title: Thyroidectomy or radioiodine? The value of ultrasonography and cytology in the assessment of nodular lesions in Graves' hyperthyroidism.
abstract: Although diffuse toxic goiter is a classical feature of Graves' disease (GD) nodular goiters are occasionally found in some patients. The aim of the present study was to investigate the ultrasonographic and corresponding cytological manifestations in GD patients with nodular lesions to decide on a therapeutic strategy. Twenty-seven consecutive GD patients with nodular goiter were included in this study (21 women and six men, mean age 41.2 years, range 22-77 years). All underwent thyroid ultrasonography and fine-needle aspiration cytology. Of the 27 patients eight underwent surgical intervention because papillary thyroid carcinoma or follicular neoplasm was diagnosed by cytology; five of these were shown to have papillary thyroid carcinomas. Ultrasonography revealed the malignant nodules to be hypoechogenic, heterogeneous, and with ill-defined margins in four of these five thyroid cancers, whereas the remaining sonogram showed a cystic change and cauliflower-like tumor formation with microcalcification. The volume and maximal diameter of cancerous nodules were significantly larger than those of benign nodules. In conclusion our results reveal that ultrasonography and fine-needle aspiration cytology are reliable and quick methods for diagnosing nodular goiters in GD patients. If thyroid neoplasms are found ablative therapy with thyroidectomy is indicated instead of radioactive iodine.
authors.affiliation: Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei.
authors.forename: C Y
authors.initials: CY
authors.lastname: Wang
authors.forename: T J
authors.initials: TJ
authors.lastname: Chang
authors.forename: T C
authors.initials: TC
authors.lastname: Chang
authors.forename: Y L
authors.initials: YL
authors.lastname: Hsiao
authors.forename: M H
authors.initials: MH
authors.lastname: Chen
authors.forename: S H
authors.initials: SH
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D002291:Carcinoma, Papillary / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006044:Goiter, Nodular / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006111:Graves Disease / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000473:pathology; D013964:Thyroid Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D013965:Thyroidectomy; D014463:Ultrasonography