The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Laszlo Hegedus - One of the best experts on this subject based on the ideXlab platform.
-
Thyroid Nodule guidelines agreement disagreement and need for future research
Nature Reviews Endocrinology, 2011Co-Authors: Ralf Paschke, Laszlo Hegedus, Erik K Alexander, Roberto Valcavi, Enrico Papini, Hossein GharibAbstract:This article reviews agreement, disagreement and need for future research of the Thyroid Nodule guidelines published by the British Thyroid Association, National Cancer Institute, American Thyroid Association and the joint, transatlantic effort of three large societies, the American Society of Clinical Endocrinologists, Associazione Medici Endocrinologi and the European Thyroid Association, published in 2010. Consensus exists for most topics in the various guidelines. A few areas of disagreement, such as the use of scintigraphy, are mostly due to differences in disease prevalence in different countries. Most of the discordance, for example, on the use of calcitonin screening or fine-needle aspiration cytology classification, could probably be resolved by further expert discussions, as the basis is the same published evidence. Importantly, owing to a current lack of evidence in many areas, clinically very relevant areas of uncertainty need to be addressed by further research. This situation applies, for instance, to better definition of ultrasound malignancy criteria and the evaluation of emerging new diagnostic and therapeutic techniques, including molecular markers. For clinicians who advise individual patients, these areas of uncertainty can currently only be resolved by sound management on the basis of clinical judgment, experience and patient preference.
-
the Thyroid Nodule
The New England Journal of Medicine, 2004Co-Authors: Laszlo HegedusAbstract:A 42-year-old woman presents with a palpable mass on the left side of her neck. She has no neck pain and no symptoms of Thyroid dysfunction. Physical examination reveals a solitary, mobile Thyroid Nodule, 2 cm by 3 cm, without lymphadenopathy. The patient has no family history of Thyroid disease and no history of external irradiation. Which investigations should be performed? Assuming that the Nodule is benign, which, if any, treatment should be recommended?
-
clinical practice the Thyroid Nodule
The New England Journal of Medicine, 2004Co-Authors: Laszlo HegedusAbstract:A 42-year-old woman presents with a palpable mass on the left side of her neck. She has no neck pain and no symptoms of Thyroid dysfunction. Physical examination reveals a solitary, mobile Thyroid Nodule, 2 cm by 3 cm, without lymphadenopathy. The patient has no family history of Thyroid disease and no history of external irradiation. Which investigations should be performed? Assuming that the Nodule is benign, which, if any, treatment should be recommended?
-
ultrasound guided interstitial laser photocoagulation of an autonomous Thyroid Nodule the introduction of a novel alternative
Thyroid, 2003Co-Authors: Helle Dossing, Finn Noe Bennedbaek, Laszlo HegedusAbstract:Radioiodine (131I) and surgery are the standard therapeutic options for the solitary autonomous Thyroid Nodule (AFTN). Percutaneous ethanol injection (PEI) has proven to be an effective technique and possible alternative to the conventional treatment options. However, PEI is not devoid of side effects and often necessitates multiple treatment sessions. We present a case of a 17-year-old female successfully treated with ultrasound (US)-guided percutaneous interstitial laser photocoagulation (ILP) for an AFTN. Initially, she had a serum thyrotropin (TSH) of 0.01 mU/L and normal peripheral Thyroid hormone levels. Scintigraphically it was a hot Nodule with suppression of extranodular uptake, and ultrasonographically it was a solitary solid 8.2-mL Nodule. One treatment session (3 W for 650 seconds [1950 J]) normalized serum thyrotropin (TSH) level within 2 months and decreased the Nodule volume to 4.9 mL (40% reduction) without further alterations during an additional 9 months of follow-up. Side effects were t...
