Clinicopathological Study of Solitary Thyroid Nodule
DOI:
https://doi.org/10.37356/cmmcj2201924Keywords:
Solitary thyroid nodule, papillary carcinoma, follicular carcinoma, medullary carcinomaAbstract
To find out the incidence of malignancy in patient with solitary thyroid nodule, this cross-sectional study was carried out in Otolaryngology & Head-Neck Surgery department of Sir Salimullah Medical College & Mitford Hospital (SSMC & MH) and Bangabondhu Sheikh Mujib Medical University (BSMMU), Dhaka; from July 2012 to December 2013. In this study mean age of the subjects was 35.6 ± 13.54 years and the highest frequency (38%) was within 21-30 years with female predominance (78%). Thyroid swelling was the common presentation in all (100%) cases. Some patients also presented with other symptoms like cervical lymphadenopathy (13%), dysphagia (1%), dyspnoea (1%), hoarseness of voice (1%). In this study, solitary thyroid nodules constituted 73% firm, 6% hard and 11% cystic. Malignancy rate (72.22%) was higher in firm nodule. Functional status of nodules was categorized by isotope scanning of the thyroid gland, which showed (96%) cold, (4%) warm and no any hot nodules. In the study out of 96 cold nodular goiters, 18.75 % were malignant and out of 89 solid nodule 80.89% were benign and 19.10% malignant, also out of 11 cystic nodules 90.9% were benign and 9.1% malignant. It is noticeable in the study that malignancy is significantly higher (p<0.001) in solid than cystic nodule. Histopathological findings showed, among the subjects, 54% were nodular goiter and 2 % thyroiditis in non-neoplastic lesion, and in neoplastic lesion 26% was benign (follicular adenoma) and 18% malignant. Among the malignants, 83.33% were papillary carcinoma, 11.11% follicular carcinoma and 5.55% carcinoma were medullary. Thus, papillary carcinoma was more common among all solitary thyroid nodular malignancies.
References
Alauddin M and Joarder AH. Management of thyroid carcinoma. Bangladesh J of otorhipnolaryngolgy. 2003;9:23-37.
Thomas V and McCaffrey. Evaluation of thyroid nodule. Cancer Control. 2000;7: 223-228.
Wienke JR, Chong WK, Fielding JR, Zou KH and Mittelstaedt CA. Sonographic features of benign thyroid nodules: interobserver reliability and overlap with malignancy. J Ultrasound Med. 2003;22:1027–1031.
Belfiore A, Giuffrida D, LaRosa GL, Ippolito O, Russo G, Fiumara A, Vigneri R and Filetti S. High frequency of cancer in cold thyroid
nodules occurring at young age. Acta Endocrinol. 1989;121(2):197-202.
Watkinson JC, Gaze MN and Wilson JA. Tumors of the thyroid and parathyroid gland.Stell and Maran’s Head Neck Surgery, 4th edn., Butterworth Heinemann. 2000;pp. 458-484.
Krukowski ZH. The thyroid gland and thyroglossal tract, Baily & Love’s short practice of surgery. 24th ed. London. Hodder education. 2004;pp. 776-804.
Vander JB, Gaston EA and Dawber TR. The significance of nontoxic thyroid nodules: final report of a 15-year study of the incidence of thyroid malignancy. Ann. Intern. Med. 1968;69:537-540.
Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccagna S, Nardi F, Panuzzi C, Rinaldi R, Toscano V and Pacella C. Risk of malignancy in
nonpalpable thyroid nodules: predictive value of ultrasound and color-doppler features. Journal of Clinical Endocrinology and Metabolism. 2002;87:1941–1946.
Gharib H, James EM, Charboneau JW, Naessens JM, Offord KP and Gorman CA. Suppressive therapy with levothyroxine for solitary thyroid nodules: a double blind controlled clinical study. N Engl J Med. 1987;317:70-75.
