Carotid Ultrasonography of Thyroid Incidentaloma

( Won Hong Lee ),( Kyung Rae Dong ),( Cha Dol Kim ),( Moo Jin Park ),( Young Hwan Ryu ),( Eun Hoe Goo ) 조선대학교 공학기술연구원 2010 공학기술논문지 Vol.3 No.4

With the widespread use of a high-resolution sonographic equipment for breast ultrasound or carotid ultrasonography, the proportion of asymptomatic cases in which thyroid nodules are incidentally found has been increased. Given the above background, we attempted to assess the incidence of incidental thyroid cancers, which were incidentally detected while examining the thyroid gland, one of the anatomical structures that are adjacently located, during the carotid ultrasonography, and the rate of malignancy on ultrasonography. The current study was conducted in 258 patients who underwent a carotid ultrasonography. Of these, excluding patients who were aware that thyroid nodules were present in these nodules, 273 patients were finally selected for the incidental thyroid tumor. Then, based on the interpretation results, the incidence of nodules, size and the findings were thyroid nodules were classified into probably benign, indeterminate and suspiciously malignant nodule. Based on this classification, the rate of malignancy was evaluated. In our series, 49 of 237 patients (20.7%) had thyroid nodules detected. Mean size was 1.13 cm (range 0.3 cm~5.1 cm). The number of cases in which the size of thyroid nodules was smaller than 1 cm (60.4%). Of thyroid nodules, probably benign nodule of < 5 mm in size was not recorded on the ultrasonography. Besides, probably benign nodules were identified from 51.7% (30/58), indeterminate nodules were identified from 39.7% (23/58) and suspiciously malignant nodules were identified from 8.6% (5/58). These results indicate that the malignancy rate was relatively higher. It can therefore be inferred that even the incidental thyroid rumors should also be managed and then treated in the same manner a thyroid nodules which are found in a clinical setting.

건강한 사람들에게서 초음파로 발견한 갑상선 결절과 갑상선기능 검사 사이의 관계

정혜진,문용식,김무영,이수형,박기현,김현준,황인영,손윤정,김태호 대한가정의학회 2019 Korean Journal of Family Practice Vol.9 No.1

Background: The detection of thyroid nodules through ultrasonography (US) has improved with the development of imaging technologies and thyroid cancer screening in Korea. We evaluated the relationship between the presence of thyroid nodules on US and thyroid function test (TFT) results in healthy individuals. Methods: We performed a retrospective review of data from 449 adults (313 men and 136 women) who underwent tests to evaluate serum thyrotropin (TSH) and free thyroxine levels, thyroid US, and if needed, fine needle aspiration cytology (FNAC). Results: Of the 449 subjects, 144 subjects (32.1%) had thyroid nodules. Among the 144 with thyroid nodules, 24 (16.7%) were advised to undergo FNAC, and all of them showed normal serum TSH levels. Logistic regression analysis showed that the presence of thyroid nodules was not related to abnormalities noted on TFTs after adjusting for age, sex, smoking status, and presence of risky drinking behavior and hypertension (P=0.647). Conclusion: The presence of thyroid nodules on US in healthy adults was not associated with abnormal TFT results. Serum TSH check-ups during the evaluation of thyroid nodules discovered through US in asymptomatic individuals living in areas with a low prevalence of autonomous functioning thyroid nodules might not be necessary from the perspective of cost-effectiveness and subject convenience.

