Colloid Nodules Research Articles

7046 Thyroid Storm After Thyroidectomy Without Underlying Hyperthyroidism

Abstract Disclosure: A.J. White-Cotsmire: None. B. Kodali: None. C. McHenry: None. M. Rahhal: None. Background: Thyroid storm is a feared complication of total thyroidectomy; however, this is a rare phenomenon seen primarily in patients with undiagnosed or poorly controlled thyrotoxicosis from Graves’ disease. Preoperative treatment of patients with hyperthyroidism with beta-adrenergic blockers and anti-thyroid medication to ensure that patients are euthyroid prior to thyroidectomy have largely eliminated this risk of thyroid storm. (1) We report a case of thyroid storm caused by release of preformed thyroid hormone, following extensive manipulation and resection of a large retrosternal nontoxic multinodular goiter. To our knowledge, this has not yet been previously described. Clinical Case: A 57yo female underwent a total thyroidectomy with resection of a large benign multinodular goiter with retrosternal extension, which was causing compressive symptoms. She had a nodular goiter for 7 years that was increasing in size. Fine needle aspiration 2 years prior to surgery demonstrated colloid and adenomatoid nodules with Hurthle cell changes. She had no history of hypo- or hyperthyroidism. TSH prior to surgery was 0.576µIU/ml (normal = 0.450-5.330µIU/ml). Extensive manipulation was required to deliver the goiter from beneath the manubrium. Pathology from her thyroid revealed a multinodular goiter without evidence of malignancy. Post-operative course was uncomplicated, and after an overnight stay, the patient was discharged home with 150mcg (1.5mcg/kg) levothyroxine daily. She presented to the emergency department 4 days later and was admitted to the intensive care unit with diffuse abdominal pain, nausea, vomiting, and myalgias, and she was diagnosed with atrial fibrillation with rapid ventricular response. TSH on admission was 0.020 µIU/ml, thyroglobulin levels were >2,250.0ng/mL (n=0.8 – 48.0 ng/mL), thyroglobulin antibodies were negative. Her levothyroxine was stopped, her heart rate was controlled with metoprolol, and she was started on oral anticoagulation with rivaroxaban. She was discharged after a 7-day hospital stay. At 3 weeks follow-up her TSH was 35.67µIU/ml and her thyroglobulin levels were 23.9ng/mL. Her symptoms had resolved, and levothyroxine was resumed at a lower dose of 137mcg daily. Six weeks later her TSH level was 7.785µIU/ml, and her thyroglobulin was 1.8ng/mL. Conclusion: To our knowledge, this is the first case of thyroid storm reported following thyroidectomy in a patient with nontoxic multinodular goiter in a clinically and biochemically euthyroid patient. Massive increase in thyroglobulin postoperatively and rapid resolution of symptoms suggest that the release of preformed thyroid hormone related to vigorous thyroid manipulation was likely the cause. Reference: (1) Christou N, Mathonnet M. Complications after total thyroidectomy. Journal of Visceral Surgery. 2013;150(4):249-256. doi:10.1016/j.jviscsurg.2013.04.003 Presentation: 6/1/2024

Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA)

Transoral endoscopic thyroidectomy vestibular approach (TOETVA)1 is a novel procedure with advantages like no visible scar, minimal invasive dissection and access to the whole of the thyroid gland. A 36-year-old female patient presented with a complaint of swelling of the right thyroid gland for the last 2-3 months. FNAC was suggestive of a benign lesion. Hence, a diagnosis of a right thyroid nodule was made and the patient underwent a transoral endoscopic right hemi thyroidectomy vestibular approach (TOETVA). The postoperative period was uneventful. HPE was reported as a Colloid Nodule. TOETVA is a good approach for benign thyroid nodules in patients who choose to avoid a neck scar. TOETVA provides patients with good cosmesis and is also safe.

Evaluation of thyroid nodules by high resolution ultrasonography (HRUSG) and its cytological correlation in a teaching hospital

Thyroid nodules are a frequent occurrence. With the widespread use of sensitive imaging methods, a growing number of thyroid nodules are being discovered by chance. High resolution ultrasonography (HRUSG) has emerged as the most appropriate imaging modality for the assessment of thyroid nodules.To Evaluate thyroid nodules by of high resolution ultrasonography (HRUSG) and its correlation with Fine needle aspiration cytology (FNAC). Prospective study done in the department of radiology at Maheshwara medical college and Hospital, Chitkul, near Isnapur, Patancheru, Sangareddy, Telangana for duration of 3 years. A total of 80 cases were studied.HRUSG was done in all cases and Fine Needle Aspiration cytology was done. Radiological and pathological correlation was done and Sensitivity, specificify PPV, NPV and accuracy were calculated. Females were predominant (62.5%) when compared to males (37.5%). Among 80 thyroid nodules , colloid nodule noted in 42.5% cases, Nodular goitre in 27.5%, Hashimotos thyroiditis and follicular adenoma in 12.5%cases and Malignancy in 5% cases HRUSG is a sensitive and specific imaging technique that has a high level of accuracy in the evaluation of thyroid nodules. Solid composition, hypoechogenicity, taller-than-wider form, ill-defined edges, and the presence of calcification are the most effective sonographic markers for predicting cancer.

