RESUMEN

Objective: This study aimed to assess the presence and type of malignancy in patients who underwent thyroid surgery for solitary thyroid nodules. Methods: A retrospective review was performed of the case notes of all adult patients with solitary thyroid nodules who underwent thyroid surgery from 1 January 2019 to 31 October 2022. All patients had solitary thyroid nodules identified by ultrasonography. The electronic records of our pathology department were used to determine the pathological diagnosis. Results: Forty-two patients with solitary thyroid nodules underwent thyroid surgery. The mean age at presentation was 39.1 ± 12.6 years, and 76.2% of patients were female. The malignancy rate was 31%. Further histopathological analysis found that malignant solitary thyroid nodules were mostly papillary carcinoma. Conclusion: This study indicates that solitary thyroid nodules should be evaluated thoroughly and treated with a high index of suspicion because they have a high chance (31%) of being malignant.

RESUMEN

The thyroid gland is an endocrine gland situated in the lower part of front and the sides of the neck. Thyroid nodules are very common with estimated prevalence that ranges from 4% by palpation to 67% by Ultrasonography. The main purpose of our study was to detect cases of thyroid carcinoma preoperatively in patients with solitary thyroid nodules and subsequently advise surgery in these selected patients only, without missing any malignancy. The goal of the investigating modalities used was that they should detect maximum (ideally all) cases of carcinoma and minimize the number of patients who might end up with unnecessary surgery. The present study was to be undertaken for assessment of accuracy of FNAC & USG in relation to Histopathology in cases of solitary thyroid nodule (accuracy in terms of sensitivity, specificity, positive predictive value, negative predictive value). In our series of total 102 pateints, 90 patients were females (88.2%) and 12 cases were males (11.8%). The overall incidence of malignancy in solitary thyroid nodules is 15.68%. In our series the sensitivity and specificity of Fine needle aspiration cytology and Ultrasonography was 81.25% & 98.84% and 75% and 77.91% respectively. The closest method to ideal was fine needle aspiration cytology. However, a combination of techniques, rather than a single technique, give optimum results & avoid unnecessary surgery in a greater number of patients without missing any malignancy.

RESUMEN

In patients with solitary thyroid nodules, the first course of action is to determine whether the nodule is benign or malignant. Many investigations are used to differentiate between benign and malignant nodules so as to avoid surgery in those who don't need it. Among these, FNAC and USG are commonly used in association with clinical features but there are drawbacks of each technique. The present study was undertaken to assess the diagnostic effectivity of thyrotropin (also known as TSH) to thyroglobulin ratio in correlation with histopathology in euthyroid patients having solitary thyroid nodule. This is a prospective study carried out on 48 euthyroid cases of solitary thyroid nodule. All patients subjected to FNAC, USG, thyrotropin and thyroglobulin assay. Then, they underwent surgery and histopathological examination (HPE) of the specimens done. Finally, the histopathology reports were correlated with the thyrotropin to thyroglobulin ratio in order to evaluate their sensitivity and specificity by statistical methods. The sensitivity and specificity of thyrotropin to thyroglobulin ratio was 100% and 100% respectively. All malignant lesions according to thyrotropin to thyroglobulin ratio were confirmed by histopathology indicating its excellence. Therefore, TSH to thyroglobulin ratio helps in planning the correct management and avoids second surgery. It was found that serum TSH:Tg is a safe, reliable and effective diagnostic modality with a high sensitivity and specificity and is the single best investigation for preoperative evaluation of solitary thyroid nodule to differentiate between benign and malignant nodules.

RESUMEN

BACKGROUND: Total thyroidectomy is a common procedure, we wish to examine the effects of utilizing a harmonic scalpel with traditional procedures on parathyroid hormone levels. PATIENTS AND METHODS: 100 patients who underwent total thyroidectomy at the Department of General Surgery, were enrolled in this prospective randomized study, were randomly allocated into two equal groups: Group I: total thyroidectomy using a harmonic scalpel (HS) and Group II: total thyroidectomy using conventional technique. RESULTS: There is a significant association between the technique of surgery and the decrease in Postoperative PTH, Mean Difference, Pre and Postoperative and the change Pre PTH (p-value <0.001). CONCLUSION: The postoperative serum level of parathyroid hormone declined significantly after thyroidectomy if the conventional method was used. Using HS during thyroidectomy is safe and effective with low rates of hypoparathyroidism.

