Endocrinology and Metabolism

Original Articles

Thyroid
Risk Stratification of Thyroid Nodules Diagnosed as Follicular Neoplasm on Core Needle Biopsy: Byeong-Joo Noh, Won Jun Kim, Jin Yub Kim, Ha Young Kim, Jong Cheol Lee, Myoung Sook Shim, Yong Jin Song, Kwang Hyun Yoon, In-Hye Jung, Hyo Sang Lee, Wooyul Paik, Dong Gyu Na; Endocrinol Metab. 2025;40(4):610-622. Published online May 28, 2025; DOI: https://doi.org/10.3803/EnM.2024.2256

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Background
This study assessed risk stratification and diagnostic performance for malignancy in thyroid nodules diagnosed as follicular neoplasm (FN) based on core needle biopsy (CNB) subcategories.
Methods
A total of 313 consecutive nodules (>1 cm) diagnosed as FN on CNB with corresponding surgical histology were included. FN subcategories were classified retrospectively for nodules diagnosed before 2022 (retrospective dataset) and prospectively for nodules diagnosed since 2022 (prospective dataset). CNB subcategories were determined using histologic criteria based on architectural uniformity and nuclear atypia, as modified from the 2019 Korean CNB pathology guideline. The diagnostic performance of CNB subcategories, nodule size, and ultrasound risk stratification systems (RSSs) for malignancy was assessed.
Results
CNB subcategory IVb showed a significantly higher malignancy risk compared to other subcategories in both datasets (34.5%–83.7% vs. 4.2%–13.6%, P<0.001). It was also identified as an independent predictor of malignancy in both datasets (P< 0.001), whereas nodule size and all ultrasound RSSs were not predictive of malignancy, including noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) (P≥0.079). CNB subcategory IVb demonstrated higher sensitivity for malignancy and a lower surgical rate for benign nodules compared to the nodule size criterion (>2 cm). The combined criterion of CNB subcategory IVb or nodule size >3 cm identified all malignant tumors, excluding NIFTP, in the prospective dataset.
Conclusion
CNB subcategory IVb effectively stratifies malignancy risk in thyroid nodules and outperforms nodule size (>2 cm) and ultrasound RSSs in diagnostic performance. Non-IVb nodules ≤3 cm can be safely managed with ultrasound surveillance instead of immediate surgery.

Citations

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Advantages of thyroid core needle biopsy: an emerging selective first-line biopsy modality
Jae Ho Shin, Yeseul Kim, Min Kyoung Lee, Jung Hwan Baek, So Lyung Jung
Ultrasonography.2026; 45(3): 205. CrossRef

Thyroid
Comprehensive Proteomics and Machine Learning Analysis to Distinguish Follicular Adenoma and Follicular Thyroid Carcinoma from Indeterminate Thyroid Nodules: Hee-Sung Ahn, Eyun Song, Chae A Kim, Min Ji Jeon, Yu-Mi Lee, Tea-Yon Sung, Dong Eun Song, Jiyoung Yu, Ji Min Shin, Yeon-Sook Choi, Kyunggon Kim, Won Gu Kim; Endocrinol Metab. 2025;40(4):623-636. Published online April 10, 2025; DOI: https://doi.org/10.3803/EnM.2024.2208

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Background
The preoperative diagnosis of follicular thyroid carcinoma (FTC) is challenging because it cannot be readily distinguished from follicular adenoma (FA) or benign follicular nodular disease (FND) using the sonographic and cytological features typically employed in clinical practice.
Methods
We employed comprehensive proteomics and machine learning (ML) models to identify novel diagnostic biomarkers capable of classifying three subtypes: FTC, FA, and FND. Bottom-up proteomics techniques were applied to quantify proteins in formalin-fixed, paraffin-embedded (FFPE) thyroid tissues. In total, 202 FFPE tissue samples, comprising 62 FNDs, 72 FAs, and 68 FTCs, were analyzed.
Results
Close spectrum-spectrum matching quantified 6,332 proteins, with approximately 9% (780 proteins) differentially expressed among the groups. When applying an ML model to the proteomics data from samples with preoperative indeterminate cytopathology (n=183), we identified distinct protein panels: five proteins (CNDP2, DNAAF5, DYNC1H1, FARSB, and PDCD4) for the FND prediction model, six proteins (DNAAF5, FAM149B1, RPS9, TAGLN2, UPF1, and UQCRC1) for the FA model, and seven proteins (ACTN4, DSTN, MACROH2A1, NUCB1, SPTAN1, TAGLN, and XRCC5) for the FTC model. The classifiers’ performance, evaluated by the median area under the curve values of the random forest models, was 0.832 (95% confidence interval [CI], 0.824 to 0.839) for FND, 0.826 (95% CI, 0.817 to 0.835) for FA, and 0.870 (95% CI, 0.863 to 0.877) for FTC.
Conclusion
Quantitative proteome analysis combined with an ML model yielded an optimized multi‐protein panel that can distinguish FTC from benign subtypes. Our findings indicate that a proteomic approach holds promise for the differential diagnosis of FTC.

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Artificial Intelligence for Thyroid Nodule Diagnosis: From Multimodal Integration to Clinical Utility
Jie Li, Xiaofei Wang
Diagnostics.2026; 16(19): 3255. CrossRef

Thyroid
Deep Learning Technology for Classification of Thyroid Nodules Using Multi-View Ultrasound Images: Potential Benefits and Challenges in Clinical Application: Jinyoung Kim, Min-Hee Kim, Dong-Jun Lim, Hankyeol Lee, Jae Jun Lee, Hyuk-Sang Kwon, Mee Kyoung Kim, Ki-Ho Song, Tae-Jung Kim, So Lyung Jung, Yong Oh Lee, Ki-Hyun Baek; Endocrinol Metab. 2025;40(2):216-224. Published online January 13, 2025; DOI: https://doi.org/10.3803/EnM.2024.2058

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Background
This study aimed to evaluate the applicability of deep learning technology to thyroid ultrasound images for classification of thyroid nodules.
Methods
This retrospective analysis included ultrasound images of patients with thyroid nodules investigated by fine-needle aspiration at the thyroid clinic of a single center from April 2010 to September 2012. Thyroid nodules with cytopathologic results of Bethesda category V (suspicious for malignancy) or VI (malignant) were defined as thyroid cancer. Multiple deep learning algorithms based on convolutional neural networks (CNNs) —ResNet, DenseNet, and EfficientNet—were utilized, and Siamese neural networks facilitated multi-view analysis of paired transverse and longitudinal ultrasound images.
Results
Among 1,048 analyzed thyroid nodules from 943 patients, 306 (29%) were identified as thyroid cancer. In a subgroup analysis of transverse and longitudinal images, longitudinal images showed superior prediction ability. Multi-view modeling, based on paired transverse and longitudinal images, significantly improved the model performance; with an accuracy of 0.82 (95% confidence intervals [CI], 0.80 to 0.86) with ResNet50, 0.83 (95% CI, 0.83 to 0.88) with DenseNet201, and 0.81 (95% CI, 0.79 to 0.84) with EfficientNetv2_ s. Training with high-resolution images obtained using the latest equipment tended to improve model performance in association with increased sensitivity.
Conclusion
CNN algorithms applied to ultrasound images demonstrated substantial accuracy in thyroid nodule classification, indicating their potential as valuable tools for diagnosing thyroid cancer. However, in real-world clinical settings, it is important to aware that model performance may vary depending on the quality of images acquired by different physicians and imaging devices.

Citations

Citations to this article as recorded by

Molecular intelligence and immune reconnaissance in thyroid cancer: a new paradigm for diagnosis, risk stratification, and therapeutic precision
Marcio J. Concepción-Zavaleta, Jenyfer M. Fuentes-Mendoza, Alfredo Cruz-Quintá, Argelia V. Cadena-Guerrero, Ximena Barrón, Luis Concepción-Urteaga, Cristian D. Armas, José Paz-Ibarra, Juan Eduardo Quiroz-Aldave
Expert Review of Anticancer Therapy.2026; 26(5): 585. CrossRef
Deep Learning for Ultrasound Classification to Identify Noninvasive Follicular Thyroid Neoplasms with Papillary–Like Nuclear Features
I-Hung Chien, Yi-Chiung Hsu, Shih-Ping Cheng
Journal of Imaging Informatics in Medicine.2026;[Epub] CrossRef
Knowledge-Prompted Trustworthy Disentangled Learning for Thyroid Ultrasound Segmentation With Limited Annotations
Wenxu Wang, Weizhen Wang, Qianjin Feng, Yu Zhang, Zhenyuan Ning
IEEE Transactions on Image Processing.2026; 35: 983. CrossRef
Integrating Robotic Bilateral Axillo-Breast Approach Thyroidectomy with Molecular Diagnostics and Artificial Intelligence in Thyroid Cancer Care
Qiang Deng, Xiaoping Men, Duo Jin, Yuzhuo Bai
Biomolecules & Therapeutics.2026; 34(1): 45. CrossRef
Improving Non-Invasive Prediction of Thyroid Nodule Malignancy: A Machine Learning-Based Clinical Approach
Maja Reiner, Hanna Drobińska, Michał Miciak, Michał Kisiel, Szymon Biernat, Krzysztof Kaliszewski
Cancer Management and Research.2026; Volume 18: 1. CrossRef
An early evaluation of MedSigLIP in thyroid cytology: a comparative frozen-encoder benchmark against ImageNet-pretrained encoders
Mehmet Poyrazer, Rıdvan Erten
Frontiers in Endocrinology.2026;[Epub] CrossRef
The Role of Cytology, Histology and Molecular Pathology in the Diagnostic Process of Thyroid Nodules
Mathilde Ribeiro, Sule Canberk, Massimo Bongiovanni
Cancers.2026; 18(11): 1814. CrossRef
Classification of Thyroid Nodules from Ultrasound Images Using Deep Learning Methods
Mehmet Emre Özbey, Mehmet Kaplan, Sercan Yalçın, Muhammed Yıldırım
Muş Alparslan Üniversitesi Fen Bilimleri Dergisi.2026; 14(1): 95. CrossRef
Explainable AI for accurate diagnosis of papillary thyroid carcinoma via fine-needle aspiration cytopathology
Ahmet Kilicarslan, Canan Tastimur, Gokhan Gundogdu, Erhan Akin
The Visual Computer.2026;[Epub] CrossRef
Artificial intelligence-assisted risk stratification of thyroid nodules with atypia of undetermined significance
Jinyoung Kim, Jeongmin Lee, Jeonghoon Ha, Ohjoon Kwon, Ki-Hyun Baek, Chang Myeon Song, Hyeon A Lee, Hyemi Kwon, Inyoung Youn, Mi-ri Kwon, Dong-Jun Lim
European Thyroid Journal.2026;[Epub] CrossRef
Artificial intelligence in otorhinolaryngology: a scoping review of diagnostic, surgical, and rehabilitative applications
Wan-Ling Lin, Sheng-Han Chen, Shih-Shuan Fang
The Egyptian Journal of Otolaryngology.2026;[Epub] CrossRef
Diagnostic performance of multimodal ultrasound-based deep learning models in differentiating benign and malignant thyroid nodules
Huajie Ding, Lei Na, Meiling Hao, Wanlou Chen, Zhen Zhang
Frontiers in Oncology.2026;[Epub] CrossRef
Development and clinical application of an ultrasound-based deep learning model for preoperative staging of colorectal cancer
Jing Zhao, Li-Juan Du, Ying Liu, Dan-Dan Zhu, Hui-Qing Wang, Ming-Kui Shen, Ling-Yue Wang, Hai-Yan Wang
World Journal of Gastrointestinal Oncology.2026;[Epub] CrossRef
Automated segmentation of thyroid tissue and carotid artery in ultrasound videos using expert-in-the-loop deep learning: a foundational step toward AI-assisted thyroid diagnostics
Maria Bolomiti, Joel Burman, Keyur Radiya, Olav Inge Håskjold, Karl Øyvind Mikalsen, Vegard Heimly Brun
Updates in Surgery.2026;[Epub] CrossRef
Artificial intelligence-driven transformation in the management of atypia of undetermined significance (AUS) thyroid nodules
Dehui Qiao, Weiting Huang, Xiaoyu Chen, Maolin Fang, Linjun Xie, Yongsheng Luo, Xiangyu Zhou
Critical Reviews in Oncology/Hematology.2026; 227: 105538. CrossRef
Multimodal Ultrasound-Based Decision Support for Bethesda IV Thyroid Nodules: Integration of Clinical, Radiomics, Deep Learning, and Topological Features
Haolun Ding, Shuangshuang Zhao, Yanwei Chen, Xin Zhang, Zheng Zhang, Jing Yang, Qi Ren, Baoding Chen
Journal of Imaging Informatics in Medicine.2026;[Epub] CrossRef
Artificial intelligence in thyroid nodules and cancer: clinical validation and real-world performance
Mustafa Sahin, Nikolaos George Angelopoulos, Rodis D Paparodis
Endocrine Connections.2026;[Epub] CrossRef
Transforming the Imaging Assessment of Thyroid Nodules with Artificial Intelligence: Advancements and Clinical Integration
Sanaz Vahdati, Kathryn A. Robinson, M. Regina Castro, Marius N. Stan, Kuan Zhang, Bradley J. Erickson
Journal of Imaging Informatics in Medicine.2026;[Epub] CrossRef
Role of artificial intelligence in head and neck surgery - A narrative review
Sarkheel Sarshar, Noor-ul-Huda Bhatti, Momina Amir, Nida Jaffar, Muhammad Hasnain, Syed Ghazi Ali Kirmani, Raza Hussain, Shayan Khalid Ghaloo
Turkish Journal of Surgery.2026;[Epub] CrossRef
Deep Learning for the Diagnosis and Treatment of Thyroid Cancer: A Review
Rili Gao, Shangqing Mai, Song Wang, Wuqiang Hu, Zhangqi Chang, Guozhi Wu, Haixia Guan
Endocrine Practice.2025; 31(12): 1608. CrossRef
Artificial Intelligence for Thyroid Ultrasound: Clinical Performance, Pitfalls, and Practice Integration
Junseok Kang, Jihyun Ahn, Jeong Hun Hah
Clinical Ultrasound.2025; 10(2): 59. CrossRef

Thyroid
Small Multi-Gene DNA Panel Can Aid in Reducing the Surgical Resection Rate and Predicting the Malignancy Risk of Thyroid Nodules: Moon Young Oh, Hye-Mi Choi, Jinsun Jang, Heejun Son, Seung Shin Park, Minchul Song, Yoo Hyung Kim, Sun Wook Cho, Young Jun Chai, Woosung Chung, Young Joo Park; Endocrinol Metab. 2024;39(5):777-792. Published online October 14, 2024; DOI: https://doi.org/10.3803/EnM.2024.2034

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Background
We explored the utility of a small multi-gene DNA panel for assessing molecular profiles of thyroid nodules and influencing clinical decisions by comparing outcomes between tested and untested nodules.
Methods
Between April 2022 and May 2023, we prospectively performed fine-needle aspiration (FNA) with gene testing via DNA panel of 11 genes (BRAF, RAS [NRAS, HRAS, KRAS], EZH1, DICER1, EIF1AX, PTEN, TP53, PIK3CA, TERT promoter) in 278 consecutive nodules (panel group). Propensity score-matching (1:1) was performed with 475 nodules that consecutively underwent FNA without gene testing between January 2021 and December 2021 (control group).
Results
In the panel group, positive call rate for mutations was 41.7% (BRAF 16.2%, RAS 12.6%, others 11.5%, double mutation 1.4%) for all nodules, and 40.0% (BRAF 4.3%, RAS 19.1%, others 15.7%, double mutation 0.9%) for indeterminate nodules. Benign call rate was 69.8% for all nodules, and 75.7% for indeterminate nodules. In four nodules, additional TP53 (in addition to BRAF or EZH1) or PIK3CA (in addition to BRAF or TERT) mutations were co-detected. Sensitivity, specificity, positive predictive value, and negative predictive value were 80.0%, 53.3%, 88.1%, 38.1% for all nodules, and 78.6%, 45.5%, 64.7%, 62.5% for indeterminate nodules, respectively. Panel group exhibited lower surgical resection rates than the control group for all nodules (27.0% vs. 52.5%, P<0.001), and indeterminate nodules (23.5% vs. 68.2%, P<0.001). Malignancy risk was significantly different between the panel and control groups (81.5% vs. 63.9%, P=0.008) for all nodules.
Conclusion
Our panel aids in managing thyroid nodules by providing information on malignancy risk based on mutations, potentially reducing unnecessary surgery in benign nodules or patients with less aggressive malignancies.

