Nodular Enlargement Of Thyroid Research Articles

Comparative effects of suture and non-suture surgical techniques on platysma after Thyroid surgery

Background: Thyroidectomy is a routine general surgical procedure and pain after thyroidectomy is responsible for prolongation of hospital stay and increased risk of respiratory complications. Platysma is routinely sutured at the end of thyroidectomy before wound closure. This randomized controlled trial was conducted to compare the outcome of suturing platysma muscle versus not suturing in thyroid surgery patients. Aim: To compare the outcome of suturing platysma muscle versus not suturing in thyroid surgery patients. Place and duration of study: Dept. of Surgery at Sh. Zayed Hospital, Lahore from 26-12-2019 to 25-06-2020. Methodology: It is a randomized controlled trial study which consists of 92 patients, between 18 to 70 years of age in both gender and planned for thyroidectomy for nodular thyroid enlargement. Patients were randomly allocated into two treatment groups. After excision of thyroid, platysma was sutured as per conventional practice in one group while in the other group platysma was not sutured. For pain assessment Visual Analogue Scale (VAS) was used to 24 hours after surgery. Results: The mean age was 36.4±13.4 years. The mean VAS score for post-operative pain measured 24 hours after the surgery was significantly lower in patients undergoing thyroidectomy without platysmal suture as compared to those with conventional suturing of platysma during thyroidectomy (2.37±0.97 vs. 3.67±1.28; p <0.001). Similar significant difference was also noted between groups and subgroups which based on patient’s age, gender, BMI and educational status. Conclusion: Avoiding the suturing of platysma significantly reduced the post-operative pain which advocates a change in current practice and encourages non-suturing of platysma to decrease the morbidity of patients in post-operative period. Keywords: Thyroidectomy, Platysma, Suture, No Suture, Pain

A study on evaluation of solitary nodular thyroid lesions by FNAC and its histopathological correlation

Background: Solitary nodular enlargement of thyroid is one of the common indications for surgical excision. Since most of the nodules are benign, symptomless, normal thyroid hormone profile, they do not require excision. This study was done to evaluate the utility of FNAC as a rapid diagnostic method in various thyroid lesions and guide the clinician for further treatment.
 Objective: This main objective of the study to evaluate the cyto-histopathological findings, and the accuracy of fine needle aspiration cytology (FNAC) procedure in solitary nodular thyroid lesions.
 Materials and Methods: This prospective study comprises total 160 cases with thyroid lesions referred to cytopathology laboratory and gland morphology studied by ultrasonography (USG). Based on ultrasonography report Fine Needle Aspiration were done manually or guided and aspirated material fixed on fixative and stained to examine.
 Results: Age incidence varied from 10-80 yrs. The commonest age group affected was 21-40 yrs. The ratio of male to female was 1:2.2. The duration of symptoms ranged from 10 days to 15 years. Maximum number of cases presented with midline swelling of the neck. On cytology 52 (32.5%) cases were diagnosed as colloid goiter, 46 (28.75%) as colloid goiter with cystic change, 16(10%) as thyroiditis - among them 6(3.75%) as granulomatous thyroiditis, 8(5%) as lymphocytic thyroiditis, 2(1.25%) as dequervain thyroiditis, 10 (6.25%) as follicular neoplasm, 2(1.25%) as hurthle cell adenoma, 5(3.3%) as papillary carcinoma, 2 (1.25%) as medullary carcinoma, 1(0.33%) anaplastic carcinoma and 1(0.33%) NHL as suspicious smear. Histopathological examination was possible in 60 cases. The overall sensitivity was 90.2%, specificity was 98.2% and accuracy was 97.1%.
 Conclusion: FNAC is a rapid, efficient, cost-effective, relatively painless procedure and produces a early result with a high diagnostic accuracy. It has high rates of sensitivity and specificity to diagnose the solitary thyroid lesions and thereby it is an important diagnostic tool and further management of patients with thyroid lesions.
 Bangladesh Journal of Medical Science Vol.18(4) 2019 p.789-795

