-
International Journal of Surgery... Mar 2016The incidence of thyroid carcinoma is increasing worldwide. Graves' disease is the most common hyperthyroid disease. Studies have suggested an increased risk of thyroid... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The incidence of thyroid carcinoma is increasing worldwide. Graves' disease is the most common hyperthyroid disease. Studies have suggested an increased risk of thyroid malignancy in Graves' disease: there has not yet been a meta-analysis to allow quantitative comparison. The purpose of this study was to determine the risk of thyroid carcinoma in Graves' disease, and to gather information on the histological subtypes of carcinoma and the co-existence of thyroid nodules.
METHODS
Several databases and article reference lists were searched. Inclusion criteria included appropriate diagnostic criteria for thyroid conditions and a diagnoses of carcinoma based on histology.
RESULTS
33 studies were selected, all reporting on surgically-resected specimens. The event rate of thyroid carcinoma in Graves' disease was 0.07 (95% CI 0.04 to 0.12). There was no data to allow comparison with patients without hyperthyroid diseases. There was no increase in the odds of developing carcinoma in Graves' disease compared to toxic multinodular goitre and toxic uninodular goitre. 88% of thyroid carcinomas in Graves' disease were papillary, with solitary papillary micro-carcinoma (diameter 10 mm or less) comprising 23% of all detected thyroid carcinomas. Patients with Graves' disease and co-existing thyroid nodules were almost 5 times more likely to be diagnosed with thyroid carcinoma than those without nodules.
CONCLUSION
Thyroid malignancy in Graves' disease requiring surgical treatment should be considered as likely as in other hyperthyroid diseases needing surgical treatment. Clinicians should consider screening selected patients with Graves' disease for nodules whilst being aware of potentially over-diagnosing papillary micro-carcinoma.
Topics: Adult; Carcinoma; Carcinoma, Papillary; Female; Graves Disease; Humans; Incidence; Male; Odds Ratio; Thyroid Neoplasms; Thyroid Nodule
PubMed: 26626367
DOI: 10.1016/j.ijsu.2015.11.027 -
International Journal of Surgery... 2014The diagnosis of incidental thyroid carcinoma in patients submitted to thyroidectomy for a benign disease is quite frequent. A retrospective analysis was performed on...
The diagnosis of incidental thyroid carcinoma in patients submitted to thyroidectomy for a benign disease is quite frequent. A retrospective analysis was performed on 455 patients submitted to surgical intervention in order to establish the incidence of this kind of carcinoma. Two hundred fifty-six patients (56%) were affected by benign disease (176 multinodular goiter, 12 uninodular goiter, 1 Plummer disease and 67 Basedow disease) and 202 (44%) by carcinoma. In 28 of 256 patients (11%), affected by benign disease, occurred a histological diagnosis of thyroid carcinoma, (10 papillary carcinoma, 1 follicular carcinoma, 29 papillary carcinoma follicular variant). In this study it's considered incidental thyroid carcinoma the one occurred in patients who never underwent Fine Needle Aspiration (FNA) and there were no suspicious features in all exams that may suggest the presence of carcinoma. Twenty-three of the 40 incidental carcinoma (57.5%) were microcarcinomas. Ten patients had a sincronous carcinoma. Actually, these patients are still in a follow up program and no recurrency of disease is occasionally observed. This study shows that the only way to put doubts on the real benignity of the disease is the fine needle aspiration; there are no other instruments that could identify the occurrence of the carcinoma. Moreover in the majority of cases the incidental carcinoma is a microcarcinoma, it doesn't reach significant volume, may be not centered by a FNA, but in most cases it's not really biologically aggressive.
Topics: Adenocarcinoma, Follicular; Adolescent; Adult; Aged; Aged, 80 and over; Biopsy, Fine-Needle; Carcinoma, Papillary; Female; Humans; Incidence; Incidental Findings; Male; Middle Aged; Retrospective Studies; Thyroid Diseases; Thyroid Neoplasms; Thyroidectomy; Young Adult
PubMed: 24866072
DOI: 10.1016/j.ijsu.2014.05.041 -
World Journal of Nuclear Medicine 2021The aim of this study is to evaluate the efficacy of a fixed 30 mCi (1110 MBq) I-iodine dose for the treatment of hyperthyroidism due to uninodular or multinodular toxic...
AIMS
The aim of this study is to evaluate the efficacy of a fixed 30 mCi (1110 MBq) I-iodine dose for the treatment of hyperthyroidism due to uninodular or multinodular toxic goiter and identify predictors of success.
