Hashimoto Thyroiditis beyond Cytology: A Correlation between Cytological, Hormonal, Serological, and Radiological...

Area of Science:

• Endocrinology and Thyroidology
• Diagnostic Imaging
• Oncology

Background:

• Hashimoto thyroiditis is the leading cause of chronic thyroid inflammation.
• Diagnosis typically involves ultrasound, fine needle aspiration, and serologic markers like anti-TPO and anti-TG antibodies.
• Elevated antithyroidal peroxidase (TPO) and antithyroglobulin (TG) antibodies are common.

Purpose of the Study:

• To evaluate the incidence of neoplasms in patients with Hashimoto thyroiditis.
• To characterize the sonographic appearances of Hashimoto thyroiditis, including nodular and focal patterns.
• To assess the sensitivity of the American College of Radiology (ACR) Thyroid Imaging and Data System (TIRADS) 2017 in patients with Hashimoto thyroiditis.

Main Methods:

• A retrospective, single-center study of 137 patients diagnosed with Hashimoto thyroiditis (January 2013-December 2019).
• Ultrasound images were reviewed by a radiologist; cytology was reported using the Bethesda System (BSRTC 2017).
• ACR TI-RADS 2017 was used for ultrasound-based risk stratification.

Main Results:

• The study included 137 patients (mean age 44.66 years, 9:1 female:male ratio).
• Papillary thyroid carcinoma was diagnosed in 8% (11 cases), and follicular adenoma in 0.7% (1 case).
• Ultrasound patterns included diffuse (50%), macronodular (32.2%), and focal nodular (17.7%); ACR TI-RADS 2017 categorized nodules from TR2 to TR5.

Conclusions:

• Hashimoto thyroiditis is a risk factor for thyroid neoplasms, requiring careful cytological and radiological assessment.
• Recognizing variable ultrasound appearances of Hashimoto thyroiditis is crucial for accurate interpretation.
• A modified ACR TI-RADS system may be beneficial for risk stratification in Hashimoto thyroiditis patients to reduce unnecessary fine needle aspirations (FNAs).