Important Role of Ultrasonography Immediately After Fine-Needle Aspiration Biopsy of Thyroid Nodules to Detect Acute Transient Thyroid Swelling.

OBJECTIVE: We aimed to determine whether early detection of acute transient thyroid swelling (ATTS) is possible using ultrasonography (US) surveillance immediately after fine-needle aspiration biopsy (FNAB) and discuss the usefulness of routine US after FNAB. METHODS: We retrospectively evaluated the incidence, clinical features, and US and computed tomography findings of ATTS in patients with thyroid nodules who underwent FNABs at our hospital. The study period was divided into two time periods: only symptomatic patients after FNAB were examined using US in the first period (period A: January 2016 to November 2020), whereas all patients were routinely examined using US shortly after FNAB in the second period (period B: December 2020 to December 2022). RESULTS: We found that the frequency of ATTS increased from 0.18% (10/5,685) in period A to 1.58% (31/1,958) in period B because the majority of ATTS cases in period B were asymptomatic. Follow-up US performed 15 minutes to 3 hours later confirmed no exacerbation of thyroid swelling in patients diagnosed with ATTS during period B. Routine US examinations, shortly after FNAB, significantly reduced the number of return visits after discharge (from 5/10 to 2/31, p=0.006). Furthermore, the incidence of unilateral swelling was higher than previously reported. CONCLUSION: Routine US examinations shortly after FNAB may be useful in identifying ATTS regardless of the presence of symptoms; moreover, they may reduce patients' return visits after leaving the hospital. It is also important to inform patients that delayed complications are possible and that severe cases, although rare, do exist.

[Solitary fibrous tumor in a thyroid follicular adenoma]. / Solitär fibröser Tumor in einem follikulären Adenom der Schilddrüse.

A 28-year-old female patient developed a 5.5 cm progressive thyroid nodule that was surgically removed due to local symptoms. Histologically, a solitary fibrous tumor (SFT) in a thyroid adenoma was diagnosed. The tumor had a specific NAB2-STAT6 fusion.Solitary fibrous tumors rarely occur in the thyroid gland and are described as both primary and secondary manifestations. The diagnosis, prognosis assessment and treatment decision are carried out analogously to SFT of other localizations.

Follicular thyroid carcinoma in an inbred family of mongrel dogs in Trinidad & Tobago.

Thyroid tumors occur in many domestic species, but are most common in the dog, in which they are classified as follicular or medullary. During 2012-2016, we received tissue specimens or whole carcasses of 4 dogs with variable enlargement of the thyroid glands. The 2 males and 2 females were of mixed (mongrel) inbreeding, 3-4.5-y-old. All tumors had lobulated architecture forming follicular structures variably containing colloid. On immunohistochemistry of the tumors from 3 of the dogs, 2 were thyroglobulin positive, and all 3 were negative for calcitonin, confirming follicular thyroid carcinoma in 2 of the dogs. Thyroid carcinomas have not been reported previously in related mongrel dogs, to our knowledge.

Real-world data analysis of next-generation sequencing and corresponding clinical characteristics in thyroid tumor.

Next-generation sequencing (NGS) is of great benefit to clinical practice in terms of identifying genetic alterations. This study aims to clarify the gene background and its influence on thyroid tumors in the Chinese population. NGS data and corresponding clinicopathological features (sex, age, tumor size, extrathyroidal invasion, metastasis, multifocality, and TNM stage) were collected and analyzed retrospectively from 2844 individual thyroid tumor samples from July 2021 to August 2022. Among the cohort, 2337 (82%) cases possess genetic alterations, including BRAF (71%), RAS (4%), RET/PTC (4%), TERT (3%), RET (2.2%), and TP53 (1.4%). Diagnostic sensitivity before surgery can be significantly increased from 0.76 to 0.91 when cytology is supplemented by NGS. Our results show that BRAF-positive papillary thyroid cancer (PTC) patients tend to have older age, smaller tumor size, less vascular invasion, more frequent tumor multifocality, and a significantly higher cervical lymph node metastatic rate. Mutation at RET gene codons 918 and 634 is strongly correlated with medullary thyroid cancer. However, it did not display more invasive clinical characteristics. TERT-positive patients are more likely to have older age, and have larger tumor size, more tumor invasiveness, and more advanced TNM stage, indicating a poor prognosis. Patients with TERT, RET/PTC1, and CHEK2 mutations are more susceptible to lateral lymph node metastasis. In conclusion, NGS can be a useful tool that provides practical gene evidence in the process of diagnosis and treatment in thyroid tumors.

