Thyroid Diseases: Gharib H

Gharib H, Papini E, Valcavi R, Baskin HJ, Crescenzi A, Dottorini ME, Duick DS, Guglielmi R, Hamilton CR, Zeiger MA, Zini M, Anonymous00012. · No affiliation provided · Endocr Pract. · Pubmed #16596732 No free full text.

Abstract: Thyroid nodules are common and are frequently benign. Current data suggest that the prevalence of palpable thyroid nodules is 3% to 7% in North America; the prevalence is as high as 50% based on ultrasonography (US) or autopsy data. The introduction of sensitive thyrotropin (thyroid-stimulating hormone or TSH) assays, the widespread application of fine-needle aspiration (FNA) biopsy, and the availability of high-resolution US have substantially improved the management of thyroid nodules. This document was prepared as a collaborative effort between the American Association of Clinical Endocrinologists (AACE) and the Associazione Medici Endocrinologi (AME). Most Task Force members are members of AACE. We have used the AACE protocol for clinical practice guidelines, with rating of available evidence, linking the guidelines to the strength of recommendations. Key observations include the following. Although most patients with thyroid nodules are asymptomatic, occasionally patients complain of dysphagia, dysphonia, pressure, pain, or symptoms of hyperthyroidism or hypothyroidism. Absence of symptoms does not rule out a malignant lesion; thus, it is important to review risk factors for malignant disease. Thyroid US should not be performed as a screening test. All patients with a palpable thyroid nodule, however, should undergo US examination. US-guided FNA (US-FNA) is recommended for nodules > or = 10 mm; US-FNA is suggested for nodules < 10 mm only if clinical information or US features are suspicious. Thyroid FNA is reliable and safe, and smears should be interpreted by an experienced pathologist. Patients with benign thyroid nodules should undergo follow-up, and malignant or suspicious nodules should be treated surgically. A radioisotope scan of the thyroid is useful if the TSH level is low or suppressed. Measurement of serum TSH is the best initial laboratory test of thyroid function and should be followed by measurement of free thyroxine if the TSH value is low and of thyroid peroxidase antibody if the TSH value is high. Percutaneous ethanol injection is useful in the treatment of cystic thyroid lesions; large,symptomatic goiters may be treated surgically or with radioiodine. Routine measurement of serum calcitonin is not recommended. Suggestions for thyroid nodule management during pregnancy are presented. We believe that these guidelines will be useful to clinical endocrinologists, endocrine surgeons, pediatricians, and internists whose practices include management of patients with thyroid disorders. These guidelines are thorough and practical, and they offer reasoned and balanced recommendations based on the best available evidence.

Gharib H, Tuttle RM, Baskin HJ, Fish LH, Singer PA, McDermott MT, Anonymous00181. · Division of Endocrinology, Diabetes, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. · Endocr Pract. · Pubmed #16033723 No free full text.

This publication has no abstract.

Gharib H, Tuttle RM, Baskin HJ, Fish LH, Singer PA, McDermott MT, Anonymous00249, Anonymous00250, Anonymous00251. · Mayo Clinic College of Medicine, Rochester, MN 55905, USA. · Thyroid. · Pubmed #15687817 No free full text.

This publication has no abstract.

Baskin HJ, Cobin RH, Duick DS, Gharib H, Guttler RB, Kaplan MM, Segal RL, Anonymous00009. · No affiliation provided · Endocr Pract. · Pubmed #15260011 No free full text.

Abstract: These clinical practice guidelines summarize the recommendations of the American Association of Clinical Endocrinologists for the diagnostic evaluation of hyperthyroidism and hypothyroidism and for treatment strategies in patients with these disorders. The sensitive thyroid-stimulating hormone (TSH or thyrotropin) assay has become the single best screening test for hyperthyroidism and hypothyroidism, and in most outpatient clinical situations, the serum TSH is the most sensitive test for detecting mild thyroid hormone excess or deficiency. Therapeutic options for patients with Graves' disease include thyroidectomy (rarely used now in the United States), antithyroid drugs (frequently associated with relapses), and radioactive iodine (currently the treatment of choice). In clinical hypothyroidism, the standard treatment is levothyroxine replacement, which must be tailored to the individual patient. Awareness of subclinical thyroid disease, which often remains undiagnosed, is emphasized, as is a system of care that incorporates regular follow-up surveillance by one physician as well as education and involvement of the patient.

