Abstract
Objective:
To assess thyroid ultrasonographic (US) findings from a male cohort of asymptomatic Saudi Arabian university students.
Materials and Methods:
Sixty-three university students were enrolled in a quantitative prospective study from February 2024 to April 2024. They were conveniently selected, excluding females. A MyLab40 US equipment system was used with a 7 MHz transducer. The thyroid was evaluated with US for size, echotexture, and abnormalities. The chi-square test, correlations, and descriptive statistics were applied for the data analysis.
Results:
The mean age of the participants was 21.5 ± 1.1 years, and the mean body mass index (BMI) was 27.03 ± 6.6. 95.2% of participants had normal findings; positive findings were found in 4.8 % of the participants. Of these, 1.6 % had multiple nodules, and 3.2 % had signs of thyroiditis. The statistical analysis revealed no significant association between right and left thyroid lobe lengths compared to BMI (p = .7 right and left 0.3). Moreover, there was no association between the thyroid echo pattern and the BMI (p = .4).
Conclusion:
This cohort study concluded that the thyroid US findings were very limited. There was no statistical correlation between the thyroid lobe length, thyroid echo pattern, compared to participants’ BMI.
A thyroid sonography screening program is generally aimed at assessing asymptomatic individuals’ thyroid function or echotexture. The thyroid stimulating hormone (TSH) test is initially used as a routine to check the thyroid function (hypo or hyperthyroidism). Usually, free thyroxine (T4) and triiodothyronine (T3) are associated with TSH when it indicates an abnormal level. Some institutions 1 recommend performing thyroid function screening for asymptomatic patients. Other institutions 2 have recommended that screening for thyroid function is allowed for those who have suspected thyroid disorders. Additionally, they provided a testing algorithm and flowchart for this type of screening program.
Thyroid texture can be screened with ultrasonography (US) and clinically by neck palpation. This type of screening helps detect palpable lesions or any changes in thyroid texture. Based on the sonographic findings for the detected lesion, a fine needle aspiration cytology or sometimes molecular testing may also be needed to confirm the diagnosis. 3 Although this thyroid US screening program may have good diagnostic value, some have 4 not endorsed it, as they reported a negative net benefit of screening for thyroid cancer.
Cystic or spongiform nodules do not need further investigations, while suspicious US findings like hypoechogenicity, irregular margins, and microcalcifications require a fine needle aspirated (FNA). 3 Walsh et al 5 suggested that a FNA biopsy should be performed only with nodules > 1 cm. Bin Saeedan et al 6 have reported that computed tomography (CT) incidentally detects thyroid nodules and may have a vital role in detecting early thyroid cancers.
The current study, utilized a thyroid US screening program, aimed to provide baseline data on a cohort of asymptomatic Saudi Arabian university students. The early detection of thyroid abnormalities in university students could improve health outcomes, guide future healthcare planning, and promote preventive strategies. As the correlation between thyroid length and body mass index (BMI) has been scarcely published, therefore the main research question was: Is there a positive US finding among the selected cohort, and is there any statistical association between the thyroid length, echo pattern, and BMI?
Materials and Methods
All participants underwent thyroid US screening using the MyLab40 (Esaote, Genoa, Italy) equipment system coupled with a 7-MHz linear transducer. This quantitative descriptive prospective study was conducted at a Saudi Arabian university from February 2024 to April 2024. The participants included a cohort of male students studying in colleges of applied medical and nursery science (n = 63). The choice of male students was based on ready accessibility. The exclusion criteria included students unwilling to participate in the study; only three female students agreed to participate in the study; therefore, the female participants were excluded. All the participants were asymptomatic, and a simple, convenient sampling was utilized to select the participants.
All participants were subjected to thyroid US screening by an expert sonologist with more than ten years of sonographic scanning experience. The US images were obtained with the participant lying on an examination table supine with his neck elevated and tilted to the opposite side of the targeted one. Both right (Rt.) and left (Lt.) thyroid lobes were scanned using grayscale and color Doppler, if needed. Both thyroid size measurements and echotexture checks were performed. The length and anteroposterior size measurements were obtained for each thyroid lobe (see Figure 1).
An example of sagittal view of a participant’s thyroid is provided and demonstrated how lobe length and diameter measurements were obtained.
