A study on risk factors for malignancy in solitary thyroid nodules at a tertiary care hospital
DOI:
https://doi.org/10.18203/2349-2902.isj20200532Keywords:
Colloid goitre, Euthyroid, Lymphadenopathy, Micro calcification, Solitary thyroid noduleAbstract
Background: Thyroid nodules are a common entity encountered in clinical practice and the prevalence by palpation is only 3-7%, but on ultrasonographic evaluation it is 20-76% with wide variability. Accurate prediction of malignancy with minimal diagnostic modalities and assessing the risk factors in malignancy may help in reducing extensive procedures. The objective of the study is to assess the risk factors associated with development of malignancy in solitary thyroid nodules and to find out the percentage of malignancy among the cases of solitary nodules.
Methods: A three year prospective study was conducted at ACSR medical college and all cases diagnosed as solitary thyroid nodules were enrolled and institutional ethical approval was obtained. Socio demographic data, clinical history and ultrasonogram findings were collected and entered in a separate data sheet for analysis. Fine needle aspiration cytology, histopathological examination was done and reported findings were noted. Statistical analysis was done in SPPS version 20 and ‘p’ value <0.05 was considered significant.
Results: 128 cases of solitary thyroid nodules (STN) with 41 male and 87 female cases and F:M ratio of 2.13:1 with mean age of 46.6±10.8 years was enrolled. 43.75% were euthyroid, 47.66% were hypothyroid and 8.59% were hyperthyroid on hormonal evaluation. Micro calcification was observed in 50.78%, increased vascularity in 38.28% and irregular margins in 34.38% of cases. Colloid goitre was predominant observation on fine needle aspiration cytology (40.6%) and follicular adenoma (32%) on histopathology.
Conclusions: Features of micro calcification, solid echogenicity, and associated lymphadenopathy are associated features with increased risk of malignancy among STN.
References
Keh S, El-Shunnar S, Palmer T, Ahsan S. Incidence of malignancy in solitary thyroid nodules. J Laryngol Otol. 2015;129(7):677-81.
Tai JD, Yang JL, Wu SC, Wang BW, Chang CJ. Risk factors for malignancy in patients with solitary thyroid nodules and their impact on the management. J Can Res Ther. 2012;8:379-83.
Kuru B, Gulcelik NE, Gulcelik MA, Dincer H. Predictive index for carcinoma of thyroid nodules and its integration with fine‑needle aspiration cytology. Head Neck. 2009;31:856‑66.
Kishan AM, Prasad K. Prevalence of solitary thyroid nodule and evaluation of the risk factors associated with occurrence of malignancy in a solitary nodule of thyroid. Int Surg J. 2018;5:2279-85.
Crockett JC. The thyroid nodule: fine needle aspiration biopsy technique. J Ultrasound Med. 2011;30:685-94.
Krashin E, Piekiełko-Witkowska A, Ellis M, Ashur-Fabian O. Thyroid Hormones and Cancer: A Comprehensive Review of Preclinical and Clinical Studies. Front Endocrinol (Lausanne). 2019;10:59.
Azizi G, Malchoff CD. Autoimmune Thyroid Disease: A Risk Factor for Thyroid Cancer. Endocr Pract. 2011;17(2):201-9.
Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: Predictive value of ultrasound and color‑Doppler features. J Clin Endocrinol Metab. 2002;87:1941‑6.
Castro MR, Espiritu RP, Bahn RS, Henry MR, Gharib H, Caraballo PJ, et al. Predictors of malignancy in patients with cytologically suspicious thyroid nodules. Thyroid. 2011;21(11):1191-8.
Lngegowda JB, Muddegowda PH, Rajesh KN, Ramkumar KR. Application of pattern analysis in fine needle aspiration of solitary nodule of thyroid. J Cytol. 2010;27:1-7.
Jaheen H, Sakr M. Predictors of malignancy in patients with solitary and multiple thyroid nodules. J Surg. 2016;12:105-10.