|Year : 2017 | Volume
| Issue : 2 | Page : 17-21
Clinico-cytoradiological correlation of thyroid surgery in patients with thyroid nodule
Harendra Kumar Gautam, Vinod Kumar, Surendra Kumar Kanaujia, Devendra Maurya, Shiromani Singh
Department of ENT, GSVM Medical College, Kanpur, Uttar Pradesh, India
|Date of Web Publication||26-Sep-2018|
Dr. Harendra Kumar Gautam
L-17, Medical College Campus, Swaroop Nagar, Kanpur - 208 002, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: Thyroid swellings are commonly encountered in the surgical practice and accurate preoperative evaluation of thyroid disorder becomes mandatory for proper management of the patient. Aims and Objectives: To evaluate the clinical and radiological features of thyroid nodule with thyroid surgery. Materials and Methods: A total of 60 patients were included with more than 15 years of age presented with thyroid nodule. Results: Fifty three patients were females and seven were males with goitre duration of 6-60 months and presented with progressive increase in the size of the goitre. After clinical evaluation majority of patients were diagnosed as STN. According to ultrasonography, 58 patients were diagnosed as benign lesions while 2 patients were diagnosed with malignant lesions. According to FNAC, maximum number of patients i.e., 37 were diagnosed with colloid goitre while 2 patients had malignant lesions. On histopathological examination, 58 patients were diagnosed with benign lesions while 2 were diagnosed with malignant lesions. USG findings were correlated with thyroid surgery, Among 60 patients of thyroid nodule. 56 patients underwent hemi thyroidectomy.in which 34 were right thyroidectomy and 22 were left thyroidectomy and 4 patients underwent total thyroidectomy. One patient of total thyroidectomy was develop recurrent laryngeal nerve palsy. Conclusion: USG and FNAC has been shown to be more sensitive, specific and accurate than either technique alone but high resolution USG has important and cost effective investigation to decide the extent and type of surgery of thyroid nodules.
Keywords: High-resolution ultrasonography, thyroid nodule, thyroidectomy
|How to cite this article:|
Gautam HK, Kumar V, Kanaujia SK, Maurya D, Singh S. Clinico-cytoradiological correlation of thyroid surgery in patients with thyroid nodule. Ann Indian Acad Otorhinolaryngol Head Neck Surg 2017;1:17-21
|How to cite this URL:|
Gautam HK, Kumar V, Kanaujia SK, Maurya D, Singh S. Clinico-cytoradiological correlation of thyroid surgery in patients with thyroid nodule. Ann Indian Acad Otorhinolaryngol Head Neck Surg [serial online] 2017 [cited 2019 Jun 25];1:17-21. Available from: http://www.aiaohns.in/text.asp?2017/1/2/17/242236
| Introduction|| |
Thyroid nodule is a common clinical problem. The occurrence of clinically evident thyroid nodules in the common population is 4%–5%. The prevalence of goiter is >40 million in India with >2 billion worldwide. High-resolution ultrasonography (USG) detects nodules in 19%–67% of cases, with higher frequencies in women and elderly persons.
Although thyroid carcinoma is rare, it occurs in 5% of thyroid nodules. Accurate diagnosis of the thyroid nodules is necessary for appropriate clinical management of these patients. The majority of clinically diagnosed thyroid nodules were benign, and those requiring surgical intervention owing to malignant lesions were 5%–20%. Clinical parameters raising the suspicion of malignancy include male gender; young people (aged <20 years) and old people (aged >70 years); and large lesion (>4 cm size).
