Multinodular goitre: a clinicopathological study from Kerala
Keywords:Multinodular goiter, Thyroid, Carcinoma thyroid
Background: Multinodular goiter (MNG) occurs due to repeated hyperstimulation of thyroid gland due to iodine deficiency, goitrogens, antithyroid drugs and genetic defects. MNG can have different complications which include treacheal compression, retrosternal extension, malignancy and secondary thyrotoxicosis. The aim of the work was to study the clinical features and histopathology of MN in patients admitted for thyroidectomy in surgical wards of a tertiary care hospital in north Kerala.
Methods: A prospective hospital based observational study in the patients in surgical wards of a tertiary care hospital in north Kerala from April 2011 to March 2012. The clinical data of patients who are subjected to thyroidectomy for MNG (clinical and fine needle aspiration cytology diagnosis) were included in this study. Patients undergoing completion thyroidectomy for recurrence or malignancy were excluded from this study.
Results: MNG is more common in females. Female to male ratio 24:1 Majority are in the age group of 30-50 years (64%) with a mean age of 41 years. 38% (38 cases) had pressure symptoms in the form of dysphagia or dyspnea. Secondary thyrotoxicosis seen in 17% (17 cases). Fine needle aspiration cytology (FNAC) is not an error-proof investigation in MNG. 14 % of our patients had malignancy inspite of being reported as benign in FNAC. Among the malignancies papillary carcinoma thyroid was found to be most common accounting for 12% of cases (12/100) followed by follicular carcinoma.
Conclusions: FNAC is not an error proof investigation in MNG. Incidental thyroid cancer in MNG is about 14 % with papillary carcinoma thyroid being the commonest.
Krohn K, Führer D, Bayer Y, Eszlinger M, Brauer V, Neumann S, et al. Molecular pathogenesis of euthyroid and toxic multinodular goiter. Endocr Rev. 2005;26(4):504-24.
Ekpechi OL, Dimitriadou A, Fraser R. Goitrogenic activity of cassava (a staple Nigerian food). Nature. 1966;210(5041):1137-8.
Langer P. Study of chemical representatives of the goitrogenic activity of raw cabbage. Physiol Bohemoslov. 1964;13:542-9.
Pacini F, Vorontsova T, Demidchik EP, Molinaro E, Agate L, Romei C. Post-chernobyl thyroid carcinoma in belarus children and adolescents: comparison with naturally occurring thyroid carcinoma in Italy and France. J Clin Endocrinol Metab. 1997;82(11):3563-9.
Taylor S. The evolution of nodular goiter. J Clin Endocrinol Metab. 1953;13(10):1232-47.
Taylor S. Physiologic considerations in the genesis and management of nodular goiter. Am J Med. 1956;20(5):698-709.
Kimpkin H. Thyroid Chapter 37, 8th edition. 1970;1065-89.
Ramzi CS. The endocrine system thyroid gland; Chapter 25, Robins pathological bases of disease, 5th edition WB Saunders Company; 1994:1121-1142.
Sokal JE. Incidence of malignancy in toxic and nontoxic nodular goitre. JAMA. 1954;154:1321-5.
Sokal JE. The problem of malignancy in nodular goiter. JAMA. 1959;170:405.
Pelizzo MR, Piotto A, Rubello D, Casara D, Fassina A, Busnardo B. High prevalence of occult papillary thyroid carcinoma in a surgical series for benign thyroid disease. Tumor. 1990;76(3):255-7.
Zambudio AR, Rodríguez J, Riquelme J, Soria T, Canteras M, Parrilla P. Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Ann Surg. 2004;240(1):18-25.
Kodi S, Waddi S, Katakam SK. A prospective study on toxic multinodular goitre in surgical wards of Andhra medical college, Visakhapatnam. J Evid Based Med Heal. 2016;3(51):2349-562.
Rios A, Rodriguez JM, Galindo PJ, Montoya M, Tebar FJ, Sola J, et al. Utility of fine-needle aspiration for diagnosis of carcinoma associated with multinodular goitre. Clin Endocrinol (Oxf). 2004;61(6):732-7.
Koh KBH, Chang KW. Carcinoma in multinodular goitre. Br J Surg.1992;79(3):266-7.
Singh B, Shaha AR, Trivedi H, Carew JF, Poluri A, Shah JP. Coexistent Hashimoto’s thyroiditis with papillary thyroid carcinoma: impact on presentation, management, and outcome. Surgery. 1999;126(6):1076-7.
Jayaprakash K, Kishanprasad H, Hegde P, Chandrika R. Hashimotos Thyroiditis with coexistent papillary carcinoma and non-Hodgkin lymphoma-thyroid. Ann Med Health Sci Res. 2014;4(2):268-70.
Pacini F, Elisei R, Di Coscio GC, Anelli S, Macchia E, Concetti R, et al. Thyroid carcinoma in thyrotoxic patients treated by surgery. J Endocrinol Invest. 1988;11(2):107-12.