Search Results (6)

Background: The characterization of thyroid lesions is essential in clinical practice. Recent advances in imaging modalities, including nuclear imaging (NM), color Doppler ultrasonography, and sonography, have markedly improved the diagnostic accuracy for thyroid nodules. Objective: To assess thyroid diseases using Doppler ultrasound, nuclear scintigraphy, and sonography. Results: In this cross-sectional single-center study, 144 patients were examined to determine their thyroid structure and function using a multimodal imaging approach. Fine-needle aspiration cytology (FNAC) indicated that most thyroid nodules were benign (62.5%), with 37.5% being malignant. Doppler vascularity demonstrated a sensitivity of 70.4% and a specificity of 40% (AUC = 0.514) for malignancy detection, while scintigraphy uptake in hypofunctioning nodules (nodules with decreased radionuclide uptake) showed a sensitivity of 37% and a specificity of 54.4% (AUC = 0.388). Thyroxine hormone levels showed a sensitivity of 57.4% and a specificity of 45.6% (AUC = 0.503) for detecting malignant thyroid nodules. In multivariate logistic regression, increased Doppler vascularity remained an independent predictor of malignancy (OR = 2.39; 95% CI: 1.15–4.96; p = 0.019), whereas decreased scintigraphic uptake showed a borderline effect (OR = 1.82; p = 0.069); high T4 level and increased uptake were not significant predictors. The combined Doppler ultrasound, scintigraphy, and thyroxine level model yielded an AUC of 0.72 (95% CI: 0.63–0.81), markedly higher than any single parameter. At the optimal Youden threshold (0.43), the model achieved 79.6% sensitivity, 68.2% specificity, and 72.4% accuracy, highlighting the superior diagnostic performance of the integrated approach for pre-FNAC stratification of thyroid malignancies. There was a strong, significant linear association between thyroxine levels and thyroid scintigraphy uptake (p-value < 0.001). Most patients with normal thyroxine levels exhibited decreased uptake (66.1%), whereas a minority (6.5%) demonstrated elevated uptake levels. This study found a strong correlation between mixed-echogenicity nodules and thyroid scintigraphy uptake (p-value = 0.019). Mixed-echogenicity nodules were most often associated with reduced uptake (57.8%), and hypoechoic nodules often had normal uptake (57.1%). Conclusions: The complementary integration of color Doppler vascularity, Tc-99m thyroid scintigraphy, and serum thyroxine levels yields superior Doppler–scintigraphy uptake correlation, increases the overall diagnostic accuracy, and offers a practical, non-invasive algorithm for differentiating benign from malignant thyroid nodules prior to FNAC or surgery. Full article

A 66-year-old woman presented with an incidental left thyroid nodule during a health examination. She had no voice change, shortness of breath, cough, or dysphagia. Repeated sonography showed a dynamic change of the lesion, which was more evident following soda consumption. A subsequent esophagography confirmed the diagnosis of a Killian–Jamieson diverticulum. This rare left-sided pharyngoesophageal diverticulum is often asymptomatic. On a sonography, air bubbles in the esophageal lumen can cause a ring-down artifact that mimics microcalcifications, which are characteristic of thyroid malignancy, and misdiagnosis may lead to unnecessary interventions, including fine-needle aspiration or thyroidectomy. A dynamic ultrasound, specifically done during soda consumption, offered a simple diagnostic distinction. No surgical intervention was pursued; the patient was monitored in the clinic. Full article

Background. Chromosome 22q11.2 Deletion Syndrome (22q11.2DS) is the most frequent microdeletion syndrome and is mainly characterized by congenital cardiac defects, dysmorphic features, hypocalcemia, palatal dysfunction, developmental delay, and impaired immune function due to thymic hypoplasia or aplasia. Thyroid anomalies are frequently reported in patients with 22q11.2DS, although only a few well-structured longitudinal studies about autoimmune thyroid disease (ATD) have been reported. Aim. To longitudinally evaluate the frequency of thyroid anomalies and ATD in patients with 22q11.2DS. Patients and Methods. Pediatric patients with a confirmed genetic diagnosis of 22q11.2DS were recruited and followed up on longitudinally. Clinical, biochemical, and immunological data were collected, as well as thyroid function, autoimmunity, and thyroid sonographic data. Results. The study included 73 children with 22q11.2DS, with a mean follow-up duration of 9.51 ± 5.72 years. In all, 16 of the 73 enrolled patients (21.9%) developed ATD before 18 years of age (mean age 12.92 ± 3.66 years). A total of 20.5% developed Hashimoto’s Thyroiditis (HT), of whom 50% required L-thyroxine treatment; 1.4% developed Graves Disease. Thyroid hypoplasia was found in 6/16 patients with ATD and left lobe hypoplasia in 9/16 patients. These features were also found in patients affected by 22q11.2DS without ATD. Among patients who developed ATD, at the first altered ultrasound scan, the most frequent anomalies suggestive of thyroiditis were inhomogeneous echotexture, diffuse or irregular hypo-echogenicity, and vascular overflow. Conclusion. We strongly recommend periodic screening of thyroid function and for autoimmunity in patients affected by 22q11.2DS. Along with blood tests, ultrasound scans of the thyroid gland should be performed periodically since some patients who go on to develop an ATD could have specific anomalies on ultrasound prior to any other anomaly. Full article

