly less extensive), active surveillance or, in selected cases, minimally invasive techniques.
CONCLUSION
Thyroid nodule evaluation is no longer a 1-size-fits-all proposition. For most nodules, the likelihood of malignancy can be confidently estimated without resorting to cytology or molecular testing, and low-frequency surveillance is sufficient for most patients. When there are multiple options for diagnosis and/or treatment, they should be discussed with patients as frankly as possible to identify an approach that best meets their needs.
Topics: Biopsy, Fine-Needle; Diagnosis, Differential; Diagnostic Techniques, Endocrine; History, 21st Century; Humans; Risk Assessment; Thyroid Gland; Thyroid Nodule; Ultrasonography
PubMed: 32491169
DOI: 10.1210/clinem/dgaa322 -
Acta Medica Indonesiana Jul 2016Thyroid nodules are frequently found. Although they are often palpable, many are found incidentally during unrelated radiographic studies. Ten to 15% of thyroid nodules... (Review)
Review
Thyroid nodules are frequently found. Although they are often palpable, many are found incidentally during unrelated radiographic studies. Ten to 15% of thyroid nodules represents thyroid malignancy. Clinician suc as an internist/endocrinologist have to classify the nodule, stratify the risk of thyroid cancer, performed a diagnostic work-up, provide medical / non-surgical therapy, select candidates for surgery and provide appropriate follow-up that should last a lifetime. This article provide an up-date review of diagnostic approach and management of thyroid nodules, focusing on current algorithm in lights of the most recent published American Thyroid Association thyroid nodule and differentiated thyroid cancer management guidelines.
Topics: Diagnosis, Differential; Disease Management; Humans; Thyroid Neoplasms; Thyroid Nodule
PubMed: 27840362
DOI: No ID Found -
Endocrine Practice : Official Journal... Mar 2021Contextualizing the evaluation of older adults with thyroid nodules is necessary to fully understand which management strategy is the most appropriate. Our goal was to... (Review)
Review
OBJECTIVE
Contextualizing the evaluation of older adults with thyroid nodules is necessary to fully understand which management strategy is the most appropriate. Our goal was to summarize available clinical evidence to provide guidance in the care of older adults with thyroid nodules and highlight special considerations for thyroid nodule evaluation and management in this population.
METHODS
We conducted a literature search of PubMed and Ovid MEDLINE from January 2000 to November 2020 to identify relevant peer-reviewed articles published in English. References from the included articles as well as articles identified by the authors were also reviewed.
RESULTS
The prevalence of thyroid nodules increases with age. Although thyroid nodules in older adults have a lower risk of malignancy, identified cancers are more likely to be of high-risk histology. The goals of thyroid nodule evaluation and the tools used for diagnosis are similar for older and younger patients with thyroid nodules. However, limited evidence exists regarding thyroid nodule evaluation and management to guide personalized decision making in the geriatric population.
CONCLUSION
Considering patient context is significant in the diagnosis and management of thyroid nodules in older adults. When making management decisions in this population, it is essential to carefully weigh the risks and benefits of thyroid nodule diagnosis and treatment, in view of older adults' higher prevalence of high-risk thyroid cancer as well as increased risk for multimorbidity, functional and cognitive decline, and treatment complications.