According to published literature, the average regular thyroid length is between 4 to 4.8 cm in sagittal, 1 to 1.8 cm in transverse, and 0.8 to 1.6 cm in anteroposterior dimensions. 7
The description of thyroid nodules was performed according to the 2021 Korean Society of Thyroid Radiology consensus statement and recommendations for managing thyroid nodules. 8 A nodule is solid when it has no obvious cystic component, predominantly solid when its cystic portion is ≤ 50%, predominantly when its cystic portion is> 50%, and cystic when it has no obvious solid component. According to published literature, 9 the diagnostic US features of thyroiditis include hypoechogenicity, heterogeneity, and hypervascularity of the intra-thyroid gland. The positive findings received additional testing in the local governmental hospital.
A structured data sheet was used to record the study data and variables such as age, weight, height, thyroid length, and echo texture. The participant’s BMI was calculated using the formula:, BMI = weight (kg)/height, m2))
Statistical Analysis
The data underwent rigorous analysis using industry-standard tools, Microsoft Excel (2021) and the Statistical Package for the Social Sciences (SPSS) program Version 26 (IBM, Armonk, New York, USA). Categorical and continuous variables were meticulously presented as percentages, frequencies, and descriptive statistics. The chi-squared test and Pearson’s correlations were used to explore the relationship between BMI and the length of the Rt. and Lt. thyroid lobes. The p-value was set for significance at < .05.
Results
The study found that the mean age of the participants was 21.5 ± SD 1.1 years, and the mean BMI was 27.03 ± SD 6.6. The right thyroid lobe’s mean length and width were 3.99 ± 0.41 cm and 1.13 ± 0.21 cm, respectively. The left lobe mean length and width were 3.77 ± 0.42 cm and 0.93 ± 0.19 cm, respectively (see Table 1). Figures 2, 3, and Table 5 summarize the US findings as follows: 60 participants (95.2% out of 63) had normal thyroid findings, positive findings were found in three participants (4.8 % out of 63), one participant (1.6%) had multiple thyroid nodules of various sizes, cystic, and mixed (predominantly solid), and two participants (3.2%) had features of thyroiditis. Besides the heterogeneity, one of the two cases showed intrathyroidal hypervascularity, which may have indicated Hashimoto’s thyroiditis. Figure 4 demonstrated that the thyroid echo pattern of the participants was homogeneous in 95.2% and heterogeneous in 4.8%. Table 2 summarizes the Pearson correlations between the right and left thyroid lobe lengths and the BMI that revealed no significant statistical association (e.g., Pearson coefficient = 0.04 and 0.12, respectively, and p = .7 and .3, respectively). Tables 3 and 4 show chi-squared tests for the association between the US findings and the thyroid echo pattern with the BMI. It revealed that there was no statistical association between the thyroid echo pattern and the BMI (e.g., p = .749 and .475, respectively).
The Descriptive Statistics Based on Cohort of Students and Their Study Variables.
The pie graph displays the thyroid sonographic findings of the participants.
A set of sample sonograms are provided of a 21-year-old participant with multiple nodules in the right thyroid lobe. Note in image A, the dominant nodule that had mixed echogenicity and measured 0.69 × 0.88 cm.
The thyroid echo pattern of the participants.
The Statistical Correlations Between the Cohort’s Thyroid Length and Their Body Mass Index (BMI), Based on 63 Participants.
The Results of the Chi-Square Tests for the Association Between the Sonographic Findings and the Body Mass Index (BMI), Based on 63 Participants.
The Results of the Chi-Square Test of the Association Between the Thyroid Sonographic Pattern and the Body Mass Index (BMI), Based on 63 Participants.
Discussion
This study involved the diagnostic assessment of bilateral thyroid lobes for texture, length, and anteroposterior measurements based on a cohort of male university students. As a review, the participants’ mean age was 21.5 ± SD 1.1 years, the mean thyroid length for the right lobe was 3.99 ± SD 0.41 cm, and for the left lobe, it was 3.77 ± 0.42 cm, and the participants’ mean BMI was 27.03 ± SD 6.68.
The findings of this current study show a high percentage of unremarkable diagnostic findings (see Figure 2). These results are consistent with Bafaraj et al 10 that conducted a thyroid sonographic screening study of university students (male and 58% females) of similar mean age. In that study, they concluded that 75.3% of the participants had no diagnostic findings. This is in comparison to Yoo J et al 11 that screened participants, of which 65% were female and found that 35.8% of their participants had no thyroid lesions. In contrast, Gnarini et al 12 showed a different result; they reported that incidental thyroid disorders were detected in 50.3% of the asymptomatic participants (67 % were females). A similarly high prevalence was detected by Kim et al 13 during thyroid screening in female participants but in association with other comorbidities (i.e., breast abnormality). Their results indicated that 42% of the participants had thyroid abnormalities.
