Differential Diagnosis of Thyroid Follicular Neoplasm from Nodular Hyperplasia by Shear Wave Elastography

OBJECTIVE: More than 50% of diagnostic surgery in cytologically indeterminate thyroid nodules revealed benign nodules of which nodular hyperplasia (NH) accounted for about half. Preoperative exclusion of NH may decrease diagnostic surgery. We aimed to study the diagnostic performance of shear wave elastography (SWE) to differentiate follicular neoplasm (FN) from NH in follicular lesions of thyroid nodules. METHODS: We analyzed the data from 61 patients who underwent SWE before ultrasound-guided core-needle biopsy (CNB) from August 2016 to May 2018 and CNB results were FN (n=19) and NH (n=42). We analyzed the magnitude of elasticity index (EI) and patterns of high EI area (EI >36 kPa). The patterns of high EI area was classified as marginal pattern (high EI areas are restricted in the outer 1/3 of the nodule) and traversing pattern (high EI areas approaching further to the center of the nodule within inner 2/3 of the nodule). RESULTS: The E(Max), E(Mean), E(SD), and percent of high EI area were significantly lower in FN than NH (P<0.001). The diagnostic performance to predict FN showed sensitivity, specificity, and accuracy of 95%, 90%, and 92% by E(Max) <42.1 kPa, and of 95%, 79%, and 84% by E(Mean) <23.5 kPa, and of 89%, 93%, and 92% by marginal pattern of high EI area, respectively. CONCLUSION: Novel diagnostic criteria of E(Max) less than 42.1 kPa and marginal pattern of high EI area on SWE can predict FN with high diagnostic accuracy, waiving diagnostic surgery of NH in indeterminate cytology.

Utility of shear wave elastography to detect papillary thyroid carcinoma in thyroid nodules: efficacy of the standard deviation elasticity

BACKGROUND/AIMS@#The aim of this study was to address the role of the elasticity index as a possible predictive marker for detecting papillary thyroid carcinoma (PTC) and quantitatively assess shear wave elastography (SWE) as a tool for differentiating PTC from benign thyroid nodules.@*METHODS@#One hundred and nineteen patients with thyroid nodules undergoing SWE before ultrasound-guided fine needle aspiration and core needle biopsy were analyzed. The mean (E(Mean)), minimum (E(Min)), maximum (E(Max)), and standard deviation (E(SD)) of SWE elasticity indices were measured.@*RESULTS@#Among 105 nodules, 14 were PTC and 91 were benign. The E(Mean), E(Min), and E(Max) values were significantly higher in PTCs than benign nodules (E(Mean) 37.4 in PTC vs. 23.7 in benign nodules, p = 0.005; E(Min) 27.9 vs. 17.8, p = 0.034; E(Max) 46.7 vs. 31.5, p < 0.001). The E(Mean), E(Min), and E(Max) were significantly associated with PTC with diagnostic odds ratios varying from 6.74 to 9.91, high specificities (86.4%, 86.4%, and 88.1%, respectively), and positive likelihood ratios (4.21, 3.69, and 4.82, respectively). The E(SD) values were significantly higher in PTC than in benign nodules (6.3 vs. 2.6, p < 0.001). E(SD) had the highest specificity (96.6%) when applied with a cut-off value of 6.5 kPa. It had a positive likelihood ratio of 14.75 and a diagnostic odds ratio of 28.50.@*CONCLUSIONS@#The shear elasticity index of E(SD), with higher likelihood ratios for PTC, will probably identify nodules that have a high potential for malignancy. It may help to identify and select malignant nodules, while reducing unnecessary fine needle aspiration and core needle biopsies of benign nodules.

Association between Serum Cystatin C and Vascular Complications in Type 2 Diabetes Mellitus without Nephropathy

BACKGROUND: Recent studies have correlated serum cystatin C (CysC) with vascular complications, but few studies have investigated this correlation in diabetes patients without nephropathy. This study aimed to evaluate if higher serum CysC levels increase the risk for vascular complications in type 2 diabetes mellitus patients with normal renal function or mild renal impairment. METHODS: A total of 806 consecutive patients with type 2 diabetes mellitus who were admitted to the diabetes center of Soonchunhyang University Hospital for blood glucose control were retrospectively reviewed. Patients with nephropathy were excluded. Subjects were categorized into quartiles of serum CysC levels (Q1, ≤0.65 mg/L; Q2, 0.66 to 0.79 mg/L; Q3, 0.80 to 0.94 mg/L; and Q4, ≥0.95 mg/L). RESULTS: The proportion of patients with diabetic retinopathy (DR) (P for trend < 0.001), coronary heart disease (CHD) (P for trend < 0.001), and stroke (P for trend < 0.001) increased across the serum CysC quartiles. After adjustment for confounding factors, the highest serum CysC level remained a significant risk factor for DR (odds ratio [OR], 1.929; 95% confidence interval [CI], 1.007 to 4.144; P=0.040). Compared with Q1, a significant positive association was observed between serum CysC and CHD in Q2 (OR, 7.321; 95% CI, 1.114 to 48.114; P=0.012), Q3 (OR, 6.027; 95% CI, 0.952 to 38.161; P=0.020), and Q4 (OR, 8.122; 95% CI, 1.258 to 52.453; P=0.007). No associations were observed between CysC and stroke after additional adjustment for confounding variables. CONCLUSION: Serum CysC levels are independently associated with DR and CHD, suggesting that CysC may be useful for identifying type 2 diabetes mellitus patients without nephropathy who are at high risk for vascular complications.

