Malignant Thyroid Nodules Less Common But More Aggressive With Age

Erik K. Alexander, MD FACP Chief, Thyroid Section, Division of Endocrinology Brigham & Women's Hospital Associate Professor of Medicine, Harvard Medical School

Dr. Erik Alexander

MedicalResearch.com Interview with:
Dr. Erik K. Alexander, MD FACP
Chief, Thyroid Section, Division of Endocrinology
Brigham & Women’s Hospital
Associate Professor of Medicine, Harvard Medical School

Medical Research: What is the background for this study? What are the main findings?

Dr. Alexander: Thyroid nodular disease has become an increasingly common medical illness, with prevalence reported to range between 26-67% in the adult.  Though advancing age is known to influence the formation of thyroid nodules, their precise relationship remains unclear.  Furthermore, it is uncertain whether age influences the risk that any thyroid nodule may prove cancerous.  Thus we conducted a study to determine the impact of patient age on nodule formation, the number of thyroid nodules, and risk of thyroid malignancy.

Medical Research:  What are the main findings?

Dr. Alexander: Our study is a prospective cohort analysis of consecutive adults who presented for evaluation of nodular disease from 1995-2011 at Brigham and Women’s Hospital, Boston, MA.  6,391 patients underwent thyroid ultrasound and fine needle aspiration that resulted in 12,115 thyroid nodules ≥1 cm.  Patients were stratified into six age groups and compared using sonographic, cytologic, and histologic endpoints.
We found that the prevalence of thyroid nodular disease increases with advancing age.  The mean number of nodules at presentation increased from 1.5 in the youngest cohort (ages 20–30) to 2.2 in the oldest cohort (>70 years).  In contrast, the risk for malignancy in a newly identified nodule declined with advancing age.  Thyroid cancer incidence per patient was 22.9% in the youngest cohort, but 12.6% in the oldest cohort.  Despite a lower likelihood of malignancy, identified cancers in older patients demonstrated a more aggressive cancer subtype.  While nearly all malignancies in younger patients were well-differentiated, older patients were more likely to have higher risk papillary thyroid cancer variants, poorly differentiated cancer, or anaplastic carcinoma.

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Practical Approach to Management of Incidental Thyroid Nodules

Dr. Jenny Hoang MBBS (Hons) Associate Professor of Radiology and Radiation Oncology Duke University Medical CenterMedicalResearch.com Interview with:
Dr. Jenny Hoang MBBS (Hons)

Associate Professor of Radiology and Radiation Oncology
Duke University Medical Center

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Hoang: The incidental thyroid nodule (ITN) is a very common finding on imaging studies of the neck, chest and cervical spine. The workup of incidental thyroid nodules has led to increased costs from additional procedures and in some cases to increased risk to the patient. Physicians are concerned about the risk of malignancy and a delayed cancer diagnosis, but the majority of incidental thyroid nodules are benign and small incidental thyroid malignancies typically have indolent behavior.

The American College of Radiology (ACR) formed the Incidental Thyroid Findings Committee to derive a practical approach to managing ITNs on CT, MRI, nuclear medicine, and ultrasound studies. This white paper describes consensus recommendations representing the Committee’s review of the literature and their practice experience. Continue reading