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Introduction/Objectives: The prevalence of thyroid disorders is high in Saudi Arabia. Among the disorders, goiter and thyroiditis are the most common and have unique ultrasound (US) features, underscoring the need for US screening for thyroid pathologies. This study aimed to determine the prevalence of thyroiditis and thyroid nodules in patients attending the Family and Community Medicine Center of Imam Abdulrahman Bin Faisal University. Methods: This registry-based crosssectional study analyzed laboratory and US data from 240 patients who attended the Family and Community Medicine Center of Imam Abdulrahman Bin Faisal University from January 2020 to December 2021. Abnormalities of the thyroid gland were categorized according to laboratory and US data. Associations between different types of thyroid pathology and clinical and laboratory findings were assessed using appropriate statistical methods. Results: The majority of participants were Saudi women. The prevalence of thyroiditis in the study population was 43%. Approximately 25% of these patients had more than 1 nodule, and fine-needle aspiration biopsy showed that most nodules were benign. Most nodules were found in clinically euthyroid patients. Thyroiditis might be associated with abnormal thyroid function. Conclusions: Thyroiditis and thyroid nodules were common in our cohort. Vitamin D deficiency, other autoimmune diseases, and a family history of thyroid disorders were associated with thyroiditis and thyroid nodules. US is useful for identifying the type of thyroid disease. [ABSTRACT FROM AUTHOR]

Context: Thyroid ultrasound screening is recommended in children with PTEN hamartoma tumor syndrome (PHTS) due to increased risk of thyroid neoplasia, but the natural history of thyroid disease in children with PHTS is unclear.Objective: Determine the prevalence and natural history of thyroid disease in children with PHTS.Methods: Retrospective cohort study (1998-2019) in an academic pediatric hospital of individuals with genetically confirmed PHTS diagnosed before age 19 years. Clinical, thyroid ultrasound, and laboratory characteristics are described. Primary outcomes were the prevalence of thyroid nodules ≥10 mm diameter and time course and risk factors for nodule development assessed by Cox regression analysis. Secondary outcomes included thyroid nodule requiring biopsy, other ultrasound findings, and prevalence of autoimmune thyroid disease.Results: Among 64 subjects with PHTS, 50 underwent thyroid ultrasound. A thyroid nodule ≥10 mm was diagnosed in 22/50 (44%) subjects at median (range) age 13.3 (7.0-22.9) years. Nodules were diagnosed earlier in females than in males (10.8 [7.0-17.9] vs 14.2 [9.9-22.9] years, P = .009). In multivariate analysis, risk of thyroid nodules was significantly associated with female sex (hazard ratio 2.90, 95% CI 1.16-7.27, P = .02) and inversely associated with the presence of neurologic findings of PHTS (HR 0.27, 95% CI 0.10-0.69, P = .007). Abnormal-appearing lymph nodes with echogenic foci were observed by ultrasound in 20% of subjects, but these were not associated with malignancy. Autoimmune thyroid disease was present in 10/33 (30.3%) of subjects in whom it was assessed.Conclusion: Thyroid disease is common in children with PHTS. This study supports current consensus recommendations for ultrasound screening. [ABSTRACT FROM AUTHOR]

* Context.--The College of American Pathologists periodically surveys laboratories to determine changes in cytopathology practices. We report the results of a 2016 survey concerning thyroid fine-needle aspiration (FNA). Objective.--To provide a cross-sectional survey of thyroid cytology practices in 2016. Design.--In 2016, a survey was sent to 2013 laboratories participating in the College of American Pathologists Non-Gynecologic Cytology Education Program (NGC-A) requesting data from 2015-2016 on several topics relating to thyroid FNA. Results.--A total of 878 laboratories (43.6% of 2013) replied to the survey. Radiologists performed the most thyroid FNA procedures in most laboratories (70%; 529 of 756), followed by endocrinologists (18.7%; 141 of 756), and most of these were performed under ultrasound guidance (92.1%; 699 of 759). A total of 32.6% of respondents (251 of 769) provided feedback on unsatisfactory rates for nonpathology providers who performed FNA. Intraprocedural adequacy assessment was primarily performed by attending pathologists (77.4%; 490 of 633) or cytotechnologists (28.4%; 180 of 633). Most laboratories used the Bethesda System for Reporting Thyroid Cytopathology (89.8%; 701 of 781) and performed molecular testing based on clinician request (68.1%; 184 of 270) rather than FNA diagnosis. Correlation of thyroid excisions with prior cytology results most often occurred retrospectively (38.4%; 283 of 737) and was used for pathologist interpretive quality assurance purposes. Conclusions.--These survey results offer a snapshot of national thyroid FNA cytology practices in 2016 and indicate that standardized cytology terminology is commonly used; pathologists perform most immediate adequacy assessments for thyroid FNA; laboratories use correlation statistics to evaluate pathologists' performance; and molecular tests are increasingly requested for indeterminate interpretations, but reflex molecular testing is rare. [ABSTRACT FROM AUTHOR]

Gallbladder mucocele formation is an emerging disease in dogs characterized by increased secretion of condensed granules of gel-forming mucin by the gallbladder epithelium and formation of an abnormally thick mucus that can culminate in obstruction of the bile duct or rupture of the gallbladder. The disease is associated with a high morbidity and mortality and its pathogenesis is unknown. Affected dogs have a significantly increased likelihood of concurrent diagnosis of hyperadrenocorticism, hypothyroidism, and hyperlipidemia. Whether these endocrinopathies represent coincidental primary disease processes that exacerbate gallbladder mucocele formation in predisposed dogs or reflect a concurrent disruption of endocrine and lipid metabolism is unclear. In this study, we investigated a hypothesis that dogs with gallbladder mucocele formation would have a high prevalence of occult and atypical abnormalities in adrenal cortical and thyroid gland function that would suggest the presence of endocrine disruption and provide deeper insight into disease pathogenesis. We performed a case-control study of dogs with and without ultrasonographic diagnosis of gallbladder mucocele formation and profiled adrenal cortical function using a quantitative mass spectrometry-based assay of serum adrenal-origin steroids before and after administration of synthetic cosyntropin. We simultaneously profiled serum thyroid hormone concentrations and evaluated iodine sufficiency by measurement of urine iodine:creatinine ratios (UICR). The studies were complemented by histological examination of archival thyroid tissue and measurements of thyroid gland organic iodine from dogs with gallbladder mucocele formation and control dogs. Dogs with gallbladder mucocele formation demonstrated an exaggerated cortisol response to adrenal stimulation with cosyntropin. A prevalence of 10% of dogs with gallbladder mucocele formation met laboratory-based criteria for suspect or definitive diagnosis of hyperadrenocorticism. A significantly greater number of dogs with gallbladder mucocele formation had basal serum dehydroepiandrosterone (DHEAS) increases compared to control dogs. A high percentage of dogs with gallbladder mucocele formation (26%) met laboratory-based criteria for diagnosis of hypothyroidism, but lacked detection of anti-thyroglobulin antibodies. Dogs with gallbladder mucocele formation had significantly higher UICRs than control dogs. Examination of thyroid tissue from an unrelated group of dogs with gallbladder mucocele formation did not demonstrate histological evidence of thyroiditis or significant differences in content of organic iodine. These findings suggest that dogs with gallbladder mucocele formation have a greater capacity for cortisol synthesis and pinpoint DHEAS elevations as a potential clue to the underlying pathogenesis of the disease. A high prevalence of thyroid dysfunction with absent evidence for autoimmune thyroiditis suggest a disrupted thyroid hormone metabolism in dogs with gallbladder mucocele formation although an influence of non-thyroidal illness cannot be excluded. High UICR in dogs with gallbladder mucocele formation is of undetermined significance, but of interest for further study. [ABSTRACT FROM AUTHOR]