Citations

Citations to this article as recorded by

Integrative multi-omics refines the molecular subtypes of thyroid cancers and enhances cancer-progression prediction: a retrospective cohort study
Yoo Hyung Kim, Joseph Wang, Jae-Kyung Won, Youngsoo Kim, Sun Wook Cho, Dohyun Han, Young Joo Park
International Journal of Surgery.2026; 112(5): 11987. CrossRef
Impact of Molecular Testing on Surgical Decision-Making in Indeterminate Thyroid Nodules: A Global Meta-Analysis Across Test Generations
Truong Phan-Xuan Nguyen, Andrey Bychkov, Chan Kwon Jung, Kennichi Kakudo, Chanchal Rana
Endocrine Pathology.2026;[Epub] CrossRef
EIF1AX Mutations in thyroid nodules and advanced thyroid carcinoma: a systematic review and meta-analysis
Vincenzo Fiorentino, Patrizia Straccia, Esther Diana Rossi
Virchows Archiv.2026;[Epub] CrossRef
Great Debate: Molecular Testing and Extent of Surgery in Well-Differentiated Thyroid Cancer
Cord Sturgeon, Ashok R. Shaha, Linwah Yip
Annals of Surgical Oncology.2025; 32(7): 4597. CrossRef
Prediction of malignancy risk in Bethesda III nodules: development and validation of multiple machine learning models
Wentian Li, Jiayu Zhu, Ying Wang, Jingxiu Li, Zhonghui Li, Cuicui Wang, Jingli Xue, Peng Zhou, Qingqing He
Frontiers in Endocrinology.2025;[Epub] CrossRef
Inside the Matrix: Integrated Cytology and Molecular Testing of Thyroid FNAC Samples Using a Commercial Synthetic 3D Scaffold
Diana Raluca Streinu, Dana Liana Stoian, Octavian Constantin Neagoe, Mihnea Derban, Paula Diana Ciordas, Catalin Marian
International Journal of Molecular Sciences.2025; 26(22): 11100. CrossRef

Review Articles

Thyroid
A Narrative Review of the 2023 Korean Thyroid Association Management Guideline for Patients with Thyroid Nodules: Eun Kyung Lee, Young Joo Park, Chan Kwon Jung, Dong Gyu Na; Endocrinol Metab. 2024;39(1):61-72. Published online February 14, 2024; DOI: https://doi.org/10.3803/EnM.2024.1938

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The 2023 Korean Thyroid Association (KTA) Management Guideline for Patients with Thyroid Nodules constitute an update of the 2016 KTA guideline for thyroid nodules and cancers that focuses specifically on nodules. The 2023 guideline aim to offer updated guidance based on new evidence that reflects the changes in clinical practice since the 2016 KTA guideline. To update the 2023 guideline, a comprehensive literature search was conducted from January 2022 to May 2022. The literature search included studies, reviews, and other evidence involving human subjects that were published in English in MEDLINE (PubMed), Embase, and other relevant databases. Additional significant clinical trials and research studies published up to April 2023 were also reviewed. The limitations of the current evidence are discussed, and suggestions for areas in need of further research are identified. The purpose of this review is to provide a summary of the 2023 KTA guideline for the management of thyroid nodules released in May 2023 and to give a balanced insight with comparison of recent guidelines from other societies.

Citations

Citations to this article as recorded by

Long-Term Surveillance for Benign Thyroid Nodules
Manuela Macera, Rossella Melcarne, Giorgio Grani
Endocrine Practice.2026; 32(1): 77. CrossRef
Ultrasonographic Features in Recognition of Malignant Thyroid Nodule with Fine Needle Aspiration Cytology as the Gold Standard
Abdul Samad, Naveed Khan Kakar, Aisha Shahid Mughal, Shazia Shabbir
Pakistan Journal of Health Sciences.2026; : 33. CrossRef
Integrative multi-omics refines the molecular subtypes of thyroid cancers and enhances cancer-progression prediction: a retrospective cohort study
Yoo Hyung Kim, Joseph Wang, Jae-Kyung Won, Youngsoo Kim, Sun Wook Cho, Dohyun Han, Young Joo Park
International Journal of Surgery.2026; 112(5): 11987. CrossRef
Elderly age and male gender as risk factors for Non Diagnostic cytology at thyroid fine needle aspiration: results of a large cytological series
Laura Croce, Spyridon Chytiris, Marsida Teliti, Isabella Chiardi, Francesca Coperchini, Linda Loretta Businaro, Flavia Magri, Tshering Dorji, Mario Rotondi
Endocrine.2026;[Epub] CrossRef
Diagnostic Performance of Five Societies’ Ultrasound Risk Stratification Systems for Thyroid Malignancy According to Nodule Size: A Comparison Using a Standardized Ultrasound Lexicon
Dong Gyu Na, Byeong-Joo Noh, Won Jun Kim, Jin Yub Kim, Ha Young Kim, Jong Cheol Lee, Myoung Sook Shim, Yong Jin Song, Kwang Hyun Yoon, Wooyul Paik
Thyroid®.2026; 36(4): 408. CrossRef
Risk Stratification Tools for Thyroid Cancer: A Systematic Review of Models Combining Ultrasound, Cytology, and Clinical Risk Factors
Emma Watts, Zakariya Sattar, Kristien Boelaert, Neil Sharma
Thyroid®.2026;[Epub] CrossRef
Impact of Health Behaviors on Cardiovascular Risk in Thyroid Cancer Survivors according to Metastasis: A Nationwide Cohort Study
Jeongmin Lee, Jaekyung Lee, Joonseon Park, Kwangsoon Kim, Ja Seong Bae, Kyung-Do Han, Dong-Jun Lim
Endocrinology and Metabolism.2026;[Epub] CrossRef
Comparison of thyroid-specific quality of life after thermal ablation vs. thyroid lobectomy for benign thyroid nodules
Yan Li, Shengnan Huo, Ying Wei, Zhenlong Zhao, Lili Peng, Jie Wu, ShiLiang Cao, Na Yu, Wenjia Cai, Song Li, Shuqi Li, Ming-an Yu
BMC Endocrine Disorders.2026;[Epub] CrossRef
Integrating Digital Ki-67 Labeling Index and K-TIRADS for Malignancy Risk Stratification in Thyroid Core Needle Biopsies
Yujin Cha, Sue Youn Kim, Chankyung Kim, Ja Seong Bae, Dong-Jun Lim, So-Lyung Jung, Chan Kwon Jung
Cancers.2026; 18(14): 2260. CrossRef
Ablation of Benign Thyroid Nodules: Indian Society of Vascular and Interventional Radiology Consensus Statement
Sanchita Gupta, Stanzin Spalkit, Chinmay P. Nagesh, Vikas HP, Gaurav Pawar, Navin M. Mulimani, Shakthi Parvathi, Pratik Bangde, Basavaraj Biradar, Tom George, Swish Kumar Singh, Jenny Gandhi, Devasenathipathy Kandasamy, Meenu Bagarhatta, Santosh B. Patil,
Journal of Clinical Interventional Radiology ISVIR.2026;[Epub] CrossRef
Prediction of Central Lymph Node Metastasis in Papillary Thyroid Microcarcinoma Using a Deep Learning Radiomics Model Based on SAM3 Automatic Segmentation of Ultrasound Images: A Multicenter Cohort Study
Jun Song, Yuan Zhang, Xiachuan Qin, Xiaoling Liu, Fanding He
Academic Radiology.2026;[Epub] CrossRef
Current Perspectives on Thyroid Nodule Evaluation: Integrating Cytomorphology, Ultrasound Risk Stratification, and Molecular Testing
Marc P. Pusztaszeri, Zubair W. Baloch
Modern Pathology.2026; 39(10): 101039. CrossRef
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Juan José Díez, Emma Anda, Irene Bretón, Cintia González-Blanco, María Miguélez, Ana Zugasti, Alberto Fernández
Endocrinología, Diabetes y Nutrición.2025; 72(3): 101531. CrossRef
Association Between Metabolic Dysfunction-Associated Steatotic Liver Disease and Thyroid Cancer
Sang Yi Moon, Minkook Son, Jung-Hwan Cho, Hye In Kim, Ji Min Han, Ji Cheol Bae, Sunghwan Suh
Thyroid®.2025; 35(1): 79. CrossRef
Comparison of core-needle biopsy and repeat fine-needle aspiration biopsy for thyroid nodules with initially inconclusive findings: a systematic review, diagnostic accuracy meta-analysis, and meta-regression
Hendra Zufry, Timotius Ivan Hariyanto
Journal of the American Society of Cytopathology.2025; 14(3): 159. CrossRef
Recommendations of the Spanish Society of Endocrinology and Nutrition (SEEN) on “what not to do” in clinical practice
Juan José Díez, Emma Anda, Irene Bretón, Cintia González-Blanco, María Miguélez, Ana Zugasti, Alberto Fernández
Endocrinología, Diabetes y Nutrición (English ed.).2025; 72(3): 101531. CrossRef
Enhancing recurrent laryngeal nerve localization during transoral endoscopic thyroid surgery using augmented reality: a proof-of-concept study
Moon Young Oh, Yeonjin Choi, Taesoo Jang, Eun Kyung Choe, Hyoun-Joong Kong, Young Jun Chai
Annals of Surgical Treatment and Research.2025; 108(3): 135. CrossRef
Surgical Extent of Low-to-Intermediate Thyroid Cancer: Molecular Testing and Clinical Decision-Making
Jae Won Chang
International Journal of Thyroidology.2025; 18(1): 19. CrossRef
Systematic review and meta-analysis of diagnostic accuracy of one-step nucleic acid amplification for lymph node metastases of papillary thyroid carcinoma
Maria Magdalena Llompart-Coll, Paula Domínguez-Garijo, Martí Manyalich-Blasi, Gemma Domènech-Gómez, Iria Perales-Galan, David Saavedra-Pérez, Maria Teresa Rodrigo, Sergi Vidal-Sicart, Miguel Pera-Roman, Oscar Vidal-Pérez
Langenbeck's Archives of Surgery.2025;[Epub] CrossRef
Diagnosis and Evaluation of Aggressiveness Using Circulating Plasma miRNAs in Papillary Thyroid Microcarcinoma
Jiwon Jang, Ji Min Kim, Sung-Chan Shin, Yong-il Cheon, Bo Hyun Kim, Mijin Kim, Sang Soo Kim, Byung-Joo Lee
Cancers.2025; 17(13): 2079. CrossRef
Ultrasound-Guided Microwave Ablation for Autonomous Hyperfunctioning Thyroid Nodule in a Child
Meiye Li, Xin Li, Hongxia Zhang, Jingyu Chen, Zhenzhen Zhao, Jun Zhang, Xiangru Kong
Indian Journal of Pediatrics.2025; 92(10): 1101. CrossRef
Sorveglianza attiva nei noduli tiroidei: pro e contro
Giulia Brigante, Gloria Agrimonti, Nicolò Bacchi, Francesco Costantino, Roberta Sueri, Vincenzo Rochira, Manuela Simoni
L'Endocrinologo.2025; 26(5): 623. CrossRef
Comparative evaluation of two automated immunoassays for serum thyroglobulin quantification
Kyoung Ho Roh, Hyunyong Hwang
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Prospective differentiation of difficult-to-diagnose thyroid nodules using shear wave elastography
Luying Gao, Xuehua Xi, Yuxin Jiang, Qiong Gao, Jiajia Tang, Xiao Yang, Shenling Zhu, Ruina Zhao, Xingjian Lai, Bo Zhang
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2023 Update of the Korean Thyroid Association Guidelines for the Management of Thyroid Nodules
Eun Kyung Lee, Young Joo Park
Clinical Thyroidology®.2024; 36(4): 153. CrossRef
Systemic therapy for differentiated thyroid cancer with distant metastasis
Eun Kyung Lee
Journal of the Korean Medical Association.2024; 67(7): 484. CrossRef
Educational exchange in thyroid core needle biopsy diagnosis: enhancing pathological interpretation through guideline integration and peer learning
Agnes Stephanie Harahap, Chan Kwon Jung
Journal of Pathology and Translational Medicine.2024; 58(5): 205. CrossRef
Standardized Ultrasound Evaluation for Active Surveillance of Low-Risk Thyroid Microcarcinoma in Adults: 2024 Korean Society of Thyroid Radiology Consensus Statement
Ji Ye Lee, Min Kyoung Lee, Hyun Kyung Lim, Chang Yoon Lee, Jin Yong Sung, Jung Hyun Yoon, Soo Yeon Han, Jung Hee Shin, Ji-hoon Kim, So Lyung Jung, Sae Rom Chung, Jung Hwan Baek, Dong Gyu Na
Korean Journal of Radiology.2024; 25(11): 942. CrossRef
Thermal ablation for Bethesda III and IV thyroid nodules: current diagnosis and management
Wen-Hui Chan, Pi-Ling Chiang, An-Ni Lin, Yen-Hsiang Chang, Wei-Che Lin
Ultrasonography.2024; 43(6): 395. CrossRef
Cytologic hallmarks and differential diagnosis of papillary thyroid carcinoma subtypes
Agnes Stephanie Harahap, Chan Kwon Jung
Journal of Pathology and Translational Medicine.2024; 58(6): 265. CrossRef
Standardized Ultrasound Evaluation for Active Surveillance of Low-Risk Thyroid Microcarcinoma in Adults: 2024 Korean Society of Thyroid Radiology Consensus Statement
Ji Ye Lee, Min Kyoung Lee, Hyun Kyung Lim, Chang Yoon Lee, Jin Yong Sung, Jung Hyun Yoon, Soo Yeon Hahn, Jung Hee Shin, Ji-hoon Kim, So Lyung Jung, Sae Rom Chung, Jung Hwan Baek, Dong Gyu Na
Journal of the Korean Society of Radiology.2024; 85(6): 1060. CrossRef

Thyroid
Novel and Advanced Ultrasound Techniques for Thyroid Thermal Ablation: Wai-Kin Chan, Jui-Hung Sun, Miaw-Jene Liou, Chia-Jung Hsu, Yu-Ling Lu, Wei-Yu Chou, Yan-Rong Li, Feng-Hsuan Liu; Endocrinol Metab. 2024;39(1):40-46. Published online February 13, 2024; DOI: https://doi.org/10.3803/EnM.2024.1917

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Thyroid radiofrequency ablation and microwave ablation are widely adopted minimally invasive treatments for diverse thyroid conditions worldwide. Fundamental skills such as the trans-isthmic approach and the moving shot technique are crucial for performing thyroid ablation, and advanced techniques, including hydrodissection and vascular ablation, improve safety and efficacy and reduce complications. Given the learning curve associated with ultrasound-guided therapeutic procedures, operators need training and experience. While training models exist, limited attention has been given to ultrasound maneuvers in ablation needle manipulation. This article introduces two essential maneuvers, the zigzag moving technique and the alienate maneuver, while also reviewing the latest ultrasound techniques in thyroid ablation, contributing valuable insights into this evolving field.

Citations

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A cost-effective porcine training model for thermal ablation of thyroid nodules and subsequent transoral endoscopic thyroidectomy
Lei Min, Yujing Weng, Weichun Chen, Debiao Chen, Qing Ai, Jiang Jiang, Zhiheng Huang
Minimally Invasive Therapy & Allied Technologies.2026; 35(1): 79. CrossRef
Factors associated with early complete resolution after radiofrequency ablation for low-risk papillary thyroid microcarcinoma: a dual-center retrospective study
Yuxuan Qiu, Yina Zhang, Jingqi Zhu, Yun Gong, Lu Yin, Pin Fan, Lian Zhang, Lingyun Bao, Jianhua Fang, Jun Lou, Chenke Xu
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Original Articles

Thyroid
The Diagnostic Role of Repeated Biopsy of Thyroid Nodules with Atypia of Undetermined Significance with Architectural Atypia on Core-Needle Biopsy: Hye Hyeon Moon, Sae Rom Chung, Young Jun Choi, Tae-Yon Sung, Dong Eun Song, Tae Yong Kim, Jeong Hyun Lee, Jung Hwan Baek; Endocrinol Metab. 2024;39(2):300-309. Published online January 3, 2024; DOI: https://doi.org/10.3803/EnM.2023.1818

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Background
We aimed to evaluate the utility of repeat biopsy of thyroid nodules classified as atypia of undetermined significance with architectural atypia (IIIB) on core-needle biopsy (CNB).
Methods
This retrospective study evaluated patients with thyroid nodules categorized as IIIB on CNB between 2013 and 2015. Demographic characteristics, subsequent biopsy results, and ultrasound (US) images were evaluated. The malignancy rates of nodules according to number of CNBs and the number of IIIB diagnoses was compared. Demographic and US features were evaluated to determine factors predictive of malignancy.
Results
Of 1,003 IIIB nodules on CNB, the final diagnosis was determined for 328 (32.7%) nodules, with 121 of them confirmed as malignant, resulting in a malignancy rate of 36.9% (95% confidence interval, 31.7% to 42.1%). Repeat CNB was performed in 248 nodules (24.7%), with 75 (30.2%), 131 (52.8%), 13 (5.2%), 26 (10.5%), one (0.4%), and two (0.8%) reclassified into categories II, IIIB, IIIA, IV, V, and VI, respectively. Malignancy rates were not significantly affected by the number of CNBs (P=0.291) or the number of IIIB diagnoses (P=0.473). None of the nodules confirmed as category II on repeat CNB was malignant. US features significantly associated with malignancy (P<0.003) included solid composition, irregular margins, microcalcifications, and high suspicion on the US risk stratification system.
Conclusion
Repeat biopsy of nodules diagnosed with IIIB on CNB did not increase the detection of malignancy but can potentially reduce unnecessary surgery. Repeat biopsy should be performed selectively, with US features guiding the choice between repeat biopsy and diagnostic surgery.

