Factors Associated with Malignancy in Patients with Maximal Thyroid Nodules ≥2 Cm

Area of Science:

• Endocrinology
• Oncology
• Pathology

Background:

• The association between large thyroid nodules and malignancy risk remains debated.
• Understanding risk factors for thyroid cancer, including occult papillary thyroid carcinoma (PTC), is crucial for patient management.

Purpose of the Study:

• To investigate the relationship between maximal thyroid nodule size (≥2 cm) and malignancy risk.
• To identify factors associated with malignancy in large thyroid nodules and the risk of occult PTC.

Main Methods:

• A retrospective analysis of 367 patients undergoing thyroidectomy for nodules ≥2 cm.
• Utilized univariable, multivariable logistic regression, and receiver operating characteristic (ROC) curve analyses to assess risk factors.

Main Results:

• Younger age, Hashimoto's thyroiditis, smaller maximal nodule diameter, and punctate echogenic foci were independently associated with malignancy.
• 12.7% of nodules without suspicious features were malignant. Younger age and elevated thyroid peroxidase antibody (TPOAb) levels (>31.4 mIU/L) correlated with occult PTC.

Conclusions:

• Key predictors for thyroid malignancy in large nodules include younger age, Hashimoto's thyroiditis, nodule size, and punctate echogenic foci.
• Younger age and elevated TPOAb levels are significant indicators for occult PTC, suggesting potential for earlier detection strategies.