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  • Author: Murat Faik Erdogan x
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Gilles Russ Thyroid and Endocrine Tumors, Institute of Endocrinology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France

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Steen J. Bonnema Department of Endocrinology, Odense University Hospital, Odense, Denmark

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Murat Faik Erdogan Department of Endocrinology and Metabolism, University of Ankara School of Medicine, İbni Sina Hastanesi, Ankara, Turkey

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Cosimo Durante Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy

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Rose Ngu Head Neck and Thyroid Imaging, Department of Radiology, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom

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Laurence Leenhardt Thyroid and Endocrine Tumors, Institute of Endocrinology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France

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Thyroid ultrasound (US) is a key examination for the management of thyroid nodules. Thyroid US is easily accessible, noninvasive, and cost-effective, and is a mandatory step in the workup of thyroid nodules. The main disadvantage of the method is that it is operator dependent. Thyroid US assessment of the risk of malignancy is crucial in patients with nodules, in order to select those who should have a fine needle aspiration (FNA) biopsy performed. Due to the pivotal role of thyroid US in the management of patients with nodules, the European Thyroid Association convened a panel of international experts to set up European guidelines on US risk stratification of thyroid nodules. Based on a review of the literature and on the American Association of Clinical Endocrinologists, American Thyroid Association, and Korean guidelines, the panel created the novel European Thyroid Imaging and Reporting Data System, called EU-TIRADS. This comprises a thyroid US lexicon; a standardized report; definitions of benign and low-, intermediate-, and high-risk nodules, with the estimated risks of malignancy in each category; and indications for FNA. Illustrated by numerous US images, the EU-TIRADS aims to serve physicians in their clinical practice, to enhance the interobserver reproducibility of descriptions, and to simplify communication of the results.

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Adile Begüm Bahçecioğlu Department of Endocrinology and Metabolism, Ankara University, School of Medicine, Ankara, Turkey

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Alptekin Gürsoy Department of Endocrinology and Metabolism, Ankara Guven Hospital, Ankara, Turkey

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Serpil Dizbay Sak Department of Pathology, Ankara University, School of Medicine Ankara, Turkey

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Seyfettin Ilgan Department of Nuclear Medicine, Ankara Guven Hospital, Ankara, Turkey

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Banu Bilezikçi Department of Pathology, Ankara Guven Hospital, Ankara, Turkey

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Murat Faik Erdoğan Department of Endocrinology and Metabolism, Ankara University, School of Medicine, Ankara, Turkey

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Objective

Punctate echogenic foci (PEF)/microcalcifications are thought to represent psammoma bodies (PB) in histopathology. However, there are few and contradictory data on this. Different types of sonographic echogenic microfoci (EMF) are seen in papillary thyroid carcinoma (PTC), and their histopathological equivalents are not clearly known. There is also conflicting data on the interobserver agreement between the sonographers on EMF.

Methods

We prospectively collected US video records of PTC nodules with and without EMF in two large thyroid centers. All video recordings were independently interpreted by three blinded, experienced sonographers. EMF were classified as true microcalcifications (punctate echogenic foci (PEF) ≤1 mm long), linear microechogenities (>1 mm long, posterior acoustic enhancement of the back wall of a microcystic area), comet-tail artifacts/reverberations or linear microechogenities with comet-tail artifacts/reverberations, non-shadowing coarse echogenic foci (>1 mm nonlinear areas) and unclassifiable. Histopathological evaluation was performed by two blinded, qualified pathologists.

Results

A total of 114 malignant nodules were included. The average Cohen’s kappa (κ) of three sonographers for the EMF presence was 0.775, indicating substantial agreement. A substantial agreement for PEF with 0.658 κ, only fair agreement for other types of EMF with 0.052 to 0.296 κ were detected. EMF were significantly associated with PB and papillae. PEF had an evident relationship with PB in multivariate analysis. There was a strong positive correlation between the amount of PEF and PB (r = 0.634, P < 0.001).

Conclusions

PEF in PTC mainly correspond to PB on histopathology. Although observation of EMF varies among sonographers, this inconsistency can be reduced by classifying EMF into subgroups and keeping the term ‘PEF’ only for true microcalcifications.

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Asena Gökçay Canpolat Department of Endocrinology and Metabolism, School of Medicine, Ankara University, Ankara, Turkey

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Murat Cinel Department of Endocrinology and Metabolism, School of Medicine, Ankara University, Ankara, Turkey

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Serpil Dizbay Sak Department of Pathology, School of Medicine, Ankara University, Ankara, Turkey

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Işılay Taşkaldıran Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Turkey

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Hakan Korkmaz Department of Endocrinology and Metabolism, School of Medicine, Süleyman Demirel University, Isparta, Turkey

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Özgür Demir Department of Endocrinology and Metabolism, School of Medicine, Ankara University, Ankara, Turkey

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Reyhan Ersoy Department of Endocrinology and Metabolism, School of Medicine, Yıldırım Beyazıt University, Ankara, Turkey

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Selçuk Dağdelen Department of Endocrinology and Metabolism, School of Medicine, Hacettepe University, Ankara, Turkey

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Dilek Berker Department of Endocrinology and Metabolism, Ankara City Hospital, University of Health Sciences, Ankara, Turkey

