Pattern of Primary Thyroid Malignancy in a Tertiary Care Hospital

Abstract

Background: Among the endocrine malignancies thyroid cancer is the most common. It constitutes a heterogeneous group of malignancies ranking it as the fifth most common cancer worldwide. On health as well as health system it has severe implication. Thyroid cancer incidence is rising most rapidly worldwide. Different thyroid malignancy requires different management strategy. Proper addressing and prompt management of different thyroid malignancies can lessen the suffering.
 Objective: The study aimed to evaluate the pattern of primary thyroid malignancy in a tertiary care hospital.
 Methods: The study was a hospital based descriptive cross sectional study and was conducted in Dhaka Medical College Hospital, Dhaka for one-year period following approval of this protocol. Patients suffering from primary thyroid carcinoma admitted in or attending the outpatient department (OPD) in the department of Otolaryngology and Head-Neck Surgery was approached for inclusion in the study. Written informed consent was taken from the subject and ethical issues were ensured. A total of 50 individual suffering from primary thyroid carcinoma calculated by sample size formula was selected by inclusion and exclusion criteria and data was collected by interview using a semi-structured questionnaire and by personal document analysis. Collected data was analyzed by the SPSS 20 for windows. This study reflects the pattern of primary thyroid malignancy in a tertiary care hospital in Bangladesh.
 Results: Mean age of the participants was 32.7 years with SD ± 13.8 years, Minimum age was 17 years and maximum age was 70 years. Majority of the patients (46%) were in the age group of 31- 40 years. Among the participants, 70% were female and 30% were male. The majority of the patients belong to Dhaka and Rangpur divisions (26% & 22% respectively) of which maximum patients were from rural area (70%). By occupation, maximum (22%) of the study subjects were businessman, maximum study subjects were below SSC (24%) and maximum patients (42%) had relatively low income per month. Half of the participants had habit of tobacco. All patients (100%) had presented with palpable thyroid swelling. Among the total participants 54% had lymphadenopathy, 10% had dysphagia, 4% had hoarseness of voice and 4% had lumpiness in throat. Only 2% of patients had the symptom of dyspnoea. No palpable lymph nodes were found in 46% followed by Single node lymphadenopathy 26%, multiple nodules in one side in 18%, bilateral lymphadenopathy 8% and 20% participants had Central compartment lymphadenopathy. USG findings of thyroid revealed Single solid nodule in 22.0%, Single cystic nodule in 16.0%, multiple mixed (solid + cystic) nodules in 62.0% cases. FNAC findings revealed Anaplastic carcinoma in 2.0%, Follicular neoplasm in 16.0% and Follicular variant of papillary carcinoma in 8.0%. Papillary carcinoma found in maximum 70.0% cases. No lymphoma found whereas medullary carcinoma found in 4.0% cases. Histopathological findings confirmed Anaplastic carcinoma in 4.0%, Follicular carcinoma in 16.0%, Follicular variant of papillary carcinoma in 8.0% and Papillary carcinoma 68.0% cases. By histopathological examination no lymphoma found whereas medullary carcinoma found in 4.0% cases. Only 24% participants had hypertension and 76% had DM as co-morbid diseases. Distant metastasis of carcinoma was not present in any of the participants.
 Conclusion: In this study, middle age group and female sex prevalent thyroid cancer. Geographical distribution also has an important role. Business, low educational level, low socioeconomic status and tobacco smoking are found the most important risk factors. Histopathologically papillary carcinoma was predominant followed by follicular carcinoma, follicular variant of papillary carcinoma, anaplastic carcinoma and medullary carcinoma. No lymphoma found.
 J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 161-174

Significance of P63 Expression in Papillary and Follicular Thyroid Carcinoma

“…The maximum number of patients (61.4%) in this study was in between 30-39 years age group. Similar pattern of age distribution was observed by Hossain et al 12 , Islam et al 13 and Hussain et al 14 The mean age of patients of this study was 40.86 ± 6.57 years. Different studies by Akhtar et al 15 , Mokhtari et al 16 , Merchant D 17 , Hussain et al 14 and Islam et al 13 showed different mean age like 45, 42.4, 41.8, 38 and 32.7.…”

“…Similar pattern of age distribution was observed by Hossain et al 12 , Islam et al 13 and Hussain et al 14 The mean age of patients of this study was 40.86 ± 6.57 years. Different studies by Akhtar et al 15 , Mokhtari et al 16 , Merchant D 17 , Hussain et al 14 and Islam et al 13 showed different mean age like 45, 42.4, 41.8, 38 and 32.7. Age range in our study was 29 to 58 years where as Mokhtari et al 16 showed 8-85 years and Hussain et al 14 showed 17-70 years.…”

“…In this study, female (70.5%) predominance was observed over male (29.5%) making a male & female ratio 1:2.4 which is comparable to the study conducted by Hossain et al 18 , Merchant D 17 and Islam et al 13 with male to female ratio of 1:3,1:2.2 and 1:2.3. This was also in agreement with studies of Mokhtari et al 16 , Sarfraz et al 19 , Rahman et al 20 and Akhtar et al 15 In the present study, papillary thyroid carcinoma was the most frequent histologic type among studied thyroid lesions and it comprises 88.6% which is comparable to the local study done by Islam et al 13 where 68% of all thyroid carcinomas were papillary thyroid carcinoma. Two another studies by Merchant D 17 and Sarfraz et al 19 showed their frequency of papillary thyroid carcinoma as 80% & 52.3%.…”

“…Two another studies by Merchant D 17 and Sarfraz et al 19 showed their frequency of papillary thyroid carcinoma as 80% & 52.3%. Among the 44 cases of our study, there were 12 cases (27.3%) of follicular variant of papillary thyroid carcinoma but the study by Islam et al 13 showed 4 cases (8%) out of 50. The frequency of follicular thyroid carcinoma in our study was 11.4% which was close to the study by Merchant D 17 (11%).…”

“…The frequency of follicular thyroid carcinoma in our study was 11.4% which was close to the study by Merchant D 17 (11%). Studies by Sarfraz et al 19 and Islam et al 13 Various studies of P63 expression in thyroid lesions have been reported to date. Unger et al 10 , Bonzanini et al 22 and El Demellawy et al 5 described that P63 was positive in a high percentage of papillary thyroid carcinomas.…”