초음파 유도 하 세침 흡입 세포 검사에서 위 음성을 보인 갑상선 결절의 초음파 소견 분석

김지영,정소령,김범수,안국진,한성태 대한영상의학회 2007 대한영상의학회지 Vol.57 No.3

Purpose: To analyze the ultrasonographic (US) findings of thyroid nodules that yielded false negative results after an initial ultrasound-guided fine needle aspiration biopsy (FNAB). Materials and Methods: Between August 2003 and February 2006, 389 patients with 405 thyroid nodules received a repeat US-guided FNAB. We retrospectively reviewed the US findings, cytology results and postsurgical pathological results. The cytology diagnoses were classified as benign, a suspicious malignancy, a follicular neoplasm, a papillary carcinoma, and a non-diagnostic result. The US findings of the thyroid nodules were analyzed with regard to size, internal content, shape, margin, echogenecity, and calcification pattern. Results: Of the 405 thyroid nodules, 17 nodules were false negative. The major US findings of these nodules were a solid internal component in 16 nodules, hypoechogenicity or marked hypoechogenicity in 14 nodules, microcalcifications in 12 nodules, an ovoid to round shape in 9 nodules and a well-defined smooth margin in 9 nodules. Conclusion: An repeat US-guided FNAB should be performed if the thyroid nodules have one of the malignant US features such as hypoechogenecity or marked hypoechogenecity, a microcalcification, a taller than wide shape or a well-defined spiculate margin although the cytology results indicated a benign lesion. In addition, thyroid nodules with findings of a well-defined smooth margin, ovoid to round shape, and solid internal component might also be subject to a repeat US-guided FNAB to exclude a malignancy. 목적: 초음파 유도 하 세침 흡입 세포 검사에서 위 음성을 보였던 결절들의 초음파 소견을 분석하여 위 음성 결절의 특징적 초음파 소견을 알아보고자 한다. 대상과 방법: 2003년 8월부터 2006년 2월까지 초음파 유도 하 세침 흡입 세포검사를 2번 이상 시행한 389명 환자의 405개의 갑상선 결절을 대상으로 초음파 소견, 세포병리 결과, 그리고 조직학적 진단을 후향적으로 조사하였다. 세포병리 결과는 양성, 악성 의심, 여포성 종양, 유두상암, 그리고 부적합으로 분류하였다. 갑상선 결절의 초음파 소견은 크기, 내부 내용, 모양, 경계, 에코, 석회화 유형을 기준으로 분석하였다. 결과: 405개 결절 중 17개의 결절이 위 음성을 보였으며 위 음성 결절들의 주 초음파 소견은 고형 결절 16개, 저에코 또는 현저한 저에코 14개, 미세석회화 12개, 난원형 및 구형 9개, 경계가 분명하면서 부드러운 경우 9개였으며 결절의 모양이 좌우 직경에 비해 전후 직경이 긴 모양이 8개, 경계가 분명하면서 침상인 경우도 6개였다. 결론: 초음파 유도 하 세침 흡입 결과가 양성이라도 갑상선 결절의 초음파 소견이 악성을 시사하는 저에코 또는 현저한 저에코, 미세석회화, 좌우 직경에 비해 전후 직경이 긴 모양, 또는 경계가 분명하면서 침상일 때 중 어느 하나의 소견이라도 있는 경우에는 반드시 재검사를 시행해야 하며 난원형 및 구형 모양을 보이고 경계가 분명하면서 부드러운 고형 결절도 악성 결절을 배제하기 위해 추적검사가 필요하다.

Endocrinology-metabolism ; Relationship between metabolic syndrome and thyroid nodules in healthy Koreans

( Juyoung Shin ),( Min Hee Kim ),( Kun Ho Yoon ),( Moo Il Kang ),( Bong Yun Cha ),( Dong Jun Lim ) 대한내과학회 2016 The Korean Journal of Internal Medicine Vol.31 No.1

Background/Aims: This study evaluated the relationship between thyroid nodules and metabolic syndrome (MS) and its components in apparently healthy Koreans. Methods: We reviewed the records of 3,298 subjects with no noticeable symptoms who underwent thyroid ultrasound imaging as part of a routine check-up between July 2009 and June 2010; of these, 1,308 were excluded based upon predefined criteria. Among the remaining 1,990 patients, we examined the association between MS and its components and the incidence of thyroid nodules. Results: Of the 1,990 subjects included in this study, 38.4% (n = 764) had thyroid nodules and 12.7% (n = 253) had MS. Female sex, older age, higher body mass index, larger waist circumference, higher glycated hemoglobin level, lower thyroid stimulating hormone level, and presence of MS were all closely related with the presence of thyroid nodules (all p < 0.05). Furthermore, the relevant number of MS components showed a positive linear correlation with the occurrence of thyroid nodules (p < 0.001). Evidence of MS alone was not independently associated with thyroid nodules after adjusting for sex and age in a multivariate binary logistic regression analysis; however, glycated hemoglobin for females and waist circumference for males, as well as both age and thyroid stimulating hormone for all patients, were identified as independent predictors for the existence of thyroid nodules (all p < 0.05).Conclusions: This study suggests a positive relationship between the components of MS and thyroid nodules in an ostensibly healthy Korean population. Our data support the idea that the recent increase in thyroid nodules is partly due to increases in both MS and obesity.

2021 Korean Thyroid Imaging Reporting and Data System and Imaging-Based Management of Thyroid Nodules: Korean Society of Thyroid Radiology Consensus Statement and Recommendations

Ha Eun Ju,Chung Sae Rom,Na Dong Gyu,Ahn Hye Shin,Chung Jin,Lee Ji Ye,Park Jeong Seon,Yoo Roh-Eul,Baek Jung Hwan,Baek Sun Mi,조성휘,Choi Yoon Jung,Hahn Soo Yeon,Jung So Lyung,Kim Ji-hoon,Kim Seul Kee,Kim 대한영상의학회 2021 Korean Journal of Radiology Vol.22 No.12

Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1–2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.

새로운 권고안(2021 Korean Thyroid Imaging Reporting and Data System)을 이용한 갑상선 결절의 평가

정소령 대한내과학회 2022 대한내과학회지 Vol.97 No.5

The rate of detection of thyroid nodules and carcinomas has increased with the widespread use of ultrasonography (US), which is the primary imaging modality for the detection and risk stratification of thyroid nodules. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.

