Endocrine Abstracts

The prevalence of thyroid nodules is extraordinarily common. An increase in the use of head and neck imaging, including ultrasound, computed tomography (CT) and carotid Dopplers, has increased the number of non-palpable thyroid nodules identified. For most patients, their thyroid disease is non-neoplastic and asymptomatic. The challenge in the management of thyroid nodules is identifying patients with clinically significant disease, most notably thyroid neoplasia, without excessive intervention.

This study investigated the prediction of neoplasia in thyroid nodules based on a combination of ultrasound features, clinical risk and TSH level. Clinical risk was based on clinical history and examination and was scored from 1 (definitely non-neoplastic) to 5 (definitely neoplastic). Thirty patients (6 male, 24 female) with thyroid nodules were included in this prospective study. Five of the 30 nodules were found to be neoplastic on cytology or histology.

Ultrasound features significantly associated with neoplasia included the presence of microcalcifications (sensitivity 40.0%, 95% CI 5.3–85.3), central vascular flow (sensitivity 60.0%, 95% CI 14.7–94.7) and an intermediate margin appearance (sensitivity 40.0%, 95% CI 5.3–85.3). A TSH level ≥1.8 mU/l (sensitivity 100.0%, 95% CI 39.7–100.0) and a clinical risk score ≥3 (sensitivity 100.0%, 95% CI 47.8–100.0) were also significantly associated with neoplasia.

A combination of clinical risk score, TSH levels and ultrasound characteristics may be useful in safely identifying low risk nodules which do not need to undergo invasive procedures such as FNA or thyroid surgery. A large prospective study which devises an objective scoring method based on these features is needed.