Abstract Studies have shown that prevalence of thyroid nodules (TNs) has been increasing recently. However, the factors that may influence TN prevalence is not fully understood. In this study, we aimed to understand the prevalence of TNs and identify possible factors that are associated with the prevalence of TNs in Tianjin, China. Subjects aged 18 years or older were randomly collected and all subjects received thyroid ultrasonography, physical examination and questionnaires. Subjects (n = 2647) were divided into the case group in which the subjects had TNs and the control group in which the subjects did not have TNs. Potential influencing factors on TNs including sex, age, iodine status, thyroid volume, thyroid hormone (TSH), thyroid autoantibody TPOAb, TGAb and living habits were analyzed. Our results showed that the overall TN prevalence was 26.7%. The prevalence of TNs in women was higher than that in men (P < 0.05). TN prevalence increased with age (P < 0.001), and a U-shaped curve relationship between urine iodine concentrations (UICs) and prevalence of TNs was observed. The positive rate of TPOAb and goiter rate in case group was higher than that in control group (P < 0.05). The thyroid volume in case group was larger than that in control group (P < 0.001). Other factors that may influence TNs included high blood pressure, iodized salt, menopause, seafood intake, and education levels. None of UIC, TSH, TPOAb and TGAb were associated with TN prevalence in regression models. In conclusion, our results showed that TNs prevalence in Tianjin was high. TNs prevalence was higher in women than in men, and it increases with age. The older, female, high education level physical labor and goiter are independent risk factors for TNs. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the diagnostic performance of ultrasound (US)-based risk-stratification systems for thyroid nodules in the 2015 American Thyroid Association (ATA) guidelines with those of the 2016 Korean Thyroid Association (KTA)/Korean Society of Thyroid Radiology (KSThR) and 2017 American Congress of Radiology (ACR) guidelines. Methods: From June 2013 to May 2015, a total of 902 consecutive thyroid nodules were enrolled in four institutions, and their US features were retrospectively reviewed and classified using the categories defined by the three guidelines. The malignancy risk of each category, as defined by all three risk-stratification systems, was calculated, and the diagnostic performance of the fine-needle aspiration (FNA) indications of the ATA guidelines were compared to those of the KTA/KSThR and ACR guidelines. Results: Of all nodules, 636 (70.5%) were benign and 266 (29.5%) malignant. The calculated malignancy risks for ATA categories 5, 4, 3, 2, and 1 nodule(s) were 71.7, 21.5, 2.6, 3.8, and 0%. Of all nodules, 7.6% (69/902) did not meet the ATA pattern criteria, but the malignancy risk was calculated to be 10.1% (7/69). The ATA guidelines afforded significantly higher diagnostic sensitivity (95.0%) than the ACR guidelines (80.2%; p = 0.001) but a lower specificity (38.1 vs. 68.9%; p < 0.001). On the other hand, the ATA guidelines exhibited a lower diagnostic sensitivity than the KTA/KSThR guidelines (100.0%; p = 0.07) but a higher specificity (28.2%; p < 0.001). The unnecessary FNA rate was the lowest when the ACR guidelines were used (25.8%), followed by the ATA (51.2%) and KTA/KSThR (59.4%) guidelines. Conclusion: The 2015 ATA guidelines afford relatively moderate sensitivity and an unnecessary FNA rate for thyroid cancer detection compared to the 2016 KTA/KSThR and 2017 ACR guidelines. US practitioners require a deep understanding of the benefits and risks of the US-based FNA criteria of different guidelines and potential impact on the diagnosis of low-risk thyroid cancers. [ABSTRACT FROM AUTHOR]

Background The differences regarding categorization of thyroid nodules among different guidelines may affect the diagnostic performances and agreement among observers. Purpose To compare the diagnostic performances and agreements between observers with various degree of experience when applying different guidelines for stratifying thyroid nodules using suspicious ultrasonography (US) features. Material and Methods This retrospective study included 370 thyroid nodules (≥10 mm). Four observers, grouped as experienced and inexperienced, evaluated the US features and made final assessments according to the Kim criteria, Thyroid Imaging Reporting and Data System (TIRADS) by Kwak et al., and the 2015 American Thyroid Association (ATA) guideline. Diagnostic performances and agreements among the two groups were compared. Results The Kim criteria shows higher specificity with significantly lower sensitivity when compared to TIRADS and the 2015 ATA guideline (all P < 0.001), regardless of the level of experience. The experienced group showed significantly higher specificity with the Kim criteria and the 2015 ATA guideline compared to the inexperienced group ( P < 0.001), and the inexperienced group showed significantly higher sensitivity using the Kim criteria ( P = 0.002). The experienced group showed significantly higher agreement than the inexperienced group when using TIRADS while higher agreement was seen when using the 2015 ATA guideline for the inexperienced group. Agreement was not significantly different for the Kim criteria according to observer experience. Conclusion The diagnostic performances and agreements show significant differences in risk stratification of thyroid nodules according to the three guidelines using suspicious US features and the level of experience of the observer. [ABSTRACT FROM AUTHOR]