This review aims to provide a functional, metabolic view of the pathogenesis of benign thyroid disease. Here, we summarize the features of our previous publications on the “WOMED model of benign thyroid disease”. As of 2021, the current state of art indicates that the basic alteration in benign thyroid disease is a metabolic switch to glycolysis, which can be recognized using 3D-power Doppler ultrasound. A specific perfusion pattern showing enlarged vessels can be found using this technology. This switch originates from an altered function of Complex I due to acquired coenzyme Q₁₀ deficiency, which leads to a glycolytic state of metabolism together with increased angiogenesis. Implementing a combined supplementation strategy that includes magnesium, selenium, and CoQ₁₀, the morphological and perfusion changes of the thyroid can be reverted, i.e., the metabolic state returns to oxidative phosphorylation. Normalization of iron levels when ferritin is lower than 50 ng/mL is also imperative. We propose that a modern investigation of probable thyroid disease requires the use of 3D-power Doppler sonography to recognize the true metabolic situation of the gland. Blood levels of magnesium, selenium, CoQ₁₀, and ferritin should be monitored. Thyroid function tests are complementary so that hypo- or hyperthyroidism can be recognized. Single TSH determinations do not reflect the glycolytic state. Full article

The presence of adipocytes within thyroid glands is a rare finding seen in thyrolipoma, diffuse lipomatosis, or thyroid teratoma. Although some cases present with multinodular goiter or autoimmune thyroiditis, the exact cause has not yet been elucidated. Among reported cases, thyrolipomas mainly occur in females and usually present as a solitary lesion. However, a few reported cases had coexisting papillary thyroid carcinomas. Herein, we present a 51-year-old female with synchronous thyrolipoma (2.0 × 1.5 × 1.3 cm) and papillary thyroid carcinoma (0.7 × 0.6 × 0.6 cm) within the same thyroid lobe. She had diabetes mellitus and hypertension and complained of anterior neck enlargement and discomfort for three months. Thyroid sonography showed multiple hypoechoic nodules, one of which was heterogeneous and ill-defined. Fine needle aspirate cytology for the ill-defined nodule was suspicious for papillary thyroid carcinoma. She subsequently received radical thyroidectomy and neck lymph node dissection. Histopathologically, one thyrolipoma and one papillary thyroid carcinoma were identified in the right lobe of the thyroid gland without metastases of lymph nodes, while other nodules were multinodular goiter. Notably, thyrolipoma may not be simply an incidental finding but might coexist with thyroid carcinomas. A brief review of the pertinent literature of prior reports is also provided. Full article

Background: Unlike cytotoxic agents, novel antineoplastic drugs can variably affect thyroid function and so impair patient outcomes. However, the widely used standard thyroid tests have demonstrated low sensitivity for detecting early thyroid damage that leads to dysfunction of the gland. To find a more reliable thyroid marker, we assessed the presence of antibodies binding thyroid hormones (thAbs) in a cancer population undergoing potentially thyrotoxic treatment. Methods: From April 2010 to September 2013, 82 patients with hematologic malignancies treated with tyrosine kinase inhibitors or immunoregulatory drugs were recruited. Healthy volunteers (n = 104) served as control subjects. Thyroid function, autoimmunity tests, thAbs, and thyroid sonography were assessed once during treatment. Results: Overall, thAb positivity was recorded in 13% of the entire cohort. In most cases, the thAbs were of a single type, with a predominance of T3 immunoglobulin G. More specifically, thAbs were detected in 11 cancer patients; and abnormal levels of thyroid-stimulating hormone, thyroglobulin antibody, and thyroperoxidase antibody were detected in 6 (p = 0.05), 0 (p = 0.0006), and 2 cancer patients (p = 0.001) respectively. Ultrasonographic alterations of the thyroid were observed in 12 cancer patients. In contrast, of the 104 healthy control subjects, only 1 was positive for thAbs (1%). Conclusions: We have demonstrated for the first time that thAbs are a reliable marker of early thyroid dysfunction when compared with the widely used standard thyroid tests. A confirmatory prospective trial aiming at evaluating thAbs at various time points during treatment could clarify the incidence and timing of antibody appearance. Full article