Thyroid Malignancy in Multinodular Goiter: A Prevalence Study in a High-Volume Tertiary Care Center

Abstract

Introduction Goiter is one of the most common endocrine neoplasms found globally and its incidence varies in each country. Evaluation includes clinical, laboratory, radiological, and pathological tests to rule out malignancy. Surgery may be indicated in cases when the patient develops compressive symptoms, risks of malignancy, or cosmetic deformity. Thyroid malignancies account for only 1 to 2% of all malignancies. Irrespective of size, 9 to 13% of preoperative pathological evaluations revealed malignancy. Objective To study the prevalence of thyroid malignancy in patients presenting with multinodular goiter (MNG) undergoing thyroidectomy in the Department of General Surgery, Government Medical College, Thiruvananthapuram, India. Material and Methods This prevalence study was conducted in the Department of General Surgery, Government Medical College, Thiruvananthapuram, India, for a year, between March 2017 and February 2018. All patients with MNG undergoing thyroidectomy in the Department of General Surgery during this period were selected. A total of 651 patients were included in the study after obtaining informed consent. Results A total of 651 patients were studied, out of which 91 patients (13.9%) had malignancy. Among the total, 529 were females and 122 were males. Total malignancies reported were 91 and in those, males were around 31.9% and females around 68.1%. But when comparing incidence of malignancy in MNG, it was found to be higher in males (23.8%) than females (11.7%). Out of 91 patients with malignancy, 77 patients were found to have papillary carcinoma thyroid. Most of the papillary carcinoma thyroid occurred between 41 and 50 years of age, although it can occur in younger patients too. Palpable cervical lymphadenopathy is seen in 34 cases (37.4%) of thyroid malignancies. Conclusion Proportion of thyroid malignancy in MNG at Government Medical College, Thiruvananthapuram, is 13.9%. Females are more commonly affected than males. Papillary carcinoma is the most common differentiated malignancy associated. Cervical lymph nodal metastasis is seen in 37.4% of thyroid malignancies. The risk of malignancy in MNG should not be underestimated as significant numbers of patients with thyroid malignancies present with MNG.