Introduction: Fine needle aspiration cytology is a rapid, accurate, inexpensive and safe diagnostic procedure in the evaluation of thyroid lesions. To avoid unnecessary invasive surgeries FNAC is used as a first line diagnostic procedure. Biopsy is advised for histopathological correlation and for confirmation, only in atypical, unequivocal, and for malignant lesions. By doing cytohistopathological correlation we can exclude false negatives and false positive cases. Aims and objectives: Providing accurate reports with clinical, ultrasonographic, fine needle aspiration cytology and histopathological correlation to exclude false positives and false negative cases. To avoid unnecessary surgeries by using FNAC as first line diagnostic procedure. Materials and Method: The present study is a prospective study from 2015 to present date and was done in 2 Institutions MIMS (Medicity Institute of Medical sciences, Ghanpur, Hyderabad) and MNR institute of medical sciences, Fassalwadi, Sangareddy. The study was done on 228 patients. Among 228 patients138 are females and the rest are male patients. The age ranged from18 years to 75 years. The female: male ratio is 3:1. The material comprises of FNA from different thyroid lesions and thyroid specimens from MIMS Ghanpur Hyderabad and from MNR Institute of medical sciences and Hospital, Hyderabad from 2015 august to present date. Hematoxylin and Eosin and Pap - routine stains. In this study FNAC was used as first line diagnostic study. In some cases of very small lesions which were difficult to palpate Ultrasound guided FNAC was done. Benign, non-neoplastic lesions were excluded from the study. Smears were fixed in 95% alcohol solution. Hematoxylin, Eosin, Geimsa and Pap stains were used to stain the smears. The cases were reported by using Bethesda system for reporting. Conclusion: FNAC is a more valuable first line diagnostic procedure in evaluating benign as well as malignant and potentially malignant thyroid nodules. Ultrasonographic findings along with histopathological and clinical correlation aid in giving accurate diagnosis and to exclude false positive and false negative cases. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study is to discuss the value of ultrasound-based shear wave™ elastography (SWE) in diffuse thyroid disease (DTD). Method Thyroid stiffness in 154 patients with DTD and 30 normal subjects was measured by SWE. The serum indicators of all subjects were detected. Results The area under the receiver operating characteristic (AUROC) curve for DTD by SWE was 0.852. The AUROCs of SWE for differentiating chronic autoimmune thyroiditis (CAT) from Graves' disease (GD) and subacute thyroiditis (SAT) were 0.549 and 0.989, respectively. The AUROCs for distinguishing GD from SAT by SWE and the fT3/fT4 ratio were 0.975 and 0.713, respectively. Conclusion SWE aids in the diagnosis of DTD, and SWE is superior to the fT3/fT4 ratio for distinguishing GD from SAT. However, SWE was unsuitable for differentiating CAT from GD. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the frequency of echogenic foci with comet-tail artifact in histologically proven thyroid nodules, and to determine the types of echogenic foci with comet-tail artifact that are associated with malignancy. We retrospectively analyzed the sonographic findings of echogenic foci with comet-tail artifact, present in thyroid nodules in 63 patients who underwent surgery for thyroid nodules at our institution between January 2016 and September 2016. The sonographic findings (appearance and background of echogenic foci, shape of comet-tail artifact) in benign and malignant nodules were compared. Seventy-one (7.4%) nodules with ultrasound finding of echogenic foci with comet-tail artifact were encountered in 962 thyroid nodules of 556 patients; 25 of these were benign, and 46 were malignant. Among the echogenic foci with comet-tail artifact categories, those (11/11, 100%) freely distributed in cystic components were all in benign nodules, whereas those (48/67, 71.6%) any part of echogenic foci or comet-tail artifact associated with solid components, were more common in malignant nodules (P < 0.001). There was no statistically significant difference in the appearance of echogenic foci and the shape of comet-tail between the benign and malignant nodules (P = 0.139, P = 0.626, respectively). Echogenic foci with comet-tail artifact freely distributed in cystic component may predict a benign nodule; those associated with solid components cannot be considered a benign finding. [ABSTRACT FROM AUTHOR]

The recently published guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) on interventional ultrasound (INVUS)-guided procedures summarize the intended interdisciplinary and multiprofessional approach. Herewith, we report on recommendations for interventional procedures for diagnosis and treatment of the thyroid gland. [ABSTRACT FROM AUTHOR]

AIM: To evaluate the role of ultrasound as the primary diagnostic imaging modality in thyroid disease. Methodology: Patients suspected to have thyroid disease were included in the study. Ultrasound was done as initial diagnostic imaging method for thyroid lesions and evaluated accordingly. These thyroid lesions were subjected to ultrasound guided FNAC, for confirmation of diagnosis. Later the validity of ultrasound diagnosis in relation to FNAC diagnosis was studied. Results: Ultrasonography showed relatively high sensitivity and specificity for diagnosing and characterizing thyroid disease. For thyroid adenomas, colloid cyst and multinodular goiter, the sensitivity of ultrasound was 98.55% and specificity in our study was 100%/. USG could considerably differentiate malignant and non-malignant thyroid lesions. USG showed relatively high diagnostic rate. USG guided FNAC was a safe procedure and yielded high diagnostic yield for detection of thyroid diseases. Conclusion: Above data suggests that USG can be used as a primary imaging modality with high sensitivity and specificity for overall diagnosis and characterization of thyroid diseases. USG helps in guiding FNAC for confirmation of diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Disorders of thyroid gland are very common in clinical practice. Thyroid diseases are most common among all the endocrine diseases in India. Methodology: Cross section study was conducted from 1st August 2016 to 28th May 2017. Based on the inclusion and exclusion criteria, 70 cases of thyroid lesions diagnosed by ultrasound were included in the study. The ultrasound examination was done in the department of Radiodiagnosis of Rural Medical College, Loni, Maharashtra, India. These 70 cases which were found to have thyroid lesion on ultrasound were subjected to FNAC for confirmation of ultrasound finding and establishment of final diagnosis. Results : In the study, maximum number of cases observed by FNAC test are Adenoma cases 28 (40%), followed by colloid goiter 20 (28.6%) and Multinodular goitre 12 (17.2%). Conclusion : Ultrasound is the cost effective modality of imaging and also the investigation of choice in thyroid diseases. In addition, ultrasound helps to differentiate benign lesions from malignant thyroid lesions in most of the cases. The characteristic of benign lesions are well defined margin, thick sonolucent halo, purely cystic lesions can be clearly depicted by ultrasound. [ABSTRACT FROM AUTHOR]

Background The purpose of this study was to validate the modified 4-tiered categorization system and to compare stratification of malignancy risk in small thyroid nodules with the 2015 American Thyroid Association (ATA) management guidelines. Methods From January 2015 to December 2015, 737 thyroid nodules measured ≥ 1 cm and <2 cm were included in this study. Each nodule was assigned a category with the ultrasonographic patterns described by the 2015 ATA guidelines. Results On univariate analysis, there was no difference of malignancy risk between low suspicion and very low suspicion nodules ( P = .584). Therefore, we suggested a modified 4-tiered categorization, which combines very low suspicion and low suspicion nodules into the 'revised low suspicion' category. Specificity, positive predictive value (PPV) and accuracy were higher with the modified 4-tiered categorization system ( P < .001 for all). Conclusion The modified 4-tiered categorization system allows more efficient management with better diagnostic performance than the 2015 ATA categorization system in small thyroid nodules. [ABSTRACT FROM AUTHOR]

Background: Clinico-pathological correlation of thyroid nodules is not routinely performed as until recently there was no objective classification system for reporting thyroid nodules on ultrasound. We compared the Thyroid Imaging Reporting and Data System (TIRADS) of classifying thyroid nodules on ultrasound with the findings on fine-needle aspiration cytology (FNAC) reported using the Bethesda System. Methods: A retrospective analysis of 100 consecutive cases over 1 year (Jan-Dec 2015) was performed comparing single-surgeon-performed bedside thyroid nodule ultrasound findings based on the TIRADS classification to the FNAC report based on the Bethesda Classification. TIRADS 1 (normal thyroid gland) and biopsy-proven malignancy referred by other clinicians were excluded. Benign-appearing nodules were reported as TIRADS 2 and 3. Indeterminate or suspected follicular lesions were reported as TIRADS 4, and malignant-appearing nodules were classified as TIRADS 5 during surgeon-performed bedside ultrasound. All the nodules were subjected to ultrasound-guided FNAC, and TIRADS findings were compared to Bethesda FNAC Classification. Results: Of the 100 cases, 74 were considered benign or probably benign, 20 were suspicious for malignancy, and 6 were indeterminate on ultrasound. Overall concordance rate with FNAC was 83% with sensitivity and specificity of 70.6 and 90.4%, respectively. The negative predictive value was 93.8%. Conclusion: It is essential for clinicians performing bedside ultrasound thyroid and guided FNAC to document their sonographic impression of the nodule in an objective fashion using the TIRADS classification and correlate with the gold standard cytology to improve their learning curve and audit their results. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the clinical value of contrast-enhanced ultrasound (CEUS) in the diagnosis of thyroid nodules in the acoustic radiation force impulse (ARFI) "gray zone" (the shear wave velocity is in the range 2.5-3 m/s). ARFI was performed before thyroidectomy in 70 patients with 200 thyroid nodules, and then CEUS was performed in 40 thyroid nodules in the "gray zone." The accuracy of ARFI for the 200 thyroid nodules was 82% (164/200). The accuracy of ARFI for the 40 "gray zone" thyroid nodules was 70% (28/40), whereas the accuracy of CEUS for the "gray zone" thyroid nodules was 90% (36/40). There was a significant difference in accuracy (p < 0.05). CEUS has better accuracy for thyroid nodules in the ARFI "gray zone." CEUS supplemented ARFI in differential diagnosis of benign and malignant thyroid nodules. [ABSTRACT FROM AUTHOR]

