Levothyroxine (LT4) is commonly prescribed, but there is evidence strongly suggesting that a significant proportion of these patients are on treatment without solid evidence of hypothyroidism. Small trials on treatment discontinuation, did not detect any predictors of success. Therefore, we conducted this study in an attempt to identify predicting factors for successful LT4 withdrawal.

In 802 consecutive patients (83% females, mean age 48 ± 16 years) on LT4 treatment for 8.8 ± 7.3 years without a solid diagnosis of hypothyroidism, therapy was abruptly discontinued. A total of 387 persons were followed up for up to 4 months (group A) and 415 individuals who were euthyroid at 4 months post LT4 discontinuation, were followed up for up to 60 months (group B). Recurrent hypothyroidism was defined if thyrotropin (TSH) level exceeded 4.5mIU/L.

Among the entire cohort, 182 patients (23%) became hypothyroid, 40% of group A and 7% of group B (p < 0.001). The Τhyroid treatment Discrimination Index (T4RxDI), the product of TSH levels multiplied by the daily LT4 dose divided by BMI, was calculated. In group A, successful LT4 withdrawal was strongly indicated by a T4RxDI value < 2.78 (72% sensitivity, 66% specificity), while in group B, the corresponding value was 3.75 (100% sensitivity, 48% specificity).

Our findings reveal considerable overuse of LT4 and propose a T4RxDI product of < 3 as a valuable predictive factor of recurrent hypothyroidism, justifying a treatment discontinuation trial. If hypothyroidism does not resume within 4 months, the risk of developing long-term hypothyroidism is likely to be minimal.

The third edition of The Bethesda System for Reporting Thyroid Cytopathology includes category IV, follicular neoplasm (FN), which is used to classify fine-needle aspirates of thyroid nodules that may correspond to invasive follicular-derived neoplasia other than papillary thyroid carcinoma. This diagnosis is infrequently rendered, and may represent a challenge for pathologists. This review presents a practical approach to FN and its subtype oncocytic follicular neoplasm (OFN). First, minimal criteria for the diagnosis must be achieved, namely sufficient cellularity, architectural features consistent with neoplasia, and follicular cell or oncocytic cytomorphology. Second, select diagnoses that are common or important differential diagnoses for FN or OFN must be ruled out, via a combination of morphological findings and limited ancillary tests, when available. These include follicular nodular disease, parathyroid sampling, metastatic carcinoma, noninvasive follicular thyroid neoplasm with papillary-like nuclear features, medullary thyroid carcinoma, certain subtypes of papillary thyroid carcinoma, and lymphocytic thyroiditis. This approach should allow for a careful selection of cases where diagnostic thyroid lobectomy is an appropriate therapeutic modality.

The preoperative risk stratification of thyroid nodules with indeterminate cytology on fine needle aspiration has been streamlined with the application of molecular diagnostics. Most molecular platforms use genotyping and mRNA or microRNA expression profiling to assign a preoperative cancer risk to thyroid nodules.

In this study, we discuss the general methodology and compare the diagnostic accuracy of 3 commercially available molecular platforms, ThyroSeq, ThyGeNEXT/ThyraMIR, and Afirma, in the evaluation of 1252 cytologically indeterminate thyroid nodules.

Molecular evaluation showed an increased malignancy risk in 28.7% of cases. Of all cases, 209 underwent partial or complete thyroid resection. 34.9% of these resected thyroid nodules were benign and non-neoplastic, 16.3% were benign neoplasms and 48.8% were malignant neoplasms. 5.5% (n = 49) of cases with negative molecular testing were found to have a neoplasm on subsequent thyroid resection. 40.8% of these cases showed benign neoplasms and 59.2% showed a malignant neoplasm.

The ThyroSeq, ThyGeNEXT/ThyraMIR, and Afirma molecular platforms demonstrate similar efficacy in ruling out malignancy in our cohort's cytologically indeterminate thyroid nodules, with sensitivities of 87.5%, 66.7%, and 73.1%, respectively, and negative predictive values of 80.0%, 70.0%, and 66.0%, respectively. Overall performance characteristics of these molecular platforms in our study are inferior to some previously published studies.

Thyroid nodules are frequent in clinical settings, and their diagnosis in adults is growing, with some persons experiencing symptoms. Ultrasound-guided thermal ablation can shrink nodules and alleviate discomfort. Because the degree and rate of lesion absorption vary greatly between individuals, there is no reliable model for predicting the therapeutic efficacy of thermal ablation.

Five convolutional neural network models including VGG19, Resnet 50, EfficientNetB1, EfficientNetB0, and InceptionV3, pre-trained with ImageNet, were compared for predicting the efficacy of ultrasound-guided microwave ablation (MWA) for benign thyroid nodules using ultrasound data. The patients were randomly assigned to one of two data sets: training (70%) or validation (30%). Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC) were all used to assess predictive performance.

In the validation set, fine-tuned EfficientNetB1 performed best, with an AUC of 0.85 and an ACC of 0.79.

The study found that our deep learning model accurately predicts nodules with VRR < 50% after a single MWA session. Indeed, when thermal therapies compete with surgery, anticipating which nodules will be poor responders provides useful information that may assist physicians and patients determine whether thermal ablation or surgery is the preferable option. This was a preliminary study of deep learning, with a gap in actual clinical applications. As a result, more in-depth study should be undertaken to develop deep-learning models that can better help clinics. Prospective studies are expected to generate high-quality evidence and improve clinical performance in subsequent research.

This review focus on the controversial benefits of thyroid hormone suppression therapy (THST) in differentiated thyroid carcinoma (DTC) and its associated risks, highlighting the need for individualized strategies to optimize therapeutic outcomes and guide future research.

A systematic literature search on TSH suppression in DTC over the past 10 years was conducted, prioritizing RCTs, large cohort studies, and non-inferiority trials, with additional references identified from retrieved articles.

Tailored postoperative TSH strategies should consider factors such as risk stratification, treatment modality, histologic subtype, and adverse effect risks. In this context, mechanistic studies offer potential insights that could inform personalized TSH management, though further validation is required. Clinical evidence on THST in DTC remains controversial, particularly for high-risk patients, where support for stringent TSH suppression (<0.1 mU/L) is limited. Data for intermediate-risk DTC are insufficient due to cohort heterogeneity, while TSH suppression in low-risk DTC is largely discouraged. The well-documented adverse effects of excessive THST, including cardiovascular complications and osteoporosis, further provide a strong rationale against its routine use. Additionally, achieving and maintaining target TSH levels in real-world practice remains challenging, underscoring the need for refined approaches.

Current evidence provides limited support for the TSH targets recommended by the 2015 ATA guidelines. Optimizing postoperative TSH management should account for individualized factors, including risk stratification, treatment modalities, histologic subtypes, and susceptibility to adverse effects. Future research should prioritize well-designed studies with clearly defined suppression levels and appropriate confounder adjustments, emphasizing personalized approaches to balance therapeutic benefits and adverse effects.

The incidental discovery of previously unknown strokes on neuroimaging is an opportunity to implement secondary prevention, reducing the risk of recurrent strokes by up to 80%.

To evaluate the prevalence of previously unknown strokes on emergency department (ED) head CT imaging and identify associated patient and imaging factors.

