Yonsei Med J.  2015 Sep;56(5):1338-1344. 10.3349/ymj.2015.56.5.1338.

Focal Lymphocytic Thyroiditis Nodules Share the Features of Papillary Thyroid Cancer on Ultrasound

• Hwang S
• Shin DY
• Kim EK
• Yang WI
• Byun JW
• Lee SJ
• Kim G
• Im SJ
• Lee EJ

• KMID: 2163626
• DOI: http://doi.org/10.3349/ymj.2015.56.5.1338

Abstract

PURPOSE
It is often difficult to discriminate focal lymphocytic thyroiditis (FLT) or adenomatous hyperplasia (AH) from thyroid cancer if they both have suspicious ultrasound (US) findings. We aimed to make a predictive model of FLT from papillary thyroid cancer (PTC) in suspicious nodules with benign cytologic results.
MATERIALS AND METHODS
We evaluated 214 patients who had undergone fine-needle aspiration biopsy (FNAB) and had shown thyroid nodules with suspicious US features. PTC was confirmed by surgical pathology. FLT and AH were confirmed through more than two separate FNABs. Clinical and biochemical findings, as well as US features, were evaluated.
RESULTS
Of 214 patients, 100 patients were diagnosed with PTC, 55 patients with FLT, and 59 patients with AH. The proportion of elevated thyrotropin (TSH) levels (p=0.014) and thyroglobulin antibody (Tg-Ab) or thyroid peroxidase antibody (TPO-Ab) positivity (p<0.001) in the FLT group was significantly higher than that in the PTC group. Regarding US features, absence of calcification (p=0.006) and "diffuse thyroid disease" (DTD) pattern on US (p<0.001) were frequently seen in the FLT group. On multivariate analysis, Tg-Ab positivity, presence of a DTD pattern on US, and absence of calcification in nodules were associated with FLT with the best specificity of 99% and positive predictive value of 96%. In contrast, a taller than wide shape of nodules was the only variable significant for differentiating AH from PTC.
CONCLUSION
Suspicious thyroid nodules with cytologic benign results could be followed up with US rather than repeat FNAB, if patients exhibit Tg-Ab positivity, no calcifications in nodules, and a DTD pattern on US.

Keyword

Differential diagnosis; focal lymphocytic thyroiditis; papillary thyroid cancer

MeSH Terms

Aged
Aged, 80 and over
Autoantibodies
Biopsy, Fine-Needle/*methods
Calcinosis
Carcinoma/*pathology
Female
Hashimoto Disease
Humans
Hyperplasia/*pathology
Male
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Retrospective Studies
Sensitivity and Specificity
Thyroglobulin/blood
Thyroid Diseases
Thyroid Neoplasms/*pathology
Thyroid Nodule/*pathology
Thyroiditis, Autoimmune/*pathology
Thyrotropin/blood
Autoantibodies
Thyroglobulin
Thyrotropin

Figure

• 

  Fig. 1 Examples of nodules suspected as malignant on US findings. (A) A 6-mm suspicious nodule (delineated by electronic calipers) was found on the right thyroid gland, and PTC was confirmed by surgical pathology. (B) A 7-mm suspicious nodule (delineated by electronic calipers) was found on the right thyroid gland and was cytologically confirmed as FLT more than twice by FNAB. The thyroid gland showed diffuse heterogeneous echogenicity, a characteristic finding of the DTD pattern of thyroid gland on US. (C) There was a 6-mm suspicious nodule (delineated by electronic calipers) on the left thyroid gland, which was cytologically confirmed as AH more than twice by FNAB. PTC, papillary thyroid cancer; FLT, focal lymphocytic thyroiditis; AH, adenomatous hyperplasia; FNAB, fine needle aspiration biopsy; DTD pattern, "diffuse thyroid disease" pattern on US; US, ultrasound.

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