Clinico Pathological Study of Solitary Thyroid Nodule - A Prospective Study of 50 Cases.

Background: A common Presentation of thyroid disorder is solitary nodule. A discrete swelling in an impalpable gland is termed as solitary nodule of thyroid. The majority of solitary thyroid nodule are benign. The incidence of malignancy is more common in female with mean age 35 years. Timely intervention in nodular lesion of thyroid can significantly reduce morbidity and mortality.Objectives: The objective of this study was to evaluate the clinicopathological aspects of solitary thyroid nodule.Materials and Methods: This study was conducted in the department of otolaryngology and general surgery of Shaheed Monsur Ali Medical College and Hospital in 50 patients with Solitary Thyroid Nodule from July 2016 to July 2019. All the patients those who were diagnosed solitary thyroid nodule underwent thyroid surgery after through clinical evaluation, USG and FNAC. The histopathological reports were evaluated and correlated with clinical diagnosis and discussed.Results: Out of 50 patients’ majority were female only 8 were male patients. Peak incidence observed in the age group 30 to 40 years. Most of the patients presented with a swelling in front of neck 100% followed by pain 8%, dysphagia 4% and change of voice 4%. Swelling is located in the right lobe 70% followed by left lobe 26%. On FNAC examination they were presented with colloid nodular goitre 66%, follicular neoplasm 14%, thyroiditis 8%, papillary carcinoma 4% & cystic lesions 8%. But final histopathological report showed highest 30 (60%) cases was nodular goiter then follicular adenoma 10 (20%) and 6 (12%) were malignant.Conclusion: From this study we considered that STN is present most commonly in female. Most of them are benign, but remarkable proportion 12% of solitary thyroid nodule were malignant, so careful assessment of thyroid nodule is important for early diagnosis and treatment. KYAMC Journal Volume: 14, No: 03, October 2023: 161-164.

SAT548 Incidental Papillary Thyroid Carcinoma Diagnosed After Total Thyroidectomy For Recurrent Grave's Disease

Abstract Disclosure: S.U. Perez-Martinez: None. S. Bao: None. Introduction: Whether Graves’ disease (GD) increases the risk of thyroid cancer (TC) has been a long-time topic of debate. Some studies reported increased risk of TC in GD, particularly when patients with GD have thyroid nodules. Other studies suggested the prevalence of incidental differentiated TC in GD is comparable to euthyroid goiter. Here we present a case of a 39-year-old female with a thyroid nodule and recurrent GD who underwent total thyroidectomy (TT) and was found to have a 0.4cm incidental papillary TC. Clinical case: 39 year-old female patient was diagnosed with hyperthyroidism due to GD and a 1.26x2.04x2.88cm complex right thyroid nodule at age 28, based on laboratory and thyroid ultrasound (US) studies, respectively. Fine needle aspiration showed a follicular lesion favoring colloid nodule. Patient preferred conservative measures at that time. She was treated with methimazole for 3 years and went into remission. Her thyroid nodule was monitored with serial thyroid US (every 1-2 years) for 7 years and remained stable. However, 7 years after discontinuation of methimazole, she developed recurrent hyperthyroidism, with laboratory findings of suppressed TSH of <0.04 (normal 0.35-5.5 mcu/mL), elevated free T4 of 2.4 (normal 0.8-1.8 ng/dL) and Thyroid Stimulating Immunoglobulin of 8.01 (normal < 0.054 IU/L). Patient was restarted on Methimazole 10mg daily. Her TSH remained to be low at < 0.015 (normal 0.35-3.6 mcu/mL) 4 months later, at which point more definitive treatment options including radioactive iodine ablation or TT were again discussed, and the patient opted to undergo TT, which was performed successfully 2 months later. Surgical pathology was consistent with GD, an encapsulated, fibrotic, and calcified nodule consistent with infarcted follicular lesion but also a 0.4cm incidental Papillary TC in right thyroid lobe. Surgical margin was clean, no extrathyroidal extension, one perithyroidal lymph node was negative for malignancy. Patient has been doing well afterwards. Discussion: The prevalence and clinical significance of incidental differentiated TC in patients with GD have been controversial topics. Incidence of TC in GD was mostly reported to be 7-17%, but may be as high as 42%, based on thyroidectomy studies. However, a recent retrospective multicenter study suggested the concomitant TC in GD was considerably lower. No difference in TC aggressiveness, US findings, or prognosis were observed between nodular GD and non-nodular GD groups. The clinical outcomes of TC were also excellent. A Cleveland Clinic study suggested nodule size > 1cm predicted incidental TC whereas Thyroid Stimulating Immunoglobulin titers and disease duration did not. These data argue for screening patients with GD more aggressively for TC or treating GD patients with coexisting thyroid nodule more aggressively; as in our case, even if incidental TC was found, prognosis is favorable. Presentation Date: Saturday, June 17, 2023

