Hashimoto Tiroditine Eşlik Eden Nodüllerin Ultrasonografik Özellikleri ve Sitolojik Bulguları

Öz

Amaç: Hashimoto tiroiditi (HT) olan hastalarda tiroid nodüllerin ultrasonografik özellikleri ve ince iğne aspirasyon biyopsisi (İİAB) sonuçlarının tiroidit varlığından etkilenip etkilenmediği net olarak bilinmemektedir. Bu çalışmada HT’ye eşlik eden nodüllerin ultrasonografik özelliklerinin ve sitolojik bulgularının HT olmayan nodüler guatrlı hastalarla karşılaştırılması amaçlanmıştır.

Materyal ve Metot: Kliniğimizde 4 ay süresince ultrason (US) eşliğinde tiroid İİAB yapılan hastalar prospektif olarak incelendi. Tüm hastalardan bilgilendirilmiş olur formu alındı ve İİAB yapılacak olan nodüllerin ultrasonografik özellikleri belirlendi. Sitolojik olarak nodüller Bethesda sınıflamasına göre yetersiz, benign, önemi belirsiz atipi/önemi belirsiz foliküler lezyon (ÖBA/ÖBFL), foliküler neoplazi/foliküler neoplazi şüphesi (FN/FNŞ), malinite şüphesi ve malign olmak üzere 6 gruba ayrıldı.

Bulgular: Çalışmaya 181 (%35,49) HT olan (166 kadın, 15 erkek) ve 329 (%64,51) HT olmayan (277 kadın, 52 erkek) 510 hasta alındı. HT olanların yaş ortalaması, olmayanlara oranla daha fazlaydı (sırasıyla 50,62±12,28 ve 46,73±12,04, p=0,001). HT’li hastalarda antikor pozitifliği ve hipotiroidi, HT olmayanlardan anlamlı derecede yüksekti (p<0,001). HT grubunda 288 (%36,00), HT olmayan grupta 512 (%64,00) olmak üzere toplam 800 nodül vardı. Ultrasonografik olarak hipoekoik halo varlığı ve kenar düzensizliği her iki grupta benzerdi (sırasıyla p=0,176 ve p=0,187). HT zemininde gelişen nodüllerde mikrokalsifikasyon oranı %11,81, HT olmayanlarda %20,31 saptandı (p=0,002). Makrokalsifikasyon oranı, HT olanlarda %19,45 HT olmayanlarda %23,83 idi (p=0,012). HT olanlarda nodüllerin %30,77’si hipoekoik, %66,43’ü izoekoik ve %2,80’i hiperekoikti; HT olmayanlarda nodüllerin %38,93’ü hipoekoik, %59,63’ü izoekoik ve %1,44’ü hiperekoikti (p=0,010). HT olanlarda nodüllerin %78,47’si solid yapıda iken HT olmayanlardaki nodüllerin %61,72’si solid yapıdaydı (p<0,001). HT olanlarda sitolojik olarak %80,21 benign, %3,81 ÖBA/ÖBFL, %0,35 malinite şüphesi, %1,74 malign ve %13,89 yetersiz sonuç elde edildi. HT olmayanlarda %80,86 benign, %3,32 ÖBA/ÖBFL, %0,98 FN/FNŞ, %1,17 malinite şüphesi, %1,37 malign ve %12,30 yetersiz sonuç saptandı (p=0,427).

Sonuç: HT zemininde gelişen nodüllerde malignite lehine kabul edilen mikrokalsifikasyon ve makrokalsifikasyon varlığı ve hipoekoik görünüm daha düşük oranda saptanmıştır. Bu nodüllerde, tiroid İİAB ile elde edilen sitolojik sonuçlar, kronik tiroidit zemininde olmayan nodüllerle benzer bulunmuştur.

Anahtar Kelimeler

• Hashimoto tiroiditi,nodül,ultrasonografi,tiroid ince iğne aspirasyon biyopsisi

The Ultrasonographical Features and Cytological Findings of Thyroid Nodules in Patients with Hashimoto Thyroiditis

Abstract

Objectives: It is unclear whether ultrasonography (US) features and fine-needle aspiration biopsy (FNAB) results of nodules accompanying with Hashimoto’s thyroiditis (HT) are affected by the presence of thyroiditis or not. In this study, we aimed to compare US features and cytological results of nodules in patients with and without HT.

Materials and Methods: Patients who underwent thyroid FNAB in our clinic during a 4 months’ period were evaluated prospectively. Informed consent was obtained from all patients and US features of nodules were determined. Cytological results were classified as nondiagnostic, benign, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), follicular neoplasia/suspicious for follicular neoplasia (FN/SFN), suspicious for malignancy and malignant.
Results: 181 (35.49%) patients with HT (166 female, 15 male) and 329 (64.51%) patients (277 female and 52 male) without HT were included. The mean age of patients with HT was significantly higher than patients without HT (50.62±12.28 vs 46.73±12.04, p=0.001). Antibody positivity and hypothyroidism were higher in patients wtih HT (p<0.001 for each). There were totally 800 nodules, of which 288 (36.00%) were in patients with HT, 512 (64.00%) in patients without HT. Ultrasonographically, presence of hypoechoic halo and marginal irregularity were similar in two groups (p=0.176 and p=0.187, respectively). Microcalcification was present in 11.81% of nodules with HT and 20.31% of nodules without HT (p=0.002). Macrocalcification was detected in 19.45% and 23.83% of nodules in patients with and without HT, respectively (p=0.012). Among nodules with HT, 30.77% were hypoechoic, 66.43% were isoechoic, and 2.80% were hyperechoic; while among nodules without HT, 38.93% were hypoechoic, 59.63% were isoechoic and 1.44% were hyperechoic (p=0.010). Solid texture was observed in 78.47% of nodules with HT and 61.72% of nodules without HT (p<0.001). Cytologically, 80.21% of nodules with HT were benign, 3.81% were AUS/FLUS, 0.35% were suspicious for malignancy, 1.74% were malignant and 13.89% were nondiagnostic. In nodules without HT, cytological results were benign in 80.86%, AUS/FLUS in 3.32%, FN/SFN in 0.98%, suspicious for malignancy in 1.17%, malignant in 1.37% and nondiagnostic in 12.30% (p=0.427).

Conclusion: Suspicious US features such as microcalcification, macrocalcification and hypoechoic appearance were found with a lower prevalence in nodules accompanying HT. Cytological results of nodules that arise on chronic thyroiditis were similar with nodules that arise on a normal parenchyma.

Keywords

• Hashimoto thyroiditis,nodule,ultrasonography,thyroid fine needle aspiration biopsy

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