Background: Ultrasound (US) is well-recognized as an excellent diagnostic tool for the study of thyroid gland and, consequently, for the detection of thyroid nodules. In particular, the identification and description of specific US-features are useful for clinicians to address patients to the most adequate follow-up.
Objective: The aim of this study was to evaluate the progression of thyroid disease in patients diagnosed with thyroid nodules and/or thyroiditis after at least five years from first thyroid US evaluation. A secondary endpoint was to register any possible thyroid examination performed in the follow-up years after the diagnosis of thyroid disease.
Material and methods: in this prospective study, eligible subjects were selected among patients diagnosed with thyroid disease in a previous study carried out at the Endocrinology Unit of the Ospedale Civile Sant’Agostino Estense of Modena. The enrolled patient underwent anamnesis, physical examination, neck palpation and US of thyroid gland. US-detected nodules were classified according to ATA and MUT classifications and treated according to clinical practice.
Results: In the previous study, a high prevalence (50,3%) of US thyroid abnormalities in volunteers, unaware of any thyroid disease, was found. Thirty-nine subjects (M: 9; F: 30; mean age: 58 ± 11 years) were enrolled in the study and underwent the follow-up evaluation. No statistically significant differences (p>0.05) were found comparing thyroid volumes from first (V0) to second (V1) thyroid evaluation (mean interval: 8 years 2 months ± 9 months).
Comparing patients examined in V0 and re-evaluated in V1, we found out that 3 out of 39 patients had been treated with total thyroidectomy and in all of them a differentiated thyroid cancer was diagnosed. Comparing the remaining 36 patients, thyroiditis only was confirmed in 4 patients, while in 32 patients nodular goiter was diagnosed. So, 4 patients developed thyroid nodules in the follow-up period.
However, considering the entire cohort, only 2 patients were addressed to fine-needle-aspiration (FNA) for suspicious/increasing nodules and cytological results were negative for atypia in both.
About follow-up evaluations, 11/39 patients (28%) did not re-evaluate the thyroid disease; 8/39 (20,5%) patients did blood exams including TSH quantification, 8/39 (20,5%) patients did US evaluation, and 12 (31%) patients executed both.
Conclusion: Asymptomatic US-detected alterations of thyroid gland may evolve in time, but rarely patients develop symptoms or need to undergo more invasive exams. Further studies with the aim to deepen the effectiveness of long-term sonographic follow-up are required.