-
management of the solitary Thyroid Nodule results of a north american survey
The Journal of Clinical Endocrinology and Metabolism, 2000Co-Authors: Finn Noe Bennedbaek, Laszlo HegedusAbstract:The present survey evaluated current trends in the management of the nontoxic solitary Thyroid Nodule by expert endocrinologists in North America and compared their results with a similar European Thyroid Association survey. A questionnaire was circulated to all clinical members of the American Thyroid Association. An index case (a 42-yr-old woman with a solitary 2 × 3-cm Thyroid Nodule and no clinical suspicion of malignancy) and 11 variations were provided to evaluate how each alteration would affect management. One hundred and seventy-eight members replied and 142 responses were retained for analysis, corresponding to a response rate of 43% of clinically active members. Based on the index case, basal serum TSH was the routine choice of 99%, and serum T4 and/or free T4 were included by 61% of the respondents. Thyroid peroxidase antibodies and serum calcitonin were included by 30% and 5%, respectively. Thyroid scintigraphy was used by 23% (123I, 63%; 99mTc, 31%; 131I, 6%), and ultrasonography was used by...
Finn Noe Bennedbaek - One of the best experts on this subject based on the ideXlab platform.
-
ultrasound guided interstitial laser photocoagulation of an autonomous Thyroid Nodule the introduction of a novel alternative
Thyroid, 2003Co-Authors: Helle Dossing, Finn Noe Bennedbaek, Laszlo HegedusAbstract:Radioiodine (131I) and surgery are the standard therapeutic options for the solitary autonomous Thyroid Nodule (AFTN). Percutaneous ethanol injection (PEI) has proven to be an effective technique and possible alternative to the conventional treatment options. However, PEI is not devoid of side effects and often necessitates multiple treatment sessions. We present a case of a 17-year-old female successfully treated with ultrasound (US)-guided percutaneous interstitial laser photocoagulation (ILP) for an AFTN. Initially, she had a serum thyrotropin (TSH) of 0.01 mU/L and normal peripheral Thyroid hormone levels. Scintigraphically it was a hot Nodule with suppression of extranodular uptake, and ultrasonographically it was a solitary solid 8.2-mL Nodule. One treatment session (3 W for 650 seconds [1950 J]) normalized serum thyrotropin (TSH) level within 2 months and decreased the Nodule volume to 4.9 mL (40% reduction) without further alterations during an additional 9 months of follow-up. Side effects were t...
-
management of the solitary Thyroid Nodule results of a north american survey
The Journal of Clinical Endocrinology and Metabolism, 2000Co-Authors: Finn Noe Bennedbaek, Laszlo HegedusAbstract:The present survey evaluated current trends in the management of the nontoxic solitary Thyroid Nodule by expert endocrinologists in North America and compared their results with a similar European Thyroid Association survey. A questionnaire was circulated to all clinical members of the American Thyroid Association. An index case (a 42-yr-old woman with a solitary 2 × 3-cm Thyroid Nodule and no clinical suspicion of malignancy) and 11 variations were provided to evaluate how each alteration would affect management. One hundred and seventy-eight members replied and 142 responses were retained for analysis, corresponding to a response rate of 43% of clinically active members. Based on the index case, basal serum TSH was the routine choice of 99%, and serum T4 and/or free T4 were included by 61% of the respondents. Thyroid peroxidase antibodies and serum calcitonin were included by 30% and 5%, respectively. Thyroid scintigraphy was used by 23% (123I, 63%; 99mTc, 31%; 131I, 6%), and ultrasonography was used by...