갑상선 결절의 진단에 있어서 TI-201 주사의 의의

윤정한,김동의,범희승 최신의학사 1993 最新醫學 Vol.36 No.4

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 ) 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.4

Background/Aims: We evaluated the prevalence and characteristics of thyroid nodules detected by thyroid ultrasound (US) at health checkups and the associated clinical parameters. Methods: A total of 72,319 subjects who underwent thyroid US at three health checkup centers in Korea from January 2004 to December 2010 were included in this study. The correlations between the presence of thyroid nodules and other clinical parameters were analyzed. Results: The prevalence of thyroid nodules and cysts was 34.2% (n = 24,757). Thyroid nodules were more prevalent in women and older age groups. Among the subjects with thyroid nodules with size information (n = 24,686), 18,833 (76.3%) had nodules measuring ≤ 1.0 cm. Women and older age groups showed higher proportion of larger nodules. Percentage of women, age, body mass index (BMI), waist circumference, body fat composition, blood pressure, and the level of fasting glucose, total cholesterol, and low density lipoprotein cholesterol were higher in the subjects with thyroid nodules compared to those without nodules. The prevalence of metabolic syndrome and overt/subclinical thyrotoxic state was higher in the subjects with thyroid nodules. In the multivariable logistic regression analysis, women, age, BMI, metabolic syndrome, and thyrotoxicosis were independently associated with the presence of thyroid nodules. Conclusions: The high prevalence of thyroid nodules in people who underwent thyroid US at a health checkup suggests that increased detection of thyroid nodules resulted in an increased prevalence in the general population. However, metabolic disturbances may also have contributed to the increase in thyroid nodule prevalence in Korea.

Ultrasound-Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules Smaller Than 5 mm in the Maximum Diameter: Assessment of Efficacy and Pathological Findings

김동욱,박오환,이은주,추혜정,김상효,이상협,엄재욱 대한영상의학회 2009 Korean Journal of Radiology Vol.10 No.5

Objective: The aim of this study was to determine the efficacy of the use of an ultrasound-guided fine-needle aspiration biopsy (US-FNAB) to diagnose thyroid nodules smaller than 5 mm in the maximum diameter and to evaluate pathological findings of small thyroid malignancies. Materials and Methods: From May 2007 to April 2008, we evaluated the findings of US-FNABs of small thyroid nodules less than 5 mm in the maximum diameter. The cytopathological findings were retrospectively reviewed and the diagnostic performance of the use of an US-FNAB was examined in all patients. Results: Of 201 small thyroid nodules in 180 patients, there were 162 adequate specimens (81%). Among 180 patients, 75 patients underwent thyroid surgery and 50 malignant and 33 benign nodules were identified based on a pathological examination. All small malignant thyroid nodules were identified as papillary thyroid microcarcinomas (PTMCs). There were 34 (55%) true positive, 0 (0%) false positive, 23 (37%) true negative and five (8%) false negative results for malignancy after performing a first US-FNAB in 62 surgically confirmed nodules. The sensitivity (87%), specificity (100%), positive predictive value (100%), negative predictive value (82%), accuracy (92%), false positive rate (0%) and false negative rate (8%) for an US-FNAB were determined. In 23 patients with a primary PTMC, capsular invasion (9%, 2 of 23), a perithyroidal lymph node metastasis (30%, 7 of 23), the rate of multifocality (9%, 2 of 23) and bilaterality (4%, 1 of 23) were also determined. Conclusion: An US-FNAB of thyroid nodules smaller than 5 mm in the maximum diameter is an effective diagnostic procedure. Objective: The aim of this study was to determine the efficacy of the use of an ultrasound-guided fine-needle aspiration biopsy (US-FNAB) to diagnose thyroid nodules smaller than 5 mm in the maximum diameter and to evaluate pathological findings of small thyroid malignancies. Materials and Methods: From May 2007 to April 2008, we evaluated the findings of US-FNABs of small thyroid nodules less than 5 mm in the maximum diameter. The cytopathological findings were retrospectively reviewed and the diagnostic performance of the use of an US-FNAB was examined in all patients. Results: Of 201 small thyroid nodules in 180 patients, there were 162 adequate specimens (81%). Among 180 patients, 75 patients underwent thyroid surgery and 50 malignant and 33 benign nodules were identified based on a pathological examination. All small malignant thyroid nodules were identified as papillary thyroid microcarcinomas (PTMCs). There were 34 (55%) true positive, 0 (0%) false positive, 23 (37%) true negative and five (8%) false negative results for malignancy after performing a first US-FNAB in 62 surgically confirmed nodules. The sensitivity (87%), specificity (100%), positive predictive value (100%), negative predictive value (82%), accuracy (92%), false positive rate (0%) and false negative rate (8%) for an US-FNAB were determined. In 23 patients with a primary PTMC, capsular invasion (9%, 2 of 23), a perithyroidal lymph node metastasis (30%, 7 of 23), the rate of multifocality (9%, 2 of 23) and bilaterality (4%, 1 of 23) were also determined. Conclusion: An US-FNAB of thyroid nodules smaller than 5 mm in the maximum diameter is an effective diagnostic procedure.