First case report of benign subcutaneous thyroid tissue implantation following transoral endoscopic thyroidectomy vestibular approach (TOETVA).

Background: Following the era of remote access thyroid surgery in the 1990s, several techniques were developed including transoral endoscopic thyroidectomy vestibular approach (TOETVA), which was invented in 2016. TOETVA has gained acceptance and proven comparable results to the conventional open thyroidectomy. Despite the potential complications that may occur as a result of remote access thyroid surgery, such as nerve, vascular, and tracheal injury, seroma, and hypoparathyroidism, there was an extremely rare late complication of a benign subcutaneous thyroid implantation, which have not been reported following TOETVA. Case Description: A 28-year-old female was developed multiple subcutaneous nodules after undergoing right lobe TOETVA for 2 years due to a 3.1 cm benign nodular goiter. The nodules were excised via submandibular incision and the pathological results were shown as benign. Conclusions: Thyroid tissue implantation may result from intracorporeal thyroid tissue rupture, as reported in this research. Extending the vestibular incision to 2-2.5 cm and partially cutting the specimen within the retrieval bag were options to prevent further tissue damage or spillage during specimen extraction. Meanwhile, a separate incision, such as the axillary or submandibular incision, may be required to retrieve the larger nodules. Even though there were no absolute guidelines or contraindications for patient selection in TOETVA, an awareness of tissue breakage should always be considered. The optimal size of the nodule for vestibular removal, which would minimize the risk of tissue breakage, still required additional research.

Recent development on nanomaterial-based biosensors for identifying thyroid tumor biomarkers.

The incidence of thyroid tumors has been increasing yearly over the past decade, making it the fourth highest tumor in women. This places various biological burdens on those affected. Currently, thyroid tumors are primarily diagnosed using percutaneous fine needle aspiration and ultrasound. However, these methods are complex, expensive, and less accurate, and they may fail to detect some thyroid nodules. As an alternative, researchers are focusing on blood-based biomarkers in addition to the traditional diagnostic methods, assisted predominantly by nanomaterials. Early identification of thyroid cancer is crucial as it is highly treatable. Various sensing systems have been developed using nanomaterial-mediated approaches to enhance the detection system. Nanomaterials are effectively applied in biosensors for surface functionalization and are conjugated with biomolecules to improve the interaction with the target analyte. This review discusses nanomaterial-assisted thyroid tumor detection, with a special focus on nanomaterial-based biosensors.

Effect of recombinant human thyroid stimulating hormone on radioactive iodine uptake by thyroid carcinoma in dogs.

BACKGROUND: The high doses of radioiodine-131 (131I) and, subsequently, the high radioactive burden for dog and environment warrants optimization of 131I therapy in dogs with thyroid carcinoma (TC). HYPOTHESIS/OBJECTIVES: To evaluate the effect of a revised protocol with recombinant human thyroid stimulating hormone (rhTSH) on tumor radioactive iodine uptake (RAIU) in dogs with TC. ANIMALS: Nine client-owned dogs diagnosed with TC. METHODS: A prospective cross-over study in which tumor RAIU was calculated and compared at 8 hours (8h-RAIU) and 24 hours (24h-RAIU) after injection of radioactive iodine-123 (123I), once with and once without rhTSH (ie, 250 µg, IM, 24 and 12 hours before 123I) in each dog. Simultaneously, serum total thyroxine (TT4) and TSH were measured at baseline (T0), and 6 (T6), 12 (T12), 24 (T24), and 48 hours (T48) after the first rhTSH administration. RESULTS: Tumor RAIU was significantly higher at 24 hours with rhTSH compared to no rhTSH (mean difference = 8.85%, 95% CI of [1.56; 16.14]; P = .03), while this was non-significant at 8 hours (mean difference = 4.54%, 95% CI of [0.35; 8.73]; P = .05). A significant change of serum TT4 (median difference T24 - T0 = 35.86 nmol/L, interquartile range [IQR] = 15.74 nmol/L) and TSH (median difference T24 - T0 = 1.20 ng/mL, IQR = 1.55 ng/mL) concentrations occurred after administration of rhTSH (P < .001). CONCLUSIONS AND CLINICAL IMPORTANCE: Recombinant human TSH could optimize 131I treatment in dogs with TC by increasing tumor RAIU and thus 131I treatment efficacy.