Post-iodination trends in thyroid pathology; 14-year experience at a single center in a goitre endemic area

Introduction: Goitre is endemic in many parts of Sri Lanka. Universal iodination of salt was commenced in Sri Lanka in 1995 as a measure to reduce the prevalence. This study was designed to identify the pattern of thyroid pathology reported during a period of 14 years from 2002 to 2015 in a Pathology Unit serving the population in a goitre endemic area in Sri Lanka.Methods: This descriptive cross-sectional study included all thyroidectomy specimens histologically assessed at our unit from 2002 to 2015. Data on age, gender, clinical presentation, type of resection, and histopathological diagnosis were retrieved from the records. The trend of change in thyroid pathology over time was analysed by comparing 2002-2010 cohort (615specimens) with the 2011-2015 cohort (995 specimens).Results: This study included 1610 thyroidectomy specimens. Features of colloid goitre were present in 71.6% (1152/1610). Prevalence of chronic autoimmune thyroiditis and thyroid cancer was 41% (660/1610) and 15.3% (246/1610) respectively. There was no significant change in the gender and the age at presentation over the years. However, an upward trend in the prevalence of both focal and diffuse chronic autoimmune thyroiditis (p<0.001), hyperplastic nodules (p=0.008), papillary microcarcinoma (p<0.001), papillary carcinoma and colloid nodular goitre (p=0.004) was evident.Conclusions: Parallel increase in the prevalence of chronic autoimmune thyroiditis and papillary carcinoma together with the upward trend in the prevalence of colloid nodular goiter was evident.

A cross-sectional analysis of the histopathologic structure of thyroid patients undergoing thyroid surgery

Major health issues in the contemporary world, thyroid illnesses are distinguished by changes in hormone output, thyroid gland hypertrophy, or both. The purpose of this study was to identify thyroid histological patterns in people who had thyroid surgery. At Kathmandu University Hospital, a retrospective study was conducted over a two-year period, from January 10, 2021, to December 30, 2022. This study includes all 300 patients who underwent thyroid surgery. gender, age, residency, the outcome of a fine needle aspiration biopsy (FNAB), and post-operative histological patterns were all taken into account. Patients who underwent FNA exclusively were ineligible.Participants' average ages ranged from 35.06 ± 15.19 years. Thyroid disorders were more frequently found in females (90%) than in males ( 10%). Nodular colloid goitre (65.1%), adenoma (5.8%), papillary thyroid neoplasms (25.4%), follicular thyroid carcinoma (6.8%), medullary thyroid carcinoma (8.5%), thyroiditis (9.3%), and anaplastic thyroid cancer (3.9%) were the histopathologic patterns. With a prevalence of 64 (23.1%), papillary thyroid cancer was the most prevalent type. The combined accuracy of the final histology and FNAB was 90.04%. However, 50% of follicular cancer preoperative diagnoses made by FNAB were insufficiently accurate. While FNAB specificity varied from 95.1% to 98.9%, FNAB sensitivity ranged from 75.8% to 90.8%. The most common thyroid condition is nodular colloid goitre, while papillary thyroid carcinoma is the most common cancer seen in this study. We suggest more research with a bigger sample size to confirm our findings.

Colloid nodular goitre treated with homoeopathic medicine Natrum muriaticum in LM potency: A case report

Colloid nodular goitre treated with homoeopathic medicine Natrum muriaticum in LM potency: A case report

Pediatric Thyroid Lesions: Synergistic Role of Clinical and Cytological Features in Diagnosis.

Thyroid lesions in childhood and adolescence are uncommon, and the risk of malignancy widely varies. They require careful evaluation and more aggressive diagnostic approach. The present study aimed to evaluate the frequency of various pediatric thyroid lesions in pediatric cases with thyroid nodules and ascertain the utility of clinical, laboratory, ultrasonography, and fine-needle aspiration cytology (FNAC) findings to discriminate between benign and malignant lesions. A retrospective study where 95 consecutive cases of pediatric patients with thyroid nodules received over six years (January 2016-December 2021) were retrieved from the hospital information system. The differences in clinical, laboratory, ultrasonography, and cytological findings between benign and malignant lesions were analysed. Statistical analysis was performed using SPSS software (version 21.0). The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was used to categorise the cases into: unsatisfactory (n=3), benign (n=66), intermediate (n=8) and suspicious/malignant (n=18). The specificity of cytopathology in diagnosing benign lesions (TBSRTC-II) was 90%, whereas sensitivity in diagnosing malignant lesions (TBSRTC-VI) was 100%. Colloid nodule (n=57) and papillary thyroid carcinoma (n=15) were the most common benign and malignant lesions encountered respectively. Malignant lesions more frequently showed the presence of palpable lymph nodes (p-value <0.001), microcalcifications (p-value 0.011) and intranodular vascularization (p-value <0.001). The diagnosis of pediatric thyroid lesions should be based on a multistep evaluation that includes clinical, laboratory, and radiographic modalities. Thyroid function tests and ultrasonography can help identify clinically unapparent thyroid nodules and provide detailed nodule characterization for suspected malignant lesions. FNAC is a simple, less-invasive, and cost-effective technique that can differentiate between benign and malignant thyroid lesions.

