Prevalence of  Hot Thyroid  Nodules Suspicious for Malignancy

Program: Abstracts - Orals, Poster Previews, and Posters
Session: SAT 270-310-Thyroid Neoplasia (posters)
Saturday, April 2, 2016: 1:15 PM-3:15 PM
Exhibit/Poster Hall (BCEC)

Poster Board SAT 272
Diana Juhee Chang*1, Stephen Samuel Lippman2, Alison Marie Semrad3 and Arthur Swislocki4
1UC Davis School of Medicine, 2Department of Veterans Affairs, Northern California Healthcare System, 3UC Davis Med Ctr, Sacramento, CA, 4VA N CA Hlth Care System, Martinez, CA
Purpose of Study:  To estimate the prevalence of thyroid nodules suspicious for malignancy in hyperthyroid patients. While contemporary guidelines emphasize that “hot,” or toxic nodules are unlikely to be malignant, case reports suggest that these nodules may be malignant in a small, but not insignificant number of individuals.  The prevalence of malignancy in “hot nodules” is unknown.

Methods used: This retrospective study analyzed data from the VA Northern California Health Care System for patients enrolled between January 2010 and December 2014.  Veterans were identified by ICD-9 codes for hyperthyroidism, and either thyroid nodules, thyroiditis, thyroid adenoma, or goiter.  Veterans who underwent radioiodine or ultrasound thyroid scanning were identified .  These records were subsequently reviewed manually for suspicious ultrasonographic findings (size, calcification, or geometry).   

Summary of Results:  760 Veterans were identified by ICD-9 coding. Of these, 230 had thyroid ultrasounds, and 113 had radioiodine thyroid scans.  There were 70 patients that had both ultrasound and radioiodine thyroid scans of which 84.3% were male and the average age was 62.9.  Twenty-five had hyperthyroid nodules or areas on radioiodine studies and 31 had suspicious ultrasound scans (we excluded 7 individuals with “cold” thyroid scans). 18 had both and of these, 6 underwent fine needle aspirate (FNA) and 1 is planned for FNA.

Conclusions:  While most Veterans identified as hyperthyroid did not undergo imaging studies, of those who did, a remarkable number had heretofore unexpected ultrasonographically-suspicious nodules.  This preliminary observation suggests that ultrasound scans, a noninvasive and relatively inexpensive diagnostic modality, may have a role in the evaluation of the hyperthyroid patient in identifying those who might benefit from FNA.

Nothing to Disclose: DJC, SSL, AMS, AS

*Please take note of The Endocrine Society's News Embargo Policy at

Sources of Research Support: Department of Veterans Afffairs