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Can we better advise our patients with nodular thyroid disease?
Published online by Cambridge University Press: 26 April 2023
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.
- Type
- Main Article
- Information
- Copyright
- Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED
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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