Some aspects of surgical strategies in patients with thyroid cancer with metastatic lesions of the neck lymph nodes

Objective — to improve the surgical treatment of patients with thyroid cancer with metastatic lesions of the neck lymph nodes by means of an individual approach to diagnostics, intraoperative imaging, and choice of optimal surgical technique.&#x0D; Materials and methods. The analysis involved results of examinations and treatment of 749 patients. The following was taken into account: complaints, thyroid and lymph nodes ultrasound, thyroid hormones level, results of general clinical examinations. Levels of parathyroid hormone, vitamin D, magnesium, total and ionic calcium were determined at the preoperative stage. In some cases, computer tomography results were included. A fine‑needle aspiration (FNA) biopsy was performed to all patients. Women prevailed: 607 from 749 (81.0%; 95% CI 78.0—83.8). The mean age of the patients was 51.3% (45.6—59.1) years. The causes of disease included: colloid nodular goiter 566 (75.6%; 95% CI 72.3—78.6), nodular (adenomatous) goiter with follicular neoplasm 72 (9.6%; 95% CI 7.6—12.0), papillary carcinoma 54 (7.2%; 95% CI 5.5—9.3), suspicious for papillary thyroid carcinoma (according to the cytology results) 17 (2.3%; 95% CI 1.3—3.6), medullary carcinoma 12 (1.6%; 95% CI 0.8—2.8), anaplastic thyroid cancer 6 (0.8%; 95% CI 0.3—1.7), other tumors 22 (2.9%; 95% CI 1.8—4.4). Statistical processing of the obtained results was carried out by using the standard program package «Statistica 6.0 for Windows» (StatSoft, USA).&#x0D; Results. Surgical interventions were performed in 89 of 749 (11.9%; 95% CI 9.7—14.4) patients with malignant tumors of the thyroid gland. The variety of surgical procedures performed on the thyroid gland: thyroidectomy performed in 81 of 89 patients (91%; 95% CI 83.1—96.0), hemithyroidectomy in 8 of 89 patients (9.0%; 95% CI 4.0—16.9). The reasons for the hemithyroidectomy: in 2 of 89 patients (2.2%; 95% CI 0.3—7.9) the diagnosis was not confirmed by express histological examination with suspicion for papillary thyroid carcinoma. In 6 other cases, single micro adenocarcinomas that ranged in size from 0.4 to 0.8 mm were found, without invasion into the tumor capsule, which was confirmed during a planned pathological examination. Lymphodisection of the central tissue, as an addition to thyroidectomy, was performed by us in 76 of 89 cases (85.4%; 95% CI 76.3—92.0). Metastatic lesions of the central tissue during pathological examination were found in 29 (32.6%; 95% CI 23.0—43.3) patients with papillary carcinoma, in 5 with medullary cancer (5.6%; 95% CI 1.8—12.6), in 6 cases with anaplastic thyroid cancer (6.7%; 95% CI 2.5—14.1). In 11 patients (12.4%; 95% CI 6.3—21.0) due to the metastatic spread to the platysma of the lateral triangle of the neck, its excision was performed. In 9 (10%; 95% CI 4.7—18.3) patients were performed thyroidectomy with sheath‑fascial excision (removal) of the neck tissue. The precession method was used to visualize the upper laryngeal nerve in order to prevent traumatization. The upper parathyroid glands served as the first anatomical landmark of the recurrent nerve, which were identified in 72 (80.9%; 95% CI 71.2—88.5) patients. Temporary unilateral vocal fold paresis was observed in 3 (3.4%; 95% CI 0.7—9.5) patients. Wound drainage was carried out separately by leaving micro‑drainage, for active aspiration, which was evacuated in 2 days.&#x0D; Соnclusions. One of the main prerequisites for the high‑quality performance surgery of thyroid gland is the precise nature of surgical manipulations with careful observance of tactical and technical requirements for a surgeon: timely identify and precisely mobilize. The choice of the final surgical intervention on lymphatic collectors in thyroid cancer is directly dependent on the preoperative and intraoperative pathological examination. However, given the substantial proportion of metastatic lesions of the central zone lymph nodes (level VI), the technical complexity of repeated operative interventions in this area, it is recommended to perform a preventive removal of the central fiber.

