Non-toxic multinodular goitre; Surgical and pathological evaluation risk of malignancy

Abstract

Background: About 500–600 million people across the globe suffer from multinodular goitre (MNG), making it the most prevalent endocrine illness. The disease is considered endemic when more than 10% of a community has MNG. Women and the elderly are disproportionately affected by non-endemic goitre. In both endemic and nonendemic areas, the female-to-male ratio is roughly 3:1. Although the patient may not notice the goitre until their 40s or 50s, nodules form early on in endemic goitre and later in sporadic goitre. Aim of the study: The purpose of this study was to use histological analysis of complete thyroidectomy specimens to identify the prevalence and subtypes of thyroid cancers in non-toxic multi-nodular goitre (NTMNG). Patients and methods: This study was conducted from January 2018 to December 2022 in the Surgical Department at the Rizgary Teaching Hospital in Erbil, Iraq. Both a physical and sonographic examination was performed on each patient diagnosed with goitre. To reduce the possibility of malignancy in NTMNG, preoperative ultrasound-guided fine needle aspiration biopsy (UG-FNAB) was done on the dominant or chosen tumour in all patients. Patients were offered surgery as a treatment when diagnostic tests revealed abnormalities. Histopathological analysis of every surgically removed thyroid tissue was performed. Pre-op, intra-op, and post-op data were meticulously documented in a standardized fashion, and the outcomes were assessed. Results The goitre cases in this prospective analysis included 128 people. Seventy-six of them had a benign form of multinodular goitre. Sixty-three (82.9%) of the sample were female and thirteen (17.1%) were male. Patients' ages ranged from 23 to 74 years, with a mean age of 36 and a median age of 34±3.35 years. Colloid goitre was found in 28(36.84) %, follicular neoplasm in 3(3.94%), suggestive for malignancy in 3(3.94%), papillary in 4(5.34%), malignant in 3(3.94%), and inconclusive in the remaining 35(46.1%) of cases. Histopathological analysis was performed on all specimens obtained during complete thyroidectomy. Our study found a 15(19.7%) incidence of CA in NTMNG based on histopathology findings that 15 individuals had a malignant focus. Thyroid malignancy was detected in 15 of 76 samples (19.7%), with 8 papillary carcinomas (53.3%), 4 follicular carcinomas (26.6%), 2 Hurthle cell carcinomas (13.3%), and 1 anaplastic carcinoma (6.6%) found in NTMNG. Conclusion: It is important to remember that multinodular goitre is not benign and calls for additional screening for incidental or undiagnosed thyroid cancer.