Clinicopathological study on multinodular goitre

Arunmozhi Vijay, N (2014) Clinicopathological study on multinodular goitre. Masters thesis, Tirunelveli Medical College, Tirunelveli.

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Abstract

INTRODUCTION: MULTINODULAR GOITER describes an enlarged, diffusely heterogeneous thyroid gland. Initial presentation may include diffuse enlargement, but the mass often develops asymmetrical nodularity. The cause of this mass is usually iodine deficiency. Initially, the mass is euthyroid; however, with increasing size, elevations in T3 and T4 can occur and progress gradually into clinical hyperthyroidism. Work-up and diagnosis include evaluation of thyroid function tests. Ultrasound and radioisotopic scanning demonstrate heterogeneous thyroid substance. Nodules with poor uptake can present as lesions suspicious for malignancy. The incidence of carcinoma in multinodular goiter has been reported as 5% to 10%. Therefore, FNAC for diagnosis and resection for suspicious lesions should be considered. Hyperthyroidism may be adequately controlled by drugs, but surgical management is the preferred treatment. Subtotal or total thyroidectomy may performed depending upon the involvement of the thyroid gland. Radioactive iodine therapy is reserved for elderly individuals who represent poor operative risk. The complications of thyroid surgeries are heamorrhage, respiratory obstruction, vocal cord paralysis, hypoparathyroidism, thyroid insufficiency, thyrotoxic storm and wound infection. MATERIALS AND METHODS: This is a prospective clinical study of randomly selected patients admitted in the department of surgery, TVMCH diagnosed and treated as a case of multinodular goitre during the study period. The patients diagnosed as a case of multinodular goitre will undergo detailed history taking, clinical examination, investigations like CBC, thyroid profile, fine needle aspiration cytology, x – ray chest and neck and ultrasonography of neck. After surgery, the patients will be followed up for any immediate post operative complications. The specimen will be sent for histopathological examination and the results will be recorded. Through this study I intend to find out Through this study I intend to emphasize the existing data regarding multinodular goitre and find out - Whether there is a specific age distribution for multinodular goitre in and around tirunelveli. - To study and discuss the most common presenting clinical features of multinodular goitre. - The percentage of thyroid malignancies presenting as multinodular goiter and whether FNAC is conclusive in confirming the diagnosis, which will be helpful in planning the surgery necessary ie., whether a subtotal or total thyroidectomy must be performed. - The percentage of post operative complications encountered in surgeries performed for multinodular goitre in our hospital. RESULTS: In our study, among the 50 cases three were male which constitutes 6% of the study group. The remaining 47 cases were females (94%). Majority of the cases were in the 30 – 40 years age group (32%), followed by the age group of 40 – 50. The Mean age of incidence was 42.26. The average post operative stay among the 50 cases studied was 5.3 days. 76% of the cases were discharged between 4 to 6 days of post operative stay. The presenting complaint was a swelling in all the cases studied (100%). The swelling was associated with pain in 48% of the cases. Pressure symptoms like dysphagia, dyspnoea and hoarseness of voice were present in 44%, 18% and 20% of cases respectively with an average of 27.3%.Of the 50 cases of Multinodular goiters studied, 7 cases were hyperthyroid on presentation which constitutes 14% of the cases. All the cases were taken up for surgery, 88% of cases underwent total thyroidectomy and 10% of cases underwent subtotal thyroidectomy. The Fine Needle Aspiration Cytology reports of the 50 cases showed Nodular Colloid Goitre (64%) as the most common FNAC finding followed by Hashimoto’s Thyroiditis (11%). The FNAC report was follicular neoplasm for 2 cases, so total thyroidectomy was performed in those cases to rule out malignancy. Post operative complication occurred in three cases. The post operative histopathological examination of the resected specimen showed that 37% of the cases were Colloid nodular goitre and 18% of cases had features suggestive of Hashimoto’s thyroidits. One case of papillary and follicular carcinoma each. CONCLUSION: MULTINODULAR GOITRE is more common among females and in the age group of 30 to 40 years and is more common among females. The chief complaint in most of the patients is swelling in front of the neck and is associated with pain in 48% of the cases. The average post operative stay in the hospital was 5.3 days. Post operative stay in hospital has to be reduced. Thyroidectomy can be done as a day care or short stay procedure in our hospital as is the recent trend in developed countries. However, the applicability of these practices to thyroid surgery remains controversial. Day care surgery can be promoted in selected and educated patients as this will be the future of thyroid surgeries. Hyperthyroidism in multinodular goitre was present in 14% of cases. Hyperthyroidism occurs in cases of multinodular goitre in the natural evolution of the disease and the patient must be treated and brought to euthyroid state before surgery. Fine Needle Aspiration Cytology is a very useful investigation in the evaluation of Multinodular goitre except for that it cannot differentiate follicular adenoma from follicular carcinoma. Most of the cases had colloid nodular goitre in multinolar goitre. Carcinoma in not uncommon in cases of Multinodular goitre. So, suspicion should always be present. Total thyroidectomy is the preferred surgery for multinodular goitre. But subtotal thyroidectomy may also be performed in cases in whom surgery is done for cosmetic reasons as in Hashimoto’s thyroiditis. Hemithyroidectomy can be an option in Multinodular goitre if the nodules are confined to one lobe and the patient is aware of the possibility of recurrence and is willing for regular follow up. Post operative complications after thyroidectomies for multinodulargoitre are less in our institution as compared to various studies. Visualization of the recurrent laryngeal nerve during surgery is an important factor contribution to the low incidence of nerve injuries in our study group.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Multinodular Goitre ; Presenting Complaints ; Fine Needle Aspiration Cytology ; Thyroidectomy.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 24 Jun 2018 18:24
Last Modified: 24 Jun 2018 18:24
URI: http://repository-tnmgrmu.ac.in/id/eprint/8614

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