Retrospective study of adult patients receiving head CT (age ≥ 18 years) at three EDs between July and December 2023. Old strokes on CT imaging were categorized as previously known or unknown. Patient and imaging factors associated with unknown strokes were assessed via univariable regression, multivariable regression, and decision tree analysis.

In 21,985 ED encounters with head CT, 869 (4.0%) examinations demonstrated an old stroke (mean age, 74.4 years ± 14.0 [SD]), of which 372 (43%; 1.7% of all CTs) were unknown. Univariable analysis showed that unknown strokes were associated with greater age (odds ratio [OR], 1.03; 95% confidence interval [CI]: 1.02-1.04; P < .001), a single site of old stroke (OR, 2.7; 95% CI: 2.06-3.58; P and < .001), smaller strokes (OR, 1.8, 95% CI: 1.6-2.0, P < .001), as well as gangliocapsular (OR, 2.8; 95% CI: 1.9-4.0; P < .001) and cerebellar location (OR, 2.1; 95% CI: 1.4-3.2; P < .001). Results of further analyses corroborated those of the univariable regression.

More than a third of old strokes on head CT imaging are unknown to patients and clinicians. Capturing this opportunity for secondary prevention could benefit 100,000 to 200,000 patients per year in the United States, based on trends in ED care.

To evaluate the predictive power of ultrasound-based radiomics models for benign thyroid nodules with a volume reduction rate (VRR) of < or ≥75% at 12 months after microwave ablation.

A retrospective study was conducted on 194 individuals with benign thyroid nodules who received ultrasound-guided microwave ablation between November 2019 and June 2023. The clinical and ultrasound features, including age, gender, volume, echogenicity, duration of ablation, and so on were analysed by t-test or chi-square test. Radiomics features were extracted from longitudinal and transverse ultrasound images of the nodules. The features were selected using methods such as least absolute shrinkage and selection operator (LASSO). Radiomics models were established using longitudinal, transverse, and longitudinal + transverse ultrasound images to predict the VRR of benign thyroid nodules after ablation. Decision curve analysis (DCA) and receiver operating characteristic (ROC) curve analysis were used to assess the models' performance.

At 12 months following ablation, the VRR of the nodules was 77.8 ± 19.4% (7.4-98.8%). Statistical analysis revealed that the duration of ablation and the proportion of liquid extracted were significantly correlated with the 12-month VRR (P <0.05). In the radiomics models, Logistic Regression (LR) performed the best. In the training cohorts, the area under the curve (AUC) for the longitudinal, transverse, and combined groups were 0.935, 0.800, and 0.937. The AUC values in the test cohort were 0.820, 0.844, and 0.917.

The radiomics models established based on pre-ablation ultrasound images showed good predictive efficacy for the VRR of nodules at 12 months following ablation. The predictive efficacy is best in the combined group. With the models, we can preoperatively predict patients' prognoses and thereby determine whether to proceed with ablation therapy.

To assess the efficacy and safety of thermal ablation (TA) in managing follicular thyroid neoplasms (FN).

This multicenter retrospective study involved participants diagnosed with FN across nine hospitals, undergoing microwave ablation or radiofrequency ablation from January 2014 to January 2024. Primary outcomes assessed were technical success and disease progression, with secondary outcomes including tumor size and volume changes, complete tumor disappearance, complications, and side effects. Subgroup analyses aimed to identify factors influencing tumor progression and complete disappearance.

The study enrolled 375 patients (mean age: 43.2 years ± 14.9 [standard deviation]; 298 women) with 482 FNs, tracked over an average of 23.6 months, achieving a 100% technical success rate. Disease progression was observed in 4.8% (18/375) of patients, with a local recurrence rate of 3.7% (14/375) and new neoplasm occurrence of 1.1% (4/375). Multifocal neoplasms emerged as an independent risk factor for disease progression (hazard ratio [HR], 3.48; 95% CI, 1.16-10.45; P = 0.026). Tumor volume significantly reduced (P < 0.001), particularly within 1-3 months post-ablation, with complete tumor disappearance observed in 10.4% (39/375) of cases, more likely in tumors smaller than 2 cm (HR, 0.11; 95% CI, 0.06-0.23; P < 0.001). Complications occurred in 2.9% of patients, with major events in 2.1% and minor in 0.8%.

TA is a safe and efficacious method for treating FN, showing low rates of disease progression and complications. Optimal outcomes may be achieved in patients with unifocal FN and neoplasms under 2 cm.

Patient adherence to thyroid-stimulating hormone (TSH) suppression therapy is crucial for optimizing prognosis.

This study aimed to examine the knowledge, attitude, and practice (KAP) toward TSH suppression therapy among patients. This cross-sectional study was conducted at our Hospital between March 2023 and October 2023 and included patients receiving TSH suppression therapy. A self-designed questionnaire was employed to collect their demographic characteristics and KAP. The analysis included 528 valid questionnaires.

The mean knowledge, attitude, and practice scores were 11.66 ± 5.82 (possible range: 0-22), 33.31 ± 4.97 (possible range: 0-40), and 24.46 ± 3.46 (possible range: 0-34), respectively, indicating poor knowledge, favorable attitudes, and moderate practice. The knowledge scores were correlated to the attitude (r=0.399, P<0.001) and practice (r=0.401, P<0.001) scores, while the attitude scores were correlated to the practice scores (r=0.512, P<0.001). The structural equation modeling revealed that knowledge directly influenced attitude (β=0.34, P<0.001) and practice (β=0.13, P<0.001) and indirectly influenced practice through attitude (β=0.10, P<0.001).

Patients receiving TSH suppression therapy in Zhanjiang demonstrated poor knowledge, favorable attitudes, and moderate practices toward TSH suppression therapy.

This study aimed to explore the performance of a model based on Chinese Thyroid Imaging Reporting and Data Systems (C-TIRADS), clinical characteristics, and other ultrasound characteristics for the prediction of Bethesda III/IV thyroid nodules before fine needle aspiration (FNA).

A total of 855 thyroid nodules from 810 patients were included. All nodules underwent ultrasound examination before FNA. All nodules were categorized according to the C-TIRADS criteria and classified into two groups, Bethesda III/IV and non-III/IV thyroid nodules, using cytologic diagnosis as the gold standard. The clinical and ultrasonographic characteristics of the nodules in the two groups were compared, and independent predictors of Bethesda III/IV nodules were determined by univariate and multivariate logistic regression analyses, based on which a prediction model was constructed. The predictive efficacy of the model was compared with that of C-TIRADS alone by sensitivity, specificity, and area under the curve (AUC).

Our study found that the C-TIRADS category, homogeneous echotexture, blood flow signal present, and posterior echo unchanged were independent predictors for Bethesda III/IV thyroid nodules. Based on multiple logistic regression, a predictive model was established: Logit (p)= - 4.213 + 0.965 × homogeneous echotexture+ 1.050 × blood flow signal present + 0.473 × posterior echo unchanged+ 2.859 × C-TIRADS 3 + 2.804 × C-TIRADS 4A + 1.824 × C-TIRADS 4B + 0.919 × C-TIRADS 4C. The AUC of the model among all nodules was 0.746 (95%CI: 0.710-0.782), 0.779 (95%CI: 0.730-0.829) among nodules with a diameter (D) > 10mm, and 0.718 (95%CI: 0.667-0.769) among nodules with D ≤ 10mm, which were significantly higher than that of the C-TIRADS alone.

