Thyroid Nodules in Severely Obese Patients: Frequency and Risk of Malignancy on Ultrasonography.

Background: We aimed to compare the thyroid ultrasonographic findings of severely obese versus nonobese individuals, and the frequency, characteristics, and risk of malignancy in detected nodules.Design: Case-control study including 67 adults with severe obesity (body mass index [BMI] ≥ 35 kg/m2) and 67 nonobese controls (BMI < 30 kg/m2). The participants underwent ultrasound evaluation of the thyroid and cervical subcutaneous tissue. The risk of malignancy in detected nodules was determined using the American Thyroid Association (ATA) 2015 and the Thyroid Imaging Reporting and Data System (TI-RADS) classifications. Fine-needle aspiration biopsy (FNAB) was performed in nodules for which the procedure was recommended according to the ATA-2015 or TI-RADS criteria, and the cytological evaluation followed the Bethesda classification.Results: The mean BMI values in the case and control groups were 47.0 ± 6.1 kg/m2 and 22.8 ± 2.7 kg/m2, respectively. There were no differences between groups regarding sex, age, total T3, and antiperoxidase (antiTPO) antibody positivity. When compared with controls, severely obese individuals showed a greater frequency of parenchymal hypoechogenicity (p = 0.042), cervical subcutaneous tissue thickness (p < 0.001), overall frequency of thyroid nodules (p = 0.038), and frequency of multiple nodules (p = 0.013). No significant differences were observed in terms of risk of nodular malignancy according to both the ATA-2015 and TI-RADS classifications in severely obese compared with nonobese individuals.Conclusions: Severely obese individuals (versus nonobese controls) presented increased parenchymal hypoechogenicity and frequency of thyroid nodules on ultrasonographic evaluation. However, no significant differences were observed in terms of risk of nodular malignancy between both groups according to the ATA-2015 and TI-RADS criteria. Thus, ultrasonographic thyroid screening of severely obese individuals is not justified.

Sonographic evaluation of the thyroid size in neonates.

PURPOSE: To validate the use of the ratio between the total transverse diameters of the thyroid lobes (Th) and the width of the trachea (Tr)-the Th:Tr or Yasumoto ratio-as a sonographic method for estimating thyroid size, and to determine reference values for this ratio and for thyroid volume in neonates. METHODS: In this cross-sectional study, we evaluated thyroid size according to the Yasumoto ratio and the thyroid volume calculated with the ellipsoid formula in 125 healthy, euthyroid, iodine-sufficient, full-term neonates. RESULTS: The mean thyroid gland volume was 1.00 ml (95% confidence interval, 0.95-1.03 ml), and the mean Yasumoto ratio was 2.29 (95% confidence interval, 2.21-2.31). The lower- and upper-limit results falling within 2 SDs of the mean were 0.45 ml and 1.53 ml for the volume and 1.71 and 2.87 for the ratio. CONCLUSIONS: In full-term, euthyroid, iodine-sufficient neonates, the normal reference interval for thyroid volume measured on sonography was 0.45-1.53 ml and that for the Yasumoto ratio was 1.71-2.87. A ratio of 1.7 may be applied as the cutoff value for sonographic diagnosis of thyroid dysgenesis in full-term neonates with congenital hypothyroidism. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:224-229, 2015.

[Usefulness of ultrasound in the diagnosis and management of well-differentiated thyroid carcinoma]. / Uso da ultra-sonografia no diagnóstico e seguimento do carcinoma bem diferenciado da tireóide.

Thyroid nodules are found in the vast majority of the population, but only 5 to 10% are malignant. Ultrasonography of the thyroid, by virtue of being a straightforward, non-invasive method presenting strong correlation with macroscopic aspects of the thyroid gland, is being increasingly used to identify nodules that present a higher risk of malignancy. The presence of certain ultrasonographic characteristics such as hypoechogenicity, microcalcifications, irregular contours and central vascularization on Doppler, increase the risk of the lesion being malignant. Conversely, nodules presenting benign ultrasonographic characteristics such as hyperechogenicity and a mixed sponge-like aspect, and a concordant cytology, have a negative predictive value of 96.6%. It is, thus, important to examine all nodular lesions and to identify suspicious lesions that need biopsy, especially in multinodular glands. Ultrasonography is also highly sensitive in the identification of suspicious cervical lymph nodes during the follow-up of patients with thyroid carcinoma, even when PCI is negative and serum thyroglobulin (Tg) levels are undetectable. Tg measurement in the needle wash-out content is recommended as this has proven to be more sensitive than cytology in the diagnosis of cervical metastasis, especially where there is liquid content, and it is not affected by the presence of anti-Tg antibodies.

