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Approach to a thyroid nodule

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https://www.readbyqxmd.com/read/29145466/serum-tsh-levels-as-a-predictor-of-malignancy-in-thyroid-nodules-a-prospective-study
#1
Lenara Golbert, Ana Patrícia de Cristo, Carlo Sasso Faccin, Mauricio Farenzena, Heloísa Folgierini, Marcia Silveira Graudenz, Ana Luiza Maia
BACKGROUND: The role of serum TSH concentrations as a predictor of malignancy of thyroid nodule remains unclear. OBJECTIVE: To prospectively evaluate the usefulness of serum TSH levels as a predictor of malignancy in thyroid nodules. METHODS: Patients with thyroid nodule(s) who underwent fine-needle aspiration biopsy under ultrasonographic guidance in a tertiary, university-based hospital were consecutively evaluated. Patients with known thyroid cancer and/or patients receiving thyroid medication were excluded...
2017: PloS One
https://www.readbyqxmd.com/read/29108474/molecular-testing-for-oncogenic-gene-alterations-in-pediatric-thyroid-lesions
#2
Sogol Mostoufi-Moab, Emmanuel Labourier, Lisa Sullivan, Virginia A LiVolsi, Yimei Li, Rui Xiao, Sylvie Beaudenon-Huibregtse, Ken Kazahaya, N Scott Adzick, Zubair W Baloch, Andrew J Bauer
BACKGROUND: Thyroid nodules are less common in pediatric patients (≤18 years) than in adults. The Bethesda System for Reporting Thyroid Cytopathology allows for individual risk stratification, but a significant number of nodules are indeterminate. Incorporating gene mutation panels and gene expression classifiers may aid in pre-operative diagnosis. The overall aim of this study was to assess the prevalence of oncogene alterations in a representative pediatric population and across a broad-spectrum of thyroid tumor diagnoses...
November 6, 2017: Thyroid: Official Journal of the American Thyroid Association
https://www.readbyqxmd.com/read/29099711/braf-antibody-expression-in-different-types-of-thyroid-nodular-lesions
#3
E Barabadze, V Munjishvili, G Burkadze
Major problems haunt the physicians who need to delineate the best management strategy for their patients with thyroid nodule is the identification of the most aggressive cases, especially among papillary thyroid cancers, which would benefit from more aggressive therapy and follow up. Beyond its strong correlation with PTC, the BRAF mutation is well described to associate with poor prognosis. The aim of our study was to identify BRAF antibody expression in different hystotypes of the thyroid nodules and assessment of it expression according to the tumor aggressiveness...
October 2017: Georgian Medical News
https://www.readbyqxmd.com/read/29083503/risk-factors-stratifying-malignancy-of-nodules-in-contralateral-thyroid-lobe-in-patients-with-preoperative-ultrasound-indicated-unilateral-papillary-thyroid-carcinoma-a-retrospective-analysis-from-single-center
#4
Tian Lv, Changbin Zhu, Zhongming Di
OBJECTIVE: Papillary thyroid carcinoma (PTC) is the most common thyroid carcinoma with a favorable clinical outcome. For unilateral PTC patients with thyroid nodules in the contralateral lobes, the necessity of total thyroidectomy (TT) is still in doubt. In this study, we aimed to define clinical factors that could be indicators for malignancy in nodules in the contralateral thyroid lobe, which could aid the clinician in selecting the appropriate operation approach. DESIGN, PATIENTS AND MEASUREMENTS: This is a retrospective study from Jan 2014 to Dec 2016 conducted in Shanghai Ruijin Hospital...
October 30, 2017: Clinical Endocrinology
https://www.readbyqxmd.com/read/29067943/transoral-endoscopic-total-thyroidectomy-vestibular-approach-a-case-series-and-literature-review
#5
REVIEW
T Sivakumar, R A Amizhthu
Conventional open thyroidectomy is often associated with post-operative complications including nerve damage, voice disturbances, paraesthesias, adhesions and prominent scarring. Several endoscopic surgical techniques have been reported as alternatives to conventional thyroidectomy. Natural orifice transluminal endoscopic surgery is a promising approach which leaves no scar, produces few complications and affords faster discharge from care. Several studies have explored its utility in total thyroidectomy in patients with benign or malignant thyroid disease...