Cobin RH, Gharib H, Bergman DA, Clark OH, Cooper DS, Daniels GH, Dickey RA, Duick DS, Garber JR, Hay ID, Kukora JS, Lando HM, Schorr AB, Zeiger MA, Anonymous00002. · No affiliation provided · Endocr Pract. · Pubmed #11430305 No free full text.

This publication has no abstract.

Layfield LJ, Cibas ES, Gharib H, Mandel SJ. · University of Utah School of Medicine, University of Utah Hospital and Clinics, Salt Lake City, UT, USA. · CA Cancer J Clin. · Pubmed #19278960 links to  free full text

Abstract: In the adult population, thyroid nodules are common and are increasingly detected by ultrasound examination or other scanning techniques. Depending on their size and ultrasonographic features, these nodules may require further investigation, including tissue diagnosis. Fine-needle aspiration (FNA) has become the predominant method to obtain tissue for microscopic analysis. In October 2007, the National Cancer Institute sponsored a conference to review the state of the science for the use of FNA in the management of thyroid nodules. This conference reviewed indications for thyroid FNA and pre-FNA requirements, training and credentialing, techniques for thyroid FNA, diagnostic terminology and morphologic criteria, utilization of ancillary studies, and post-FNA testing and treatment options. The results of those discussions have been published in both print and electronic versions. The aim of the current article was to discuss indications for FNA, diagnostic terminology, and post-FNA options, issues that are important to physicians who are managing patients with thyroid nodules.

Dean DS, Gharib H. · Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. · Best Pract Res Clin Endocrinol Metab. · Pubmed #19041821 No free full text.

Abstract: Thyroid nodules are common and are commonly benign. The reported prevalence of nodular thyroid disease depends on the population studied and the methods used to detect nodules. Nodule incidence increases with age, and is increased in women, in people with iodine deficiency, and after radiation exposure. Numerous studies suggest a prevalence of 2-6% with palpation, 19-35% with ultrasound, and 8-65% in autopsy data. With widespread use of sensitive imaging in clinical practice, incidental thyroid nodules are being discovered with increasing frequency. Ultrasonography is the most accurate and cost-effective method for evaluating and observing thyroid nodules. Current ultrasonography machines are relatively inexpensive, sensitive, and easy to operate. Most endocrinologists are now using ultrasound examination in the initial evaluation of a patient with known or suspected thyroid nodule. The management of thyroid incidentalomas is a matter of controversy.

Gharib H, Papini E, Paschke R. · Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota 55905, USA. · Eur J Endocrinol. · Pubmed #18728120 links to  free full text

Abstract: In 2006, two major society-sponsored guidelines and one major consensus statement for thyroid diagnosis and management were published by: the American Association of Clinical Endocrinologists/Associazione Medici Endocrinologi (AACE/AME); the American Thyroid Association (ATA); and the European Thyroid Association (ETA). A careful review of these guidelines reveals that despite many similarities, significant differences are also present, likely reflecting differences in practice patterns, interpretation of existing data, and availability of resources in different regions. The methodology of the guidelines is similar, but a few differences in the rating scale make a rapid comparison of the strength of both evidence and recommendations difficult for the use in current clinical practice. Some recommendations are based mostly on experts' opinion. Thus, a same recommendation may be based on a different evidence; on the other hand, sometimes the same evidence may induce a different recommendation. Therefore, efforts are needed to produce a few high-quality clinical studies to close the evidence gaps in the still controversial fields of thyroid disease and to create a joint task force of the most authoritative societies in the field of thyroid disease in order to reach a common document for clinical practice recommendations.

Gharib H, Papini E. · Mayo Clinic College of Medicine, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, MN 55905, USA, and Department of Endocrine & Metabolic Diseases, Regina Apostolorum Hospital, Albano Laziale, Italy. · Endocrinol Metab Clin North Am. · Pubmed #17673125 No free full text.

Abstract: In the general population, thyroid nodules are found in 5% by palpation and in 50% by ultrasonography (US). Initial evaluation of nodules should include serum thyroid-stimulating hormone measurement, fine-needle aspiration (FNA) biopsy, and US. Thyroid micronodules are being detected with increasing frequency and are currently evaluated by US-FNA. Routine measurement of serum calcitonin and thyroglobulin and FNA rebiopsy are not recommended. Cytologically benign thyroid nodules should be followed rather than treated. Novel treatment options including iodine 131, percutaneous ethanol injection, and percutaneous laser thermal ablation have specific indications, advantages, and adverse effects.