RESUMEN

Background Solitary thyroid nodule (STN) is a well-documented entity. Autopsy data indicate a 50% prevalence of thyroid nodules >10 mm in patients without clinical evidence of thyroid disease. Prevalence of palpable nodules is 4-7%. Solitary thyroid nodules are often asymptomatic and found incidentally. Fine needle aspiration cytology is recommended to determine the nature of the thyroid nodule. 5-10% of the thyroid nodules are found to be malignant following thyroidectomy. Objective Our study aims to explore the relationship between solitary thyroid nodule size and malignancy. Methods A prospective, observational analysis looking at preoperative thyroid ultrasound scan findings and post-operative histology for a total of 100 female patients referred to our unit within a university hospital from November 2016 to April 2019. Statistical analysis including One-Way ANOVA was performed where appropriate. Results Total number of patients was 100 female patients divided according to the size of the nodule into three groups with the correlation between the size of the nodule and the incidence of malignancy. Group A: Patients with a STN <20 mm; eight patients; post-operative histology = all benign. Group B: Patients with a STN measuring 20-40 mm; 80 patients: 68 patients were benign, and 12 patients (12%) were malignant (incidence of malignancy in the group is 15%). Group C: Patients with a STN >40 mm; 12 patients: eight patients were benign, four patients were malignant, (incidence of malignancy = 33%). Correlation between the size of the nodule and the incidence of malignancy: Group A: 0/8 malignancy; Group B: 12/80 patients were malignant; Group C: 4/12 malignant. Conclusion Our results suggest that the size of a solitary thyroid nodule cannot be reliably used for at predicting malignancy and should not be influencing patient's management.

RESUMEN

BACKGROUND AND OBJECTIVE: Surgical managements for these suspicious nontoxic swellings requires open conventional method of thyroidectomy by neck incisions that can result in prominent scars and immediate risk usually hemorrhage. However new technological innovations came into practiced that include video assisted minimal invasive endoscopy by axillo-breast approach that gives very promising results with excellent cosmesis. In this study, we compared conventional open surgery with minimal invasive endoscopic techniques and associate various complaints and complications that were encountered in surgery. METHODS: Sixty patients were enrolled in this comparative study. It was conducted from period February 2018 to February 2019. The patients were randomized alternatively in two groups. Group-I patients underwent conventional lobectomy while Group-II patients were operated endoscopically, Patients having nodules less than 3cm and Thy 1 and 2 were included in this study. Patient having nodules greater than 3cm, Multinodular goiter, recurrent nodule and Thy 3-6 were excluded from the study. RESULTS: Patients who underwent endoscopic lobectomy were much more satisfied about scar marks whereas some developed post-operative complications. It included hoarseness of voice in Three (13.62%) patients, two patients developed seroma (9.08%), three patients (13.62%) erythema, whereas no postoperative complications were seen in patients who underwent open thyroid lobectomy. No signs of hypocalcemia noted in both approaches. CONCLUSIONS: The complications with endoscopic approaches are higher but they are minor and resolved spontaneously within maximum period of six weeks. However scar mark satisfaction was much higher in endoscopic lobectomy group.

RESUMEN

BACKGROUND: It is generally believed that multinodular goiter (MNG) is associated with a lower risk of malignancy compared to solitary thyroid nodules (STN). This will be the null hypothesis in this retrospective study and we aim to prove or reject it. METHODS: Medical files and histopathology reports of 600 patients who underwent thyroidectomy over 4-year period were reviewed. Data including patient' age, gender, presentation, ultrasonography, FNAC, surgical procedures, final histopathologic diagnosis and stage of malignant tumors were collected and analyzed. The primary end point was assessment of risk of thyroid carcinoma in patients with MNG compared to those with STN. Secondary endpoints included demographic differences and prognosis. RESULTS: There were 459 females (76.5%). Mean age was 44.3 ± 14.5 years (range 14-85). After exclusion of 33 patients, 224 (39.5%) had STN and 343 (60.5%) had MNG. The prevalence of thyroid cancer was 41.1% (92/224) in STN compared to 29.2% (100/343) in MNG (Chi-Square = 8.593, p < 0.01). However, on multiple logistic regression analysis this correlation was found insignificant (p = 0.640). Only male gender (p = <0.000005) and preoperative impression of malignancy (p = 0.000082) were significantly associated with thyroid carcinoma. CONCLUSION: The risk of thyroid carcinoma in STN and MNG was similar. Male gender was identified as a risk factor for thyroid cancer while age, number and size of nodules were not.

