Risk factors associated with benign and malignant thyroid nodules in autoimmune thyroid diseases

Thyroid nodules in childhood-onset Hashimoto's thyroiditis: Frequency, risk factors, follow-up course and genetic alterations of thyroid cancer

OBJECTIVE

We evaluated the frequency, risk factors and the follow-up outcomes of thyroid nodules, and genetic alterations in thyroid cancer, in youth with childhood-onset Hashimoto thyroiditis (HT) residing in an iodine-sufficient country.

DESIGN

A retrospective cohort study.

PATIENTS AND MEASUREMENTS

A total of 213 patients (194 females, mean age 10.6 years at the time of HT diagnosis) were ultrasonographically evaluated. Thyroid nodules were categorized using the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TI-RADS).

RESULTS

Thyroid nodules were detected in 40 (18.8%) patients over a median follow-up period of 3.4 years, usually after the onset of puberty. A family history of thyroid disease (hazard ratio 2.1, p = .031) was predictive of thyroid nodule detection. Papillary thyroid carcinoma (PTC) was diagnosed in 9 (4.2% of all and 22.5% of nodule-positive patients). The malignant nodules had a higher K-TIRADS or ACR-TI-RADS risk level compared with benign nodules (p < .01 for both). Genetic alterations were revealed in 7 (BRAF^V600E in 6 and RET-ERC1 fusion in 1) of the eight available tumour tissue samples. None showed evidence of disease over a median follow-up period of 3.4 years.

CONCLUSIONS

The nodule detection rate was 18.8%, with a 22.5% risk of malignancy among the detected nodules in childhood-onset HT patients, showing increased risk in those with a family history. Additional large-scale studies are required to evaluate the usefulness of K-TIRADS or ACR-TI-RADS risk level for the differentiation of paediatric thyroid nodules.

Validation of Diagnostic Performance and Interobserver Agreement of DTD-TIRADS for Diffuse Thyroid Disease on Ultrasound: A Single-Center Study

OBJECTIVE. This retrospective study aimed to investigate the capability of the already-proposed thyroid imaging reporting and data system for detecting diffuse thyroid disease (DTD-TIRADS) on ultrasound (US) by assessing interobserver agreement and diagnostic performance. MATERIALS AND METHODS. A total of 180 patients who underwent thyroid US before thyroid surgery were included. Three radiologists blinded to the pathologic and serologic data independently categorized the US features according to a four-category DTD-TIRADS classification system. On the basis of the pathologic results of thyroid parenchyma, diagnostic performance values were calculated using ROC curve analyses. Interobserver agreements of each US feature and DTD-TIRADS category among the three radiologists were also assessed. RESULTS. Of the 180 patients, 143 (79.4%) had normal thyroid parenchyma and 37 (20.6%) had diffuse thyroid disease (DTD). The areas under the ROC curve for DTD were not significantly different among the three radiologists: 0.876 (95% CI, 0.819-0.920) for radiologist 1, 0.883 (95% CI, 0.827-0.926) for radiologist 2, and 0.861 (95% CI, 0.801-0.908) for radiologist 3 (p > .05). The cutoff for the diagnosis of DTD was category III DTD-TIRADS. The sensitivity, specificity, and accuracy of DTD-TIRADS for detecting DTD were 86.5%, 81.1%, and 82.2% for radiologist 1; 86.5%, 83.2%, and 83.9% for radiologist 2; and 83.8%, 82.5%, and 82.8% for radiologist 3, respectively. Interobserver agreement of DTD-TIRADS categorization was almost perfect (κ = 0.81). CONCLUSION. DTD-TIRADS has high diagnostic performance and almost-perfect interobserver agreement. Thus, DTD-TIRADS can be considered to be an effective classification system for diagnosing DTD.

Effect of IL-6 on proliferation of human thyroid anaplastic cancer stem cells

OBJECTIVE

To investigate the effect of IL-6 on the proliferation of thyroid cancer stem cells.

METHODS

HTh74 and HTh74R thyroid cancer stem cells were cultured. The proliferation of thyroid cancer stem cells after IL-6 treatment was assessed by the MTT method. The effect of IL-6 on colony formation was observed by colony formation experiments. The expression of OCT4, ABCG2, CD133, and EMT markers was detected by real-time quantitative PCR.

RESULTS

IL-6 promoted the proliferation of HTh74 and HTh74R thyroid cancer stem cells and enhanced sphere formation. However, anti-IL-6 inhibited the proliferation of cancer stem cells. IL-6 promoted colony formation by HTh74 and HTh74R cells and enhanced the expression of stem cell genes OCT4 and ABCG2. The expression of EMT markers E-cadherin was significantly decreased but the expression of vimentin and Snail was increased by IL-6 treatment.

