Histopathological Evaluation of 432 Cases of Goiter

Abstract

Introduction Thyroid nodules are among the commonly encountered surgical specimens in histopathology laboratory. Thyroid nodules can be solitary or multiple. Carcinoma of thyroid is uncommon accounting for only 1% of all human tumors. Annual incidence of thyroid cancer is 0.5 to 10:100,000 person’s world wide. The prevalence of carcinoma is lower in multinodular goiter (MNG) than in solitary thyroid nodule (STN) (2). Malignancy is seen in only 0 to 11% of patients with MNG and is usually an incidental finding in thyroidectomy specimens, and in 3 to 33% of patients with STN. Clinical assessment based on physical examination of thyroid nodule helps to distinguish cases having high risk of malignancy. Iodine uptake thyroid scan, ultrasonography of the gland and fine needle aspiration cytology (FNAC) can also play a significant role in establishing the preoperative diagnosis of malignancy, but FNAC is the modality of choice. One shortcoming of FNAC in MNG is false negative result because the needle may not go into the nodule on which the test needs to be done. However, its role in solitary nodule is well established. Help of ultrasound guidance for FNAC can be taken if the cell yield is poor on aspiration. STN is the most common indication for surgical resection as prevalence of malignancy is more in solitary nodules. However, the solitary nodules should be cold on thyroid scan because hot nodules are less likely to be malignant. Malignancy in thyroid is mostly seen in hypo functioning cold nodules which do not take up iodine. Men develop thyroid nodules less frequently than women. Another fact is that frequency of malignancy in STN is more common in men than in women. Solitary cold nodules in men should be thoroughly investigated. Malignant nodules need to be treated surgically whereas benign nodules can be managed conservatively. Thyroid malignancy does not cause hypo or hyperthyroidism. Patients with thyroid malignancy usually reveal normal thyroid function tests. This study is aimed to see the histological pattern and ascertain the frequency and pattern of malignancy in goiter and STN in both sexes so that recommendations can be made for management.