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Natural History of Thyroid Nodule

Natural History of Thyroid Nodule. Xiaohong Wu Department of Endocrinology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China. Thyroid Nodules: the scope of the problem. Palpation: 3% ~ 7% Ultrasonography: 20% ~76% More common in:

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Natural History of Thyroid Nodule

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  1. Natural History of Thyroid Nodule Xiaohong Wu Department of Endocrinology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

  2. Thyroid Nodules: the scope of the problem • Palpation: 3% ~ 7% • Ultrasonography: 20% ~76% • More common in: elderly persons; women; those with iodine deficiency; those with a history of radiation exposure. Endocr Pract. 2010;16(Suppl 1)

  3. Prevalence of Thyroid Incidentalomas in health check-up Note: compared with other ages, 1) P < 0.01, 2) P <0.05, compared with group A、B, 3) P < 0.05 Wu X, Liu C, et al. Chinese Journal of Practical Internal Medicine，2005; 25(9):823-824

  4. Prevalence of Thyroid Nodules in Jiangsu Province In China, according to a recent community survey in ten cities, thyroid nodules have a prevalence of approximately 18.6%. Feng C, Liu C, et al. Chinese Journal of Endocrinology and Metabolism. 2011, 27: 492-494

  5. Etiology of Thyroid Nodules Endocr Rev. 2003;24(1):102-32.

  6. Endocr Pract. 2010;16(Suppl 1)

  7. Pat. P.M. Nodular Volume After 6 Years 3.1 ml 4.3 ml 6.3 ml

  8. Course of Thyroid Nodules • What is the long-term course of thyroid nodules? • What influences growth and function of thyroid nodules? Questions

  9. Long-Term Follow-up of Thyroid Nodule Growth 109 euthyroid patients with benign thyroid nodules 95 women, 14 men; 46,2 ± 12,7 (14 - 73) years Follow-up of at least 3 years 3 - 13 years (median 4,9 years) Quadbeck B, et al. Exp Clin Endocrinol Diabetes. 2002;110:348-354

  10. Development of Thyroid Nodules Quadbeck B, et al. Exp Clin Endocrinol Diabetes. 2002;110:348-354

  11. Evaluation of Factors affecting Thyroid Nodules Growth Quadbeck B, et al. Exp Clin Endocrinol Diabetes. 2002;110:348-354

  12. Evaluation of Factors affecting Thyroid Nodules Growth Quadbeck B, et al. Exp Clin Endocrinol Diabetes. 2002;110:348-354

  13. Determinants of Nodular Growth According to the Cox Proportional Harzards Model There was no significant influence on the growth pattern of thyroid nodules of: • Age and sex of the patient, • Initial size of the nodule, • Scintigraphic behaviour of the nodule, • TSH-suppression by therapy Quadbeck B, et al. Exp Clin Endocrinol Diabetes. 2002;110:348-354

  14. Conclusions • The majority of benign thyroid nodules exhibits a slow growth rate during long-term observation. • After 3 yeras only half of the nodules have significantly increased in size. • Thyroid nodules do grow more rapidly than the whole goitre of the same patient. • The growth rate of thyroid nodules is mainly determined endogeneously rather than by exogenous factors, which show little, if any, infleunce. Quadbeck B, et al. Exp Clin Endocrinol Diabetes. 2002;110:348-354

  15. How about Thyroid Incidentalomas Health check-up n=323, M/F=196/144 Thyroid ultrasonography Clinical evaluation Incidentalomas FT3,FT4,TSH,Tg, Nodule volumes Follow-up n=144,M/F=62/52 d>1cm, US-FNA Wu X, Liu C, et al. Chinese Journal of Practical Internal Medicine,2005;25(9):823-824

  16. Four-year Follow-up of Thyroid Incidentalomas Wu X, Liu C, et al. Chinese Journal of Practical Internal Medicine,2005;25(9):823-824