THYROID DISORDERS

Objective: to study the spectrum of various thyroid disorders presentingin peripheral teaching hospitals of Gujranwala region. Study Design: Descriptive, Crosssectional, Interventional. Setting: Department of Surgery Islam Teaching Hospital Sialkot &Surgical Department of Aziz Bhatti Shaheed (Teaching) Hospital. Nawaz Sharif medical College,University of the Gujrat. Study Period: February 2011 to June 2016. Results: A total of 236patients of all age groups with thyroid gland disorders were enrolled in this study. Majority ofpatients were of middle age group with mean age of 43+ years. Male to female ratio was 1:4.Nodular thyroid enlargement was the commonest presentation. Solitary thyroid nodule was thecommonest variant of nodular goitre seen in 48.52% cases. Thyroid carcinoma was found in36.45% cases among the nodular goitres. Conclusion: Thyroid disorders are common in hillyareas of Pakistan, more common in female population. High prevalence thyroid malignancy inpopulation of the Gujranwala Division of Central Punjab is an alarming and worrisome finding inour study. Larger multicenter studies are suggested in this particular region to know the exactincidence, predisposing factors/ carcinogens etc if any responsible for thyroid malignancies inthis region.

Hashimoto′s thyroiditis - A Malaysian perspective

This study was undertaken to analyze the fine needle aspiration (FNA) cytologic, functional and immunologic features in Hashimoto's thyroiditis (HT) with special reference to ethnicity in Malaysian patients. 88 cases of HT retrieved from the archives of the cytology laboratory were reviewed. Ethnic, clinical, cytologic, biochemical, and immunologic features were correlated. HT <http://correlated.HT> was more common in Indian patients (57%). 33% of HT cases presented with nodular thyroid enlargement (47.5% were Chinese). 57.5% were euthyroid and 35% hypothyroid. Thyroglobulin antibody (TG Ab) and thyroid peroxidase antibody (TPO Ab) (tested in 29/88 cases) were elevated in 83% and 93% cases respectively. Review of cytologic smears showed Hurthle cells in 56% cases, high lymphoid to epithelial ratio in 38%, lymphoid follicles in 67%, follicular cell infiltration by lymphoid cells in 69% and lymphohistiocytic clusters in 40%. Giant cells and/or granulomas were present in 45% and plasma cells and/or immunoblasts in 40% of cases. 17% showed neutrophils and/or eosinophils infiltrating follicular epithelial cells. Follow up FNA of eight cases showed appearance of a diagnostic cytologic pattern in all and changes in clinical presentation in four. Hashimoto's thyroiditis was more common among Indian women with nodular presentation seen more often in Chinese. Hurthle cell change, lymphoid follicles and follicular cell infiltration by lymphoid cells, considered histologic hallmarks of HT, were seen less frequently. 17% cases showed infiltration of follicular cells by neutrophils and eosinophils, a hitherto undescribed feature in HT. Follow up cytology was helpful in monitoring progression of disease and arriving at a definitive diagnosis.

Pattern of thyroid lesions and role of fine needle aspiration cytology (FNA) in the management of thyroid enlargement: a retrospective study from a teaching hospital in Riyadh.

The study aims to determine the cytological pattern of thyroid lesions, in addition to the utility and accuracy of fine needle aspiration (FNA) cytology as an initial diagnostic method in the investigation of these lesions among Saudi patients. Four hundred and seventy-nine (479) FNAs were performed on patients presenting with diffuse or nodular thyroid enlargement to the endocrinology clinic at King Khalid University Hospital in Riyadh during the period September 1993 to September 1996. The results of the FNA and the 125 histological diagnoses obtained from the subsequent partial and subtotal thyroidectomies were retrospectively and independently reviewed and compared by two cytopathologists. The results of the FNA cytological diagnosis showed that 372 patients (77.7%) had benign lesions, 24 (5%)) had lesions which were suspected of malignancy, 25 (5.2%) had malignant neoplasms, and 58 (12.1%) had FNAs which were inadequate for cytological assessment. Colloid and adenomatous nodules were the most common benign lesions reported (47.8%). Papillary carcinoma was the most common malignant neoplasm (4.2%). Despite the relatively limited number of patients who underwent surgery, cytohistopathology combined with statistical analysis of the results showed that our FNA accuracy rate is in the region of 94.4% with a sensitivity of 78% and a specificity of 100%. In addition, the negative predictive value (NPV) and the positive predictive value (PPV) of FNA thyroid cytology were 93% and 100% respectively. Our findings indicate that FNA cytology can be used effectively in the evaluation of both nodular and diffuse thyroid lesions whilst cytopathologist should be aware of the potential diagnostic pitfalls and the limitations of the procedure in the diagnosis of follicular, cystic, and small neoplasms, the positive identification of thyroiditis and most cases of neoplasia by itself provides justification for FNA.