Comparative study of fine needle aspiration cytology and histopathology of thyroid swellings in tertiary health centre

<p><strong>Background: </strong>Thyroid swelling being the most common presentation in ENT clinical practice, a prospective study was done to assess the role of Fine needle aspiration cytology in diagnosing the nature of thyroid swellings and comparing its results with histopathological examination findings.<strong></strong></p><p><strong>Methods: </strong>This is a prospective institutional based study comparing cytology and corresponding histopathology findings reported in 60 cases of thyroid swelling. The statistical analysis included sensitivity, specificity, positive predictive value, negative predictive value and accuracy in thyroid swelling.<strong></strong></p><p><strong>Results: </strong>Out of 60 cases, FNAC showed 93.3% and 6.6% of benign and malignant cases respectively whereas HPE showed 86.7% and 13.3% of benign and malignant cases respectively. On FNAC-HPE correlation using HPE as standard reference the diagnostic accuracy of present study is 91.66%.<strong></strong></p><p><strong>Conclusions: </strong>It was observed that FNAC is a reliable tool, safe and accurate method in evaluating thyroid swelling thus having great influences in treatment decision. Thus FNAC is the investigation of choice in thyroid swellings with excellent patient compliance, simple, safe and cost effective.<strong></strong></p>

COVID-19 vaccine-associated subacute thyroiditis: an unusual suspect for de Quervain’s thyroiditis

Subacute thyroiditis following vaccination is an uncommon presentation of thyrotoxicosis. As the world undertakes its largest immunisation campaign to date in an attempt to protect the population from COVID-19 infections, an increasing number of rare post vaccine side effects are being observed. We report a case of a middle-aged woman who presented with painful thyroid swelling following the second dose of the COVID-19 mRNA vaccine BNT162b2 (Pfizer–BioNTech) with clinical, biochemical and imaging features consistent with destructive thyrotoxicosis. Symptomatic management only was required for the self-limiting episode. Thyroiditis typically has a mild and self-limiting course and thus this observation should not deter people from vaccination, as COVID-19 infection has a far greater morbidity and mortality risk than thyroiditis.

The Bethesda System for Reporting Thyroid Cytopathology: Validating at Tribhuvan University Teaching Hospital

Introduction Fine needle aspiration cytopathology (FNAC) is widely used for the stratification of thyroid nodules. Objective The objective of the present study is to validate FNAC reporting based on The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) at our institution and to calculate the risk of malignancy in each category. Methods This was a descriptive cross-sectional study conducted jointly at the Department of Ear, Nose and Throat and at the Department of Pathology for a period of 1.5 years (May 2018 to November 2018). All cases presenting with thyroid swelling in the outpatient department were investigated with ultrasonography (USG) of the neck, thyroid function test, and FNAC. All FNAC reporting was done according to TBSRTC. Results A total of 134 thyroidectomies were performed during the study period. The female to male ratio was 5.3:1. The age ranged from 11 to 74 years old. with a mean age of 51 years old. The FNAC has a specificity of 84.9%, a sensitivity of 89.4%, a positive predictive value of 86.4%, a negative predictive value of 88.2%, and an accuracy of 87.3% in detecting thyroid cancer. The implied risk of malignancy (ROM) in Bethesda II, III, IV, V and VI is 11.7%, 25%,40%,76.6% & 96%, respectively. Conclusion The four studied categories had a ROM comparable to other studies, except for the Bethesda III category. Further studies with larger sample sizes and with the use of USG guidance for the aspiration from the thyroid swelling may give better results by reducing the number of false negative and false positive cases.

Clinical study of prevalence of malignancy in nodular thyroid swelling

Background: Large proportion of thyroid cancers arose from a pre-existing adenoma or from multinodular goiters. Surgical practice of removing thyroid nodule or multiple nodules of thyroid gland has been challenged for surgeons to prevent cancer. Aim of this study is to find out the prevalence of malignancy in solitary thyroid nodule and multi-nodular goitre in relation to age and sex. The aim of the study was to determine the incidence of malignancy in patients who underwent thyroidectomies.Methods: Study of 100 cases of nodular thyroid swelling has been done during the period from November 2017 to November 2019 on inpatients admitted to GEMS Hospital, Srikakulam, and Andhra Pradesh, India. Detail clinical examination, relevant investigations, surgical management and histopathological reports were collected and analyzed using software package for statistical analysis (SPSS 20).Results: Out of 100 patients with thyroid swellings, thyroid malignancies constitute 4%. The occurrence of thyroid cancer was maximum in the 4th decade of life. Female patients outnumbered males with a ratio of 4:0. Relative frequency of malignancy in solitary thyroid nodule was 4.76% and in multi-nodular goitre was 3.03%. Most common histopathological type was papillary carcinoma thyroid (50%); followed by follicular carcinoma thyroid (25%) and medullary carcinoma (25%).Conclusions: The prevalence of thyroid malignancy in the present study is at an earlier age group due to early diagnosis and treatment. The prevalence of thyroid cancer is higher in female when compared to those reported in the literature. The proportion of medullary cancer is more in present study.