We developed a predictive model for Bethesda III/IV thyroid nodules that is better for nodules with D > 10mm FNA operators can choose the optimal puncture strategy based on the prediction results to improve the rate of definitive diagnosis of the first FNA of Bethesda III/IV nodules and thus reduce repeat FNA.

The current requirement is to establish the preoperative diagnosis accurately as possible and to achieve an adequate extent of surgery. The aim of this study was to define the preoperative clinical and molecular genetic risks of malignancy in indeterminate thyroid nodules (Bethesda III and IV) and to determine their impact on the surgical strategy.

Prospectively retrospective analysis of 287 patients provided the basis of preoperative laboratory examination, sonographic stratification of malignancy risks and cytological findings. Molecular tests focused on pathogenic variants of genes associated with thyroid oncogenesis in cytologically indeterminate nodules (Bethesda III and IV). The evaluation included clinical risk factors: positive family history, radiation exposure and growth in size and/or number of nodules.

Preoperative FNAB detected 52 cytologically indeterminate nodules (28.7%) out of 181 patients. Postoperative histopathological examination revealed malignancy in 12 cases (23.7%) and there was no significant difference between Bethesda III and IV categories (P=0.517). Clinical risk factors for malignancy were found in 32 patients (61.5%) and the presence of at least one of them resulted in a clearly higher incidence of malignancy than their absence (31.3% vs. 10.0%, respectively). Pathogenic variants of genes were detected in 12/49 patients in Bethesda III and IV, and in 4 cases (33.3%) thyroid carcinoma was revealed. The rate of malignancies was substantially higher in patients with pathogenic variants than in those without (33.3% vs. 16.2%, respectively).

Our experience implies that molecular genetic testing is one of several decision factors. We will continue to monitor and enlarge our patient cohort to obtain long-term follow-up data.

The role of prophylactic central neck dissection (pCND) in differentiated thyroid cancer (DTC) is still controversial.

In a cohort of 274 DTC cN0 patients with a high rate of tumor recurrence, who underwent total thyroidectomy with or without pCND, clinical and histopathological features were retrospectively analyzed.

In our cohort, no clinical or histopathological features are able to predict the presence of central lymph node metastases (CLNM) at diagnosis, which instead represents the only variable significantly associated with a higher risk of long-term tumor relapse, independently from age, sex, BMI and radioiodine treatment (OR=1.03, 95% CI: 1.002-1.074, P<0.05). Moreover, our study demonstrates that pCND does not significantly increase the risk of post-surgical complications.

In our setting, pCND could have a key role in the management of DTC. The risks and benefits of pCND should be evaluated for each population to make the most appropriate therapeutic choice.

The thyroid imaging reporting and data system (TIRADS) was developed as a standard global term to describe thyroid nodule risk features, aiming to address issues such as variability and low reproducibility in nodule feature detection and interpretation by different physicians. The objective of this study is to comprehensively study articles that utilize AI techniques to design and develop decision support systems for classifying thyroid nodule risk on the basis of various TIRADS guidelines from ultrasound images.

This protocol includes five steps: identification of key research questions of the review, descriptions of the systematic literature search strategies, criteria for study inclusion and exclusion, study quality measures, and the data extraction process. We designed a complete search string using PubMed, Scopus, and Web of Sciences to retrieve all relevant English language studies up to January 2024. A PRISMA diagram was constructed, inclusion and exclusion criteria were defined, and after a quality assessment of the included papers, relevant data were extracted. The protocol of this systematic review was registered in the PROSPERO database (CRD42024551311).

We anticipate that our findings will assist researchers in creating higher-quality systems with increased efficiency, reducing unnecessary biopsies, improving the reproducibility and reliability of thyroid nodule diagnostics, and providing good educational opportunities for less experienced physicians.

In this study, a protocol was used for performing a systematic review to evaluate the diagnostic performance and other various aspects used in the design and development of artificial intelligence CAD systems based on various thyroid imaging reporting and data systems (TI-RADSs).

Thyroid nodules are infrequent findings in children, though malignancy rates are higher in this population. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) standardizes the reporting of thyroid fine needle aspiration (FNA) specimens and has become a global reference for assessing the risk of malignancy (ROM) of thyroid nodules. The 2023 update includes pediatric-specific risk predictions and management recommendations. Our study aimed to evaluate the ROM for each Bethesda (BT) category in our pediatric population and compare them with the 2023 TBSRTC update.

This retrospective cohort study studied pediatric patients who underwent FNA from 2008 to 2023 at our tertiary care center. ROM was assessed by comparing each Bethesda category with histology after thyroid surgery or with long-term follow-up data for non-surgical cases. Comparison among our observed ROM and the 2023 TBSRTC was done by assessing whether the mean ROM from the 2023 TBSRTC fell within the 95 % Confidence Intervals (CIs) of our cohort's ROM for each Bethesda category.

165 patients with thyroid nodules underwent FNA and Bethesda system classification. 55 patients were excluded due to incomplete follow-up. Thyroid surgery was required in 58 patients. All Bethesda I nodules were benign, while malignancy rates (ROM) were 10.5 % for Bethesda II, 42.8 % for Bethesda IV, 87.5 % for Bethesda V, and 100 % for Bethesda VI. The mean follow-up was 58,2 months (±41,4 SD, range 6-170 months). The comparison of the ROM in our cohort with the 2023 Bethesda pediatric population reveals notable consistency across all Bethesda categories.

The ROM among patients with Bethesda II, IV, V, and VI was higher than reported in TBSRTC for adults and similar to those published in the 2023 TBSRTC for children. The development of updated pediatric-specific guidelines could have a significant impact on follow-up strategies and therapeutic algorithms.

Prognosis Study.

II (retrospective).

Thyroid cancer is the most prevalent endocrine cancer. The prognosis depends on the type and stage at diagnosis. Thyroid cancer treatments involve surgery, possibly followed by additional therapeutic options such as hormone therapy, radiation therapy, targeted therapy and chemotherapy. Besides the well-known thyroid tumor biomarkers, new circulating biomarkers are now emerging. Advances in genomic, transcriptomic and proteomic technologies have allowed the development of novel tumor biomarkers. This review explores the current literature data to critically analyze the benefits and limitations of routinely measured circulating biomarkers for the diagnosis and monitoring of thyroid cancer. The review also sheds light on new circulating biomarkers, focusing on the challenges of their use in the clinical management of thyroid cancer, underlining the need for the identification of a new generation of circulating biomarkers.

