Surgical anatomy of thyroid and incidence of malignancy in solitary nodule of thyroid

Abstract

India has the world`s biggest goitre belt in sub-Himalayan. Even though national goitre control programme is reducing the prevalence of goitre but there is significant increase in incidence of solitary thyroid nodules (STN) in India so also in the worldwide. 1 ABSTRACT Background: Thyroid diseases are the commonest endocrine disorders worldwide and India it about 42 million suffering from thyroid disease. Thyroid nodules are up to 8% of the adult population having palpable nodules. With the use of ultrasound, up to 10 times more nodules are likely to be detected. Fine-needle aspiration biopsy is crucial in the investigation of a thyroid nodule since the frequency of malignancy is estimated to be 15-25%. These may be subject to surgical intervention than is required because histological examination is the only way in which malignancy can be excluded. Early diagnosis and treatment remains the cornerstone of management. A thorough understanding of thyroid anatomy is central to the performance of safe thyroid surgery and reduces the incidence of post-operative morbidity and mortality. Methods: Fifty nodular patients were studied prospectively in department of surgery, Rajarajeswari Medical College Bangalore for a period of 2 years with prior approval of Ethical Committee. Aim of the study was to know the incidence of malignancy in solitary nodule thyroid in our institute. Results: Out of 50 patients, 4 (8%) were males and 46 were females (96%) with female to male ratio of 11.5:1. Maximum age of presentation was 60 years and minimum age was 16 years with an average age incidence of 36.14 years. Histopathological examination proved to be papillary carcinoma in 6 cases, Hashimotos thyroiditis in 3 cases and 1 each showed follicular adenoma and follicular carcinoma and total incidence of malignancy in this study is 14%. Conclusions: Solitary nodule thyroid commonest disease of thyroid with high prevalence in females. Malignancy is around 14% and can come as surprise on post-operative HPE even when no suspicion by FNAC, which is comparable with others study. The main indication for surgery in STN are cosmetic or pressure symptoms or suspicious of malignancy. Near total thyroidectomy or lobectomy are the known surgeries for STN. Thorough surgical anatomy is must to prevent post-operative complications.