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Thyroid cancer is the most prevalent endocrine cancer (1). The prevalence of palpable thyroid nodules in the general adult population is 4% to 7% (2). Ultrasound imaging detects thyroid nodules in 19%-68% of randomly selected individuals (3). The rate of thyroid cancer in nodules found on US is 4% to 15% (4). In order to evaluate thyroid nodules patients undergo thyroid ultrasonography and, if needed, a fine-needle aspiration biopsy. Of all fine-needle aspiration biopsies, 15-30% are indeterminate on cytology (5). While only 3% of these nodules are malignant on average, a much higher percentage of nodules are surgically removed in order to rule out malignancy after indeterminate FNA results. Our goal is to identify clinical and ultrasound predictors of benign results in indeterminate nodules, to assist physicians in selecting nodules for surgical removal versus monitoring with ultrasound imaging. Between October 2010 and November 2017 there were 129 patients with 134 thyroid nodules from Temple University Hospital, Jeanes Hospital, and Fox Chase Cancer Center who had a total or partial thyroidectomy after a cytology report of at least one AUS or FLUS thyroid nodule. These patients were evaluated for age, sex, BMI, TSH, fT4, tT3, nodule size, and ultrasonography features to determine if any features were predictive of a benign or malignant thyroid nodule. Additionally, we looked at whether any of these features were more likely to occur in an AUS nodule or a FLUS nodule. We found that none of the demographic factors, thyroid function tests, or ultrasound features were good predictors of malignancy in AUS or FLUS thyroid nodules. We found that AUS nodules are more likely to be malignant than FLUS nodules, and this held true when we accounted for age, sex, smoking history, and BMI. We concluded that demographic factors and thyroid function tests are unable to predict increased risk of malignancy in Bethesda category III nodules, AUS nodules are more likely to be malignant that FLUS nodules, and nodules with at least one suspicious ultrasound feature are more likely to be AUS nodules than FLUS nodules due to AUS nodules having nuclear atypia and FLUS nodules having architectural atypia.

This dissertation is submitted as a final copy as the University’s Academic and Clinical supervisor / Background Thyroid gland involvement in advanced laryngeal malignancies is a rare entity, mostly resulting from direct contiguous spread from anterior and inferior tumours. Reported practice is to perform a hemithyroidectomy at the time of laryngectomy. However, this results in pointless excision of functional tissue and the added morbidity of hypothyroidism post operatively. Aim The aim of this study is twofold: firstly, to assess the frequency of thyroid gland involvement in laryngectomy specimens from Chris Hani Baragwanath Hospital, and secondly, to determine any association between the anatomical subsites of tumour and thyroid gland involvement. Methods This is a retrospective clinical audit of histological reports on laryngectomy specimens collected over a 10 year period from January 2005 and December 2014. The study was conducted at Chris Hani Baragwanath Hospital, affiliated to the University of the Witwatersrand, in South Africa. ENT operating registries and the laboratory database were used to access all records of total laryngectomies done over the 10 year period. Seventy-three laryngectomies were done, 9 were excluded as no thyroid tissue was included in the sample and 1 was excluded due to inadequate demographic detail. Thus a total of 63 histological reports were included in the study. Data extracted included age, race, sex, pathological stage of tumour, thyroid gland involvement and anatomical subsites involved by tumour (subglottis, anterior commissure and transglottic tumours). Data was analysed using standard statistical methods including a Fischer-exact test and an ANOVA association test. Statistica software was used. Results Four of the 63 cases had thyroid gland involvement (6.35%). The majority of the patients were black males in the age group 50 to 60 years of age. The tumours were all advanced laryngeal malignancies and only 2 of the 63 cases were found to have a diagnosis of adenosquamous carcinoma and chondrosarcoma. None of the anatomical subsites were found to be statistically significant in association with thyroid gland involvement, however, this result was thought to be skewed due to the small number of tumours involving the thyroid gland. Conclusion In accordance with South African and international studies on the same topic, thyroid gland involvement in laryngeal tumours is a rare occurrence. Due to the complications of performing a thyroidectomy and the hypothyroidism that accompanies it, a thyroidectomy should not always be performed. However, due to the recurrence rates and poor prognosis of patients with stomal recurrence (associated with thyroid gland involvement), thyroidectomy still needs to be considered. Based on known anatomical pathways of extralaryngeal spread of tumours via the anterior commissure, paraglottic spaces and those tumours involving the subglottis, selected patients require thyroidectomy at the time of laryngectomy to achieve adequate oncological margins. / MT2017

This document only includes an excerpt of the corresponding thesis or dissertation. To request a digital scan of the full text, please contact the Ruth Lilly Medical Library's Interlibrary Loan Department (rlmlill@iu.edu).

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The metabolism of iodide was investigated in the adult amphibian, Amphiuma means using an adaptation of a standard clinical radio-iodine technique. The thyroid uptake of I131 after intraperitoneal injection of a tracer does was linear on arithmetic plotting for seven days. The uptake then increased to a pronounced peak at seven days. / Thesis / Master of Science (MS)

published_or_final_version / abstract / Surgery / Master / Master of Philosophy