Identifying preoperatively cases of more indolent papillary thyroid carcinoma (PTC)could be of high interest. The aim of this study was to verify previously published data on the prognostic value of fine needle aspiration cytology (FNAC)in PTC, also comparing findings from high-volume (HV)and low-volume (LV)institutions. From January 2022 to June 2024, the institutional database of the endocrinological surgery unit of Sant'Eugenio Hospital (Rome, Italy)was retrospectively reviewed to select patients who underwent thyroid surgery for PTC. To evaluate the prognostic value of presurgical FNAC, all histological features and the ATA risk of the study groups were compared. Later, data of patients entirely managed at our institution, considered as an HV institute, were compared with that of cases operated at our institution following FNAC performed LV centres.The 159 PTC nodules included were classified as TIR3B (20.1%),TIR4 (32.7%),and TIR5 (47.2%).The distribution of FNAC report between HV and LV was different (p = 0.01). The presence of lymph node metastasis (p = 0.004), and peri-thyroid tissue invasion (p = 0.02)increased according to the FNAC category. Significant difference among the three FNAC categories was also observed in PTC subtype (p = 0.006)and Hashimoto's thyroiditis (p = 0.02).In addition, a significant different trend was found in ATA risk assessment, being the risk of recurrence more prevalent according to the FNAC category (p = 0.008). According to the second study aim, the higher prevalence of low-risk cases in TIR3B was confirmed in both HV (p = 0.04) and LV (p = 0.03)subgroups.PTCs with preoperative TIR3B have different histological features and ATA risk assessment with respect to cases with presurgical FNAC of TIR4/5.Particularly, PTC from TIR3B should have a pattern of more indolent cancers. As non-negligible extension, this data is not influenced by the institutional setting with high or low thyroid-FNAC volume.

Background/Objectives: Guidelines for the risk stratification of thyroid nodules are based on certain well-recognized sonographic features of nodules. However, significant variations in reported sensitivity and specificity values are observed due to the overlap of imaging characteristics between benign and malignant nodules. Additionally, differences in ultrasound (US) equipment and the varying experience levels of radiologists performing the imaging procedures contribute to these discrepancies. Inevitably, there are also interobserver differences. The aim of this study was to investigate interobserver agreement on these criteria using the international thyroid imaging reporting and data system (I-TIRADS) thyroid evaluation framework, independently assessed by three residents and one consultant. Methods: We included 393 patients who underwent ultrasound-guided fine needle aspiration biopsy (FNAB) within four months. In each case, longitudinal and transverse video images of the thyroid gland, neck chain, and biopsied nodules were recorded. The evaluations of the parameters defined in the I-TIRADS dictionary were then performed by a radiologist with 15 years of experience and radiology assistants with 3, 3, and 2 years of experience, respectively, blinded to the images, pathology data, and patient demographics. The parameters evaluated included composition, echogenicity, margin, direction of growth, calcification, extension beyond the thyroid, and lymph node. An interobserver comparison between the US lexicon classifications of thyroid nodules was then performed. Results: The results of our study showed that the highest level of consensus was observed in the 'mixed predominantly cystic' classification, indicating a solid consistency between the assessors (κ = 0.729). Conversely, the subcategories 'Solid', 'Mixed Predominantly Solid' and 'Spongiform' showed moderate agreement, while the "Pure Cyst" subcategory exhibited the lowest level of agreement among the assessors (κ = 0.292). Agreement among the three radiology assistants was strong concerning the evaluation of nodule composition, growth direction, and lymph node assessment. In contrast, a moderate level of consensus was noted regarding the assessment of extrathyroidal extension, margins, and echogenicity. Notably, the parameter exhibiting moderate agreement across all readers was the presence of echogenic foci or calcifications. Conclusions: the reproducibility observed in the parameters defined within the lexicon supports its potential to enhance consistency and interobserver agreement in thyroid nodule assessment.

The incidence of thyroid nodules is rapidly increasing worldwide. Raman spectroscopy (RS) is a powerful label-free and non-invasive technique, successfully used for early stage diagnosis. Here, RS is proposed as a tool to investigate the thyroid disease, including neoplasms, through the study of cell oxidative stress (OS), which represents one of the main cancer risk factors. In this study, we enrolled 28 patients, submitted to a first and second thyroid fine needle aspiration (FNA) during follow up. The cytological samples were studied by RS and morphological examination. Typical Raman spectra of thyroid cytological samples are reported and the contribution of oxidized and reduced cytochrome b and c and carotenoids are discussed. On the basis of the evolution of the Raman features over the time lapse between the two FNAs, the 28 patients have been classified into 4 different categories and the most representative case for each category is reported and discussed in detail. For each category, the different Raman intensity ratio between oxidized and reduced cytochromes b and c is reported and associated to different cell OS status, along with the presence of carotenoids. Overall, our results support a correlation among changes in oxidative stress, carotenoids uptake and thyroid diseases, which could inspire new fundamental research on biomarkers and signaling pathways involved in thyroid OS.

Several ultrasound-based risk stratification systems (RSSs) have been developed and introduced into clinical practice for managing thyroid nodules. However, there are essential differences among these systems. This study aimed to determine and compare the category-based diagnostic performance of four ultrasound-based risk stratification systems in the detection of thyroid cancer: ACR-TIRADS, ATA, K-TIRADS, and EU-TIRADS.This study included 4238 nodules sampled by fine-needle aspiration biopsy between January 2018 and December 2021. Nodules were classified according to ultrasound imaging features and correlated with biopsy results. The diagnostic success of the risk stratification systems was evaluated and compared.Of the 4238 nodules, 3861 (91.1%) were benign and 376 (8.9%) were malignant. Malignancy was significantly higher in hypoechoic and marked hypoechoic nodules (p=0.001), and solid nodules (p=0.002). For detection of malignancy, areas under the receiving operator characteristics curves were 0.862, 0.850, 0.842, and 0.835 for 2017 ACR-TIRADS, EU-TIRADS, for K-TIRADS, and 2015 American Thyroid Association guidelines, respectively. EU-TIRADS showed the highest sensitivity (91%), whereas ACR-TIRADS had the highest specificity (87%). Compared to other risk stratification systems, ACR-TIRADS resulted in significantly fewer unnecessary biopsies (p=0.009). All RSSs show high diagnostic accuracy and have their own advantages and disadvantages. When selecting an appropriate RSS, the population, the prevalence of the disease, and gender distribution should be considered.

Thyroid nodules are common incidental findings. Most of them are benign, but many unnecessary fine-needle aspiration procedures, core biopsies, and even thyroidectomies or non-invasive treatments have been performed. To improve thyroid nodule characterization, the use of multiparametric ultrasound evaluation has been encouraged by most experts and several societies. In particular, US elastography for assessing tissue stiffness and CEUS for providing insight into vascularization contribute to improved characterization. Moreover, the application of AI, particularly machine learning and deep learning, enhances diagnostic accuracy. Furthermore, AI-based computer-aided diagnosis (CAD) systems, integrated into the diagnostic process, aid in risk stratification and minimize unnecessary interventions. Despite these advancements, challenges persist, including the need for standardized TIRADS, the role of US elastography in routine practice, and the integration of AI into clinical protocols. However, the integration of clinical information, laboratory information, and multiparametric ultrasound features remains crucial for minimizing unnecessary interventions and guiding appropriate treatments. In conclusion, ultrasound plays a pivotal role in thyroid nodule management. Open questions regarding TIRADS selection, consistent use of US elastography, and the role of AI-based techniques underscore the need for ongoing research. Nonetheless, a comprehensive approach combining clinical, laboratory, and ultrasound data is recommended to minimize unnecessary interventions and treatments.

To establish and validate a dual-modal radiomics nomogram from grayscale ultrasound and color doppler flow imaging (CDFI) of cervical lymph nodes (LNs), aiming to improve the diagnostic accuracy of metastatic LNs in differentiated thyroid carcinoma (DTC).

