A Rare Case of Systemic Sarcoidosis in a Middle-Aged Female with a Solitary Thyroid Nodule

Sarcoidosis is a multisystem inflammatory disease characterized by the presence of noncaseating granulomas. Sarcoidosis can affect any organ of the body, the lung being the most affected. Sarcoidosis rarely affects the thyroid gland, and only a few cases of thyroid-related sarcoidosis have been reported in the literature. Herein, we report a case of systemic sarcoidosis with multiple organ involvement in a patient with a solitary left thyroid nodule and benign Fine Needle Aspiration (FNA) findings. The patient was eventually diagnosed with thyroid sarcoidosis using a core needle biopsy of the thyroid nodule. With this case report, we highlight the limitations of the FNA. This case report has the objective to encourage clinicians to include thyroid sarcoidosis in the differential diagnosis of thyroid nodules in patients with systemic sarcoidosis even with unremarkable FNA findings.

Prevalence of Malignancy in Solitary Thyroid Nodule-A Retrospective Study

Background: Solitary thyroid nodule is defined as discrete mass palpable in an otherwise apparently normal thyroid gland. Solitary nodule is the common presentation of thyroid disorders. Objective: This study aimed to look into the prevalence of malignancy in clinico-radiologically detected solitary thyroid nodule and to correlate the findings in pre-operative fine needle aspiration cytology(FNAC) and post-operative histopathological examination(HPE). Materials and Methods: A retrospective study was carried out in our Institute for a period of 6 months using the data obtained between 2018-2020 of patients who were clinically and radiologically diagnosed as solitary thyroid nodule in the Department of General Surgery. Results: Out of 30 cases of clinically detected solitary thyroid nodule 7(23.3%)cases was found to be malignant. The mean age of presentation was 41.2 years with male female ratio of 1:9. 25(83.3%)cases was reported as benign nodules according to pre-operative FNAC out of these 2(6.6%)cases turned out to be malignant on post-operative histopathological examination. Conclusion: It is concluded that from the present study the prevalence of malignancy in clinically detected solitary thyroid nodule is 23.3%. FNAC being sensitive, cost effective and reliable tool in the preoperative assessment of solitary thyroid nodules and HPE in post operative evaluation of clinical specimen both playing a vital role in management of solitary thyroid nodule thus helping in early diagnosis and proper surgical intervention.

Patients’ Preferences’ Impact on Decision Making for Clinical Solitary Thyroid Nodule in a Global Healthcare Setting: A Clinical Study

Objective: Evaluation of patients’ preferences (PP) impact on decision-making for solitary thyroid nodule management. Study Design: A retrospective review of prospectively collected data in patients with clinical solitary nodules admitted for thyroid surgery. PP survey in various management strategies included determinants of surgery, fine-needle aspiration cytology (FNAC), frozen section (FS), and PP for total thyroidectomy (TT) or total lobectomy (TL) compared to guidelines concordance. Results: Thyroid surgery was performed for 558 patients, 75.8% were females and 43.7% were international. FNAC was done in 79.8% and refused by 20.2% due to the misperception that it spreads cancer. The risk of malignancy was the reason for choosing surgery in 35.1%. FS was preferred by 87% of the patients for decision-making (TT vs TL) in our setting with available pathology resources and low FS cost. FS based decisions were more guideline-concordant (79%) with TT performed in 41% patients compared to 74.4% in PP based decisions alone (P < 0.001). 57.9% of the patients preferred surgeon authorization for decision-making when FS was unavailable. Papillary thyroid carcinoma (PTC) occurred in 85.3%. FS diagnosed PTC in 79% of the patients with malignant nodules in inconclusive FNACs (Bethesda I, III, IV, and V). Conclusion: Decisions (TT vs TL) based on PP and beliefs compared to FS based decisions were less guideline-concordant (21% vs 79%) with more TT performed (74.4% vs 41%) (P < 0.001). Advancing patients’ knowledge on their disease, guidelines, and equipoise awareness is needed for better-shared decision-making.

Diagnosis and Surgical Management of Solitary Thyroid Nodule

Aim Preoperative distinction between benign and malignant in solitary thyroid nodules is important. It helps to avoid unnecessary surgery and its adverse effects, such as hypothyroidism, hypocalcemia, and recurrent nerve injury. Methods Descriptive perspective analyzed data over a period of 6 years April 2015__April 2021 in Saudi Hospital at Hajjah, Yemen. 226 thyroid operations for 207 patients ,135 patients diagnosis as Solitary thyroid nodule and 72 patients as Multi nodular goiter. Patients with a clinically solitary thyroid nodule were included in the study group. Results 135 cases of clinically detected STN,126 female and 9 male patients, between 14_65 years age, median 41 years and mean 39.76 years, (94, 41)patients respectively Rt side thyroid effect more than Lt side, FNAC sensitivity, specificity and accuracy was (61%, 72%, 64%)respectively. Postoperative histopathology reported 100 (74%) patients as having benign thyroid nodules and 35 patients (26%) as having malignant thyroid nodules. Postoperative transient hypocalcemia was observed in 9 patients (7%), and temporary horsnese was observed in 3 patients (2%). Conclusion The incidence of malignancy in STN is high. Rapid growth by history and hard fixed nodule by examination and hypoechoic, micro calcification and cervical lymphadenopathy on USG frequently in malignant nodules. Male risk factors for thyroid cancer included age, number and size of nodules. FNAC is more helpful for diagnosing aspiration under USG guidance and reading by experience histopathologists. The type of surgery depends on preoperative evaluation, including history, examination, ultrasound, FNAC result, and intraoperative assessment of the nodule. There are fewer complications of thyroid surgery by experienced surgeons.

