Incidental Papillary Thyroid Microcarcinoma in an Endemic Goiter Area

Abstract

Clinical and pathological characteristics of incidental papillary thyroid microcancer cases, surgical, medical, and nuclear treatment methods, and patients' outcome were studied during follow-up period of 102 months. We studied 37 patients with incidental papillary thyroid microcancer (I-PTM). The surgical procedure was total thyroidectomy in 29 and hemithyroidectomy in 8 patients. Size, multifocality, and bilateralism of PTM foci, thyroid capsule invasion, and presence of lymphovascular invasion were histopathological parameters. We analysed adjuvant medical and nuclear treatment and patients' outcome during follow-up period of 102 (61–144) months. The prevalence rates of I-PTM were 9.4% in 395 thyroidectomy cases. Histopathological examination reported unifocal disease in 30 and multifocal disease in 7 (18%) patients. Multifocal disease was bilateral in 6 (20.1%) patients. The mean size of the PTM foci was 4.88 mm. The rate of thyroid capsule invasion was 5.4%. All patients received a suppressive dose of LT4 to achieve a low serum TSH level. Adjuvant surgical and nuclear treatment was not performed in our cases. We did not find any negative changes in blood chemistry and ultrasound imaging, and any unfavourable events as locoregional and systemic recurrence. In conclusion, diagnosis of I-PTM is common that multifocality and bilateralism appear as pathologic features. The prognosis is excellent after surgical treatment and TSH suppression. Routine adjuvant nuclear treatment is unnecessary in majority of patients.

Value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in papillary thyroid carcinoma

“…Currently, ultrasound is commonly used in the diagnosis of PTC cervical lymph node metastasis[12-14]. The possible ultrasound results including L/S ratio < 2, missing lymphatic portal, liquefaction, calcification and other ultrasound signs suggest lymph node metastasis[15-17]. However, not every patient with lymph node metastasis has typical ultrasound signs.…”

Pattern of Thyroid Lesions in Western Region of Saudi Arabia: A Retrospective Analysis and Literature Review

“…Thyroid lesions are not only a sign of the expression of a single disease but are the clinical manifestation of a wide range of different diseases [ 3 ]. Goitrous thyroid lesion is postulated as a precursor lesion to thyroid carcinoma, because in many parts of the world, endemic goiter is a major concern [ 4 ]. It is also well understood that the occurrence of thyroid lesions will increase with iodine deficiency [ 5 ].…”

“…Other common complications of thyroid are Graves’ disease, Hashimoto’s thyroiditis, adenoma, thyroid carcinoma, hypothyroidism, and hyperthyroidism, which are the prevalent types of thyroid disorders [ 6 , 7 ]. Several previous studies have reported that the prevalence of goiter varies according to the geographical region, age, and sex [ 4 , 6 - 8 ]. The incidence of thyroid lesion increases with age, after radiation exposure, and women are 10 times more likely than men to have thyroid problems.…”

Comparison of Histopathological Features of ‘Incidental’ and ‘Non-Incidental’ Papillary Thyroid Microcarcinomas

“…Female preponderance is seen in both incidental and nonincidental Pm. (3,14,18) However, no difference is noted in the incidental and non-incidental group. This is in comparison with study of Provenzale et al (3) The mean age at presentation for incidental and nonincidental Pm (Table 1) is comparable and is not significantly different.…”

“…Incidental Pm has been associated with Multinodular/ endemic goitre, and increased levels of Thyroid Stimulating Hormone. (3,10,11,12,13,14) Many researchers correlate the incidental Pm with the variable use of ultrasonography and ultrasound guided needle aspiration. Regardless of the pre -operative diagnostic method, cases of Pm are detected incidentally post-operatively in many instances.…”