DTC patients with suspected cervical LNs in two medical centers were retrospectively enrolled. Pathological results were set as gold standard. We extracted radiomic characteristics from grayscale ultrasound and CDFI images, then applied lasso (least absolute shrinkage and selection operator) regression analysis to analyze radiomics features and calculate the rad-score. A nomogram based on rad-score, clinical data, and ultrasound signs was developed. The performance of the model was evaluated using AUC and calibration curve. We also assessed the model's diagnostic ability in European Thyroid Association (ETA) indeterminate LNs.

377 DTC patients and 726 LNs were enrolled. 37 radiomics features were determined and calculated as rad-score. The dual-modal radiomics model showed good calibration capabilities. The radiomics model displayed higher diagnostic ability than the traditional ultrasound model in the training set [0.871 (95% CI: 0.839-0.904) vs. 0.848 (95% CI: 0.812-0.884), p<0.01], internal test set [0.804 (95% CI: 0.741-0.867) vs. 0.803 (95% CI: 0.74-0.866), p = 0.696], and external validation cohort [0.939 (95% CI: 0.893-0.984) vs. 0.921 (95% CI: 0.857-0.985), p = 0.026]. The radiomics model could also significantly improve the detection rate of metastatic LNs in the ETA indeterminate LN category.

The dual-modal radiomics nomogram can improve the diagnostic accuracy of metastatic LNs of DTC, especially for LNs in ETA indeterminate classification.

This longitudinal study sought to identify distinct body mass index (BMI) trajectories and investigate the impact of these level-independent BMI trajectories on the prevalence of thyroid nodules (TN).This study encompassed a cohort of 1967 participants from a hospital in China. Utilizing latent class growth mixture modeling (LCGMM), four BMI trajectory groups were identified based on the BMI of individuals without TN from 2017 to 2019. The occurrence of TN in participants was monitored from 2020 to 2021. BMI trajectory classes and age were considered potential risk factors for TN development. After adjusting for covariates, the odds ratios (ORs) of model-estimated BMI levels were confirmed in the 27-50-year age group, ranging from 1.077 (1.000-1.158) to 1.189 (1.072-1.319). Significant associations between model-estimated BMI slope and TN were observed in the 21-47-year-old age group, with ORs varying between 1.270 (1.014, 1.591) and 2.490 (1.004, 6.174). The level-independent BMI trajectories throughout life significantly influenced the risk of TN prevalence. Moreover, controlling BMI growth rate in early adulthood (27-47 years old) emerged as a critical age window for reducing TN prevalence, underscoring its importance in TN prevention strategies.

Over the past millennia, the evaluation and management of thyroid nodules has essentially remained the same with thyroidectomy as the only reliable method to identify malignancy. However, in the last 30 years, technological advances have significantly improved diagnostic management of thyroid nodules. Advances in imaging have allowed development of a reliable risk- based stratification system to identify nodules at increased risk of malignancy. At the same time, sensitive imaging has caused collateral damage to the degree that we are now identifying and treating many small, low risk nodules with little to no clinical relevance.

To review the history of thyroid nodule evaluation with emphasis on recent changes and future pathways.

Literature review and discussion.

Thyroid ultrasound remains the best initial method to evaluate the thyroid gland for nodules. Different risk-of-malignancy protocols have been developed and introduced by different societies, reporting methods have been developed and improved each, with goals of improving the ability to recognize nodules requiring further intervention and minimizing excessive monitoring of those who do not. Once identified, cytological evaluation of nodules further enhances malignancy identification with molecular markers assisting in ruling out malignancies in indeterminate nodules preventing unneeded intervention. And all societies have urged avoidance of overdiagnosis and overtreatment of low-risk cancers of little to no clinical relevance.

In this review, we describe advancements in nodule evaluation and management, while emphasizing caution in overdiagnosing and overtreating low-risk lesions without clinical importance.

Calcitonin (CTN) is a polypeptide hormone consisting of 32 amino acids with a disulfide bridge between position 1 and 7 that is mainly produced by the C-cells of thyroid gland. The measurement of CTN concentrations in blood reflects C-cell activity and is performed in general by immunoassay methods. However, there are analytical, physiological, pharmacological, and pathological factors that can influence results of serum CTN values. Due to the influence of these factors there is a high variability in assay-dependent cutoffs used to discriminate between MTC, C-cell hyperplasia (CCH) and the absence of the pathological impairment of C cells. There is a lot of evidence that the measurement of serum CTN concentrations in patients with thyroid nodules can lead to an earlier diagnosis of MTC or CCH than the exclusive use of imaging procedures and/or fine needle aspiration cytology. Basal CTN concentrations higher than 60-100 pg/mL are highly indicative for the diagnosis MTC. In the range between cutoff and 60 pg/mL CTN, both MTC and HCC may be a relevant diagnosis. Procalcitonin (PCT) and CTN appear to have a comparable diagnostic capability to diagnose MTCs. However, "positive" PCT values more than 50 pg/mL may be reached also in subclinical infections and will lead, therefore, to an overdiagnosis of the tumor. Calcium-stimulated serum CTN concentrations higher than cutoff values could improve diagnostics of MTC but a lack of replicable cutoff values in different studies favors the use of only basal values, currently.

Thermal ablation is widely accepted as an effective and safe method for treating benign thyroid nodules. Many studies reporting short-term results have consistently demonstrated the efficacy and safety of thermal ablation. However, as the clinical application of thermal ablation grows and follow-up periods extend, long-term clinical outcomes of thermal ablation have revealed several issues, including regrowth and diagnosis of malignancy in ablated lesions. In this systematic review, we analyze the long-term clinical outcomes of thyroid thermal ablation, focusing on regrowth, delayed surgery, and the potential for malignancy after thermal ablation and propose solutions to address these unresolved issues and enhance the management of benign thyroid nodules through thermal ablation.

Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor originating from thyroid C cells that produces mainly calcitonin (Ctn) and is used as a tumor marker. MTC can occur either sporadically (75%) or in a hereditary variant (multiple endocrine neoplasia type 2, MEN2) due to germline mutations in the RET proto-oncogene. The discovery of MTC in a patient has several diagnostic implications involving a specific strategy, preoperative evaluation of the tumor marker Ctn and the extent of the disease, classification of MTC as sporadic or hereditary using germline RET testing, screening for associated endocrinopathies in hereditary MTC, and somatic RET testing in sporadic MTC. Elevated Ctn is a highly sensitive and specific tumor marker for the diagnosis and follow-up of MTC. Ctn is directly related to the tumor mass. In patients with nodular thyroid disease, MTC can be diagnosed by Ctn determination. Ctn is an indicator of tumor burden. Patients with confirmed sporadic or hereditary MTC should undergo total thyroidectomy. Depending on the preoperative Ctn value, additional dissection of the lymph nodes in the central and lateral neck compartments should be performed. In MEN 2 patients diagnosed by RET mutation analysis, the timing of prophylactic thyroidectomy depends on the specific RET mutation and Ctn level.

