Association between multi nodular goitre and thyroid malignancy at a tertiary care centre

Background: Over the past few decades, the incidence of thyroid cancer has dramatically increased. Thyroid malignancy in multinodular goitre is considered to be high and these occult malignancies are detected only in post operative histopathological analysis. The study helps in finding association between multinodular goitre and thyroid malignancy. Objective was to find the association between multinodular goitre and thyroid malignancy in those who underwent total thyroidectomy.Methods: A cross sectional study conducted in department of general surgery, KIMS hospital, Bangalore. The 236 randomized cases of multinodular goitre who underwent total thyroidectomy were selected. Patients underwent thorough clinical examination pre operatively and were reassessed in post-operative period following surgery. Later, histopathology report on thyroidectomy specimen of the patients were obtained. This report was considered the gold standard for the diagnosis of thyroid malignancy.Results: Occult malignancies were commoner in middle aged females. Most of the patients in the study underwent total thyroidectomy. The prevalence of thyroid malignancy in our study was found to be 7.2%. In the study, 17 incidental malignancies were papillary carcinomas. It revealed a highly significant relation between the lymphocytic thyroiditis and occult malignancy (p<0.0001)Conclusions: The prevalence of malignancy in multinodular goitre is 7.2%. The only variant of incidental malignancy detected in histopathological examination of excised thyroid was papillary carcinoma. There is a statistically significant association between presence of thyroiditis in preoperative FNA and presence of occult malignancy carcinoma.

Prevalence of Pathogenic Germline DICER1 Variants in Young Individuals Thyroidectomised Due to Goitre – A National Danish Cohort

IntroductionDICER1 syndrome encompasses a variety of benign and malignant manifestations including multinodular goitre, which is the most common manifestation among individuals carrying pathogenic DICER1 variants. This is the first study estimating the prevalence of pathogenic DICER1 variants in young individuals with multinodular goitre.MethodsDanish individuals diagnosed with nodular goitre based on thyroidectomy samples in 2001-2016 with the age limit at time of operation being ≤ 25 years were offered germline DICER1 gene testing.ResultsSix of 46 individuals, 13% (CI [3.3;22.7], p &lt;0.05), diagnosed with nodular goitre on the basis of thyroidectomy samples under the age of 25 years had pathogenic germline variants in DICER1. They were found in different pathoanatomical nodular goitre cohorts i.e. nodular goitre (n=2), colloid nodular goitre (n=3) and hyperplastic nodular goitre (n=1).ConclusionsWe recommend referral of patients thyroidectomised due to goitre aged &lt;21 years and patients thyroidectomised due to goitre aged &lt;25 years with a family history of goitre to genetic counselling. Patients of all ages thyroidectomised due to goitre, who are affected by another DICER1 manifestation should be referred to genetic counselling.

Prevalence and predictors of thyroid cancer among thyroid nodules: a retrospective cohort study of 1,000 patients

Introduction Thyroid cancer is increasing in incidence globally due either to early detection (overestimation) or true increment. A recent debate concerns multinodular goitre (MNG) or toxic goitres which have classically been considered at a lower risk for cancer. Methods In this study, we enrolled retrospectively all patients with nodular goitre treated at our tertiary hospital and analysed their data with the aim of detecting the rate of cancer among different types of nodular goitre. We also studied predictors of incidental malignancy among thyroidectomies. Results A predilection for solitary thyroid nodules (STNs) was found in women of younger age, with STNs tending to be larger in comparison with MNG in the same age group. However, both types of nodules were at equal risk of harbouring malignancy. Thyroid Imaging Reporting and Data System (TI-RADS) and Bethesda scores were the only dependent predictors of malignancy within thyroid nodules. Conclusion The authors recommend management of both STNs and MNG using the same algorithm.

