Nodular goiter (epidemiology and diagnostics)

Thyroid nodules measuring 1cm and more revealed in 27% adult inhabitants of region. Malignant tumors were diag nosed in 2.9% of them. There was increase in the number of people with nodules in the territories exposed to radioactive fallout after Chernobyl accident in comparison to the territories without such pollution – 57.3%/42.4% as well as malignant tumors among them (5.2%/2.7%) Comparison of thyroid palpation and ultrasound in detection of thyroid nodules revealed that thyroid nodules of 10 mm were detected only in every 10th patient by means of pal pation: and nodules of 11–15 mm in every 4th patient, comparing to ultrasound data of the same patients’ group. Malignant tumors were detected on cytology in 2.9% of thyroid nodules less than 2 cm (30171 patients) and in 1.9% of thyroid nodules larger than 2 cm (15 656 patients). At the same time the frequency of regional lymph node metas tases was significantly higher in patients with thyroid nodules larger than 2 cm (34.8%), than in patients with nod ules less than 2 cm – 18.3%. Only one malignant tumor was detected among 358 patients with autonomously func tioning nodules. Risk groups with higher rate of malignancy were patients living in the areas with Chernobyl’s fall out, and patients in whom nodules with “suspicious” sonographic features were revealed (rough edges, capsule inva sion, microcalcifications). Patients with high risk of malignant transformation should be submitted to FNAB regard less of thyroid nodule size. Biopsy is unnecessary for the patients with autonomously functioning nodules detected by scintigraphy.

nodular goiter, thyroid cancer, fineneedle aspiration biopsy

1. Davies L., Welch H.G. Increasing incidence of thyroid cancer in the United States, 19732002. J. Am. Med. Assoc. 2006; 295: 2164–2167.

2. Дедов И.И., Мельниченко Г.А., Фадеев В.В. и др. Клинические рекомендации Российской ассоциации эндокринологов по диагностике и лечению узлового зоба. Пробл. эндокринол. 2005; 51 (5): 40–42.

3. Cooper D.S., Doherty G.M., Haugen B.T. et al. (American Thyroid Association Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer). Revised American Thyroid Association management guidelines for patients with thyroid no dules and differentiated thyroid cancer. Thyroid. 2009; 19: 1167–1214.

4. Gharib H., Papini E., Paschke R. et al. (AACE/AME/ETA Task Force on Thyroid Nodules). American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr. Pract. 2010; 16 (Suppl. 1): 1–43.

5. Moon W.J., Baek J.H., Jung S.L. et al. (Korean Society of Thyroid Radiology [KSThR]; Korean Society of Radiology). Ultrasono graphy and the ultrasoundbased management of thyroid nodules: consensus statement and recommendations. Korean J. Radiol. 2011; 12: 1–14.

6. Семенов А.А. Влияние малых доз ионизирующего облучения на структуру хирургической патологии щитовидной железы в регионе легкого йододефицита. Дисс. … канд. мед. наук. СПб., 2010. 161 с.

7. Бубнов А.Н., Кузьмичев А.С., Гринева Е.Н., Трунин Е.М. Узловой зоб (диагностика, тактика лечения). СПб., 1997. 96 с.

8. Тимофеева Н.И. Современный алгоритм дифференциальной диагностики и оптимизация тактики хирургического лечения у больных с узловыми образованиями щитовидной железы. Дисс. … канд. мед. наук. СПб., 2007. 170 с.

9. Коренев С.В., Плешков В.Г., Тугай В.В. Особенности дооперационной диагностики рака щитовидной железы. Росс. мед. журн. 2005; 3: 13–16.

10. Brander A., Viikinkoski P., Nickels J., Kivisaari L. Thyroid gland: US screening in a random adult population. Radiology. 1991; 181: 683–687.

11. Bonavita J.A., Mayo J., Babb J. et al. Pattern recognition of benign nodules at ultrasound of the thyroid: which nodules can be left alone? Am. J. Roentgenol. 2009; 193: 207–213.

12. Nikiforov Y.E., Thompson P.W., Lester D. Diagnostic pathology and molecular genetics of the thyroid. 1st ed. Lippincott Williams & Wilkins (LWW). 2009.

13. Ali S.Z., Cibas E.S. The Bethesda system for reporting thyroid cytopathology. Definitions, criteria and explanatory notes. NY: Springer, 2010.