Clinical case of development of thromboembolism after thyroidectomy with concomitant diseases

Objective. To study a clinical case after a planned thyroidectomy. Venous thromboembolism in the form of deep vein thrombosis or LE is the third most common in the world, being the second only to myocardial infarction and stroke. In epidemiological studies, the annual incidence of pulmonary embolism ranges from 39 to 115 persons per 100 000 of the population; for deep vein thrombosis, the incidence rates range from 53 to 162 per 100 000 of the population. The cross-sectional analysis data show that the frequency of venous thromboembolism is almost 8 times higher in persons over 80 years of age than in the fifth decade of life. Pulmonary embolism is a stop of blood flow in the branch of the pulmonary artery due to obstruction by a clot. The most frequent places of blood clots are the deep veins of the lower extremities. Risk factors for thromboembolism may be surgical operations, varicose veins, age, overweight. This is one of the most common and severe complications of the postoperative period. Our article considers a clinical example of the development of thromboembolism after thyroidectomy, presents the results of pathomorphological studies, autopsy, histological studies.&#x0D; Materials and methods. The work consisted in the study of a clinical case of pulmonary embolism after a planned surgical intervention for nodular goiter. Histological sections of organs such as the heart, kidneys, gallbladder, thyroid gland, liver were studied.&#x0D; Results. The results of our study showed that thyroidectomy refers to operations of a high complexity and high risk of multiple complications as well as the occurrence of a fatal outcome. Therefore, a thorough examination of all organs and systems in patients is necessary, especially those who belong to the elderly and severe comorbid pathology groups. This is due to the fact that the risk of death without a proper preparation for surgery with available concomitant diseases (nodular colloidal goiter, empyema of the gallbladder, Gilbert's disease, persistent hepatitis, type 2 diabetes mellitus, hypertension, chronic coronary heart disease) was very high for this patient.&#x0D; Conclusions. Diffuse nodular toxic goiter is a complex surgical pathology involving many organs and systems. Patients with such a diagnosis require a thorough history collection, carrying out clinical, instrumental and laboratory research methods, including successful surgical intervention.

RETROSPECTIVE STUDY OF ULTRASONOGRAPHIC AND FNAC CORRELATION OF THYROID LESIONS WITH HISTOPATHOLOGY

INTRODUCTION: Thyroid diseases, a common clinical problem have prevalence rate of 4–7% in the general population. Fine-needle aspiration cytology (FNAC) is a minimally invasive, accurate diagnostic tool which can differentiate neoplastic from non-neoplastic lesions and reduces the number of unnecessary thyroidectomies, but has limitations . Our study was a retrospective an METHODOLOGY: alysis of 124 cases of thyroid lesions over a period of 3 years from April2019 to April 2022. The FNAC ndings were reviewed and data was compared with the histopathological, imaging ndings and data was analysed. Majority of the pat RESULTS: ients were females in the age group of 41–60 years with a mean age of 42 years and most were non-neoplastic lesions. 76 cases were diagnosed as colloid nodular goitre and benign cystic lesions by FNAC. 44 cases were diagnosed as neoplastic lesions (follicular neoplasm, papillary carcinoma, and suspected malignancy) by FNAC. 18 of these cases were non neoplastic lesions, 24 were papillary carcinoma, 2 were follicular carcinoma on histopathological examination . Statistical analysis of neoplastic lesions showed sensitivity, specicity, accuracy, false positive rate, false negative rate, positive predictive value, and negative predictive value of FNAC to be 69.09%, 90.7%, 80.8%, 9.2%, 30.9%, 86.3% and 77.6% respectively. Ultrasound was foun CONCLUSION: d to be more reliable than palpation, but denitive diagnosis can be reached only with FNAC/Biopsy. Bethesda system of reporting thyroid cytology should be meticulously followed to minimize errors and a repeat FNAC asked for discordant cases after a multidisciplinary team conference.

A Rare Case of Double Pyramidal Lobe of the Thyroid Gland.

The pyramidal lobe is an anatomical component of the thyroid gland seen in up to 65% of individuals. It represents the distal, nondegenerate part of the thyroglossal duct. The double pyramidal lobe is a very rare occurrence, and this is the first reported case in Sri Lanka. A 40-year-old woman presented a long-standing goiter. Her evaluation revealed a benign multinodular goiter with a dominant right colloid nodule and background thyroiditis. She was euthyroid and had no compressive symptoms. Considering cosmesis, the patient opted for total thyroidectomy during which two pyramidal lobes were identified. The rest of the thyroid gland and the parathyroids had no anomalies. After an uneventful postoperative stay, she was discharged later. This is a very rare case where the patient had two separate pyramidal lobes; a phenomenon documented in less than 10 cases around the world. In addition to embryology, the pyramidal lobe has significance in clinical practice. It can be associated with benign and malignant disease of the thyroid; focal and diffuse. Incomplete removal may result in recurrence of the disease in the remaining thyroid tissue of the pyramidal lobe. Therefore, active inspection of the lobe including its anatomy during thyroid surgery and complete excision when indicated is of paramount importance.

