Prevalence of US-detected nodules 13 MHz Scanner n 635

Prevalence of US-detected nodules 13 MHz Scanner n=635 (33%F/67% M) Total=68% age 56. 7+7. 2 y (19 -93) 55%< 5 mm! Females=75% Males=65% Guth S et al. Eur J Clin Invest 2009; 39 (8): 699– 706

Prevalence of US-detected nodules Papillion study 7. 5 MHz Scanner n=96, 278 (54%F/46% M) age 41. 4+10. 6 y (18 -65) Total prevalence: 33. 1% nodules > 5 mm Reiners et al. Thyroid 2004; 11: 926 -932

Prevalence of Unsuspected Thyroid Nodules and Cancer at Autopsy • • 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)

Thyroid Cancer Incidence and Mortality in the US, 1973 -2002 Davies, L. et al. JAMA 2006; 295: 2164 -2167.

Thyroid Cancer Incidence in Israel ♀ 1998 -2002 Kilfoy et al. Cancer Causes Control 2009

Thyroid Cancer Incidence in the Middle East (1996 -2001) ♀ Ronckers C, MECC monograph, 2006

Management and Follow-up of DTC • Deleterious effects of treatment for DTC – Almost irreversible effect on QOL – Hypoparathyroidism with compartment neck dissection – Suppressive T 4 Rx: angina, AF, osteoporosis – Side effects of RAI: • • Sialoadenitis Nasolacrimal duct obstruction Increased risk for malignancy (>500 -600 m. Ci) Pulmonary fibrosis

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