Castro MR, Gharib H. · Mayo Clinic College of Medicine, Rochester, Minnesota 55902, USA. · Ann Intern Med. · Pubmed #15941700 links to  free full text

Abstract: Although thyroid nodules are common, few are malignant and require surgical treatment. A systematic approach to their evaluation is important to avoid unnecessary surgery. Fine-needle aspiration biopsy has resulted in substantial improvements in diagnostic accuracy, cost reductions, and higher malignancy yield at time of surgery. The preferred approach when repeated fine-needle aspiration biopsy fails to yield an adequate specimen remains a challenge. Management of patients with nodules "suspicious for follicular neoplasm" is difficult, since only 15% to 20% of such lesions have been shown to be malignant. Immunohistochemical markers, such as galectin-3 and human bone marrow endothelial cell (HBME-1), have shown promise in preliminary studies. Routine calcitonin measurement in patients with thyroid nodules has been advocated for early detection of medullary thyroid cancer. However, the low frequency of this cancer, coupled with the high cost associated with case detection, has resulted in a lack of general acceptance of this recommendation.

Gharib H. · Division of Endocrinology, Diabetes, Metabolism, Nutrition and, Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA. · Endocr Pract. · Pubmed #15251619 No free full text.

Abstract: OBJECTIVE: To describe changes that have occurred between 1952 and 2002 in the evaluation and management of nodular thyroid disease. METHODS: A 30-year personal experience, institutional contributions, and the related published literature on evaluation of thyroid function and evolving strategies for management of thyroid nodules are reviewed. RESULTS: Triiodothyronine (T(3)) was discovered in 1952, and measurement of plasma thyroxine by a competitive protein-binding technique became available in the 1960s. Late during that decade, the first radioimmunoassay for thyroid-stimulating hormone (TSH) was described, modified, and then used in clinical practice until the mid-1980s, when the more sensitive TSH assays became widely available. T(3) determination by radioimmunoassay was introduced early in the 1970s. Currently, sensitive thyroid function tests can detect early disease. In the general population, thyroid nodules have a prevalence higher than 50% after age 65 years, affecting more than 100 million people in the United States. Two important developments influenced thyroid nodule evaluation and management-- fine-needle aspiration (FNA) biopsy and ultrasonography. Because FNA biopsy has emerged as the most accurate test for nodule diagnosis, it has decreased the need for scanning and for thyroidectomy and thereby is likely to reduce health-care costs by more than $500 million annually in the United States. Thyroid ultrasonography is the imaging method of choice for evaluation of thyroid gland structure. Management of cytologically benign thyroid nodules remains controversial. CONCLUSION: TSH seems to be only one of many factors in pathologic thyroid growth. FNA, because of its diagnostic accuracy, should be the initial procedure used in nodule evaluation.

Castro MR, Gharib H. · Department of Medicine and Endocrinology, Stratton VA Medical Center, Albany, New York, USA. · Endocr Pract. · Pubmed #12917075 No free full text.

Abstract: OBJECTIVE: To provide an updated review of the current progress in, and the practice and pitfalls of, thyroid fine-needle aspiration (FNA) biopsy. METHODS: The medical literature on the topic was reviewed, and the current methods, advantages, and controversies concerning FNA biopsy of thyroid nodules are summarized. RESULTS: Thyroid nodules are a common clinical problem, with an estimated prevalence ranging from 19 to 35%. Most thyroid cancers manifest as thyroid nodules; however, only a small fraction of all thyroid nodules harbor malignant disease. Certain clinical features increase the likelihood of malignant involvement, but the absence of such features does not exclude the possibility of cancer. Of all currently available methods of evaluating nodular thyroid disease, FNA biopsy has been found to have the greatest diagnostic accuracy, approaching 95%, and its widespread use has resulted in substantial cost savings and has allowed a much better selection of patients in need of surgical treatment. The procedure, however, has two major limitations: nondiagnostic yield and indeterminate results. The approach to the management of patients with thyroid nodules is summarized. CONCLUSION: FNA is the most reliable and cost-effective method of distinguishing benign from suspicious or malignant thyroid nodules.