Background: Thyroid cancer is the most common endocrine malignancy, and accurate diagnosis is crucial for effective management. Fine needle aspiration cytology, guided by the Bethesda System for Reporting Thyroid Cytopathology, categorizes thyroid nodules into six categories, with Bethesda III and IV representing indeterminate diagnoses that pose significant challenges for clinical decision-making. Understanding the molecular profiles of these categories may enhance diagnostic accuracy and guide treatment strategies. Methods: This study retrospectively analyzed data from 217 patients with Bethesda III and IV thyroid nodules who underwent ThyroSeq v3 molecular testing followed by thyroid surgery at McGill University teaching hospitals. The analysis focused on the presence of specific molecular mutations, copy number alterations (CNAs), and gene expression profiles (GEPs) within these nodules. The relationship between these molecular findings and the clinico-pathological features of the patients was also examined. Results: This study identified notable differences in the molecular landscape of Bethesda III and IV thyroid nodules. Bethesda IV nodules exhibited a higher prevalence of CNAs and distinct GEPs compared to Bethesda III nodules. Interestingly, the BRAFV600E mutation was found exclusively in Bethesda III nodules, which correlated with more aggressive malignant behavior. These findings underscore the potential of molecular profiling to differentiate between the clinical behaviors of these indeterminate nodule categories. Conclusions: Molecular profiling, including the assessment of CNAs, GEPs, and specific mutations like BRAFV600E, provides valuable insights into the nature of Bethesda III and IV thyroid nodules. The distinct molecular characteristics observed between these categories suggest that such profiling could be instrumental in improving diagnostic accuracy and tailoring treatment approaches, ultimately enhancing patient outcomes in thyroid cancer management.

Papillary thyroid cancer (PTC) is the most frequent thyroid malignancy. Recently, the incidence has become widespread among both male and female individuals worldwide. In this article, we aim to report a 32-year-old Saudi female who presented with a painless lateral neck mass for more than seven months, and on excisional biopsy, was found to have features of PTC. Therefore, the patient underwent total thyroidectomy and central neck dissection with left lateral neck dissection with uneventful recovery, and final histopathology resulted in PTC with two out of thirteen central lymph nodes being positive for metastasis. PTC should always be included in the differential diagnosis when patients present with lateral neck cystic mass. Therefore, an excisional biopsy should be considered even if the fine-needle aspiration (FNA) result was benign.

Thyroid nodules, with a prevalence of almost 25% in the general population, are a common occurrence. Their prevalence varies considerably depending on demographics such as age and sex as well as the presence of risk factors. This article provides a comprehensive overview of the prevalence, risk stratification and current management strategies for thyroid nodules, with a particular focus on changes in diagnostic and therapeutic protocols that have occurred over the past 10 years. Several sonography-based stratification systems (such as Thyroid Imaging Reporting and Data Systems (TIRADS)) might help to predict the malignancy risk of nodules, potentially eliminating the need for biopsy in many instances. However, large or suspicious nodules necessitate cytological evaluation following fine-needle aspiration biopsy for accurate classification. In the case of cytology yielding indeterminate results, additional tools, such as molecular testing, can assist in guiding the management plan. Surgery is no longer the only treatment for symptomatic or malignant nodules: active surveillance or local ablative treatments might be beneficial for appropriately selected patients. To enhance clinician-patient interactions and discussions about diagnostic options, shared decision-making tools have been developed. A personalized, risk-based protocol promotes high-quality care while minimizing costs and unnecessary testing.

To evaluate the prevalence of thyroid dysfunction and its association with possible contributing factors related to diagnosis and treatment in children who received hematopoietic stem cell transplantation (HSCT) in the only national transplant unit in Greece.

This is an observational, retrospective, single center cohort study that included 194 patients (58.6% boys) who survived for at least 1 year following allogeneic HSCT. Conditioning regimens depended upon diagnosis and protocols active at the time of transplantation. Some patients received irradiation, either central nervous system prophylaxis (n = 20), or total body irradiation (TBI) (n = 8). Thyroid gland evaluation included thyroid-stimulating hormone, free thyroxine, thyroid autoantibodies, and sonogram. Univariate and multivariate logistic models were used to examine the association of the above-mentioned factors with hypothyroidism.

The mean age at diagnosis and at bone marrow transplant (BMT) in years was 7.51 ± 0.46 and 7.58 ± 0.36, respectively. The median follow-up time was 4.83 years. Hypothyroidism was detected in 33 cases (17.7%), four of those patients having received TBI. Factors contributing to hypothyroidism as per the multivariate analysis were male sex, [OR: 3.005, 95% CI (1.145-7.890)], irradiation, [OR: 2.876, 95% CI (1.120-7.386)], and years after HSCT [OR: 1.148, 95% CI (1.042-1.266)], while malignancy was identified only in the univariate analysis. The multivariate model presents a good class separation capacity [AUC = 72%, 95% CI (61.4%-82.4%)], Two patients had papillary thyroid cancer, both among children who had received TBI.

These data highlight the fact that male sex and radiotherapy are two independent factors that lead to increased risk for hypothyroidism. Furthermore, the prevalence of hypothyroidism increases with time post HSCT.

The thyroid nodule is a frequent lesion within the thyroid. Its incidence is between 50%-60% and most of them are asymptomatic and benign (90-95%) and its diagnosis is frequently made as an incidental finding. The main objective of their study is to rule out thyroid cancer. Cervical ultrasound is the non-invasive diagnostic technique of choice to study the thyroid gland and its pathology, including the thyroid nodule, as it is the technique with the best cost-benefit ratio. Together with the anamnesis, physical examination, personal and family history and laboratory tests, it enables the first diagnostic approach. Ultrasonography allows the description of thyroid nodules according to their structure, morphology, margins, size,echogenicity, vascularization, calcifications and whether or not there are pathological lymph nodes. Subsequently, the application of risk stratification systems, such as the TI-RADS classification, will make it possible to identify those nodules suspected of having a high risk of malignancy, establishing the indication for FNA, which is decisive for the subsequent therapeutic approach. Ultrasound therefore allows the family physician a quick orientation of the patient with a thyroid nodule, especially useful when there is a high suspicion of malignancy. As it is an operator-dependent technique, acquiring knowledge and skills in its use will increase diagnostic reliability.

Shear wave elastography (SWE) is an ultrasound diagnostic method used to measure tissue stiffness. Since the mechanical properties of tissue involved in the pathological process change, SWE might indicate regions of the examined tissue covered by the disease. It is well documented that SWE helps to differentiate benign and malignant nodules in thyroid glands in adults, however, there are few studies on the application of SWE in thyroid diagnosis in children. The purpose of the study was to assess the application of SWE based on Young's modulus expressed in kPa in the management of thyroid nodules in children and adolescents.

In total, 116 pediatric patients (81 girls and 35 boys) with 168 thyroid nodules were enrolled in the study and qualified for SWE followed by fine needle aspiration biopsy.

According to the result of the cytological examination presented in the Bethesda System, nodules were classified as benign (147 nodules classified as category II according to the Bethesda System) or indeterminate or suspicious (21 nodules classified as categories III, IV, and V according to the Bethesda System). Benign cytological diagnoses were nodular goiter, parenchymal goiter, nodular colloid goiter, or lymphocytic inflammation. Among the indeterminate or suspicious nodules, 15 were diagnosed as category III according to the Bethesda System (atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) in cytology), 1 nodule was diagnosed as category IV according to the Bethesda System (suspicious for follicular neoplasm - oxyphilic cell tumor), and 5 as category V according to the Bethesda System (suspicious for malignancy). There were no significant differences in thyrotropin (TSH) and free thyroxine (fT4) concentrations between the benign and suspicious groups. Patients with benign and indeterminate or suspicious thyroid nodules were of comparable age. Mean SWE in benign nodules was statistically significantly lower than in nodules with indeterminate or suspicious cytology (42.22 ± 16.69 vs. 57.4 ± 24.0 kPa, p=0.0004). Six patients from the indeterminate or suspicious group were revealed to be malignant in the final histopathological examination.

