Impact Factor: 5.2 IJAR

Abstract

Disease of the thyroid organ particularly Multinodular Goiter because of inadequacy of iodine is pervasive in India. Greatest goiter belt on the planet lies in the sub Himalayan areas and slopes of Maharashtra (Satpuda) and Vindya ranges. Multinodular goiter (MNG) just as solitary thyroid nodule (STN) are the basic types of thyroid swelling. This forthcoming study was completed to discover the Incidence of separated thyroid malignant growth among patients with goiter and to contemplate the statistic and clinical profile of separated thyroid disease. Results signified that dominant part of the malignancies happened in the 41-50 yrs. The extent of thyroid swelling forming into malignancies is higher in females when contrasted with males. The frequency of harm was observed to be higher among male when contrasted with females, being 38.47% and 17.29% individually. Among 120 licenses incorporated into this examination, 15 (12.5%) were found to have raised TSH levels. 7 patients created hypocalcaemia includes in prompt post-operative period. every one of the 29 malignant patients had experienced radioiodine scan postoperatively and an improved result of patients had been seen amid rehashed subsequent meet-ups. Increasingly over it might presume that progresses in cytological identification and imaging modalities, FNAC and USG have turned out to be basic diagnostic tools in diagnosing just as arranging a legitimate therapeutic surgical intervention.

Full text

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ISSN Print: 2394-7500
ISSN Online: 2394-5869
Impact Factor: 5.2
IJAR 2019; 5(4): 340-342
www.allresearchjournal.com
Received: 08-02-2019
Accepted: 10-03-2019
Priyadarshan Konar
Department of General Surgery, IMS
& SUM hospital, Siksha O
Anusandhan University, K8, Kalinga
Nagar, Bhubaneswar, Odisha, India
Prakash Kumar Sahoo
Department of General Surgery, IMS
& SUM hospital, Siksha O
Anusandhan University, K8, Kalinga
Nagar, Bhubaneswar, Odisha, India
Debasis Samal
Department of General Surgery, IMS
& SUM hospital, Siksha O
Anusandhan University, K8, Kalinga
Nagar, Bhubaneswar, Odisha, India
Suman Saurav Rout
Department of General Surgery, IMS
& SUM hospital, Siksha O
Anusandhan University, K8, Kalinga
Nagar, Bhubaneswar, Odisha, India
Kasturi Bharadwaj
Department of General Surgery, IMS
& SUM hospital, Siksha O
Anusandhan University, K8, Kalinga
Nagar, Bhubaneswar, Odisha, India
Rima Sultana
Department of General Surgery, IMS
& SUM hospital, Siksha O
Anusandhan University, K8, Kalinga
Nagar, Bhubaneswar, Odisha, India
AA Naidu
Department of General Surgery, IMS
& SUM hospital, Siksha O
Anusandhan University, K8, Kalinga
Nagar, Bhubaneswar, Odisha, India
K Ujwal
Department of General Surgery, IMS
& SUM hospital, Siksha O
Anusandhan University, K8, Kalinga
Nagar, Bhubaneswar, Odisha, India
M Vishnu Teja
Department of General Surgery, IMS
& SUM hospital, Siksha O
Anusandhan University, K8, Kalinga
Nagar, Bhubaneswar, Odisha, India
Correspondence
Prakash Kumar Sahoo
Department of General Surgery, IMS
& SUM hospital, Siksha O
Anusandhan University, K8, Kalinga
Nagar, Bhubaneswar, Odisha, India
Incidences of differentiated thyroid cancer in goitre
cases with special reference to clinicopathological
study and management
Priyadarshan Konar, Prakash Kumar Sahoo, Debasis Samal, Suman
Saurav Rout, Kasturi Bharadwaj, Rima Sultana, AA Naidu, K Ujwal and
M Vishnu Teja
Abstract
Disease of the thyroid organ particularly Multinodular Goiter because of inadequacy of iodine is
pervasive in India. Greatest goiter belt on the planet lies in the sub Himalayan areas and slopes of
Maharashtra (Satpuda) and Vindya ranges. Multinodular goiter (MNG) just as solitary thyroid nodule
(STN) are the basic types of thyroid swelling. This forthcoming study was completed to discover the
Incidence of separated thyroid malignant growth among patients with goiter and to contemplate the
