Why in Auvergne, endocrinologists see a little more thyroid nodules than elsewhere

Thyroid nodules often cause concern. We take stock with Professor Igor Tauveron, head of the diabetes and metabolic diseases endocrinology department at Clermont-Ferrand University Hospital, on the occasion of the first European Hormone Day, Monday May 23, organized by the European Society of Endocrinology ( SFE).

What are endocrine diseases and what is the most common?

These diseases correspond to a malfunction: either an excess of hormones (example of hyperthyroidism), or a deficit of hormones (type 1 diabetes). Another anomaly is the appearance of nodules in the various endocrine glands. Today, probably the most common pathology is nodules in the thyroid gland.

Thyroid nodules: a frequent pathology in certain regions… is this the case in Auvergne?

A fairly old study has, in fact, shown that thyroid nodules concerned about 11% of the population and its frequency is a little higher in Auvergne (12%) compared to other regions of France (with variations between 9 and 12 %).

Do we know why?

What we do know is that the occurrence of the disease was historically favored by an iodine deficiency. The distance from the sea could explain it. In the elements also mentioned, without formal proof, volcanism: there could be, here, a little more radiation emanating from the ground. Endocrine disruptors are also mentioned as responsible for the development of goiters and nodules. But it is still difficult to say.

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How are these nodules diagnosed and managed?

The diagnosis is made by the clinic: the palpation of the neck by his doctor once a year. There are usually no signs, the discovery is made on examination. If a nodule is present, there is concern about whether the nodules are benign or cancerous. It is necessary to begin by specifying the thyroid functioning by a dosage of TSH (by a blood test). Then, it is necessary to specify its size and structure by ultrasound. There are very precise classifications and criteria (EU-Tirads) that allow endocrinologists to make their conclusion on the abnormalities.

After that ?

According to these conclusions, it will be decided either a simple surveillance, or a cytopuncture: a sample of the cells at the level of the nodule using an extremely fine needle. An almost painless gesture. The cells will be analyzed under a microscope. And depending on the results, either surveillance is set up or the thyroid gland or part of it is removed. Lifelong hormone treatment then follows.

For what reasons does SFE speak of over-detection leading to treatments whose benefit-risk impact is considered to be unfavourable?

In France, too much of the thyroid gland is operated on. You should know that the vast majority of thyroid nodules are benign and not very progressive. Almost 90%. They then require monitoring by an annual ultrasound.

In addition, there are interesting perspectives from molecular biology. Tomorrow’s strategy will also be based on new tools (currently not covered by Medicare) such as radio frequency or laser to destroy nodules.

Michele Gardette

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