Our results suggest that SWE is a viable diagnostic method, however, it still seems to need some adjustment for pediatric patients.

Although thyroid cancer is an indolent tumor with a favorable prognosis, lymph node metastasis (LNM) serves as a major concern for many patients. Because LNM is strongly correlated with recurrence, distant metastasis, and shortened survival, a precise and timely diagnosis and following appropriate management for LNM are necessary. However, significant challenges still exist in the diagnosis of small LNs (<1 cm in diameter), and their low volume makes it difficult to determine whether they are metastatic or benign. Therefore, the diagnostic technique for these small and indeterminate LNs (siLNs) has been one of the leading research subjects in recent years. The implementation of innovative technologies, such as contrast-enhanced ultrasonography, frozen section, and molecular detection, has brought great progress to the diagnosis of siLNs. Meanwhile, the strategies for managing siLNs in clinical practice have evolved considerably over the past several years, with several appropriate options recommended by guidelines. In this review, we aim to provide a systematic overview of the latest studies and potential evidence about effective approaches for detecting and evaluating siLNs. Furthermore, the following management modalities of siLNs in different situations are well discussed.

The ultrasound examination (USE) feature of taller-than-wide (TTW) shape is highly specific but low sensitive in diagnosis of thyroid carcinoma. Relationships between other USE malignant features (such as irregular margin, ill-defined, markedly hypoechoic, and microcalcification) with histopathological features have been well investigated, while studies about the histopathologic features of TTW shape are rare.

The present study aimed to investigate the histopathological features of thyroid nodules with TTW shapes.

A total of 85 thyroid nodules with TTW were selected from 1680 consecutive patients who underwent thyroid resection. USE features of the nodules, including size, location, boundary, margin, composition, echogenicity, and calcification, were recorded according to the China Thyroid Imaging Reporting and Data System (C-TIRADS). Hypoechoic lesions were further categorized as mild, moderate or markedly hypoechoic lesions. The histological features of the specimens were evaluated according to the arrangement of follicular cells, presence of papillary structures or psammoma bodies, degree of fibrosis, and amount of lymphoid infiltration. Differences in the USE and histological features between benign and malignant nodules were compared.

Among the 85 nodules, 72 (84.71%) were malignant, and 13 (15.29%) were benign. Only echogenicity showed a statistically significant difference between benign and malignant nodules (P=0.003). Apart from microfoci, papillary structures, and psammoma bodies, the degree of fibrosis was also significantly different between benign and malignant tumors (all P<0.05). Regression analysis showed a trend of decreasing nodule echogenicity with increasing fibrosis frequency (odds ratio [OR] = 4.500).

Extensive fibrosis is the most common histopathological feature of thyroid cancer and corresponds to hypoechogenicity in USE. TTW-shaped thyroid nodules are highly suggestive of malignancy, especially those with moderate or markedly hypoechogenicity.

The accurate diagnosis of thyroid nodules with indeterminate cytology, particularly in the atypia of undetermined significance (AUS) category, remains challenging. This study aims to predict the risk of malignancy in AUS nodules by comparing two machine learning (ML) and three conventional logistic regression (LR) models.

A retrospective study on 356 AUS nodules in 342 individuals from 6728 patients who underwent thyroid surgery in 2021. All the clinical, ultrasonographic, and molecular data were collected and randomly separated into training and validation cohorts at a ratio of 7: 3. ML (random forest and XGBoost) and LR (lasso regression, best subset selection, and backward stepwise regression) models were constructed and evaluated using area under the curve (AUC), calibration, and clinical utility metrics.

Approximately 90% (321/356) of the AUS nodules were malignant, predominantly papillary thyroid carcinoma with 68.6% BRAF V600E mutations. The final LR prediction model based on backward stepwise regression exhibited superior discrimination with AUC values of 0.83 (95% CI: 0.73-0.92) and 0.80 (95% CI: 0.67-0.94) in training and validation, respectively. Well calibration, and clinical utility were also confirmed. The ML models showed moderate performance. A nomogram was developed on the final LR model.

The LR model developed using the backward stepwise regression, outperformed ML models in predicting malignancy in AUS thyroid nodules. The corresponding nomogram based on this model provides a valuable and practical tool for personalized risk assessment, potentially reducing unnecessary surgeries and enhancing clinical decision-making.

In recent years, technological innovation have emerged to standardize pathology laboratory processes and reduce the handling of diagnostic samples. Among them is an automatic tissue embedding system that eliminates the need for manual activity in tissue paraffin embedding, thereby improving sample preservation. Unfortunately, this system cannot be used for cytological specimens due to the lack of an effective holder to support the procedure steps. In this study, we evaluated the performance of a commercial polymer matrix to enable and standardize the automatic paraffin embedding of cytological material from different organs and sources. Cytological samples from 40 patients were collected on the matrices and submitted for fully automatic workflow preparation, from formalin fixation until paraffin block, using the Sakura embedding system. Our results demonstrated the feasibility of the automated procedure, from loading cytological sample onto the matrix to obtaining the paraffin cellblock, thereby avoiding manual manipulation of cellular material. All samples resulted adequately processed and paraffin-embedded showing satisfactory tissue permeation by processing reagents, optimal preservation of cytoplasmic and nuclear details, and good quality of staining results on paraffin sections. Automated embedding of cytological samples eliminates the risk of lost specimens, reduces laboratory burden, standardizes procedures, increases diagnostic yield, and ultimately improves patients' management.

This study aimed to evaluate the performance of an integrated risk stratification system (RSS) based on ultrasound (US) RSSs, nodule size, and cytology subcategory for diagnosing malignancy in thyroid nodules initially identified as Bethesda category III on fine-needle aspiration.

This retrospective study was conducted at two institutions and included consecutive patients with Bethesda category III nodules, and final diagnoses confirmed by repeat biopsy or surgery. A total of 320 Bethesda category III nodules (≥1 cm) from 309 patients (223 female and 86 male; mean age, 50.9 ± 12.0 years) were included. The malignancy risk of Bethesda category III nodules and predictors of malignancy were assessed according to US RSSs, nodule size, and cytology subcategory. The diagnostic performances of US-size cytology (USC) RSS and US RSS alone for malignancy were compared.

The intermediate or high suspicion US category independently increased the malignancy risk in all US RSSs (P ≤ 0.001). Large nodule size (≥3 cm) independently increased the malignancy risk of low- or intermediate suspicion US category nodules. Additionally, the atypia of undetermined significance cytology subcategory independently increased the malignancy risk of low suspicion US category nodules in most US RSSs. The area under the receiver operating characteristic curve of the USC RSSs was greater than that of the US RSSs alone (P < 0.048). Malignancy was not found in the very low risk category of USC RSS.

The diagnostic performance of USC RSS for malignancy was superior to that of US RSS alone in Bethesda category III nodules. Malignancy can be ruled out in the very low-risk category of USC RSS.

