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Goiter refers to an abnormal enlargement of the thyroid gland that may appear as a diffuse goiter (uniform enlargement) or nodular (single or multiple nodules). Functionally, it is classified as nontoxic (normal/low hormone levels) or toxic (excess hormone production).PathophysiologyDiffuse thyroid enlargement typically results from prolonged stimulation by thyroid-stimulating hormone (TSH) or TSH-like agents, commonly seen in hypothyroidism or iodine deficiency. In contrast, in hyperthyroid...
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The thyroid gland is a small, butterfly-shaped gland located in the neck and covers the anterior surface of the trachea. The gland has two lateral lobes connected by a thin tissue mass called the isthmus. Internally, each lobe comprises many small spherical structures known as thyroid follicles, surrounded by a network of blood vessels.
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Hyperthyroidism is a hypermetabolic state caused by elevated levels of thyroid hormones, triiodothyronine (T3) and thyroxine (T4). It results from dysregulation at the thyroid, pituitary, or immune system level and affects multiple organ systems.PathophysiologyThe most common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder in which antibodies, specifically thyroid-stimulating antibodies (TSAb), a subtype of TSH receptor antibodies (TRAb), bind to and activate TSH...
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Graves’ disease is an autoimmune disorder characterized by the production of thyroid-stimulating immunoglobulins (TSI) that activate TSH receptors, leading to excessive synthesis and release of thyroid hormones (T3 and T4) and resulting in hyperthyroidism.Among all causes of hyperthyroidism, Graves’ disease is the most common and can happen at any age, though it is more frequent in women. It produces a hypermetabolic state with features such as weight loss, tachycardia, tremor,...
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Hyperthyroidism is a type of thyrotoxicosis characterized by the thyroid gland's overproduction of the thyroid hormones triiodothyronine (T3) and thyroxine (T4). This hormone excess increases the basal metabolic rate and enhances sensitivity to catecholamines.DiagnosisDiagnosis is based on clinical features and biochemical testing. It typically shows suppressed thyroid-stimulating hormone (TSH) levels below 0.4 mIU/L, with elevated free T3 and/or T4. Additional tests, including thyroid...
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Hypothyroidism is a disorder characterized by insufficient production of thyroid hormones, which regulate metabolism, energy balance, and multiple organ systems.TypesHypothyroidism is classified based on the level of dysfunction. Primary hypothyroidism results from intrinsic thyroid gland dysfunction, causing reduced hormone production despite normal or increased stimulation. Secondary hypothyroidism arises from inadequate thyroid-stimulating hormone (TSH) secretion by the pituitary. Tertiary...
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False negative cytology in large thyroid nodules.

Wesley H Giles1, Reid A Maclellan, Atul A Gawande

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Fine-needle aspiration (FNA) of large thyroid nodules (≥3 cm) has an 11.7% false-negative rate, indicating potential cancer missed by initial cytology. Large nodules with benign FNA results may warrant surgical removal.

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Area of Science:

  • Endocrinology
  • Surgical Pathology
  • Oncology

Background:

  • Fine-needle aspiration (FNA) accuracy for large thyroid nodules is debated.
  • False-negative rates in surgical series range from 0.7% to 13%.

Purpose of the Study:

  • To evaluate the accuracy of benign FNA cytology in large thyroid nodules (≥3 cm).
  • To identify patient and nodule characteristics associated with false-negative FNA results.

Main Methods:

  • Retrospective analysis of thyroidectomy specimens (January 2009 - October 2011).
  • Identified nodules ≥3 cm with benign preoperative FNA cytology.
  • Compared findings with nodules <3 cm from the same cohort.

Main Results:

  • The false-negative rate for nodules ≥3 cm was 11.7%, compared to 4.8% for nodules <3 cm (p=0.03).
  • Risk factors for false-negative results included age ≥55 years and asymptomatic status.
  • False-negative specimens predominantly showed follicular variant of papillary thyroid cancer and follicular thyroid cancer.

Conclusions:

  • Large thyroid nodules (≥3 cm) with benign FNA cytology have a significant false-negative rate.
  • Surgical consideration for large nodules is recommended even with benign preoperative cytology.