Topics: Aged; Biopsy, Fine-Needle; Endocrinologists; Humans; Thyroid Neoplasms; Thyroid Nodule
PubMed: 33588062
DOI: 10.1016/j.eprac.2021.02.003 -
Frontiers in Endocrinology 2023Thyroid nodules have garnered attention due to changes in population surveillance systems and rising concerns about the associated financial burden on healthcare... (Review)
Review
Thyroid nodules have garnered attention due to changes in population surveillance systems and rising concerns about the associated financial burden on healthcare systems, payers, and patients. In this review, we find that prevalence rates vary widely based on method of detection and may particularly pronounced in asymptomatic patients undergoing routine screening. Incidence rates may be particularly rising in lower-income and middle-income countries and may be declining in higher-income countries. Despite high incidence rates, survival rates continue to be as high as 97% for papillary thyroid cancer. Over the last few decades, thyroid nodule workup and management has grown more sophisticated with the advent of fine-needle aspiration biopsy, specialized biomarkers, and molecular testing. However, gaps remain in risk stratification that can lead to substantial costs of care. Certain molecular tests, such as the Afirma Gene Sequencing Classifier can lead to a cost per diagnosis of $17,873 while achieving only mild decreases in diagnostic lobectomies for patients (11.6% to 9.7% in one study). Out-of-pocket costs associated with thyroid nodule management continue to drive significant financial toxicity for patients, especially for individuals with thyroid cancer. Financial toxicity has been defined as a term that describes how direct and indirect medical costs of cancer care strain patients and households decreased income, assets, and spending on basic necessities. Recent studies suggest that such toxicity can lead to adverse financial outcomes, such as foreclosure and bankruptcy. Additional cost-effectiveness analyses are needed to improve existing thyroid nodule management systems and new clinical tools are needed to avoid unnecessary workup and management.
Topics: Humans; Thyroid Nodule; Retrospective Studies; Gene Expression Profiling; Thyroid Neoplasms; Thyroid Cancer, Papillary
PubMed: 36755911
DOI: 10.3389/fendo.2023.1113977 -
Gaceta Medica de Mexico 2019The physician that has the first contact with the patient is the general or family doctor, on whose initial assessment patient treatment success often depends. National... (Review)
Review
The physician that has the first contact with the patient is the general or family doctor, on whose initial assessment patient treatment success often depends. National and international treatment guidelines are designed for specialists in the area, and the primary care physician often finds them difficult to interpret. The purpose of this document is to offer primary care physicians the fundamentals for the diagnostic and reference process of patients with thyroid nodules and possibly with well-differentiated thyroid cancer, from an objective and pragmatic point of view. Not all thyroid nodules require the same approach, and not all nodules are associated with cancer and neither should they be removed. The bases for a proper diagnosis of a thyroid tumor are patient history, physical examination and ultrasound. The results of these three initial assessment methods shall support the decision on the diagnostic-therapeutic process. This article explains the appropriate way to approach the diagnosis of a thyroid tumor, which studies are unnecessary, and which are the principles of thyroid cancer treatment.
Topics: Humans; Physician's Role; Physicians, Primary Care; Thyroid Neoplasms; Thyroid Nodule; Ultrasonography
PubMed: 31787768
DOI: 10.24875/GMM.19005072 -
Journal of Clinical Oncology : Official... Feb 2023To explore the novel diagnostic value of epigenetic imprinting biomarkers in thyroid nodules.
PURPOSE
To explore the novel diagnostic value of epigenetic imprinting biomarkers in thyroid nodules.
PATIENTS AND METHODS
A total of 550 patients with fine-needle aspiration (FNA)-evaluated and histopathologically confirmed thyroid nodules were consecutively recruited from eight medical centers. Quantitative chromogenic imprinted gene in situ hybridization (QCIGISH) was used to assess the allelic expression of imprinted genes and , on the basis of which a diagnostic grading model for thyroid nodules was developed. The model was retrospectively trained on 124 postsurgical thyroid samples, optimized on 32 presurgical FNA samples, and prospectively validated on 394 presurgical FNA samples. Blinded central review-based cytopathologic and histopathologic diagnoses were used as the reference standard.
RESULTS
For thyroid malignancy, the QCIGISH test achieved an overall diagnostic sensitivity of 100% (277/277), a specificity of 91.5% (107/117; 95% CI, 86.4 to 96.5), a positive predictive value (PPV) of 96.5% (95% CI, 94.4 to 98.6), and a negative predictive value (NPV) of 100% in the prospective validation, with a diagnostic accuracy of 97.5% (384/394; 95% CI, 95.9 to 99.0). QCIGISH demonstrated a PPV of 97.8% (95% CI, 94.7 to 100) and NPV of 100%, with a diagnostic accuracy of 98.2% (111/113; 95% CI, 95.8 to 100), for indeterminate Bethesda III-V thyroid nodules. QCIGISH demonstrated a PPV of 96.6% (95% CI, 91.9 to 100) and a NPV of 100%, with a diagnostic accuracy of 97.5% (79/81; 95% CI, 94.2 to 100), for Bethesda III-IV. For Bethesda VI, QCIGISH showed a 100% (184/184) accuracy.