Regarding the thyroid nodules, the current study indicated that 1.6% of the participants exhibit multiple nodules. Based on a limited search of the literature, there was no availability of published data, regarding the thyroid nodules, in asymptomatic male participants. Some authors 13 proceeded with a FNA based on sonographic criteria, as a part of their screening. This opinion is supported by Kim et al 14 who reported that US findings carrying malignancy suspicion should be considered indicators for FNA, regardless of size. While Remonti et al 15 had a contrasting opinion and suggested that US criteria alone would not provide reliable information for selecting nodules that should have an FNA performed. Bin Saeedan et al 6 suggested that the US is the diagnostic technique of choice for thyroid evaluation. Lee et al 16 reported that US is essential in directing the most appropriate monitoring strategy for patients with nodular thyroid disease. Compared to CT, Tao et al 17 have shown that CT examinations are more accurate than US examinations in the differential diagnosis of thyroid nodules.
There is significant variability regarding thyroiditis across different study populations. The current study was relatively low; only 3.2% of the participants were diagnosed with this condition. Again, based on a limited search of literature, there were no available published results about thyroiditis among asymptomatic male participants. Yoo et al 11 identified thyroiditis in 7.0% of their screening population, and Mogahed et al 18 reported that 30.1% of the participants had thyroiditis, indicating a slightly higher prevalence.
Regarding thyroid length, the current study’s results showed that the mean length of the right lobe of the thyroid was slightly longer than the left lobe. These findings agree with Alsaqer et al 19 who studied a similar population with a similar age group and stated that the right lobe volume is slightly larger than the left.
Regarding the correlation analysis between thyroid length and BMI, a selective search of the literature indicated limited published data was available. As a reminder, the current study showed no significant relationship between thyroid length and BMI (e.g., Pearson coefficient = 0.049, p = .700 for the right lobe; Pearson coefficient = −0.123, p = .336 for the left lobe; see Table 2). These findings do not agree with those of Sobhani et al 20 who studied male university students of a similar age group and showed that the estimated thyroid volume decreased significantly as participants’ weight and BMI increased.
The current findings also concluded that the analysis of the association between the thyroid echo pattern and the BMI revealed no significant association (e.g., chi-squared = 51.9, P = .4; see Table 5). In contrast, Sobhani S et al21 indicated that overweight participants (BMI > 25) have more heterogeneous thyroid echogenicity. Their work was based on a mixed population, 53% of the participants were females. 20
The Subset of Diagnostically Positive Participant Sonograms is Provided, Along With the Descriptive Findings and Echo-Pattern in the Thyroid.
The outcome of the current study was that the data indicated that 4.8 % of the selected population (n= 3) among these university students had asymptomatic positive US findings, one case of multiple nodules, and two cases of thyroiditis. However, these findings were relatively low but have significant clinical importance. Those students were directed to do further assessments for early suitable monitoring and treatment.
Limitations
This study’s significant limitation was the study design, which has threats to internal and external validity. The convenience of sampling participants and small sample size should also be considered limitations. Additionally, the cohort had limited diversity due to only male students being included. No generalizations can be made due to internal and external validity issues based on the nature of the study design.
Conclusion
The current study’s findings suggest that this cohort had few incidental findings with no significant statistical association between the thyroid length and echo pattern with the BMI among this cohort of male university students. The study should be considered a reference baseline data on the prevalence of thyroid abnormalities in a young male university student population. Screening the thyroid in younger adults may have some impact, but the outcomes need to balance against missed lesions and an increase in biopsy rates.
Further future studies were recommended and should include more extensive and diverse sample sizes, including female students, and a random sample selection should be applied. The benefit of the association between incidentally discovered thyroid findings, echogenicity, and BMI serves as a valuable avenue for understanding potential correlations between anthropometric measures and thyroid abnormalities. This association offers insights into whether body weight or height variations might predispose individuals to an increased likelihood of thyroid irregularities.
Footnotes
Acknowledgements
The authors thank all students who participated in the study.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Ethics Approval
Ethical approval of this study was obtained from the postgraduate studies and scientific research deanship, of the host University (Approval Number/ID: 2024/189/307 DRD).
Informed Consent
Written informed consent was obtained from all subjects before the study.
Animal Welfare
Guidelines for humane animal treatment did not apply to the present study because no animals were used during the study.
Trial Registration
Not applicable.