125I seed implantation for lymph node metastasis from radioactive iodine-refractory differentiated thyroid carcinoma: a study on short-term efficacy and dosimetry.

Objective: To investigate the feasibility and evaluate the safety and effectiveness of Computed Tomography (CT) guided125I radioactive particle implantation for treating lymph node metastases in radioiodine-refractory differentiated thyroid cancer (RAIR-DTC). To verify the accuracy of the computerized three-dimensional treatment planning system (TPS) in treating lymph node metastasis using125I particle implantation at the dosimetric level. Methods: A retrospective analysis was conducted on 42 patients with RAIR-DTC and lymph node metastases who were admitted to the General Hospital of the Northern Theater Command between December 2016 and January 2019. During this analysis, physicians utilized preoperative CT images to design an intraoperative plan using TPS. The dosimetric parameters of the postoperative plan were then compared to the preoperative plan. Additionally, this study examined the changes in tumor size and tumor-related marker Thyroglobulin (Tg) values in patients at 2, 6, and 12 months after the operation. Results: The number of125I radioactive particles implanted in 42 patients was 226, with an average of 14.5 (range 2.0-30.0) particles implanted per lesion. The local remission rates were 97.62% (41/42), 88.10% (37/42), and 85.71% (36/42) at 2, 6, and 12 months postoperatively, respectively. The volume of the lesions was (4.44 ± 1.57) cm3, (4.20 ± 1.70) cm3, and (4.23 ± 1.77) cm3at 2, 6, and 12 months after treatment, respectively, which significantly decreased from the preoperative baseline level of (6.87 ± 1.67) cm3(t-values: 9.466, 9.923, 7.566, all P<0.05). The Tg levels were 15.95 (5.45, 73.93) µg/L, 8.90 (2.20, 39.21) µg/L, and 6.00 (1.93, 14.18) µg/L at 2, 6, and 12 months after treatment, respectively, which were significantly lower than the preoperative baseline levels of 53.50 (20.94, 222.92) µg/L (Z values: -5.258, -5.009, -4.987, all P < 0.001). Postoperatively, Delivered to 90% of the GTV(D90) was slightly lower than the prescribed dose in 95.23% (40/42) of patients, but the difference was not statistically significant [(12,378.8 ± 3,182.0), (12,497.8 ± 1,686.4) cGy; t=0.251, P>0.05], and postoperative dose parameters delivered to 100% of the gross tumor volume (GTV)(D100) (6,881.5 ± 1,381.8) cGy, the volume percentages of GTV receiving 150% of the prescribed dose(V150) (58.5 ± 18.40)%) were lower than the preoperative plan D100 (8,085.8 ± 2,330.0) cGy, V150 (66.5 ± 17.70)%; t-value=8.913 and 3.032, both P<0.05; the remaining indicators were not significantly different from the preoperative plan (the differences in the number of implanted particles, Planning Target Volume(PTV), the volume percentages of GTV receiving 100% of the prescribed dose(V100), Homogeneity Index(HI)were not statistically significant (t/Z = -0.593, -1.604, 1.493, -0.663, all P>0.05). Conclusion: Referring to the TPS preoperative plan, the125I particle implantation therapy for RAIR-DTC lymph node metastasis can achieve the expected dose distribution, ensuring precise short-term local tumor control efficacy.