MATERIALS AND METHODS
Fifty-nine patients diagnosed with nonautoimmune toxic goiter were treated with a fixed 30 mCi dose of I-iodine and were followed at a tertiary service between 2000 and 2016. The therapy was considered successful if the patient reached euthyroidism or hypothyroidism without needing an extra I-iodine dose or antithyroid drugs for at least 1 year after the radioiodine therapy (RIT).
RESULTS
Patients with a single toxic nodule were younger at diagnosis (52 vs. 63 years; = 0.007), presented a shorter disease duration until RIT (2 vs. 3.5 years; = 0.007), smaller total thyroid volume (20 vs. 82 cm; = 0.044), and lower pre-RIT thyroid uptake ( = 0.043) than patients with multinodular goiter. No significant difference was seen with antithyroid drug use, thyroid-stimulating hormone and free thyroxine level, and follow-up after RIT. After RIT, 47 patients (79.66%) met the success criteria, and 12 (20.33%) remained hyperthyroid. Among the success group, 32 (68.08%) reached euthyroidism, while 31.92% developed hypothyroidism after 1 year. Patients with single toxic nodules who achieved success after RIT presented smaller nodules (2.8 vs. 5.75 cm; = 0.043), while the pre-RIT thyroid uptake was higher among patients with multinodular toxic goiter who achieved success after RIT (5.5% vs. 1.5%; = 0.007). A higher success rate was observed among patients with a single toxic nodule than those with a toxic multinodular goiter (92.3% vs. 55%; = 0.001), and a single toxic nodule presentation was found to be an independent predictor of success ( = 0.009).
CONCLUSIONS
The fixed 30 mCi I-iodine dose was particularly effective in the group of patients with single autonomously functioning nodule rather than the group with multiple nodules. A single toxic nodule was an independent predictor of treatment success.
PubMed: 35018149
DOI: 10.4103/wjnm.wjnm_150_20 -
Journal of Postgraduate Medicine 1993334 consecutive cases of thyroid swellings operated by a single surgical unit over 9 years have been analysed prospectively. There was a female preponderence (4.39:1).... (Clinical Trial)
Clinical Trial Comparative Study Review
334 consecutive cases of thyroid swellings operated by a single surgical unit over 9 years have been analysed prospectively. There was a female preponderence (4.39:1). The swellings were clinically differentiated into uninodular (39.52%), multinodular (47.31%) and diffuse (13.17%). Hyperthyroidism was manifested in 49 cases (14.67%). Pressure symptoms were present in only 1.5% cases. FNAC detected malignancy in 14 of 162 cases (8.64%). The initial 100 cases were operated upon by standard Lahey's technique and the latter 234 by modified technique described by Bapat et al for benign thyroid disease. Operations performed included nodulectomies (5.39%), hemithyroidectomies (41.92%), partial thyroidectomies (25.75%), subtotal (25.45%) and near total thyroidectomies (1.5%). Post-operative complications were higher in the first group and included unilateral cord palsies-5 (5%). hypocalcemia-4 (4%) hypoparathyroidism-1 (1%) haemorrhage-1 (1%) and mortality-1 (1%) vis a vis cord palsies-2 (0.85%), hypocalcemia-3 (1.28%), hypoparathyroidism-1 (0.43%) and there was no mortality. Histopathology revealed 83 (24.85%) colloid goiters, 193 (57.78%) nodular goiters, 21 (6.29%) follicular adenomas, 7 (2.10%) cases of thyroiditis and 30 (8.98%) malignancies. This study reveals the lower incidence of RLN palsy after modified thyroidectomies, and a low incidence of malignancy.
Topics: Adolescent; Adult; Aged; Biopsy, Needle; Child; Female; Goiter; Humans; Incidence; India; Male; Middle Aged; Population Surveillance; Postoperative Complications; Prospective Studies; Sex Factors; Thyroidectomy; Treatment Outcome
PubMed: 7996497
DOI: No ID Found -
Endocrine Connections Dec 2023An improvement in iodine status in Veneto Region has been documented in the last decade. We aimed at estimating the incidence of hyperthyroidism in the Veneto Region...
OBJECTIVE
An improvement in iodine status in Veneto Region has been documented in the last decade. We aimed at estimating the incidence of hyperthyroidism in the Veneto Region (Italy) over the period 2013-2022.