RESUMEN

OBJECTIVE: To assess the Solitary thyroid nodules by surgeon- performed ultrasound-guided FNAC and evaluate with the histopathological findings. METHODS: This study includes 100 Consecutive patients of a solitary thyroid nodule which were presented to the Outpatients Department of Surgery during the period of two years from September 2016 to August 2018. Exclusion criteria were patients with extra-thyroid swelling, diffuse goiter and multinodular goiter. All patients with a solitary thyroid nodule underwent Surgeon -performed ultrasound-guided FNAC in the department of Radiology. After thyroid surgery, thyroid specimens were sent for histopathology and evaluate with FNAC findings. RESULTS: The study included hundred patients with solitary thyroid nodule, 75(75%) female and 25 (25%) male with a ratio of F 3:1M. The age of the patients ranged from 15-75 years with a mean age of 35 years. The result of 100 cases of Surgeon -performed Ultrasound -guide FNAC of a solitary thyroid nodule were inconclusive in 10 cases (10%), Non-neoplastic in 60 cases (60%) and Neoplastic lesions in 30 cases (30%). After evaluation of findings from FNAC and histopathology, four cases with benign FNAC (adenomatous/colloid Goiter) turnout as neoplastic (papillary carcinoma) on histopathology and six cases with neoplastic FNAC (papillary carcinoma), just two cases turnout as benign (nodular colloid goiter with cystic degeneration) on histopathology. In present study Surgeon - performed Us FNAC has found to be 87.5% sensitive, 95.3% specific and 92.0% diagnostic accuracy. CONCLUSION: Surgeon - performed Ultrasound-guided FNAC is a safe, simple and accurate technique in the diagnosis of solitary thyroid nodule.

RESUMEN

INTRODUCTION: Pathology of thyroid nodules is present in all ages and it is frequently encountered in clinical practice. Thyroid nodules do not represent a single disease, but they are the clinical manifestation of a wide range of different thyroid diseases. AIM: The objective of this study is to evaluate the frequency and localization of malignancy in solitary scintigraphic cold nodules, as well as the sensitivity, specificity and diagnostic accuracy of FNAB in comparison with histopathological findings. METHODS: The study was included 49 patients with palpatory findings of the solitary nodule located in the both lobes or isthmus of thyroid gland. All subjects underwent the scintigraphy and FNAB, followed by a cytologic results that was compared to the final histopathological diagnosis, after surgery. RESULTS: The study results show that the highest number of solitary nodules (81,6%) is localized in the lower pole of the both lobes of the thyroid gland. The cytologic results were benign 8 cases, malignant in 23 and indeterminate (follicular neoplasm) in 18 cases. The highest number of thyroid cancer is histopathologically confirmed in the patients with cytological diagnosis of follicular neoplasms, i.e. follicular cancer is found in 66.7% and papillary cancer is found in 33.3% of subjects. The most common cancer is papillary cancer found in 61,2%. Since the pathohistological diagnosis of all our patients responded to cancer, it was done indirect statistical evaluation of the diagnostic sensitivity of cytological method in the estimation of malignant thyroid lesion, which was 83,7%. CONCLUSION: FNAB is a highly sensitive method in the diagnostics of malignant thyroid lesions with the sensitivity Se=83,7%. The highest number of thyroid cancer is histopathologically confirmed in the patients with cytological diagnosis of follicular neoplasm (66.7%). The highest number of patients had a cytological diagnosis of papillary cancer.

RESUMEN

BACKGROUND: The study aims to assess the risk of cancer in solitary thyroid nodules ≥30 mm in size reported as Bethesda II, and its implications. METHOD: The clinical records of 202 patients, who underwent thyroid lobectomy for solitary nodules measuring ≥30 mm, reported as Bethesda II on preoperative FNAC between Jan 2015 and Apr 2016 were reviewed. Data collected included nodule size and consistency, and final histopathology results. The risk of cancer and the recommended management according to ATA guidelines were the outcomes of interest. Comparisons were then made between two size categories: (30-40 mm; n = 72; C1) and (>40 mm; n = 130; C2), and two nodule consistencies. RESULTS: Mean nodule size was 43.2 mm (range 30-92). Ninety-five percent were solid and 5% were predominantly cystic. The risk of cancer was 22.8% (46/202) with no size threshold, or graded increase in risk observed. Based on biologic behavior, 50% of cancers were considered clinically significant. Accordingly, the risk of cancer for which surgery is recommended was 11.4% (23/202). The risk of cancer requiring total thyroidectomy was 9.4% and was influenced by nodule size (19 vs. 60% in C1 and C2, respectively; p = 0.01). Predominantly cystic nodules had a greater risk of malignancy compared to predominantly solid nodules even after adjusting for size (40 vs. 9.9%; p = 0.01 and 40 vs. 12.5%; p = 0.02, respectively). CONCLUSION: The risk of malignancy in Bethesda II solitary nodules ≥30 mm is considerable implying a need for changing the way these are approached and refining cytopathology reporting.

