title: Screening for thyroid cancer according to French recommendations with thyroid ultrasound in newly diagnosed Graves' disease without palpable nodule is not useful.
abstract: OBJECTIVE
  The aim of the study was to evaluate systematic thyroid ultrasonography (US) relevance in newly diagnosed Graves' disease among patients presenting without palpable nodules.
  
  
  METHODS
  We consecutively recruited 208 cases of Graves' disease without palpable nodule. All patients were screened for thyroid antibodies and underwent a thyroid US. Ultrasonically guided biopsy was proposed for the assessment of all nodules upper or equal to 10mm in diameter.
  
  
  RESULTS
  Two third of patients had an abnormal thyroid at palpation requiring an US. One third of patients had a normal thyroid at palpation and US was consequently unwarranted. Among all patients, US detected non-palpable nodules in 26% of cases. We found no smears suspected to be cancerous.
  
  
  CONCLUSIONS
  In newly diagnosed Graves' disease, the US relevance is only questionable in patients without abnormal thyroid at palpation. Ultrasonography detected non-palpable nodules and none was suspected to be cancerous. These data suggest that US is not useful in patients without abnormal thyroid at palpation. Nevertheless, the recent Thyroid Imaging-Reporting And Data System classification (TI-RADS) might change our conclusions. The TI-RADS classification indeed improves the selection of nodules lower than 10mm in diameter requiring a biopsy. Nodules lower than 10mm in diameter were not biopsied in the present study. The other US data presented herein (echogenicity, vascularisation) provide no further relevance for systematic US in newly diagnosed patients.
authors.affiliation: Groupe de recherches cliniques en endocrinologie, 5, rue Dupin, 75006 Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Nys
authors.affiliation: Groupe de recherches cliniques en endocrinologie, 5, rue Dupin, 75006 Paris, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Cordray
authors.affiliation: Groupe de recherches cliniques en endocrinologie, 5, rue Dupin, 75006 Paris, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Sarafian
authors.affiliation: Cabinet de pathologie Tolbiac, 92, avenue d'Ivry, 75013 Paris, France.
authors.forename: Ève
authors.initials: È
authors.lastname: Lefort-Mossé
authors.affiliation: Groupe de recherches cliniques en endocrinologie, 5, rue Dupin, 75006 Paris, France. Electronic address: robert.merceron99@orange.fr.
authors.forename: Robert-Édouard
authors.initials: RÉ
authors.lastname: Merceron
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D006111:Graves Disease / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010173:Palpation; D013964:Thyroid Neoplasms / Q000145:classification / Q000000981:diagnostic imaging* / Q000473:pathology; D016606:Thyroid Nodule / Q000145:classification / Q000473:pathology*; D014463:Ultrasonography
keywords: Cancer de la thyroïde; Graves’ disease; Maladie de Basedow; Nodule non-palpable; Non-palpable nodule; Thyroid cancer; Ultrasonography; Échographie