Pediatric Thyroidectomy: Experience From a Portuguese Hospital.

Background and objective Pediatric thyroid disease requiring surgery is rare. Thyroid nodules are a frequent indication for surgery and are mostly benign. However, up to 25% of cases can be malignant. In this study, we aimed to describe our center's experience with regard to pediatric thyroid surgery. Methods This was a retrospective transverse study involving pediatric patients who underwent thyroid surgery at a tertiary hospital between January 2010 and December 2021. Results A total of 14 patients underwent 15 surgeries. The main reason for referral to pediatric endocrinology was thyroid nodules (n=10). Thirteen fine needle aspirations (FNAs) were performed, with follicular tumor (n=6) being the most common finding. The median age of patients at surgery was 15.9 years [interquartile range(IQR): 14.0-16.8]. The most common surgical indications were the presence of a follicular tumor on FNA (n=5) and thyroid nodule size causing symptoms (n=5). There was one case of prophylactic thyroidectomy due to the identification of a multiple endocrine neoplasia type 2A (MEN2A) mutation. The most frequently described histopathology results were follicular adenoma (n=6) and colloid nodular goiter (n=6). Three postoperative complications were observed in three different patients: bilateral lesion of the recurrent laryngeal nerve, cervical hematoma, and transient hypoparathyroidism with hypocalcemia. Conclusion In our study, the most frequent surgical indication was a follicular tumor. A good correlation was found between FNA cytology and final histopathology results, which is in accordance with previous studies. This reinforces the importance of FNA in diagnosis and surgical planning. The rate of complications in our study is comparable to that in larger single-center series in the literature.

Cytological spectrum of diseases in goiter in Kadapa, a semiurban city in southern part of India – A 2-year retrospective study

Background: Thyroid gland produces thyroid hormone, thyroxine. Goiter is an indefinite term applied to the enlargement of thyroid gland. The normal thyroid gland in non-goitrous state weighs 25–35 g. Thyroid gland disorders are common endocrine disorders in the world. Aims and Objectives: This is a retrospective study done to know the age and gender distribution of goiter and various pathological conditions in goiter. This study showed that the incidence is common in 3rd–5th decade of life and nodular and colloid goiter are the common causes of goiter followed by follicular adenoma and papillary carcinoma. Materials and Methods: The data were collected from cytology registers of Pathology Department of FIMS Hospital, Image Diagnostics and Seetha Diagnostics, Kadapa, during the 2-year period from January 2021 to December 2022. The data collected as above were systematically analyzed and reviewed for age and sex distribution, clinical presentation, and cytological diagnosis. Results: Majority of the patients were female accounting for 324 cases (94.18%) and 20 patients (5.81%) were male. The maximum incidence is in young females between 31 and 40 years age group (24.70%) followed by 41–50 years age group (23.83%) and then in 21–30 years age group (22.38%). All together, the overall maximum incidence is seen in females between 21 and 50 years age group (70.91%). The most common pathological disease is nodular goiter followed by colloid nodule, both being iodine deficiency goiters. Conclusion: The study showed the thyroid disorders are more common in females. The non-neoplastic lesions constitute the predominant cause for goiter followed by benign neoplasms and then malignant neoplasms.

Histopathologic Patterns and Cytohistologic Correlation of Thyroid Lesions among Patients with Thyroid Biopsies in Jimma Medical Centre, South West Ethiopia: A Retrospective Study

Introduction Thyroid diseases are major health problems that are manifested by alteration in hormone secretion, enlargement of the thyroid gland (goitre), or both. Identifying and characterizing lesions of the thyroid gland has a pivotal role since most of the lesions require medical or surgical management. Fine needle aspiration cytology (FNAC) is an important initial screening tool and histopathologic examination is the gold standard in the definitive diagnosis of thyroid disease. Objectives To assess histopathologic patterns and cytohistologic correlation of thyroid lesions among patients with thyroid biopsy. Methods A five-year retrospective study was conducted with a review of 581 biopsies submitted from thyroidectomy specimens at Jimma University Medical Centre (JUMC), Pathology Department from September 2015 to September 2020. This also includes a review of 286 cases in which fine needle aspiration was done prior to surgery. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 26. Descriptive and analytic studies were done. Cross tabulation, chi square (χ2 ) test and logistic regression with multivariate analysis were done to look for associations between the study variables. Results Majority of thyroid lesions were found to be non-neoplastic and 149 (25.6%) were neoplastic. Colloid goitre was found in 417 (71.8%) cases. Adenoma, carcinoma, and thyroiditis accounted for 54 (9.3%), 95 (16.3%) and 12 (2.1%) cases respectively. Among 286 FNAC results, cyto-histologic correlation was achieved in 233 (86.6%) cases. Sensitivity and specificity of FNAC were 71% and 92.7% respectively, with diagnostic accuracy of 86.6%. Conclusion Nodular colloid goitre is by far the most common thyroid lesion and papillary thyroid carcinoma (PTC) is the most frequent histologic type of malignancy. FNAC remains a sensitive, specific and accurate tool in the evaluation and management of thyroid lesions.

