Evaluation of a Scoring System for predicting the risk of malignancy in thyroid nodules using Clinical, Laboratory and Sonological data

Sadhana, S (2017) Evaluation of a Scoring System for predicting the risk of malignancy in thyroid nodules using Clinical, Laboratory and Sonological data. Masters thesis, Madras Medical College, Chennai.


Download (12MB) | Preview

Download (17kB) | Preview


INTRODUCTION: Many patients present to the surgical department with a thyroid nodule. However not all require surgery and only 5-6% of these are malignant. There are many methods to diagnose and predict malignancy in thyroid nodules. This study throws light on the usefulness of combining clinical, radiological and laboratory investigations into a single scoring system which is used to predict the risk of malignancy in thyroid nodules thereby helping the surgeon to make appropriate decisions regarding the operative management and follow up of the patient. AIMS AND OBJECTIVES: To evaluate a scoring system using clinical, laboratory and sonological data for predicting the risk of malignancy in patients with thyroid nodules, in a tertiary care centre in South India, which caters mostly for an economically underprivileged population. MATERIALS AND METHODS: This prospective observational study involved 50 patients admitted in MMC, Chennai with thyroid nodules. Analysis of a scoring system was done which combined clinical findings, radiological features and laboratory findings such as TSH level and FNAC report. The final scores were compared with the post-operative histopathology of the patient and the risk of malignancy was predicted. OBSERVATION AND RESULTS: The scoring system had a maximum score of 26. The observed score ranged from 3 to 19. The mean score was 11. All the malignant cases observed in our study had a score greater than 11. The incidence of thyroid carcinoma for scores of 1 to 11 was 0%, 12 to 13 was 20%, 14 to 18 was 75% and ≥19 was 100%. The average risk of malignancy for a score ≤11 was 0% and for a score >11 was 54.166%.The sensitivity and specificity of the scoring system was 70.2% and 100% respectively. The positive and negative predictive value for the scoring system was 100% and 43.83% respectively.The greater risk of malignancy demonstrated for patients above a score of 11 was statistically significant (p < 0.0001, χ2 = 14.965, df = 1). The risk of malignancy increased with increasing scores and was found to be 100% for a score ≥16. CONCLUSION: This scoring system has proved to be accurate in predicting the risk of malignancy in patients with thyroid nodules by combining various parameters derived from the patient’s history, clinical examination and simple, cost-effective investigations like thyroid function test, ultrasonogram and FNAC. Each of these factors has variable reliability, but their combination has proven to be a better predictor of malignancy. It can be routinely introduced in every hospital for pre-operative assessment of patients presenting with thyroid nodules, thus helping the surgeon to make rational and individualized decision while treating such patients.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Scoring System, predicting, risk of malignancy, thyroid nodules, Clinical, Laboratory and Sonological data.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 18 Mar 2020 17:12
Last Modified: 18 Mar 2020 17:12
URI: http://repository-tnmgrmu.ac.in/id/eprint/12332

Actions (login required)

View Item View Item