Thyroid nodules continue to be a source of concern to patients, and their management remains a controversy among physicians. Several diagnostic techniques have been proposed to distinguish benign nodules (the majority) from malignant lesions (the minority). The trend in the management of thyroid nodular disease has been to use these diagnostic techniques with increasing frequency. The past decade has seen widespread application of fine-needle aspiration biopsy, new radionuclide scanning agents, and sensitive ultrasonography for diagnosing thyroid nodular disease. The diagnostic techniques used to distinguish benign from malignant nodules, however, vary in reliability. Furthermore, technological improvements have introduced new problems — . . .

Nodular thyroid disease. Evaluation and management.

The thyroid gland is highly sensitive to the carcinogenic effects of ionizing radiation. Previously, we reported a significant increase of thyroid cancer and adenomas among 10,834 persons in Israel who received radiotherapy to the scalp for ringworm. These findings have now been extended with further follow-up and revised dosimetry. Overall, 98 thyroid tumors were identified among the exposed and 57 among 10,834 nonexposed matched population and 5392 sibling comparison subjects. An estimated thyroid dose of 9 cGy was linked to a fourfold (95% Cl = 2.3-7.9) increase of malignant tumors and a twofold (95% Cl = 1.3-3.0) increase of benign tumors. The dose-response relationship was consistent with linearity. Age was an important modifier of risk with those exposed under 5 years being significantly more prone to develop thyroid tumors than older children. The pattern of radiation risk over time could be described on the basis of a constant multiplication of the background rate, and an absolute risk model was not compatible with the observed data. Overall, the excess relative risk per cGy for thyroid cancer development after childhood exposure is estimated as 0.3, and the absolute excess risk as 13 per 10(6) PY-cGy. For benign tumors the estimated excess relative risk was 0.1 per cGy and the absolute risk was 15 per 10(6) PY-cGy.

Thyroid Neoplasia following Low-Dose Radiation in Childhood

The risk of developing thyroid cancer and other thyroid neoplasms after radiation exposure is well known, but specific modifiers of the dose-response relationship are not. We have identified 4296 subjects who received treatment before their sixteenth birthday with orthovoltage radiation for benign conditions in the head and neck area. Individual thyroid dose estimates were calculated for 3843 subjects. Of the 2634 subjects who have been found, 1043 have developed thyroid nodules of all types, and 309 have developed thyroid cancer. The radiation dose-response relationship was consistent with a linear excess relative risk model for thyroid cancer and thyroid nodules within the range of observed doses. Women developed thyroid cancer and thyroid nodules at a higher rate, but the slopes of the dose-response curves were the same for men and women. Age at radiation exposure was a significant factor of the risk, with a lower age at exposure associated with a higher risk. To determine the effect of the wide publicity and our screening program, which began in 1974, we compared the dose-response relationship for cases diagnosed before and after 1974. The overall rates increased dramatically after 1974, but the estimates of the slopes of the dose-response curves were not statistically different. The slope of the dose-response curve for thyroid neoplasms appears to have reached a maximum 25-29 yr after radiation exposure, but the dose response continued to be elevated at the end of follow-up. These data are consistent with the tumorigenic effects of radiation lasting at least 40 yr.

Dose-response relationships for radiation-induced thyroid cancer and thyroid nodules: evidence for the prolonged effects of radiation on the thyroid.

Solitary thyroid nodule: diagnosis and management.

Thyroid-stimulating hormone (TSH) and thyroxine (T4) were measured in sera from 214 patients with Hodgkin's disease. The literature was reviewed for patients with lymphoma or head and neck...

Radiation-related thyroid dysfunction: implications for the treatment of Hodgkin's disease.

Incidence, prevalence and characteristics of radiation-induced thyroid tumors

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Incidence, prevalence and characteristics of radiation-induced thyroid tumors