ODP470 Compressive Goiter with COVID-19: An Unusual Etiology of Respiratory Distress Requiring Endotracheal Intubation with Surgical Resection

Abstract Introduction Gradual enlargement of multinodular goiter (MNG) may compress surrounding structures which may progressively cause complications of tracheal stenosis and airway compromise. Surgical resection remains the gold standard treatment in MNG patients presenting with respiratory distress. In the current global COVID -19 pandemic, compressive goiter should be a differential diagnosis in patients with stable benign thyroid goiter presenting with dyspnea. We present a case of MNG with life threatening airway obstruction during an active COVID-19 infection. Case presentation A 74-year-old female with a history of hyperthyroidism with multi-nodular goiter and recurrent atrial fibrillation status-post ablation, was transferred to the intensive care unit for treatment after being intubated for respiratory distress at a nearby hospital. She was diagnosed with hyperthyroidism about 40 years ago and managed with methimazole. Over the last two years, thyroid ultrasound and prior imaging showed MNG with patent but moderate tracheal narrowing; fine-needle aspiration (FNA) confirmed benign colloid nodules with cystic degeneration. She was pending cardiac clearance for surgery when symptoms acutely worsened two days before admission. On initial assessment, she was hemodynamically stable, afebrile, with oxygen saturation of 86% on room air. She was alert and able to follow commands. On physical examination, she had stridor and thyromegaly was evident with mild tenderness on palpation. Cardiopulmonary examination was remarkable for coarse breath sounds. Labs showed TSH 4.82 (Normal 0.3 - 4.5 ulU/mL), FT4 0.64 (Normal 0.5- 1.26 ng/dL). Respiratory panel test came back positive for SARS-CoV-2. Racemic epinephrine and albuterol nebulizers were administered to help with her symptoms. CT scan of the neck revealed a severe narrowing and mild rightward shift of the trachea by a large multinodular goiter, prompting the decision to intubate for airway protection. CT scan of the chest with contrast demonstrated the large MNG with tracheal stenosis. Her methimazole dose was adjusted. After cardiac clearance, she underwent thyroidectomy through a transcervical approach. Levothyroxine and calcium supplementation were started post-surgery. She was extubated two days after her thyroidectomy. Pathology results showed no evidence of malignancy. Discussion Acute airway obstruction by large MNG requiring emergent airway protection is rare. Typically airway compromise from large otherwise stable benign goiters results from sudden hemorrhage into a cyst, upper respiratory tract infection leading to tracheal edema, or worseningcomorbid conditions. During the COVID-19 pandemic, acute respiratory failure and shortness of breath is typical of worsening disease course. This case highlights the importance of maintaining wider differentials of respiratory failure even and we need to consider worsening of tracheal narrowing with a large goiter due to tracheal edema from SARS- CoV-2 Infection. Thyroidectomy before SARS-CoV-2 infection may have reduced her need for emergent intubation for acute respiratory failure by improving pre existing airway compression. Presentation: No date and time listed

ESTIMATION OF CYTOMORPHOLOGICAL SPECTRUM OF THYROID LESIONS BY FINE-NEEDLE ASPIRATION CYTOLOGY BASED ON BETHESDA SYSTEM FOR REPORTING IN TERTIARY CARE HOSPITAL

Objectives: The objectives of this study were as follows: (1) To estimate thecytomorphological spectrum of thyroid lesions. (2) To categorize the thyroid lesions based on Bethesda system reporting. (3) To correlate the spectrum of thyroid lesions with demographic parameters. Methods: A retrospective record-based study was conducted at the Department of Pathology in Tertiary Care Institute, from January 2017 to January 2021. A total of 346 case files were retrieved consisting of all the patients having thyroid lesions who underwent the procedure of fine-needle aspiration cytology. Statistical analysis was done using the software Statistical Package for the Social Sciences (SPSS) 22.0 version. Continuous variables were presented by mean±SD and categorical variables by frequency or percentages. Results: Majority of the case are falling between the age group of 26–35 years, followed by 36–45 years of age. The majority of cases in the study population were presented with Bethesda Category II lesion (88.7%) which was found to be statistically significant (p&lt;0.05), the most common spectrum was seen, which was Colloid nodule in 40.46% of cases categorized to Bethesda Class II. This was found to be statistically significant (p&lt;0.05), followed by adenomatoid nodule in 30.92% of cases also Category II. Conclusion: Fine-needle aspiration cytology is a cost effective procedure that provides specific diagnosis rapidly with minimum complications.