Sattar MA, Alam MM and Haider A. Clinicopathological study of solitary cold thyroid nodule. Bangladesh J Otolaryngol. 2003;9: 24-27.
Lyshchik A, Higashi T, Asato R, Tanaka S, Ito J, Mai JJ, Pellot- Barakat C, Insana MF, Brill AB, Saga T, Hiraoka M and Togashi KL. Thyroid gland tumor diagnosis at US Elastography. Radiology. 2005;237:202–211.
Kang HW, No H, Chung JH, Min YK, Lee MS, Lee MK, Yang JH, Kim KW. Prevalence, clinical and ultrasonographic characteristics of thyroid incidentalomas. Thyroid. 2004;14:29–33.
Brown CL. Pathology of the cold nodule. Clin Endocrinol Metab. 1981;10:235-245.
Cole WH. Incidence of carcinoma of the thyroid in nodular goiter. Semin Surg Oncol. 1991;7:61-63.
Belfiore A, LaRosa GL, LaPorta GA, Giuffrida D, Milazzo G, Lupo L, Regalbuto C and Vigneri R. Cancer risk in patients with cold thyroid
nodules: relevance of iodine intake, sex, age, and multinodularity. Am J Med. 1992; 93(4):363-369.
Solbiati L, Volterrani L, Rizzatto G, Bazzocchi M, Busilacci P, Candiani F, Ferrari F, Giuseppetti G, Maresca G and Mirk P. The thyroid gland with low uptake lesions: evaluation by ultrasound. Radiology. 1985;155(1):187-191.
Islam R, Ekramuddaula AFM, Alam MS ,Kabir MS, Hossain D and Alauddin M. Frequency & pattern of malignancy in solitary thyroid
nodule. Bangladesh J Otorhinolaryngology. 2009;15(1):1-5.
Venkatachalapathy TS, Sreeramulu PN, Prathima S and Kumar K. A prospective study of clinical, sonological & pathological evaluation of thyroid nodule. J Biosci Tech. 2012;3(1):474-478.
Inder JC and David HS. Thyroid function test and there alteration by drugs. The thyroid nodules clinical nuclear medicine. 1997;2(9):324-333.
Ashraf SA and Matin ASM. A Review of thyroid diseases in Bangladesh .Journal of BCPS. 1996;2(1):6-10.
Rains AJH and Charles VM. Bailey and Love’s short practice of surgery, twenty third ed. London, ELBS. 2004;pp. 707-733.
Stark DD, Clark OH, Gooding GAW and Moss AA. High-resolution ultrasonography and computed tomography of thyroid lesions in patients with hyperparathyroidism. Surgery. 1983;94.
Dudley H and Pories WJ. General Principles, Breast and Extracranial endocrines in Rob and Smith’s Operative Surgery.4thedn. London. Butterworth Scientific. 1986;pp. 332-386.
BasharatR, Hussain M, Saeed S and Hamid T. Comparison of Fine Needle Aspiration Cytology and Thyroid Scan in Solitary Thyroid Nodule. SAGE-Hindawi Access to Research Pathology Research International Volume 2011, Article ID 754041, 9 pagesdoi:10.4061/2011/754041.
Chandanwale S, Singh N, Kumar H, Pradhan P, Gore C and Rajpal M. Clinicopatholological correlation of thyroid nodules. Int J Pharm Biomed Sci. 2012;3(3): 97-102.
Khairy GA. Solitary thyroid nodule:the risk of cancer & the extent of surgical therapy. Eastafrican medical journal. 2004;81(9):459-461.
Tarrar AM, Khan OU, Walah MS, Waqas A, Ilyas S and Raza A. Solitary thyroid nodule. Professional Med J. 2010;17(4):598-602.
Shaheen OH. The thyroid gland. In: Kerr AG(eds). Scott-Brown’s otolargyngology. 6th Ed vol-5. London, Butter worth Heinemann. 1997. 5/18/1-5/18/22.