October 23, 2017: Journal of Minimal Access Surgery
https://www.readbyqxmd.com/read/29044289/preoperative-diagnostics-in-differentiated-thyroid-carcinoma
#6
Philipp Seifert, Martin Freesmeyer
AIM: The preoperative diagnosis of differentiated thyroid carcinomas (DTC) is particularly challenging in view of the high prevalence of thyroid nodules in the general population. Incidental diagnosis of DTC, on the other hand, can lead to reoperations and increased risk of morbidity. This study aimed to assess the prediction value of preoperative DTC dignity assessment and it's impact on surgical approaches. METHODS: We retrospectively reviewed 107 cases of DTC and subdivided them in three groups based on the preoperative dignity assessment: suspected malignancy (SM), unclear dignity (UD), and incidental findings (IF)...
October 18, 2017: Nuklearmedizin. Nuclear Medicine
https://www.readbyqxmd.com/read/29039253/stakeholder-driven-quality-improvement-a-compelling-force-for-clinical-practice-guidelines
#7
Richard M Rosenfeld, Peter C Wyer
Clinical practice guideline development should be driven by rigorous methodology, but what is less clear is where quality improvement enters the process: should it be a priority-guiding force, or should it enter only after recommendations are formulated? We argue for a stakeholder-driven approach to guideline development, with an overriding goal of quality improvement based on stakeholder perceptions of needs, uncertainties, and knowledge gaps. In contrast, the widely used topic-driven approach, which often makes recommendations based only on randomized controlled trials, is driven by epidemiologic purity and evidence rigor, with quality improvement a downstream consideration...
October 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/29039144/transoral-endoscopic-thyroidectomy-via-a-vestibular-approach-why-and-how
#8
Gianlorenzo Dionigi, Young Jun Chai, Ralph P Tufano, Angkoon Anuwong, Hoon Yub Kim
The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel, scar-free surgical procedure that does not require visible incisions. Indications for TOETVA are as follows: predicted gland width on diagnostic imaging ≤10 cm; a thyroid volume outline of <45 mL or dominant nodule dimension of ≤50 mm; three or four Bethesda lesions; a primary papillary microcarcinoma without local or distant metastasis; and patient request for optimal esthetic results. Contraindications are as follows: patients unfit for general anesthesia; precedent radiation in the head, neck, upper mediastinum; antecedent neck surgery; recurrent goiter; a gland volume of >45 mL or main nodule diameter of >50 mm; and documentation of lymph node or distant metastases, tracheal/esophageal infiltration, preoperative laryngeal nerve palsy, hyperthyroidism, mediastinal goiter, or an oral abscess...
October 16, 2017: Endocrine
https://www.readbyqxmd.com/read/29025986/-18-f-fluorodeoxyglycose-avid-thyroid-incidentalomas-the-importance-of-contextual-interpretation
#9
David A Pattison, Michael Bozin, Alexandra Gorelik, Michael S Hofman, Rodney J Hicks, Anita Skandarajah
Background: FDG-avid thyroid incidentalomas (TI) are seen in approximately 2.5% of patients imaged for staging or response assessment of malignancy and represent thyroid cancer in approximately 35% of cases. Consequently, the 2015 ATA guidelines strongly recommend investigation of all FDG-avid nodules ≥1cm with US and fine needle aspiration cytology (FNA). This study aims to assess the overall and thyroid cancer specific survival in a large cohort of patients with FDG-avid TI with long-term follow-up to assess the validity of this approach...
October 12, 2017: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
https://www.readbyqxmd.com/read/29019758/sonographic-evaluation-of-pediatric-thyroid-nodules
#10
Alex C Essenmacher, Peter H Joyce, Simon C Kao, Monica Epelman, Liuska M Pesce, Michael P D'Alessandro, Yutaka Sato, Craig M Johnson, Daniel J Podberesky
A thyroid nodule detected clinically or incidentally at medical imaging is a common indication for ultrasonography (US) in the adult population. This scenario is less frequently the case in pediatric patients, and the approach to evaluation of thyroid nodules deserves modification in these patients because of the increased probability of malignancy in children, compared with adults. Evaluating a thyroid nodule with US in a systematic way requires familiarity with a number of features that can be assessed and the terms that the radiologist uses in each category...