-
diagnosis and treatment of the solitary Thyroid Nodule results of a european survey
Clinical Endocrinology, 1999Co-Authors: Finn Noe Bennedbaek, Hans Perrild, Laszlo HegedusAbstract:BACKGROUND AND OBJECTIVE The optimum diagnostic and therapeutic strategy for the euThyroid patient with a solitary Thyroid Nodule is still a matter of debate. The aim was to assess the attitudes towards management of such patients in clinical centres throughout Europe by means of a questionnaire. DESIGN The questionnaire was circulated to all clinical members of the European Thyroid Association (ETA). A case report was followed by diagnostic investigations and choice of therapy in the index case (a 42-year old woman with a solitary 2 × 3 cm Thyroid Nodule and no clinical suspicion of malignancy). Eleven variations of the basic case report were proposed in order to evaluate how each alteration would affect management. MATERIAL 151 members replied to the letter and 110 individuals from 20 countries completed the questionnaire (corresponding to approximately two-thirds of the clinical members of the ETA). They represented clinicians who had diagnosed and treated more than 50 (76%) or less than 50 (24%) patients with nodular Thyroid disease within the previous 6 months. RESULTS Based on the index case, basal serum TSH was the routine choice of 99% and serum T4 and/or free T4 were included by 70% of the respondents. Almost 50% included determination of serum Thyroid autoantibodies (TPOab: 47%, Tgab:26%) and 43% measured serum calcitonin. Thyroid scintigraphy was used by 66% (99mTc: 86%, 123I: 10%, 131I: 4%), ultrasonography (US) by 80% (size: 75%, grey scale: 57%, Doppler: 33%). Scintigraphy in addition to US was used by 58%. Fine-needle aspiration biopsy (FNAB) was routinely used by 99% of the respondents, and performed under US-guidance by 42%. Based on the individually chosen diagnostic tests indicating a benign solitary Thyroid Nodule, a non-surgical strategy was advocated by 77%. Despite controversies on L-T4 treatment this treatment was supported by more than 40% of the clinicians. Surgery was advocated by 23% and the preferred technique was hemiThyroidectomy (70%). Clinical factors raising suspicion of Thyroid malignancy (e.g. family history of Thyroid cancer, history of external radiation, rapid Nodule growth and a large Nodule of 5 cm) lead the majority (70–91%; P < 0.000001) to disregard FNAB results and to choose a surgical strategy. CONCLUSIONS The favoured diagnostic strategy in the workup of patients with a solitary Thyroid Nodule include determinations of serum TSH combined with serum T4 and/or free T4 followed by FNAB and US together with scintigraphy. A nonsurgical strategy was favoured by the majority supporting the use of L-T4 as the first choice. In case of clinical factors raising the likelihood of malignancy, the majority recommended diagnostic Thyroidectomy despite FNAB suggesting a benign condition.
-
effect of percutaneous ethanol injection therapy versus suppressive doses of l thyroxine on benign solitary solid cold Thyroid Nodules a randomized trial
The Journal of Clinical Endocrinology and Metabolism, 1998Co-Authors: Finn Noe Bennedbaek, Lars Kjaer Nielsen, Laszlo HegedusAbstract:The results of studies using suppressive doses of l-T4 on benign solitary solid cold Thyroid Nodules have been conflicting. Recently, intranodular injection of absolute ethanol has been proposed as an effective treatment, but has been evaluated only in uncontrolled studies. Our objective was to evaluate the effect of two alternative medical treatment modalities, percutaneous ethanol injection therapy and l-T4, on the benign solitary solid cold Thyroid Nodule. In a prospective randomized clinical trial, 50 euThyroid patients with a single solid colloid Thyroid Nodule causing local discomfort were assigned to a single intranodular injection of sterile 98% ethanol (n = 25) or suppressive doses of l-T4 (n = 25). We aimed at an ethanol dose of 20–50% of the pretreatment nodular volume. The initial daily dose of l-T4 was 1.5 μg/kg BW and was adjusted monthly during the first 6 months to reduce serum TSH to subnormal levels (<0.40 mU/L). Thyroid Nodule volume and total Thyroid volume were assessed by ultrasound,...
Gilbert H Daniels - One of the best experts on this subject based on the ideXlab platform.
-
ultrasound guided percutaneous Thyroid Nodule core biopsy clinical utility in patients with prior nondiagnostic fine needle aspirate
Thyroid, 2012Co-Authors: Anthony E Samir, Abhinav Vij, Melanie K Seale, Gaurav S Desai, Elkan F Halpern, William C Faquin, Sareh Parangi, Peter F Hahn, Gilbert H DanielsAbstract:Background Five percent to 20% of Thyroid Nodule fine-needle aspiration (FNA) samples are nondiagnostic. The objective of this study was to determine whether a combination of FNA and core biopsy (CFNACB) would yield a higher proportion of diagnostic readings compared with FNA alone in patients with a history of one or more prior nondiagnostic FNA readings. Methods We conducted a retrospective study of 90 core biopsies (CBs) performed in 82 subjects (55 women and 27 men) between 2006 and 2008 in an outpatient clinic. Results CFNACB yielded a diagnostic reading in 87%. The diagnostic reading yield of the CB component of CFNACB was significantly superior to the concurrent FNA component, with CB yielding a diagnosis in 77% of cases and FNA yielding a diagnosis in 47% (p Conclusion Thyroid Nodule CFNACB is safe and clinically useful in selected patients when a prior FNA reading is nondiagnostic. CFNACB is superior to either CB or FNA alone. CFNACB should be strongly considered as an alternative to surgery in individuals with two prior nondiagnostic FNAs.