Subcutaneous implantation after endoscopic and traditional thyroid surgery: a retrospective case report.

Subcutaneous implantation is an unexpected complication of thyroid surgery. Our study aimed to analyze the clinical features and outcomes of implantation after thyroid surgery. We retrospectively searched for the patients with implants of thyroid tumor after surgery from our database prior to August 2023. The clinical and pathological data were reviewed. Six female patients with a mean age of 33.6 ± 13.3 years were enrolled in this study. There was a rare case with mucinous adenocarcinoma, three follicular thyroid carcinoma, and two papillary thyroid carcinoma. The case with primary enteric adenocarcinoma of thyroid with subcutaneous implantation was first reported. The patient with mucinous adenocarcinoma received six courses of TP regimen chemotherapy. Five cases received radioactive iodine therapy. After a mean of 69.5 months of follow-up, one case recurred in the lateral region, and no metastasis or recurrence happened in the other five cases. Although the implantation after thyroid surgery is uncommon, the cases serve as a reminder to take greater care to avoid implantation.

Cancer-associated fibroblast-derived periostin promotes papillary thyroid tumor growth through integrin-FAK-STAT3 signaling.

Background: Periostin (POSTN) is a critical extracellular matrix protein in various tumor microenvironments. However, the function of POSTN in thyroid cancer progression remains largely unknown. Methods: Postn and Rag1 knock-out mice and orthotopic mouse models were used to determine the role of POSTN on papillary thyroid tumor progression. Immunofluorescence, cell co-culture, fluorescence in situ hybridization, chromatin immunoprecipitation assay, recombinant protein and inhibitor treatment were performed to explore the underlying mechanisms of POSTN-promoted papillary thyroid tumor growth. Results: POSTN is up-regulated in papillary thyroid tumors and negatively correlates with the overall survival of patients with thyroid cancer. Cancer-associated fibroblast (CAF)-derived POSTN promotes papillary thyroid tumor growth in vivo and in vitro. POSTN deficiency in CAFs significantly impairs CAF-promoted papillary thyroid tumor growth. POSTN promotes papillary thyroid tumor cell proliferation and IL-4 expression through integrin-FAK-STAT3 signaling. In turn, tumor cell-derived IL-4 induces the activation of CAFs and stimulates POSTN expression by activating STAT6. We reveal the crucial role of CAF-derived POSTN and tumor cell-derived IL-4 in driving the development of papillary thyroid tumors through the POSTN-integrin-FAK-STAT3-IL-4 pathway in tumor cells and IL-4-STAT6-POSTN signaling in CAFs. Conclusion: Our findings underscore the significance of POSTN and IL-4 as critical molecular mediators in the dynamic interplay between CAFs and tumor cells, ultimately supporting the growth of papillary thyroid tumors.

(Pentamethylcyclopentadienyl)chloridoiridium(III) Complex Bearing Bidentate Ph2PCH2CH2SPh-κP,κS Ligand.

The (pentamethylcyclopentadienyl)chloridoiridium(III) complex bearing a κP,κS-bonded Ph2PCH2CH2SPh ligand ([Ir(η5-C5Me5)Cl(Ph2P(CH2)2SPh-κP,κS)]PF6, (1)] was synthesized and characterized. Multinuclear (1H, 13C and 31P) NMR spectroscopy was employed for the determination of the structure. Moreover, SC-XRD confirmed the proposed structure belongs to the "piano stool" type. The Hirshfeld surface analysis outlined the most important intermolecular interactions in the structure. The crystallographic structure was optimized at the B3LYP-D3BJ/6-311++G(d,p)(H,C,P,S,Cl)/LanL2DZ(Ir) level of theory. The applicability of this level was verified through a comparison of experimental and theoretical bond lengths and angles, and 1H and 13C NMR chemical shifts. The Natural Bond Orbital theory was used to identify and quantify the intramolecular stabilization interactions, especially those between donor atoms and Ir(III) ions. Complex 1 was tested on antitumor activity against five human tumor cell lines: MCF-7 breast adenocarcinoma, SW480 colon adenocarcinoma, 518A2 melanoma, 8505C human thyroid carcinoma and A253 submandibular carcinoma. Complex 1 showed superior antitumor activity against cisplatin-resistant MCF-7, SW480 and 8505C cell lines. The mechanism of tumoricidal action on 8505C cells indicates the involvement of caspase-induced apoptosis, accompanied by a considerable reduction in ROS/RNS and proliferation potential of treated cells.