Nonrecurrent laryngeal nerve-an anatomical deviation

<p>Thyroidectomy is one of the most dispute and discussed surgery. Identification of recurrent laryngeal nerve is the most important step in this surgery. Among postop complications of thyroidectomy, the commoner is haematoma, transient hypocalcaemia and hoarseness.<strong> </strong>We report a rare case of nonrecurrent laryngeal nerve in a 25-year-old male with swelling in the right thyroid lobe. A 25-year-old male presented to the ENT OPD with complaints of swelling in thyroid region for 6 months with no other symptoms. On examination there was a 2×3 cm size nodule in the right lobe of thyroid. Rest of ORL examination was normal. On ultrasonogram there was an enlarged right lobe of thyroid with a nodular goitre. Fine needle aspiration cytology showed colloid goitre. Patient was planned for right hemithyroidectomy. Right side type 1 nonrecurrent laryngeal nerve was identified at the level of superior pole of thyroid branching from vagus and entering the larynx at the level of cricothyroid joint was identified intraoperatively.<strong> </strong>In conclusion, nonrecurrent laryngeal nerve though a very rare anomaly forms a crucial anatomical structure in thyroid surgery and is prone to injury. It is one of the preventable complications during thyroid surgery leading to postop vocal cord palsy. An in-depth anatomical knowledge and diligent surgical technique will help in identification and preservation of nonrecurrent laryngeal nerve.</p>

Clinical study of prevalence of malignancy in nodular thyroid swelling

Background: Large proportion of thyroid cancers arose from a pre-existing adenoma or from multinodular goiters. Surgical practice of removing thyroid nodule or multiple nodules of thyroid gland has been challenged for surgeons to prevent cancer. Aim of this study is to find out the prevalence of malignancy in solitary thyroid nodule and multi-nodular goitre in relation to age and sex. The aim of the study was to determine the incidence of malignancy in patients who underwent thyroidectomies.Methods: Study of 100 cases of nodular thyroid swelling has been done during the period from November 2017 to November 2019 on inpatients admitted to GEMS Hospital, Srikakulam, and Andhra Pradesh, India. Detail clinical examination, relevant investigations, surgical management and histopathological reports were collected and analyzed using software package for statistical analysis (SPSS 20).Results: Out of 100 patients with thyroid swellings, thyroid malignancies constitute 4%. The occurrence of thyroid cancer was maximum in the 4th decade of life. Female patients outnumbered males with a ratio of 4:0. Relative frequency of malignancy in solitary thyroid nodule was 4.76% and in multi-nodular goitre was 3.03%. Most common histopathological type was papillary carcinoma thyroid (50%); followed by follicular carcinoma thyroid (25%) and medullary carcinoma (25%).Conclusions: The prevalence of thyroid malignancy in the present study is at an earlier age group due to early diagnosis and treatment. The prevalence of thyroid cancer is higher in female when compared to those reported in the literature. The proportion of medullary cancer is more in present study.

Correlation of Fine Needle Aspiration Cytology with Histopathological Findings in the Diagnosis of Thyroid Swellings – A One Year Study in a Tertiary Care Hospital, Hyderabad