Complications of Advanced Stage of Various Types of Thyroid Tumors at Tertiary Care Hospital

Objective: To determine the complications associated various types of tumors of advanced stage of thyroid disease at tertiary care hospital. Study Design: Descriptive study. Place and Duration: Two years study from April 2018 to March 2020 was conducted in Liaquat University of Medical and health sciences Jamshoro. Patients and Methods: All patients were admitted from Outpatient department (OPD) with advance stage of tumor of thyroid and either of gender were included. The patients were evaluated fully after history and clinical examinations berries sign and specific investigations of thyroid profile (T3,T4,TSH), ultrasound of thyroid, fine-needle aspiration cytology FNAC, image guided biopsy, frozen section biopsy for confirmation of diagnosis, indirect laryngoscopy, x - Ray neck and MRI. All the patients were assessed for pre-operative evaluation (complications) with advanced stage of thyroid tumors. All the data regarding developed complications was recorded via study proforma. Data was analyzed by using the SPSS version 20. Results: Most of the patients were found with age groups of 20 to 34 years and 35 to 55 years. Out of all, 25 patients were diagnosed papillary carcinoma, 12 patients were diagnosed as follicular carcinoma, 7 patients had Anaplastic carcinoma, 4 patients were diagnosed lymphoma and 2 patients were diagnosed as medullary carcinoma. As per complications of advanced disease 23 patients had thyroid swelling with cervical lymphadenopathy and pain, 13 patients had thyroid swelling with change of voice, 7 patients had thyroid swelling with dyspnea and dysphagia, 5 patients were presented with thyroid swelling with bony pain, weight loss and pathological fractures, 2 patients were presented with thyroid swelling with diarrhea. Conclusion: Various complications such as swelling, pain, hemorrhage, cervical lymphadenopathy, change in voice, weight loos, pathological fracture, dyspnea and dysphagia were frequently seen in patients presented with advanced stage of thyroid disease.

Correlation of Fine Needle Aspiration Cytology with Histopathological Findings in the Diagnosis of Thyroid Swellings – A One Year Study in a Tertiary Care Hospital, Hyderabad

BACKGROUND Most of the thyroid swellings are non-neoplastic and with normal thyroid hormone. So, it doesn't require any surgical excision, even though the thyroid swelling is an indication for surgical excision. The present study was done to evaluate the accuracy of fine needle aspiration cytology (FNAC) for the thyroid swellings and correlate it with the histopathological findings. METHODS This is a prospective study. A total of 47 cases were studied. Fine needle aspiration cytology was done, slides were made and studied. Histopathological examination of the corresponding 47 cases was also done and correlated with FNAC findings. Sensitivity, specificity and accuracy were calculated. RESULTS Age of the patients varied from 20 - 69 yrs. Most of them were in the age group of 30 - 39 years and 50 - 59 years. The ratio of male to female was 1:4.9. Swelling of the neck was the most common presentation in most of the patients. On FNAC 33 (70.2 %) cases were diagnosed as colloid nodular goitre, 04 (8.5 %) as autoimmune thyroiditis, 08 (17.0 %) as follicular neoplasm, 01 (2.1 %) as suspicious of malignancy, 01 (2.1 %) as papillary carcinoma. On histopathological examination 25 (53.2 %) cases were diagnosed as colloid nodular goitre, 01 (2.1 %) as fibrous thyroiditis, 01 (2.1 %) as Graves’ disease, 07 (14.9 %) as Hashimoto’s’ thyroiditis, 06 (12.8 %) as follicular adenoma, 01 (2.1 %) as follicular carcinoma, 04 (8.5 %) as papillary carcinoma and 02 (4.2 %) as NIFTP (noninvasive follicular thyroid neoplasm with papillary like nuclear features). The overall sensitivity was 69.2 %, specificity was 97.0 % and accuracy was 89.3 %. CONCLUSIONS FNAC is a minimally invasive, highly accurate and cost-effective procedure. FNAC helps the clinician to diagnose malignant lesions with confidence. It has high rates of specificity and accuracy but comparatively has less sensitivity. However, it is very important for the management of patients with thyroid swelling. KEYWORDS Fine Needle Aspiration, Prospective Study, Sensitivity, Specificity, Thyroid Swelling

Incidence of Thyroid Cancer in Thyroid Swelling, Study of 200 Cases

Objective: The incidence of thyroid cancer has rapidly increased in the United States (US) and other developed countries over the past 30 years but there is no study to find out the true incidence of thyroid cancer in Bangladesh. The aim of this study is to compare FNAC with histopathology reports and to find out the true incidence of thyroid malignancy in thyroidectomy patients presenting with thyroid swelling. Methods: This is a prospective study of 200 thyroid swelling patients underwent thyroid surgery done at Shaheed Suhrawardy Medical College Hospital, a tertiary Care Hospital in Dhaka from July 2017 to December 2020. FNAC and histopathology reports were studied to find out the incidence of benign and thyroid malignancy among the thyroid swelling. Results: The age of the patients ranged from 8 to 75 years. The mean age was 37.2 years. There were 156 female and 44 male patients with female male ratio 3.54:1. Diagnostic categorization of 200 thyroid swelling underwent surgery, FNAC based on Bathesda classification showed that 163 (81.5%) cases were cytologically benign, 37 (18.5%) cases were malignant category. Out of 200 cases histopathology showed134 cases(67.0%) are benign and 66(33.0%) are malignant thyroid swelling. Among the benign lesions96.31% are colloid goiter and among the malignant lesions 93.4% are papillary thyroid carcinoma. Conclusion: Although FNAC is an essential diagnostic test to rule out thyroid malignancy but histopathological examination is the only way to give true incidence of thyroid malignancy among the thyroid swelling and it is observed that there is high incidence of thyroid malignancy(33.0%) among the thyroid swelling patient underwent thyroid surgery. Bangladesh J Otorhinolaryngol; April 2021; 27(1): 12-16