METHODS
Retrospective population-based study conducted in Veneto (4.9 million people) using the population registry, an administrative health database. Between 2012 and 2022, hyperthyroidism incidence was defined thank to a health-care co-payment exemption for hyperthyroidism or any hospital diagnosis of hyperthyroidism. Incident hyperthyroidism was defined from 2013 to 2022 to exclude prevalent cases. Standardized incidence rates (IRs) were reported by age, sex, and etiology of thyroid hyperfunction too.
RESULTS
We identified 26,602 incident cases (IR of 54.38 per 100,000 person-years, 2.47-fold higher in females than in males). IR decreased from 69.87 (95% CI: 67.49, 72.25) in 2013 to 42.83 (95% CI: 40.99, 44.66) in 2022. In 2020, an out-of-trend decrease in hyperthyroidism incidence was documented, corresponding to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic outbreak, with a realignment to the trend in the subsequent years. The annual percentage change according to the cause of hyperthyroidism was as follows: -6.62% (95% CI: 8.47, 4.73) (P < 0.0001) in toxic multinodular goiter, -7.56% in toxic uninodular goiter (95% CI: 10.54, 4.48) (P < 0.001) and -4.70% (95% CI: 6.33, 3.04) in toxic diffuse goiter (Graves' disease) (P < 0.001).
CONCLUSIONS
We documented a decline in the incidence of hyperthyroidism in Veneto Region, paralleling the improvement of the iodine status, thanks to a long and sustained iodine prophylaxis campaign. SARS-CoV-2 pandemic and vaccination campaign did not change the declining trend of hyperthyroidism incidence in our study region.
SIGNIFICANCE STATEMENT
An improvement in iodine status in the population residing in the Veneto region has been documented in the last decade, thanks to a nationwide voluntary iodine prophylaxis program running since 2005, but its impact on the epidemiology of thyroid disease has never been documented. This is the largest study on the incidence rates of hyperthyroidism carried out in Italy and covers the longest observation period among all regionwide population-based studies of hyperthyroidism in our country. We documented a reduction in the incidence of hyperthyroidism, which was more pronounced in nodular goiter diagnosis but involved also toxic diffuse goiter. The decline in the incidence of hyperthyroidism in Veneto Region shows the efficacy and safety of the iodine prophylaxis campaign.
PubMed: 37855396
DOI: 10.1530/EC-23-0292 -
Deutsches Arzteblatt International Dec 2013In Germany, about 59 000 thyroid operations are performed each year for uni- or multinodular goiter, most of them for diagnostic purposes. The rate of detection of...
BACKGROUND
In Germany, about 59 000 thyroid operations are performed each year for uni- or multinodular goiter, most of them for diagnostic purposes. The rate of detection of thyroid cancer in such operations is relatively low, at 1:15. Evidence suggests that the preoperative tests recommended in guidelines for estimating the risk of cancer are not being performed as often as they should. In the present study, we determined the measures that were actually taken to diagnose and treat thyroid nodules and compared the findings with the guideline recommendations.
METHOD
We retrospectively analyzed data from a single, large statutory healthinsurance carrier in Germany (AOK), determining the diagnostic and therapeutic measures that were reimbursed for 25 600 patients in whom a uni- or multinodular goiter was newly diagnosed in the second quarter of 2006 (none of these patients had carried such a diagnosis 1 year previously). We recorded the diagnostic measures performed in the preceding 9 months and all other tests and treatments, including surgery and radioactive iodine treatment, in the 2 years thereafter.
RESULTS
Among patients who underwent surgery for uninodular goiter, the preoperative diagnostic studies included ultrasonography (in 100% of patients), scintigraphy (94%), measurement of thyroid-stimulating hormone (95%), measurement of calcitonin (9%), and fine-needle aspiration cytology (FNAC)(21%). An ultrasonographic examination was billed for only 28% of patients with uninodular goiter in the two years after the diagnosis was made. 13% of patients with uninodular goiter who were not operated on were given L-thyroxine, even though this is against guideline recommendations.
CONCLUSION
Inadequate preoperative risk stratification of thyroid nodules may explain the large number of thyroid operations that are performed for diagnostic purposes, resulting in a low percentage of malignancies detected. Preoperative FNAC and calcitonin measurement should be used in the diagnostic evaluation of thyroid nodules far more often than this is now done. As a rule, follow-up ultrasonography should be performed for all thyroid nodules that are not operated on. Patients with non-operated thyroid nodules should not be given thyroxine. A limitation of this study is that diagnostic measures were only recorded if they were performed in the 9 months before surgery, with earlier diagnostic measures (if any) being missed.