Citations

Citations to this article as recorded by

Integrating Digital Ki-67 Labeling Index and K-TIRADS for Malignancy Risk Stratification in Thyroid Core Needle Biopsies
Yujin Cha, Sue Youn Kim, Chankyung Kim, Ja Seong Bae, Dong-Jun Lim, So-Lyung Jung, Chan Kwon Jung
Cancers.2026; 18(14): 2260. CrossRef

Thyroid Thyroid Cancer Screening
Diagnostic Performance of Ultrasound-Based Risk Stratification Systems for Thyroid Nodules: A Systematic Review and Meta-Analysis: Leehi Joo, Min Kyoung Lee, Ji Ye Lee, Eun Ju Ha, Dong Gyu Na; Endocrinol Metab. 2023;38(1):117-128. Published online February 27, 2023; DOI: https://doi.org/10.3803/EnM.2023.1670

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Background
This study investigated the diagnostic performance of biopsy criteria in four society ultrasonography risk stratification systems (RSSs) for thyroid nodules, including the 2021 Korean (K)-Thyroid Imaging Reporting and Data System (TIRADS).
Methods
The Ovid-MEDLINE, Embase, Cochrane, and KoreaMed databases were searched and a manual search was conducted to identify original articles investigating the diagnostic performance of biopsy criteria for thyroid nodules (≥1 cm) in four widely used society RSSs.
Results
Eleven articles were included. The pooled sensitivity and specificity were 82% (95% confidence interval [CI], 74% to 87%) and 60% (95% CI, 52% to 67%) for the American College of Radiology (ACR)-TIRADS, 89% (95% CI, 85% to 93%) and 34% (95% CI, 26% to 42%) for the American Thyroid Association (ATA) system, 88% (95% CI, 81% to 92%) and 42% (95% CI, 22% to 67%) for the European (EU)-TIRADS, and 96% (95% CI, 94% to 97%) and 21% (95% CI, 17% to 25%) for the 2016 K-TIRADS. The sensitivity and specificity were 76% (95% CI, 74% to 79%) and 50% (95% CI, 49% to 52%) for the 2021 K-TIRADS_1.5 (1.5-cm size cut-off for intermediate-suspicion nodules). The pooled unnecessary biopsy rates of the ACR-TIRADS, ATA system, EU-TIRADS, and 2016 K-TIRADS were 41% (95% CI, 32% to 49%), 65% (95% CI, 56% to 74%), 68% (95% CI, 60% to 75%), and 79% (95% CI, 74% to 83%), respectively. The unnecessary biopsy rate was 50% (95% CI, 47% to 53%) for the 2021 K-TIRADS_1.5.
Conclusion
The unnecessary biopsy rate of the 2021 K-TIRADS_1.5 was substantially lower than that of the 2016 K-TIRADS and comparable to that of the ACR-TIRADS. The 2021 K-TIRADS may help reduce potential harm due to unnecessary biopsies.

Citations

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L. A. Timofeeva, T. N. Makarova, A. O. Yumanov, S. S. Alekseev
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THE IMPACT OF STANDARDIZATION IN ULTRASOUND DIAGNOSTICS AND THE UNIFICATION OF TI-RADS ON THE JUSTIFICATION FOR REFERRING THYROID NODULES FOR FINE-NEEDLE ASPIRATION BIOPSY
Natalia I. Zinchenko
Clinical and Preventive Medicine.2026; (4): 15. CrossRef
Validation of a thyroid malignancy risk calculator in a Portuguese cohort
Beatriz Tavares da Silva, Liliana Fonseca, Cláudia Freitas, André Carvalho
Endocrine.2026;[Epub] CrossRef
Enhancing diagnostic accuracy of thyroid nodules: integrating self-learning and artificial intelligence in clinical training
Daham Kim, Yoon-a Hwang, Youngsook Kim, Hye Sun Lee, Eunjung Lee, Hyunju Lee, Jung Hyun Yoon, Vivian Youngjean Park, Miribi Rho, Jiyoung Yoon, Si Eun Lee, Jin Young Kwak
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Andrea Leoncini, Pierpaolo Trimboli
Endocrine.2025; 89(1): 197. CrossRef
A comparative study of Chinese and ACR-TIRADS diagnostic accuracy in small thyroid nodule risk evaluation
Rasha Nadeem Ahmed, Maysaloon Shaman Saeed, Nazar M. T. Jawhar, Mohamed Tarek El-Diasty, Noha Yahia Ebaid, Mostafa Mohamad Assy
Egyptian Journal of Radiology and Nuclear Medicine.2025;[Epub] CrossRef
Risk Stratification of Thyroid Nodules 10 mm in Diameter or Less: Strength and Pitfalls of the Ultrasonographic Assessment From a Cross‐Sectional Study
Giuseppe Lisco, Anna De Tullio, Vito Angelo Giagulli, Giuseppina Renzulli, Vincenzo Triggiani, Suraiya Saleem
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Analysis of FNAC indication in thyroid nodules assessed as low risk according to various TIRADSs
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European Thyroid Journal.2025;[Epub] CrossRef
Accuracy of ultrasound in predicting thyroid malignancy: a comparative analysis of the ACR TI-RADS and ATA risk stratification systems
Shaza Samargandy, Aliaa H. Ghoneim
Archives of Endocrinology and Metabolism.2024;[Epub] CrossRef
Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules 2024
Young Joo Park, Eun Kyung Lee, Young Shin Song, Su Hwan Kang, Bon Seok Koo, Sun Wook Kim, Dong Gyu Na, Seung-Kuk Baek, So Won Oh, Min Kyoung Lee, Sang-Woo Lee, Young Ah Lee, Yong Sang Lee, Ji Ye Lee, Dong-Jun Lim, Leehi Joo, Yuh-Seog Jung, Chan Kwon Jung,
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Individual Ultrasonographic Characteristics of Thyroid Nodules and Their Cytopathological Correlation to Determine Malignancy Risk
Miguel Ángel Castilla Villanueva, Dania Guadalupe Solis Cano, Ana Amador Martínez, Marco Antonio Téliz Meneses, Jesús Baquera-Heredia, Cesar Eduardo Vallin Orozco, Mónica Loya Ceballos
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Improving the diagnostic performance of inexperienced readers for thyroid nodules through digital self-learning and artificial intelligence assistance
Si Eun Lee, Hye Jung Kim, Hae Kyoung Jung, Jin Hyang Jung, Jae-Han Jeon, Jin Hee Lee, Hanpyo Hong, Eun Jung Lee, Daham Kim, Jin Young Kwak
Frontiers in Endocrinology.2024;[Epub] CrossRef
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Eun Kyung Lee
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Do Joon Park
Endocrinology and Metabolism.2023; 38(1): 69. CrossRef
The 2017 United States Preventive Services Task Force Recommendation for Thyroid Cancer Screening Is No Longer the Gold Standard
Ka Hee Yi
Endocrinology and Metabolism.2023; 38(1): 72. CrossRef
Thyroid Cancer Screening: How to Maximize Its Benefits and Minimize Its Harms
Jung Hwan Baek
Endocrinology and Metabolism.2023; 38(1): 75. CrossRef
2023 Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules
Young Joo Park, Eun Kyung Lee, Young Shin Song, Soo Hwan Kang, Bon Seok Koo, Sun Wook Kim, Dong Gyu Na, Seung-Kuk Baek, So Won Oh, Min Kyoung Lee, Sang-Woo Lee, Young Ah Lee, Yong Sang Lee, Ji Ye Lee, Dong-Jun Lim, Leehi Joo, Yuh-Seog Jung, Chan Kwon Jung
International Journal of Thyroidology.2023; 16(1): 1. CrossRef
Evaluation of the Appropriateness of Thyroid Fine-Needle Aspiration
Lairce Cristina Ribeiro Brito, Iara Beatriz De Carvalho Botêlho, Lanna Matos Silva Fernandes, Nayze Lucena Sangreman Aldeman, Uziel Nunes Silva
International Journal for Innovation Education and Research.2023; 11(6): 8. CrossRef

Thyroid Thyroid Cancer Screening
A Comprehensive Assessment of the Harms of Fine-Needle Aspiration Biopsy for Thyroid Nodules: A Systematic Review: Ji Yong Park, Wonsuk Choi, A Ram Hong, Jee Hee Yoon, Hee Kyung Kim, Ho-Cheol Kang; Endocrinol Metab. 2023;38(1):104-116. Published online February 27, 2023; DOI: https://doi.org/10.3803/EnM.2023.1669

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Background
There have concerns related with the potential harms of fine-needle aspiration biopsy (FNAB). We aimed to summarize the clinical complications and evaluate the safety of FNAB.
Methods
Studies related with the harms of FNAB were searched on MEDLINE, Embase, Cochrane library, and KoreaMed from 2012 to 2022. Also, studies reviewed in the previous systematic reviews were evaluated. Included clinical complications were postprocedural pain, bleeding events, neurological symptoms, tracheal puncture, infections, post-FNAB thyrotoxicosis, and needle tract implantation of thyroid cancers.
Results
Twenty-three cohort studies were included in this review. Nine studies which were related with FNAB-related pain showed that most of the subjects had no or mild discomfort. The 0% to 6.4% of the patients had hematoma or hemorrhage after FNAB, according to 15 studies. Vasovagal reaction, vocal cord palsy, and tracheal puncture have rarely described in the included studies. Needle tract implantation of thyroid malignancies was described in three studies reporting 0.02% to 0.19% of the incidence rate.
Conclusion
FNAB is considered to be a safe diagnostic procedure with rare complications, which are mainly minor events. Thorough assessement of the patients’ medical condition when deciding to perform FNABs would be advisable to lower potential complications.

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Review Article

Thyroid
Update from the 2022 World Health Organization Classification of Thyroid Tumors: A Standardized Diagnostic Approach: Chan Kwon Jung, Andrey Bychkov, Kennichi Kakudo; Endocrinol Metab. 2022;37(5):703-718. Published online October 4, 2022; DOI: https://doi.org/10.3803/EnM.2022.1553

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The fifth edition of the World Health Organization (WHO) histologic classification of thyroid neoplasms released in 2022 includes newly recognized tumor types, subtypes, and a grading system. Follicular cell-derived neoplasms are categorized into three families (classes): benign tumors, low-risk neoplasms, and malignant neoplasms. The terms “follicular nodular disease” and “differentiated high-grade thyroid carcinoma” are introduced to account for multifocal hyperplastic/neoplastic lesions and differentiated thyroid carcinomas with high-grade features, respectively. The term “Hürthle cells” is replaced with “oncocytic cells.” Invasive encapsulated follicular and cribriform morular variants of papillary thyroid carcinoma (PTC) are now redefined as distinct tumor types, given their different genetic alterations and clinicopathologic characteristics from other PTC subtypes. The term “variant” to describe a subclass of tumor has been replaced with the term “subtype.” Instead, the term “variant” is reserved to describe genetic alterations. A histologic grading system based on the mitotic count, necrosis, and/or the Ki67 index is used to identify high-grade follicular-cell derived carcinomas and medullary thyroid carcinomas. The 2022 WHO classification introduces the following new categories: “salivary gland-type carcinomas of the thyroid” and “thyroid tumors of uncertain histogenesis.” This review summarizes the major changes in the 2022 WHO classification and their clinical relevance.

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Original Articles

Thyroid
Diagnostic Performance of Thyroid Core Needle Biopsy Using the Revised Reporting System: Comparison with Fine Needle Aspiration Cytology: Kwangsoon Kim, Ja Seong Bae, Jeong Soo Kim, So Lyung Jung, Chan Kwon Jung; Endocrinol Metab. 2022;37(1):159-169. Published online February 28, 2022; DOI: https://doi.org/10.3803/EnM.2021.1299

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231 Download
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Abstract PDF Supplementary Material PubReader ePub

Background
We aim to validate the diagnostic performance of thyroid core needle biopsy (CNB) for diagnosing malignancy in clinical settings to align with the changes made in recently updated thyroid CNB guidelines.
Methods
We retrospectively analyzed 1,381 thyroid CNB and 2,223 fine needle aspiration (FNA) samples. The FNA and CNB slides were interpreted according to the Bethesda System for Reporting Thyroid Cytopathology and updated practice guidelines for thyroid CNB, respectively.
Results
Compared to FNA, CNB showed lower rates of inconclusive results: categories I (2.8% vs. 11.2%) and III (1.2% vs. 6.2%), and higher rates of categories II (60.9% vs. 50.4%) and IV (17.5% vs. 2.0%). The upper and lower bounds of the risk of malignancy (ROM) for category IV of CNB were 43.2% and 26.6%, respectively. The CNB subcategory IVb with nuclear atypia had a higher ROM than the subcategory without nuclear atypia (40%–62% vs. 23%–36%). In histologically confirmed cases, there was no significant difference in the diagnostic performance between CNB and FNA for malignancy. However, neoplastic diseases were more frequently detected by CNB than by FNA (88.8% vs. 77.6%, P=0.046). In category IV, there was no difference in unnecessary surgery rate between CNB and FNA (4.7% vs. 6.9%, P=0.6361).
Conclusion
Thyroid CNB decreased the rate of inconclusive results and showed a higher category IV diagnostic rate than FNA. The revised guidelines for thyroid CNB proved to be an excellent reporting system for assessing thyroid nodules.

Citations

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Integrating Digital Ki-67 Labeling Index and K-TIRADS for Malignancy Risk Stratification in Thyroid Core Needle Biopsies
Yujin Cha, Sue Youn Kim, Chankyung Kim, Ja Seong Bae, Dong-Jun Lim, So-Lyung Jung, Chan Kwon Jung
Cancers.2026; 18(14): 2260. CrossRef
Risk-adapted trajectory selection for ultrasound-guided thyroid fine-needle aspiration biopsy: a multicenter study of in-plane and out-of-plane approaches
Xiubin Tang, Wenjin Lin, Youhai Wu, Ming Chen, Xiao Yang
Frontiers in Endocrinology.2026;[Epub] CrossRef
Diagnostic Accuracy of Elastography Combined with TI-RADS for Differentiating Benign and Malignant Thyroid Nodules: A Systematic Review and Meta-Analysis
Noraiz Ali, Mahrukh Latif, Muhammad Zubair, Farheen Fatima, Esha Saleem, Muhammad Ishaq Khan
Journal of Diagnostic Medical Sonography.2026;[Epub] CrossRef
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Thyroid
Comparison of Korean vs. American Thyroid Imaging Reporting and Data System in Malignancy Risk Assessment of Indeterminate Thyroid Nodules: Sunyoung Kang, Seul Ki Kwon, Hoon Sung Choi, Min Joo Kim, Young Joo Park, Do Joon Park, Sun Wook Cho; Endocrinol Metab. 2021;36(5):1111-1120. Published online October 21, 2021; DOI: https://doi.org/10.3803/EnM.2021.1208

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162 Download
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Abstract PDF Supplementary Material PubReader ePub

Background
The management of cytologically indeterminate thyroid nodules is challenging for clinicians. This study aimed to compare the diagnostic performance of the Korean Thyroid Imaging Reporting and Data Systems (K-TIRADS) with that of the American College of Radiology (ACR)-TIRADS for predicting the malignancy risk of indeterminate thyroid nodules.
Methods
Thyroid nodules diagnosed by fine-needle aspiration (FNA) followed by surgery or core needle biopsy at a single referral hospital were enrolled.
Results
Among 200 thyroid nodules, 78 (39.0%) nodules were classified as indeterminate by FNA (Bethesda category III, IV, and V), and 114 (57.0%) nodules were finally diagnosed as malignancy by surgery or core needle biopsy. The area under the curve (AUC) was higher for FNA than for either TIRADS system in all nodules, while all three methods showed similar AUCs for indeterminate nodules. However, for Bethesda category III nodules, applying K-TIRADS 5 significantly increased the risk of malignancy compared to a cytological examination alone (50.0% vs. 26.5%, P=0.028), whereas applying ACR-TIRADS did not lead to a change.
Conclusion
K-TIRADS and ACR-TIRADS showed similar diagnostic performance in assessing indeterminate thyroid nodules, and K-TIRADS had beneficial effects for malignancy prediction in Bethesda category III nodules.

