As the detection of thyroid nodules increases, it is important to differentiate whether thyroid nodules are malignant or not. Ultrasonography-guided fine-needle aspiration cytology is the standard method to diagnose thyroid nodules. Ultrasonographic findings of thyroid nodules can predict the risk of malignancy, and fine-needle aspiration allows the examination of cytopathology of thyroid nodules. However, both are not perfect, with a certain degree of false negative or false positive results. Therefore, we can face thyroid nodules with discordant results of ultrasonographic and fine-needle aspiration findings. In the case of benign features on ultrasonography with malignant cytology, follicular thyroid cancer, follicular variant papillary thyroid cancer, cystic or degenerative changes of thyroid cancer, and thyroiditis are candidates for diagnosis. In contrast, for the nodules with ultrasonographic features of highly suspicious of malignancy but benign cytology, we can consider the possibility of thyroiditis, changes of benign nodule, and cystic changes of thyroid cancer. These various conditions may result in discordant results of ultrasonographic features and fine-needle aspiration cytology, which need special attention not to miss the diagnosis of malignant nodules.
Biopsy, Fine-Needle ; Diagnosis ; Methods ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroiditis ; Ultrasonography

No abstract available.
Adult ; Biomarkers/analysis ; Biopsy ; Diagnosis, Differential ; Female ; Goiter/complications/diagnostic imaging/immunology/*surgery ; Humans ; Immunoglobulin G/*analysis ; Pain/diagnosis/*etiology ; Predictive Value of Tests ; Thyroid Gland/diagnostic imaging/immunology/pathology/*surgery ; *Thyroidectomy ; Thyroiditis/complications/diagnostic imaging/immunology/*surgery ; Treatment Outcome ; Ultrasonography

PURPOSE: The aim of this study was to validate the superior thyroidal artery mean peak systolic velocity (STA-mPSV) as an alternative to other diagnostic parameters in the differentiation of the causes of thyrotoxicosis in Korean patients. METHODS: This study was conducted with newly diagnosed and untreated thyrotoxic patients. Forty patients were diagnosed with Graves disease (GD) and 20 patients with destructive thyroiditis (DT). Another 60 healthy subjects without thyroid disease participated as the control group. Blood samples were taken to evaluate the thyroid function and thyroid autoantibodies (TRAb). Twenty-four hour radioactive iodine uptake (RAIU) scanning was performed to confirm GD or DT. The STA-mPSV was measured using color Doppler ultrasonography. RESULTS: The STA-mPSV was significantly higher in the untreated GD group than in the DT group (GD, 78.96+/-29.04 cm/sec; DT, 29.97+/-14.67 cm/sec; control, 17.55+/-4.99 cm/sec; P<0.001). The area under the curve (AUC) of the STA-mPSV for the differential diagnosis of untreated GD and DT was 0.9506 (optimal cutoff value, 41.3 cm/sec; sensitivity, 95%, 38/40; specificity, 85%, 17/20) in the receiver operating characteristic analysis. The AUC values of the STA-mPSV, RAIU, and TRAb were 0.9506, 1, and 0.9988, respectively (P=0.159). CONCLUSION: In clinical practice, the STA-mPSV has a diagnostic value similar to that of the TRAb and 24-hour RAIU in the differential diagnosis of newly diagnosed Korean thyrotoxic patients.
Area Under Curve ; Arteries* ; Autoantibodies ; Diagnosis, Differential* ; Graves Disease ; Humans ; Iodine ; ROC Curve ; Sensitivity and Specificity ; Thyroid Diseases ; Thyroid Gland* ; Thyroiditis ; Thyrotoxicosis* ; Ultrasonography, Doppler ; Ultrasonography, Doppler, Color

Thyroid imaging is indicated to evaluate congenital hypothyroidism during newborn screening or in cases of a palpable thyroid mass in children and adolescents. This pictorial essay reviews the ultrasonography (US) of thyroid diseases in children and adolescents, including normal thyroid gland development, imaging features of congenital thyroid disorders (dysgenesis, [aplasia, ectopy, hypoplasia], dyshormonogenesis, transient hypothyroidism, thyroglossal duct cyst), diffuse thyroid disease (Grave's disease, Hashimoto's thyroiditis, and suppurative thyroiditis), and thyroid nodules. The primary imaging modalities for evaluating thyroid diseases are US and radionuclide scintigraphy. Additionally, US can be used to guide aspiration of detected nodules.
Adolescent ; Child ; Congenital Hypothyroidism/diagnosis/*ultrasonography ; Female ; Graves Disease/diagnosis/ultrasonography ; Hashimoto Disease/diagnosis/ultrasonography ; Humans ; Hypothyroidism/diagnosis/*ultrasonography ; Infant, Newborn ; Male ; Thyroid Dysgenesis/diagnosis/ultrasonography ; Thyroid Nodule/embryology/*ultrasonography ; Thyroiditis/diagnosis/*ultrasonography