October 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/29017861/propensity-score-matched-analysis-of-the-endoscopic-bilateral-axillo-breast-approach-baba-versus-conventional-open-thyroidectomy-in-patients-with-benign-or-intermediate-fine-needle-aspiration-cytology-results-a-retrospective-study
#11
Mansoor Alramadhan, Jun Ho Choe, Jun Ho Lee, Jung Han Kim, Jee Soo Kim
BACKGROUND: The purpose of this study was to compare the surgical outcomes of endoscopic bilateral axillo-breast approach (BABA) to conventional open thyroidectomy (COT) in patients who had thyroid nodule(s) with a benign or intermediate fine-needle aspiration cytology (FNAC) results. MATERIALS AND METHODS: All patients with benign or intermediate thyroid nodule(s) who underwent BABA (n = 95) or COT (n = 262) between 2008 and 2015 were reviewed. Then, 1:1 propensity score matching was performed, and 66 matched pairs were obtained...
October 7, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28989887/a-pragmatic-approach-to-the-indeterminate-thyroid-nodule
#12
REVIEW
Krishna G Seshadri
Thyroid nodules are prevalent in upto 68% of randomly selected individuals in whom high resolution ultrasound is performed. The majority of nodules are benign. The use of ultrasound coupled with FNAC has dramatically reduced the number of patients who undergo surgery for nodules. The six tier Bethesda scoring system has reduced variability and increased the ability to clinicians to guide patients with thyroid nodules. There is good correlation between cytology and histopathologic outcomes. A significant proportion of patients will however fall into an indeterminate category...
September 2017: Indian Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28975825/evaluation-and-management-of-indeterminate-thyroid-nodules-the-revolution-of-risk-stratification-beyond-cytological-diagnosis
#13
Pablo Valderrabano, Bryan McIver
In accordance with National Guidelines, we currently follow a linear approach to the diagnosis of thyroid nodules, with management decision based primarily on a cytological diagnosis following fine-needle aspiration biopsy. However, 25% of these biopsies render an indeterminate cytology, leaving uncertainty regarding appropriate management. Individualizing the risk of malignancy of these nodules could improve their management significantly. We summarize the current evidence on the relevance of clinical information, radiological features, cytological features, and molecular markers tests results and describe how these can be integrated to personalize the management of thyroid nodules with indeterminate cytology...
October 2017: Cancer Control: Journal of the Moffitt Cancer Center
https://www.readbyqxmd.com/read/28898614/-fine-needle-aspiration-of-thyroid-nodules-is-it-worth-repeating
#14
Vera Fernandes, Tânia Pereira, Catarina Eloy
INTRODUCTION: The fine-needle aspiration has a significant role in assessing the malignancy risk of thyroid nodules. There is uncertainty regarding the value of repeat fine-needle aspiration in benign nodules. This study aims to evaluate the concordance of results in consecutive fine-needle aspiration and to study the relevance of repetition in benign results. MATERIAL AND METHODS: Retrospective study of the 4800 thyroid nodules fine-needle aspiration held in Instituto de Patologia e Imunologia Molecular da Universidade do Porto between January 1, 2014 and May 2, 2016...
June 30, 2017: Acta Médica Portuguesa
https://www.readbyqxmd.com/read/28872097/robot-assisted-thyroidectomy-using-a-gasless-transaxillary-approach-for-the-management-of-thyroid-lesions-indian-experience
#15
S P Somashekhar, K R Ashwin
AIM: Since last decades, more and more thyroidectomies have been performed by the minimally invasive method. Compared to conventional thyroidectomy, minimally invasive thyroidectomy has a superior cosmetic result. However, the outcome depends, in a large extent, on the skill of the operator and the learning curve is relatively long. Robotic thyroidectomy (RT) is a relatively new approach in treating thyroid lesions with improved ergonomics and surgical outcomes. PURPOSE: We performed a prospective study of robotic-assisted transaxillary approach for thyroidectomy in Indian patients to examine the feasibility of the procedure...