Background: The reported malignancy rates of thyroid nodules that appear suspicious on ultrasound (US) but yield benign fine-needle aspiration (FNA) cytology results range from 13.6% to 56.6%. However, the malignancy risk of nodules that are discordant on US and core-needle biopsy (CNB) pathological findings has not been evaluated. This study evaluated the malignancy risk associated with thyroid nodules that are suspicious on US but yield benign CNB results. Methods: Between July 2008 and November 2011, 1309 patients with 1313 thyroid nodules underwent US-guided CNB. Among these, 166 thyroid nodules that were suspicious on US but yielded benign CNB results were retrospectively reviewed. Benign nodules were diagnosed by surgery, FNA, and/or CNB that was repeated at least twice or CNB and lesion size stability on follow-up. The malignancy risk of US-pathology discordant nodules was calculated according to recommendations by Moon et al., and a further evaluation was conducted using four different US risk systems. Factors that differentiated benign from malignant nodules were assessed using the chi-square test or Fisher's exact test. Moreover, the histological findings of US-pathology discordant nodules were analyzed. Results: Patients with benign and malignant nodules did not differ significantly regarding clinical and demographic characteristics. Of the 166 US-pathology discordant nodules, seven (4.2%) were confirmed malignant. The malignancy risks associated with the five US risk systems ranged from 3.6% to 5.5%. Regarding suspicious US features, only the number of suspicious features was associated with malignancy ( p = 0.002). Histological analysis of benign CNB specimens with suspicious US features revealed fibrosis (77.6%), thyroiditis (28.7%), calcifications (10.6%), and hemosiderin deposition (6.4%). Conclusions: The malignancy risk among thyroid nodules with discordant US and CNB results ranged from 3.6% to 5.5%, depending on US risk systems. However, repeated biopsy may be necessary for selected thyroid nodules with more than two suspicious US features. [ABSTRACT FROM AUTHOR]

Background: An initial clinical assessment is described of a new, commercially available, computer-aided diagnosis (CAD) system using artificial intelligence (AI) for thyroid ultrasound, and its performance is evaluated in the diagnosis of malignant thyroid nodules and categorization of nodule characteristics. Methods: Patients with thyroid nodules with decisive diagnosis, whether benign or malignant, were consecutively enrolled from November 2015 to February 2016. An experienced radiologist reviewed the ultrasound image characteristics of the thyroid nodules, while another radiologist assessed the same thyroid nodules using the CAD system, providing ultrasound characteristics and a diagnosis of whether nodules were benign or malignant. The diagnostic performance and agreement of US characteristics between the experienced radiologist and the CAD system were compared. Results: In total, 102 thyroid nodules from 89 patients were included; 59 (57.8%) were benign and 43 (42.2%) were malignant. The CAD system showed a similar sensitivity as the experienced radiologist (90.7% vs. 88.4%, p > 0.99), but a lower specificity and a lower area under the receiver operating characteristic (AUROC) curve (specificity: 74.6% vs. 94.9%, p = 0.002; AUROC: 0.83 vs. 0.92, p = 0.021). Classifications of the ultrasound characteristics (composition, orientation, echogenicity, and spongiform) between radiologist and CAD system were in substantial agreement (κ = 0.659, 0.740, 0.733, and 0.658, respectively), while the margin showed a fair agreement (κ = 0.239). Conclusion: The sensitivity of the CAD system using AI for malignant thyroid nodules was as good as that of the experienced radiologist, while specificity and accuracy were lower than those of the experienced radiologist. The CAD system showed an acceptable agreement with the experienced radiologist for characterization of thyroid nodules. [ABSTRACT FROM AUTHOR]

Purpose: To study the thyroid image reporting and data system (TI-RADS) classification and the contrast-enhanced ultrasound (CEUS) enhancement pattern of thyroid nodules, and to determine whether combined use of both methods is helpful in the diagnosis of thyroid nodules.Methods: A total of 319 thyroid nodules in 246 patients were assessed with TI-RADS, CEUS and a combination of both methods. The diagnostic performance of TI-RADS, CEUS and a combination of both methods was compared.Results: The accuracy in the diagnosis of thyroid nodules was 90.3 % for TI-RADS, 90.0 % for CEUS and 96.0 % for a combination of both methods respectively. A statistically significant difference was not observed in the diagnostic accuracy of CEUS and TI-RADS (P > 0.05). However, a significant difference was observed between a combination of both methods and either alone (P < 0.01). A combination of both methods showed high sensitivity, specificity and accuracy for TI-RADS classifications of 4a and 4b thyroid nodules compared with TI-RADS alone (P < 0.01) and a statistically significant difference was not observed for thyroid nodules classified as 2, 3, and 5 (P > 0.05).Conclusions: The improved TI-RADS, when combined with CEUS, could significantly improve the diagnostic accuracy for thyroid nodules, especially for TI-RADS class-4 thyroid nodules.Key Points: • TI-RADS can be used as the primary diagnostic standard for thyroid nodules • CEUS can be used as an important complement to TI-RADS • The improved TI-RADS can significantly improve the qualitative diagnostic accuracy. [ABSTRACT FROM AUTHOR]

The World Federation for Ultrasound in Medicine and Biology (WFUMB) has produced guidelines for the use of elastography techniques including basic science, breast and liver. Here we present elastography in thyroid diseases. For each available technique, procedure, reproducibility, results and limitations are analyzed and recommendations are given. Finally, recommendations are given based on the level of evidence of the published literature and on the WFUMB expert group's consensus. The document has a clinical perspective and is aimed at assessing the usefulness of elastography in the management of thyroid diseases. [ABSTRACT FROM AUTHOR]

Enhancement heterogeneity on contrast-enhanced ultrasonography (CEUS) is used to differentiate between benign and malignant thyroid nodules. In this study, we used an algorithm to quantify enhancement heterogeneity of solid thyroid nodules on CEUS. The heterogeneity value (HV) is calculated as standard deviation/mean intensity × 100 (using Adobe Photoshop). The heterogeneity ratio (HR) is calculated as the ratio of the HV of the nodule to that of the surrounding parenchyma. Three phases-ascending, peak and descending phases-were studied. HV values at ascending (HVa) and peak (HVp) phases were significantly higher in malignant nodules than in benign nodules (95.57 ± 43.87 vs. 73.06 ± 44.04, p = 0.009, and 32.53 ± 10.73 vs. 26.44 ± 8.25, p = 0.002, respectively). HRa, HRp and HRd were significantly higher in malignant nodules than in benign nodules (1.93 ± 1.03 vs. 1.00 ± 0.47, p = 0.000, 1.43 ± 0.51 vs. 1.09 ± 0.28, p = 0.000, and 1.33 ± 0.40 vs. 1.08 ± 0.33, p = 0.001, respectively). HRa achieved optimal diagnostic performance on receiver operating characteristic curve analysis. The algorithm used for assessment of image heterogeneity on CEUS examination may be a useful adjunct to conventional ultrasound for differential diagnosis of solid thyroid nodules. [ABSTRACT FROM AUTHOR]