Citations

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Clinical Study
Efficacy of Ethanol Ablation for Benign Thyroid Cysts and Predominantly Cystic Nodules: A Systematic Review and Meta-Analysis: Cheng-Chun Yang, Yung Hsu, Jyun-Yan Liou; Endocrinol Metab. 2021;36(1):81-95. Published online February 24, 2021; DOI: https://doi.org/10.3803/EnM.2020.833

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Background
Ultrasound-guided minimally invasive procedures are widely used to treat thyroid diseases. The objective of this study was to assess the efficacy and safety of ethanol ablation (EA) in comparison with other non-surgical options in the treatment of benign thyroid cystic nodules.
Methods
We conducted a systematic search of studies on EA for thyroid cystic nodules, mainly in the Ovid-MEDLINE and Embase, Web of Science, and Cochrane databases. The standardized mean difference (SMD) of the volume reduction ratio (VRR) after EA versus other non-surgical treatments comprised the primary outcome, whereas the odds ratio (OR) of therapeutic success rates between the two groups comprised the secondary outcome.
Results
The meta-analysis included 19 studies (four randomized controlled trials and 15 non-randomized studies) with 1,514 participants. The cumulative VRR of EA was 83.908% (95% confidence interval [CI], 79.358% to 88.457%). EA had a significantly higher pooled VRR (SMD, 0.381; 95% CI, 0.028 to 0.734; P=0.030), but not a significantly higher pooled therapeutic success rate (OR, 0.867; 95% CI, 0.132 to 5.689; P=0.880), than other forms of non-surgical management including radiofrequency ablation (RFA), polidocanol sclerotherapy, and simple aspiration with or without saline flush. However, the VRR and therapeutic success rate were not significantly different between EA and RFA. Major complications were recorded only in six patients (0.53%) with self-limiting dysphonia.
Conclusion
The role of EA as the first-line treatment for benign thyroid cysts and predominantly cystic nodules is supported by its high effectiveness and good safety profile compared to other currently available non-surgical options.

Citations

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Clinical Study
Effectiveness of Injecting Cold 5% Dextrose into Patients with Nerve Damage Symptoms during Thyroid Radiofrequency Ablation: Min Kyoung Lee, Jung Hwan Baek, Sae Rom Chung, Young Jun Choi, Yu-Mi Lee, Tae Yong Kim, Jeong Hyun Lee; Endocrinol Metab. 2020;35(2):407-415. Published online June 24, 2020; DOI: https://doi.org/10.3803/EnM.2020.35.2.407

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178 Download
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Abstract PDF PubReader ePub

Background
Although radiofrequency ablation (RFA) is a safe treatment for thyroid tumors, nerve damage is a frequent complication. A previous retrospective study suggested that an injection of cold 5% dextrose in water (5% DW) can reduce nerve damage during RFA. This study validated the efficacy of injecting cold 5% DW for management of nerve damage during RFA.
Methods
Between November 2017 and December 2018, 242 patients underwent 291 RFA sessions for treatment of benign thyroid nodules or recurrent thyroid cancers. Using a standardized technique, cold (0°C to 4°C) 5% DW was immediately injected around the damaged nerve into patients with any symptoms suggesting nerve damage. The incidence of nerve damage, the volume of 5% DW injected, symptom recovery time and the incidence of permanent nerve damage were evaluated.
Results
Nineteen patients experienced nerve damage symptoms related to 21 RFA sessions, including 17 patients during 19 sessions and two patients on the day after two sessions. Patients with nerve damage symptoms detected during RFA were treated by injection of a mean 41 mL (range, 3 to 260) cold 5% DW, but the two patients who experienced symptoms the next day did not receive cold 5% DW injections. Immediate recovery was observed after 15 RFA sessions in 14 patients. No patient experienced permanent nerve damage.
Conclusion
Injection of cold 5% DW is effective in managing nerve damage during RFA of thyroid lesions.

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Clinical Study
Revisiting Rupture of Benign Thyroid Nodules after Radiofrequency Ablation: Various Types and Imaging Features: Sae Rom Chung, Jung Hwan Baek, Jin Yong Sung, Ji Hwa Ryu, So Lyung Jung; Endocrinol Metab. 2019;34(4):415-421. Published online December 23, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.4.415

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Background

To evaluate the imaging features, clinical manifestations, and prognosis of patients with thyroid nodule rupture after radiofrequency ablation (RFA).

Methods

The records of 12 patients who experienced thyroid nodule rupture after RFA at four Korean thyroid centers between March 2010 and July 2017 were retrospectively reviewed. Clinical data evaluated included baseline patient characteristics, treatment methods, initial presenting symptoms, imaging features, treatment, and prognosis.

Results

The most common symptoms of post-RFA nodule rupture were sudden neck bulging and pain. Based on imaging features, the localization of nodule rupture was classified into three types: anterior, posterolateral, and medial types. The anterior type is the most often, followed by posterolateral and medial type. Eight patients recovered completely after conservative treatment. Four patients who did not improve with conservative management required invasive procedures, including incision and drainage or aspiration.

Conclusion

Thyroid nodule rupture after RFA can be classified into three types based on its localization: anterior, posterolateral, and medial types. Because majority of thyroid nodule ruptures after RFA can be managed conservatively, familiarity with these imaging features is essential in avoiding unnecessary imaging workup or invasive procedures.

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A Clinical Analysis of 2,500 Cases of Thyroid Nodules in the Korean People.: Chong Suk Lee; J Korean Endocr Soc. 1996;11(4):418-430. Published online November 7, 2019

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Abstract PDF: Background
Thyroid nodules are one of the most clinical problems encounted by physieian. Palpation, radianuclide imaging, and sonography do not deterrnine whether a thyroid nodule is benign and malignant. So, the purpose of this study is to investigate how many thyroid cancer consist in thyroid nodule by using the fine needle aspiration(FNA) technique. Methods: With a disposable #23 gauge needle attached to 5rnl disposable plastic syringe was inserted at the thyroid nodules of the patients after rectinilinear thyroid scanning or ultrasono- graphy. All cells aspirated from the thyroid nodules were smeared on the 3 slide glasses and then, 2 slide glasses were immersed in 95% ethanol for Papanicolaou staining and one slide was air dried m room temperature for Giemsa staining. After complete staining the cytologic diagnosis of all slide glasses were reviewed by general light mi~eroscope. Results: Approximately, three-quarters(73.0%) of thyroid nodules aspirated by FNA were diagnosed as benign or inflammatory nodules, rnalignant neoplasia including follicular neoplasia 12.5%, and indeterminate cases 14.5% of thyroid nodules. Conclusion: Fine needle aspiration(FNA) has become the diagnostic procedure of choiee in the evaluation of the nodular thyroid disease because of its easiness, safety, cost effectiveness, and high diagnostic accuracy. Malignant neopleasia including follicular neopleasia were found 12.5% of thyroid nodules in Korean, aspirated by FNA which was same category in prevalence rate compared to known abroad results(8~20%).

The Diagnostic Value of Ultrasound-Guided Fine Needle Aspiration Cytology in the Thyroid Nodules.: Yang Hun Koo, Sung Jun Hong, Hwi Choi, Hark Rim, Young Sik Choi, Yo Han Park, Kyung Seung Oh, Hee Kyung Chang; J Korean Endocr Soc. 1996;11(4):391-400. Published online November 7, 2019

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Abstract PDF: Background
Thyroid nodule is a common disease of thymid gland. The incidence of malignant nodule is about 3%, so most of thyroid nodules are benign. Because most thyroid nodule morbidity is related to cancerous lesions, early detection of malignant nodule is important. However, some of these nodules are srnall sized or deep seated which were not detected by physieal exarnination but by ultrasonography incidentally. In these cases the diagnostic approach is difficult with conventional methods but it is easy with ultrasound-guided fine needle aspiration (FNA). However, the role of ultrasound-guided FNA on the thyroid nodules has been poorly evaluated, so we tried to assess the diagnostic value of high resolution ultrasound-guided FNA in the thyroid nodules. Methods: We examined the medical records retrospectively of all patients who were engaged in high resolution ultrasonography(ATL Ultramark-9, 10 MHz linear transducer) due to thyroid nodules and/or other thyroid abnormalities from September, 1995 to March, 1996. Ultrasound- guided FNA was performed in 137 patients with palpable or nonpalpable(small sized or deep seated) nodules which were detected by high resolution ultrasonography. Results: The mean age of the patients was 45 and most of them were middle aged. Male to female ratio was 1:8.1. Malignant nodules were frequent in patients over 30 yus of age. Of 137 patients 43 were involutional change, 45 hyperplasia, 12 Hashimotos thyroiditis, 12 follicular neoplasm, ll papillary carcinoma, 1 Hurthle cell tumor, 1 medullary carcinoma, and 12 inadequate specimen. In 22 cases thyroid nodules were not detected by physical examinatian but by ultrasonography and in 31 cases additional thyroid nodules were detected by ultrasonography. In the nature of thyroid nodules, 99 cases were solid, 16 cystic, 22 mixed. Malignant nodule were more frequent in the solid nodule, but thete was no significant difference between each group. The size of masses was categorized into four groups. Thirty-one cases measured less than 1cm, 63 between 1cm and 1.9cm, 29 between 2cm to 2.9cm, and 14 over 3cm. The malignant nodule was not palpable in 3 cases and the smallest was 0.7cm in diameter. Most of malignant lesions were between 1cm and 2.9cm, but the difference of incidence rate of rnalignant nodules between each group was not significant. The incidence rate of malignancy was 8.8% in solitary nodule and 8.7% in multiple nodules. Twenty-three cases including 12 malignancies diagnosed by FNA underwent operation. Of those 13 were papillary earcinoma, 1 follicular carcinoma, 1 medullary carcinoma. Upon the correlation of ultrasound-guided FNA cytology with pathologic diagnosis, the sensitivity of ultrasound-guided FNA cytology in differentiating benign and malignant nodule was 80.0%, the specificity 100% and overall diagnostic accuracy was 86.1%. The obtainability of adequate cytologic specimen by ultrasound-guided FNA was 91%. No complication except pain was noted during this study. Conclusion: High resolution ultrasound-guided FNA cytology in the thyroid nodules may be useful in the diagnosis of thyroid cancer especially in the nodules which were small sized or deep seated and also useful in early detection of recurrence of thyroid cancer.

Diagnostic Value of Thallium-201 Scan in The Thyroid Nodule.: Jeong Sik Moon, Kee Hyeon Kim, Chul Sung Park, Jae Haak Lee, Gyeong Heon Jeong, Sun Ho Kim, Jung Kyu Lim, Chin Duk Huh, Hyeng Suk Cho, Jang Shin Son; J Korean Endocr Soc. 1996;11(2):175-181. Published online November 7, 2019

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Abstract PDF: To investigate diagnostic value of Thallium 201(T1-201) thymid scan in differentiating malignant nodule from benign, 135 patients with thyroid nodule were evaluated with Tl-201 thyroid scan, fine needle aspiration(FNA), clinical characteristics and laboratory data. Each had histological diagnosis after thyroidectomy. Tl-201 scan had a sensitivity of 67.3% and a specificity of 66.3% and FNA had sermitivity of 46.9% and specificity of 100% in predicting malignancy. As the size of thyroid nodule and age of patient incteases, diagnostic value of 11-201 thyroid scan was improved. In the thyroid nodules larger then 3cm, sensitivity, specificity and negative predictive value were 100%, 70% and 100%, reqectively. By cornbining Tl-201 throid scan and FNA, sensitivity had 91.8%. From the data we conclude that Tl-201 thyroid scan is valuable with adjuvant diagnostic method in differentiating malignant fmm benign thyroid nodule and treatment planning.

Case Reports

A Case of Autonomously Functioning Thyroid Nodule Treated with Percutaneous.: Min Ho Shin, Chun Hee Koo, Young Ju Park, Jeong Yim Lee, Tae Yong Park, Eun Sil Kim, Jong Soon Kim, Seung Soo Han; J Korean Endocr Soc. 1994;9(3):258-264. Published online November 6, 2019

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Abstract PDF: Autonomously functioning thyroid nodules(AFTNs) are so named because they presumably are independent of TSH for growth and function. In general, surgery and radioactive iodine are effective therapies but reluctant to use because of complications such as hypothyroidism or cosmetic problems.Percutaneous ethanol injection therapy(PEIT) under sonographic guidance has recently been introduced as alternative therapy. But its adverse effects such as severe local pain, subcutaneous hematoma or palsy of the recurrent nerve are not negligible, therefore sufficient skill is required.In this case, the levothyroxine therapy in reducing the size of colloid thyroid nodules was not apparent within three months. Therefore we selected another sclerosing therapeutic method such as percutaneous tetracycline injection(PTI) and followed up thyroid function test, thyroid scan, ultrasonographical size and volume of nodule. The results were as follows: 1) With 0.5-0.8 cc tetracycline injection for three times, the volume of nodule was reduced after PTI; About 2.3 X 1.7 X 0.7 cm sized nodule was reduced to about 1.3 X 1.0 X 0.5 cm sized nodule. 2) There were significant improvements of TFT(subclinical hyperthyroidism to euthyroidism) and thyroid scan(solitary hot nodule to completely ablated AFTN) during 9 months follow-up after PTI as compared with the base line study. In conclusion, we experienced good results in a 22-year-old woman suffered from AFTN treated with PTI and think that PTI could be the effective, safe, simple, well tolerable procedure in the treatment of AFTN.

A Case of Anterior Cervical Lipoma Mimicking Thyroid Nodule.: Yong Keol Yoo, Dong Seok Lee, Chul Hun Jung, Ock Chan Lee, Ho Jung Kim, In Soon Kim, You Hern Ahn, Mok Hyun Kim, On Koo Cho; J Korean Endocr Soc. 1994;9(1):32-34. Published online November 6, 2019

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Abstract PDF: Lipomas are among the most common of all benign neoplasma and occur more frequently over the back, between the shoulders, and on the back of the neck. They are usually subcutaneous in origin, and characteristically multilobulated masses of fatty tissue that vary from small nodules to large masses weighing several kilograms.A mass in the anterior part of the neck may be initially thought to be thyroid nodules and then other cervical masses should be considered. Ultrasonographic examination of benign lipoma demonstrates solid and echogenic mass and may differentiate nonthyroid from thyroid masses. When lipoma is clinically suspected, the use of CTs can establish the correct diagnosis without the use of thyroid hormone suppression or the need for urgent surgery.We experienced a case of anterior cervical mass in a 51-year-old male patient presenting a non-tender and soft mass rapidly growing for recent several months and moved with swollowing, and diagnosed his case as benign lipoma using ultrasonography, computed tomographic scan, and fine niddle asperation biopsy and therefore when we encounter patients with anterior neck mass, we should consider benign lipoma mimicking thyroid nodule.

Original Article

Clinical Study
Comparison of Natural Course between Thyroid Cancer Nodules and Thyroid Benign Nodules: Kyun-Jin Yun, Jeonghoon Ha, Min-Hee Kim, Ye Young Seo, Mee Kyoung Kim, Hyuk-Sang Kwon, Ki-Ho Song, Moo Il Kang, Ki-Hyun Baek; Endocrinol Metab. 2019;34(2):195-202. Published online June 24, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.2.195

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Background

The natural course of thyroid cancer nodules and benign nodules is different. This study was to compare the changes in size between thyroid cancer nodules and thyroid benign nodules. The risk factors associated with the changes of thyroid cancer nodules were assessed.

Methods

This study contains retrospective observational and prospective analysis. A total of 113 patients with 120 nodules were recruited in the cancer group, and 116 patients with 119 nodules were enrolled in the benign group. Thyroid ultrasonography was performed at least two times at more than 1-year interval.

Results

The mean follow-up durations were 29.5±18.8 months (cancer group) and 31.9±15.8 months (benign group) (P=0.32). The maximum diameter change in length was 0.36±0.97 mm/year in the cancer group and –0.04±0.77 mm/year in the benign group (P<0.01). The volume was significantly increased in the cancer group compared with the benign group (0.06±0.18 mL/year vs. 0.004±0.05 mL/year, respectively, P<0.01; 26.9%±57.9%/year vs. 1.7%±26.0%/year, P<0.01). Initial maximum diameter (β=0.02, P<0.01) and initial volume (β=0.13, P<0.01) were significantly associated with volume change (mL)/year. Initial maximum standardized uptake value did not predict the nodule growth.

Conclusion

It is suggested that thyroid cancer nodules progress rapidly compared with benign nodules. Initial size and volume of nodule were independent risk factors for cancer nodule growth.

