1. Guth S et al. Eur J Clin Invest 2009; 39 (8): 699–706 13 MHz Scanner n=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!

2. Prevalence of US-detected nodules Reiners et al. Thyroid 2004; 11:926-932 7.5MHz Scanner Papillion study n=96,278 (54%F/46% M) age 41.4+10.6 y (18-65) Total prevalence: 33.1% nodules > 5 mm

3. 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

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

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

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

7. 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 mCi) Pulmonary fibrosis Management and Follow-up of DTC

8. 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