The World Federation for Ultrasound in Medicine and Biology (WFUMB) has produced guidelines for the use of elastography techniques, including basic science, breast, liver and thyroid elastography. Here we present elastography in prostate diseases. For each available technique, procedure, reproducibility, results and limitations are analyzed and recommendations are given. Finally, recommendations are given based on the level of evidence of the published literature and on the WFUMB expert group's consensus. This document has a clinical perspective and is aimed at assessing the usefulness of elastography in the management of prostate diseases. [ABSTRACT FROM AUTHOR]

The aims of our study were to determine whether shear wave elastography (SWE) can improve the conventional B-mode differentiation of thyroid lesions, determine the most accurate SWE parameter for differentiation and assess the influence of microcalcifications and chronic autoimmune thyroiditis on SWE values. We examined 119 patients with 169 thyroid nodules who prospectively underwent B-mode ultrasound and SWE using the same ultrasound machine. The parameters assessed using SWE were: mean elasticity within the entire lesion (SWE-whole) and mean (SWE-mean) and maximum (SWE-max) elasticity for a 2-mm-diameter region of interest in the stiffest portion of the lesion, excluding microcalcifications. The discriminant powers of a generalized estimating equation model including B-mode parameters only and a generalized estimation equation model including both B-mode and SWE parameters were assessed and compared using the area under the receiver operating characteristic curve, in association with pathologic verification. In total, 50 and 119 malignant and benign lesions were detected. In generalized estimated equation regression, the B-mode parameters associated with higher odds ratios (ORs) for malignant lesions were microcalcifications (OR = 4.3), hypo-echogenicity (OR = 3.13) and irregular margins (OR = 10.82). SWE-max was the only SWE independent parameter in differentiating between malignant and benign tumors (OR = 2.95). The area under the curve for the B-mode model was 0.85, whereas that for the model combining B-mode and SWE parameters was 0.87. There was no significant difference in mean SWE values between patients with and without chronic autoimmune thyroiditis. The results of the present study suggest that SWE is a valuable tool for the characterization of thyroid nodules, with SWE-max being a significant parameter in differentiating benign and malignant lesions, independent of conventional B-mode parameters. The combination of SWE parameters and conventional B-mode parameters does not significantly improve the diagnosis of malignant thyroid nodules. The presence of microcalcifications can influence the SWE-whole value, whereas the presence of chronic autoimmune thyroiditis may not. [ABSTRACT FROM AUTHOR]

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Introduction: High resolution ultrasound is the most sensitive imaging test available for the examination of the thyroid gland and due to increase in use of ultrasound more incidental thyroid nodules are diagnosed. In this study we try to establish the specific grayscale, color and spectral Doppler characteristics of malignant and benign thyroid nodules. Aim: To determine the specific gray scale characteristics, angioarchitecture and cut-off values of Doppler indices of malignant and benign thyroid nodules. To assess the efficacy of grayscale, Doppler and combined conventional and Doppler using defined criteria in differentiating malignant from benign nodules. Materials and Methods: We prospectively examined 194 thyroid nodules which were confirmed on FNAC. Each nodule was described according to size, number, contents, echogenicity, margins, halo, shape, calcification, local infiltration and lymphnode enlargement. Vascularity, RI and PI values of each nodule were assessed on Doppler. Each nodule was characterized as benign, indeterminate or malignant based on grayscale and Doppler characteristics. Cut-off RI and PI values for malignant thyroid nodules were obtained by ROC. Results: Out of 194 nodules, 151 nodules were benign and 43 nodules were malignant. Significant relationship was observed between malignancy and hypoechogenicity, irregular margins, taller than wide, thick incomplete halo, micro calcifications, lymphnode enlargement and local infiltration. Intranodular vascularity was a significant criterion to suggest malignancy in thyroid nodules on color Doppler. Malignant nodules had a mean RI of 0.73 and mean PI of 1.3 which were significantly higher than the benign nodules. Accuracy of detecting malignant thyroid nodules by combining gray scale and Doppler is higher than either of them alone. Conclusion: Using specific morphological pattern recognition features like microcalcifications, hypoechogenicity, taller than wide, irregular thick halo, lymphadenopathy and local extra thyroidal invasion has helped in differentiating malignant from benign features. Intranodular vascularity and high RI indices were the specific Doppler signs for malignant thyroid nodules. Since, Gray scale and Doppler have their own strengths and weaknesses, they were complementary rather than competitive modalities in diagnosing benign from malignant thyroid nodules. [ABSTRACT FROM AUTHOR]

Objective To assess the effect of different levels of salt iodine content on thyroid volume (ThV) distribution using data from the 1999, 2011, and 2014 Chinese national iodine deficiency disorder (IDD) surveys. Methods Probability proportion to size (PPS) sampling method was used to obtain a representative national sample of 34,547, 38,932, and 47,188 Chinese children aged 8-10 years in 1999, 2011, and 2014 Chinese national IDD surveys, respectively. The iodine content in household iodized salt and urinary iodine concentration were measured and thyroid ultrasound examination was performed. The data were analyzed by SAS software using histograms and box plots. The skewness and kurtosis were calculated for testing the normality of ThV. Results The median iodine content in household iodized salt dropped from 42.30 mg/kg in 1999 to 25.00 mg/kg in 2014. The median urinary iodine concentration of children aged 8-10 years decreased from 306.0 μg/L in 1999 to 197.9 μg/L in 2014. The median and interquartile range (IQR) of ThV in 1999, 2011, and 2014 surveys were 3.44 mL and 1.50 mL, 2.60 mL and 1.37 mL, 2.63 mL and 1.25 mL, respectively. The skewness and kurtosis of ThV distribution in 1999, 2011, and 2014 surveys were 1.34 and 5.84, 0.98 and 3.54, 1.27 and 5.49, respectively. Conclusion With reduced salt iodization levels, the median urinary iodine concentration and median ThV of children decreased significantly, and the symmetry of the ThV distribution improved. [ABSTRACT FROM AUTHOR]