Topics: Adult; Aged; Female; Germany; Humans; Male; Middle Aged; National Health Programs; Patient Selection; Prevalence; Radiotherapy; Retrospective Studies; Risk Factors; Thyroid Nodule; Thyroidectomy; Treatment Outcome; Ultrasonography; Young Adult
PubMed: 24355935
DOI: 10.3238/arztebl.2013.0827 -
Stem Cell Investigation 2020Epidermal inclusion cysts (EIC) are common benign lesions of the skin, ovaries, and testicles. However, their occurrence in thyroid gland is rare. We reported a case in...
Epidermal inclusion cysts (EIC) are common benign lesions of the skin, ovaries, and testicles. However, their occurrence in thyroid gland is rare. We reported a case in which a 57-year-old male patient with history of nontoxic uninodular goiter presented with dysphonia and dysphagia. The cytology of ultrasound guided fine needle aspiration of the thyroid nodule revealed epidermal cyst. Despite the benign presentation. The patient underwent lobectomy to relieve his clinical symptoms and the surgical pathology exam confirmed the diagnosis of benign thyroid cyst, consistent with EIC of the thyroid.
PubMed: 33209917
DOI: 10.21037/sci-2020-021 -
Case Reports in Surgery 2020The nonrecurrent laryngeal nerve (NRLN) is a rare anatomical variation of the recurrent laryngeal nerve (RLN) that may hinder the identification and preservation of this...
The nonrecurrent laryngeal nerve (NRLN) is a rare anatomical variation of the recurrent laryngeal nerve (RLN) that may hinder the identification and preservation of this nerve during surgery and is associated with increased iatrogenic risks. Zuckerkandl's tubercle (ZT) is considered a useful reference for locating the RLN during thyroid surgery. We report the case of an asymptomatic patient with a 23 mm uninodular goitre suspicious for cancer. Ultrasound examination showed a hypoechoic nodule with regular contours and microcalcifications. The patient had normal thyroid-stimulating hormone and thyroxine levels, and aspiration biopsy was suspicious for follicular cancer. She was treated with total thyroidectomy after the intraoperative examination confirmed the presence of a papillary thyroid carcinoma. The standard approach to the RLN below the inferior thyroid artery was used on both sides. The nerve displayed anatomical variation in the nonrecurrent form (NRLN) on the right side and was associated with another variation that was not found in the consulted literature. It was completely surrounded by thyroid tissue in the region of ZT, and the surgeon was forced to remove it from within the thyroid tissue. This combination of anatomical variations seems to be quite rare. Knowledge of the anatomy of the RLN and its variations, as well as its identification and careful dissection, is essential to avoid injury to the nerve during surgical procedures.
PubMed: 32832187
DOI: 10.1155/2020/2459321 -
International Journal of Endocrinology 2020Primary hyperparathyroidism (PHPT) and thyroid diseases are a frequent concomitant occurrence, but the surgical approach to associated disease is still debated.
BACKGROUND
Primary hyperparathyroidism (PHPT) and thyroid diseases are a frequent concomitant occurrence, but the surgical approach to associated disease is still debated.
METHODS
We retrospectively evaluated a series of PHPT patients focusing on thyroid disease and surgery.
RESULTS
Among 238 PHPT patients undergoing parathyroidectomy (PTX) between 2002 and 2017, 128 were affected also by a benign thyroid disease, namely, goiter in 118 (76 multinodular (MNG) and 42 uninodular (UNG)), autoimmune thyroiditis in 10, and hyperthyroidism in 21. Surgical approach was unilateral neck exploration (UNE) in 59 patients and bilateral neck exploration (BNE) in 69. The PHPT cure rate was 94%. On comparing patients submitted to PTX only and PTX plus thyroidectomy (TX), in the latter MNG and hyperthyroidism were more frequent, and surgical time and length of stay were longer. No difference in surgical complications was found between patients undergoing UNE and BNE.
CONCLUSION
PHPT patients with a concomitant thyroid disease underwent double surgery in almost two-thirds of the cases, mostly by BNE. The main factors driving the decision to perform concomitant PTX and TX were the presence of thyroid nodular disease with the nodule site ipsilateral to the presurgically localized parathyroid adenoma.
PubMed: 32148486
DOI: 10.1155/2020/2182539