Uso da ultra-sonografia no diagnóstico e seguimento do carcinoma bem diferenciado da tireóide / Usefulness of ultrasound in the diagnosis and management of well-differentiated thyroid carcinoma

Os nódulos tireóideos são encontrados em grande parte da população, mas somente 5 a 10 por cento são malignos. A ultra-sonografia da tireóide, por ser um método simples, não-invasivo e apresentar boa correlação com os aspectos macroscópicos da glândula tireóide, é cada vez mais utilizada para identificar os nódulos que apresentam maior risco de malignidade. A presença de algumas características ultra-sonográficas como hipoecogenicidade, microcalcificações, contornos irregulares e vascularização central ao Doppler, aumenta o risco de malignidade da lesão. Por outro lado, nódulos que apresentam características ultra-sonográficas benignas, como hiperecogenicidade e aspecto misto semelhante a uma esponja, apresentam concordância com a citologia, com valor preditivo negativo de 96,6 por cento. É importante, pois, examinarmos e classificarmos todas as lesões nodulares para selecionarmos aquelas suspeitas para a biópsia, principalmente em uma tireóide multinodular. A ultra-sonografia também apresenta alta sensibilidade para identificar gânglios cervicais suspeitos no seguimento de pacientes com carcinoma da tireóide, mesmo quando a PCI é negativa e a tireoglobulina (Tg) sérica, indetectável. É recomendável a dosagem da Tg no lavado da agulha da punção, pois esta tem-se mostrado mais sensível que a citologia no diagnóstico de metástase cervical, principalmente quando existe conteúdo líquido, e não é afetada pela presença de anticorpos anti-Tg.

Thyroid nodules are found in the vast majority of the population, but only 5 to 10 percent are malignant. Ultrasonography of the thyroid, by virtue of being a straightforward, non-invasive method presenting strong correlation with macroscopic aspects of the thyroid gland, is being increasingly used to identify nodules that present a higher risk of malignancy. The presence of certain ultrasonographic characteristics such as hypoechogenicity, microcalcifications, irregular contours and central vascularization on Doppler, increase the risk of the lesion being malignant. Conversely, nodules presenting benign ultrasonographic characteristics such as hyperechogenicity and a mixed sponge-like aspect, and a concordant cytology, have a negative predictive value of 96.6 percent. It is, thus, important to examine all nodular lesions and to identify suspicious lesions that need biopsy, especially in multinodular glands. Ultrasonography is also highly sensitive in the identification of suspicious cervical lymph nodes during the follow-up of patients with thyroid carcinoma, even when PCI is negative and serum thyroglobulin (Tg) levels are undetectable. Tg measurement in the needle wash-out content is recommended as this has proven to be more sensitive than cytology in the diagnosis of cervical metastasis, especially where there is liquid content, and it is not affected by the presence of anti-Tg antibodies.

Classificação ultra-sonográfica dos nódulos tireóideos segundo o risco de malignidade / Ultrasonographic classification of thyroid nodules according the risk of malignancy

A ultra-sonografia da tireóide, por ser um método simples, não invasivo e apresentar boa correlação com os aspectos macroscópicos dos nódulos tireóideos é um procedimento cada vez mais empregado na avaliação inicial da lesão nodular da tireóide. Nenhum sinal ultra-sonográfico é patognomônico para nódulo maligno mas a associação de algumas características como ausência de halo, presença de microcalcificações, hipoecogenicidade e contornos irregulares, aumenta o risco de malignidade de uma lesão. Dessa forma, o ultra-som pode identificar as lesões nodulares com maior potencial de malignidade, permitindo selecionar nódulos para biópsias em uma tireóide multinodular / Thyroid ultrasound is widely used as the initial work-up in patients with thyroid nodules. This imaging method is easy, noninvasive and very sensitive for detecting subtle variations in thyroid nodule architecture. However, there has been no reliable sonographic signs for distinguishing benign from malignant thyroid conditions. In the case that multiple ultrasonographic abnormalities are simultaneously present in a thyroid nodule, such as absence or an incomplete peripheral halo, internal microcalcifications, hypoechoic pattern and irregular margin, this echographic appeareance may favour the diagnosis of malignancy...