Otonom (Toksik) Tiroid Nodüllerinin Ultrasonografik Özelliklerinin ve Sitopatolojik Sonuçlarının Degerlendirilmesi

Abstract

Amaç: Tiroid nodülleritoplumda sık karşılaşılan ve maligniteyle ilişkili olduğu bilinen klinik durumlardır. Bu çalışmada otonom (toksik) tiroid nodülleri (TTN) tanısı konulan hastalardaki malignite sıklığını belirlemek amaçlandı. Ayrıca ultrasonografi (US) bulguları ve ince iğne aspirasyonu (İİA) sonuçlarının malignite tanısına yardımcı olmadaki etkinliği araştırıldı. Gereç ve Yöntem: Otonom (Toksik) tiroid nodülü tanısı, subklinik veya klinik hipertiroidi varlığında US’de nodül ve Tc‐99m perteknetat ile yapılan sintigrafide nodül veya nodüllere uyan alanlarda aktivite tutulumda artış ile birlikte bezin diğer kısımlarında supresyon saptanması ile kondu. Ultrasonografi bulguları ile şüpheli olarak değerlendirilen hastalara ince iğne aspirasyonu yapıldı. Cerrahi rezeksiyon gerekliliği saptanan hastaların histopatoloji sonuçları kaydedildi. Bulgular: Çalışmaya otonom (toksik) tiroid nodülü saptanan 125 hasta dahil edilmiştir. Hastaların 82’si (%65,60) kadın, 43’ü (%34,40) erkek olup yaş ortalamaları 63,55±11,13 idi. Ultrasonografide nodüllerin isthmus ve sol üst polde daha az sıklıkla yerleştiği saptanmıştır. İzoekoik nodül görüntüsünün hipoekoik ve karışık eko görüntüden daha az olduğu görülmüştür (p<0,001). Mikrokalsifikasyon varlığı ise 8 (%6,4) hastada tespit edilmiştir. Histopatolojik olarak 2 (%1,6) hastanın nodülü malign olarak tespit edilmiştir. Malign olarak saptanan iki hasta da erkekti ve nodülleri US’de hipoekoik olarak görülmüştür. Sonuç: Otonom (toksik) tiroid nodüllerinin malignite ile ilgili olabileceği görüldüğünden, US’de hipoekoik görüntüsü olan erkek hastalarda dikkatli değerlendirme yapılmasının uygun olduğu düşünülmüştür.

Keywords

• Toksik Tiroid Nodulü
• Malignite
• Ultrasonografi.

Evaluation of Ultrasonographic Characteristics and Cytopathological Results of Autonomous (Toxic) Thyroid Nodules

Abstract

Objective: Thyroid nodules are clinical conditions frequently encountered in the community and known to be associated with malignancy. In this study, it was aimed to determine the frequency of malignancy in patients diagnosed with autonomous (toxic) thyroid nodules (TTN). In addition, the effectiveness of ultrasonography (US) findings and fine needle aspiration (FNA) results in helping the diagnosis of malignancy were investigated. Methods: Autonomous (Toxic) thyroid nodule was diagnosed by presence of nodule on US in the presence of subclinical or clinical hyperthyroidism, and detection of suppression in other parts of the gland with increased activity in scintigraphy performed with Tc‐99m pertechnetate. Fine-needle aspiration was performed on patients who were considered suspicious by ultrasonographic findings. The histopathology results of the patients who were found to need surgical resection were recorded. Results: 125 patients with autonomous (toxic) thyroid nodules were included in the study. Of the patients, 82 (65.60%) were female and 43 (34.40%) were male, with a mean age of 63.55±11.13 years. Ultrasonography revealed that nodules were less frequently located in the isthmus and left upper pole. The presence of microcalcification was detected in 8 (6.4%) patients. Histopathologically, the nodules of 2 (1.6%) patients were found to be malignant. Both patients who were found to be malignant were male and their nodules were seen as hypoechoic on US. Conclusions: Since it has been seen that autonomic (toxic) thyroid nodules may be related to malignancy, careful evaluation of male patients with a hypoechoic image on US was considered appropriate.

Keywords

• Toxic Thyroid Nodule
• Malignancy
• Ultrasonography.

