DOI: https://dx.doi.org/10.18203/2349-2902.isj20215136
Published: 2021-12-28

Association between multi nodular goitre and thyroid malignancy at a tertiary care centre

Sreenidhi G. M., Jyothi S.

Abstract


Background: Over the past few decades, the incidence of thyroid cancer has dramatically increased. Thyroid malignancy in multinodular goitre is considered to be high and these occult malignancies are detected only in post operative histopathological analysis. The study helps in finding association between multinodular goitre and thyroid malignancy. Objective was to find the association between multinodular goitre and thyroid malignancy in those who underwent total thyroidectomy.

Methods: A cross sectional study conducted in department of general surgery, KIMS hospital, Bangalore. The 236 randomized cases of multinodular goitre who underwent total thyroidectomy were selected. Patients underwent thorough clinical examination pre operatively and were reassessed in post-operative period following surgery. Later, histopathology report on thyroidectomy specimen of the patients were obtained. This report was considered the gold standard for the diagnosis of thyroid malignancy.

Results: Occult malignancies were commoner in middle aged females. Most of the patients in the study underwent total thyroidectomy. The prevalence of thyroid malignancy in our study was found to be 7.2%.  In the study, 17 incidental malignancies were papillary carcinomas. It revealed a highly significant relation between the lymphocytic thyroiditis and occult malignancy (p<0.0001)

Conclusions: The prevalence of malignancy in multinodular goitre is 7.2%. The only variant of incidental malignancy detected in histopathological examination of excised thyroid was papillary carcinoma. There is a statistically significant association between presence of thyroiditis in preoperative FNA and presence of occult malignancy carcinoma.


Keywords


Incidental thyroid malignancy, Occult thyroid malignancy, Thyroiditis

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References


Mittendorf MD, Christopher R, McHenry. MD Thyroidectomy for Selected Patients with Thyrotoxicosis. Arch Otolaryngol Head Neck Surg. 2001;127:61-5.

Gangappa RB, Kenchannavar MB, Chowdary PB, Patanki AM, Ishwar M. Total Thyroidectomy for Benign Thyroid Diseases: What is the Price to be Paid? J Clin Diagn Res. 2016 ;10(6):PC04-7.

Bombil, Bentley A, D Kruger, Luvhengo TE. Incidental cancer in multinodular goitre post thyroidectomy. S Afr J Surg. 2014;52(1):5-9.

Karthik KS, Suresh SS, Balakrishna MA, Ramesh DB. Study of incidence of malignancy in clinically benign thyroid swelling. South Asian J Cancer. 2015;4(3):151-3.

Rehman A, Lodli S, Anwar IM. Histopathological evaluation of 432 cases of goiter. Ann King Edward Med Univ. 2010;15:54-6.

Nanjappa N, Kumar A, Swain SK, Aroul TT, Smile SR, Kotasthane D. Incidental thyroid carcinoma. Indian J Otolaryngol Head Neck Surg. 2013;65:37-9.

Hanumanthappa MB, Gopinath S, Suvarna R, Rai GD, Shetty G, Shetty A et al. The incidence of malignancy in multinodular goitre: A prospective study at a tertiary academic centre. J Clin Diagn Res. 2012;6:267-70.

Jo SW, Park HK, Kwun T. Prediction of Contralateral Occult Malignant Nodule in Patients with Unilaterally Confined Papillary Thyroid Carcinomas. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2014;49(11):881-4.

Iida F, Sugenoya A, Muramatsu A. Clinical and pathologic properties of small differentiated carcinomas of the thyroid gland. World J Surg. 1991;15(4):511-5.

Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. Systematic autopsy study. Cancer. 1985;56:531-8.

Yamamoto Y, Maeda T, Izumi K, Otsuka H. Occult papillary carcinoma of the thyroid. A study of 408 autopsy cases. Cancer. 1990;65:1173-9.

Kaliszewski K, Strutyńska-Karpińska M, Zubkiewicz-Kucharska A, Wojtczak B, Domosławski P, Balcerzak W et al. Should the Prevalence of Incidental Thyroid Cancer Determine the Extent of Surgery in Multinodular Goiter? PLoS One. 2016;11(12):e0168654.

Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Maso LD. Worldwide Thyroid-Cancer Epidemic? Increasing Impact Overdiagnosis. N Engl J Med. 2016;375(7):614-7.

Rosai J, Li Volsi VA, Sobrinho-Simoes M, Williams ED. Renaming papillary microcarcinoma of the thyroid gland: the Porto proposal. Int J surg Patho. 2009;11(4):249-51.

Okayasu I, Fujiwara M, Hara Y, Tanaka Y, Rose NR. Association of chronic lymphocytic thyroiditis and thyroid papillary carcinoma. A study of surgical cases among Japanese, and white and African Americans. Int J Head Neck Surg. 2016;7(4):213-9.

Holm LE, Blomgren H, Löwhagen T. Cancer risks in patients with chronic lymphocytic thyroiditis. N Engl J Med. 1985;312(10):601-4.

Kim EY, Kim WG, Kim WB, Kim TY, Kim JM, Ryu JS et al. Coexistence of chronic lymphocytic thyroiditis is associated with lower recurrence rates in patients with papillary thyroid carcinoma. Clin Endocrinol (Oxf). 2009;71(4):581-6.

Kebebew E, Treseler PA, Ituarte PH, Clark OH. Coexisting chronic lymphocytic thyroiditis and papillary thyroid cancer revisited. World J Surg. 2001;25(5):632-7.

Jeong JS, Kim HK, Lee CR, Park S, Park JH, Kang SW et al. Coexistence of chronic lymphocytic thyroiditis with papillary thyroid carcinoma: clinical manifestation and prognostic outcome. J Korean Med Sci. 2012;27(8):883-9.

Lee J, Hasteh F. Oncocytic variant of papillary thyroid carcinoma associated with Hashimoto's thyroiditis: a case report and review of the literature. Diagn Cytopathol. 2009;37(8):600-6.

Rio PD, Cataldo S, Sommaruga L, Concione L, Arcuri MF, Sianesi M. The association between papillary carcinoma and chronic lymphocytic thyroiditis: does it modify the prognosis of cancer? Minerva Endocrinol. 2008;33(1):1-5.

Anand A, Singh KR, Kushwaha JK, Hussain N, Sonkar AA. Papillary Thyroid Cancer and Hashimoto’s Thyroiditis: An Association Less Understood. Indian J Surg Oncol. 2014;5(3):199-204.

Kwong N, Medici M, Angell TE, Liu X, Marqusee E, Cibas ES et al. The Influence of Patient Age on Thyroid Nodule Formation, Multinodularity, and Thyroid Cancer Risk. J Clin Endocrinol Metab. 2015;100(12):4434-40.

Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998;338(5):297-306.

Bessey LJ, Lai NBK, Coorough NE, Chen H, Sippel RS. The incidence of thyroid cancer by fine needle aspiration varies by age and gender. J Surg Res. 2013;184(2):761-5.

Yao R, Chiu CG, Strugnell SG, Gill S, Wiseman SM. Gender differences in thyroid cancer: a critical review. Expert Rev Endocrinol Metab. 2011;6(2):215-43.

Rojeski MT, Gharib H. Nodular thyroid disease. Evaluation and management. N Engl J Med. 1985;313(7):428-36.