CONCLUSION
This imprinting biomarker-based test can effectively distinguish malignant from benign thyroid nodules. The high PPV and NPV make the test both an excellent rule-in and rule-out diagnostic tool. With such a diagnostic performance and its technical simplicity, this novel thyroid molecular test is clinically widely applicable.
Topics: Humans; Thyroid Nodule; Retrospective Studies; Thyroid Neoplasms; Biomarkers; Epigenesis, Genetic
PubMed: 36378996
DOI: 10.1200/JCO.22.00232 -
CA: a Cancer Journal For Clinicians Mar 2018Incidental thyroid nodules that are found on an imaging study performed for reasons other than thyroid pathology represent a common scenario encountered by health care... (Review)
Review
Incidental thyroid nodules that are found on an imaging study performed for reasons other than thyroid pathology represent a common scenario encountered by health care providers. The initial workup for these nodules comprises a thorough history and physical examination, thyroid function tests, a dedicated thyroid ultrasound, and fine-needle aspiration of any suspicious lesions. Management ranges from observation and reassurance to surgical resection and depends on the cytologic diagnosis. In cases of cytologically indeterminate or discordant nodules, surgical excision (lobectomy) offers a definitive diagnosis, although molecular testing or a reasonable period of observation may be useful as less invasive adjuncts. CA Cancer J Clin 2018;68:97-105. © 2018 American Cancer Society.
Topics: Biopsy, Fine-Needle; Diagnosis, Differential; Humans; Incidental Findings; Molecular Diagnostic Techniques; Positron-Emission Tomography; Practice Guidelines as Topic; Thyroid Function Tests; Thyroid Neoplasms; Thyroid Nodule; Ultrasonography
PubMed: 29369334
DOI: 10.3322/caac.21447 -
The Medical Clinics of North America Mar 2012Thyroid nodules are common entities, clinically important primarily because of their malignant potential. Serum thyrotropin and thyroid ultrasonography are pivotal in... (Review)
Review
Thyroid nodules are common entities, clinically important primarily because of their malignant potential. Serum thyrotropin and thyroid ultrasonography are pivotal in evaluating thyroid nodules. Fine-needle aspiration biopsy is the most accurate tool for diagnosing malignancy and selecting candidates for surgery. An approach to the initial evaluation and management of single nodules, functioning nodules, multinodular glands, incidental nodules, and cysts is discussed, as are therapeutic interventions for benign nodules. Thyroid cancer discovered during pregnancy is also discussed.
Topics: Diagnosis, Differential; Humans; Incidental Findings; Neoplasm Staging; Risk Factors; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule; Ultrasonography, Interventional
PubMed: 22443979
DOI: 10.1016/j.mcna.2012.02.002 -
Ugeskrift For Laeger Feb 2023Different congenital and acquired lesions can present as a cystic mass of the neck. The diagnostics and treatment of these is described in this review. Ultrasound and... (Review)
Review
Different congenital and acquired lesions can present as a cystic mass of the neck. The diagnostics and treatment of these is described in this review. Ultrasound and fine-needle aspiration biopsy are essential in the diagnostic workup of neck cysts, and especially cysts located laterally in the neck in adults over 40 years of age require further examination, due to the risk of malignancy. Treatment of the cysts depends on the type and location and can consist of aspiration, surgery, and sclerotherapy. Especially cystic thyroid nodules and macrocystic lymphatic malformations may be treated with schlerotherapy.
Topics: Adult; Humans; Middle Aged; Neck; Thyroid Nodule; Ultrasonography; Cysts; Thyroid Neoplasms
PubMed: 36896617
DOI: No ID Found -
Archives of Endocrinology and Metabolism Oct 2018
Topics: Humans; Magnetic Resonance Spectroscopy; Metabolomics; Thyroid Nodule
PubMed: 30462800
DOI: 10.20945/2359-3997000000080