-
ultrasound guided percutaneous Thyroid Nodule core biopsy clinical utility in patients with prior nondiagnostic fine needle aspirate
Thyroid, 2012Co-Authors: Anthony E Samir, Melanie K Seale, Gaurav S Desai, Elkan F Halpern, William C Faquin, Sareh Parangi, Peter F Hahn, Gilbert H DanielsAbstract:Background: Five percent to 20% of Thyroid Nodule fine-needle aspiration (FNA) samples are nondiagnostic. The objective of this study was to determine whether a combination of FNA and core biopsy (CFNACB) would yield a higher proportion of diagnostic readings compared with FNA alone in patients with a history of one or more prior nondiagnostic FNA readings. Methods: We conducted a retrospective study of 90 core biopsies (CBs) performed in 82 subjects (55 women and 27 men) between 2006 and 2008 in an outpatient clinic. Results: CFNACB yielded a diagnostic reading in 87%. The diagnostic reading yield of the CB component of CFNACB was significantly superior to the concurrent FNA component, with CB yielding a diagnosis in 77% of cases and FNA yielding a diagnosis in 47% (p<0.0001). The combination of CB and FNA had a higher diagnostic reading yield than either alone. In 69 Nodules that had only one prior nondiagnostic FNA, CB was diagnostic in 74%, FNA was diagnostic in 52%, CFNACB was diagnostic in 87%, and ...
Ellen Marqusee - One of the best experts on this subject based on the ideXlab platform.
-
bethesda categorization of Thyroid Nodule cytology and prediction of Thyroid cancer type and prognosis
Thyroid, 2016Co-Authors: Norra Kwong, Ellen Marqusee, Mathew I Kim, Xiaoyun Liu, Marco Medici, Trevor E Angell, Reed P Larsen, Nancy L Cho, Matthew A NehsAbstract:Background: Since its inception, the Bethesda System for Reporting Thyroid Cytopathology (TBS) has been widely adopted. Each category conveys a risk of malignancy and recommended next steps, though it is unclear if each category also predicts the type and extent of malignancy. If so, this would greatly expand the utility of the TBS by providing prognostic information in addition to baseline cancer risk. Methods: All patients prospectively enrolled into the authors' Thyroid Nodule database from 1995 to 2013 with histologically proven malignancy were analyzed. The primary ultrasound-guided fine-needle aspiration cytology (AUS, atypia of unknown significance; FN, follicular neoplasm; SUSP, suspicious; M, malignant) was correlated with the type of Thyroid cancer and histological features known to impact prognosis and recurrence, including lymph node metastasis (LNM), lymphovascular invasion, and extraThyroidal extension (ETE). Primary cytology was separately correlated with higher risk malignancy. Results: A ...
-
the influence of patient age on Thyroid Nodule formation multinodularity and Thyroid cancer risk
The Journal of Clinical Endocrinology and Metabolism, 2015Co-Authors: Norra Kwong, Edmund S Cibas, Ellen Marqusee, Mathew I Kim, Justine A Barletta, Xiaoyun Liu, Marco Medici, Trevor E Angell, Jeffrey F Krane, Reed P LarsenAbstract:Introduction: Although advancing age is known to influence the formation of Thyroid Nodules, the precise relationship remains unclear. Furthermore, it is uncertain whether age influences the risk that any Thyroid Nodule may prove cancerous. Aim: The aim was to determine the impact of patient age on Nodule formation, multinodularity, and risk of Thyroid malignancy. Method: We conducted a prospective cohort analysis of consecutive adults (ages 20–95 y) who presented for evaluation of nodular disease from 1995 to 2011. A total of 6391 patients underwent ultrasound and fine-needle aspiration of 12 115 Nodules ≥1 cm. Patients were divided into six age groups and compared using sonographic, cytological, and histological endpoints. Result: The prevalence of Thyroid nodular disease increases with advancing age. The mean number of Nodules at presentation increased from 1.5 in the youngest cohort (age, 20–30 y) to 2.2 in the oldest cohort (age, >70 y; P < .001), demonstrating a 1.6% annual increased risk for multin...