Asunto(s)

RESUMEN

CONTEXT: FNAC thyroid is more sensitive as well as specific in segregating neoplastic and non-neoplastic thyroid lesions. Identification of predominant cell pattern, cell morphology and background details in FNAC smears play an important role in categorisation of various thyroid lesions with accuracy. Marginal vacuoles (MVs) have been described as irregular cytoplasmic vacuoles with largely unstained central area. MVs, although suggestive of thyrotoxicosis, are non-specific, as they are also encountered in non- toxic goitre, Hashimoto's thyroiditis and follicular carcinoma. This cytologic finding therefore deserves further study to precisely delineate its utility. Aims & Objective: To investigate whether MVs have a diagnostic role in FNAC of solitary thyroid nodule Setting & Design: This study was conducted on 40 patients who presented with solitary thyroid nodule. METHODS & MATERIAL: Forty patients having solitary thyroid nodule were subjected to FNAC on an outpatient basis. Their cytomorphological features were studied with special attention to presence of MVs. MVs if present were then graded as no/ scant (gradeI ), moderate (gradeII) and abundant (gradeIII). RESULTS AND CONCLUSION: Majority (77.5%) of nodular goitres had insignificant MVs (gradeI) in their smears. Significant MVs (gradeII+III) were limited to autoimmune thyroiditis presenting as solitary nodule and follicular neoplasms. Abundant MVs/ gradeIII were seen in follicular neoplasm only. MVs were not present in rest of neoplastic goitres. This implies that MVs are a marker of follicular differentiation.

RESUMEN

INTRODUCTION: This study was conducted at the Department of ear, nose, throat, head and neck surgery, Post Graduate Medical Institute Lady Reading Hospital Peshawar. The duration of the study was one year from June 17, 2009 to June 16, 2010. The sample size was 82 patients with solitary thyroid nodule, fulfilling the inclusion criteria. After taking detailed history, thorough examination, relevant investigation and informed consent fine needle aspiration cytology was performed in all cases by the same cytopathologist. Thyroid surgery was performed and specimens were examined by the same histopathologist. The statistical analysis was performed using the statistical program for social sciences (SPSS version 11). MATERIALS AND METHODS: Our study included 82 cases consisting on 57 female and 25 male, with female: male ratio of 2.28: 1.The age of the patients was ranged from 16-65 years with mean age of 42.56 + S.D 11.60 years. Most of the patients presented in 3(rd) and 4(th) decade followed by the 5(th) and 2(nd) decade. The diagnostic yield of Fine Needle Aspiration Cytology (FNAC) in this study was accuracy 82.92%, sensitivity 88.09%, specificity 77.50% and positive predictive value was 80.43%. RESULTS: One hundred twenty six patients entered the study among which 77 (61%) were female and 49 (39%) male. Mean age was obtained as 26.9 ± 7.7 yrs. Up to 79.4% of patients had complaints concerning the cosmetic outcomes, 39.7% with respiratory and 4.8% with olfactory problems. The reason to sue the physician had a significant relationship with the patients' age and sex, and also with the surgeons' experience. CONCLUSION: FNAC has key rule in diagnosis of solitary thyroid nodule because it is safe, minimally invasive and cost effective diagnostic tool.

RESUMEN

BACKGROUND: Various methods are used to arrive at a conclusive diagnosis of thyroid lesions on fine needle aspiration cytology (FNAC). Systemic pattern analysis is one such that can be used to analyze the lesions and divide them into individual categories. AIMS: To study the application of pattern analysis in the interpretation of solitary thyroid nodule (STN). MATERIALS AND METHODS: Two hundred and nineteen cases of fine needle aspiration cytology of STN were reviewed along with histopathological correlation. Smears were classified based on primary and secondary patterns. Predominant pattern (primary) was identified and lesion categorized. This was followed by identifying the next dominant pattern (secondary) and recategorization. Cytological diagnosis based on primary and secondary patterns was correlated with the histopathological diagnosis. RESULTS: Based on pattern analysis, the study had a sensitivity of 66.7% and specificity of 98.9%. The positive predictive value and negative predictive value were 88.9% and 96% respectively and the overall diagnostic accuracy was 95.4%. CONCLUSIONS: The present study demonstrates the feasibility and applicability of pattern analysis in diagnosing thyroid lesions by FNAC, which could be easily reproducible.

