Israel Medical Association Journal

Background: Increased utilization of imaging modalities has led to a significant rise in the detection of incidental thyroid nodules (ITN). Discrepancies in the prevalence of thyroid nodules with malignant potential exist worldwide.

Objectives: To analyze demographic and clinical data among patients with thyroid nodules in our geographic region.

Methods: The medical records of patients diagnosed with symptomatic or incidental thyroid nodules at the Galilee Medical Center between 2018 and 2023 were reviewed. Demographic and clinical data were collected and analyzed.

Results: The study population included 402 patients with thyroid nodules, 292 females. Symptomatic patients were younger (mean age 55.9 vs. 60.8 years) and had larger nodules (mean size 2.5 vs. 2.1 cm) compared to incidentally diagnosed patients (P < 0.001, P < 0.001, respectively). Male patients demonstrated a higher rate of malignancy for both symptomatic and incidental nodules compared to females (P < 0.05). Pathological examination revealed that malignant nodules were smaller (mean size 2.10 cm vs. 2.87 cm) and detected at a younger age (mean age 48.56 years vs. 56.5 years), compared to benign nodules (P < 0.05, P < 0.01, respectively).

Conclusions: We found a higher prevalence of both symptomatic and ITN among females. However, malignant thyroid nodules were more frequently observed in males. Notably, malignant nodules tended to be smaller and were more commonly diagnosed in younger individuals compared to benign nodules. These findings highlight significant sex and age disparities in the occurrence and characteristics of thyroid nodules, emphasizing the need for tailored diagnostic and management strategies.

Background: Due to the high variability in malignancy rate among cytologically indeterminate thyroid nodules (Bethesda categories III–V), the American Thyroid Association recommends that each center define its own categorical cancer risk.

Objectives: To assess cancer risk in patients with cytologically indeterminate thyroid nodules who were operated at our center.

Methods: In a retrospective study, we analyzed the pathology results of all the patients whose fine needle aspiration results showed Bethesda III–V cytology and who subsequently underwent total thyroidectomy or lobectomy from December 2013 to September 2017.

Results: We analyzed 56 patients with indeterminate cytology on fine needle aspiration. Twenty-nine (52%) were defined as Bethesda III, 19 (34%) Bethesda IV, and 8 (14%) Bethesda V category. Malignancy rates were 38%, 58%, and 100% for Bethesda categories III, IV, and V, respectively. Most malignancies in Bethesda categories III and IV were follicular in origin (follicular thyroid carcinoma and follicular type papillary thyroid carcinoma), while 100% of the patients with Bethesda category V were diagnosed with classical papillary thyroid carcinoma. No correlation was found between sonographic and cytological criteria of nodules with Bethesda categories III and IV and rates of malignancy.

Conclusions: We found higher than expected rates of malignancy in indeterminate cytology. This finding reinforces the guidelines of the American Thyroid Association to establish local malignancy rates for thyroid nodules with indetermined cytology.