CONCLUSIONS

IL-6 promoted proliferation of thyroid cancer stem cells and colony formation, and increased characteristics of thyroid cancer stem cells and EMT. The proliferative effect of thyroid cancer stem cells depends on activation of the IL6/JAK1/STAT3 pathway. These effects may contribute to the development and metastasis of thyroid cancer.

Clinical, Hormonal, and Ultrasound Characteristics of Patients with Newly Diagnosed Graves’ Disease And Different Thyroid Antibody Profiles

Objective: Graves’ disease (GD) is characterized by elevated TSH-receptor antibodies (TRAb) and less often – thyroid peroxidase (TPOAb) and thyroglobulin antibodies (TgAb). Our aim was to examine the hormonal and ultrasound characteristics of patients with newly diagnosed GD with differing positive thyroid antibodies.

Materials and Methods: This study included 249 patients with newly diagnosed GD (191 women, 58 men). 40.2% of them had Graves’ ophtalmopathy. The serum levels of TSH, free T4, free T3, TRAb, TPOAb, and TgAb were measured with third generation ECLIA assays (Roche Diagnostics, Switzerland). Thyroid ultrasound was performed with a Fukuda-Denshi 550 device (Fukuda Corp., Japan) and an Ultrasonix device (Ultrasonix Medical Corp., Canada). Statistical analyses were done using the SPSS 23.0 statistical package (Chicago, IL).

Results: 64% of the patients were TPOAb+ and 36% − TgAb+. One third were only TRAb+, 1/3 had two positive antibodies (TRAb + second antibody) and 1/3 – all three positive antibodies. Patients with more positive antibodies tended to be younger, had higher fT4, TRAb levels, thyroid volume but rarely had nodules on US and accompanying GO. Positive TPOAb antibodies were found in younger patients, with higher fT4 and TRAb levels, higher thyroid volume and lower prevalence of nodules and GO. The same trends were found in patients with positive TgAb.

Conclusion: The different characteristics of GD patients with varying thyroid antibody profiles may be due to a variation in the pathogenesis of the disease. An individualized clinical approach may be suitable in those cases.

Thyroid Imaging Reporting and Data System for Detecting Diffuse Thyroid Disease on Ultrasonography: A Single-Center Study

Objective: This study aimed to compare the ultrasonography (US) features of diffuse thyroid disease (DTD) and normal thyroid parenchyma (NTP), and to propose a structured imaging reporting system for detecting DTD. Methods: This retrospective study assessed the findings for 270 consecutive patients who underwent thyroid US before thyroid surgery. The following US data were analyzed: DTD-specific features, parenchymal echotexture and echogenicity, anteroposterior diameter, glandular margin, and parenchymal vascularity. Univariate and multivariate analyses with generalized estimating equations were performed to investigate the relationship between US features and DTD. The fitted probability of DTD was analyzed by using a regression equation. Results: Of the 270 patients, there were NTP (n = 193), Hashimoto thyroiditis (n = 24), non-Hashimoto lymphocytic thyroiditis (n = 51), Graves' disease (n = 1), and diffuse hyperplasia (n = 1). The following US features were significantly associated with DTD: decreased or increased parenchymal echogenicity, coarse parenchymal echotexture, increased anteroposterior diameter, lobulated glandular margin, and increased parenchymal vascularity. Of these, coarse parenchymal echotexture was the most significant independent predictor of DTD. The numbers of abnormal US features were positively correlated with the fitted probability and risk of DTD. The diagnostic indices were highest when the chosen cut-off criterion was category III with the largest Az value (0.867, 95% confidence interval: 0.820-0.905), yielding a sensitivity of 68.8%, specificity of 92.2%, positive predictive value of 77.9%, negative predictive value of 88.1%, and accuracy of 85.6% (p < 0.001). Conclusions: Our sonographic reporting and data system may be useful for detecting DTD.

Socioeconomic disparities in a population of patients undergoing total thyroidectomy for benign disease

BACKGROUND

This study examines the effect of insurance status (as a measure of socioeconomic status) on patient with benign thyroid disease.

METHODS

A retrospective review was performed among 60 patients undergoing total thyroidectomy for benign thyroid disease. Univariate and multivariable analyses examined the relationship between insurance status and thyroid volume (sum of the left and right lobe volumes).