statistic and clinical profile of separated thyroid disease. Results signified that dominant part of the
malignancies happened in the 41-50 yrs. The extent of thyroid swelling forming into malignancies is
higher in females when contrasted with males. The frequency of harm was observed to be higher among
male when contrasted with females, being 38.47% and 17.29% individually. Among 120 licenses
incorporated into this examination, 15 (12.5%) were found to have raised TSH levels. 7 patients created
hypocalcaemia includes in prompt post-operative period. every one of the 29 malignant patients had
experienced radioiodine scan postoperatively and an improved result of patients had been seen amid
rehashed subsequent meet-ups. Increasingly over it might presume that progresses in cytological
identification and imaging modalities, FNAC and USG have turned out to be basic diagnostic tools in
diagnosing just as arranging a legitimate therapeutic surgical intervention.
Keywords: Multinodular goitre, solitary thyroid nodule, TSH
Introduction
Diseases of the thyroid gland are common and comprise a spectrum of entities causing
systemic disease (Grave’s disease) or a localized abnormality in the thyroid gland such as
nodular enlargement (goiter) or a tumor mass [1]. After diabetes mellitus, the thyroid gland is
the most common organ to cause endocrine disorders 2. Thyroid disorders are the most
common endocrine diseases particularly in countries where iodine intake through diet is low.
Thyroid carcinoma closely resembles its benign counterpart in physical characteristics,
measurable physiological parameters such as serum T3/T4 levels and ultrasonic characteristics
[2]. Therefore, the surgical excision of the nodule and its histological examination is the only
way to differentiate between the more frequent benign and much less frequent malignant
nodules. Since most of the thyroid nodule are benign, symptomless and small in size, they do
not require surgical excision.
The optimal outcome of management of thyroid cancer is achieved only via coordinated
multimodal therapy, which includes thyroidectomy, radio-iodine (RAI) ablation and thyroid
stimulating hormone (TSH) suppression therapy [3]. Of these treatments, surgery is the
cornerstone of initial management. Most patients should undergo thyroidectomy with
concomitant central neck (level VI) lymph node dissection. On the other hand, thyroidectomy
alone may be appropriate for patients with smaller tumors (T1 or T2) with no evidence of
suspicious lymphadenopathy. Surgery is also indicated in cases of cervical lymph node
metastases and locoregional recurrence [4-7]. The principal adjuvant therapy is radioactive
iodine, which should be considered in patients with a high risk of locoregional recurrence or
with metastatic disease. Similarly, suppression of endogenous thyroid- stimulating hormone is
recommended in patients with an elevated risk of recurrence.
International Journal of Applied Research 2019; 5(4): 340- 342

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International Journal of Applied Research
External-beam radiotherapy is indicated in patients with
gross extrathyroidal extension or residual disease not
amenable to surgery. Finally, molecular therapies, especially
those targeting key tyrosine kinases and/or inhibiting
angiogenesis, are emerging treatment modalities that could
replace the limited efficacy of conventional chemotherapy.
In cancer care, multidisciplinary team approach is always
needed. For thyroid cancer, this team consists of surgeon,
medical oncologist, nuclear medicine specialist and
endocrinologist [9]. The cancer care teams may also include
health care professionals from other varieties, including
physician assistants, oncology nurses, social workers,
pharmacists, counsellors, dieticians, and others. Treatment
options and recommendations depend on several factors,
including the type of thyroid cancer, staging, possible side
effects, associated co-morbidities, patient’s preferences and
patient’s overall health.
