The thyroid gland is the largest endocrine organ which plays vital role in body metabolism. A unique feature of Thyroid lesions is that both non-neoplastic and neoplastic diseases affect it and lead to diffuse or nodular enlargement. Non-neoplastic lesions are comparatively more common in thyroid like goitre, thyroiditis and graves’ disease [1]. Even after much advances in the field of endocrinology, the thyroid gland still remains a subject of keen interest and importance due to the broad spectrum of lesions and presentations [2].

Fine Needle Aspiration Cytology (FNAC) is the present day’s worldwide accepted diagnostic tool as it is a cost effective, minimally invasive, low complication, non-operative method and has a high sensitivity and specificity in most of thyroid lesions [2].

As a diagnostic test, FNAC can diagnose most benign lesions, inflammatory lesions as well as malignant lesions. The test can be used to differentiate thyroid lesions which require surgical excision from conditions which can be managed medically [3].

However, the success of FNA is contingent upon several important contributing influences including aspirator experience, skillful cytological interpretation and a rational analysis based upon a synthesis of cytological and clinical information in the context of an individual patient[4].

Objectives: To study the spectrum of clinical presentation of individuals with thyroid lesions and correlate the clinical diagnosis with the Biochemical, radiological and cytomorphological features.

Study Setting: Gadag Institute of Medical Sciences, Gadag

Study Duration: January 2018 to January 2019

Type of Study: Retrospective study

Sample Size: A total of 101 case files were retrieved, consisting of all the patients having thyroid lesions who underwent the procedure of FNAC

Inclusion criteria: All the cases which have underwent FNAC in the study hospital and Complete Report of the FNAC was available

The majority of the clinical presentation of the study subjects was enlargement of the thyroid gland in all the cases. Nearly 22.7% had tenderness, 8.9% had dysphagia, 6.9% presented with voice changes, 23.7% presented with hypothyroidism features and 0.9% with hyperthyroidism features.

Table-3: Thyroid function test

In the study subjects nearly 53.4% of the study subjects had euthyroid, 21.7% presented with Hypothyroid, 1.99% with hyperthyroid and 23.7% nothing was available.

Table-4: Clinical and radiological diagnosis of the study subjects:

The clinical diagnosis was established in all the cases of the study subjects. Majority (67.3%) of them presented with colloid goiter ,18.8% presented with Thyroiditis, 5.95% with solitary thyroid nodule,1.9 % with malignancy and 5.9% no diagnosis could be achieved.

Where as in radiological diagnosis colloid goiter was established in 42.5% of the subjects, thyroiditis in 21.7%, solitary thyroid nodule 4.9%, malignancy in 2.9% and 0.99% had nodular colloid goiter with cystic changes.

Table-5: Cytological diagnosis

The Ultrasonography report was available in 74 out 101 cases, of which 43 (42.5%) cases were diagnosed as colloid goitre, 22 (21.7%) cases were diagnosed as thyroiditis, 5 (4.9%) cases were diagnosed as Solitary Thyroid nodule, 1 (0.99%) was diagnosed as Nodular colloid goitre with cystic change and 3 (2.9%) cases were diagnosed as malignancy. were similar to the results seen in study by Dhanadia et al [5].

The cytological slide review was done in all the 101 cases.

It was noted that out of 101 cases, clinical diagnosis was mentioned in 92 cases, of which a cytological concordance was seen in 70 (77.7%) cases and discordance was seen in 22 (23.9%) cases. The histopathological data was available for 15 cases in the study population of which 85% showed a cyto-histo concordance.

A case that would be worth mentioning would be a 65year old lady who presented with a nodular enlargement of thyroid since past six months, on FNAC the cytological smears revealed highly cellular smears showing monolayered sheets of follicular cells with oxyphilic change. The impression on FNAC was given was Hurthle Cell Neoplasm. On Histopathological examination, the slides revealed the features of Tall Cell Variant of Papillary Carcinoma Thyroid. (Refer Figure 1 and 2)

Ultrasound, TFT was not done in 20% of the cases. Due unavailability of Anti TPO test a complete work up of thyroiditis was not done.

In conclusion, this study affirms the importance of FNAC as the first line screening test and hence giving a direction to the clinician for further management of the patients. However, there are a few draw backs in the methods, a reason behind missing the diagnosis on FNAC could be attributed to mainly sampling error, wherein an inadequate sample, or co-existing benign and malignant lesion where the needle does not hit the lesion and hence the representative material is not obtained. These drawbacks can be corrected by opting for ultrasound guided FNAC especially in difficult lesions.

In the era of evidence based medicine, FNAC place a vital role in the management of patients with thyroid lesions however a low percentage of false negatives can be avoided by inculcating ultrasound guided FNAC in difficult cases.

Data collection was done by Dr. Akshatha N. while data interpretation and manuscript writing done by both Dr. Akshatha N. and Dr. Shwetha Patil. Review of articles, references and introduction done by Dr. Akshatha N., Dr. Shwetha Patil and Dr. Basavaraj Bommanahalli. Proof reading done by Dr. Shwetha Patil.