October 2017: Journal of Minimal Access Surgery
https://www.readbyqxmd.com/read/28806881/cancer-risk-stratification-of-indeterminate-thyroid-nodules-a-cytological-approach
#16
Pablo Valderrabano, Laila Khazai, Zachary J Thompson, Marino E Leon, Kristen J Otto, Julie E Hallanger-Johnson, J Trad Wadsworth, Bruce M Wenig, Christine H Chung, Barbara A Centeno, Bryan McIver
BACKGROUND: Management recommendations for thyroid nodules rely primarily on the cytological diagnosis. However, 25% of biopsies render an indeterminate cytology for which management decision is more challenging due to heterogeneity of the specimens. This study aimed to stratify the cancer risk through subcategorization of indeterminate cytology. METHODS: The indeterminate cytological specimens (Bethesda-III or IV) of 518 thyroid nodules consecutively evaluated at our academic cancer center between October 2008 and September 2015, blinded to the histological outcome, were retrospectively reviewed...
October 2017: Thyroid: Official Journal of the American Thyroid Association
https://www.readbyqxmd.com/read/28762196/ultrasound-image-based-thyroid-nodule-automatic-segmentation-using-convolutional-neural-networks
#17
Jinlian Ma, Fa Wu, Tian'an Jiang, Qiyu Zhao, Dexing Kong
PURPOSE: Delineation of thyroid nodule boundaries from ultrasound images plays an important role in calculation of clinical indices and diagnosis of thyroid diseases. However, it is challenging for accurate and automatic segmentation of thyroid nodules because of their heterogeneous appearance and components similar to the background. In this study, we employ a deep convolutional neural network (CNN) to automatically segment thyroid nodules from ultrasound images. METHODS: Our CNN-based method formulates a thyroid nodule segmentation problem as a patch classification task, where the relationship among patches is ignored...
November 2017: International Journal of Computer Assisted Radiology and Surgery
https://www.readbyqxmd.com/read/28749104/platelet-distribution-width-and-serum-albumin-levels-for-discrimination-of-thyroid-cancer-from-benign-thyroid-nodules
#18
Na Li, Shuang Fu, Ming-Ming Cui, Ye Niu, Baoxin Li, Zhi-Ping Liu, Tiemin Liu, Rui-Tao Wang
Thyroid cancer is the most rapidly increasing cancer type among women and the second among men. Early detection greatly improves the prognosis. For this purpose, the platelet distribution width (PDW), an early indicator of platelet activation, might be useful. The aim of this study was to investigate the ability of PDW and serum albumin levels individually or in combination to distinguish between thyroid cancer and benign thyroid nodules. A total of 265 patients with thyroid cancer and 243 with benign thyroid nodules were included in a development set...
July 27, 2017: Asian Pacific Journal of Cancer Prevention: APJCP
https://www.readbyqxmd.com/read/28734529/ultrasound-based-differentiation-of-malignant-and-benign-thyroid-nodules-an-extreme-learning-machine-approach
#19
Jianfu Xia, Huiling Chen, Qiang Li, Minda Zhou, Limin Chen, Zhennao Cai, Yang Fang, Hong Zhou
BACKGROUND AND OBJECTIVES: It is important to be able to accurately distinguish between benign and malignant thyroid nodules in order to make appropriate clinical decisions. The purpose of this study was to improve the effectiveness and efficiency for discriminating the malignant from benign thyroid cancers based on the Ultrasonography (US) features. METHODS: There were 114 benign nodules in 106 patients (82 women and 24 men) and 89 malignant nodules in 81 patients (69 women and 12 men) included in this study...
August 2017: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/28726141/transoral-robotic-thyroidectomy-lessons-learned-from-an-initial-consecutive-series-of-24-patients
#20
Hoon Yub Kim, Young Jun Chai, Gianlorenzo Dionigi, Angkoon Anuwong, Jeremy D Richmon
BACKGROUND: Transoral thyroid surgery is an ideal method for minimally invasive thyroidectomy, as there is less flap dissection during the procedure and no postoperative scars. Nonetheless, technical obstacles have precluded the wide dissemination of this procedure. We present the surgical procedures and outcomes of transoral robotic thyroidectomy (TORT). METHODS: From September 2012 to June 2016, we performed TORT at Korea University Hospital. We used three intraoral ports and a single axillary port for the system's four robotic arms...
July 19, 2017: Surgical Endoscopy
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