Endocrinology Section, Hospital General de Granollers, Granollers, Spain.
Medicine Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Spain.
Int J Clin Pract. 2021 Jul;75(7):e14211. doi: 10.1111/ijcp.14211. Epub 2021 Apr 14.
It has been suggested, on a theoretical basis, that ultrasound screening of thyroid nodules in obese patients with additional risk factors (family history, chronic autoimmune thyroiditis or high thyrotropin) might be cost-effective for the early detection and treatment of thyroid cancer. The present study evaluates if this approach can be validated in a real clinical setting.
Patients with obesity who attended hospital-based clinics were evaluated for risk factors of thyroid cancer and ultrasound screened for thyroid nodularity. Detected nodules were evaluated according to current guidelines.
A total of 429 patients were evaluated (70.2% women, mean age 49.1 ± 11.0, mean body mass index 42.6 ± 5.8 kg/m ). Risk factors were present in 129 (30.1%) patients. Thyroid nodules with indication for fine-needle aspiration biopsy were detected in 69 (16.1%). We did not find differences in the risk of harbouring thyroid nodules according to the presence of risk factors (no risk factors 16.6%, risk factors 14.1%, P = .64). No single risk factor conferred an increased risk for thyroid nodules During the screening procedure, four cases of thyroid cancer were detected, none of them with the evaluated risk factors.
The presence of known risk factors for thyroid cancer does not improve the performance of a US screening strategy aimed at the detection of thyroid nodules in obese patients. According to current guidelines, screening for thyroid nodules in obese patients is not recommended regardless of the presence of thyroid cancer risk factors.
基于理论依据，有人提出对于肥胖伴有其他危险因素（家族史、慢性自身免疫性甲状腺炎或高促甲状腺素）的甲状腺结节患者进行超声筛查可能有利于甲状腺癌的早期发现和治疗，具有成本效益。本研究旨在评估该方法是否可在真实临床环境中得到验证。
对因肥胖就诊于医院门诊的患者进行甲状腺癌危险因素评估，并进行甲状腺结节超声筛查。根据现行指南评估检出的结节。
共评估了 429 名患者（70.2%为女性，平均年龄 49.1±11.0 岁，平均体重指数 42.6±5.8kg/m2）。129 名（30.1%）患者存在危险因素。发现 69 名（16.1%）患者存在需要进行细针抽吸活检的甲状腺结节。我们未发现存在或不存危险因素的患者发生甲状腺结节的风险存在差异（无危险因素患者为 16.6%，有危险因素患者为 14.1%，P=0.64）。在筛查过程中，发现了 4 例甲状腺癌，均无评估的危险因素。
已知的甲状腺癌危险因素的存在并不能提高针对肥胖患者甲状腺结节进行超声筛查策略的性能。根据现行指南，无论是否存在甲状腺癌危险因素，均不建议对肥胖患者进行甲状腺结节筛查。