BACKGROUND Most of the thyroid swellings are non-neoplastic and with normal thyroid hormone. So, it doesn't require any surgical excision, even though the thyroid swelling is an indication for surgical excision. The present study was done to evaluate the accuracy of fine needle aspiration cytology (FNAC) for the thyroid swellings and correlate it with the histopathological findings. METHODS This is a prospective study. A total of 47 cases were studied. Fine needle aspiration cytology was done, slides were made and studied. Histopathological examination of the corresponding 47 cases was also done and correlated with FNAC findings. Sensitivity, specificity and accuracy were calculated. RESULTS Age of the patients varied from 20 - 69 yrs. Most of them were in the age group of 30 - 39 years and 50 - 59 years. The ratio of male to female was 1:4.9. Swelling of the neck was the most common presentation in most of the patients. On FNAC 33 (70.2 %) cases were diagnosed as colloid nodular goitre, 04 (8.5 %) as autoimmune thyroiditis, 08 (17.0 %) as follicular neoplasm, 01 (2.1 %) as suspicious of malignancy, 01 (2.1 %) as papillary carcinoma. On histopathological examination 25 (53.2 %) cases were diagnosed as colloid nodular goitre, 01 (2.1 %) as fibrous thyroiditis, 01 (2.1 %) as Graves’ disease, 07 (14.9 %) as Hashimoto’s’ thyroiditis, 06 (12.8 %) as follicular adenoma, 01 (2.1 %) as follicular carcinoma, 04 (8.5 %) as papillary carcinoma and 02 (4.2 %) as NIFTP (noninvasive follicular thyroid neoplasm with papillary like nuclear features). The overall sensitivity was 69.2 %, specificity was 97.0 % and accuracy was 89.3 %. CONCLUSIONS FNAC is a minimally invasive, highly accurate and cost-effective procedure. FNAC helps the clinician to diagnose malignant lesions with confidence. It has high rates of specificity and accuracy but comparatively has less sensitivity. However, it is very important for the management of patients with thyroid swelling. KEYWORDS Fine Needle Aspiration, Prospective Study, Sensitivity, Specificity, Thyroid Swelling

THYROID CYTOLOGY AND IT'S INTERPRETATION WITH THYROID FUNCTION TEST

INTRODUCTION: The Thyroid gland is unique among the endocrine glands. It is the largest of all the endocrine glands and it is supercial in location. It is the only gland which is easily approachable to direct physical, cytological and histopathological examination. The thyroid gland is affected by a variety of pathological lesions that are manifested by various morphologies including developmental, inammatory, hyperplastic and neoplastic pathology which are quiet common in the clinical practice. AIM OFTHE STUDY:In this study, we aimed to assess the cytological ndings of palpable thyroid nodules in conjunction with thyroid hormonal prole of the patient. To study the incidence in relevance to age, sex in various categories of thyroid lesions. MATERIALS & METHODS: Study Design: Institutional based Cross-sectional Study. Duration of study: January 2019 to August 2020. Source of data: Patients presenting to the OPD and admitted in the In-patient ward at Darbhanga Medical College, Bihar. Place of study: Department of Pathology, Darbhanga Medical College and Hospital, Laheriasarai, Bihar. Sample Size: 60 patients of enlarged thyroid gland. RESULTS & OBSERVATIONS: We found that the 53.3% Patients are in euthyroid state. Nodular goitre is the most common nding. In the present study among 60 patients, Nodular goiter accounts for 83.3 % of all cases; 41.7% of them were in euthyroid state, 21.7 % in hypothyroid state , 8.3 % in subclinical hypothyroid and remaining 11.7 % in hyperthyroid state . SUMMARY AND CONCLUSION: FNAC together with thyroid function test (TFT) analysis leads to early and accurate diagnosis of various thyroid diseases and reduces surgical intervention. The study showed that FNAcytologic diagnosis cannot be used to predict thyroid function using total serum T4, T3 and TSH concentrations. Measurement of TSH, free T4, and free T3 would be preferable

Surgery for Grave’s Disease

Graves’ disease (GD) is the commonest cause of hyperthyroidism followed by toxic nodular goitre. Patients presenting as goitre with clinical features of hyperthyroidism are to be carefully evaluated with biochemically with thyroid stimulating hormone (TSH), free thyroxine (fT4) and radionuclide scan (Technitium-99/Iodine-123). Those with GD also have raised thyroid receptor stimulating antibody levels. Patients are simultaneously evaluated for eye disease and managed accordingly. Initial treatment is rendering patient euthyroid using anti thyroid drugs (ATD) and if remission does not occur either continue medical therapy or proceed for definitive therapy by radioactive iodine ablation (RAI) or surgery. In last decades there is ample literature preferring surgery as preferred definitive therapy. Surgery in thyroid disease has become safer with development of many intra-operative adjuncts but it should be performed by high volume thyroid surgeon. The procedure of choice is near total or total thyroidectomy as it avoids recurrences. Patients who are not eligible or willing for surgery can be managed with RAI.