-
determination of the optimal time interval for repeat evaluation after a benign Thyroid Nodule aspiration
The Journal of Clinical Endocrinology and Metabolism, 2014Co-Authors: Eric Nou, Norra Kwong, Lukas K Alexander, Edmund S Cibas, Ellen Marqusee, Erik K AlexanderAbstract:Introduction: The optimal timing for repeat evaluation of a cytologically benign Thyroid Nodule greater than 1 cm is uncertain. Arguably, the most important determinant is the disease-specific mortality resulting from an undetected Thyroid cancer. Presently there exist no data that evaluate this important end point. Methods: We studied the long-term status of all patients evaluated in our Thyroid Nodule clinic between 1995 and 2003 with initially benign fine-needle aspiration (FNA) cytology. The follow-up interval was defined from the time of the initial benign FNA to any one of the following factors: Thyroidectomy, death, or the most recent clinic visit documented anywhere in our health care system. We sought to determine the optimal timing for repeat assessment based on the identification of falsely benign malignancy and, most important, disease-related mortality due to a missed diagnosis. Results: One thousand three hundred sixty-nine patients with 2010 cytologically benign Nodules were followed up for...
-
Thyroid Nodule size and prediction of cancer
The Journal of Clinical Endocrinology and Metabolism, 2013Co-Authors: Sophia C Kamran, Edmund S Cibas, Ellen Marqusee, Mathew I Kim, Mary C Frates, Julie A Ritner, Hope E Peters, Carol B Benson, Peter M Doubilet, Justine A BarlettaAbstract:Context: Thyroid Nodule size is routinely measured, although its impact on Thyroid cancer risk is unclear. Objective: Our objective was to evaluate the association of Nodule size upon cancer risk. Design, Setting, and Patients: We conducted a retrospective cohort analysis at an academic hospital with 4955 consecutive patients evaluated between 1995 and 2009. Intervention: Ultrasound and ultrasound-guided fine-needle aspiration of Nodules >1 cm was done. Indeterminate and malignant Nodules were referred for surgery, and histopathology was reviewed. Main Outcome Measure: The presence and histological subtype of cancer was evaluated. Results: Of 7348 evaluated Nodules, 927 (13%) were cancerous. Of those 1.0 to 1.9 cm in diameter, 10.5% were cancerous. In contrast, of those >2.0 cm, 15% were cancerous (P 4 cm were cancerous in 14%, 16%, and 15% of cases (P = .14), respectively, demonstrating no graded increase in risk beyond the 2-cm threshold. When malign...
-
usefulness of ultrasonography in the management of nodular Thyroid disease
Annals of Internal Medicine, 2000Co-Authors: Ellen Marqusee, Edmund S Cibas, Mary C Frates, Carol B Benson, Peter M Doubilet, Reed P Larsen, Susan J MandelAbstract:Ultrasonography altered clinical management for 63% of patients referred to a Thyroid Nodule clinic after abnormal results on Thyroid physical examination. The results suggest that routine Thyroid ...
Ralf Paschke - One of the best experts on this subject based on the ideXlab platform.
