Thyroid Nodules in the Follow-Up of Irradiated Individuals: Comparison of Thyroid Ultrasound with Scanning and Palpation1
Arthur B. Schneider,
Carlos Bekerman,
Joel Leland,
Jeffrey Rosengarten,
Hyewon Hyun,
Barbara Collins,
Eileen Shore-Freedman and
Theresa C. Gierlowski
University of Illinois College of Medicine (A.B.S., B.C.) and
Columbia-Michael Reese Hospital (A.B.S., C.B., J.L., J.R., H.H.,
E.S.-F., T.G.), Chicago, Illinois 60612
Address all correspondence and requests for reprints to: Arthur B. Schneider, M.D., Ph.D., Section of Endocrinology and Metabolism (MC 640), University of Illinois College of Medicine, 1819 West Polk Street, Chicago, Illinois 60612.
In 1974 we began a prospective study of a cohort of 4296 individuals
exposedto therapeutic head and neck irradiation during childhood for
benignconditions. To define the role of thyroid ultrasonography in
followingirradiated individuals, we studied a subgroup of 54
individuals.They all had been screened between 1974–1976 and had
normalthyroid scans and no palpable nodules at that time. Thyroid
ultrasonography,thyroid scanning, physical examination, and serum
thyroglobulinmeasurements were performed. One or more discrete
ultrasound-detectednodules were present in 47 of 54 (87%) subjects.
There werea total of 157 nodules, 40 of which were 1.0 cm or larger in
largestdimension. These 40 nodules occurred in 28 (52%) of the
subjects.Thirty (75%) of these 1.0-cm or larger nodules matched
discreteareas of diminished uptake on corresponding thyroid scans. The
10that did not match (false negative scans for 1.0-cm nodules)were
the only nodules of this size in 7 subjects. Of 11 nodules1.5 cm or
larger, only 5 were palpable. Serum thyroglobulincorrelated to the
number (P = 0.04; r2 = 0.10), but not
thevolume of the thyroid nodules (P = 0.07;
r2 = 0.08). We concludethat thyroid nodules are continuing
to occur and are exceedinglycommon in this irradiated cohort of
individuals. The resultsconfirm that thyroid ultrasonography is more
sensitive thanphysical examination and scanning. However, thyroid
ultrasoundis so sensitive and nodules so prevalent that great caution
isneeded in interpreting the results.
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1.0-cm nodules) were
the only nodules of this size in 7 subjects. Of 11 nodules 1.5 cm or
larger, only 5 were palpable. Serum thyroglobulin correlated to the
number (P = 0.04; r2 = 0.10), but not
the volume of the thyroid nodules (P = 0.07;
r2 = 0.08). We conclude that thyroid nodules are continuing
to occur and are exceedingly common in this irradiated cohort of
individuals. The results confirm that thyroid ultrasonography is more
sensitive than physical examination and scanning. However, thyroid
ultrasound is so sensitive and nodules so prevalent that great caution
is needed in interpreting the results. 