Giuffrida D, Gharib H. · Division of Medical Oncology, Ospedale San Luigi, Az. Osp. 'Garibaldi', Catania, Italy. · Endocr Relat Cancer. · Pubmed #11350728 links to  free full text

Abstract: BACKGROUND: Clinically evident cardiac metastases from malignant neoplasms are uncommon. The frequency of thyroid metastasis to the heart is very low. To our knowledge, over the last 20 years only a few cases have been reported in the entire literature. Metastatic cardiac involvement occurs most often during the terminal stage. PATIENTS: We present three cases of anaplastic thyroid cancer with metastatic involvement of the heart. RESULTS: Two of the patients died from cardiac problems. The absence of early symptoms makes the clinical diagnosis of metastatic carcinoma difficult. CONCLUSIONS: Anaplastic thyroid cancer is an aggressive cancer with a dismal prognosis. It should be borne in mind as a source of cardiac metastasis and a cause of cardiac death.

Giuffrida D, Gharib H. · Division of Endocrinology, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. · Ann Oncol. · Pubmed #11061600 links to  free full text

Abstract: BACKGROUND: Anaplastic thyroid carcinoma (ATC), accounting for 5% to 15% of primary malignant thyroid neoplasms, is one of the most aggressive solid tumors in humans. Generally, it is rapidly fatal, with a mean survival of six months after diagnosis. Multimodality treatment with surgery and/or external beam radiotherapy and chemotherapy are of fundamental importance for local control of disease and to enhance survival. DESIGN: We evaluated consecutive patients with ATC observed at the Mayo Clinic from 1971 to 1993 and reviewed relevant articles published in major English-language medical journals. We used the MEDLINE database, selected bibliographies, and articles available in our personal files. RESULTS: ATC usually does not concentrate radioiodine or express thyroglobulin. It is essential to verify the diagnosis histologically because insular thyroid cancer, lymphomas, and medullary thyroid cancer are occasionally confused with undifferentiated neoplasms. Immunohistochemical study is helpful in establishing the diagnosis. Multimodal therapy and the development of effective systemic chemotherapeutic agents should result in improvements in survival, although no single agent has yet been identified. CONCLUSIONS: Aggressive multimodality treatment regimens show promise in improving local control in patients with ATC. However, survival rates remain low. Despite intense application of such therapy, no standardized successful treatment protocol has been established.

Burguera B, Gharib H. · Mayo Graduate School of Medicine, Mayo Medical School, Rochester, Minnesota, USA. · Endocrinol Metab Clin North Am. · Pubmed #10732271 No free full text.

Abstract: Thyroid incidentalomas are common, always impalpable, often less than 1.5 cm in size, and frequently benign. The authors recommend that low-risk patients with incidentalomas be followed up with clinical palpation in 6 to 12 months and not be subjected to routine testing with US-FNA. In the authors' strategy, fine-needle aspiration is reserved for an impalpable nodule and is performed under ultrasonographic guidance in the high-risk group of patients in whom either the imaging features or the clinical history is worrisome for malignancy. It does not seem necessary, practical, or cost-effective to perform biopsy or to excise surgically all impalpable nodules. Because of the high prevalence of thyroid incidentalomas, most of which are benign, a nonsurgical approach is logical.

Erdal M, Sahin M, Saglam K, Hasimi A, Uckaya G, Yarpuz MY, Taslipinar A, Gharib H, Kutlu M. · Department of Family Medicine Gulhane School of Medicine, Etlik, Ankara, Turkey. · Intern Med. · Pubmed #18628578 links to  free full text

Abstract: OBJECTIVE: Whether to treat subclinical hypothyroidism (SH) remains controversial. Serum chitotriosidase activity, a marker of activated macrophages, predicts new cardiovascular events. Chitotriosidase activity (ChT) is a new cardiovascular risk marker and is independent of C-reactive protein. The purpose of this study was to determine ChT levels in SH and to examine the effect of levothyroxine replacement on ChT. SUBJECTS AND METHODS: A cohort of 60 patients with subclinical hypothyroidism and 62 healthy controls were enrolled in this study. Serum total and LDL cholesterol, total homocysteine (t-Hyc), highly sensitive C-reactive protein (hsCRP) levels and serum ChT in patients with subclinical hypothyroidism at baseline and after achieving euthyroid state by levothyroxine were assessed. RESULTS: Pretreatment levels of TSH (10.06+/-5.09 vs. 2.08+/-0.95 mIU/L, p<0.05), and free T4 (0.94+/-0.21 vs. 1.35+/-0.26 ng/dl, p<0.05) were significantly higher than controls while total cholesterol, LDL cholesterol, t-Hyc, ChT and hsCRP levels were not different. ChT levels significantly increased after replacement therapy (137.2+/-14.18 vs. 156.88+/-13.10 nmol/mL/h, p<0.05). T-Hyc and hsCRP levels were not significantly different after treatment with levothyroxine therapy even in this subgroup of patients. None of the other biochemical risk factors improved after euthyroidism in patients with SH with average dose of 85+/-30 mug/day when compared to pretreatment levels. CONCLUSION: We conclude that clinical management of subclinical hypothyroidism does not decrease the serum hsCRP or t-Hyc levels but does increase the serum ChT levels. The clinical significance of this increment should be studied in further studies.