Extension of Multinodular Goiter to the Parapharyngeal Space - a Case Report.

parapharyngeal space can have a mass of thyroid origin following metastasis from the thyroid or ectopic thyroid tissue. The extension of multinodular goiter into the parapharyngeal space is rare. A 54-year-old female presented with a 5-month history of neck mass and dyspnea. On examination, a large mass was seen on the right side of the neck which was bulging into the right parapharngeal. In the sonography, a large 50 × 57 mm cyst seen at the upper end of the right lobe of the thyroid. Computed tomography (CT) identified a 46 × 56 mm lesion medial to the right carotid sheath with a mass effect on the parapharyngeal space from the posterolateral aspect and appeared to be an exophytic cystic nodule arising from the upper pole of the right thyroidal lobe. The patient underwent total thyroidectomy, and the final pathology of multinodular goiter was reported. The spread of masses of the thyroid origin to the parapharyngeal space should be considered one of the differential diagnoses of these space masses.

Possible Markers for Distinguishing benign and Malignant Thyroid Tumors and Predicting Malignancy in Patients with Genetic Predisposition to Cancer.

BACKGROUND: We hypothesized that mutations in several genes disrupt oxidative metabolism, increasing the risk of developing tumors and their malignancy in patients with a family predisposition to cancer. The purpose of our study was to assess the characteristics of oxidative metabolism in patients with malignant and benign tumor with and without a family history of cancer and identify the marker predicting the likelihood of malignancy. METHODS: We conducted a study on patients with thyroid pathology (thyrotoxicosis, benign tumor pathology of the thyroid gland, and thyroid cancer) who underwent treatment at LLC "Oncology Scientific Research Center" in Tbilisi, Georgia between 2020-2021.  In patients' blood the thyroid hormones content, the oxidative metabolism parameters (activity of nonenzymatic antioxidant system (TAA), malondialdehyde (MDA) content),  geometrical and rheological (deformability index (EDI), membrane proteins content) characteristics of erythrocytes were determined. RESULTS: in the patient's blood serum with benign tumor (47 patients) MDA exceeded (p<0.005) and TAA decreased (p<0.005) in comparison to the control level; in patients with thyroid cancer (35 patients), MDA also exceeded (p<0.005), while TAA increased (p<0.005) up to the control level. In patients with benign and malignant tumors, the size of erythrocytes increased compared to the control indicators (p<0.005); in patients with thyroid cancer and benign tumors with a family history of cancer (29 patients) EDI increased (p<0.005), content of GLUT1 in erythrocyte membranes decreased (p<0.005) compared to the control level. CONCLUSIONS: Alterations in redox metabolism play a crucial role in tumor formation; an imbalance between anti-/pro-oxidant systems may contribute to tumor formation and support its progression into a more malignant state. Thyroid cancer is characterized by a reduction in erythrocyte deformability, related to TSH levels. These alterations are less detectable in patients with benign thyroid tumors with a family history of cancer.

A hybrid thyroid tumor type classification system using feature fusion, multilayer perceptron and bonobo optimization.