This paper seeks to qualify and quantify non detectable clinical changes in the initial stages of thyroid disease, through orbit ultrasound and Doppler color duplex ultrasonography; as well as to measure the hemodynamic values of the ophthalmic artery and vein for early detection of observable changes in the optic nerve. Descriptive, cross-sectional and correlational field study of 80 patients, 40 patients diagnosed with thyroid disease and 40 control group patients, who underwent orbital color Doppler ultrasound from July 2006 to December 2007. From the thyroid disease group, 90% were female and 10% male; 75% were between 25-59 years, 45% with hyperthyroidism, 35% with hypothyroidism and 10% euthyroid; 35% had positive smoking habits and 47.5% caffeine habits. 87.3% with <23mm of Exophtalmometry. Moderate reflectivity was present in 136 muscles (43%) with predominance in the upper-right lifting complex of the upper eyelid. Pulsatility index, resistance index and systolic peak velocity of the ophthalmic artery were elevated in hyperthyroidism subjects. Indices of the ophthalmic vein as V1 and V2 were elevated in all groups (hyper, hypo and euthyroid). It is concluded that the orbital eco evaluates quantitative and qualitative alterations such as edema and fibrosis, which are significant in the diagnosis and monitoring of these patients. The Doppler echo revealed significant hemodynamic changes in pulsatility index parameters and systolic peak velocity in hyperthyroidism patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the diagnostic performance of quantitative shear wave velocity (SWV) measurement on acoustic radiation force impulse (ARFI) elastography for differentiation between benign and malignant thyroid nodules using meta-analysis. The databases of PubMed and the Web of Science were searched. Studies published in English on assessment of the sensitivity and specificity of ARFI elastography for the differentiation of thyroid nodules were collected. The quantitative measurement of ARFI elastography was evaluated by SWV (m/s). Meta-Disc Version 1.4 software was used to describe and calculate the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and summary receiver operating characteristic curves. We analyzed a total of 13 studies, which included 1,854 thyroid nodules (including 1,339 benign nodules and 515 malignant nodules) from 1,641 patients. The summary sensitivity and specificity for differential diagnosis between benign and malignant thyroid nodules by SWV were 0.81 (95% confidence interval [CI]: 0.77-0.84) and 0.84 (95% CI: 0.81-0.86), respectively. The pooled positive and negative likelihood ratios were 5.21 (95% CI: 3.56-7.62) and 0.23 (95% CI: 0.17-0.32), respectively. The pooled diagnostic odds ratio was 27.53 (95% CI: 14.58-52.01), and the area under the summary receiver operating characteristic curve was 0.91 (Q* = 0.84). In conclusion, SWV measurement on ARFI elastography has high sensitivity and specificity for differential diagnosis between benign and malignant thyroid nodules and can be used in combination with conventional ultrasound. [ABSTRACT FROM AUTHOR]

Thyroid and salivary gland are amongst the most common sites subjected to fine needle aspiration cytology (FNAC) due to easy accessibility of these sites along with high diagnostic accuracy of FNAC. The performance of FNAC can be increased with the use of ultrasonographic guidance and rapid on-site evaluation. Cell block along with immunochemistry and other ancillary techniques further helps in clinching the correct diagnosis in certain diagnostically challenging cases. Core needle biopsy (CNB) is proposed to have a better diagnostic accuracy in certain situations. However, CNB has no definite role as an upfront first-line diagnostic technique for thyroid or salivary gland lesions. We describe role of FNAC and CNB in thyroid and salivary gland lesions with detailed discussion of advantages and disadvantages of both these techniques. [ABSTRACT FROM AUTHOR]

• Multi-classifying thyroid disease leads to enhanced diagnostic decision-making. • Ultrasound image modalities outperform CT scans regarding CAD detection. • Xception generalizes well to different medical image modalities. • Adoptions of CAD in the clinic need to earn confidence among doctors and patients. [Display omitted] Background and Objective: As one of the largest endocrine organs in the human body, the thyroid gland regulates daily metabolism. Early detection of thyroid disease leads to reduced mortality rates. The diagnosis of thyroid disease is usually made by radiologists and pathologists, which heavily relies on their experience and expertise. To mitigate human false-positive diagnostic rates, this paper proves that deep learning-driven techniques yield promising performance for automatic detection of thyroid diseases which offers clinicians assistance regarding diagnostic decision-making. Method: This research study is the first of its kind, which adopts two pre-operative medical image modalities for multi-classifying thyroid disease types (i.e., normal, thyroiditis, cystic, multi-nodular goiter, adenoma, and cancer). Using the current state-of-the-art performing deep convolutional neural network (CNN) architecture, this study builds a thyroid disease diagnostic model for distinguishing among the disease types. Results: The model obtains unprecedented performance for both medical image sets, and it reaches an accuracy of 0.972 and 0.942 for ultrasound images and computed tomography (CT) scans correspondingly. Conclusion: The experimental results illustrate that the selected CNN can be adapted to both image modalities, indicating the feasibility of the deep learning model and emphasizing its further applications in clinics. [ABSTRACT FROM AUTHOR]

Thyroid nodules, with their high prevalence in the general population, represent a diagnostic challenge for clinicians. Ultrasound (US), although absolutely reliable in detecting thyroid nodules, is still not accurate enough to differentiate them into benign and malignant. A promising novel modality, US elastography, has been introduced in order to further increase US accuracy. The purpose of this review article is to assess the thyroid application of US strain elastography, also known as real-time elastography or quasistatic elastography. We provide a presentation of the technique, and of up-to-date literature, analyzing the most prominent results reported for thyroid nodules differentiation. The practical advantages and limitations of strain elastography are extensively discussed herein. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the diagnostic performance of two-dimensional shear wave elastography (2D-SWE) in distinguishing malignant from benign thyroid nodules. Methods: A total of 331 focal thyroid nodules from 271 patients scheduled for fine-needle aspiration or thyroid surgery were included. After a routine conventional ultrasound evaluation, 2D-SWE examinations were performed to obtain 2D-SWE measurements on a colour-coded mapping, which were then correlated with pathology results. Results: A total of 230 nodules were benign and 101 were malignant on pathology. The areas under the receiver operating characteristic curve (AUC) of mean and minimum values in the largest region of interest (ROI) over the whole nodule, and mean, maximum and minimum values in 2-mm ROI over the stiffest area of the nodule were 0.794, 0.673, 0.808, 0.805 and 0.799, respectively. The most accurate cut-off value, 39.3 kPa, for mean value in a 2-mm ROI achieved 66.3 % sensitivity and 84.4 % specificity to discriminate malignancy. Nodule size correlated with 2D-SWE value for malignant nodules ( P < 0.01). In the group of nodules ≤10 mm, the AUC was 0.730, while it was 0.883 in nodules sized 11-30 mm and 0.821 in nodules >30 mm. Conclusion: 2D-SWE is a promising diagnostic tool for discriminating malignant thyroid nodules, although the performance for nodules ≤10 mm is not satisfactory. Key Points: • 2D-shear wave elastography (2D-SWE) helps differentiate benign nodules from malignancy. • Calcification will increase the 2D-SWE value. • 2D-SWE appears limited in terms of identifying papillary thyroid microcarcinomas accurately. • Combination of 2D-SWE and conventional ultrasound is highly sensitivity for thyroid malignancy. [ABSTRACT FROM AUTHOR]