Association between Sarcopenia, Sarcopenic Obesity, and Chronic Disease in Korean Elderly

BACKGROUND: It is a very important social issue for Korea to have a healthy old age as an aged society. Aging causes a lot of physical changes, especially sarcopenia. Sarcopenia is defined as a persistent decrease in skeletal muscle and muscle strength. Sarcopenic obesity is a phenomenon in which fat is replaced instead of muscle. The purpose of this study was to examine the prevalence of sarcopenia and sarcopenic obesity in Korean elderly and to analyze the relationship with chronic disease. METHODS: Data from the 2008 to 2011 the Korea National Health and Nutrition Survey were used. A total of 3,492 patients were classified into 3 groups (non-sarcopenia, sarcopenia, sarcopenic obesity), and general, anthropometry, health behavior, nutrient intake and chronic disease status were compared by the statistical analysis. RESULTS: The rate of moderate exercise was significantly lower in the sarcopenia and sarcopenic-obesity group than in the non-sarcopenia group (P=0.007). The sarcopenic obesity group had significantly higher energy (P=0.005), protein (P=0.046) and fat (P=0.001) intake than the sarcopenic group. The sarcopenic-obesity group had the highest ratio of diabetes (P=0.023) and dyslipidemia (P=0.004) in the 3 groups. Compared with the non-sarcopenia group, in the sarcopenia and sarcopenic obesity groups, the odds ratios (ORs) of diabetes was increased by 1.24 and 2.16 while the ORs of dyslipidemia was increased by 1.12 and 1.50, respectively. CONCLUSIONS: Regular exercise and adequate nutrient intake (energy, protein and fat) are essential for the prevention of sarcopenia in Korean elderly, and management of chronic disease in sarcopenic obesity elderly is important.

Triiodothyronine Levels Are Independently Associated with Metabolic Syndrome in Euthyroid Middle-Aged Subjects

BACKGROUND: Recent studies have shown an association between thyroid hormone levels and metabolic syndrome (MetS) among euthyroid individuals; however, there have been some inconsistencies between studies. Here, we evaluated the relationship between thyroid hormone levels and MetS in euthyroid middle-aged subjects in a large cohort. METHODS: A retrospective analysis of 13,496 euthyroid middle-aged subjects who participated in comprehensive health examinations was performed. Subjects were grouped according to thyroid stimulating hormone, total triiodothyronine (T3), total thyroxine (T4), and T3-to-T4 ratio quartile categories. We estimated the odds ratios (ORs) for MetS according to thyroid hormone quartiles using logistic regression models, adjusted for potential confounders. RESULTS: Of the study patients, 12% (n=1,664) had MetS. A higher T3 level and T3-to-T4 ratio were associated with unfavourable metabolic profiles, such as higher body mass index, systolic and diastolic blood pressure, triglycerides, fasting glucose and glycated hemoglobin, and lower high density lipoprotein cholesterol levels. The proportion of participants with MetS increased across the T3 quartile categories (P for trend <0.001) and the T3-to-T4 ratio quartile categories (P for trend <0.001). The multi-variate-adjusted OR (95% confidence interval) for MetS in the highest T3 quartile group was 1.249 (1.020 to 1.529) compared to the lowest T3 quartile group, and that in the highest T3-to-T4 ratio quartile group was 1.458 (1.141 to 1.863) compared to the lowest T3-to-T4 ratio quartile group, even after adjustment for potential confounders. CONCLUSION: Serum T3 levels and T3-to-T4 ratio are independently associated with MetS in euthyroid middle-aged subjects. Longitudinal studies are needed to define this association and its potential health implications.

Consideration of Discrepancy between Needle-Washout Thyroglobulin and Serum Thyroglobulin of Recurrent Papillary Thyroid Cancer

Although the prognosis of papillary thyroid cancer (PTC) is extremely good, locoregional recurrences after initial treatment occur. Thyroglobulin (Tg) is a reliable tumor marker to detect recurrence or persistence of PTC. However, occasionally serum Tg may miss the detection of a recurrence. We report a 54-year-old female presented with hoarseness due to cervical recurrence without concomitant elevation of serum Tg and anti-Tg antibody, in contrast to extremely increased needle-washout Tg, who had undergone a total thyroidectomy and radioiodine ablation as initial therapies for PTC. Several factors causing such discrepancy between needle-washout Tg and serum Tg can be suggested including site of recurrence, volume of tumor, interference by some kind of plasma antibodies other than anti-Tg antibody, and any conformational defect of Tg protein. Among them, the most convincing explanation is that any conformational defect of Tg may lead to impaired secretion of Tg to blood. We suggest that more studies are needed to find the cause for potential mechanisms involved in PTC recurrences without increased serum Tg.