Thyroid nodules are very frequent in the iodine deficiency regions of central Europe and some of the affected patients are referred for definitive treatment, such as surgery and radioiodine treatment. In recent years nonsurgical and non-radioiodine techniques have been introduced to treat thyroid gland pathologies. These techniques include the probe-based techniques of radiofrequency, microwave and laser application. The only noninvasive technique is high-intensity focused ultrasound. All mentioned techniques have the goal to reduce the volume of the thyroid nodule by application of energy/heat. The knowledge of all techniques and their advantages and risks is necessary to help physicians and patients in making decisions for the appropriate method of treatment of thyroid nodules.

The purpose of this study was to evaluate the diagnostic value of ultrasound-guided fine needle aspiration biopsy (US-FNAB) and contrast-enhanced ultrasound (CEUS) in the presence of thyroid nodules of different sizes. We retrospectively analyzed 110 patients with surgically operated unimodular thyroid nodules in Yichang City Central Hospital from July 1, 2021, to April 1, 2023, all of whom underwent conventional thyroid ultrasound, CEUS, and US-FNAB, and all of whom were classified according to the size of nodules into <0.5, 0.5 to 1, and ≥1 cm groups. The diagnostic accuracy, sensitivity, and specificity of the 2 methods for benign and malignant nodules were calculated. Among 110 thyroid nodules, 102 were malignant nodules and 8 were benign nodules. In patients with nodule diameters <1 cm the sensitivity of US-FNAB and CEUS was 87.02% and 93.89%, respectively, and the specificity was 100.00% and 66.67%, with an accuracy of 87.31% and 93.28%, respectively. In patients with nodule diameter <0.5 cm, the sensitivities of US-FNAB and CEUS were 74.29% and 100.00%, respectively, and the differences were statistically significant (P < 0.05); in patients with nodule diameter 0.5 to 1 cm, the sensitivities of US-FNAB and CEUS were 79.59% and 95.92%, respectively, and the differences were statistically significant (P < 0.05); among patients with nodule diameters ≥1 cm, the sensitivities of US-FNAB and CEUS were 88.89% and 77.78%, respectively, with no statistically significant difference (P > 0.05). For thyroid nodules ≤1 cm in diameter, the sensitivity of CEUS examination was higher than that of US-FNAB; and CEUS still has good diagnostic accuracy in the diagnosis of benign and malignant thyroid nodules <0.5 cm, CEUS is recommended for thyroid nodules diagnosed negatively by US-FNAB with a diameter of <1 cm; and CEUS should be preferred for thyroid nodules with a diameter of <0.5 cm. CEUS should be preferred for thyroid nodules <0.5 cm in diameter.

Thermal ablation (TA) is a safe and effective treatment for benign thyroid nodules (BTNs). However, there has been no consensus on the optimal maximum diameter (MD) of BTNs for TA. This study aimed to identify the optimal MD of BTNs for TA based on complete disappearance rate after TA.

This retrospective study included 639 BTNs treated with TA from June 2014 to January 2022. The complete disappearance rate of BTNs after TA was summarized, related influencing factors were explored, and the optimal MD of BTNs for TA was identified.

At the final follow-up (median: 40 months, range: 24-95 months), the overall volume reduction rate was 95.4 ± 9.0%, and 50.5% of the BTNs (323/639) completely disappeared. The MD was significantly negatively correlated with complete disappearance (odds ratio 0.89, 95% confidence interval 0.87-0.92; p < 0.001). Calcification, comet-tail artifacts, multilocular cysts, and composition of BTNs, as well as diabetes were negatively correlated with complete disappearance. Restricted cubic spline indicated that an MD of 25.0 mm was the optimal threshold of BTNs for TA, which was confirmed by subgroup logistic regression analysis. Compared with BTNs with MD ≤ 25.0 mm, those with MD > 25.0 mm had a greater complication rate (6.5% vs. 2.4%, p = 0.012).

The MD of BTNs was negatively correlated with complete disappearance after TA; an MD > 25.0 mm indicated a reduced likelihood of complete disappearance compared with an MD ≤ 25.0 mm. An MD of 25.0 mm is an appropriate threshold of BTNs for TA on the basis of complete disappearance rate.

This study included 468 patients and aimed to use multimodal ultrasound radiomic technology to predict the malignancy of TI-RADS 4-5 thyroid nodules. First, radiomic features are extracted from conventional two-dimensional ultrasound (transverse ultrasound and longitudinal ultrasound), strain elastography (SE), and shear-wave-imaging (SWE) images. Next, the least absolute shrinkage and selection operator (LASSO) is used to screen out features related to malignant tumors. Finally, a support vector machine (SVM) is used to predict the malignancy of thyroid nodules. The Shapley additive explanation (SHAP) method was used to intuitively analyze the specific contributions of radiomic features to the model's prediction. Our proposed model has AUCs of 0.971 and 0.856 in the training and testing sets, respectively. Our proposed model has a higher prediction accuracy compared to those of models with other modal combinations. In the external validation set, the AUC of the model is 0.779, which proves that the model has good generalization ability. Moreover, SHAP analysis was used to examine the overall impacts of various radiomic features on model predictions and local explanations for individual patient evaluations. Our proposed multimodal ultrasound radiomic model can effectively integrate different data collected using multiple ultrasound sensors and has good diagnostic performance for TI-RADS 4-5 thyroid nodules.

Thyroid nodules are a prevalent health issue in society. Interventional radiological methods are successfully applied for both the diagnosis and treatment of nodules. Diagnostically, a fine-needle aspiration biopsy and a core needle biopsy can be performed to ascertain the benign or malignant nature of a lesion. In recent years, imaging-guided percutaneous treatment methods have become popular in the treatment of thyroid nodules. Aspiration, ablation, and embolization are techniques employed in the treatment process. In this study, we aimed to discuss the current role of interventional radiology in the diagnosis and treatment of thyroid nodules, which occupy an important place in clinical practice.

To assess the feasibility, efficacy, and safety of microwave ablation in treating follicular thyroid neoplasms and suspicious follicular thyroid neoplasms.

In this retrospective study, the data of patients treated with microwave ablation for follicular neoplasms from December 2016 to January 2024 were summarized. The changes in nodule size, volume, technical success rate, disease progression, complete tumor resolution, thyroid function, and complications post-ablation were evaluated.

Seventy-four patients (15 men, 59 women; mean age 46.3 ± 15.2 years) with follicular neoplasms were included. Over a median follow-up of 13 months, complete ablation was achieved, giving a 100% technical success rate. At the first month post-ablation, the maximum diameter of nodules showed no significant change (p = 0.287). From the third month, both maximum diameter and volume significantly decreased (p < 0.005 for all). Volume reduction rates remained stable at one and three months (p = 0.389 and 0.06, respectively) but increased significantly thereafter (p < 0.005 for all). By 24 months, the median maximum diameter had reduced from 2.3 cm to 0 cm, achieving a median volume reduction rate of 100%. Nodules disappeared completely in 20.3% (15/74). Local recurrence was noted in 2.7% of cases (2/74), with no metastasis or neoplasm-related deaths reported. Thyroid function remained unchanged post-treatment (p > 0.05). The complication and side effect rates were 8.1% and 4.1%, respectively.

Initial findings suggest microwave ablation is an effective and safe treatment for follicular neoplasms, with low incidences of disease progression and complications, while maintaining thyroid function.