The Accuracy of the Cytological Examination of Fine Needle Aspiration in Papillary Thyroid Carcinoma at General Hospital H. Adam Malik (HAM), Medan

Background: Thyroid nodules are disorders of the thyroid gland, consisting of colloid nodules, cysts, and thyroiditis found in 80% of cases, while benign follicular neoplasms and thyroid carcinomas occur in 10%-15% and 5% of cases. The most common thyroid carcinoma is Papillary Thyroid Carcinoma (PTC), with an incidence rate of about 80% of all thyroid carcinomas. Distinguishing preoperative benign lesions is very important to prevent unnecessary surgery, therefore Fine Needle Aspiration Biopsy (FNAB) is needed, and easy to perform, this examination is the first line in evaluating preoperative thyroid lesions. Objective: Assess the accuracy of FNAB examination compared to histopathological examination in diagnosing PTC. Methods: This study is a diagnostic test. The population of this consisted of secondary data, patients with thyroid nodules diagnosed with PTC and non-PTC who underwent FNAB examination compared with Histopathological at the Anatomical Pathology Unit of General Hospital HAM, Medan. Results: Based on age group, from 62 samples, there were 56.5% PTC aged 41-60 years, (21.0%) 21-40 years, (19.4) and (3.2%) <21 years. There are 80.6% of the samples are female. PTC has a sensitivity value of 28.57%, specificity of 100%, false positive of 100%, false negative of 73.21%, and accuracy of 85.48%. Conclusion: This study can be used as a diagnostic tool for early diagnosis and a fairly accurate monitoring tool, however, a cytological diagnosis is not a substitute for a histopathological diagnosis which is still a definite diagnosis. Malignancy of PTC on cytological examination must be followed by Histopathological as the gold standard. Background: Thyroid nodules are disorders of the thyroid gland, consisting of colloid nodules, cysts, and thyroiditis found in 80% of cases, while benign follicular neoplasms and thyroid carcinomas occur in 10%-15% and 5% of cases. The most common thyroid carcinoma is Papillary Thyroid Carcinoma (PTC), with an incidence rate of about 80% of all thyroid carcinomas. Distinguishing preoperative benign lesions is very important to prevent unnecessary surgery, therefore Fine Needle Aspiration Biopsy (FNAB) is needed, and easy to perform, this examination is the first line in evaluating preoperative thyroid lesions. Objective: Assess the accuracy of FNAB examination compared to histopathological examination in diagnosing PTC. Methods: This study is a diagnostic test. The population of this consisted of secondary data, patients with thyroid nodules diagnosed with PTC and non-PTC who underwent FNAB examination compared with Histopathological at the Anatomical Pathology Unit of General Hospital HAM, Medan. Results: Based on age group, from 62 samples, there were 56.5% PTC aged 41-60 years, (21.0%) 21-40 years, (19.4) and (3.2%) <21 years. There are 80.6% of the samples are female. PTC has a sensitivity value of 28.57%, specificity of 100%, false positive of 100%, false negative of 73.21%, and accuracy of 85.48%. Conclusion: This study can be used as a diagnostic tool for early diagnosis and a fairly accurate monitoring tool, however, a cytological diagnosis is not a substitute for a histopathological diagnosis which is still a definite diagnosis. Malignancy of PTC on cytological examination must be followed by Histopathological as the gold standard.

Distinguishing Intrathyroid Parathyroid Adenoma from Colloid Nodules and Papillary Thyroid Carcinomas Using Multiphasic Multidetector Computed Tomography.

The aim of the study is to determine whether multiphase multidetector computed tomography (4D-MDCT) can differentiate between intrathyroid parathyroid adenomas (ITPAs), colloid nodules, and papillary thyroid carcinoma (PTC). We studied 22 ITPAs, 22 colloid nodules, and 11 PTCs in 55 patients. Hounsfield unit (HU) values of the nodules were measured on 4D-MDCT in the precontrast, arterial, venous, and delayed phases. Raw HU values, phase with peak enhancement, and washout percentages between the phases were evaluated. Regardless of size, all ITPAs (22/22) showed peak enhancement in the arterial phase, which was significantly greater than both colloid nodules (15/22) and PTC (6/11, P = 0.002); thus, nodules with peak enhancement in the venous or delayed phase were not ITPAs (specificity = 1). For nodules with peak enhancement in the arterial phase, the percentage washout in the arterial-to-venous phases separated ITPAs from PTC and colloid nodules (P < 0.001) with greater than or equal to 23.95% loss of HU value implying IPTA (area under curve, 0.79). This left a subset of colloid nodules or PTC that either peaked in the venous or delayed phase or had an arterial-to-venous phase washout of less than 23.95%. From this subset, PTC measuring 1 cm or greater could be separated from colloid based on HU values in the arterial phase with a cutoff HU value less than 81.4 for PTC (area under curve, 0.72) and an HU value greater than 164.5 suggested colloid. Intrathyroid parathyroid adenomas can be distinguished from colloid nodules and PTC by peak enhancement in the arterial phase and rapid washout. A subset of colloid and PTC measuring 1 cm or greater can be separated using arterial phase HU values.