BACKGROUND:Fine-needle aspiration cytology (FNAC) is an integral part of thyroid nodule assessment. Nodules with an indeterminate cytology (THY3a-f) require formal histological assessment to confirm benign or malignant pathology. This study aimed to provide data for an evidence-based approach for management of patients with THY3f nodules. METHODS:Retrospective review of patients who had a thyroid FNAC reported as suspicious of follicular neoplasm (THY3f) or showing atypia (THY3a) were identified, and clinical, operative and outcomes data were analysed. RESULTS:Between 2018 and 2020, 200 patients (167F:33M, median age 51 years (range:18-86 years)) had a THY3f cytology. Most presented with a palpable nodule (n=104; 68.4%). Overall, 152 (76.0%;130F:23M) underwent surgery and 31 (20.4%) were found to have a thyroid carcinoma (22 follicular carcinomas, 7 papillary carcinomas, 1 medullary thyroid carcinoma and 1 metastatic renal carcinoma). An additional incidental carcinoma (size: 0.7-13mm) was found in seven (4.6%). Among those with cancer, a completion thyroidectomy and radioactive iodine treatment was indicated in nine (<6% of the entire cohort). Previously suggested risk factors for malignancy, eg male gender, large tumour size (>4cm) or age, were not found to be associated with increased risk. During the same period, THY3a cytology was reported in 53 patients, of whom 29 underwent diagnostic surgery and 4 patients were found to have a thyroid cancer (follicular, n=3 and medullary, n=1). CONCLUSION:One in five patients with features suspicious of a follicular neoplasm (THY3f) has a thyroid carcinoma. This risk is much lower for THY3a. This study reinforces the current recommendation for thyroid surgery in all patients with a reliable THY3f cytology, as no further stratifying risk factors could be identified.

Iliac artery syndrome has been described in competition cyclists or other endurance athletes who present with claudication during intense activity. It may be difficult to diagnose, as the patient's pulses and ankle brachial pressure index (ABPI) are often normal at rest. We report a case of external iliac artery stenosis in a 30-year-old male competition cyclist. Exploration revealed a markedly hypertrophied psoas muscle with a thickened external iliac artery. The course of the EIA was markedly angulated down into the pelvis and then up over the prominent psoas muscle. It was treated successfully by iliac endarterectomy and vein patch angioplasty.

We don't need to live next to a faulty crematorium to inhale bits of dead people. On an atomic level, every breath we take contains stuff that was once someone else. So what claim do we have, during the period between death and atomic recycling, on the physical material that used to be ours? For those who believe in literal resurrection of the body the claim is total. The body must be buried complete or it won't work properly next time. But few truly believe this. Even the ancient Egyptians preserved the body's external appearance while removing organs and replacing them with sand and cloth. Throughout history the emphasis has been on preserving appearance, leaving the messy inner details to the gods. > The body and its components have gained the holy quality previously reserved for relics So why should most of us care what happens to our livers when we've finished with them? Mine can go to the worms, or preferably to one of my desperately ill fellow humans who needs a transplant. My friends can say goodbye to the …