| Materials and Methods|| |
This was a prospective study of 60 patients of clinically diagnosed thyroid nodules. The study was carried out at the Department of ENT of a tertiary care medical college and hospital during the period of 2 years from August 2015 to July 2017. All patients with thyroid nodules underwent provisional diagnoses on the basis of history, physical examination of the neck, ultrasound for the thyroid gland, serum TSH level, fine-needle aspiration cytology (FNAC), and biopsy whenever it was required. After clinically detected, thyroid nodule was confirmed by high-resolution USG. The main focus was to correlate USG finding with surgical procedure accordingly and to compare with gold standard histopathological findings wherever possible. [Figure 1], [Figure 2], [Figure 3], [Figure 4] Data were statistically analyzed using the Chi-square test.
| Results|| |
Age distribution of the patients was between 18 and 60 years with mean age of 40.68 ± 13.64; 86.66%, i.e., 52 patients, were female and 13.33%, i.e., 8 patients, were male [Table 1]. All patients presented with progressive increase of swelling in the anterior part of neck with compression symptoms such as discomfort in swallowing. A maximum number of patients were suffering from goiter for the last 6–12 months. Eleven patients had swelling of thyroid for <6 months while there were 11 patients who had goiter for >60 months' duration. On the basis of clinical examination 55 patients were solitary thyroid nodule and 5 patients were multinodule. Routine thyroid function test was done in all patients, and all were found to be in the euthyroid state.
USG Findings showed 32 cases of thyroid nodule, 18 cases showed colloidal cyst and 5 cases showed multinodular goiter followed by neoplasm in 2 cases. Three patients had thyroiditis on USG [Table 2]. On FNAC, 63.33% patients had colloid nodule, 16.66% patients were follicular neoplasm, 10% patients were adenomatous hyperplasia, 5% patients were hyperplastic multinodular goiter, and 3.33% had lymphocytic thyroiditis. Two had malignant lesions which included 1.66% papillary carcinoma and 1.66% anaplastic carcinoma [Table 3]. Among patients with benign lesions, 34 patients were right thyroidectomy in which 20 were benign thyroid nodule, 10 were colloidal cyst, and 2 were multinodular goiter in USG findings and 22 patients were left thyroidectomy in which 12 were benign thyroid nodule, 8 were colloidal cyst, and 1 was multinodular goiter in USG findings. Total thyroidectomy was done for two patients with benign (MNG) lesions. While two malignant cases had undergone total thyroidectomy with neck dissection and send to post of chemoradiation in the Department of Radiotherapy. One patient of total thyroidectomy developed recurrent laryngeal nerve palsy [Table 4].
|Table 2: Distribution of various conditions by high-resolution ultrasonography findings among cases|
Click here to view
|Table 3: Distribution of various conditions by routine cytological diagnosis among cases|
Click here to view
|Table 4: Ultrasonography findings correlate with Surgical procedure and complication|
Click here to view
On final diagnosis on histopathological evaluation (HPE), a total of 58 out of total 60 patients with benign lesions which included 37 patients of colloid goiter, 10 with follicular adenoma, 2 with lymphocytic thyroiditis, and 9 with adenomatous goiter. Two out of total 60 patients had malignant lesions. Among malignant lesions, papillary carcinoma was found in one patient and anaplastic carcinoma in one patient [Table 5].
| Discussion|| |
Nodular thyroid disease is detected in 3%–7% of the adult population worldwide. They are common in females with a ratio of 5:1 and the prevalence mainly depends on age, sex, iodine intake, diet (goitrogens), and therapeutic and environmental exposure.