Citations

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Review Article

Thyroid
Long-Term Outcomes Following Thermal Ablation of Benign Thyroid Nodules as an Alternative to Surgery: The Importance of Controlling Regrowth: Jung Suk Sim, Jung Hwan Baek; Endocrinol Metab. 2019;34(2):117-123. Published online June 24, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.2.117

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Thermal ablation (TA) procedures, such as radiofrequency ablation and laser ablation, are used for the treatment of benign thyroid nodules. Short-term studies (<2 years) have demonstrated that TA is an effective and safe procedure to improve cosmetic or symptomatic problems. However, studies including a longer follow-up period show that treated thyroid nodules can increase in size after 2 to 3 years. Several studies suggest that this results from regrowth at the undertreated nodule margins. Here, we review current data on regrowth after TA and describe factors related to it and possible approaches to prevent it.

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Original Articles

Clinical Study
Does Radiofrequency Ablation Induce Neoplastic Changes in Benign Thyroid Nodules: A Preliminary Study: Su Min Ha, Jun Young Shin, Jung Hwan Baek, Dong Eun Song, Sae Rom Chung, Young Jun Choi, Jeong Hyun Lee; Endocrinol Metab. 2019;34(2):169-178. Published online May 15, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.2.169

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Background

To evaluate the clinical feasibility of radiofrequency ablation (RFA) of benign thyroid nodules along with cytomorphological alteration, and any malignant transformation through biopsy.

Methods

The data were retrospectively collected between April 2008 and June 2013 and core needle biopsy (CNB) was performed on 16 benign thyroid nodules previously treated using RFA. The parameters of the patients were compared, between the time of enrollment and the last follow-up examination, using linear mixed model statistical analysis.

Results

No atypical cells or neoplastic transformation were detected in the undertreated peripheral portion of treated benign nodules on the CNB specimen. RFA altered neither the thyroid capsule nor the thyroid tissue adjacent to the treated area. On histopathological examinations, we observed 81.2% acellular hyalinization, which was the most common finding. After a mean follow-up period of over 5 years, the mean volume of thyroid nodule had decreased to 6.4±4.2 mL, with a reduction rate of 81.3%±5.8% (P<0.0001).

Conclusion

RFA is a technically feasible treatment method for benign thyroid nodules, with no carcinogenic effect or tissue damage of the normal thyroid tissue adjacent to the RFA-treated zone.

Citations

Citations to this article as recorded by

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Thyroid
Procalcitonin as Marker of Recurrent Medullary Thyroid Carcinoma: A Systematic Review and Meta-Analysis: Pierpaolo Trimboli, Luca Giovanella; Endocrinol Metab. 2018;33(2):204-210. Published online June 21, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.2.204

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Background

Calcitonin measurement is pivotal in the management of medullary thyroid carcinoma (MTC), but several pitfalls can affect its reliability. Other potential markers have been proposed, and procalcitonin (ProCT) has been reported as promising. The present study was undertaken to summarize the published data and provide more robust estimates on the reliability of ProCT as marker in the management of patients with MTC.

Methods

The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The sources comprised studies published through May 2018. Original articles that reported series of MTC patients undergone ProCT during postoperative follow-up were searched. A random-effects model was used for statistical pooling of the data. The I² index was used to quantify the consistency among the studies. The Egger test evaluated the possible presence of significant publication bias. Quality assessment of the studies was performed according to Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2).

Results

According to inclusion and exclusion criteria five papers, reporting 296 MTC patients undergone ProCT evaluation, were finally selected. The number of MTC with recurrence was 140. The pooled sensitivity of ProCT in detecting recurrence was 96% (95% confidence interval [CI], 92% to 99%), with neither heterogeneity (I²=0%) nor publication bias (Egger test, 3.16; P=0.99). The pooled specificity was 96% (95% CI, 87% to 100%) with mild heterogeneity (I²=66.6%), while Egger test was not calculable.

Conclusion

The present meta-analysis provides evidence that ProCT is reliable to manage MTC patients during their postoperative follow-up.

Citations

Citations to this article as recorded by

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Thyroid
A Comparison of Ultrasound-Guided Fine Needle Aspiration versus Core Needle Biopsy for Thyroid Nodules: Pain, Tolerability, and Complications: Eun Ji Jeong, Sae Rom Chung, Jung Hwan Baek, Young Jun Choi, Jae Kyun Kim, Jeong Hyun Lee; Endocrinol Metab. 2018;33(1):114-120. Published online March 21, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.1.114

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Background

To compare pain, tolerability, and complications associated with fine needle aspiration (FNA) versus core needle biopsy (CNB).

Methods

FNAs were performed using 23-gauge needles and CNBs were performed using 18-gauge double-action spring-activated needles in 100 patients for each procedure. Patients were asked to record a pain score using a 10-cm visual analog scale and procedure tolerability. Complications and number of biopsies were recorded.

Results

The median pain scores were similar for the FNA and CNB approaches during and 20 minutes after the biopsy procedures (3.7 vs. 3.6, P=0.454; 0.9 vs. 1.1, P=0.296, respectively). The procedure was tolerable in all 100 FNA patients and in 97 CNB patients (P=0.246). The mean number of biopsies was fewer in the CNB group (1.4 vs. 1.2, P=0.002). By subgroup analysis (staff vs. non-staff), no significant difference was detected in any parameter. There were no major complications in either group, but three patients who underwent CNB had minor complications (P=0.246).

Conclusion

FNA and CNB show no significant differences for diagnosing thyroid nodules in terms of pain, tolerability, or complications.

Citations

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Review Article

Recent Advances in Core Needle Biopsy for Thyroid Nodules: Chan Kwon Jung, Jung Hwan Baek; Endocrinol Metab. 2017;32(4):407-412. Published online December 14, 2017; DOI: https://doi.org/10.3803/EnM.2017.32.4.407

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Core needle biopsy (CNB) was introduced as an alternative diagnostic tool to fine-needle aspiration (FNA), and is increasingly being used in the preoperative assessment of thyroid nodules. CNB provides a definitive diagnosis in most cases, but it sometimes may be inconclusive. CNB has the advantage of enabling a histologic examination in relation to the surrounding thyroid tissue, immunohistochemistry, and molecular testing that can provide a more accurate assessment than FNA in selected cases. Nevertheless, CNB should be performed only by experienced experts in thyroid interventions to prevent complications because CNB needles are larger in caliber than FNA needles. As recent evidence has accumulated, and with improvements in the technique and devices for thyroid CNB, the Korean Society of Thyroid Radiology released its 2016 thyroid CNB guidelines and the Korean Endocrine Pathology Thyroid Core Needle Biopsy Study Group published a consensus statement on the pathology reporting system for thyroid CNB in 2015. This review presents the current consensus and recommendations regarding thyroid CNB, focusing on indications, complications, and pathologic classification and reporting.

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Original Articles

Risk of Malignancy in Thyroid Nodules 4 cm or Larger: Uchechukwu C. Megwalu; Endocrinol Metab. 2017;32(1):77-82. Published online February 6, 2017; DOI: https://doi.org/10.3803/EnM.2017.32.1.77

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Background

Several authors have questioned the accuracy of fine-needle aspiration cytology (FNAC) in large nodules. Some surgeons recommend thyroidectomy for nodules ≥4 cm even in the setting of benign FNAC, due to increased risk of malignancy and increased false negative rates in large thyroid nodules. The goal of our study was to evaluate if thyroid nodule size is associated with risk of malignancy, and to evaluate the false negative rate of FNAC for thyroid nodules ≥4 cm in our patient population.

Methods

This is a retrospective study of 85 patients with 101 thyroid nodules, who underwent thyroidectomy for thyroid nodules measuring ≥4 cm.

Results

The overall risk of malignancy in nodules ≥4 cm was 9.9%. Nodule size was not associated with risk of malignancy (odds ratio, 1.02) after adjusting for nodule consistency, age, and sex (P=0.6). The false negative rate for FNAC was 0%.

Conclusion

Nodule size was not associated with risk of malignancy in nodules ≥4 cm in our patient population. FNAC had a false negative rate of 0. Patients with thyroid nodules ≥4 cm and benign cytology should not automatically undergo thyroidectomy.

Citations

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Clinical Study
Molecular Diagnosis Using Residual Liquid-Based Cytology Materials for Patients with Nondiagnostic or Indeterminate Thyroid Nodules: Hyemi Kwon, Won Gu Kim, Markus Eszlinger, Ralf Paschke, Dong Eun Song, Mijin Kim, Suyeon Park, Min Ji Jeon, Tae Yong Kim, Young Kee Shong, Won Bae Kim; Endocrinol Metab. 2016;31(4):586-591. Published online November 4, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.4.586

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Background

Molecular analysis for common somatic mutations in thyroid cancer can improve diagnostic accuracy of fine-needle aspiration cytology (FNAC) in the nondiagnostic or indeterminate category of thyroid nodules. In this study, we evaluated the feasibility of molecular diagnosis from residual liquid-based cytology (LBC) material after cytological diagnosis.

Methods

This prospective study enrolled 53 patients with thyroid nodules diagnosed as nondiagnostic, atypia of undetermined significance (AUS), or follicular lesion of undetermined significance (FLUS) after FNAC. DNAs and RNAs were isolated from residual LBC materials. BRAF^V600E and RAS point mutations, PAX8/peroxisome proliferator-activated receptor γ (PPARγ), RET/PTC1, and RET/PTC3 rearrangements were evaluated by real-time polymerase chain reaction and pyrosequencing.

Results

All DNAs from 53 residual LBC samples could be analysed and point mutations were detected in 10 samples (19%). In 17 AUS nodules, seven samples (41%) had point mutations including BRAF (n=4), NRAS (n=2), and KRAS (n=1). In 20 FLUS nodules, three samples (15%) had NRAS point mutations. RNA from only one FLUS nodule could be analysed for rearrangements and there was no abnormality.

Conclusion

Molecular analysis for BRAF and RAS mutations was feasible in residual LBC materials and might be useful for diagnosis of indeterminate thyroid nodules.

Citations

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Review Article

Thyroid
The Revised 2016 Korean Thyroid Association Guidelines for Thyroid Nodules and Cancers: Differences from the 2015 American Thyroid Association Guidelines: Ka Hee Yi; Endocrinol Metab. 2016;31(3):373-378. Published online September 26, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.3.373

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Increased detection of thyroid nodules using high-resolution ultrasonography has resulted in a world-wide increase in the incidence of differentiated thyroid cancer (DTC). Despite the steep increase in its incidence, the age-standardized mortality rate of thyroid cancer has remained stable, which leads toward a trend of more conservative treatment. The latest American Thyroid Association (ATA) guidelines for thyroid nodules and thyroid cancer revised in 2015 suggested that fine needle aspiration biopsy should be performed for thyroid nodules larger than 1 cm and lobectomy might be sufficient for 1 to 4 cm intrathyroidal DTC. In addition, active surveillance instead of immediate surgical treatment was also recommended as a treatment option for papillary thyroid microcarcinoma based on the results of a few observational studies from Japan. The Korean Thyroid Association (KTA) has organized a task force team to develop revised guidelines for thyroid nodules and DTC after an extensive review of articles and intense discussion on whether we should accept the changes in the 2015 ATA guidelines. This paper introduces and discusses the updated major issues and differences in the ATA and the KTA guidelines.

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Original Articles

Thyroid
The Validity of Ultrasonography-Guided Fine Needle Aspiration Biopsy in Thyroid Nodules 4 cm or Larger Depends on Ultrasonography Characteristics: Jin Hwa Kim, Na Kyung Kim, Young Lyun Oh, Hye Jeong Kim, Sang Yong Kim, Jae Hoon Chung, Sun Wook Kim; Endocrinol Metab. 2014;29(4):545-552. Published online December 29, 2014; DOI: https://doi.org/10.3803/EnM.2014.29.4.545

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36 Download
9 Web of Science
11 Crossref

Abstract PDF PubReader

Background

The objective of this study was to evaluate the validity of fine needle aspiration biopsy (FNAB) according to ultrasonography (US) characteristics in thyroid nodules 4 cm and larger.

Methods

We retrospectively reviewed the cases of 263 patients who underwent thyroid surgery for thyroid nodules larger than 4 cm between January 2001 and December 2010.

Results

The sensitivity of US-FNAB was significantly higher in nodules with calcifications (micro- or macro-) than those without (97.9% vs. 87.% P<0.05). The accuracy of US-FNAB was higher in large thyroid nodules with US features suspicious of malignancy, such as a solid component, ill-defined margin, hypoechogenicity or marked hypoechogenicity, or any calcifications (micro- or macro-) compared to thyroid nodules with none of these features. Furthermore, the accuracy improved as the number of these features increased. The overall false negative rate (FNR) was 11.9%. The FNR of thyroid nodules that appeared benign on US, such as mixed nodules (7.7%) or nodules without calcification (9.8%), trended toward being lower than that of solid nodules (17.9%) or nodules with any microcalcification or macrocalcification (33.3%). In nodules without suspicious features of malignancy, the FNR of US-FNAB was 0% (0/15).

Conclusion

We suggest individualized strategies for large thyroid nodules according to US features. Patients with benign FNAB can be followed in the absence of any malignant features in US. However, if patients exhibit any suspicious features, potential false negative results of FNAB should be kept in mind and surgery may be considered.

Citations

Citations to this article as recorded by

Challenging the 4 cm Rule: Nodule Size Does not Predict the Risk of Occult Malignancy in Cytologically Benign Thyroid Nodules
Burak Altunpak, Hüsnü Aydın, Fevzi Cebi, Sezer Bulut, Alpen Gümüşoğlu, Deniz Güzey
Bakirkoy Tip Dergisi / Medical Journal of Bakirkoy.2026; : 64. CrossRef
The Effect of Thyroid Nodule Size and Characteristics on the Accuracy of Fine-Needle Aspiration Biopsy and the Risk of Malignancy
Mehmet Alperen Avcı, Can Akgün, Mustafa Gün, Selim Tamam, Meltem Türk
Hitit Medical Journal.2024; 6(3): 321. CrossRef
Risk of malignancy and diagnostic accuracy of fine-needle aspiration biopsy in thyroid nodules with diameters greater than 4 centimeters
Rafaela N. Barcelos, Cléber P. Camacho, Maria da Conceição de O. C. Mamone, Elza S. Ikejiri, Felipe A. B. Vanderlei, Ji H. Yang, Rosália P. Padovani, Leandro A. L. Martins, Rosa Paula M. Biscolla, Danielle Macellaro, Susan C. Lindsey, Rui M. B. Maciel, Jo
Archives of Endocrinology and Metabolism.2023;[Epub] CrossRef
The comparison of accuracy of ultrasonographic features versus ultrasound-guided fine-needle aspiration cytology in diagnosis of malignant thyroid nodules
Mehrdad Nabahati, Zoleika Moazezi, Soude Fartookzadeh, Rahele Mehraeen, Naser Ghaemian, Majid Sharbatdaran
Journal of Ultrasound.2019; 22(3): 315. CrossRef
False negative rate of fine‐needle aspiration in thyroid nodules: impact of nodule size and ultrasound pattern
Hye Shin Ahn, Dong Gyu Na, Jung Hwan Baek, Jin Yong Sung, Ji‐Hoon Kim
Head & Neck.2019; 41(4): 967. CrossRef
Thyroid nodules over 4 cm do not have higher malignancy or benign cytology false-negative rates
Muhammed Kizilgul, Rupendra Shrestha, Angela Radulescu, Maria R. Evasovich, Lynn A. Burmeister
Endocrine.2019; 66(2): 249. CrossRef
Large Cytologically Benign Thyroid Nodules Do Not Have High Rates of Malignancy or False-Negative Rates and Clinical Observation Should be Considered: A Meta-Analysis
Nicole A. Cipriani, Michael G. White, Peter Angelos, Raymon H. Grogan
Thyroid®.2018; 28(12): 1595. CrossRef
Risk of Malignancy in Thyroid Nodules 4 cm or Larger
Uchechukwu C. Megwalu
Endocrinology and Metabolism.2017; 32(1): 77. CrossRef
Usefulness of NRAS codon 61 mutation analysis and core needle biopsy for the diagnosis of thyroid nodules previously diagnosed as atypia of undetermined significance
Eun Kyung Jang, Won Gu Kim, Eui Young Kim, Hyemi Kwon, Yun Mi Choi, Min Ji Jeon, Jung Hwan Baek, Jeong Hyun Lee, Tae Yong Kim, Young Kee Shong, Jene Choi, Dong Eun Song, Won Bae Kim
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Association between neck ultrasonographic findings and clinico‐pathological features in the follicular variant of papillary thyroid carcinoma
Eun Kyung Jang, Won Gu Kim, Yun Mi Choi, Min Ji Jeon, Hyemi Kwon, Jung Hwan Baek, Jeong Hyun Lee, Tae Yong Kim, Young Kee Shong, Dong Eun Song, Won Bae Kim
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Thyroid
Clinicopathological, Biochemical, and Sonographic Features of Thyroid Nodule Predictive of Malignancy among Adult Filipino Patients in a Tertiary Hospital in the Philippines: Edwin Jadulco Cañete, Cherrie Mae Sison-Peña, Cecilia Alegado Jimeno; Endocrinol Metab. 2014;29(4):489-497. Published online December 29, 2014; DOI: https://doi.org/10.3803/EnM.2014.29.4.489

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60 Download
15 Web of Science
9 Crossref

Abstract PDF PubReader

Background

Thyroid nodules may harbor cancer in 5% to 15% of cases. Specific clinical and sonographic features predictive of malignancy have been investigated in various populations, but due to differences in epidemiology, risk factors and iodine nutrition status, these predictors may not be valid in the Philippines. This study determined the clinicopathological, biochemical, and sonographic features of thyroid nodules predictive of malignancy among adult Filipino patients at the University of the Philippines-Philippine General Hospital (UP-PGH).