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Klara Dalva Department of Haematology, School of Medicine, Ankara University, Ankara, Turkey

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Adile Begüm Bahçecioğlu Mutlu Department of Endocrinology and Metabolism, School of Medicine, Ankara University, Ankara, Turkey

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Murat Faik Erdoğan Department of Endocrinology and Metabolism, School of Medicine, Ankara University, Ankara, Turkey

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Background: Riedel thyroiditis (RT) is a rare form of thyroiditis; thus, data about the disease course and treatment options are limited. Therefore, we aimed to assess the clinical, serological, radiological, and histopathological features, as well as short- and long-term follow-up of RT patients under glucocorticoid (GC) and tamoxifen citrate (TMX). Parameters related to IgG4-related diseases (IgG4-RD) were also investigated. Methods: Eight patients with RT diagnosed between 2000 and 2019 were enrolled. Data were collected in a retrospective and prospective manner. The diagnosis was confirmed with histopathological features in all patients. Results of the treatment with GCs on short- to mid-term, followed by TMX in the long term, were evaluated. Results: The mean age at diagnosis was 40.5 ± 6.8 years; female predominance was observed (F/M:7/1). Parameters related to IgG4-RD, like increase in IgG4 serum levels, total plasmablast counts, and IgG4+ plasmablasts, were negative in most of our patients in both active and inactive states of the disease. Likewise, an increased ratio of IgG4/IgG-positive plasma cells >40% could only be observed in 2 cases. GCs followed by TMX were given to the patients with an over-all median follow-up time of 67 (8–216) months. All the patients considerably improved clinically and had a reduction in the size of the mass lesion on GCs, followed by TMX therapy. None of the patients had a recurrence under TMX therapy for a median period of 18.5 (7–96) months. Conclusion: Even though RT is suggested to be a member of IgG4-RD, serologic or histological evidence of IgG4 elevation or positivity is only useful for diagnosis and follow-up of RT. The diagnosis should be based on clinical and radiological evidence and confirmed by histopathology. GCs are effective for initial treatment, and TMX is a successful and safe therapeutic option for long-term maintenance therapy.

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Murat Faik Erdoğan Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey

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Özgür Demir Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey

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Reyhan Ünlü Ersoy Department of Endocrinology and Metabolic Diseases, Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey

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Kamile Gül Department of Endocrinology and Metabolic Diseases, Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey

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Berna İmge Aydoğan Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey

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Ziynet Alphan Üç Department of Endocrinology and Metabolic Diseases, Ankara Training and Research Hospital, Ankara, Turkey

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Türkan Mete Endocrinology and Metabolic Diseases, Ankara Numune Training and Research Hospital, Ankara, Turkey

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Sibel Ertek Department of Endocrinology and Metabolic Diseases, Ufuk University Medical Faculty, Ankara, Turkey

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Uğur Ünlütürk Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey

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Bekir Çakır Department of Endocrinology and Metabolic Diseases, Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey

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Yalçın Aral Department of Endocrinology and Metabolic Diseases, Ankara Training and Research Hospital, Ankara, Turkey

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Serdar Güler Endocrinology and Metabolic Diseases, Ankara Numune Training and Research Hospital, Ankara, Turkey

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Sevim Güllü Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey

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Demet Çorapçıoğlu Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey

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Selçuk Dağdelen Department of Endocrinology and Metabolic Diseases, Hacettepe University Medical Faculty, Ankara, Turkey

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Gürbüz Erdoğan Department of Endocrinology and Metabolic Diseases, Ufuk University Medical Faculty, Ankara, Turkey

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Background: The optimal therapeutic choice for Graves' hyperthyroidism in the presence of moderate-severe Graves' orbitopathy (GO) remains controversial. Objectives: We aimed to compare GO course in patients with moderate-severe GO treated with early total thyroidectomy (TTx) versus antithyroid drug (ATD) regimens, in a prospective, randomized manner. Methods: Forty-two patients with moderate-severe GO were enrolled. A total of 4.5 g of pulse corticosteroids were given intravenously to all patients before randomization. Patients in the first group were given TTx, whereas patients in the second group were treated with ATDs. TSH was kept between 0.4 and 1 mIU/l. The clinical course of GO was evaluated with proptosis, lid aperture, clinical activity score (CAS), and diplopia. Results: Eighteen and 24 patients were randomized to the TTx and ATD groups, respectively. Thyroid autoantibodies decreased significantly, and there were significant improvements in proptosis, lid aperture, and CAS in the TTx group. While in the ATD group the decrement in thyroid autoantibodies was not significant, there were significant improvements in proptosis and CAS. When the TTx group was compared with the ATD group, anti-TPO, anti-Tg, and TSH-receptor antibodies were significantly decreased in the TTx group (p < 0.01), but there was no significant difference with respect to proptosis, lid aperture, CAS, and diplopia between the two groups during a median (min.-max.) follow-up period of 60 months (36-72). Conclusion: Although no definitive conclusions could be drawn from the study, mainly due to limited power, early TTx and the ATD treatment regimens, followed by intravenous pulse corticosteroid therapy, seemed to be equally effective on the course of GO in this relatively small group of patients with moderate-severe GO during a median (min.-max.) follow-up period of 60 months (36-72).

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