Basic use of sonography in the nodular thyroid is to determine the location of palpable neck mass, characterize nodule as benign or malignant, know about extent of thyroid malignancy, and guide fine needle aspiration of the thyroid nodule or cervical lymph node. The categorization of thyroid nodules into benign and malignant nodules by USG is very important as it helps in the further management of the patients with nodular thyroid disease. Ultrasound has become the first-line imaging modality for the evaluation of the thyroid gland due to excellent visualization of the thyroid parenchyma. It is highly sensitive in detective small nodules, calcification, septations, and cysts as well as in guiding fine needle aspiration biopsies. Thyroid nodules are very common and may be observed at USG in 50% of the adult population. In the present study, age of the patients ranged from 11 to 60 years with mean age of 40.68 ± 13.64. Whereas in the study of Singh P et al. 2000, of 108 cases. age range was 12-80 years, mean age was 47 years. Similarly, Rangaswamy et al. in 2013 studied 585 cases of age ranging from 11 to 70 years with a mean age of 40.57 years. Female to male ratio in our study was 7:1. It was similar to Mandal et al. in which female to male ratio was also 5:1. In this study, the most common clinical presentation was the presence of swelling in front of neck and some patients had compression symptoms such as discomfort in swallowing 17 (28.3%). There was progressive increase in lesion in 90% of the patients, while sudden increase was noticed in 5%. In a study done by Kurele et al., where they analyzed 97 patients having thyroid nodules with USG and computed tomographic scans, sudden increase in size of the lesion was seen in 8% of the patients, dysphagia was seen in 7% of the patients, while local pain was present in 5% of the patients. Eleven patients had swelling of thyroid for <6 months while there were 11 patients who had goiter for >60 months' duration. Handa et al. (2008) studied the thyroid swelling and maximum number of patients 62.2% had thyroid lesion with symptoms >1 year. Clinical diagnosis was solitary thyroid nodule in 55 patients, multinodular goiter in 2 patients, and thyroiditis in 2 patients and 1 patient was diagnosed as patients of possible malignancy. Jayaramand Orellstated that nodules <1 cm in diameter are not detected by palpation, but rather detected during USG thyroid examination. Ultrasound suggested solitary thyroid nodule in 32 patients, colloid nodule/cyst in 18 patients, MNG in 5 patients, and malignancy in 2 patients. Three patients had thyroiditis on USG. Walker et al. have shown that the prevalence of multinodularity in clinically solitary thyroid nodules is between 20% and 40%. 96.34% of patients had benign lesions. Among them, 91.66% patients had colloid nodule and 5% had lymphocytic thyroiditis. Out of the 60 patients, two had malignant lesions in the form of papillary carcinoma –1.66% and anaplastic carcinoma –1.66%.
In the present study, 37 patients (63.33%) in FNAC were found to have colloid goiter, 12 (16.66%) patients had features of follicular neoplasm, 6 (10%) adenomatous hyperplasia, 3 (5%) hyperplastic multinodular goiter, while 2 (3.3%) lymphocytic thyroiditis. Among malignant lesions, 1 (1.66) patient showed anaplastic carcinoma, while 1 (1.66) patient showed papillary carcinoma on FNAC. In a study done by Avinash et al., after cytological evaluation/HPE, 6 (8.57%) of the 70 nodules were found to be malignant and 59 (91.43%) were benign. Ten nodules, which were given as follicular neoplasms on FNAC, were diagnosed as follicular adenomas at histopathology. All the malignant nodules on FNAC were found to be papillary carcinoma and anaplastic carcinoma.
In the present study, among patients with benign lesions, 34 patients were right thyroidectomy in which 20 were benign thyroid nodule, 10 were colloidal cyst, and 2 were multinodular goiter in USG findings and 22 patients were left thyroidectomy in which 12 were benign thyroid nodule, 8 were colloidal cyst, and 1 was multinodular goiter in USG findings. Total thyroidectomy was done for 2 patients with benign (MNG) lesions. While 2 malignant cases had undergone total thyroidectomy with neck dissection and send to post of chemoradiation in the Department of Radiotherapy. According to Gharib et al., surgery is generally recommended for malignant patients. Furthermore, surgical removal may be needed for benign nodules if they are causing pressure or structural symptoms.
