{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T10:53:04Z","timestamp":1791370384179,"version":"4.3.1"},"reference-count":16,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Nuclear atypia is associated with an increased risk of malignancy in Bethesda III thyroid nodules; however, reactive nuclear changes related to Hashimoto thyroiditis (HT) may complicate its interpretation. We investigated whether HT modifies the association between nuclear atypia and malignancy in Bethesda III nodules. Methods: This retrospective single-center study included 426 surgically selected patients with Bethesda III nodules who underwent thyroidectomy between January 2015 and August 2026. HT was defined by postoperative histopathology. The association between nuclear atypia and malignancy was evaluated according to HT status. Effect modification was assessed using an HT \u00d7 nuclear atypia interaction term in unadjusted and multivariable logistic regression models. Results: HT was present in 199 (46.7%) patients. Malignancy was less frequent in patients with HT than in those without HT (26.1% vs. 38.8%, p = 0.006), whereas nuclear atypia was more frequent (91.0% vs. 45.8%, p &lt; 0.001). In patients without HT, nuclear atypia was strongly associated with malignancy and remained an independent predictor after multivariable adjustment (adjusted OR 13.24, 95% CI 5.46\u201332.10; p &lt; 0.001). In patients with HT, nuclear atypia was not associated with malignancy (OR 0.68, 95% CI 0.24\u20131.94; p = 0.466). The HT \u00d7 nuclear atypia interaction was significant in both unadjusted (OR 0.040, p &lt; 0.001) and adjusted models (OR 0.031, p &lt; 0.001). Conclusions: HT significantly modified the association between nuclear atypia and malignancy in Bethesda III nodules. Nuclear atypia strongly predicted malignancy in the absence of HT but not in its presence. Given the postoperative definition of HT, prospective validation using preoperative HT indicators is required before clinical application.<\/jats:p>","DOI":"10.3390\/diagnostics16193235","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T10:13:02Z","timestamp":1791367982000},"page":"3235","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hashimoto Thyroiditis Modifies the Association Between Nuclear Atypia and Malignancy in Bethesda III Thyroid Nodules"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7626-4649","authenticated-orcid":false,"given":"Adem","family":"\u015eent\u00fcrk","sequence":"first","affiliation":[{"name":"Department of Surgical Oncology, Sakarya Training and Research Hospital, Sakarya 54100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7526-6063","authenticated-orcid":false,"given":"Yusuf","family":"\u00d6zt\u00fcrk","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sakarya Training and Research Hospital, Sakarya 54100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6391-4414","authenticated-orcid":false,"given":"Emre","family":"G\u00f6n\u00fcll\u00fc","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Surgery, Sakarya Training and Research Hospital, Sakarya 54100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"\u0130smail","family":"\u00d6zer","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sakarya University, Sakarya 54050, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"given":"K\u00fcbra Tuba","family":"\u00c7ayir","sequence":"additional","affiliation":[{"name":"Department of \u0130nternal Medicine, Sakarya University, Sakarya 54050, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2888-7646","authenticated-orcid":false,"given":"Ahmet Tar\u0131k","family":"Harmantepe","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Surgery, Van Training and Research Hospital, Van 65300, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6639-9593","authenticated-orcid":false,"given":"Yavuz Selim","family":"Kahraman","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Kastamonu Training and Research Hospital, Kastamonu 37150, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7761-2417","authenticated-orcid":false,"given":"Fuldem","family":"Mutlu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sakarya University, Sakarya 54050, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"supervision","vocabulary":"credit"},{"role":"conceptualization","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1001\/jama.2018.0898","article-title":"The Diagnosis and Management of Thyroid Nodules: A Review","volume":"319","author":"Durante","year":"2018","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/S2213-8587(22)00101-2","article-title":"Diagnosis of Thyroid Nodules","volume":"10","author":"Alexander","year":"2022","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_3","first-page":"1039","article-title":"The 2023 Bethesda System for Reporting Thyroid Cytopathology","volume":"33","author":"Ali","year":"2023","journal-title":"Thyroid Off. 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