Clinico pathological study of thyroid lesions in a rural tertiary care centre

Objective: Present study is clinic pathological study of thyroid lesions in a rural tertiary care Centre. Thyroid lesions are fairly common world wide and are commonly encountered in clinical practice in rural areas also. It causes more concern because of high probability of malignancy in solitary thyroid nodules. Materials and Methods: Prospective study done in Dept. of pathology over a period of 6 months in a rural tertiary care centre. It included clinical examination, routine investigations and histo pathological diagnosis. Result: In our study of 40 cases, 31 were diagnosed as non-neoplastic and 9 as neoplastic. Most common clinical presentation was midline neck swelling, commonly on right side and majority of patients were diagnosed with colloid goitre (62.5%) followed by multinodular goitre (20%) on ultra sonography. The non-neoplastic to neoplastic ratio of 3.4:1. with female to male ratio of 19:1. Colloid goitre was the most common non neoplastic lesion and follicular adenoma was the most common neoplastic lesion. Conclusion: In current study conducted in a rural tertiary care centre, thyroid lesions were common in age group of 3 rd to 5 th decade with female predominance. Benign lesions were common than neoplastic lesions. Histopathological diagnosis of thyroid lesions is important for early diagnosis and treatment of neoplastic lesions.


Introduction
Thyroid lesions are fairly common world wide and are commonly encountered in clinical practice [1]. The problem in clinical practice is to distinguish reliably the few malignant tumors from the many harmless nodules so that a definitive preoperative tissue diagnosis of the malignancy allows planning of appropriate surgery and relevant patient counselling. The prevalence of thyroid swelling ranges from 4% to 10% in the general adult population and from 0.2% to 1.2% in children [2].
They constitute only 0.7% of all cancers in female and 0.2% in males. The majority of clinically diagnosed thyroid swelling are non-neoplastic; only 5% to 30% are malignant and require surgical intervention [3]. Thyroid lesions may be developmental, inflammatory, hyper plastic and neoplastic. The surgical excision of the nodule and its histological examination is the only way to differentiate between the more frequent benign and much less frequent malignant nodules [4]. A solitary thyroid nodule is defined as a palpable single, clinically detected nodule in the thyroid. It causes more concern because of high probability of malignancy in it, which can range from 5-35% of all solitary thyroid nodules [5]. Diffuse thyroid lesions are those that are associated with conditions affecting entire gland such as hyper plasia and thyroiditis. Nodular lesion comprises those disorders that produce a clinical nodule and consists of non-neoplastic hyper plasia as well as benign and malignant tumors [6]. Current study is about thyroid lesions in rural tertiary care centre conductedover a period of six months, this will help in obtaining recent data of thyroid lesions and its prevalence in patients presenting to a rural tertiary care centre.

Materials and methods
Type of study: Prospective, observational and descriptive. Sample collection and methods: In this study we have included hemithyroidectomy, sub total thyroidectomy and total thyroidectomy specimens received in department of pathology. Complete clinical history, along with ultra sonographic (USG) findings and related investigations were taken into consideration.
Inclusion criteria: Hemithyroidectomy, subtotal thyroidectomy and total thyroidectomy specimens received for histo pathological examination suspected for neoplastic and non-neoplastic lesions of thyroid.

Discussion
Present study was conducted in Department of Pathology, SRTR GMC Ambajogai over a period of 6 months from July 2017 to December 2017. All the specimens of thyroid i.e. hemithyroidectomy, subtotal and total thyroidectomy which were sent for histopathological examination were considered for this study.
Diseases of thyroid are of great importance because most are amenable to medical or surgical treatment [13]. It is known that approximately 1-10% adults in USA ae reported to have solitary thyroid nodules [14,15,16].
Single nodules are four times more common in women than in men and its incidence increase throughout life benign lesion outnumber malignant lesions by ratio of 10:1 [14]. Overall incidence of thyroid malignancy is low 0.5-1.0% of all cases and 3.3 to 17% of all thyroid cases [14,15,16].
In our study, age of patients ranged from 16-75 years with mean age of 45 years. Findings of present study correlate with that of studies conducted by other Indian authors [7,8].
Almost all of the patients in present study presented as midline neck swelling. Few of the patients presented with dyspnoea (5%) and hoarseness of voice (5%). In study conducted by Prakash A et al thyroid swelling was in 95.5% cases [11] and Godinho-Matos L et al, the thyroid swelling was present in 100% cases, dyspnoea in 3% cases and hoarseness of voice in 3% cases [12].
Thus findings of present study correlate with studies conducted by other authors.

Original Research Article
Pathology Update: Tropical Journal of Pathology & Microbiology Available online at: www.pathologyreview.in 44 | P a g e In current study out of total 40 cases, 20 (50%) cases presented with right lobe involvement,15 cases (37.5%) with left sided thyroid swelling and remaining 5 cases (12.5%) with diffuse thyroid swelling which correlates with study conducted by Gupta et al [4].
USG is used to establish physical characteristics like size, shape and number of nodules [4]. In our study colloid goitre 25 cases (62.5%) was the most common finding on USG followed by multinodular goitre 8 cases (20%). Similarly study conducted by Gupta et al, multinodular goitre (55%) was the most common ultrasonographic finding followed by solitary thyroid nodule (19%) [4]. In our study most common lesions were non neoplastic 31 (77.5%) and remaining were neoplastic 09 (22.5%) with non-neoplastic to al neoplastic ratio of 3.4:1. Similar findings reported by other authors Magdalene et al [13] and Abdul Gafoor etal [17].
Among non-neoplastic lesions, colloid goitre was the most common lesion 22 cases (70.97%) followed by multinodular goitre 05cases (16.2%). Magdalene et al noted colloid goiter (42%) was the most common lesion in their studies [13] and Kusum et al, as multinodular goiter (73%) followed by adenomatous goiter (8%) [15]. Among neoplastic cases follicular adenoma 06 cases (66.7%) was the most common lesion followed by one each case of Follicular carcinoma, Papillary carcinoma and Medullary carcinoma. Similar results were noted by Abdul Gafoor et al and Sapna et al [17,18]. Overallbenign lesion were more common than malignant lesions and findings of present study correlate with other studies [9,10].
As our centre is rural tertiary care centre, very few patients of malignancy are reported. Because most patients are referred to higher centre, the incidence of papillary carcinoma, medullary carcinoma and follicular carcinoma are less. Also there is high illiteracy, lack of knowledge and importance about health problems the patients ignore the symptoms of disease and present late to the institute. This maybe the reason for lower incidence of malignant lesions and mostly non neoplastic lesions in present study.

Conclusion
Thyroid lesions are fairly common in females of young age group. Also the incidence of thyroid lesions is increasing in rural population. The thyroid gland may be affected with various disorders. Thyroidectomy may have both therapeutic and diagnostic value. in present study, thyroid lesions were most common in age group of 3rd to 5th decade with female predominance. In present study colloid goitre was the most common nonneoplastic lesion and follicular adenoma was the most common neoplastic lesion. Combined opinion on nature of thyroid lesion should be done based on history, clinical examination and ultra sonographic features. Early diagnosis by FNAC and excision of lesion will provide comfort for the patient and also decrease the problems arising from malignant lesions.
Present study describes the current data on thyroid lesions in rural tertiary care centre and will help clinicians in diagnosing the lesions. Also present data will help in understanding the occurrence of disease in rural population and may help in creating awareness in public regarding the thyroid lesions and help in early diagnosis and treatment of these lesions.