Increasing diagnostic accuracy for thyroid nodules by an integrated multivariate approach: a methodological study.

OBJECTIVES: Current guidelines for diagnostic management of thyroid nodules are based on a linear approach, using categorial classifications to cluster diagnostic findings and they still lead to unnecessary surgery. A diagnostic scoring system, based on clinical, cytological and ultrasound findings is described. MATERIALS AND METHODS: Two groups of patients (168 and 55 pts) were used to compute a multivariate model and the discriminating threshold by ROC curves. The performance of the derived scoring system was assessed by a simulation on a third group of 60 patients, who had undergone surgery according to current guidelines. RESULTS: The scoring system displayed a sensitivity of 100%, specificity 53.3%, positive and negative predictive values of 68.1% and 100%. According to the scoring system, 16 out of 60 operations would have been saved. CONCLUSIONS: A scoring system can take into account in a more accurate way the full informative content of the fine-grained description of diagnostic and clinical features.

Risk of malignancy from thyroid nodular disease as an element of clinical management of patients with Hashimoto's thyroiditis.

BACKGROUND: Many studies have investigated the association between chronic lymphocytic thyroiditis (CLT) and papillary thyroid carcinoma (PTC), but clinical management of this condition has never been addressed specifically, even in recent guidelines. Surprisingly the likelihood of a nodule as being cancerous in a CLT has never been explicitly expressed in terms of relative risk. METHODS: This study was based on a retrospective analysis of 404 patients undergoing total thyroidectomy. RESULTS: Sixty-nine patients (17.1%) had histological findings of true CLT, and 36.2% had concurrent PTC versus 22.6% of patients in the non-CLT group (p < 0.05), with a tumour risk in the CLT group of ×1.6 (95% CI = 1.21-1.94, likelihood ratio = +1.63). CONCLUSIONS: Patients with CLT and a nodular condition have a ×1.6 increased risk of harbouring a PTC. Moreover, these patients develop multicentric PTC more frequently, and, as a result, total thyroidectomy should always be considered.

[FT3 value is a possible risk indicator for patients undergoing vascular surgery]. / Il valore di FT3 è un possibile indicatore di rischio per pazienti sottoposti a chirurgia vascolare.

A study on 28 patients undergoing vascular surgery was performed with the aims to confirm the postoperative decrease of serum FT3 value, to study the correlation between Euthyroid Sick Syndrome (ESS) and postoperative complications, to detect a possible correlation between markers of severity of atherosclerosis and ESS. A slight but significant decrease in postoperative FT3 value was observed (3.88 +/- 0.73 vs 3.32 +/- 1.07 p < 0.05), while we could not find any difference in pre-postoperative FT4 and TSH values. Six patients developed inflammation-related complications (Systemic Inflammatory Response Syndrome--SIRS) and they all showed a deeper postoperative decrease of FT3 value than non complicated subjects, even if the difference was not statistically significant (1st postop day 3.60 +/- 1.05 vs 2.47 +/- 0.61 p = 0.06). Finally, a strong negative linear correlation was observed between preoperative fibrinogen value and FT3 (r = -0.48). FT3 value could be a good predictor of risk for inflammatory-related postoperative complications. Preoperative FT3 value in patients with atherosclerosis is inversely correlated with markers of inflammation activity, mainly with fibrinogen.

Radiation-induced coronary artery disease.

This report describes three patients who developed myocardial infarction at an untimely age, 4 to 12 years after radiation therapy for Hodgkin's disease. These cases lend credence to the cause and effect relation of such therapy to coronary artery disease.