Materials and methods
It was a prospective study of 24 months (July 2016 to June
2018). All patients who presented with thyroid swelling in
surgical OPD of IMS and SUM hospital were included for
this study i.e around 120 patients attending General Surgery
OPD of IMS and SUM hospital. The study was conducted in
the department of general surgery at IMS and SUM hospital,
in collaboration with the department of Radio diagnosis and
department of Pathology. The inclusion criteria was thyroid
swelling and patient giving consent. The elusion was based
in Patient not giving consent, hospice patient and patients
with neck swellings other than thyroid.
The individual data was collected from patients who
presented to OPD or emergency of IMS and SUM hospital
with thyroid swellings. Data was collected through a
Proforma questionnaire. Categorical variables are expressed
as Number of patients and percentage of patients and
compared across the groups using Pearson’s Chi Square test
for Independence of Attributes/ Fisher's Exact Test as
appropriate. Continuous variables are expressed as Mean ±
Standard Deviation and compared across the 2 groups using
unpaired ‘t’ test. The statistical software has been used for the
analysis. An alpha level of 5% has been taken, i.e. if any p
value is less than 0.05 it has been considered as significant.
Results
We Included 120 patients in our study from various age
ranging from 18 years to 67 years. All the patients were
admitted through the Surgical department of IMS and SUM
Hospital, a multi-speciality 1000 bedded hospital. The
provisional diagnosis was made that of Multinodular Goitre
or Solitary Nodular goitre. A proper history taking, clinical
evaluation and thorough physical examination was done. The
patients were subjected to initial radiological investigation
and image guided FNAC before a provisional diagnosis was
made. The following statistics were compiled after the
patients were operated and a confirmatory histopathological
diagnosis was obtained.
Amongst the 120 patients included, 81 (68%) were females
and 33 (32%) individuals were males.
Table 1: Gender participated in the study
HPE
Male
Female
Benign
24 (20%)
67 (55.83%)
Malignant
15 (12.5%)
14 (11.67%)
Total
39
81
A total of 29 participants i.e. 24% were eventually found to
have thyroid malignancy. The remaining 91 patients i.e. 76%
of the study group had benign thyroid disorders.
The incidence of malignancy was found to be higher amongst
males as compared to females, being 38.47% and 17.29%
respectively. However, 20% of the malignancies occurred in
females, i.e. 24 patients out of 120 patients.
Table 2: Malignant cells in male and female
Male
Female
Malignant
14 (48%)
15 (52%)
The complete age wise distribution of malignant cases is
shown in the below table:
Table 3: Number of cases with respect to age
Age (yrs)
PTC
FTC
MTC
Anaplastic
11-20
00
00
01
00
21-30
04
00
00
00
31-40
07
01
00
00
41-50
09
02
00
00
51-60
03
00
00
00
61-70
00
00
00
02
71-80
00
00
00
00
Total
23
03
01
02
Most of the cases of papillary thyroid carcinoma which were
diagnosed had a duration of signs and symptoms <1 year
owing to the increased awareness among patients and better
modality of diagnosis.
Table 4: Number of cases with respect to duration
Duration
PTC
FTC
MTC
Anaplastic
1yr
14
01
01
00
1-5yrs
05
01
00
02
5-10yrs
04
01
00
00
10yrs
00
00
00
00
Total
23
03
01
02
Table 5: Number of cases with respect to benign and malignant
Euthyroid
Hypothyroid
Hyperthyroid
Benign
79 (65.8%)
07 (5.8%)
05 (4.16%)
Malignant
21 (17.5%)
08 (6.7%)
00
Total
96 (83.3%)
15 (12.5%)
05 (4.16%)
It was observed during surgical intervention that among the
malignant cases where initially only a single lobe
involvement was detected (clinically) the other lobe was also
involved in form of nodularity or change in lobular texture or
consistency; vascularity and capsular adhesions.