BACKGROUND: Thyroid tumor is considered to be a very rare form of cancer. But recent researches and surveys highlight the fact that it is becoming prevalent these days because of various factors. OBJECTIVES: This paper proposes a novel hybrid classification system that is able to identify and classify the above said four different types of thyroid tumors using high end artificial intelligence techniques. The input data set is obtained from Digital Database of Thyroid Ultrasound Images through Kaggle repository and augmented for achieving a better classification performance using data warping mechanisms like flipping, rotation, cropping, scaling, and shifting. METHODS: The input data after augmentation goes through preprocessing with the help of bilateral filter and is contrast enhanced using dynamic histogram equalization. The ultrasound images are then segmented using SegNet algorithm of convolutional neural network. The features needed for thyroid tumor classification are obtained from two different algorithms called CapsuleNet and EfficientNetB2 and both the features are fused together. This process of feature fusion is carried out to heighten the accuracy of classification. RESULTS: A Multilayer Perceptron Classifier is used for classification and Bonobo optimizer is employed for optimizing the results produced. The classification performance of the proposed model is weighted using metrics like accuracy, sensitivity, specificity, F1-score, and Matthew's correlation coefficient. CONCLUSION: It can be observed from the results that the proposed multilayer perceptron based thyroid tumor type classification system works in an efficient manner than the existing classifiers like CANFES, Spatial Fuzzy C means, Deep Belief Networks, Thynet and Generative adversarial network and Long Short-Term memory.

Follicular adenoma with a papillary architecture originating from an ectopic thyroid gland: a case report.

BACKGROUND: Follicular adenomas with papillary architecture are rare tumors of thyroid origin and are composed of completely encapsulated follicular cells with a papillary architecture lacking the nuclear characteristics of papillary carcinoma. Herein, we present a case of follicular adenoma with papillary architecture originating from an ectopic thyroid gland, diagnosed from a mass in the submandibular region. CASE PRESENTATION: A 70-year-old woman was referred to our hospital with the chief complaint of a painless left submandibular mass that had been present for one year. The patient underwent left submandibular dissection for therapy and diagnosis. Microscopically, papillary lesions with fibrovascular cores were observed in the interior, and the epithelial cells were cylindrical in shape with eosinophilic cytoplasm, round or oval nuclei, with no pathological features, leading to a diagnosis of papillary carcinoma or follicular carcinoma. The mass was diagnosed as a follicular thyroid adenoma with papillary architecture. This is the first report of a follicular adenoma with a papillary architecture originating from an ectopic thyroid gland. CONCLUSION: This experience suggests that follicular adenoma should be included in the differential diagnosis of ectopic thyroid tumors.

The rights and wrongs of ablation in treating thyroid tumors / 西安交通大学学报(医学版)

This article summarizes the current status of the application of ablation in thyroid tumors with reference to relevant guidelines and expert consensus.The application of ablation in treating benign thyroid tumors has gradually gained maturity in recent years,but the application in malignant thyroid tumors is controversial.Currently,some clinical practices are constantly trying to broaden the application of ablation in treating malignant thyroid tumors.Ablation,which is mainly applied to benign thyroid tumors,has good prognosis and high patient satisfaction.Since this technique cannot avoid the potential recurrence risk of malignant thyroid tumors or eradicate local or distant occult metastases,the indications for the use of ablation in malignant thyroid tumors should be strictly controlled.

Application of Suture Traction Suspension Method in Anterior Chest Approach Endoscopic Thyroid Cancer Radical Surgery / 中国微创外科杂志