RESUMEN

Solitary thyroid nodule is a common clinical entity encountered by the otorhinolaryngologist and physcians. The optimum diagnostic strategy for the euthyroid patient with a soilitary thyroid nodule is still a matter of debate. The goal of diagnostic workup now is to select those patients for surgery who have a high likelihood of harbouring malignancy in the solitary thyroid nodule. The present study was undertaken to evaluate the utility of FANC in the preoperative diagnosis of solitary thyroid nodule and to evaluate the efficacy of FNAC, VSG and RNS in differentiating between benign and malignant nodules. It was found that FNAC is a safe, reliable and cost effective diagnostic modality with a high sensitivity of 83.3% and specificity of 100% and is the single best investigation for preoperative evaluation of solitary thyroid nodules to differentiate between benign and malignant nodules.

RESUMEN

Purpose:To study the malignant probability of a solitary thyroid nodule,probable risk factor,the status of B-mode ultrasonography,computed tomography,fine needle aspiration and frozen section in the operation and other adjuvant examination in the diagnosis.Methods:In the retrospective analysis of 902 cases of solitary thyroid nodule treated by surger- y and diagnosed by pathology in the Cancer Hospital of Fudan University from March 1998 to May 2001,we analyzed the value of B-mode ultrasonography,computed tomography,fine needle aspiration and frozen section in the operation and com- pared them with the final pathological conclusion.Results:This disease occurred mostly in 20～50 years old women,while the malignant nodules occurred more frequently in men(P50 years) (P50 years) is a risk factor.B-mode ultrasonography can be used as routine preoperative examination.CT is valuable in the cases with metastasis to neck lymph nodules.With FNA the pathological diagnosis of the nodule suspected to be malignant can be made preoperatively.

RESUMEN

BACKGROUND: Percutaneous ethanol injection(PEI) performed in guidance of ultrasonography has been used in cases of thyroid cyst and autonomous functiong thyroid nodule(AFTN). We performed this study to determine the feasibility of PEI on the various type of benign cold nodules(solid, pure cyst, complex cyst) and AFTN. METHOD: Ninety patients(age 41+12 years; 83 women and 7 men) with hot and cold nodule were included in this study. All cases were subjected to FNAB, and sono-guided in cases of complex cyst, at least twice with results of colloid nodule. T4 suppression treatment was done for cold solid nodules for at least 6 months and cases which had partial response(50% or more volume reduction but no further volume decrease on T4 suppression) were included in this study. After PEI, we classified AFTN into three different response groups; complete response (normali- zation of TFT and thyroid scan finding), partial response(normalized freeT4 but suppressed TSH or persistently suppressed scan), or failure group. Each subtypes(solid, pure cyst, complex cyst) of cold nodules were also classified into three groups in accordance with volume reduction; complete response(above 90% of volume reduction), partial response(50-90%), and failure(below 50% or increase in size) group. RESULTS: Overall responses rate of PEI for benign thyroid nodule were complete; 70(78%), partial; 18(20%), and failure; 2(2%). In 27 cold solid nodules, complete response was observed in 23(85%) and partial response in 4(15%). In 11 pure cysts, complete response was observed in 7(64%), partial response in 3(27%), and 1 case(9%) of failure was lost after 1 trial of PEI. In 45 cases of complex cyst, complete response was observed in 36(80%), partial response in 8 (18%), and 1 case(2%) of failure was subjected to operation with pathology report of Hiirthle cell adenoma. In 7 cases of AFTN, complete response was observed in 4(57%) and partial response in 3(43%). We observed complications during PEI therapy such as transient neck pain(n=10), transient unilateral vocal cord palsy(n=l), and intracavitary hemorrhage(n=2), transient hypotension during ethanol injection(n 1). CONCLUSION: Our data suggest that efficacy of PEI(57%) in AFTN is inferior to conventional therapies like surgery and radioiodine, but still can be an alternative therapeutic modality in selected cases. In cold nodules, especially of solid type and complex cyst, PEI may have feasibility as a therapeutic modality in restricted cases. Further studies of prolonged follow-up for the possibility of neglecting occult malignancy are warranted.

Asunto(s)