Thyrotoxic periodic paralysis (TPP) is a rare manifestation of hyperthyroidism characterized by muscle weakness and hypokalemia. All ethnicities can be affected, but TPP typically presents in men of Asian descent. The most common cause of TPP in thyrotoxicosis is Graves' disease. However, TPP can occur with any form of thyrotoxicosis. Up to our knowledge, very few cases ever reported the relationship between TPP and painless thyroiditis. We herein report a 25-yr-old Korean man who suffered from flaccid paralysis of the lower extremities and numbness of hands. The patient was subsequently diagnosed as having TPP associated with transient thyrotoxicosis due to painless thyroiditis. The paralytic attack did not recur after improving the thyroid function. Therefore, it is necessary that early diagnosis of TPP due to transient thyrotoxicosis is made to administer definite treatment and prevent recurrent paralysis.
Administration, Oral ; Adult ; Anti-Arrhythmia Agents/therapeutic use ; Humans ; Hypokalemic Periodic Paralysis/*diagnosis/drug therapy/etiology ; Male ; Organotechnetium Compounds/chemistry/diagnostic use ; Potassium Chloride/therapeutic use ; Propranolol/therapeutic use ; Radiopharmaceuticals/diagnostic use ; Thyroiditis/*complications/radiography/ultrasonography ; Thyrotoxicosis/*diagnosis/etiology

PURPOSE: Thyroid lobectomy is one of the common operative procedures in patients with benign thyroid nodules. The procedure is relatively feasible, but some patients who receive lobectomies have the complications, such as nerve injury, hypocalcemia, and hypothyroidism. We examined the frequency of hypothyroidism and predictable factor following thyroid lobectomy due to benign thyroid nodules. METHODS: Retrospective analysis was carried out on 212 patients who underwent thyroid lobectomy to benign nodules from January 2005 to May 2010. The risk factors, including sex, age at diagnosis, thyroid function test results, existence of thyroiditis, thyroid volume, and results of the preand post-operation thyroid ultrasounds, were analyzed between euthyroidism and hypothyroidism groups. RESULTS: The rate of hypothyroidism was 17%. In the univariate analysis, age, multiplicity of nodules, thyroiditis, preoperative levels of Tg and TSH, and thyroid volume were significantly predictable factors of hypothyroidism. In the multivariate analysis, the significant factors associated with hypothyroidism were being over 40 years old, having a preoperative TSH of more than 2 mlU/L, and having a small thyroid volume. CONCLUSION: Hypothyroidism following lobectomy is not disasterous complication. We should discuss the possibility of postoperative hypothyroidism carefully with patients before operation, especially when we plan to perform lobectomy on the patients who are over 40, have high TSH levels before surgery, or have a small thyroid volume.
Diagnosis ; Disasters ; Humans ; Hypocalcemia ; Hypothyroidism* ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Surgical Procedures, Operative ; Thyroid Function Tests ; Thyroid Gland* ; Thyroid Nodule ; Thyroiditis ; Ultrasonography

PURPOSE: To evaluate the sonographic findings of Hashimoto's thyroiditis and associated nodular lesions. MATERIALS and METHODS: We retrospectively reviewed the sonographic findings of twenty patients who had surgically confirmed Hashimoto's thyroiditis between 1 March 2005, and 26 November 2005. In these patients, we reviewed the sonographic findings of the associated focal nodular lesion. Assessed were size, homogeneity, and echogenicity of the diseased thyroid gland and shape, echogenicity, margin, rim, microcal cification of the associated nodules. Without knowledge of the pathological diagnosis of the nodular lesions, based on the sonographic criteria, the nodules were classified as either malignant or benign. RESULTS: Hashimoto's thyroiditis demonstrates a variety of sonographic findings for size, homogeneity, and echogenicity. Among the nineteen nodules that were sonographically diagnosed and pathologically confirmed, nine papillary cancers, seven nodular hyperplasias, two Huthle cell adenomas, and one focal hyalinized fibrosing nodule were included. All of the nine papillary cancers showed more than one malignant finding such as marked hypoechogenicity, an irregular shape, a taller than wide shape, a spiculated margin, or microcalcifications that were classified as malignant nodulea, and all of the ten benign nodules showed no malignant findings. Circumscribed isoechoic, hyperechoic, or hypoechoic nodules without calcification were classified as bending nodules. CONCLUSION: Hashimoto's thyroiditis demonstrates various findings on a sonographic examination,and associated various benign and malignant lesions. Moreover, a sonographic examination is helpful to differentiate between malignant and benign lesions in Hashimoto's thyroiditis as in the normal thyroid.
Adenoma ; Diagnosis ; Humans ; Hyalin ; Hyperplasia ; Retrospective Studies ; Thyroid Gland* ; Thyroiditis* ; Ultrasonography*