Objective To explore the application value of suture traction suspension method in endoscopic thyroid cancer radical surgery through the anterior chest approach.Methods A retrospective analysis was made on 108 cases of papillary thyroid cancer from January 2020 to December 2022,who underwent unilateral lobectomy and ipsilateral central lymph node dissection through anterior chest approach.After May 2021,the suture traction and suspension method was gradually carried out by using 2-0 polypropylene suture to suspend the muscles,trachea,and thyroid gland lobes.There were 51 cases in the suture traction suspension group and 57 cases in the conventional endoscopic group.The intraoperative and postoperative indicators were compared between the two groups.Results The surgery was successfully completed in both groups.As compared to the conventional endoscopic group,the suture traction suspension group had shorter surgical time for thyroidectomy[(35.3±7.3)min vs.(43.4±8.4)min,t =-5.342,P<0.001],shorter surgical time for central lymph node dissection[(20.1±3.5)min vs.(27.7±4.9)min,t =-9.271,P<0.001],less intraoperative bleeding[10(5-15)ml vs.15(5-30)ml,Z =-6.250,P<0.001],and more central lymph nodes dissected[8(3-13)vs.6(4-10),Z =3.272,P =0.001].There were fewer cases of transient recurrent laryngeal nerve injury after surgery in the suture traction suspension group,but no statistical significance was noted(1 case vs.8 cases,χ2 =3.678,P =0.055).There were no statistically significant differences in postoperative hospitalization time,postoperative lymph leakage,parathyroid gland detection in postoperative specimens,postoperative hypoparathyroidism,postoperative pain score,and postoperative cosmetic effect score between the two groups(P>0.05).Conclusion Suture traction suspension method can shorten surgical time,reduce intraoperative bleeding,reduce the occurrence of recurrent laryngeal nerve injury,and increase the number of central lymph node dissection.

Hyperfunctioning papillary thyroid carcinoma - a case report and literature review.

BACKGROUND: Malignant hyperfunctioning thyroid nodules are rare and more likely to occur in follicular cancer types rather than papillary variants. The authors present a case of a papillary thyroid carcinoma associated with a hyperfunctioning nodule. METHODS: A single adult patient submitted to total thyroidectomy with the presence of thyroid carcinoma within hyperfunctioning nodules was selected. Additionally, brief literature was conducted. RESULTS: An asymptomatic 58-year-old male was subjected to routine blood analysis and a TSH level of <0.003 mIU/L was found. Ultrasonography revealed a 21 mm solid, hypoechoic, and heterogenous nodule with microcalcifications in the right lobe. A fine needle aspiration guided by ultrasound resulted in a follicular lesion of undetermined significance. A 99mTc thyroid scintigram was followed and identified a right-sided hyperfunctioning nodule. Another cytology was performed and a papillary thyroid carcinoma was derived as a result. The patient underwent a total thyroidectomy. Postoperative histology confirmed the diagnosis and a tumor-free margin with no vascular or capsular invasions. CONCLUSION: Hyperfunctioning malignant nodules are a rare association, although a careful approach should be led since major clinical implications arise. Selective fine needle aspiration in all suspicious ≥1 cm nodules should be considered.

Pitfalls in Thyroid Fine-Needle Aspiration Cytopathology: An Approach to Atypical Findings.

BACKGROUND: Thyroid nodules are prevalent among the general population, thus imposing substantial demands upon healthcare providers to establish effective management paradigms when investigating these lesions. A pivotal component in the diagnostic process involves the cytomorphological evaluation of fine-needle aspiration (FNA) specimens extracted from the nodule under scrutiny. This examination serves the critical purpose of enabling a comprehensive assessment for the risk of either a neoplasm or malignancy, thereby providing the clinical team with the requisite information to render decisions regarding potential surgical intervention and/or a structured clinical follow-up. A subset of FNA specimens obtained from the thyroid gland present a vexing challenge for interpretation and cannot be classified based on cytomorphology as either benign or malignant and are classified as "indeterminate" for neoplasm or malignancy. The indeterminate thyroid FNA diagnosis in the third iteration of the Bethesda classification is termed as "atypia of undetermined significance" (AUS). SUMMARY: The thyroid FNA specimens classified as "atypical" constitute a perplexing category, necessitating considerations such as repeated cytological evaluations, supplementary molecular analyses, diagnostic lobectomy, or vigilant surveillance. This review article draws upon the most recent Bethesda classification guidelines and delineates various potential pitfalls encountered during the interpretation of atypia observed in thyroid fine-needle aspiration and histopathologic counterparts. Additionally, it proffers strategic algorithms devised to effectively navigate these diagnostic challenges. KEY MESSAGES: It is important to recognize the value of an integrated approach when triaging AUS lesions, considering various clinical, morphological, and sometimes also immunocytochemical or molecular features.