Guth S et al. Eur J Clin Invest 2009; 39 (8): 699–706

13 MHz Scannern=635 (33%F/67% M) Total=68%

age 56.7+7.2 y (19-93)

Females=75%

Prevalence of US-detected nodules

Males=65%

55%< 5 mm!

Prevalence of US-detected nodules

Reiners et al. Thyroid 2004; 11:926-932

7.5MHz ScannerPapillion study n=96,278 (54%F/46% M)

age 41.4+10.6 y (18-65)

Total prevalence: 33.1% nodules > 5 mm

• Over 50% in some series (Mayo Clinic 1955)• 19% in healthy young men (deceased US soldiers)• Occult thyroid cancer in the US 0.5-13% (mean 3.6%)• Spanish series OTC in 5.3% of visible nodules, but

22% microscopically• Up to 36% in some series (Finland)

Prevalence of Unsuspected Thyroid Nodules and Cancer

at Autopsy

Davies, L. et al. JAMA 2006;295:2164-2167.

Thyroid Cancer Incidence and Mortality in the US, 1973-2002

Thyroid Cancer Incidence in Israel

Kilfoy et al. Cancer Causes Control 2009

♀

1998-2002

Thyroid Cancer Incidence in the Middle East

♀

(1996-2001)

Ronckers C, MECC monograph, 2006

• Deleterious effects of treatment for DTC– Almost irreversible effect on QOL– Hypoparathyroidism with compartment neck

dissection

– Suppressive T4 Rx: angina, AF, osteoporosis

– Side effects of RAI:• Sialoadenitis• Nasolacrimal duct obstruction• Increased risk for malignancy (>500-600 mCi)• Pulmonary fibrosis

Management and Follow-up of DTC

• Irresistible “appeal” to biopsy small non palpable nodules• 150 million Americans have nodules• 10% represent PTC/DTC• Potential for 15 million thyroidectomies, RAI and

surveillance• Estimated 30 billion USD cost• Essentially no lives saved• Adverse effects of Rx• Impact on quality of life

Managing the Tsunami of Thyroid Nodules and the Epidemic of Thyroid Cancer