Layfield LJ, Abrams J, Cochand-Priollet B, Evans D, Gharib H, Greenspan F, Henry M, LiVolsi V, Merino M, Michael CW, Wang H, Wells SA. · Department of Pathology, University of Utah Hospital and Clinics, Salt Lake City, Utah 84112, USA. · Diagn Cytopathol. · Pubmed #18478610 No free full text.

Abstract: The National Cancer Institute (NCI) sponsored the NCI Thyroid Fine Needle Aspiration (FNA) State of the Science Conference on October 22-23, 2007 in Bethesda, MD. The 2-day meeting was accompanied by a permanent informational Web site and several on-line discussion periods between May 1 and December 15, 2007 (http://thyroidfna.cancer.gov). This document addresses follow-up procedures and therapeutic options for suggested diagnostic categories. Follow-up options for "nondiagnostic" and "benign" thyroid aspirates are given. The value of ultrasound examination in the follow-up of "nondiagnostic" and "benign" thyroid aspirates is discussed. Ultrasound findings requiring reaspiration or surgical resection are described as are the timing and length of clinical and ultrasonographic surveillance for cytologically "benign" nodules. Options for surgical intervention are given for the diagnostic categories of "atypical/borderline," "follicular neoplasm," "suspicious for malignancy" and "malignant" (http://thyroidfna.cancer.gov/pages/info/agenda/).

Schmit GD, Gorman B, van Heerden JA, Gharib H. · Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. · Endocr Pract. · Pubmed #16901801 No free full text.

Abstract: OBJECTIVE: To report an unusual case of inferior laryngeal paraganglioma that manifested as a thyroid neoplasm. METHODS: A case report is presented, including ultra-sonographic, surgical, histologic, and immunohistochemical findings, and diagnostic and therapeutic strategies are discussed. RESULTS: In a 33-year-old man with a mass in the left side of his neck, color Doppler ultrasonography revealed an extremely hypervascular lesion that appeared to arise in the left lobe of the thyroid gland. Fine-needle aspiration was noncontributory because of bloody samples, but core biopsy specimens suggested a nonthyroidal neoplasm. At surgical intervention, a 3.5-cm mass was found immediately posterior to the left thyroid lobe, not involving the thyroid capsule. Because the mass could not be dissected free from the thyroid, performance of a left thyroid lobectomy and isthmectomy was necessary. The pathology specimen was a paraganglioma. CONCLUSION: Paragangliomas may be sonographically similar to thyroid neoplasms and may be included in the differential diagnosis of a hypervascular thyroid mass.

Gharib H, Tuttle RM, Baskin HJ, Fish LH, Singer PA, McDermott MT. · Mayo Clinic College of Medicine, 200 First Street SW, Rochester, Minnesota 55905, USA. · J Clin Endocrinol Metab. · Pubmed #15643019 links to  free full text

This publication has no abstract.

Zangeneh F, Gharib H, Goellner JR, Kao PC. · Division of Endocrinology, Diabetes, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic Rochester, Rochester Minnesota 55905, USA. · Endocr Pract. · Pubmed #14561572 No free full text.

Abstract: OBJECTIVE: To evaluate preoperative hypercalcitonine-mia further as a marker of prognosis in patients with medullary thyroid carcinoma (MTC). METHODS: We reviewed the clinical and laboratory data in six patients (four men and two women, 39 to 76 years old)--three with sporadic MTC, one with familial MTC, and two with multiple endocrine neoplasia type 2A--who had preoperative basal serum calcitonin levels of 400 to 16,000 pg/mL (normal, 0 to 19). Pentagastrin stimulation was performed in patients who had preoperative basal calcitonin levels less than 1,000 pg/mL, and responses ranged from 2,600 to 8,500 pg/mL. Thyroidectomy revealed intrathyroidal MTC in four patients; MTC and nodal metastatic lesions were present in two. The tumor cells were immunoreactive with anti-calcitonin immunoperoxidase staining. RESULTS: Serum calcitonin and carcinoembryonic antigen levels were normal postoperatively. In serial postoperative evaluation during a follow-up period of 2 to 9 years, stimulated peak plasma calcitonin levels after pentagastrin or calcium infusion were normal (in five patients) or near normal (in one patient), without clinical evidence of recurrent disease. The two patients with nodal metastatic disease have had normal calcitonin levels during a mean duration of follow-up of approximately 3 years. CONCLUSION: Pronounced preoperative hypercalci-toninemia does not necessarily preclude a favorable short-term outcome in patients with MTC.

