Burden and Determinants of Malignancy in Solitary Nodule of Thyroid in a Tertiary Care Hospital in Chennai

BACKGROUND: The concern with thyroid nodules is the possibility of malignancy. Thyroid cancers are rare, accounting for only 1.0% of all cancers in most populations and 0.5% of all cancer deaths. Nonetheless, thyroid cancers occur in approximately 5% of all thyroid nodules independent of their size. With thyroid nodules being so prevalent in the general population, it is important to have a clear strategy of assessing nodules and determining which of these will require surgery or can be managed conservatively. The main problem posed by the discovery of a thyroid nodule is distinguishing between a benign and a malignant lesion. Nowadays, this problem has largely been solved by fine-needle biopsy. When performed by an experienced cytologist, this technique allows diagnosis of the nature of thyroid nodules with great sensitivity and specificity. . But FNAC is, however not without limitations; accuracy is lower in suspicious cytology and in follicular neoplasms. Despite all the newer techniques available, histopatholgy remains the most conclusive in the evaluation of the pathology of solitary nodule of thyroid. OBJECTIVES: To evaluate a patient with solitary nodule thyroid in terms of: 1. Clinical presentation, age & sex distribution of solitary nodule thyroid & complications. 2. To compare and correlate the findings of investigation i.e. FNAC,USG with the histopathology of resected specimen. 3. Usefulness of FNAC,USG,HPE in the management of solitary nodule thyroid. 4. Differential Diagnosis for solitary nodule thyroid. MATERIALS AND METHODS: This is a prospective study going to be conducted in the department of General surgery, GOVERNMENT STANLEY MEDICAL COLLEGE FROM (MAY 2018 TO MAY 2019) SOURCE OF DATA: The patients admitted in our hospital wards for management of SOLITARY NODULE OF THYROID from May 2018 to May 2019 will be taken up for the study. Study design : Descriptive study. Sample size : Total number of eligible patients admitted during study period(May 2018 to May 2019). Sample design : Purposive sampling. Study place : Dept. of General Surgery,STANLEY MEDICAL COLLEGE. Study period : May 2018 to May 2019. METHOD OF COLLECTION OF DATA: ▪ Pre tested Questionnaire will be filled based on history given. ▪ Clinical examination of patient. ▪ Thyroid profile. ▪ Routine investigations. ▪ Ultrasound of the neck. ▪ Fine needle aspiration cytology with hypodermic needle of 21-24 gauge. ▪ Indirect laryngoscopy will be done to rule out a symptomatic paralysis of vocal cords & also for medico legal purpose. ▪ Surgery as per the diagnosis made. ▪ Histopathology of resected specimen. ▪ Age,sex distribution, Symptomatology. ▪ Indication for surgery and its complications will be analysed. INCLUSION CRITERIA: 1. All the eligible patients admitted to STANLEY MEDICAL COLLEGE during the period of study will be included. 2. All the patients of age more than 13years. 3. Both sex are included. EXCLUSION CRITERIA 1. On evaluation more than one thyroid nodule within the gland are excluded. 2. Pregnant and Lactating women. 3. Patients unfit for surgery. RESULT: Commonest presentation of solitary thyroid nodule was asymptomatic. The Peak incidence of solitary nodule was observed in 3rd to 5th decade, constituting 58% of the cases studied. Females predominated in number over males in occurrence of solitary nodule in ratio of 1:15.67. The common causes of solitary nodule was MNG (16%), follicular adenoma (14%), adenomatous goiter(56%). 96% of cases presented in euthyroid state. Incidence of malignancy in solitary thyroid nodule was 12%. Male to female ratio in case of malignant nodule was1:6. Incidence of carcinoma in females presenting as solitary nodule was higher compared to that of males. The most common cause of malignancy was papillary carcinoma (83.33%) followed by follicular carcinoma (16.67%). INTERPRETATION AND CONCLUSION: Solitary nodule of thyroid is more common in females.Solitary nodule of thyroid is more common in the age group of 20-50years.Most of the patients with solitary nodule of thyroid present with swelling alone.Most of the patients with solitary nodule of thyroid are in euthyroid state.Incidence of malignancy in female patients presenting with solitary nodule thyroid is more.commonest cause of solitary nodule of thyroid is adenoma. USG can be used to detect multi-nodular goitre in patients presenting with solitary nodule thyroid. FNAC is the investigation of choice in the evaluation of solitary nodule of thyroid. It has few pitfalls. In such situations, only histopathology can confirm the exact pathology. It detects papillary carcinoma in a solitary nodule with high sensitivity and specificity. Papillary carcinoma is the most common malignancy of thyroid, followed by follicular carcinoma