References

1. 1. Wong R, Farrell SG, Grossmann M. Thyroid nodules: diagnosis and management. Med J Aust. 2018;209(2):92-8.
2. 2. Özdemir D, Beştepe N, Dellal FD, Gümüşkaya Öcal B, Kılıç İ, Ersoy R. Thyroid cancer incidence in patients with toxic nodular and multinodular goiter. Ankara Med J. 2018;(4):664‐74.
3. 3. Kang AS, Grant CS, Thompson GB, van Heerden JA. Current treatment ofnodular goiter with hyperthyroidism (Plummer’s disease): surgery versusradioiodine. Surgery. 2002;132:916e923.
4. 4. Gelmini R, Franzoni C, Pavesi E, Cabry F, Saviano M. Incidental thyroid carcinoma (ITC): a retrospective study in a series of 737 patients treated for benigndisease. Ann Ital Chir. 2010;81:421e427.
5. 5. Smith JJ, Chen X, Schneider DF, Nookala R, Broome JT, Sippel RS, et al. Toxic nodular goiter and cancer: acompelling case for thyroidectomy. Ann Surg Oncol. 2013;20:1336e1340.
6. 6. Senyurek Giles Y, Tunca F, Boztepe H, Kapran Y, Terzioglu T, Tezelman S. Therisk factors for malignancy in surgically treated patients for Graves’disease, toxic multinodular goiter, and toxic adenoma. Surgery. 2008;144:1028e1036.
7. 7. Cappelli C, Castellano M, Pirola I, Cumetti D, Agosti B, Gandossi E, et al. The predictive value of ultrasound findings in the management of thyroid nodules. QJM. 2007;100(1):29-35.
8. 8. Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, et al; and Thyroid Study Group, Korean Society of Neuro‐ and Headand Neck Radiology. Benign and malignant thyroid nodules: US differentiation–multicenterretrospective study. Radiology. 2008;247(3):762‐70.

9. 9. Brunn J, Block U, Ruf G, Bos I, Kunze WP, Scriba PC. Volumetric analysis of thyroid lobes by realtime ultrasound (in German). Dtsch Med Wochenschr. 1981;106:1338-40.
10. 10. Shabana W, Peeters E, De Maeseneer M. Measuring thyroid gland volume: should we change the correction factor? AJR Am J Roentgenol. 2006;186(1):234-6.
11. 11. Mohamed TZ, Sultan AAEA, Tag El-Din M, Mostafa AAE, Nafea MA, Kalmoush AE, et al. Incidence and risk factors of thyroid malignancy in patients with toxic nodular goiter. Int J Surg Oncol. 2022;2022:1054297.
12. 12. Smith JJ, Chen X, Schneider DF, Nookala R, Broome JT, Sippel RS, et al. Toxic nodular goiter and cancer: a compelling case for thyroidectomy. Ann Surg Oncol. 2013;20(4):1336-40.
13. 13. Tam AA, Ozdemir D, Alkan A, Yazicioglu O, Yildirim N, Kilicyazgan A, et al. Toxic nodular goiter and thyroid cancer: Is hyperthyroidism protective against thyroid cancer? Surgery. 2019;166(3):356-61.
14. 14. Choong KC, McHenry CR. Thyroid cancer in patients with toxic nodular goiter-is the incidence increasing? Am J Surg. 2015;209(6):974-6.
15. 15. Preece J, Grodski S, Yeung M, Bailey M, Serpell J. Thyrotoxicosis does not protect against incidental papillary thyroid cancer. Surgery. 2014;156(5):1153-6.
16. 16. Özsan M, Üstün İ, Gökçe C. Current management of thyroid nodules. Mustafa Kemal Üniv Tıp Derg. 2016; 7(27): 54-62.
17. 17. Önver H, Özbey AO, Duymuş M, Yılmaz Ö, Koşar PN. Evaluation of ultrasonographicc, cytological and histopathological findings of thyroid nodules. Kafkas J Med. 2013; 3(2):80-7.
18. 18. Satta MA, De Rosa G, Testa A, Maussier ML, Valenza V, Rabitti C, et al. Thyroid cancer in suppressed contralaterallobe of patients with hot thyroid nodule. Eur J Cancer. 1993;29A:1190e1192.