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.

Lindsay tumour

The follicular tumours with nuclear features of papillary carcinoma are categorised as follicular variant of papillary thyroid carcinoma (FVPTC). They exhibit biologic and molecular properties that are different from conventional papillary thyroid cancer. Solid encapsulated follicular variant of papillary carcinoma of thyroid is termed as Lindsay tumour. Since they are encapsulated, they follow an indolent course. We present a case of Lindsay tumour in a 34-year-old female, who presented with swelling in the neck for six months. She had no other specific complaints. On local examination of her neck, there was a hemispherical swelling of size 6×5×2 cm, found in the midline which moves with deglutition. The swelling was firm in consistency and its surface was nodular. There were no palpable lymph nodes in the neck. The ultrasonogram of her neck revealed multinodular goitre. The fine needle aspiration cytology from neck swelling revealed colloid goitre with cystic degeneration. Her thyroid function tests were within normal limit. She was then, proceeded with total thyroidectomy. Her postoperative recovery was uneventful. Her histopathological report revealed an encapsulated follicular variant of papillary carcinoma of thyroid. She was then kept on half yearly follow-up with serum thyroglobulin. Therefore, this case provides an opportunity to review the encapsulated follicular variant of papillary carcinoma thyroid (Lindsay tumour) and its management.

CLINICOPATHOLOGICAL STUDY OF PAPILLARY CARCINOMA THYROID IN TERTIARY CARE CENTRE- THREE YEAR STUDY.

INTRODUCTION: Papillary carcinoma thyroid (PTC) is the predominant form of thyroid cancer in both adults and children [1]. The incidence of thyroid cancer is increasing [2]. Incidence of PTC is 3 times more common in female than male, but this disparity decreases with increasing patient age [1]. AIM: To analyse the clinicopathological profile of PTC in Madras Medical College located in Chennai, TamilNadu, India. MATERIALS AND METHODS: Data on age, sex, size, histological subtype, centricity of the tumor, nodal metastasis, extra thyroidal extension and associated non malignant condition of all cases of PTC diagnosed in Madras Medical College, Chennai from January 2016 to December 2018 were obtained clinicopathological documents. Histopathological slides were analysed and Immunohistochemistry was done to differentiate PTC from other non malignant lesion. The cases were divided into four catagories based on age and sex. RESULT: Totally 189 thyroid malignancies were reported of which 161 were PTC (85%). Female: male ratio was 3.5: 1. This disparity decreases after 50 years of age. In males above 50years of age had nodal metastasis (47%) and extra thyroidal extension (47%) which was high when compared with other groups. Extrathyroidal extension (50%) was found to be more frequent in cases with tumor size more than >4cm. CONCLUSION: Papillary thyroid carcinoma was common in female. Extra thyroidal extension (P =0.014996), nodal metastasis (P =0.030258) was most common in elderly male (> 50 years).

Multinodular goitre: a clinicopathological study from Kerala

Background: Multinodular goiter (MNG) occurs due to repeated hyperstimulation of thyroid gland due to iodine deficiency, goitrogens, antithyroid drugs and genetic defects. MNG can have different complications which include treacheal compression, retrosternal extension, malignancy and secondary thyrotoxicosis. The aim of the work was to study the clinical features and histopathology of MN in patients admitted for thyroidectomy in surgical wards of a tertiary care hospital in north Kerala.Methods: A prospective hospital based observational study in the patients in surgical wards of a tertiary care hospital in north Kerala from April 2011 to March 2012. The clinical data of patients who are subjected to thyroidectomy for MNG (clinical and fine needle aspiration cytology diagnosis) were included in this study. Patients undergoing completion thyroidectomy for recurrence or malignancy were excluded from this study.Results: MNG is more common in females. Female to male ratio 24:1 Majority are in the age group of 30-50 years (64%) with a mean age of 41 years. 38% (38 cases) had pressure symptoms in the form of dysphagia or dyspnea. Secondary thyrotoxicosis seen in 17% (17 cases). Fine needle aspiration cytology (FNAC) is not an error-proof investigation in MNG. 14 % of our patients had malignancy inspite of being reported as benign in FNAC. Among the malignancies papillary carcinoma thyroid was found to be most common accounting for 12% of cases (12/100) followed by follicular carcinoma.Conclusions: FNAC is not an error proof investigation in MNG. Incidental thyroid cancer in MNG is about 14 % with papillary carcinoma thyroid being the commonest.

Incidence of thyroid pathologies requiring thyroid surgeries in a tertiary care hospital

Background: Diseases of the thyroid gland are one of the most common endocrine disorders in India and the world, many of these diseases require surgery for their treatment. The incidence of thyroid diseases differs from one geographical area to another. This study was aimed at finding out the thyroid pathologies for which thyroid surgeries were performed in D. Y. Patil Hospital, Nerul, Navi Mumbai.Methods: It is a retrospective analysis of all the patients who have undergone thyroid surgeries (lobectomy, hemithyroidectomy, subtotal or near total thyroidectomy or total thyroidectomy) in D. Y. Patil hospital, Nerul, Navi Mumbai from 1st January 2018 to 31st December 2019 (2 years duration).Results: Most common pathology for which thyroidectomy was performed was colloid goitre (41.33%). Benign diseases of the thyroid was much more common (76%) than malignant diseases (24%). Most common malignancy was papillary carcinoma thyroid. Thyroid surgeries were most commonly performed on women in their 5th decade of life.Conclusions: Colloid goitre was the most common pathology for which thyroid surgeries were performed and females in their 5th decade of life were the most common patients undergoing thyroidectomy.