Introduction: Thyroid nodules are a common finding. A high-resolution thyroid nodule clinic (HR-TNC) condenses all tests required for the evaluation of thyroid nodules into a single appointment. We aimed to evaluate the clinical outcomes at HR-TNCs. Design and Methods: A retrospective cross-sectional multicenter study including data from four HR-TNCs in Spain. We evaluated fine-needle aspiration (FNA) indications and the association between clinical and ultrasound characteristics with cytological and histopathological outcomes. Results: A total of 2809 thyroid nodules were included; FNA was performed in 82.1%. Thyroid nodules that underwent FNA were more likely larger, isoechoic, with microcalcifications, and in younger subjects. The rate of nondiagnostic FNA was 4.3%. A solid component, irregular margins or microcalcifications, significantly increased the odds of Bethesda IV-V-VI (vs. Bethesda II). Irregular margins and a solid component were independently associated with increased odds of malignancy. Thyroid nodules <20 mm and ≥20–<40 mm had a 6.5-fold and 3.3-fold increased risk for malignancy respectively in comparison with those ≥40 mm. Conclusion: In this large multicenter study, we found that the presence of a solid component and irregular margins are factors independently related to malignancy in thyroid nodules. Since nodule size ≥40 mm was associated with the lowest odds of malignancy, this cut-off should not be a factor leading to indicate thyroid surgery. HR-TNCs were associated with a low rate of nondiagnostic FNA.

The aim of this study was to investigate whether hypoalbuminemia and other risk factors for mortality after stroke have the same or different short (1 month), medium (3 months), long (1 year) or very long term (5 years) prognostic value. clinical and analytical data from 254 patients admitted to our Hospital with an ischemic stroke and followed up prospectively for 2 years were collected with a prospective standard protocol. Additional data up to 5 years were obtained from Clinical and Laboratory Registries of the Hospital, a mailed questionnaire, a phone call and the Council Registry of Mortality. Risk factors for mortality at different time points were calculated with logistic regression and Cox proportional hazard analyses. The following factors were significantly associated with mortality at one month: cardioembolic mechanism, hypoalbuminemia, glycemia, age, low diastolic arterial pressure and Canadian Scale, at three months: previous stroke and Barthel index at discharge, at one year: previous dementia and Barthel index at three months and at five years: age, Canadian Scale score at discharge and low cholesterol at admission. Cox regression analysis considering survival time showed hypoalbuminemia at admission (hazard ratio (HR) 2; p = 0.03), age (HR 1.06; p < 0.00), previous dementia (HR 2; p < 0.00), cardioembolic mechanism (HR 2; p < 0.00) and severity on the Canadian Neurological Stroke Scale (HR 1.2; p < 0.00) to be independently associated with mortality. Mortality after ischemic stroke seems to depend on different factors along time. Hypoalbuminemia at admission is an independent factor for short term (acute) and global mortality. Other risk factors for global mortality were previous dementia, cardioembolic mechanism and severity on the Canadian Neurological Stroke Scale at admittance.

Background: Antithyroid drug-induced agranulocytosis (AIA) (neutrophils <500/µL) is a rare but serious complication in the treatment of hyperthyroidism. Methodology: Adult patients with AIA who were followed up at 12 hospitals in Spain were retrospectively studied. A total of 29 patients were studied. The etiology of hyperthyroidism was distributed as follows: Graves’ disease (n = 21), amiodarone-induced thyrotoxicosis (n = 7), and hyperfunctioning multinodular goiter (n = 1). Twenty-one patients were treated with methimazole, as well as six patients with carbimazole and two patients with propylthiouracil. Results: The median (IQR) time to development of agranulocytosis was 6.0 (4.0–11.5) weeks. The most common presenting sign was fever accompanied by odynophagia. All of the patients required admission, reverse isolation, and broad-spectrum antibiotics; moreover, G-CSF was administered to 26 patients (89.7%). Twenty-one patients received definitive treatment, thirteen patients received surgery, nine patients received radioiodine, and one of the patients required both treatments. Spontaneous normalization of thyroid hormone values occurred in six patients (four patients with amiodarone-induced thyrotoxicosis and two patients with Graves’ disease), and two patients died of septic shock secondary to AIA. Conclusions: AIA is a potentially lethal complication that usually appears around 6 weeks after the initiation of antithyroid therapy. Multiple drugs are required to control hyperthyroidism before definitive treatment; additionally, in a significant percentage of patients (mainly in those treated with amiodarone), hyperthyroidism resolved spontaneously.

Objective: Patients with differentiated thyroid carcinoma (DTC) classified as low risk of recurrence and an excellent response to initial treatment should have a particularly low risk of recurrence. Our objective was to assess the recurrence rate in these patients to support follow-up de-escalation. Methods: A multicenter retrospective study was conducted in six Spanish hospitals, including consecutive patients diagnosed with low-risk DTC between 2015 and 2018 with an excellent response to initial therapy. Results: A total of 379 patients were included, with a median follow-up of 6.7 years. Response to therapy at the last follow-up, according to the 2015 ATA/Momesso criteria, was excellent in 349 patients (92.1%), indeterminate in 29 (7.6%), and biochemical incomplete in 1 (0.3%). The overall incidence of indeterminate response was 11.8 events per 1,000 person-years, peaking at year 3 of follow-up and dropping to nearly zero after year 7. PTC and RAI treatment were associated with a lower probability of developing an indeterminate response (P = 0.02 and P = 0.03, respectively). When applying the 2025 ATA criteria, the excellent response rate increased to 95.8% and neither papillary histology nor RAI treatment was significantly associated (P = 0.07 and P = 0.61, respectively). During follow-up, indeterminate/suspicious findings on ultrasound were observed in 39 patients (10.3%). FNA was performed in 20 of these, none of which found recurrence. Conclusions: Recurrences in patients with low risk of recurrence and an excellent response to initial therapy are extremely infrequent. These data support follow-up de-escalation in this population. Significance statement: In this multicenter retrospective study of low-risk DTC patients with an excellent response to initial treatment, no recurrences were observed among 379 patients after a median follow-up of 6.7 years. The overall incidence rate of indeterminate response was 11.8 events per 1,000 person-years, peaking around year 3 after surgery and progressively declining thereafter, approaching zero after year 7. Using the 2025 ATA response-to-therapy criteria, 95.8% of patients maintained an excellent response at the last follow-up, and no variable was associated with the development of an indeterminate response. These findings support follow-up de-escalation.