Endocrine Abstracts

Background: Thyroid nodules (TN) are common. Their prevalence increases with age. A thyroid incidentaloma (TI) is defined as a non-palpable TN detected fortuitously during a radiological investigation performed for reasons unrelated to the thyroid gland. Although they are mostly benign, the risk of malignancy is estimated from 7% to 15% of nodules. The objective of this study is to investigate the characteristics of TI in a cohort of patients admitted in an internal medicine department.

Methods: A descriptive retrospective study identifying 48 records of TN in patients hospitalized in an internal medicine department between 2016 and 2021. Then we studied cases of TI.

Results: Among the 48 cases of TN, 50% were incidentalomas. There was a clear female predominance (gender ratio: 0.17). The mean age was 50.8 years old (ranging between 29 and 73). The patients had a medical history of chronic renal failure in 6 cases, Systemic Lupus in 4 cases, Sjögren syndrome in 3 cases, Crohn disease in 1 case, sarcoidosis in 1 case, myelodysplasic syndrome in 1 case and AL amyloidosis in 1 case. TI were mostly detected by neck ultrasound. Only 12.5% were discovered by chest CT scan. These investigations were performed in order to examine lymph nodes (45.83%), parathyroid glands (33.33%) lung parenchyma (12.5%) or parotid glands (8.33%). Ultrasonography, performed in all patients, showed: a solitary nodule (41.7%), a multinodular goiter (29.2%) and lymphadenopathy (14.6%). According to the European Thyroid Imaging Reporting and Data System (EU-TIRADS), TN were classified as EU-TIRADS 2 (4.17%), EU-TIRADS 3 (75%), EU-TIRADS 4 (12.5%), and EU-TIRADS 5 (8.33%). Thyroid function test was abnormal in 5 cases: 3 cases of hypothyroidism and 2 cases of hyperthyroidism. Fine needle aspiration biopsy, performed in 6 patients, revealed: benign cytology in 3 cases, atypia of undetermined significance (oncocytic tumor) in 1 case, cytology suspicious for malignancy in 1 case, and was unsatisfactory in 1 case. Thyroidectomy was conducted in 9 cases, revealing a malignant origin in 2 patients (papillary carcinoma in both cases). Therapeutic modalities were surgery (29.2%), radioactive iodine (14.6%) and monitoring (54.2%).

Conclsion: In our study, incidentalomas were discovered in 50% of TN cases. Among them, 2 cases were malignant (8.33%). Thus, screening for thyroid nodules, by cervical ultrasound, seems necessary for internal medicine patients, so as not to miss thyroid cancer, mainly at a subclinical stage.