Abstract

Lesions of thyroid are predominantly confined to female in the ratio 5:1 to male. Thyroid enlargement may be diffuse or generalized or localized. Both benign and malignant lesions of thyroid commonly present with a nodule. Prevalence of thyroid nodule ranges from 0.2% to 1.2% in children and from 4-10% in general adult population. Presently due to common use of ultra-sonography in the clinical practice the incidence of thyroid nodule has risen to 14-50%. Aim and Objective of the study: The aim and objective of the study is to correlate thyroid function tests with thyroid nodules and to find out the percentage of different thyroid lesions based on Bethesda system of reporting thyroid cytopathology. Materials and Methods: The study included data from all patients of both genders and all ages presenting with diffuse or nodular thyroid swelling. Demographic and clinical details of the patients were recorded on a pre-approved, pre-validated data sheet. Data of thyroid function tests, i.e. the levels ofT3, T4 and TSH hormones was recorded. In all the patients, FNA using a 22 or 23-gauge needle was done following standard procedure under aseptic precautions. Smears were made from the aspirates and were immediately fixed with methanol and stained with H&E and PAP stains. Smears were evaluated by pathologist and categorized as per The Bethesda system of reporting thyroid cytopathology (TBSRTC). The Thyroid Function Test (TFT) profile (T3, T4, TSH) was performed using Chemiluminescence immunoassay method. Results: In the present study, we have included a total of 126 subjects presented to ENT OPD of our hospital based on inclusion and exclusion criteria. 77.7% were females and 22.2% were males, the mean age of the patients was 41.2 ± 5.62 years. Gender distribution showed female preponderance. The distribution of thyroid lesions showed that 88.88% had benign lesion, 7.9% had pre-malignant and 3.17 % had malignant lesions. The cytological diagnosis shows, 66% were consistent with benign follicular nodule, 17.8% Consistent with lymphocytic thyroiditis, 7.14% Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance, 3.57% Suspicious for a follicular neoplasm and 1.7% suspicious of malignancy. Category 1: 5 had euthyroid, 4 with hyperthyroidism and 1 with hypothyroidism, Category II: 62 had euthyroid, 20 with hyperthyroidism and 30 with hypothyroidism, Category III: 8 had euthyroid, none had hyperthyroidism or hypothyroidism, Category IV: 2 were euthyroid and 2 were hypothyroid and none were hyperthyroid, Category V: 2 had euthyroid, none had hyper or hypothyroid and in Category VI: I euthyroid, 3 had hypothyroid and none had hyperthyroid. Discussion and Conclusion: In the present study we found that the cytology remains the gold standard for the diagnosis of thyroid lesions. Hormonal status alone does not help in screening of thyroid lesion. Accurate sampling and USG guided FNAC for sub-centimeter size nodules can help in reducing the number of indeterminate, false-positive, and false-negative diagnoses. In cytologically equivocal cases combination of cyto-morphology, clinical features, thyroid hormonal profile, antibody testing and ultra-sonographic features help in the diagnosis of thyroid lesions. It is recommended that surgical indications must not depend solely on cytology. Indeed, the results of medical history, physical examination, laboratory tests and ultrasonography should also be evaluated simultaneously. Further studies correlating the FNAC results and surgical confirmation can help in strengthening the evidence in support of cytological diagnosis.

Description