Background Non-palpable thyroid nodules can be difficult to access by conventional ultrasound-guided fine needle aspiration, particularly when they are intrathoracic. Many of these patients are subject to multiple follow up scans or invasive diagnostic procedures such as mediastinoscopy or surgical resection. We aim to describe the feasibility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for diagnosis of thyroid lesions. Methods All EBUS-TBNA performed at our institutions from February 2010 to February 2013 were screened, and those in which a thyroid biopsy was performed were reviewed. Results We identified 12 cases of EBUS-TBNA thyroid biopsy. Nine patients had an indication for EBUS in addition to their thyroid lesions. The median age was 64 years (range 44 to 84 years), and 10 patients were male. Median lesion size was 22.5 mm (range, 10 to 43 mm). Five lesions were strictly intrathoracic. All cases were sampled with a 22G needle and rapid on-site cytologic examination. Adequate samples were obtained in all 12 cases. Malignancy was identified in 3 of the 12 patients (metastatic breast adenocarcinoma, large B-cell lymphoma, and metastatic lung adenocarcinoma). The remaining 9 samples were deemed to be benign nodules. Seven of these were confirmed by clinical follow-up (n = 3), biopsies (n = 3), or surgery (n = 1). There were no EBUS-related complications. Conclusions EBUS-TBNA might be a safe and effective alternative for sampling thyroid lesions, particularly useful for those located below the thoracic inlet. Further prospective studies are required to compare its diagnostic yield and safety profile with standard techniques. [ABSTRACT FROM AUTHOR]

The thyroid gland was assessed by ultrasound in healthy euthyroid mixed-breed medium size dogs in different age groups. The objective was to verify ultrasonographic imaging patterns in these groups, as well as to identify possi-ble changes in imaging features resulting from ageing. Thirty dogs - 10 young (<1 year), 10 adult and 10 elderly - without clinical signs or history of thyroid gland disease with complete blood count and thyroid function tests within the reference values were evaluated. Each thyroid lobe was examined by ultrasound for shape, size, echogenicity and echotexture. The analysis of echogenicity and echotexture was made by histogram. Thyroid volume was estimated by the equation for ellipsoid (length x width x height) π/6. The thyroid volume of the young dogs in this study had a tendency to be higher than in adult dogs (P = 0.068) and older dogs (P = 0.120). The height of the thyroid lobe in the longitudinal plane was significantly higher (P = 0.026) in young dogs com-pared with the other dogs. The echotexture and echogenicity had no significant differences between groups, but the echogenicity was greater in older dogs. The results point out that ultrasound imaging of the thyroid volume is influenced by age in euthyroid dogs. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the diagnostic utility of PAI at detecting thyroid microcalcifications at 700 nm laser wavelengths. Methods: This study included 36 resected samples in 18 patients. To evaluate the PA manifestation of microcalcifications in PAI, gray level histogram and co-occurrence matrix (COM) texture parameters were extracted from the 3 fixed ROI US and PA images, respectively, per sample. We compared the textural parameters obtained from specimen PAIs between samples with punctate microcalcifications on specimen radiography and those without microcalcifications. Results: On specimen US, the mean value (2748.4±862.5) of samples with microcalcifications on specimen radiography was higher than that (1961.9±780.2) of those without microcalcifications (P = 0.007). However, there were no significant differences in textural parameters obtained from specimen PAIs between samples with punctate microcalcifications on specimen radiography and those without when applying both the mean value of the three slices of thyroid specimens and the value of the thyroid specimen slice which had the highest value of the mean values in specimen US. Conclusion: PAI did not show significant PA contrast on thyroid microcalcifications indicating that the experimental setup and protocols should be enhanced, e.g., method of complete blood rejection from ex vivo specimens, the multi-wavelength spectroscopic PA imaging method which can solely extract the PA signal from microcalcifications even with high spectral interferences, or PA imaging with narrower slice thickness using 2-dimensional array transducer, etc. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the diagnostic performance of quantitative histogram parameters using real-time tissue elastography (RTE) in the diagnosis of patients with diffuse thyroid disease. One hundred and sixteen patients (mean age, 43.7 ± 10.97 y) who had undergone pre-operative staging ultrasonography and RTE were included. For each patient, 11 parameters were obtained from RTE images, from which the "elastic index" was calculated. Diagnostic performance of the elastic index and that of the 11 parameters on RTE were calculated and compared. Of the 116 patients, 31 had diffuse thyroid disease and 85 had normal thyroid parenchyma. Area under the receiver operating characteristic curve (Az) of MEAN (average relative value) elasticity was high (0.737), without significant differences from other elasticity values. Diagnostic performance of the elastic index was higher than the MEAN, Az = 0.753, without significance (p = 0.802). In conclusion, RTE using the elastic index was found to have good diagnostic performance and may be useful in the diagnosis and management of patients with diffuse thyroid disease. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to compare the diagnostic values of thyroid ultrasound (US) and neck computed tomography (CT) in incidentally detecting diffuse thyroid disease (DTD). A single radiologist made US and CT diagnoses of incidentally detected DTD in 130 consecutive patients before thyroidectomy for various malignancies. Histopathologic examinations confirmed normal thyroid (n = 80), Hashimoto thyroiditis (n = 20), non-Hashimoto lymphocytic thyroiditis (n = 28) and diffuse hyperplasia (n = 2). Receiver operating characteristic curves revealed that the best diagnostic indices of both imaging methods were achieved on the basis of two or more abnormal imaging findings. The sensitivity, specificity and accuracy of US and CT in incidentally detecting DTD by this classification were 72% and 72%, 87.5% and 91.3% and 81.5% and 83.8%, respectively. Thyroid US and neck CT have similar diagnostic values for differentiating incidental DTD from normal thyroid. [Copyright &y& Elsevier]

Background. Ultrasound (US) is the most accurate tool in the diagnosis of thyroid nodules if performed by expert physician. Misdiagnosis due to extrathyroidal lesions mimicking thyroid nodules is reported in literature. We describe the first case of an esophageal fibrovascular polyp misdiagnosed as a thyroid nodule on US examination. Patient Findings. A 54-year-old woman presented to emergency department for headache and underwent carotid Doppler extended to neck ultrasound with incidental finding of a nodule in the posterior side of the left thyroid lobe. A following thyroid US performed by an endocrinologist allowed the characterization of the lesion as an esophageal pathology, considering the extrathyroidal position, the typical peripheral hyperechoic spots and hypoechoic rim, the connection to the esophagus, and the swallowing connected movement. The patient was addressed to further investigations and finally to anterior pharyngotomy with histological diagnosis of esophageal fibrovascular polyp. Summary. Differential diagnosis between thyroid nodules and other neck lesions is important to prevent an unnecessary fine needle aspiration biopsy and to treat the extrathyroidal pathology. In this case, an US performed by an expert endocrinologist allowed detecting an esophageal fibrovascular polyp requiring surgical removal. In conclusion, the possibility of an esophageal pathology, and even fibrovascular polyp, should be considered during US thyroid examination. [ABSTRACT FROM AUTHOR]

Thyroid gland infection, although rare, may be a life threatening disease. Thyroid abscess, arising from acute suppurative thyroiditis (AST), is a rare clinic condition depending on widespread use of antibiotics. Infection may involve one or both lobes and abscess formation may not be apparent until late stage of the progress of illness. Thyroid left lobe is more often affected than the right one. Brucellosis, especially obvious in endemic areas, is a widely seen zoonosis around the world. Although brucella infection can affect many organs through various complications, thyroid gland infection is rare. We aimed to present ultrasonography (USG) and magnetic resonance images (MRI) of a case with an acute thyroiditis which rapidly developed and grew fast on the left half of the neck during the first postpartum month. As far as we know from literature reviewing, our case is the first case report of a thyroid abscess arising from brucella infection which is developed in first postpartum period with images of ultrasonography and MRI. [ABSTRACT FROM AUTHOR]