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.

Solitary Thyroid Nodule High Incidence of Thyroid Cancer

The Aim: The preoperative distinguish between benign and malignant in solitary thyroid nodule is important. It helps to avoid unnecessary surgery and its adverse effects, such as hypothyroidism, hypocalcemia, and recurrent nerve injury.Methods: descriptive perspective analyzed data over a period of 6 years April 2015__April 2021 In Saudi hospital at Hajjah, Yemen. 226 thyroid operations for 207 patients ,135 patients diagnosis as Solitary thyroid nodule and 72 patients as Multi nodular goiter. the patients with a clinically as solitary thyroid nodule were included in the study group. Results: 135 cases of clinically detected STN,126 female and 9 male patients, between 14_65 years age, median 41 years and mean 39.76 years, (94 , 41)patients respectively Rt side thyroid effect more than Lt side, FNAC sensitivity, specificity and accuracy was (61% , 72% , 64%)respectively. Postoperative histopathology was reported 100(74%)patients as benign thyroid nodule and 35 patients(26%) as malignant thyroid nodule . Post operative transient hypocalcemia in 9 patients (7%), and temporary horsnese in 3 patients (2%). Conclusion: The incidence of malignancy in STN is high. Rapid growth by history and hard fixed nodule by examination and hypoechoic, micro calcification and cervical lymphadenopathy on USG frequently in malignant nodules. Male risk factor for thyroid cancer while age, number and size of nodules were not. FNAC more helpful for diagnosis if aspiration under USG guide and reading by experience histopathologest .Type of surgery depending on preoperative evaluation including history, examination, ultrasound, FNAC result, and intraoperative assessment of the nodule .Less complications of thyroid surgery by experience surgeon.

Clinicopathological study of solitary thyroid nodule in Kolhan belt of Jharkhand

<p class="abstract"><strong>Background:</strong> Thyroid disorders are commonly encountered in our daily practice and specially in countries like India and Nepal (foothill areas). There are variety of lesions that can arise within thyroid gland. In such scenario it is important to diagnose neoplastic and non-neoplastic conditions accurately with minimum complications so that proper management can be done as early as possible. The aim of the study was to know clinical spectrum of solitary thyroid nodules and diagnostic accuracy of fine needle aspiration cytology as compared to histopathological examination.</p><p class="abstract"><strong>Methods:</strong> We conducted our study over a period of 21 months from July 2018 to March 2020. 74 patients who gave consent and presented with solitary thyroid swelling were included in the study. </p><p class="abstract"><strong>Results:</strong> In our study, cases mostly presented in the age group of 31-40 years with a female preponderance. Colloid goiter was the most common pathology which presented as solitary thyroid nodule. Among neoplastic lesions, follicular adenoma was the most common benign neoplasia with papillary thyroid carcinoma being the most common malignancy. FNAC had sensitivity of 78%, specificity-100%, positive predictive value-100%, negative predictive value-88% and diagnostic accuracy-92%.</p><p class="abstract"><strong>Conclusions:</strong> Majority of solitary thyroid nodules are found in females of middle age group. In our study we found FNAC as valuable diagnostic tool specially in benign cases.</p><p class="abstract"> </p><p> </p>

“TUBERCULOUS THYROIDITIS: A RARE CASE REPORT”

Tuberculosis of thyroid gland is a rare entity even in countries with high prevalence of tuberculosis. The diagnosis of extra-pulmonary tuberculosis, especially in the rare sites like thyroid, pancreas, striated and cardiac muscles is difcult. Thyroid tuberculosis, if at all present, is more commonly associated with either miliary or disseminated tuberculosis or with contagious involvement from adjacent viscera and vertebral body. Hence, for an accurate diagnosis of thyroid tuberculosis, pathological examination with demonstration of acid-fast bacilli is important along with a proper clinico-radiological evaluation. Herein we report a case of 30-year-old male with swelling on the right side of neck who presented with a “solitary thyroid nodule” on ultrasound and “colloid” in ne needle aspiration cytology (FNAC) with scattered epithelioid like cells along with benign follicular epithelial cells. However, no denitive diagnosis could be given on cytology due to pauci-cellularity. Tuberculous thyroiditis was diagnosed on histopathology since the patient underwent right hemithyroidectomy for right side solitary nodule. The patient was started on Anti-tubercular therapy (ATT) and had no complications in 6 months follow up period. Although rare, thyroid tuberculosis should be kept in mind in differential diagnosis of thyroid nodules, even in patients with no history and symptoms of TB disease elsewhere specially in TB endemic areas.