RESULTS

Twenty-eight (47%) patients were considered of underinsured/uninsured status, and 32 (53%) patients were considered of private/government/military insurance status. Median pathologic whole thyroid volume was 66 mL (range, 2-855). After multivariable linear regression, underinsured/uninsured status was the only significant predictor of larger volume (correlation coefficient [r] = 118; 95% CI, 42 to 194; P = .003), after adjusting for age, sex, body mass index, and presence of concomitant thyroid disease and compressive symptoms.

CONCLUSION

Patients of underinsured/uninsured status suffered more severe disease presentations at time of thyroidectomy, as measured by larger thyroid volumes.

Diagnostic accuracy of computed tomography for differentiating diffuse thyroid disease from normal thyroid parenchyma: A multicenter study

This study aimed to assess the diagnostic performance of computed tomography (CT) for differentiating diffuse thyroid disease (DTD) from normal thyroid parenchyma (NTP) using multicenter data. Between January 2016 and June 2016, 229 patients underwent preoperative neck CT and subsequent thyroid surgery at five participating institutions. The neck CT images of each patient were retrospectively reviewed and classified into the following four categories: no DTD, indeterminate, suspicious for DTD, and DTD. The results of the CT image evaluations were compared with the histopathological results to determine the diagnostic accuracy of CT at each institution. According to the histopathological results, there were NTP (n = 151), Hashimoto thyroiditis (n = 24), non-Hashimoto lymphocytic thyroiditis (n = 47), and diffuse hyperplasia (n = 7). The CT categories of the 229 patients were "no DTD" in 89 patients, "indeterminate" in 40 patients, "suspicious for DTD" in 42 patients, and "DTD" in 58 patients. The presence of two or more CT features of DTD, which was classified as "suspicious for DTD" by all radiologists, had the largest area under the receiver-operating characteristic curve (Az = 0.820; 95% confidence interval: 0.764, 0.868), with sensitivity of 85.9% and specificity of 78.2%. However, no statistical significance between readers' experience and their diagnostic accuracy was found. In conclusion, evaluations of CT images are helpful for differentiating DTD from NTP.

A case of metastatic follicular thyroid carcinoma complicated with Graves' disease after total thyroidectomy

Thyroid cancer and Graves' disease may present simultaneously in one patient. The incidence of the development of hyperthyroidism from metastatic differentiated thyroid carcinoma is rare. We herein report a case of metastatic follicular carcinoma complicated with Graves' disease after total thyroidectomy. A 57-year-old woman underwent right hemithyroidectomy for follicular carcinoma. Metastatic lesions appeared in the lungs and skull two years after the first surgery, and remnant thyroidectomy was performed for radioactive iodine-131 (RAI) therapy, during which the TSH receptor antibody (TRAb) was found to be negative. The patient was treated with RAI therapy four times for four years and was receiving levothyroxine suppressive therapy. Although radioiodine uptake was observed in the lesions after the fourth course of RAI therapy, metastatic lesions had progressed. Four years after the second surgery, she had heart palpitations and tremors. Laboratory data revealed hyperthyroidism and positive TRAb. She was diagnosed with Graves' disease and received a fifth course of RAI therapy. 131I scintigraphy after RAI therapy showed strong radioiodine uptake in the metastatic lesions. As a result, the sizes and numbers of metastatic lesions decreased, and thyroid function improved. Metastatic lesions produced thyroid hormone and caused hyperthyroidism. RAI therapy was effective for Graves' disease and thyroid carcinoma.

A comparative study of nuclear 8-hydroxyguanosine expression in Autoimmune Thyroid Diseases and Papillary Thyroid Carcinoma and its relationship with p53, Bcl-2 and Ki-67 cancer related proteins

PURPOSE

To investigate whether the oxidative stress is involved in the evolution of Graves' disease (GD) and Hashimoto thyroiditis (HT) into Papillary Thyroid Carcinoma (PTC), 8-hydroxy-2'-deoxyguanosine (8-OHdG) and cancer related proteins (Bcl-2, p53 and Ki-67) expressions were evaluated in these pathologies.

PATIENTS AND METHODS

Immunohistochemical method was applied on 25 thyroid tissues. Allred score (AS) serving to evaluate the immunostaining is based on a scale from 0 to 8. "Negligible expression" was assigned to a score of 0 to 2, "expression" and "overexpression" were attributed to a score of 3-5 and ≥6 respectively.