In the present study, one patient of total thyroidectomy developed complication like right recurrent nerve palsy. In the study by Alimoglu et al., 29 of 581 patients who developed recurrent laryngeal nerve palsy after thyroidectomy were analyzed retrospectively. There were 23 women (79%) and 6 men (21%), with a mean age of 45.6 years (range, 22–66 years). Eleven patients had right vocal cord paralysis, 8 had left vocal cord paralysis, and 10 patients had bilateral involvement. Ten patients underwent near-total thyroidectomy (34.4%), eight patients underwent bilateral subtotal thyroidectomy (27.5%), six patients underwent total thyroidectomy (20.7%), and five patients underwent unilateral lobectomy (17.2%).
| Conclusion|| |
USG and FNAC have been shown to be more sensitive, specific, and accurate than either technique alone, but high-resolution USG has important and cost-effective investigation to decide the extent and type of surgery of thyroid nodules.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gharib H, Papini E, Valcavi R, Baskin HJ, Crescenzi A, Dottorini ME, et al.
American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the diagnosis and management of thyroid nodules. Endocr Pract 2006;12:63-102.
Shah SN, Joshi SR. Goiter and goitrogenesis – Some insights. J Assoc Physicians India 2000;48 Suppl 1:S13-4.
Marqusee E, Benson CB, Frates MC, Doubilet PM, Larsen PR, Cibas ES, et al.
Usefulness of ultrasonography in the management of nodular thyroid disease. Ann Intern Med 2000;133:696-700.
Chen H, Nicol TL, Rosenthal DL, Udelsman R. The role of fine needle aspiration in the evaluation of thyroid nodules. Probl Gen Surg 1997;14:1-13.
Latoo M, Lateef M, Kirmani O. Ultrasonography a useful adjunctive in management of thyroid neoplasms. Indian J Otolaryngol Head Neck Surg 2007;59:13-4.
Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, et al.
Management of thyroid nodules detected at US: Society of radiologists in ultrasound consensus conference statement. Radiology 2005;237:794-800.
Singh P, Chopra R, Calton N, Kapoor R. Diagnostic accuracy of fine needle aspiration cytology of thyroid lesions. J Cytol 2000;17:135-9. [Full text]
Rangaswamy M, Narendra K, Patel S, Gururajprasad C, Manjunath G. Insight to neoplastic thyroid lesions by fine needle aspiration cytology. J Cytol 2013;30:23-6.
] [Full text]
Mandal S, Barman D, Mukherjee A, Mukherjee D, Saha J, Sinhas R, et al.
Fine needle aspiration cytology of thyroid nodules – Evaluation of its role in diagnosis and management. J Indian Med Assoc 2011;109:258-61.
Kurele A, Patel A, Zala PJ. Radiographic analysis of thyroid lesions using USG and CT scan. Int Assoc Infant Massages 2015;2:55-68.
Handa U, Garg S, Mohan H, Nagarkar N. Role of fine needle aspiration cytology in diagnosis and management of thyroid lesions: A study on 434 patients. J Cytol 2008;25:13-7. [Full text]
Jayaram G, Orell SR. Thyroid. In: Orell SR, Sterrett GF, editors. Fine Needle Aspiration Cytology. 5th
ed. Gurgaon: Reed Elsevier India Private Limited.; 2012. p. 118-55.
Walker J, Findlay D, Amar SS, Small PG, Wastie ML, Pegg CA, et al.
Aprospective study of thyroid ultrasound scan in the clinically solitary thyroid nodule. Br J Radiol 1985;58:617-9.
Avinash B, Ahmed N, Sreedevi T, Swapna CH, Latha RM, Babu J. Role of ultrasonography to differentiate benign and malignant thyroid nodules in correlation with fine-needle aspiration cytology. Int J Sci Stud 2016;4:81-7.
Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, et al.
American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the diagnosis and management of thyroid nodules--2016 update. Endocr Pract 2016;22:622-39.
Alimoglu O, Akdag M, Kaya B, Eryilmaz R, Okan I, Coskun A, et al.
Recurrent laryngeal nerve palsy after thyroid surgery. Int Surg 2008;93:257-60.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]