Clinical, sonographical and cytological comparison of toxic and non-toxic thyroid nodules

Year 2022, Volume: 5 Issue: 3, 922 - 925, 30.05.2022

Zeynep Çetin Derya Köseoğlu Özden Özdemir Başer

https://doi.org/10.32322/jhsm.1089028

Abstract

Aim: To compare patients with toxic and non-toxic nodular/multinodular goiter in terms of clinical, sonographical and cytological features.
Material and Method: The medical data of 326 patients were reviewed retrospectively. Clinical and sonographic features were examined. Four hundred and eighty-one nodules were compared sonographically and cytologically. One hundred twenty-four patients had toxic nodular goiter and 202 of them had non-toxic nodular goiter.
Results: The toxic nodular goiter group was older, they had more male sex, more multi-nodularity, larger thyroid glands and nodules with more sonographically suspicious features (p<0.05). One hundred sixty-five of 481 nodules belonged to the toxic group. Nodule size was > 40 mm in 13.9% of the nodules in the toxic group and 5.4% of those in the non-toxic group (p= 0.003). Central vascularization (p <0.0001) and hypoechogenicity (p =0.005) were higher in nodules of the toxic group. The two groups were similar in terms of fine needle aspiration biopsy (FNAB) results.
Conclusion: Toxic nodules can have sonographically suspicious features like non-toxic nodules, and their evaluation with FNAB should not be avoided or postponed, thus ensuring more adequate treatment and follow-up of toxic nodular thyroid disease.

Keywords

Thyroid nodule, toxic, sonography, biopsy, malignancy risk

References

• Gilbert J. Thyrotoxicosis – investigation and management. Clin Med (Lond) 2017; 17: 274-7.
• Bahn RS, Burch HB, Cooper DS, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011; 21: 593-646.
• Fiore E, Rago T, Provenzale MA. Lower levels of TSH are associated with a lower risk of papillary thyroid cancer in patients with thyroid nodular disease: thyroid autonomy may play a protective role. Endocr Relat Cancer 2019; 16: 1251-60.
• Mandel SJ. A 64-year-old woman with a thyroid nodule. JAMA 2004; 292: 2632-42.
• Maia FFR, Zantut-Wittmann DE. Thyroid nodule management: clinical, ultrasound and cytopathological parameters for predicting malignancy. CLINICS 2012; 67: 945-54.
• Eng CY, Quraishi MS, Bradley PJ. Management of thyroid nodules in adult patients. Head Neck Oncol 2010; 2: 1–5.
• Tam AA, Ozdemir D, Alkan A, et al. Toxic nodular goiter and thyroid cancer: Is hyperthyroidism protective against thyroid cancer? Surgery 2019; 166: 356-61.
• Baser H, Topaloglu O, Bilginer MC, et al. Are cytologic and histopathologic features of hot thyroid nodules different from cold thyroid nodules? Diagn Cytopathol 2019; 47: 898-903.
• Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016; 26: 1-133.
• Cibas E, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid 2017; 27: 1341-6.
• De Leo S, Lee SY, Braverman LE. Hyperthyroidism. Lancet 2016; 388: 906–18.
• LiVolsi VA, Baloch ZW. The pathology of hyperthyroidism. Front Endocrinol (Lausanne) 2018; 9: 737.
• Knobel M. Etiopathology, clinical features, and treatment of diffuse and multinodular nontoxic goiters. J Endocrinol Invest 2016; 39: 357.
• Medeiros-Neto G. Multinodular goiter. Feingold KR, Anawalt B, Boyce A, eds. In: Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–16.
• Abraham-Nordling M, Torring O, et al. Graves’ disease: a long-term quality-of-life follow up of patients randomized to treatment with antithyroid drugs, radioiodine, or surgery. Thyroid 2005; 15:1279–86.
• Rosario PW, Rocha TG, Mourão GF, Calsolari MR. Is radioiodine scintigraphy still of value in thyroid nodules with indeterminate cytology?: a prospective study in an iodine-sufficient area [eng]. Nucl Med Commun 2018; 39: 1059-60.
• Mirfakhraee S, Mathews D, Peng L, Woodruff S, Zigman JM. A solitary hyperfunctioning thyroid nodule harboring thyroid carcinoma: review of the literature. Thyroid Res 2013; 6: 7.