Large, slowly growing, benign thyroid nodules frequently coexist with synchronous thyroid cancers

• Published in: The journal of clinical endocrinology and metabolism Vol. 107; no. 8; pp. e3474 - e3478
• Main Authors: Paparodis, Rodis D, Karvounis, Evangelos, Bantouna, Dimitra, Chourpiliadis, Charilaos, Hourpiliadi, Hara, Livadas, Sarantis, Imam, Shanawaz, Jaume, Juan C
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.08.2022
• Subjects: Cancer; Diagnosis; Health aspects; Medicin och hälsovetenskap; Metastasis; Thyroid cancer; Greece; thyroid nodules; screening; Thyroid cancer
• ISSN: 0021-972X; 1945-7197; 1945-7197
• DOI: 10.1210/clinem/dgac242

Thyroid nodules' size should not be the sole criterion for thyroidectomy, however many patients are still operated for large, or slowly growing nodules. We reviewed the data from two prospectively collected databases of patients undergoing thyroidectomies in tertiary referral centers, in the USA (A) and in Greece (B) over 14 consecutive years. We collected data on the preoperative surgical indication, FNA cytology and surgical pathology.We included subjects operated solely for large or growing thyroid nodules, who did not have any known or presumed thyroid cancer, or high risk for malignancy (FNA suspicious for thyroid cancer, follicular neoplasm, suspicious for follicular neoplasm, FLUS/AUS), family history of thyroid cancer or prior radiation exposure. We reviewed 5523 consecutive cases (A:2711, B:2812). After excluding n=3059 subjects, we included n=2464 subjects in the present analysis. Overall, 533 thyroid cancers were identified (21.3%): 372 (69.8%) microcarcinomas (<1cm), 161 (30.2%) macrocarcinomas (≥1cm). The histology was consistent with papillary cancer (PTC) n=503, follicular cancer (FTC) n=12, Hurthle cell cancer (HCC) n=9, medullary cancer (MTC) n=5, and mixed histology cancers n=4. Only n=47 (1.9%) of our subjects had any form of thyroid cancer in the nodule which led to surgery originally.The cancers were multifocal in n=165 subjects; had extrathyroidal extension in n=61, capsular invasion in n=80, lymph node involvement in n=35 and bone metastasis in n=2 subjects. The risk of synchronous, clinically-important, thyroid cancers is small, but not null in patients with large or growing thyroid nodules. Therefore, more precise preoperative evaluation is needed to separate the patients, who would clearly benefit from thyroid surgery from the vast majority of those who do not need to be operated.