Emotional burden of TI-RADS 4 thyroid nodules: clinical and psychosocial correlation

Thyroid nodules classified as the Thyroid Imaging Reporting and Data System 4 (TI-RADS 4) present an intermediate risk of malignancy, often necessitating further diagnostic evaluation. While clinical and imaging factors are routinely assessed, the psychological impact of these findings is underexplored. This study investigates the prevalence and correlation of anxiety and depression in patients with TI-RADS 4 nodules.

In this retrospective cross-sectional study, 65 patients with TI-RADS 4 thyroid nodules evaluated between 2021 and 2024 were included. Demographic, clinical, and biochemical data were collected, including body mass index (BMI), carcinoembryonic antigen (CEA) and thyroid-stimulating hormone (TSH) levels. Psychological symptoms were assessed using the Zung Self-Rating Anxiety Scale (SAS) and the Zung Self-Rating Depression Scale (SDS). Correlation analyses were performed to examine associations between psychological scores and clinical variables.

The mean age of participants was 45.8 years, with 58.5% being female. Most patients (54/65, 83.1%) had normal thyroid function, and only 10 (15.4%) had undergone prior surgery. A minority had undergone fine-needle aspiration biopsy. Anxiety and depression scores showed a positive correlation (Pearson r=0.80, P<0.001). Weak or negligible correlations are observed between psychological scores and clinical markers such as TSH, BMI, and CEA.

In this cohort of patients with TI-RADS 4 thyroid nodules, symptoms of anxiety and depression are common, but showed only weak associations with clinical and imaging characteristics. These symptoms appear to be weakly related to clinical and imaging characteristics, underscoring the importance of routine psychological screening and support in this population.