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Can we better advise our patients with nodular thyroid disease?

Published online by Cambridge University Press:  26 April 2023

Orla Busby Open the ORCID record for Orla Busby [Opens in a new window] ,
Claire McArthur ,
Sylvia Wright  and
Omar Hilmi Open the ORCID record for Omar Hilmi [Opens in a new window]
Orla Busby
Affiliation:
School of Medicine, University of Glasgow, Glasgow, Scotland, UK
Claire McArthur
Affiliation:
Department of Radiology, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
Sylvia Wright
Affiliation:
Department of Pathology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
Omar Hilmi*
Affiliation:
Department of Otolaryngology, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
*
Corresponding author: Omar Hilmi; Email: [email protected]
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Abstract

Background

The 2014 British Thyroid Association guidelines acknowledged the value of risk-stratifying thyroid nodules by utilising an ultrasound reporting system (‘U’ classification). This study assessed whether using pre-existing parameters in combination can better stratify patients’ malignancy and completion thyroidectomy risks.

Method

A multicentre, retrospective, observational review identified 936 NHS Greater Glasgow and Clyde patients from pathology records who underwent hemithyroidectomy between 1 January 2014 and 31 December 2019.

Results

A total of 308 patients had thyroid malignancy, 180 (58.4 per cent) progressed to completion thyroidectomy. A nodule classified as ‘U3’ (indeterminate) was associated with a 35.4 per cent chance of malignancy and a 21.6 per cent risk of requiring completion surgery. Amalgamation of ‘U’ score with Thy score enhanced risk prediction. The malignancy rate in U3, Thy-3f nodules was 38 per cent, and 21 per cent required completion surgery. The malignancy and completion thyroidectomy rates were comparatively lower for U3, Thy-3a nodules (22 per cent and 14.3 per cent, respectively).

Conclusion

Combining ultrasound ‘U’ score and Thy score improves pre-operative thyroid nodule risk stratification, leading to better informed patients regarding the risks of malignancy and completion surgery. A move towards an integrated assessment approach should be considered.

Keywords

Ultrasoundradiologypathologythyroidhead and neck cancerclinical audit
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 138 , Issue 1 , January 2024 , pp. 75 - 82
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Omar Hilmi takes responsibility for the integrity of the content of the paper

The paper is based on a presentation to the British Journal of Surgery prize session at the British Association of Endocrine and Thyroid Surgeons’ annual meeting, 7–8 October 2021, Leeds, UK.

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