-
european Thyroid association guidelines regarding Thyroid Nodule molecular fine needle aspiration cytology diagnostics
European thyroid journal, 2017Co-Authors: Ralf Paschke, Thomas J Musholt, Silvia Cantara, Anna Crescenzi, Barbara Jarzab, Manuel Sobrinho SimoesAbstract:Molecular fine-needle aspiration (FNA) cytology diagnostics has the potential to address the inherent limitation of FNA cytology which is an indeterminate (atypia of undetermined significance/follicular lesion of undetermined significance follicular neoplasm) cytology. Because of the emerging role of molecular FNA cytology diagnostics, the European Thyroid Association convened a panel of international experts to review methodological aspects, indications, results, and limitations of molecular FNA cytology diagnostics. The panel reviewed the evidence for the diagnostic value of mutation panel assessment (including at least BRAF, NRAS, HRAS, KRAS, PAX8/PPARG, RET/PTC) of targeted next generation sequencing and of a microarray gene expression classifier (GEC) test in the diagnostic assessment of an indeterminate cytology Thyroid Nodule. Moreover, possible surgical consequences of molecular FNA diagnostic results of Thyroid Nodules and the evidence that analysis of a molecular FNA diagnostic panel of somatic mutations or a microarray GEC test can alter the follow-up were reviewed. Molecular tests may help clinicians to drive patient care and the surgical decision if the analysis is performed in specialized laboratories. These molecular tests require standardization of performance characteristics and appropriate calibration as well as analytic validation before clinical interpretation.
-
reduction of Thyroid Nodule volume by levothyroxine and iodine alone and in combination a randomized placebo controlled trial
The Journal of Clinical Endocrinology and Metabolism, 2011Co-Authors: M Grussendorf, Ralf Paschke, Chr Reiners, Karl WegscheiderAbstract:Results: Nodule volume reductions were 17.3% [95% confidence interval (CI) 24.8/9.0%, P 0.001]intheT4Igroup,7.3%(95%CI15.0/1.2%,P0.201)intheT4group,and4.0%(95% CI11.4/4.2%,P0.328)intheIgroupascomparedwithplacebo.Indirectcomparison,theT4I therapywassignificantlysuperiortoT4(P0.018)orI(P0.003).Thyroidvolumereductionswere 7.9%(95%CI11.8/3.9%,P0.001),5.2%(95%CI8.7/1.6%,P0.024)and2.5%(95% CI6.2/1.4%,P0.207), respectively. The T4I therapy was significantly superior to I (P0.034) but not to T4 (P 0.190). Conclusion: In a region with a sufficient iodine supply, a 1-yr therapy with a combination of I and T 4with incomplete suppression of thyrotropin reduced Thyroid Nodule volume further than either component alone or placebo. (J Clin Endocrinol Metab 96: 2786–2795, 2011)
-
Thyroid Nodule guidelines agreement disagreement and need for future research
Nature Reviews Endocrinology, 2011Co-Authors: Ralf Paschke, Laszlo Hegedus, Erik K Alexander, Roberto Valcavi, Enrico Papini, Hossein GharibAbstract:This article reviews agreement, disagreement and need for future research of the Thyroid Nodule guidelines published by the British Thyroid Association, National Cancer Institute, American Thyroid Association and the joint, transatlantic effort of three large societies, the American Society of Clinical Endocrinologists, Associazione Medici Endocrinologi and the European Thyroid Association, published in 2010. Consensus exists for most topics in the various guidelines. A few areas of disagreement, such as the use of scintigraphy, are mostly due to differences in disease prevalence in different countries. Most of the discordance, for example, on the use of calcitonin screening or fine-needle aspiration cytology classification, could probably be resolved by further expert discussions, as the basis is the same published evidence. Importantly, owing to a current lack of evidence in many areas, clinically very relevant areas of uncertainty need to be addressed by further research. This situation applies, for instance, to better definition of ultrasound malignancy criteria and the evaluation of emerging new diagnostic and therapeutic techniques, including molecular markers. For clinicians who advise individual patients, these areas of uncertainty can currently only be resolved by sound management on the basis of clinical judgment, experience and patient preference.
-
interobserver variation for ultrasound determination of Thyroid Nodule volumes
Thyroid, 2005Co-Authors: V Brauer, P Eder, K Miehle, T Wiesner, H Hasenclever, Ralf PaschkeAbstract:Thyroid ultrasound is used in the routine clinical assessment and the follow-up of Thyroid disorders. The follow- up of patients with Thyroid Nodules is mostly based on Thyroid Nodule volume determ...