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    Comparison of Papillary Thyroid Microcarcinoma and Carcinoma
    (Turkiye Klinikleri, 2009) Gül, Kamile; Özdemir, Didem; Ersoy, Reyhan; Aydın, Cevdet; Erkan, Ali; Ersoy, Pamir Eren; Aydın, Raci; Uğraş, Serdar Nevzat; Çakır, Bekir
    Objective: The aim of this study is to evaluate some preoperative and postoperative clinical and histopathological characteristics of patients with papillary thyroid microcarcinoma (PTMC). We also compared these features with papillary thyroid carcinoma greater than 1 cm (PTC). Materials and Methods: We reviewed the clinical data of 224 patients who were diagnosed and treated for papillary thyroid carcinoma. Both the preoperative and postoperative features of patients were assessed. There were 132 patients with PTMC and 92 patients with PTC. Results: The mean age and the incidence of hyperthyroidism were higher in patients with PTMC compared to patients with PTC. There were also a higher number of patients operated for benign lesions in PTMC group. In histopathologic examination, mean tumor diameter was 5.8±2.8 mm in PTMC patients. Although, we found capsular invasion in 17.4%, vascular invasion in 1.5%, extrathyroidal extension in 3%, lymph node involvement in 3.8% and multifocality in 18.9% of PTMC patients, these percentages were significantly lower than in PTC patients. Tumor was detected incidentally in 37.1% and nonincidentally in 62.9% of PTMC patients. No significant difference was present between incidental and nonincidental PTMC in terms of age, sex, and histopathological findings. Anyway, tumor diameter was greater in nonincidental PTMC compared to incidental PTMC. Conclusions: Histopathological features of incidental and nonincidental PTMC did not differ, while there was a significant difference between PTMC and PTC in terms of tumoral characteristics. However, particularly multifocality and capsular invasion were present in a considerable number of PTMC patients. We suggest that patients with PTMC should also be managed like patients with PTC.
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    Preoperative and Postoperative Evaluation of Thyroid Disease in Patients Undergoing Surgical Treatment of Primary Hyperparathyroidism
    (Amer Assoc Clinical Endocrinologists, 2010) Gül, Kamile; Özdemir, Didem; Korukluoğlu, Birol; Ersoy, Pamir Eren; Aydın, Raci; Uğraş, Serdar Nevzat; Ersoy, Reyhan; Çakır, Bekir
    Objective: To evaluate the occurrence of thyroid disease in patients undergoing parathyroidectomy for primary hyperparathyroidism. Methods: In this case series, records of all parients with a diagnosis of primary hyperparathyrodism who underwent parathyroidectomy bewteen January 2005 and December 2008 in our clinic were analyzed retrospective Preoperatively, all patients were evaluated with ultrasonography and parathyroid scintigraphy, when needed, thryoid scintigraphy and ultrasound-guided fine-needle aspiration biopsy (FNAB) were used All patients underwent standard neck exploration Postoperative histopathologic findings of thyroid tissue were classified as nodular/multinodular hyperplasia. Hashimoto thyroiditis, papillary thyroid carcinoma, or normal Results: Fifty-one women and 9 men were included In the 60 patients, preoperative ultrasonography revealed thyroiditis (without nodules) in 13 (22%), a solitary nodule in 9 (15%) (coexistent with thyroditis in 7 patients), multinodular goiter in 24 (40%) (coexistent with thyroiditis in 5 patients), and normal findings in 14 (23%) Rates of thyroiditis and nodular goiter were 42% and 55%, respectively. Collectively, prevalence of thyroid disease was 77% Total thyroidectomy was performed in 27 patiens, and hemithyroidectomy was performed in 15 patients Indications for total thyroidectomy were nondiagnostic or suspecious FNAB results in 5 patients, hyperthyroidism in 4 patients, ultrasonography findings in 11 patients, and intraoperatively recognized suspicious nodularity in 7 patients Postoperatively, thyroid carcinoma was dragnosed in 9 patients (15%) Conclusions: Thyroid disease, particularly thyroid carcinoma, is common in patients with primary hyperparathyroidism This association should be considered when selecting the surgical procedure Intraoperative evaluation of the thyroid is as important as preoperative evaluation with ultrasonography and FNAB in patients with thyroid disease and primary hyperparathyroidism.
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    Ultrasonographic Evaluation of Thyroid Nodules: Comparison of Ultrasonographic, Cytological, and Histopathological Findings
    (Springer, 2009) Gül, Kamile; Ersoy, Reyhan; Dirikoç, Ahmet; Körüklüoglu, Birol; Ersoy, Pamir Eren; Aydın, Raci; Uğraş, Serdar Nevzat; Belenli, Olcay K.; Çakır, Bekir
    Thyroid ultrasonography (US) and fine needle aspiration biopsy (FNAB) are the most important tools in evaluating thyroid nodules. A total of 3,404 nodules in 2,082 cases referred to our clinic between 2005 and 2008 were analyzed retrospectively. Considering US features of nodules, risk factors predicting malignancy were: margin irregularity as the most important predictor, hypoechoic pattern and microcalcification (Odds ratios: 63.2, 13.3, 7.03, respectively). Cytologic results of the patients were as follows: 1,718 (82.5%) benign, 196 (9.4%) suspicious, 68 (3.3%) nondiagnostic, and 100 (4.8%) malignant. In histopathologic examination, we determined a malignancy rate of 7.59% (158/2082). We calculated the sensitivity of FNAB as 89.16%, specificity as 98.77%, positive predictive value as 96.10%, negative predictive value as 96.39%, and accuracy as 96.32%. In cytologic examination, the malignancy rate of subcentimetric (a parts per thousand currency sign1 cm) nodules was higher than supracentimetric (> 1 cm) nodules (5.1% vs. 1.5%, P = 0.001). In postoperative histopathologic examination, although the malignancy rate of subcentimetric nodules was higher than that of supracentimetric nodules, the difference was statistically insignificant (5.5%, 4.4%, respectively; P > 0.05). Cytologically diagnosed malignancy was detected in 4.5% of patients with multiple nodules, while it was present in 6% of patients with solitary nodule indicating no significant difference. However, postoperative histopathologic examination revealed a significantly higher malignancy rate in patients with solitary nodule compared to in patients with multiple nodules (11.7%, 6.5%; respectively, P < 0.001). The malignancy rate of patients operated for suspicious cytology was found to be 46.15%; for nondiagnostic cytology, it was 64.29%. In conclusion, ultrasonographically, hypoechoic pattern, microcalcification and margin irregularity of thyroid nodules are important features in determining the malignancy risk. The nodule size alone still remains inadequate to exclude malignancy risk.