  17. Changes of Thyroid Incidentalomas after Four-year Follow-up Wu X, Liu C, et al. Chinese Journal of Practical Internal Medicine,2005;25(9):823-824

  18. Characteristics of 20 included publications

  19. Forest plot of 9 studies providing the percentage of volume increase for benign thyroid nodules

  20. Forest plot of 6 studies providing rate of no-change of the volume for benign thyroid nodules

  21. Forest plot of 17 publications providing rate of volume decrease for benign thyroid nodules

  22. How about nodular goiter? • On the basis of cross-sectional data and ultrasonic scanning, an average annual growth rate of 4.5% in multinodular goiter has been reported---Am J Med 1990;89:602–608 • In the Whickham survey, 20% of the women and 5% of the men who had goiters in the initial survey had no goiter in the follow-up survey, whereas only 4% of the women and none of the men acquired a goiter between the two surveys. ---Clin Endocrinol (Oxf) 1995;43:55–68 • In a 20-yr follow-up study of 11- to 18-yr-old subjects in the southwestern United States, 60% of the 92 subjects who had diffuse goiters initially had spontaneous regression by the age of 30 yr.---Am J Med 1991;91:363–370

  23. Decreasing frequency of goiter with age • A fall in lean body mass with age, known to be related to thyroid volume • A fall with age in IGF-I and GH • At least in women, the loss of estradiol-mediated increase in proliferation and down-regulation of the NIS gene Clin Endocrinol (Oxf) 1998;48:701–706 J Am Geriatr Soc 1999;47:1238–1243 Endocrinology 1999;140:5705–5711

  24. Follow-up of Nontoxic AutonomouslyFunctioning Thyroid Nodules J Clin Endocrinol Metab 1980;50:1089–1093

  25. Correlation of change in nodule size and function and duration of follow up for nontoxic AFTN Increase: 15/159=9.4% No change: 138/159=86.8% Decrease: 6/159=3.8% Toxic: 14/159=8.8% J Clin Endocrinol Metab 1980;50:1089–1093

  26. Correlation of function of untreated AFTN with age after varying follow-up periods Nodules greater than 3 cm in size at diagnosis carried a 20% risk of developing hyperthyroidism, whereas nodules less than 2.5 cm in size had only a 2-5% risk of developing hyperthyroidism within the same time frame J Clin Endocrinol Metab 1980;50:1089–1093

  27. Correlation of changes in nodule size and function andduration of follow up for nontoxic AFTN from iodine-sufficient (control) and iodine-deficient (endemic) areas J Clin Endocrinol Metab 1983;56:283–287

  28. Nontoxic Nodular Goiter • An incidence of 8-10% of overt hyperthyroidism during a 6- to 12-yr follow-up period corresponding to 0-6% per year. . • In part, this progression depends on genetic predisposition, somatic mutations in individual nodules, and extrinsic factors such as iodine intake. Postgrad Med J 1990;66:186–190 Clin Nucl Med 1979;4:181–190 J Clin Endocrinol Metab 1980;50:1089–1093 J Clin Endocrinol Metab 1983;56:283–287 Acta Endocrinol (Copenh) 1993;128:51–55

  29. Summary • The natural history of thyroid nodule with respect to growth and function varies and is difficult to predict in a given patient. • Most patients need no treatment after malignancy is ruled out. • New molecular genetic techniques applied on FNAB should lead to an increasing understanding of the pathogenesis of nodular thyroid disease and a better characterization of phenotypes.

  30. Acknowledgements Collaborators: Yu Duan Xinhua Ye Hongjun Lin Meiping Shen Wei Liu Yingyue Lv Yili Xu Xiaojing Wang Jiayu Zhu Xiaoyun Liu Huanhuan Chen Kuangfeng Xu Tao Yang Supervisor: Chao Liu Grants: NSFC(30971404/C140406 and 81070621/H0704) Jiangsu Province key medical personnel project (RC2011068) International Science and technology cooperation (BZ2011042)

  31. Thank you!

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