Mózes G, van Heerden JA, Gharib H. · Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. · Endocr Pract. · Pubmed #12917093 No free full text.

Abstract: OBJECTIVE: To present a case of multiple endocrine neoplasia type 2B (MEN2B) with a prolonged course. METHODS: We describe the clinical, laboratory, and radiologic findings in a patient with MEN2B and review the various interventions during a period of approximately 3 decades. RESULTS: In 1962, a 19-year-old man with a marfanoid body habitus presented with multiple thyroid nodules and neurofibromas of the tongue. Total thyroidectomy demonstrated multicentric medullary thyroid carcinoma with cervical lymph node metastatic involvement. At the time of the first description of the MEN2B syndrome, the patient was enrolled in a surveillance program. An increase in urinary metanephrines resulted in bilateral adrenalectomy for multinodular pheochromocytoma in 1972. Increased serum calcitonin levels and the appearance of cervical lymphadenopathy led to modified radical neck dissection 12 years after the initial diagnosis of medullary thyroid carcinoma. In 1975, angiography revealed extensive hepatic lesions metastatic from the medullary thyroid carcinoma; this finding was confirmed by open liver biopsy in 1988. The patient lived 16 years after the initial diagnosis of liver metastatic disease and died 29 years after the initial examination. CONCLUSION: The 3-decade course of this patient not only represents a classic case of MEN2B but also allows us to present the history of this disease from its discovery to the current era of genetic testing and exemplifies the possibility of long-term survival in a patient with liver metastatic involvement from medullary thyroid carcinoma.

Zangeneh F, Powell CC, Gharib H. · Division of Endocrinology, Diabetes, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic Rochester, Rochester, Minnesota 55905, USA. · Endocr Pract. · Pubmed #12917081 No free full text.

This publication has no abstract.

Chow LS, Gharib H, Goellner JR, van Heerden JA. · Division of Endocrinology, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. · Thyroid. · Pubmed #12186502 No free full text.

Abstract: Approximately 10% to 20% of thyroid biopsies by fine-needle aspiration (FNA) are nondiagnostic. The management of thyroid nodules in which FNA is nondiagnostic remains controversial because few studies have addressed this issue. We retrospectively reviewed the medical records of 153 patients with nondiagnostic FNAs of the thyroid performed in 1994. Sixty patients had reaspiration biopsies performed. Thirty-seven specimens (62%) were diagnostic and 23 (38%) remained nondiagnostic. Of the 27 patients who had a thyroid operation, 10 (37%) had a malignancy. Preoperative information about physical examination, ultrasound imaging, or nondiagnostic FNA did not predict outcome. Nondiagnostic FNAs of the thyroid may be associated with a high probability of thyroid malignancy. Nondiagnostic FNAs should not be considered benign. Reaspiration followed by selective surgical treatment is recommended.

Castro MR, Gharib H. · Division of Endocrinology/Metabolism, Mayo Clinic, Rochester, MN 55905, USA. · Postgrad Med. · Pubmed #10649669 No free full text.

Abstract: Thyroid nodules, a common problem in clinical practice, are usually benign; only about 5% of these nodules harbor malignancy. The first step in evaluation is measurement of serum TSH levels. When the TSH value is suppressed, a hyperfunctioning nodule is likely, and scintigraphy may be helpful for confirming the diagnosis. Because thyroid cancer is extremely rare in "hot" nodules, such a finding is reassuring. Observation alone or treatment with radioiodine is a reasonable alternative to surgery in many of these patients. Fine-needle aspiration biopsy is the single most important procedure for differentiating benign from malignant thyroid nodules, and its role in evaluation and management of nodular thyroid disease cannot be overemphasized. Ultrasound, scintigraphy, and radioiodine scanning, together with measurement of various tumor markers, are useful adjuncts in the preoperative and postoperative management of patients with thyroid cancer. A carefully thought-out management plan can help reduce the risk of unnecessary surgery in these patients.