Methods

We reviewed the medical records of Filipino patients ≥19 years of age who underwent thyroid surgery in UP-PGH from 2008 to 2011.

Results

A total of 837 of 1,670 patients (50.1%) were enrolled in the study, which included 417 benign and 420 malignant tumors. The mean age at diagnosis was 38±11 years, with female predominance. Multiple logistic regression analysis showed that the presence of a hard or firm nodule (odds ratio [OR], 58.8, P<0.001; OR, 12.8, P<0.001), presence of microcalcifications (OR, 11.1; P<0.001), irregular margins on ultrasound (OR, 4.5; P<0.001), and absence of associated symptoms (OR, 2.3; P<0.002) increased significantly the likelihood of thyroid malignancy.

Conclusion

Similar to international data, the absence of associated symptoms, firm to hard thyroid nodules, and the presence of microcalcifications and irregular margins were significant predictors of thyroid malignancy.

Citations

Citations to this article as recorded by

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Endocrinology, Diabetes & Metabolism.2023;[Epub] CrossRef
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Mohamed Said Ghali, Walid El Ansari, Abdelrahman Abdelaal, Mohamed S. Al Hassan
Annals of Medicine and Surgery.2022; 81: 104202. CrossRef
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JSL Chieng, CH Lee, AA Karandikar , JPN Goh, SSS Tan
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Agustina D. Abelardo
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Lei Zheng, Wenhua Yan, Yue Kong, Ping Liang, Yiming Mu
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Case Report

Thyroid
Delayed Surgery for Parathyroid Adenoma Misdiagnosed as a Thyroid Nodule and Treated with Radiofrequency Ablation: Ho-Su Kim, Bong Hoi Choi, Jung Rang Park, Jong Ryeal Hahm, Jung Hwa Jung, Soo Kyoung Kim, Sungsu Kim, Kyong-Young Kim, Soon Il Chung, Tae Sik Jung; Endocrinol Metab. 2013;28(3):231-235. Published online September 13, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.3.231

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Primary hyperparathyroidism occurs as a result of isolated parathyroid adenoma in 80% to 85% of all cases. A ^99mtechnetium (^99mTc) sestamibi scan or neck ultrasonography is used to localize the neoplasm prior to surgical intervention. A 53-year-old female was referred for the exclusion of metabolic bone disease. She presented with low back pain that had persisted for the past 6 months and elevated serum alkaline phosphatase (1,253 IU/L). Four years previously, she had been diagnosed at a local hospital with a 2.3-cm thyroid nodule, which was determined to be pathologically benign. Radiofrequency ablation was performed at the same hospital because the nodule was still growing during the follow-up period 2 years before the visit to our hospital, and the procedure was unsuccessful in reducing the size of the nodule. The results of the laboratory tests in our hospital were as follows: serum calcium, 14.6 mg/dL; phosphorus, 3.5 mg/dL; and intact parathyroid hormone (iPTH), 1,911 pg/mL. Neck ultrasonography and ^99mTc sestamibi scan detected a 5-cm parathyroid neoplasm in the left lower lobe of the patient's thyroid; left parathyroidectomy was performed. This case indicated that thyroid ultrasonographers and pathologists need to be experienced enough to differentiate a parathyroid neoplasm from a thyroid nodule; ^99mTc sestamibi scan, serum calcium, and iPTH levels can help to establish the diagnosis of parathyroid neoplasm.

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Review Article

Thyroid
Indications for Fine Needle Aspiration in Thyroid Nodules: Jin Young Kwak; Endocrinol Metab. 2013;28(2):81-85. Published online June 18, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.2.81

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Thyroid nodules are a common clinical problem with the widespread use of ultrasonography. Fine needle aspiration (FNA) is the mainstay for diagnosing a thyroid malignancy. There have been several guidelines on when to perform FNA in thyroid nodules. This review is based on several published recommendations and helps physicians easily understand the factors favoring FNA.

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Original Article

Thyroid
Natural Course of Cytologically Benign Thyroid Nodules: Observation of Ultrasonographic Changes: Dong Jun Lim, Jee Young Kim, Ki Hyun Baek, Mee Kyoung Kim, Woo Chan Park, Jong Min Lee, Moo Il Kang, Bong Yun Cha; Endocrinol Metab. 2013;28(2):110-118. Published online June 18, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.2.110

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Background

The natural course of cytologically benign thyroid nodules remains unclear. The aim of this study was to evaluate whether ultrasonographic (US) changes are associated with changes in nodule volume during follow-up.

Methods

We retrospectively reviewed over 4 years of clinical records of patients with benign thyroid nodules as confirmed by fine needle aspiration (FNA). In total, 186 patients with 202 benign thyroid nodules were included for study. We assessed for changes in nodule volume and examined the cystic portion of the nodule as well as four US features (echogenicity, margin, calcification pattern, and shape).

Results

During follow-up (mean, 21.7±10.7 months) and using 50% as a cutoff value, nodule volumes increased in 11.8%, exhibited no change in 79.9%, and decreased in 8.3% of patients. Proportion of nodules demonstrating at least one US change was 20.8% (42/202). The most common US changes (in descending order of frequency) were cystic change, margin change, and calcification pattern change. Nodule shape and echogenicity rarely changed. Increased nodule volume was not significantly associated with any US features or with the number of FNAs but was associated with younger age at time of diagnosis.

Conclusion

Although a portion of thyroid nodules confirmed as benign showed US changes or volume changes during the follow-up period, these findings may only represent the natural course of benign nodules. Frequent follow-up with US might be needed for only a small number of cases with suspicious US findings.

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Case Report

Papillary Thyroid Carcinoma Manifesting as an Autonomously Functioning Thyroid Nodule.: Ji Hyun Kim, Gyeong Jae Na, Ki Won Kim, Hee Ja Ko, Sung Wan Jeon, Yeo Joo Kim, Sang Jin Kim, Hyeun Duk Jo, Chang Jin Kim; Endocrinol Metab. 2012;27(1):59-62. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.59

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Abstract PDF

Hyperfunctioning thyroid carcinoma is very rare. Hence, radionuclide imaging of thyroid hot nodules usually suggests a benign tumor, and less than 4% of cases have been reported as malignant. We would like to present a case of a hyperfunctioning papillary thyroid carcinoma that was initially treated with radioactive iodine. A 58-year-old woman was referred to our hospital for palpable thyroid nodule and a 5-kg weight loss within 6 months. Thyroid function test revealed thyrotoxicosis, and thyroid autoantibodies were absent. 99mTc thyroid scintigraphy showed a 2 x 2 cm-sized hyperactive hot nodule at the left lobe. Despite radioactive iodine treatment with a dose of 10 mCi 131I, thyroid function did not improve. Fine needle aspiration revealed papillary thyroid cancer. The patient underwent total thyroidectomy. Although clinical features and thyroid scans suggest a benign nodule, the possibility of malignancy should not be ruled out. Malignant thyroid hot nodules are rare; however, its possibility should be taken into account. Therefore, we suggest that ruling out malignancy by existing diagnostic guidelines can misdiagnose even a typical case with benign features. As thyroid nodule detection is getting sensitive and accurate, we present this case to discuss whether additional diagnostic approaches would be necessary for thyroid nodules.

Citations

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Ultrasonographic Characteristics of the Hyperfunctioning Thyroid Nodule and Predictive Factors for Thyroid Stimulating Hormone Suppression
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Original Articles

Association between Serum Thyroid Stimulating Hormone Level and Papillary Thyroid Microcarcinoma in Korean Euthyroid Patients.: Hyun Sook Kim, Seung Joon Lee, Jung Kyu Park, Chang Ho Jo, Ho Sang Shon, Eui Dal Jung; Endocrinol Metab. 2011;26(4):297-302. Published online December 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.4.297

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Abstract PDF

BACKGROUND
Thyroid cancer is a common disease and its prevalence is increasing. Recent reports have shown that an elevated thyrotropin (thyroid stimulating hormone, TSH) level is associated with thyroid cancer risk. However, the association between TSH level and thyroid cancer risk is not yet known for euthyroid patients diagnosed with papillary thyroid microcarcinoma (PTMC). METHODS: Our study included 425 patients who underwent thyroid surgery and were diagnosed with PTMC between 2008 and 2009. Control group patients were diagnosed with benign nodules < or = 1 cm in size by US-guided fine needle aspiration. Nodules with one or more suspected malignant-ultrasonographic feature(s) were excluded from this study. Patients who were not euthyroid or who took thyroid medication were also excluded. RESULTS: The mean age of all patients was 48.5 +/- 11.0 years and 88.8% were women. The mean age of those with PTMC was significantly lower than that of the control group. The mean TSH level was 1.78 +/- 0.93 mIU/L, and the mean free T4 level was 15.96 +/- 2.32 pmol/L. There was no difference in TSH level between the PTMC and control groups (1.77 +/- 0.93 mIU/L vs. 1.79 +/- 0.91 mIU/L, P = 0.829). After adjusting for age, TSH level was not correlated with tumor size (r = 0.02, P = 0.678) in the PTMC group. Moreover, the TSH level did not differ between patients with stage I and stage III-IV carcinoma (stage I, 1.77 +/- 0.95 mIU/L; stage III-IV, 1.79 +/- 0.87 mIU/L; P = 0.856). CONCLUSION: TSH levels are not elevated in euthyroid PTMC patients. Thus, further evaluation is needed before serum TSH can be used as a tumor marker for small nodules < or = 1 cm in size in euthyroid patients.

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Prevalence of Thyroid Nodules Detected by Ultrasonography in Adults for Health Check-Ups and Analysis of Fine Needle Aspiration Cytology.: Won Jun Kim, Joo Hyong Kim, Dong Won Park, Chang Beom Lee, Yong Soo Park, Dong Sum Kim, Woong Hwan Choi, Tae Wha Kim, You Hern Ahn; J Korean Endocr Soc. 2008;23(6):413-419. Published online December 1, 2008; DOI: https://doi.org/10.3803/jkes.2008.23.6.413

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Abstract PDF

BACKGROUND
The purpose of this study was to assess the prevalence of thyroid nodules in healthy adults without a history of thyroid disease and the results of fine needle aspiration cytology (FNAC). METHODS: We retrospectively studied 4,832 adults (2,427 women, 2,405 men) over the age of 20 who had visited our health care center from January, 2005, to March, 2008. Subjects with previous thyroid disease were excluded. All were screened by thyroid ultrasonography and FNAC was performed on large or potentially malignant nodules. RESULTS: Thyroid nodules were present in 686 women (28.3%) and 396 men (16.5%), with a female predominance (odds ratio = 1.47, 95% CI = 1.35~1.60). The prevalence of a thyroid nodule was significantly correlated with age in both women and men (P < 0.001). Multinodularity also increased according to age in both groups. Ninety patients were tested with conventional FNAC and 195 underwent ultrasonography-guided FNAC. The rate of inadequate cytology by ultrasonographic guidance was lower than by freehand methods, and the total rate of malignant cytology per patient was 17.9%. Ultrasonographic characteristics that significantly correlated with histologically-confirmed papillary carcinoma included a solid component, hypoechogenecity, irregular margin, and the presence of microcalcification or macrocalcification. CONCLUSION: The prevalence of thyroid nodules detected by ultrasonography was 28.3% in healthy women and 16.5% in healthy men population. The prevalence and multinodularity was significantly correlated with age in both groups. It's useful to examine thyroid by ultrasonography because of detecting more nodules, providing guidance of FNAC, achieving more adequate sampling and not missing small malignant nodules.

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The Prevalence of Thyroid Nodules and the Morphological Analysis of Malignant Nodules on Ultrasonography
An Hyun, Ji Tae-jeong, Lee Hyo-young, Im In-chul
Journal of Radiological Science and Technology.2019; 42(3): 201. CrossRef
Ultrasonographic Characteristics of the Hyperfunctioning Thyroid Nodule and Predictive Factors for Thyroid Stimulating Hormone Suppression
Won Sang Yoo, Hoon Sung Choi
International Journal of Thyroidology.2019; 12(1): 35. CrossRef
Prevalence and Annual Incidence of Thyroid Disease in Korea from 2006 to 2015: A Nationwide Population-Based Cohort Study
Hyemi Kwon, Jin-hyung Jung, Kyung-Do Han, Yong-Gyu Park, Jung-Hwan Cho, Da Young Lee, Ji Min Han, Se Eun Park, Eun-Jung Rhee, Won-Young Lee
Endocrinology and Metabolism.2018; 33(2): 260. CrossRef
Prevalence of thyroid nodules and their associated clinical parameters: a large-scale, multicenter-based health checkup study
Jae Hoon Moon, Min Kyung Hyun, Ja Youn Lee, Jung Im Shim, Tae Hyuk Kim, Hoon Sung Choi, Hwa Young Ahn, Kyung Won Kim, Do Joon Park, Young Joo Park, Ka Hee Yi
The Korean Journal of Internal Medicine.2018; 33(4): 753. CrossRef
Analysis of Fine Needle Aspiration Results of Thyroid Nodules in Ultrasonography
Jong-Gil Kwak, Jae-Bok Han, Jong-Nam Song, Il-Bong Moon, Nam-Gil Choi
The Journal of the Korea Contents Association.2016; 16(5): 290. CrossRef
Clinical Characteristics and Incidence of Thyroid Nodule in the Male Population for Health Check-up
Yeon Jin Jeon, Young Teag Koh, Seung Jong Oh, Min Young Koo
Korean Journal of Endocrine Surgery.2015; 15(4): 93. CrossRef
Clinical Characteristics and Incidence of Thyroid Nodule in the Male Population for Health Check-up
Yeon Jin Jeon, Young Teag Koh, Seung Jong Oh, Min Young Koo
Korean Journal of Endocrine Surgery.2015; 15(4): 93. CrossRef
Management of Thyroid Nodules and Cancers Arising in the Elderly
Eunyoung Kim, June Young Choi, Kyu Eun Lee
Journal of Korean Thyroid Association.2012; 5(2): 99. CrossRef
Screening of Thyroid Cancer and Management of Thyroid Incidentaloma
Jung Jin Cho
Korean Journal of Family Medicine.2010; 31(2): 87. CrossRef

Case Report

A Case of Hyalinizing Trabecular Tumor of the Thyroid Gland Misdiagnosed as Medullary Carcinoma at Cytologic Examination.: Jae Joon Han, Yun Jung Lee, Moon Chan Choi, Mikwang Kwon, Suk Chon, Juhie Lee; J Korean Endocr Soc. 2008;23(5):327-331. Published online October 1, 2008; DOI: https://doi.org/10.3803/jkes.2008.23.5.327

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Abstract PDF

A hyalinizing trabecular tumor (HTT) is a rare benign thyroid tumor that can present as a solitary thyroid nodule, a prominent nodule in a multinodular goiter, or as an incidental finding within a thyroidectomy specimen. The clinical importance of this entity is that it is frequently misdiagnosed as papillary carcinoma or medullary carcinoma on fine-needle aspiration cytology or histopathologic examination. The cytology of HTT is characterized by hypercellularity, nuclear grooves, nuclear pseudoinclusions, and powdery chromatin of the tumor cells, which is frequently seen in papillary carcinomas. The histologic findings of the tumor show polygonal and spindle cells arranged in a trabecular growth pattern with the presence of a variable hyalinized stroma. Calcitonin and other neuroendocrine markers can be used to differentiate HTT from medullary carcinoma. MIB-1, galectin-3, or other cytokeratin markers help to exclude papillary carcinoma. We report a patient with a thyroid tumor misdiagnosed as a medullary carcinoma on fine-needle aspiration and finally diagnosed as HTT after total thyroidectomy and immunohistochemical examination.