PURPOSE: Hashimoto's thyroiditis is an autoimmune disease involving the thyroid gland that slowly leads to hypothyroidism. In some patients, Hashimoto's thyroiditis can lead to distinct nodule formation in the absence of true neoplasm. We reviewed the diagnostic approach and clinical outcome of thyroid surgery conducted on patients with Hashimoto's thyroiditis presenting as distinct thyroid nodules. METHODS: We performed a retrospective review of the medical records of patients who underwent thyroid surgery for thyroid nodules that showed no evidence of true neoplasm other than Hashimoto's thyroiditis in the final histopathologic diagnosis. RESULTS: Between July 2003 and June 2007, 12 patients in whom the final pathologic diagnosis showed nodular Hashimoto's thyroiditis received a hemithyroidectomy. Six of these patients developed postoperative hypothyroidism. Preoperative fine needle aspiration (FNA) suggested the diagnosis of a benign nodule in 2 patients, follicular neoplasm in 2 patients, Hürthle cell neoplasm in 3 patients, and suspicious malignancies in 3 patients. Two patients had non-diagnostic FNA results. Thyroid scans revealed the presence of cold nodules in 4 out of 5 patients. However, thyroid ultrasonography showed features suggesting benign nodules in all 12 patients. CONCLUSION: Because this study only included patients who underwent surgery, the diagnostic accuracy of each modality cannot be determined based on these results. However, the high incidence of postoperative hypothyroidism suggests that surgical decisions should be made with caution when dealing with patients with Hashimoto's thyroiditis. Additionally, the role of ultrasonography in these patients should be evaluated further.
Autoimmune Diseases ; Biopsy, Fine-Needle ; Diagnosis ; Humans ; Hypothyroidism ; Incidence ; Medical Records ; Retrospective Studies ; Thyroid Gland* ; Thyroid Nodule* ; Thyroidectomy* ; Thyroiditis* ; Ultrasonography

We report here on a rare case of papillary and follicular carcinoma of the thyroid gland that developed in a 31 years old woman who was previously diagnosed with Hashimoto's thyroiditis. Her chief complaint was a palpable neck mass. The antimicrosomal and antithyroglobulin antibody levels were elevated. Ultrasonography of the left thyroid gland revealed a 2.5x2.0 cm sized thyroid nodule. Fine needle aspiration biopsy of the thyroid nodule was done and this was diagnosed as Hashimoto's thyroiditis. There was no evidence of thyroid cancer. After 1 year, thyroid ultrasonography and biopsy were repeated for examining an enlarged thyroid nodule. Total thyroidectomy was then performed. The histopathologic examination revealed that the right and left thyroid glands were in accordance with the diagnosis of papillary and follicular cancer, respectively. Until now, no known case of simultaneous papillary and follicular carcinoma in Hashimoto's thyroiditis has been reported. This case suggests that adequate follow up for Hashimoto's thyroiditis patients with thyroid nodule may help the early detection and management of thyroid cancer.
Adult ; Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Papillary ; Diagnosis ; Female ; Humans ; Neck ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy ; Thyroiditis* ; Ultrasonography

The primary esophageal lymphoma is extremely rare, and shows various morphologic characteristics. Only a single case of mucosa-associated lymphoid tissue (MALT) type lymphoma confined to the esophagus has been reported in the literature. A 61-yr-old man was referred to our hospital for evaluation of an esophageal submucosal tumor (SMT) that had been detected incidentally by endoscopy. He had a history of pulmonary tuberculosis with long-term anti-tuberculosis medication 15 yr before, and also had a history of syphilis, which had been treated one year before. He had been taking a synthetic thyroid hormones for the past 10 months because of an autoimmune thyroiditis. Endoscopy showed a longitudinal round and tubular shaped smooth elevated lesion, which was covered with intact mucosa and located at the mid to distal esophagus, 31 cm to 39 cm from the incisor teeth. Endoscopic ultrasonography (EUS) showed a huge longitudinal growing intermediate- to hypo-echoic mass located in the submucosal layer with internal small, various sized honeycomb-like anechoic lesions suggesting germinal centers. Subsequently, he underwent a surgery, which confirmed the mass as a primary esophageal low-grade B-cell lymphoma of MALT type.
Alcoholism/complications ; Diagnosis, Differential ; Esophageal Neoplasms/pathology* ; Esophageal Neoplasms/radiography ; Esophageal Neoplasms/ultrasonography ; Esophagoscopy ; Gastritis/complications ; Helicobacter Infections/complications ; Hemangioma, Cavernous/diagnosis ; Human ; Incidental Findings ; Lymphoma, Mucosa-Associated Lymphoid Tissue/pathology* ; Lymphoma, Mucosa-Associated Lymphoid Tissue/radiography ; Lymphoma, Mucosa-Associated Lymphoid Tissue/ultrasonography ; Male ; Middle Aged ; Mucous Membrane/pathology ; Neoplasm Invasiveness ; Smoking ; Thyroiditis, Autoimmune/complications