Table 6: Types of tumour with respect to side
Side of swelling
Benign
Malignant
Right
28 (23.34%)
09 (7.5%)
Left
20 (16.67%)
10 (8.34%)
B/L
43(35.84%)
10 (8.34%)
Total
91
29
Multinodular goitre was noted to have higher incidence of
cases in both benign (46.67%) and malignant groups
(18.83%).

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International Journal of Applied Research
Table:7 Presence of neck nodes
Neck nodes
PTC
FTC
MTC
ANAPLASTIC
Y
02
00
00
00
N
21
03
01
02
In this study, out of 3 Follicular Carcinoma detected in HPE
results, no case was diagnosed with malignancy
preoperatively from FNAC report. FNAC of the 3 patients in
our study had shown follicular adenoma, whereas HPE report
revealed follicular carcinoma in all. This predicts that FNAC
as a pre-operative diagnostic tool is unreliable in follicular
variety.
Discussion
The study tends to highlight the fact that a significant
proportion of the cases are occurring in the younger
population as compared to the elderly. The same has also
been established through studies across US and Europe.
Multinodular goitre has more chance of malignancy than
Solitary thyroid nodule. Incidence of such malignancies are
significant. Therefore, high incidence of malignancy in multi-
nodular goitre patient, makes total thyroidectomy as
preferable procedure in the treatment of the disease.
This study also revealed that the number of histo-
pathologically proven malignancies, are more in the females
as compared to males. In this study amongst total of 29
patients with malignancy, 15 (52%) were females as
compared to 14 (48%) males. All the participants of the study
who presented with thyroid swellings were classified as per
the duration. They were classified into four groups, i.e. <1, 1-
5, 5-10, >10 years of duration. Amongst 120 patents included
in this study, 15 (12.5%) were found to have elevated TSH
levels. Eight out of these 15 patients were eventually
diagnosed with thyroid malignancy and remaining 7 had
benign lesions. The correlation between incidence of elevated
TSH levels and the ultimate confirmation of malignancy was
50% in the entire group of participants with malignant thyroid
disease [10]. All 29 cases of malignant goitre were subjected
to total thyroidectomy with neck dissection. 2 cases showed
extensive involvements of neck nodes of levels II, III, IV, VI.
All the nodes in each case were dissected out and tested (+ve)
for malignancy although no vascular involvement or
encasement or nerve damage were noted in either. There was
no intra-operative complication in any of these cases, except
in 1 case where thoracic duct was accidentally injured and
there was persistent lymphoria for about 8-10 days which
subsided spontaneously. 3 patients had developed hoarseness
of voice postoperatively, out of which 2 patients recovered
and in the other patient it still persists. Among 120 patients,
7 patients developed hypocalcaemia features in immediate
post-operative period, but recovered with I.V. calcium and
vitamin D3. The routine use of postoperative radioiodine is
more and more accepted. In our studies, all 29 malignant
patients had undergone radioiodine scan postoperatively and
an improved outcome of patients had been observed during
repeated follow ups.
Conclusion
Over all in this study we observed that a complete thyroid
profile is highly essential as hypothyroid cold nodules are
more predictive of malignancy than a hyperthyroid swelling.
With advances in cytological detection and imaging
modalities, FNAC and USG have become essential
diagnostic tools in diagnosing as well as planning a proper
therapeutic surgical intervention. According to the recent
ATA guidelines, total thyroidectomy remains the mainstay in
the management of Malignant thyroid swellings following
proper assessment of extent and nodal involvement. It
sometimes comes down to the high expertise, skill and
experience of the surgeon in undertaking such surgeries
without causing serious intra or post-operative complications.
Radioiodine uptake study and Radio iodine ablation are
adjuvant to surgical therapy. Follow up with serum
thyroglobulin assay is an important tool for future assessment
for recurrence. With increasing incidence of thyroid
malignancies as shown in various studies it is essential to
have a multimodality approach for the proper assessment,
evaluation and surgical management of malignant thyroid
swellings.
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