Thyroid hemiagenesis is a rare congenital anomaly in which one lobe of thyroid gland fails to develop. It is much rarer in males. There is a higher incidence of associated thyroid disorders in patients with thyroid hemiagenesis; therefore early and prompt diagnosis is important for children. We present the ultrasonographic and scintigraphic findings of thyroid hemiagenesis in an eight-year-old-boy. On ultrasonography (US), left lobe of the thyroid gland could not be demonstrated and the right lobe showed minimal hyperplasia. Its echogenicity was normal and no nodule was seen. On thyroid scintigraphy, left lobe of thyroid gland or any ectopic thyroid tissue could not be demonstrated, while the right lobe showed minimal hyperplasia. Without performing any invasive procedure, we enrolled the child in a follow-up program with the guidance of US and scintigraphy, which were effective both in making the final diagnosis of thyroid hemiagenesis and in evaluating the current status of the present thyroid tissue. In conclusion, if only one thyroid lobe is detected in a pediatric case initially with US or scintigraphy, the diagnosis of thyroid hemiagenesis should be suggested and, before any unnecessary or invasive attempt, the other complementary method (scintigraphy/US) should be performed. [ABSTRACT FROM AUTHOR]

Background: Thyroid imaging reporting and data system (TIRADS) is the assessment of a risk stratification of thyroid nodules, usually using a score. However, there is no consensus as to the version of TIRADS for reporting the results of thyroid ultrasound in clinic. The objective of this study is to develop a practical TIRADS with which to categorize thyroid nodules and stratify their malignant risk.Methods: A TIRADS scoring system was developed to provide more decision levels than standard scoring through the selection of the ultrasound features which include the calcification shape, margins, taller-than-wide, internal echo, blood flow quantization of features, setting of the weight, and calculation of the score. Ultimately, the accuracy of our TIRADS was evaluated by comparing with the results of current vision of TIRADS and thyroid radiologist in 153 patients who had US-guided fine-needle aspiration biopsy.Results: Classification results showed that the total accuracy reached 97% (100% of malignant and 95% of the benign) in 153 cases (benign:78, malignant:75). The percentages of malignancy is defined in our TIRADS were as follows: TIRADS 2 (0% malignancy), TIRADS 3 (3.6% malignancy), TIRADS 4 (17-75% malignancy), and TIRADS 5 (98% malignancy).Conclusions: We established a novel TIRADS to predict the malignancy risk of the thyroid nodules based on six categories US features by a scoring system, which included a standardized vocabulary and score and a quantified risk assessment. The results showed that objective quantitative classification of thyroid nodules by our TIRADS can be useful in guiding management decisions. [ABSTRACT FROM AUTHOR]

Acute suppurative thyroiditis (ST) is caused by infection of the thyroid gland. Abscess formation in acute ST is a rare, but potentially life-threatening condition. Most patients with acute ST have predisposing conditions. Herein, we report a 24-year-old female who presented on the fifth postpartum day with severe dysphagia, fever, chills, and sore throat. Thyroid hormone levels were consistent with thyrotoxicosis. Based on the clinical, radiological and laboratory findings, ST and abscess caused by Peptostreptococcus was diagnosed. The patient was successfully treated with appropriate antibiotics and ultrasound-guided abscess drainage. Turk Jem 2015; 19: 67-68 [ABSTRACT FROM AUTHOR]

Introduction: Ultrasound scan (USS) is useful in assessing thyroid size and differentiate cystic from solid nodules, but cannot be used to distinguish benign and malignant disease. However there are some US characteristics which favour either benign or malignant lesions and these can be used to select the nodules for fine needle aspiration cytology (FNAC). Objectives: Aim of this study is to evaluate the accuracy of USS with FNAC in diagnosis of thyroid nodules. Materials and Methods: A prospective study was carried out on 100 cases with nodular goitre attending the Base Hospital Kalmunai from May 2015 to June 2016. All patients were underwent USS by a single experienced radiologist and nodule size more than 1 cm were subjected to FNAC. Results: Radiologically, 74% cases were diagnosed as benign thyroid lesion, 19% as malignant and 6% were diagnosed as indeterminate. While on FNAC, 82% were benign thyroid lesions and 12% were malignant, and 5% were indeterminate. The accuracy of USS findings with FNAC for benign, and malignant and indeterminate lesions were 86.2%, 100% and 0% respectively. USS detected all malignant lesions as malignant but it has 36% of false positives in detecting malignant lesions. Conclusion: In the present study, we had concluded that in the diagnosis of thyroid lesions USS is useful guide to select nodules for FNAC with high accuracy for malignant lesions and reasonable accuracy for benign lesions if done by a experienced person. [ABSTRACT FROM AUTHOR]

Objective. To determine the expression of chemokine receptors in lymphocytes from thyroid nodules and peripheral blood in patients with and without Hashimoto's thyroiditis (HT). Patients and Methods. The study included 46 women with thyroid nodules and HT and 60 women with thyroid nodules without HT (controls) who underwent a fine needle aspiration biopsy (FNAB). Expression of chemokine receptors CXCR3, CCR5, and CRTH2 was assessed by flow cytometry in lymphocytes from FNAB samples and from peripheral blood. Results. The percentage of CRTH2+ lymphocytes was higher in nodules with HT in comparison with controls, both in FNAB samples (13.95 versus 6.7%, p = 0.008) and in peripheral blood (6.7 versus 5.13%, p = 0.047), and positively correlated with serum antibodies to thyroid peroxidase (r = 0.243; p = 0.026) and negatively correlated with thyroid volume (r = -0.346; p = 0.008). Lymphocytes from neoplastic nodules showed a higher expression of both CXCR3 and CCR5 than those from hyperplastic ones. Conclusion. Flow cytometry performed in FNAB samples may serve as a good tool in investigation of intrathyroidal expression of immunological parameters. In our study, the CRTH2 expression on thyroid-infiltrating lymphocytes as well as on lymphocytes from peripheral blood was increased in HT as compared to controls. [ABSTRACT FROM AUTHOR]

The thyroid imaging reporting and data system (TIRADS) and Bethesda system for reporting thyroid cytopathology (BSRTC) have been used for interpretation of ultrasound and fine-needle aspiration cytology (FNAC) results of thyroid nodules. BRAFV600E mutation analysis is a molecular tool in diagnosing thyroid carcinoma. Our objective was to compare the diagnostic value of these methods in differentiating high-risk thyroid nodules. Total 220 patients with high-risk thyroid nodules were recruited in this prospective study. They all underwent ultrasound, FNAC and BRAFV600E mutation analysis. The sensitivity and specificity of TIRADS were 73.1% and 88.4%. BSRTC had higher specificity (97.7%) and similar sensitivity (77.6%) compared with TIRADS. The sensitivity and specificity of BRAFV600E mutation (85.1%, 100%) were the highest. The combination of BSRTC and BRAFV600E mutation analysis significantly increased the efficiency, with 97.8% sensitivity, 97.7% specificity. In patients with BSRTC I-III, the mutation rate of BRAFV600E was 64.5% in nodules with TIRADS 4B compared with 8.4% in nodules with TIRADS 3 or 4A (P < 0.001). Our study indicated that combination of BSRTC and BRAFV600E mutation analysis bears a great value in differentiating high-risk thyroid nodules. The TIRADS is useful in selecting high-risk patients for FNAB and patients with BSRTC I-III for BRAFV600E mutation analysis. [ABSTRACT FROM AUTHOR]