Citations

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Clinical features and outcomes of thyroid hyalinizing trabecular tumors: An 11‑year experience at a tertiary referral hospital
Hye Lim, Hye-Bin Jang, Kyung-Hwa Lee, Ji Lee, Tae Yoon
Experimental and Therapeutic Medicine.2025; 30(1): 1. CrossRef

Original Articles

Prevalence of Thyroid Nodules Detected by Ultrasonography in Adult Men Attending Health Check-ups.: Jung Hyun Kim, Sang Jun Park, Sang Eok Kim, Kwang Hee Lee, Il Kwon Cho, Sun Ik Jang, Jin Kwan Lee, Keum Soo Seo, Hyuck Po Kwon, Sung Chang Chung; J Korean Endocr Soc. 2007;22(2):112-117. Published online April 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.2.112

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Abstract PDF

BACKGROUND
Thyroid nodules are a common disease in clinical practice. The prevalence of thyroid nodules has recently been increased by according to the development of thyroid ultrasonography. Thyroid nodules are more commonly found in women, but the potential for malignant nodules is much higher in men. So, we aimed to focus on the prevalence of thyroid nodules in the adult male population. METHODS: We studied men over the age of 30 who visited our health care center for routine health check-ups from January, 2005 to December, 2005. After excluding the patients with previous thyroid disorders, 1081 men were selected to undergo thyroid ultrasonography for detecting the presence of thyroid nodules. If nodules were found, then their size and numbers were recorded. These data were then correlated with the age of the patients. If needed, ultrasound-guided fine needle aspiration was performed. RESULTS: Among the 1,081 subjects, thyroid nodules were detected in 152 (14.1%) with its prevalence increasing with the increasing age of the patients (age 30 to 49: 12.3%, over 50: 17.2%, P = 0.026). Among these study subjects, nodules larger than 5 mm in size were detected in 99 patients and fine needle aspirations were performed on 53 of these patients. Six patients were diagnosed with papillary carcinoma. CONCLUSION: The prevalence of thyroid nodules in the male population was 14.1%, with an increasing prevalence in the over 50 age group.

Citations

Citations to this article as recorded by

The Prevalence of Thyroid Nodules and the Morphological Analysis of Malignant Nodules on Ultrasonography
An Hyun, Ji Tae-jeong, Lee Hyo-young, Im In-chul
Journal of Radiological Science and Technology.2019; 42(3): 201. CrossRef
Prevalence of thyroid nodules and their associated clinical parameters: a large-scale, multicenter-based health checkup study
Jae Hoon Moon, Min Kyung Hyun, Ja Youn Lee, Jung Im Shim, Tae Hyuk Kim, Hoon Sung Choi, Hwa Young Ahn, Kyung Won Kim, Do Joon Park, Young Joo Park, Ka Hee Yi
The Korean Journal of Internal Medicine.2018; 33(4): 753. CrossRef
Prevalence and Annual Incidence of Thyroid Disease in Korea from 2006 to 2015: A Nationwide Population-Based Cohort Study
Hyemi Kwon, Jin-hyung Jung, Kyung-Do Han, Yong-Gyu Park, Jung-Hwan Cho, Da Young Lee, Ji Min Han, Se Eun Park, Eun-Jung Rhee, Won-Young Lee
Endocrinology and Metabolism.2018; 33(2): 260. CrossRef
Clinical Characteristics and Incidence of Thyroid Nodule in the Male Population for Health Check-up
Yeon Jin Jeon, Young Teag Koh, Seung Jong Oh, Min Young Koo
Korean Journal of Endocrine Surgery.2015; 15(4): 93. CrossRef
An Iodine Database for Common Korean Foods and the Association between Iodine Intake and Thyroid Disease in Korean Adults
Mi-Rhan Han, Dal Lae Ju, Young Joo Park, Hee-Young Paik, YoonJu Song
International Journal of Thyroidology.2015; 8(2): 170. CrossRef
Clinical Characteristics and Incidence of Thyroid Nodule in the Male Population for Health Check-up
Yeon Jin Jeon, Young Teag Koh, Seung Jong Oh, Min Young Koo
Korean Journal of Endocrine Surgery.2015; 15(4): 93. CrossRef
Screening of Thyroid Cancer and Management of Thyroid Incidentaloma
Jung Jin Cho
Korean Journal of Family Medicine.2010; 31(2): 87. CrossRef
Prevalence of Thyroid Nodules Detected by Ultrasonography in Adults for Health Check-Ups and Analysis of Fine Needle Aspiration Cytology
Won Jun Kim, Joo Hyong Kim, Dong Won Park, Chang Beom Lee, Yong Soo Park, Dong Sum Kim, Woong Hwan Choi, Tae Wha Kim, You Hern Ahn
Journal of Korean Endocrine Society.2008; 23(6): 413. CrossRef
Prevalence of Thyroid Nodules Detected by Ultrasonography in Adults for Health Check-up and Analysis of Fine Needle Aspiration Cytology
Jae Hoon Chung
Journal of Korean Endocrine Society.2008; 23(6): 391. CrossRef

Galectin-3 and Thyroid Peroxidase Expression in Thyroid Nodules.: Gyu Hwan Bae, Hyun Dae Yoon, Jong Yup Bae, Ho Sang Son, Eui Dal Jung, Sung Pyo Hong, Myung Hwan Kim, Sun Ah Lee, Hyun Sook Kim, Sun Young Ahn; J Korean Endocr Soc. 2007;22(2):105-111. Published online April 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.2.105

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Abstract PDF

BACKGROUND
The accurate diagnosis of a thyroid nodule is important in deciding a patient's treatment plan and for predicting the prognosis. The histopathological diagnosis of resected specimens are largely positively accomplished, but the consistency of the diagnosis is low when the specimen shows a small carcinomatous cytological feature or the nodule does not express papillary proliferation. Therefore, the need for supplementary diagnostic measures is increased. Herein, the expressions of galectin-3 and thyroid peroxidase (TPO) of resected specimens were investigated using immunohistochemical staining, and their potential for contributing to an accurate diagnosis studied. METHODS: The specimens included 195 resected thyroid nodules obtained from 179 patients having undergone thyroid surgery. Immunohistochemical staining for two useful antibodies, galectin-3 and TPO, were performed, and the expressions of these two antibodies investigated with regard to the histological diagnosis. RESULTS: The sensitivity, specificity, and positive and negative predictive values of galectin-3 and TPO for detecting papillary carcinomas were all 100%, but these values were low for other forms of carcinoma. CONCLUSION: Our data showed the diagnosis of thyroid nodules, using immunohistochemical staining for galectin-3 and TPO, was very useful for detecting thyroid papillary carcinoma, but insufficiently sensitive for follicular carcinoma. Immunohistochemical staining for TPO is also useful for distinguishing cases when a false positive result for galectin-3 is obtained.

Citations

Citations to this article as recorded by

Immunohistochemical Expression of CXC Chemokine Receptor 4 and Galectin-3 in Follicular Tumors of Thyroid
Ji Eun Park, Bu Kyung Kim, Sangeon Gwoo, Yo-Han Park, Young Sik Choi, Young Ok Kim
Journal of Korean Thyroid Association.2012; 5(1): 45. CrossRef
The Significance of Immunohistochemical Staining in Thyroid Nodule: TPO and Galectin-3
G Gong
Journal of Korean Endocrine Society.2007; 22(2): 95. CrossRef

Prevalence of Ultrasonographically-Detected Thyroid Nodules in Adults without Previous History of Thyroid Disease.: Ji Hye Suk, Tae Yong Kim, Mi Kyung Kim, Won Bae Kim, Hong Kyu Kim, Seong Hoon Jeon, Young Kee Shong; J Korean Endocr Soc. 2006;21(5):389-393. Published online October 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.5.389

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Abstract PDF

BACKGROUND
The prevalence of palpable thyroid nodules in the general population is about 5%, and is 3~5 times higher in women than in men. However, much higher prevalence, up to 50%, was reported from autopsy data. Recently, the use of high resolution ultrasonography for routine check-up has resulted in much more detection of non-palpable thyroid nodules. We studied the prevalence of thyroid nodules in healthy adults without history of thyroid disease, and compared the prevalence in relation to palpability, age and gender. METHODS: The prevalence of thyroid nodules was studied in adults aged from 20 to 79 years who had visited the health promotion center at Asan Medical Center, Seoul, Korea, from Jan 2002 to Dec 2003. Subjects with previous thyroid disease were excluded. 7,440 subjects (6,168 female, 1,272 men) were included in this study. Thyroid palpation was performed and followed by ultrasonography using a 12-MHz real-time scanner. RESULTS: Thyroid nodules were detected in 3,040 of the 7,440 subjects (41%). Palpable nodules were present in 213 (3%), and non-palpable, but ultrasonographically detected thyroid nodules were present in 2,827 (38%). Thyroid nodules were present in 2,602 women (42.2%) and 370 men (29%). Among them, 159 women (2.6%) and 54 men (4.2%) had palpable thyroid nodules and 2,443 women (39.6%) and 316 men (24.8%) had non-palpable but ultrasonographically detected nodules. A significant linear trend was found between age and the prevalence of thyroid nodules. CONCLUSIONS: The prevalence of ultrasonographically detected thyroid nodules in adults with no previous history of thyroid disease was 41%. The prevalence of palpable nodules and non-palpable, but ultrasonographically detected nodules were 3% and 38%, respectively. Thyroid nodules were detected in 42.2% of women and 29% of men, showing that thyroid nodules are very common in healthy adults, even in men.

Citations

Citations to this article as recorded by

The Prevalence of Thyroid Nodules and the Morphological Analysis of Malignant Nodules on Ultrasonography
An Hyun, Ji Tae-jeong, Lee Hyo-young, Im In-chul
Journal of Radiological Science and Technology.2019; 42(3): 201. CrossRef
Prevalence of thyroid nodules and their associated clinical parameters: a large-scale, multicenter-based health checkup study
Jae Hoon Moon, Min Kyung Hyun, Ja Youn Lee, Jung Im Shim, Tae Hyuk Kim, Hoon Sung Choi, Hwa Young Ahn, Kyung Won Kim, Do Joon Park, Young Joo Park, Ka Hee Yi
The Korean Journal of Internal Medicine.2018; 33(4): 753. CrossRef
Prevalence and Annual Incidence of Thyroid Disease in Korea from 2006 to 2015: A Nationwide Population-Based Cohort Study
Hyemi Kwon, Jin-hyung Jung, Kyung-Do Han, Yong-Gyu Park, Jung-Hwan Cho, Da Young Lee, Ji Min Han, Se Eun Park, Eun-Jung Rhee, Won-Young Lee
Endocrinology and Metabolism.2018; 33(2): 260. CrossRef
An Iodine Database for Common Korean Foods and the Association between Iodine Intake and Thyroid Disease in Korean Adults
Mi-Rhan Han, Dal Lae Ju, Young Joo Park, Hee-Young Paik, YoonJu Song
International Journal of Thyroidology.2015; 8(2): 170. CrossRef
Management of Thyroid Nodules and Cancers Arising in the Elderly
Eunyoung Kim, June Young Choi, Kyu Eun Lee
Journal of Korean Thyroid Association.2012; 5(2): 99. CrossRef
Screening of Thyroid Cancer and Management of Thyroid Incidentaloma
Jung Jin Cho
Korean Journal of Family Medicine.2010; 31(2): 87. CrossRef
Postoperative Findings of the Cytological Diagnosis of Follicular Neoplasm or Hürthle Cell Neoplasm and the Risk of Malignancy
Ji Hye Yim, Eui Young Kim, Won Gu Kim, Tae Yong Kim, Gyungyup Gong, Suck Joon Hong, Won Bae Kim, Young Kee Shong
Endocrinology and Metabolism.2010; 25(4): 316. CrossRef
Prevalence of Thyroid Nodules Detected by Ultrasonography in Adults for Health Check-up and Analysis of Fine Needle Aspiration Cytology
Jae Hoon Chung
Journal of Korean Endocrine Society.2008; 23(6): 391. CrossRef
Prevalence of Thyroid Nodules Detected by Ultrasonography in Adults for Health Check-Ups and Analysis of Fine Needle Aspiration Cytology
Won Jun Kim, Joo Hyong Kim, Dong Won Park, Chang Beom Lee, Yong Soo Park, Dong Sum Kim, Woong Hwan Choi, Tae Wha Kim, You Hern Ahn
Journal of Korean Endocrine Society.2008; 23(6): 413. CrossRef
Trends Analysis of Characteristics of Thyroid Cancer Patients in One Medical Center
Seung Hun Lee, Tae Yong Kim, Jin-Sook Ryu, Gyungyub Gong, Won Bae Kim, Seong Chul Kim, Suck Joon Hong, Young Kee Shong
Journal of Korean Endocrine Society.2008; 23(1): 35. CrossRef
Prevalence of Thyroid Nodules Detected by Ultrasonography in Adult Men Attending Health Check-ups
Jung Hyun Kim, Sang Jun Park, Sang Eok Kim, Kwang Hee Lee, Il Kwon Cho, Sun Ik Jang, Jin Kwan Lee, Keum Soo Seo, Hyuck Po Kwon, Sung Chang Chung
Journal of Korean Endocrine Society.2007; 22(2): 112. CrossRef

The Adequacy of Ultrasound-Guided Fine Needle Aspiration in Thyroid Nodules.: Hyo Jin Lee, So Young Rha, Ki Hyun Kwon, Jun Chul Lee, Koon Soon Kim, Young Suk Jo, Bon Jeong Ku, Minho Shong, Young Kun Kim, Heung Kyu Ro; J Korean Endocr Soc. 2005;20(2):154-159. Published online April 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.2.154

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Abstract PDF

BACKGROUND
Fine needle aspiration(FNA) is an accurate and safe method for the diagnosis of thyroid nodules. One of the limitations of FNA is the variable rate of unsatisfactory specimens, especially in small sized, deep seated or complex cystic nodules. To overcome this problem, ultrasound-guided FNA(US-FNA) has been widely used. In this study, the adequacy of cytologic specimens by US-FNA was compared with that of conventional palpation-guided FNA(P-FNA). METHODS: The medical records of all patients who were engaged in FNA due to thyroid nodules at Chungnam National University Hospital from January 2003 to July 2004 were retrospectively examined. The US-FNA and P-FNA were performed in 114 and 185 patients, respectively. RESULTS: Comparison of the adequacy of the two techniques in providing sufficient material for the cytologic diagnosis showed that specimens in 24(13.0%) and 6(5.3%) patients collected by P-FNA and US-FNA, respectively, were unsatisfactory(P=0.031). A total of 23 patients underwent thyroid surgery due to strong suspicion of malignancy at cytologic finding and/or on clinical judgement. Seventeen patients belonged to the P-FNA group and 6 patients to the US-FNA group. In the P-FNA group, a histologic diagnosis revealed two false-negative cytologic findings, but no false-negative findings were found in the US-FNA group. CONCLUSION: Compared with P-FNA, US-FNA may reduce the possibility of unsatisfactory cytologic specimens and the rate of false-negative diagnosis, and may improve the diagnostic accuracy in investigating thyroid nodules

Citations

Citations to this article as recorded by

Prevalence of Thyroid Nodules Detected by Ultrasonography in Adults for Health Check-up and Analysis of Fine Needle Aspiration Cytology
Jae Hoon Chung
Journal of Korean Endocrine Society.2008; 23(6): 391. CrossRef

Relationship between The Expressions of Sodium/Iodide Symporter and The Findings of Thallium-201 Scan in Thyroid Nodules.: Joon Hyop An, Min Ah Na, Sang Soo Kim, Ok Nyu Kong, Ju Won Seok, Chang Hun Lee, Chang Won Lee, In Joo Kim, Yong Ki Kim; J Korean Endocr Soc. 2004;19(2):165-174. Published online April 1, 2004

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Abstract PDF: BACKGROUND
The sodium/iodide symporter (NIS) has an important role in the diagnosis and treatment of well differentiated thyroid carcinoma. The relationship between the uptake of thallium- 201 scan (201Tl scan) and the expression of sodium/iodide symporter (hNIS) was studied in thyroid nodules. METHODS: Patients that had undergone operations for thyroid nodules, and who received a 201Tl scan before their operations, were investigated. Anti-NIS antibodies were used to analyze the presence and distribution of the hNIS protein by immunohistochemical staining of their thyroid tissues. RESULTS: Forty-four patients (papillary carcinoma; 18, follicular adenoma; 11, adenomatous goiter; 14, nonspecific thyroiditis; 1) 30 with no immunoreactivity and 14 with a positive reaction to the anti-NIS antibody, were included. The NIS negative patients (12/30) had no 201Tl uptake, but all others were positive on 201Tl scan, and the NIS-positive patients (13/14) had positive 201Tl uptake, with 1 negative on 201Tl scan, with significant difference (p=0.035). Of the 18 patients with a papillary thyroid carcinoma, the NIS negative patients (2/10) had no 201Tl uptake and the others were positive on 201Tl scan, but without significant difference. NIS positive patients (1/8) with a papillary thyroid carcinoma had no 201Tl uptake, and the others were positive on 201Tl scan, but without significant difference. Whether the results of NIS staining and 201Tl scan were positive or not did not affect the responses of radioactive iodine therapy in our study. CONCLUSION: These results suggest that thallium-201 uptake may be correlated with hNIS expression in thyroid nodules

Case Report

A Case of Acute Suppurative Thyroiditis as a Complication of Acupuncture in Patient with a Benign Thyroid Nodule.: Tae Yong Kim, Han Mo Yang, Jae Kyung Hwang, Young Min Cho, Young Joo Park, Do Joon Park, Seong Yeon Kim, Hong Kyu Lee, Bo Youn Cho; J Korean Endocr Soc. 2002;17(4):576-582. Published online August 1, 2002

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Abstract PDF: Acute suppurative thyroiditis is an uncommon disease, and usually affects patients with preexisting thyroid gland pathology. Penetrating injury could provide an acquired channel for the infection to spread into the relatively infection-resistant thyroid gland. We describe the first case of acute suppurative thyroiditis, as a complication of acupuncture, in a patient with a benign thyroid nodule. A 54-year-old male received acupuncture on his neck for the treatment of a previously diagnosed thyroid nodule. Four days after the acupuncture, the patient was admitted due to severe pain of the anterior neck and odynophagia. Fever and tenderness over the thyroid gland were observed. Burkholderia cepacia was isolated from a culture dish of aspirate of the thyroid gland. A neck computed tomography scan showed an abscess in the thyroid gland. Antibiotic treatment, and repeated drainage of the abscess, ameliorated the symptoms of infection. Two weeks after admission, the patient was discharged without sequela. Acupuncture should be considered as a kind of penetrating injury, which may induce acute suppurative thyroiditis.

