Thyroid cancer among patients with thyroid nodules in Yemen: a three-year retrospective study in a tertiary center and a specialty clinic

Abstract

Background: The prevalence of thyroid cancer is increasing worldwide. No previous data are available on the prevalence of thyroid cancer in Yemen. We performed this study to determine the prevalence of thyroid cancer among patients with thyroid nodules in Yemen. Methods: A retrospective chart review was performed for 550 patients with thyroid nodules who underwent fine needle aspiration and/or thyroid surgery at a private endocrine clinic and at an endocrine clinic in a tertiary hospital in Yemen over a 3-year period from October 2016-2019. The prevalence of thyroid cancer; the sonographic findings, Bethesda classification, age, sex, thyroid stimulating hormone (TSH) levels of the patients; and the nodule size and number were reviewed. Results: A total of 550 charts were reviewed [501 females (91.1%) and 49 males (8.9%)]. The thyroid cancer prevalence among the patients was 13.8% (CI = 10.9-16.7), and the mean age of the patients was 38.5 years (SD = 12.2). The TSH level and the rate of cancer were significantly related (P = 0.01), but no significant difference in the prevalence of thyroid cancer was found between females (13.4%) and males (18.4%) (P = 0.334). When correlating the rate of cancer with the ultrasound guided fine needle aspiration (UG-FNA) result, those with Bethesda system category III and IV, V and VI had malignancy rates of 20.8, 27.2, 52.4 and 69.2%, respectively. Thyroid nodules highly suspicious for malignancy on ultrasound had a 70% cancer diagnosis rate. The most common thyroid cancer was papillary cancer (71%), followed by follicular cancer (23.7%). Among those undergoing surgery, 44.2% had thyroid cancer, and 5.2% had a premalignant diagnosis. Conclusion: Thyroid cancer has a higher prevalence in Yemen than in other middle eastern countries. Our study also reports a higher rate of follicular thyroid cancer than that in other published data, which has to be confirmed by further studies. The malignancy and premalignant diagnosis rate was~50% in our patients who underwent surgery. Many centers in Yemen still do not perform FNA before thyroid surgery. It is important that other centers in the country start emphasizing the need for FNA before surgery. This will decrease the number of unnecessary surgeries and associated complications.

Characteristics of patients undergoing thyroidectomy in a resource-limited setting in Ibb city of Yemen: a retrospective monocentric study

“…evaluated thyroid disorders histopathologically and reported that multinodular goiter was the most prevalent preoperative cytology result [ 3 ]. These results are consistent with previous findings that goiter is the most pervasive thyroid condition affecting young women in their teens and twenties [ 4 ]. Iodine-deficient regions are rampant with nodular goiter; a greater proportion of multimodular goiter in our study's representative areas may imply an iodine deficit.…”

“…study [ 3 ]. Thyroid diseases affect women more than men, owing to thyroid disorders' autoimmune nature and changes in thyroid function during pregnancy [ 4 ]. The main indications for thyroid surgeries are thyroid cancer, toxic multinodular goiter, toxic adenomas, local compressive symptoms, Graves' disease that failed or refractory to medical treatment or for whom medical management may not be advised, such as those attempting to become pregnant, and, rarely, cosmesis [ 5 ].…”

Surgical management of thyroid gland swellings in 22 May Hospital, Aden, Yemen

“…The study revealed a distinct female preponderance over males with a ratio of 10.7:1. This observation shows similarity with previous studies that in Yemen by Alhuraibi K. et al [4], Al-Sharafi B et al [6], and Al-wageeh S et al [9], who described , in their studies, that females to males ratios were of 11.6:1, 10.2:1 and 9:1 respectively. However, other research papers recognize female preponderance of thyroid disease to a much lesser extent: 1.85:1-2.31:1 [18,34].…”

“…The majoriy of the patients in the study were euthyroid (88.1%) and this is similar to what mentioned by Al-SharafiB. et al [6] in their studies (87.6%). However, in the work of Al-HuraibiK.et al [4], euthyroid patients were slightly less frequent 80%.…”

Thermography as an aid for the complementary diagnosis of nodules in the thyroid gland

“…It occupies the eighth position in the ranking of cancers that affect women [ 1 , 2 ]. Worldwide, this neoplasm affects, on average, 3% to 5% of all female cancers and 0.6% to 1.5% of male cancers [ 3 , 4 ].…”