RESULTS

PTC cancer cells exhibited 100% 8-OHdG "overexpression" compared to 87.5% in PTC non-malignant epithelial (NME) ones (p<0.05). Higher 8-OHdG AS was found in PTC NME cells compared to GD and HT (p<0.001, p<0.05 respectively). "Overexpression" of Bcl-2 was noted in all PTC cell types. Remarkably, just like the PTC cancer and NME cells 33.3% of HT and 50% of GD patients' revealed simultaneous "overexpression" of Bcl-2 and 8-OHdG in epithelial cells. No staining was detected for p53 in all pathologies. PTC lymphoid cells exhibited 100% "overexpression" for 8-OHdG and Bcl-2 with concomitant "negligible expression" for Ki-67 in 87.5% of patients. In contrast, HT lymphoid cells showed 22.2% "expression" and GD 62.5% "expression" and 12.5% "overexpression" of Ki-67.

CONCLUSIONS

Simultaneous "overexpression" of 8-OHdG and Bcl-2 in GD and HT could be considered as prognostic markers while "negligible expression" of Ki-67 in PTC lymphoid cells suggests an anergic state favoring the tumor escapes from the immune system.

Evaluation the Relationship Between Thyroid Nodule Size with Malignancy and Accuracy of Fine Needle Aspiration Biopsy (FNAB)

INTRODUCTION

Some studies have shown largest thyroid nodule size, especially ≥4cm that can predict malignancy and reduce fine needle aspiration biopsy (FNAB) accuracy. Therefore, this study is designed to evaluate relationship between thyroid nodule sizes with malignancy and its effect on FNBA accuracy.

MATERIALS AND METHODS

a retrospective analytical study design aims to investigate all patients with thyroid nodules who referred to surgery department of Imam-Khomeini Hospital of Mazandaran University of Medical Sciences in Sari from 20 March 2008 to 22 March 2014. We collected patient's demographic data, nodules size, FNAB reports and final pathology (after surgery) reports from their medical records. All data were analyses performed by SPSS18.

RESULTS

167 patients (153 women) with mean age of 41.56±13.24 years old were enrolled for this study. In final pathology; 38 patients (22.8%) had malignant nodules. The mean age of patients with or without malignant nodules were 34.93±11.86 and 42.37±12.26 years old, respectively (P=0.002). The mean size of benign and malignant nodules were 2.91±1.29 cm and 3.38±1.86 cm, respectively (P=0.15). 25.2% of <4 cm nodules and 17.9% of ≥4 cm nodules were diagnosed as a malignant (P=0.29). FNAB was done on 95 patients that reported benign in 60 patients (63.2%), malignant in 18 patients (18.9%) and suspicious in 17 patients (17.9%). Positive and negative results of FNAB in all nodules were 3.5% and 6.3%, in <4cm nodules were 5.8% and 6.2% and in ≥4cm nodules were zero and 6.7%, respectively. The sensitivity, specificity, Positive predict value (PPV), negative predict value (NPV) and overall accuracy (OA) of FNAB in all nodules were 76.19%, 96.49%, 88.88%, 91.66% and 91.02%, and in <4cm nodules were 78.57%, 94.11%, 84.61%, 91.42% and 89.58%, and in ≥4cm nodules were 71.4%, 100%, 100%, 92% and 93.33%, respectively.

CONCLUSION

the results of this study revealed that the size of the thyroid nodules is not reliable at predicting malignancy and should not be applied in medical decision making. FNAB showed good specificity but the sensitivity was low in our study. In ≥4cm nodules; FNAB sensitivity was decreased and accompanied by higher false-negative results. Furthermore, FNABs with suspicious results were associated with high probability of malignancy.

Diagnosis of Malignancy in Thyroid Tumors by Multi-Layer Perceptron Neural Networks With Different Batch Learning Algorithms

To diagnose the malignancy in thyroid tumor, neural network approach is applied and the performances of thirteen batch learning algorithms are investigated on accuracy of the prediction. Therefore, a back propagation feed forward neural networks (BP FNNs) is designed and three different numbers of neuron in hidden layer are compared (5, 10 and 20 neurons). The pathology result after the surgery and clinical findings before surgery of the patients are used as the target outputs and the inputs, respectively. The best algorithm(s) is/are chosen based on mean or maximum accuracy values in the prediction and also area under Receiver Operating Characteristic Curve (ROC curve). The results show superiority of the network with 5 neurons in the hidden layer. In addition, the better performances are occurred for Polak-Ribiere conjugate gradient, BFGS quasi-newton and one step secant algorithms according to their accuracy percentage in prediction (83%) and for Scaled Conjugate Gradient and BFGS quasi-Newton based on their area under the ROC curve (0.905).