title: Hyperfunction thyroid nodules: their risk for becoming or being associated with thyroid cancers.
abstract: OBJECTIVE
  To retrospectively evaluate the risk of thyroid cancer in patients with hyperfunctioning thyroid nodules through ultrasonographic-pathologic analysis.
  
  
  METHODS
  Institutional review board approval was obtained and informed consent was waived. From 2003 to 2007, 107 patients consecutively presented with hot spots on thyroid scans and low serum thyroid-stimulating hormone levels. Among them, 32 patients who had undergone thyroid ultrasonography were analyzed in this study. Thyroid nodules depicted on ultrasonography were classified based on size and categorized as benign, indeterminate, or suspicious malignant nodules according to ultrasonographic findings. The thyroid nodules were determined as either hyperfunctioning or coexisting nodules and were then correlated with pathologic results.
  
  
  RESULTS
  In 32 patients, 42 hyperfunctioning nodules (mean number per patient, 1.31; range, 1-6) were observed on thyroid scans and 68 coexisting nodules (mean, 2.13; range, 0-7) were observed on ultrasonography. Twenty-five patients (78.1%) had at least one hyperfunctioning (n = 17, 53.1%) or coexisting (n = 16, 50.0%) nodule that showed a suspicious malignant feature larger than 5 mm (n = 8, 25.0%), or an indeterminate feature 1 cm or greater (n = 20, 62.5%) in diameter, which could have been indicated by using fine needle aspiration (FNA). Seven patients were proven to have 11 thyroid cancers in 3 hyperfunctioning and 8 coexisting nodules. All of these had at least one thyroid cancer, which could have been indicated by using FNA. The estimated minimal risk of thyroid cancer was 6.5% (7/107).
  
  
  CONCLUSIONS
  Patients with hyperfunctioning nodules may not be safe from thyroid cancer because hyperfunctioning nodules can coexist with thyroid cancer nodules. To screen out these cancers, ultrasonography should be performed.
authors.affiliation: Department of Radiology, Seoul National University Hospital, Seoul 110-744, Korea.
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Lee
authors.forename: Ji-Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Dong Gyu
authors.initials: DG
authors.lastname: Na
authors.forename: Jin Chul
authors.initials: JC
authors.lastname: Paeng
authors.forename: Hye Sook
authors.initials: HS
authors.lastname: Min
authors.forename: Seung Hong
authors.initials: SH
authors.lastname: Choi
authors.forename: Chul Ho
authors.initials: CH
authors.lastname: Sohn
authors.forename: Ki-Hyun
authors.initials: KH
authors.lastname: Chang
mesh_terms: D000328:Adult; D044963:Biopsy, Fine-Needle; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000097:blood / Q000175:diagnosis*; D016606:Thyroid Nodule / Q000097:blood / Q000175:diagnosis*; D013972:Thyrotropin / Q000097:blood*
chemical_list: D013972:Thyrotropin
keywords: Guideline; Hyperfunctioning nodule; Radionuclide imaging; Thyroid cancer; Ultrasonography
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