Endocrine Abstracts

Current UK guidelines for thyroid nodules advise a thyroid ultrasound (ThyUSS) with U-Classification with or without Fine Needle Aspiration (FNA) with Thy-Classification to determine malignancy risk. We report four cases where thyroid carcinoma was diagnosed histologically following reassuring cytology and radiological examination. This is a case of 28-year-old female who presented with neck swelling. ThyUSS showed an enlarged left thyroid with cystic and solid components; FNA was Thy2. Surveillance ThyUSS showed additional right-sided nodules without pathological features; FNA was Thy1. The patient opted for thyroidectomy; histology showed two small foci of papillary carcinoma. 53-year-old female referred with a right dominant nodule following ThyUSS; FNA was Thy2. Subsequent ThyUSS showed a mildly hypoechoic, vascularised nodule with peripheric halo; FNA was Thy1. The patient opted for right thyroid lobectomy; histology showed benign follicular nodules with the dominant nodule containing an incidental papillary microcarcinoma. 60-year-old female had an incidental finding of a left thyroid nodule on CT neck on a background of autoimmune hypothyroidism and a family history of thyroid cancer. ThyUSS showed a left-dominant nodule with increased peripheral vascularity and smaller right-sided nodules; FNA was Thy2. The patient opted for a left thyroid lobectomy; histology showed papillary thyroid carcinoma and subsequent right thyroidectomy histology also showed papillary micro-carcinoma. 41-year-old female presented with T3-thyrotoxicosis with positive thyroglobulin antibodies and swelling corresponding to the thyroid. ThyUSS showed a right-sided, solid homogenous nodule and two small left-sided nodules. Repeated ThyUSS over nine months were stable; FNA was Thy2 and Thy1c. Technetium scan showed a right-sided toxic nodule and co-existent cold nodule. Following right hemi-thyroidectomy histology showed benign follicular adenoma and an incidental papillary microadenoma.

Conclusion: These cases demonstrate that whilst the U- and Thy-Classifications are reassuring they do not exclude malignancy. This uncertainty should be highlighted to patients when discussing management of thyroid nodules.