Profile of thyroid lesions presenting at a tertiary care health centre of North India: 2-year pilot study (2018-2019)

INTRODUCTION

The gland of Kocher, the thyroid, largest of all endocrine glands, is of concern when its functional integrity is disturbed or anatomy becomes disproportionate. The latter is the commonest presentation with prevalence of thyroid nodules, 4%-10% in adults and 0.2%-1.2% in children.¹ Malignant pathology is seen in only 5%-30% of thyroids. Most of the thyroid nodules belong to the non-neoplastic category.² WHO, manual emphasizes that iodine deficiency accounts to goitre in 7% of the world population.³ With India being the largest goitre belt in the sub Himalayan region. Thyromegaly can be multinodular, solitary or diffuse goitre.

The incidence of thyroid nodules has shown a marked rise in the recent decade primarily due to the wider application of neck imaging. Therefore, the incidental finding of a thyroid nodule, the “incidentaloma”, in an asymptomatic population is not rare. Nowadays the aim of evaluating these nodules is to identify those with a malignant potential.

Obstructive complaints due to tracheal or esophageal compression and change in the voice can be the usual presentation. Isolated lower cervical cosmetic deformity, is often the only presenting complaint.

Fine needle aspiration cytology (FNAC) is the gold standard. The only diagnostic test for pre-operative evaluation as it is simple, cost effective, and a quick to perform as an outpatient procedure. The patient compliance too is good. FNAC has its limitations, in differentiating between benign and malignant follicular neoplasms. Incidence of thyroid neoplasms is high in both men and women with higher preponderance in women.

Objectives

To study the incidence, gender profile, intervention undertaken, fine needle aspiration cytology and histopathological profile of thyroid lesions and correlation of FNAC and histopathological examination (HPE) studies done after surgical resection.

METHODS

This is a prospective study of individuals with swelling of the thyroid presenting to the head and neck clinic of otorhinolaryngology and head and neck surgery Dayanand Medical College and Hospital, Ludhiana. The period of the study was 2 years i.e., (January 2018 to November 2019).

Inclusion criteria

Patients presenting with thyroid swelling confirmed as thyroid pathology (both benign and malignant) on Fine need aspiration cytology.

Exclusion criteria

Patients amenable with medical therapy, thyrotoxic and hypothyroid.

Incidence, gender profile, intervention undertaken, fine needle aspiration cytology and histopathological profile of thyroid lesions and correlation of FNAC and HPE studies done after surgical intervention were analysed. Ethical approval of the study was taken from the Institutional Ethics Committee.

Statistical analysis

All statistical calculations were done using statistical package of social sciences (SPSS) 17 version statistical program for Microsoft windows (SPSS Inc. released 2008. SPSS statistic for windows, version 17.0, Chicago).

RESULTS

The study included 80 subjects who presented to the ENT head and neck clinic with a FNAC confirmed thyroid swelling; over a period of 2 years (January 2018-November 2019). All patients were evaluated by clinical examination followed by routine investigations. X-ray neck (lateral view), thyroid profile, ultrasonography and computed tomography. A computed tomography neck with contrast was carried out in in patients suspected of metastasis and those with large thyroid swelling to rule out neurovascular invasion.

Thyroid tumours comprise 37.7% (80/212) of all head and neck tumour patients presenting at our head and neck clinic over a period of 2 years (2018-2019). Female patients outnumbered the male.

Out of 80 patients, 57 were reported as benign on HPE. These included benign nodular goitre in 55 patients and thyroiditis in 2 patients.23 patients out of 80 were reported to have malignant nodule on HPE, among which 19 were papillary and 3 were reported as follicular carcinoma. Among 23 malignant swellings, 5 were found to have lymph node involvement (positive on HPE) with level 2, 3 and 4 being involved most commonly.

A total 62 patients had benign pathology while 18 had malignant pathology on fine needle aspiration cytology.

Hemithyroidectomy was done in 41 patients (51.2%) while total thyroidectomy was done in 20 patients (25%) while total thyroidectomy with lymph node clearance was done in 19 patients (23.7%).

Out of 80 patients, 57 were reported as benign on histopathological specimen.

Multinodular goitre was commonest amongst benign (45 cases/78.9%) pathology followed by follicular adenoma (12.2%).

Papillary carcinoma (82.6%) was the most common carcinoma followed by follicular carcinoma (13%) and lymphoma (4.3%).

Pathological lymph node involvement was seen in 23% of the malignant pathology.

Level ii, iii, vi lymph nodes were the commonest involved among pathological lymph node involvement. All 5 were cases of papillary carcinoma.

FNAC and HPE correlation was seen in the 93.75% of the patients.

DISCUSSION

Thyroid lesions can be non-neoplastic and neoplastic. Among the non-neoplastic lesions, common ones encountered are hyperplastic lesions like multinodular goitre and inflammatory lesions like lymphocytic thyroiditis and hashimoto thyroiditis. Neoplastic lesions can be benign tumors like adenoma or malignant tumours like papillary carcinoma thyroid, follicular carcinoma, medullary carcinoma, anaplastic carcinoma and hurthle cell carcinoma.

Among the present study thyroid tumours comprise 37.7% (80/212) of all head and neck tumour patients presenting at our head and neck clinic over a period of 2 years (January2018 to December2019) with 76.2% being female patients. The female preponderance is similar to other studies done by Sengupta and Welker.^4,5

Multinodular goiter is the most common disease diagnosed clinically, by FNAC and histopathologically as comparable to previous studies done by Tsegaye et al, Nggada HA et al, and Sushel et al.^6-8

Incidence of benign pathology is higher (57 cases/71.25%) as compared to malignant (23 cases/28.75%). These results are similar to study done by Keh et al.⁹

Hemithyroidectomy was done in 41 patients (51.2%) while total thyroidectomy was done in 20 patients (25%) while total thyroidectomy with lymph node clearance was done in 19 patients (23.7%).

Multinodular goitre was commonest amongst benign (45 cases/78.9%) pathology followed by follicular adenoma (12.2%). Papillary carcinoma (82.6%) was the most common carcinoma followed by follicular carcinoma (13%) and lymphoma (4.3%) in this study.

Fine needle aspiration cytology and histopathological examination correlation was seen in the 93.75% of the patients but was absent in 5. These patients who were diagnosed as benign pathology as multinodular goitre in 2 and follicular adenoma in 3 were diagnosed as follicular carcinoma and papillary carcinoma on histopathological examination later on.

Lymph node involvement was seen in 5 out of 23 malignant cases (21.7%) with level 6, 2 and 3 being involved most commonly. Wang et al, reported the involvement of central compartment (level 6, 7) followed by spread to lateral compartment (level 2, 3 and 4) in papillary thyroid carcinoma.¹⁰

Amarasinghe, documented in their study on papillary thyroid carcinoma that among the patients with nodal disease, 13 had a single nodal group involvement and the majority of these were level 4 nodes (46.2%). Central node (level 6) involvement was found in nine (15.3%) patients 3.75%).¹¹

CONCLUSION

Benign lesions are more common than the malignant and amongst malignant papillary carcinoma is the commonest necessitating lymph node clearance.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

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