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Review Article
Volume 5 Issue 7 - 2020
The Thyroid Nodule: New Diagnostic and Therapeutic Approaches
Francesco Lippi1* and Antonietta Picone2
1Thyroid Center Diseases, School of Endocrinology, University of Pisa, Pisa, Italy
2Department of Endocrinology, University of Pisa, Pisa, Italy
*Corresponding Author: Francesco Lippi, Thyroid Center Diseases, School of Endocrinology, University of Pisa, Pisa, Italy.
Received: May 20, 2020; Published: June 17, 2020




Abstract

The thyroid nodule is a neoformation that occurs within the thyroid gland in about 1/3 of the population, usually with normal thyroid function. Females are more affected than males (4:1 ratio) in areas with sufficient iodine intake and increases in areas with mild or severe iodine deficiency. The most affected age ranges between 30 and 50 years old, but using the high-resolution ultrasound study its frequency reaches 20-68% of the population and age also decreases, affecting young people. Using a high-resolution ultrasound, the structure of the thyroid nodules can be solid (therefore made up of cells), mixed (partly liquid and partly solid), or completely liquid (cyst). The thyroid nodule can appear in a normal-sized gland or in a goiter; it can be single or multiple, unilateral or bilateral. Elastography exam can be added to improve the diagnosis.The causes of the appearance of a nodule can be familiar, related to the origin area (iodine deficiency), after external been radiations exposure (during pediatric or young age), or ionizing radiation or radioactive fallout, after a trauma in the neck region (hemorrhagic cyst), or from unknown causes. The most frequent diagnostic method for the detection of thyroid nodule is the high-resolution ultrasound with color doppler, which can be performed both for a specific reason, but also randomly for other organs evaluation (breast or neck vessels control). The nature of the thyroid nodule occurs with the fine needle aspiration (FNA) biopsy by ultrasound guide, with the subsequent cytological examination. The pathologist expresses the diagnostic opinion according to an international classification (Bethesda Classification System). For a more in-depth diagnosis, the new molecular biology methods can also be used searching for possible onco-gene modifications. The percentage of benign nodules is prevalent (90%) compared to thyroid carcinomas. Thyroid nodule therapy can only be follow-up or using thyroid hormone suppressive therapy (L-Thyroxine) or surgery. New therapies for nodules reduction, such as laser photocoagulation therapy, the use of radiofrequency and the high intensity focused ultrasound, have recently been introduced. Typically, these techniques are reserved for those patients with absolute or partially contraindications to surgery. The data published in the literature are encouraging, however other studies will be necessary to evaluate their concrete reliability and success in particular in large size nodules.

Keywords: Thyroid Nodule; Fine Needle Aspiration; Follicular Neoplasia; Bethesda Classification System; HIFU; RFA; L-Thyroxine Therapy

References

  1. Durante C., et al. “The Diagnosis and Management of Thyroid Nodules: A Review”. The Journal of the American Medical Association 9 (2018): 914-924.
  2. Haugen B R., et al. “2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer”. Thyroid 1 (2016).
  3. Dean DS and Gharib H. “Epidemiology of Thyroid nodules”. Best Practice and Research Clinical Endocrinology and Metabolism 6 (2008): 901-911.
  4. Tan GH and Gharib H. “Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging”. Annals of Internal Medicine 126 (1997): 226-231.
  5. Guth S., et al. “Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination”. European Journal of Clinical Investigation 39 (2009): 699-706.
  6. Rago T and Vitti, P. “Diagnostic role of ultrasound elastosonography in nodular goiter”. Best Practice and Research Clinical Endocrinology and Metabolism 4 (2014): 519-529.
  7. Magri F., et al. “The role of elastography in thyroid ultrasonography”. Current Opinion in Endocrinology, Diabetes and Obesity 5 (2016): 416-422.
  8. Tuttle M., et al. “Thyroid- differentiated and anaplastic carcinoma”. In: Amin MB, Edge SB, Greene F, Byrd D, Brookland RK, Washington MK, Gershenwald JE, Compton CC, Hess KR, Sullivan DC, Jessup JM, Brierley J, Gaspar LE, Schilsky RL, Balch CM, Winchester DP, Asare EA, Madera M, Gress DM, Meyer LR, (editions) AJCC Cancer Staging Manual. Eighth edition. Springer International Publishing, New York, New York (2017).
  9. Fadda G., et al. “Cytological classification of thyroid nodules. Proposal of SIAPEC-IAP Italian consensus working group”. Pathologica 102 (2010): 405-406.
  10. Wong R., et al. “Thyroid nodules: diagnosis and management”. Medical Journal of Australia 2 (2018): 92-98.
  11. Roth MY., et al. “Molecular testing for thyroid nodules: review an current state”. Cancer 5 (2018): 888-898.
  12. Monzani F., et al. “Percutaneous aspiration and ethanol sclerotherapy for thyroid cysts”. The Journal of Clinical Endocrinology and Metabolism 3 (1994): 800.
  13. Odserya A., et al. “Percutaneous ethanol injection for benign cysts and mixed thyroid nodules”. Endocrine Practice 6 (2018): 548-555.
  14. Kalra N., et al. “Comparison of sonographically guided percutaneous sodium tetradecyl sulfate injection with ethanol injection in the treatment of benign nonfunctioning thyroid nodules”. Journal of Vascular and Interventional Radiology 8 (2014): 1218-1224.
  15. Grussendorf M., et al. “Reduction of thyroid nodule volume by levothyroxine and iodine alone and in combination: a randomized, placebo-controlled trial”. The Journal of Clinical Endocrinology and Metabolism 9 (2011): 2786-2795.
  16. Reverter JL., et al. “Suppressive therapy with levothyroxine for solitary thyroid nodules”. Clinical Endocrinology 1 (1992): 25-28.
  17. Derwal KM. “Medical treatment of thyroid nodule”. Laryngorhinotologie 2 (2018): 89-91.
  18. Noureldine SI and Tufano RP. “Association of Hashimoto’s thyroiditis and thyroid cancer”. Current Opinion in Oncology 1 (2015): 21-25.
  19. Magri F., et al. “Laser photocoagulation therapy for thyroid nodules: long-term outcome and predictors of efficacy”. Journal of Endocrinological Investigation 1 (2020): 95-100.
  20. Lee GM., et al. “Successful radiofrequency ablation strategies for benign thyroid nodules”. Endocrine 2 (2019): 316-321.
  21. Hung-Hin Lang B., et al. “Single-Session High-Intensity Focused Ultrasound Treatment in Large-Sized Benign Thyroid Nodules”. Thyroid 5 (2017): 714-721.
Citation: Francesco Lippi and Antonietta Picone. “The Thyroid Nodule: New Diagnostic and Therapeutic Approaches”. EC Endocrinology and Metabolic Research 5.7 (2020): 11-28.

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