Original Articles

Prevalence of Thyroid Nodules detected by Ultrasonography in Womens Attending Health Check-Ups.: Chang Hoon Yim, Han Jin Oh, Ho Yeon Chung, Ki Ok Han, Hak Chul Jang, Hyun Ku Yoon, In Kwon Han, Byoung Hee Han, Kyung Sang Lee, Byung Jae Cho; J Korean Endocr Soc. 2002;17(2):183-188. Published online April 1, 2002

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Abstract PDF: BACKGROUND
Thyroid nodules are commonly found in clinical practice, and the recent development of thyroid ultrasonography has allowed for the detection of small nodules previously undetectable by routine palpations. Since previous studies on thyroid ultrasonography have been focused on patients with known thyroid disorders, we aimed to determine the prevalence of thyroid nodules in a female population. METHODS: We studied women in the age range 30 to 70 years visiting the health promotion center at Samsung Cheil Hospital for routine health check-ups. After excluding patients with previous thyroid disorders, 1300 women where selected to undergo thyroid ultrasonography for the detection of the presence of thyroid nodules. If nodules were found, their size and numbers were recorded, and these data correlated with the patients age. RESULTS: Of the 1300 subjects, thyroid nodules were detected in 490 (37.7%) with their prevalence (p=0.009), and that of multinodularity of thyroid nodules (p=0.001), increasing with the increasing age of the patients (Age 30 to 39: 30.8%, 40 to 49: 37.0%, 50 to 59: 41.5% and 60 to 69: 65.2%). Among these study subjects, nodules larger than 15 mm in size were detected in 29 and after performing fine needle aspirations on 18 nodules, 17 were found to be benign, with 1 papillary carcinoma, which required a total thyroidectomy. CONCLUSION: The prevalence of thyroid nodules in our female study population was 37.7%, with their prevalence, and that of multinodularity of thyroid nodules, increasing with increased age.

Percutaneous Ethanol Injection in Autonomous Functioning Thyroid Nodules and Complex Cysts: Five Years' Experience.: Seong Jin Lee, Jung Hee Han, Ha Young Kim, Jong Chul Won, Sang Wook Kim, Ho Kyu Lee, Il Min Ahn; J Korean Endocr Soc. 2002;17(1):57-68. Published online February 1, 2002

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Abstract PDF: BACKGROUND
Percutaneous ethanol injection therapy (PEI) performed with ultrasonography guidance has recently been used in cases of autonomous functioning thyroid nodules (AFTN) and benign complex cysts. We performed this study to analyze the effects of PEI on AFTN and benign complex cysts. METHEODS: From September 1995 to September 2000, we performed PEI on 456 outpatients (47 men and 409 women, mean age 42.4+/-11.8 years) with AFTN or benign complex cysts. All cases were subjected to fine needle aspirations (FNA) by ultrasonography-guidance if necessary. FNA was performed at least twice with results of colloid nodule in cases of complex cysts. For AFTN, cases with FNA results of follicular neoplasm were also included. After PEI on AFTN, patients were classified into three response groups: complete response as judged by our new criteria (CR, normalization of TSH and free T4, disappearance of hot nodule on thyroid scan) along with the old criteria of previous studies (normalization of TSH and free T4, recovery of suppressed extranodular tissue on thyroid scan), partial response (PR, normalized free T4 but suppressed TSH, persistent hot nodule despite recovery in suppressed extranodular tissue) and no response (no change of hot nodule). Complex cysts were classified into three groups in accordance with volume reduction after PEI: complete response (CR, above 90% of volume reduction), partial response (PR, 50~89%) and no response (below 50%). RESULTS: Overall pre-treatment volumes were 15.3+/-12.1 mL and post-treatment volumes were 2.8+/-2.9 mL, with 66.4+/-19.9% of volume reductions in AFTN and complex cysts. Volume reductions were 71.5+/-18.0% in AFTN, and 66.1+/-15.0% in complex cysts. In 24 cases of AFTN, responses satisfying the previous criteria were 14 (58.3%) of CR, 6 (25.0%) of PR, and 4 (16.7%) of no response. However, by the new criteria there were 1 (4.2%) of CR, 10 (41.6%) of PR, and 13 (54.2%) of no response. In 432 cases of complex cysts, CR was observed in 82 (19.0%), PR in 261 (60.4%) and no response in 89 (20.6%). The volume reductions in complex cysts with pre-treatment volume larger than 15 mL were higher than those of groups with smaller volumes (p<0.001). Pre-treatment volumes were not correlated with post-treatment volumes, nor with volume reductions. Volume reductions were not correlated with the amounts of injected ethanol. Mild and transient complications were observed in 41 cases (9.0%) during PEI, consisting of transient neck pain (n=36, 7.9%), transient unilateral vocal cord palsy (n=3, 0.7%), intracavitary hemorrhage (n=1, 0.2%), and transient hypotension (n=1, 0.2%). CONCLUSION: Our data suggest that the efficacy of PEI on AFTN is temporary and does not usually induce long-term complete remissions. In complex cysts, however, PEI may have potential as an additive treatment modality to thyroid hormone suppressive therapy

Usefulness of Thallium-201 Scintigraphy for Differentiating Benign and Malignant Thyroid Nodules in Inconclusive Cases with Fine Needle Aspiration.: Young Sil Lee, Chang Won Lee, Mi Hwa Jang, Ju Won Seok, Seok Man Son, Seok Dong Yoo, In Joo Kim, Yong Ki Kim; J Korean Endocr Soc. 2001;16(4-5):447-456. Published online October 1, 2001

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Abstract PDF: BACKGROUND
Although fine needle aspiration(FNA) is recognized as the most accurate procedure in the differential diagnosis of thyroid nodules, about 20~30% of nodules remain inconclusive in FNA. Therefore, we assessed the usefulness of Thallium-201 scintigraphy in differentiating benign from malignant thyroid nodules in patients with inconclusive diagnosis by FNA. METHODS: We studied 43 patients with inconclusive diagnosis(29 of follicular neoplasm, 11 of cystic change and 3 of inadequate) by FNA, with the results being confirmed histopathologically by operation. Thallium-201 scintigraphy was performed at 15 minutes(early scan) and 2-3 hours(late scan) after the intravenous administration of 37 MBq of thallium-201. Malignant nodules were defined by the retention of Thallium-201 on delayed images. RESULTS: In the 43 patients with inconclusive FNA diagnosis, Thallium-201 scan had a sensitivity of 75.0%, specificity of 62.9% and accuracy of 65.1%. The positive and negative predictive values were 31.6% and 91.7%, respectively. In the 29 patients with follicular neoplasm by FNA, Thallium-201 scan had a sensitivity of 83.3%, specificity of 60.9% and accuracy of 65.5%. The positive and negative predictive values were 35.7% and 93.3%, respectively. CONCLUSION: In particular, Thallium-201 scintigraphy demonstrated a high negative predictive value, Therefore, for patients with inconclusive FNA findings, Thallium-201 scintigraphy might be useful in differentiating between benign and malignant thyroid nodules, and has the potential to reduce the rate of unnecessary operations in benign nodules.

Effectiveness of Percutaneous Ethanol Injection in Benign Cold Thyroid Nodules: Five Years' Experience.: Seong Jin Lee, Jung Hee Han, Ha Young Kim, Jong Chul Won, Sang Wook Kim, Ho Kyu Lee, Il Min Ahn; J Korean Endocr Soc. 2001;16(2):210-220. Published online April 1, 2001

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Abstract PDF: BACKGROUND
Percutaneous ethanol injection therapy (PEI) which is performed with the guidance of ultrasonography has recently been used in patient who had benign cold thyroid nodules. We performed this study to analyze the long-term effects of PEI on benign cold thyroid nodules. METHOD: From September 1995 to September 2000, we treated 198 outpatients (12 men and 186 women, who had a mean age of 40.8 years, with a range of 15-71) who had benign cold thyroid nodules at the Asan Medical Center. The PEI was performed on 141 patients who had solitary nodules (SN) and on 57 patients who had prominent nodules or Questionable or typing error? multiple nodules (MN). All patients had fine needle aspirations (FNAs) at least twice which resulted in a diagnosis of the presence of a colloid nodule. Thyroid hormone was given to all patients along with TSH measurements. The thyroid hormone dose was titrated to correspond to TSH level of a low normal range. These patients were followed up for mean period of 37.6 months (range 18-60). Patients who were treated with PEI were classified into three groups according to their volume reduction: a complete response (CR, which was above 90% in volume reduction), a partial response (PR, which was a 50-89%) reduction and No Response (which was below 50% or an increased size) groups. RESULTS: The overall pre-treatment volumes of the nodules were 15.7+/-19.8 mL. The overall post-treatment volumes were 2.4+/-2.6 mL and consisted of volume reductions of 70.1+/-17.1%. The results of PEI for all of the patients were: a complete reduction (CR) in 34 cases (17.2%), a partial reduction (PR) in 142 cases (71.7%) and No Response in 22 patients (11.1%). In 141 patients in the SN group, in which there was a mean follow-up duration of 36.7+/-11.2 months, the volume reductions were 68.3+/-18.8%. CR was observed in 20 patients (14.2%), PR in 103 (73.0%) and No Response in 18 (12.8%). In twenty-two of the SN patients (22/141, 15.6%) we were able to discontinue the thyroid hormone suppressive therapy because those nodules had markedly decreased in volume after PEI without any further increase of nodule size during the follow-up period. In 57 patients in the MN group, over a mean follow-up durations of 37.1+/-11.4 months, the volume reductions were 74.3+/-12.1%. CR was observed in 14 patients (24.6%), PR in 39 (68.4%) and No Response occurred in 4 (7.0%). During the follow-up period after PEI, further volume reductions were observed for 36 months after thyroid hormone suppressive therapy in the Response Group. Differences in volume reductions between the SN and MN groups were not statistically significant but the volume reductions in patients who had a pre-treatment volume larger than 15 mL were higher than those in the smaller group (p<0.001). In the cases of the SN and MN groups, volume reductions did not correlate with either the amount of injected ethanol or the pre-treatment volumes, but the pre-treatment volumes correlated with post-treatment volumes in the patients who had SN (p<0.001, r=0.411) and MN (p<0.001, r=0.729). We observed mild, but transient complications in 32 patients (16.2%) during PEI which included a transient neck pain (n=27, 13.6%), a transient unilateral vocal cord palsy (n=4, 2.0%), and an abscess formation (n=1, 0.5%) which was cured. CONCLUSION: These results suggest that PEI is a feasible adjunctive therapy to use in thyroid hormone suppressive therapy for benign cold thyroid nodules

Percutaneous Ethanol Injection in Benigh Thyroid Nodules.: Hong Kyu Kim, Il Min Ahn, Eun Joo Lee, Jin Yub Kim, Mi Heon Lee, Sung Jin Lee, Ho Kyu Lee; J Korean Endocr Soc. 1998;13(3):373-383. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Percutaneous ethanol injection(PEI) performed in guidance of ultrasonography has been used in cases of thyroid cyst and autonomous functiong thyroid nodule(AFTN). We performed this study to determine the feasibility of PEI on the various type of benign cold nodules(solid, pure cyst, complex cyst) and AFTN. METHOD: Ninety patients(age 41+12 years; 83 women and 7 men) with hot and cold nodule were included in this study. All cases were subjected to FNAB, and sono-guided in cases of complex cyst, at least twice with results of colloid nodule. T4 suppression treatment was done for cold solid nodules for at least 6 months and cases which had partial response(50% or more volume reduction but no further volume decrease on T4 suppression) were included in this study. After PEI, we classified AFTN into three different response groups; complete response (normali- zation of TFT and thyroid scan finding), partial response(normalized freeT4 but suppressed TSH or persistently suppressed scan), or failure group. Each subtypes(solid, pure cyst, complex cyst) of cold nodules were also classified into three groups in accordance with volume reduction; complete response(above 90% of volume reduction), partial response(50-90%), and failure(below 50% or increase in size) group. RESULTS: Overall responses rate of PEI for benign thyroid nodule were complete; 70(78%), partial; 18(20%), and failure; 2(2%). In 27 cold solid nodules, complete response was observed in 23(85%) and partial response in 4(15%). In 11 pure cysts, complete response was observed in 7(64%), partial response in 3(27%), and 1 case(9%) of failure was lost after 1 trial of PEI. In 45 cases of complex cyst, complete response was observed in 36(80%), partial response in 8 (18%), and 1 case(2%) of failure was subjected to operation with pathology report of Hiirthle cell adenoma. In 7 cases of AFTN, complete response was observed in 4(57%) and partial response in 3(43%). We observed complications during PEI therapy such as transient neck pain(n=10), transient unilateral vocal cord palsy(n=l), and intracavitary hemorrhage(n=2), transient hypotension during ethanol injection(n 1). CONCLUSION: Our data suggest that efficacy of PEI(57%) in AFTN is inferior to conventional therapies like surgery and radioiodine, but still can be an alternative therapeutic modality in selected cases. In cold nodules, especially of solid type and complex cyst, PEI may have feasibility as a therapeutic modality in restricted cases. Further studies of prolonged follow-up for the possibility of neglecting occult malignancy are warranted.

Prevalence Thyroid Cancer in Patients with Cold Thyroid Nodules in Relation to Sex, Age, And Multinodularity.: Won Bae Kim, Hyun Kyung Chung, Chang Hoon Yim, Do Joon Park, Sung Yeon Kim, Bo Yeon Cho, Hong Gyu Lee; J Korean Endocr Soc. 1998;13(3):366-372. Published online January 1, 2001

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Abstract PDF: BACKGROUND
We evaluated the prevalence of thyroid cancer in patients with cold thyroid nodules and the impact of sex, age, hardness of nodule, and multinodularity as factors able to predict the probability of malignancy in patients with nodular thyroid diseases. METHODS: We examined a 728 patients who visited Seoul National University Hospital with one or more cold thyroid nodules between Jan. 1996 and Dec. 1997. After clinical evaluations including medical history, physical examinations(size, hardness and multiplicity of nodule), fine needle aspiration biopsies and cytologic examinations were carried out. RESULTS: Among the 728 cases, 76 cases(10.4%) were diagnosed as cancer and 602 cases (82.6%) were diagnosed as benign nodule. The prevalence of cancer was significantly lower in female patients with cold nodules(9.4%, 62/662) than in males(17.5%, 11/63)(p=0.041). Age was an important factor in both sexes. The proportion of nodules that were malignant was lower in patients of 20-60 years old(8,9%, 56/632) than patients younger than 20 years old(1S.1%, 2/11) or older than 60 years old(18.3%, 15/82)(p=0.019). The prevalence of cancer was significantly higher in hard nodules(36.3%, 41/113) than firm(5.2%, 30/574) or soft nodules(5.3%, 2/38)(p= 0.001). There was no size difference between malignant(25.2 +- 13.7mm) and benign nodules(25.3 +- 8.9mm)(p=0.9425). The prevalence of thyroid cancer in solitary nodule(10.6%, 63/593) was not different from that in multiple nodules(7.6%, 10/132)(p=0.293). CONCLUSION: Our data suggest that thyroid nodules of the patients who are younger than 20 years old or older than 60 years old, male, as well as hard nodule require more careful evaluation for the risk of thyroid malignancies.

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