Ultrasound-Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules: is it Necessary to Use Local Anesthesia for the Application of One Needle Puncture?

김동욱,김기남,노명호 대한영상의학회 2009 Korean Journal of Radiology Vol.10 No.5

Objective: This study was designed to evaluate the difference in the degree of patient pain for an ultrasound-guided fine-needle aspiration biopsy (USFNAB) of a thyroid nodule with one needle puncture with and without local anesthesia. Materials and Methods: A total of 50 patients participated in the study. We examined prospective patients who would undergo US-FNABs of two thyroid nodules (larger than 10 mm maximum diameter), which were located in separate thyroid lobes. For one of these thyroid nodules, US-FNAB was performed following the administration of local anesthesia; for the other nodule, no anesthesia was administered. The application of anesthesia was alternatively administered between patients (either prior to the first US-FNAB procedure or prior to the second procedure). For all patients, the degree of pain during and after each US-guided FNAB was evaluated according to a 4-category verbal rating scale (VRS), an 11-point numeric rating scale (NRS) and a 100-mm visual analogue scale (VAS). Results: The mean maximum diameters of thyroid nodules examined by US-FNAB with the use of local anesthesia and with no local anesthesia were 13.6 mm and 13.0 mm, respectively. There was no significant difference in nodule size (p > 0.05) between two groups. For the VRS, there were 27 patients with a higher pain score when local anesthesia was used and four patients with a higher pain score when no local anesthesia was administered. Nineteen patients had equivalent pain score for both treatments. This finding was statistically significant (p < 0.001). For the NRS, there were 33 patients with a higher pain score when local anesthesia was used and 10 patients with a higher pain score when no local anesthesia was administered. Seven patients had an equivalent pain score for each treatment. This finding was statistically significant (p < 0.001). For the VAS, there were 35 patients with a higher pain score when local anesthesia was used and 11 patients with a higher pain score where no local anesthesia was administered. Four patients had an equivalent pain score for both treatments. This finding was also statistically significant (p = 0.001). Conclusion: In our study, patient pain scales were significantly lower when no local anesthesia was used prior to US-FNABs of thyroid nodules as compared to when local anesthesia was administered. Therefore, we believe that when one needle puncture is used, US-FNAB should be performed without administering local anesthesia. Objective: This study was designed to evaluate the difference in the degree of patient pain for an ultrasound-guided fine-needle aspiration biopsy (USFNAB) of a thyroid nodule with one needle puncture with and without local anesthesia. Materials and Methods: A total of 50 patients participated in the study. We examined prospective patients who would undergo US-FNABs of two thyroid nodules (larger than 10 mm maximum diameter), which were located in separate thyroid lobes. For one of these thyroid nodules, US-FNAB was performed following the administration of local anesthesia; for the other nodule, no anesthesia was administered. The application of anesthesia was alternatively administered between patients (either prior to the first US-FNAB procedure or prior to the second procedure). For all patients, the degree of pain during and after each US-guided FNAB was evaluated according to a 4-category verbal rating scale (VRS), an 11-point numeric rating scale (NRS) and a 100-mm visual analogue scale (VAS). Results: The mean maximum diameters of thyroid nodules examined by US-FNAB with the use of local anesthesia and with no local anesthesia were 13.6 mm and 13.0 mm, respectively. There was no significant difference in nodule size (p > 0.05) between two groups. For the VRS, there were 27 patients with a higher pain score when local anesthesia was used and four patients with a higher pain score when no local anesthesia was administered. Nineteen patients had equivalent pain score for both treatments. This finding was statistically significant (p < 0.001). For the NRS, there were 33 patients with a higher pain score when local anesthesia was used and 10 patients with a higher pain score when no local anesthesia was administered. Seven patients had an equivalent pain score for each treatment. This finding was statistically significant (p < 0.001). For the VAS, there were 35 patients with a higher pain score when local anesthesia was used and 11 patients with a higher pain score where no local anesthesia was administered. Four patients had an equivalent pain score for both treatments. This finding was also statistically significant (p = 0.001). Conclusion: In our study, patient pain scales were significantly lower when no local anesthesia was used prior to US-FNABs of thyroid nodules as compared to when local anesthesia was administered. Therefore, we believe that when one needle puncture is used, US-FNAB should be performed without administering local anesthesia.