FREQUENCY OF CARCINOMA IN NON-TOXIC MULTI NODULAR GOITRES (MNGs

)
Presenter: Muhammad Saaiq Authors: Muhammad Saaiq , Khushal Khan, Syed Aslam Shah, DEPARTMENT OF SURGERY, PIMS , ISLAMABAD, PAKISTAN PIMS , ISLAMABAD. Presented at: PIMS Symposium 2004. Pakistan Institute of Medical Sciences (PIMS), Islamabad. May 09, 2004.

SETTING:
• • • • PIMS, Islamabad . Two hundred consecutive patients. From October 2000 to Sept 2002. Without any obvious symptoms and signs of malignant disease. • Pre-op. assessed for non-toxic MNGs . • Histopathological examination performed after subtotal-thyroidectomies (STT)

OBJECTIVE:
To assess the frequency of Carcinoma in patients with non-toxic Multi nodular goitres.
(MNGs)

INCLUSION CRITERIA:
• All patients above the age of 14. • All patients with multinodular goitres. • All clinically and biochemically euthyroid patients.

EXCLUSION CRITERIA:
• Clinically solitary nodule. • Clinically diffuse goitre. • Cases of thyroid carcinoma diagnosed pre-operatively on clinical basis or FNAC.

METHODS:
• Preoperatively pts were assessed by : History Physical examination Investigations (TFTs, FNAC of dominant nodules and IDL). • All patients underwent Subtotal thyroidectomies. • All surgical specimens were subjected to Histopathological examinations .

RESULTS

SEX DISTRIBUTION (n=200)
200 180 160 140 120 100 80 60 40 20 0 Female 182 Male 18

AGE DISTRIBUTION (n=200)
90 80 70 60 50 40 30 20 10 0 10-20 21-30 31-40 41-50 51-60 61-70

Residence (n=200)
S.NO REGIONS
1. 2. 3. 4. 5. 6.

NO. OF
PATIENTS 80 56 35 12 10 7

%
40% 28% 17.5% 6% 5% 3.5%

ISLAMABAD
. RAWALPINDI

AJK
NWFP. FATA NORTHERN AREAS

COMMON SYMPTOMS OF PATIENTS (n=200)
S.N. SYMPTOMS NO OF PATIENTS 200 30 20 OF 3 %

1. 2. 3. 4.

SWELLING IN FRONT OF NECK. DYSPHAGIA DYSPNOEA HOARSENESS VOICE.

100% 15% 10% 1.5%

CLINICAL FINDINGS:
• Enlargement was bilateral in 142 pts (71%) . • Enlargement was unilateral in 58 pts (29%). • Consistency was firm / rubbery in 98% of the patients.

Clin.findings contd:
• Dominant nodule……... 61 patients (30%) • Hard nodule …………… 4 patients (2%) • Retrosternal extension …. 9 pts (4.5%) • Tracheal deviation…….. 5 patients (2.5%)
• FIXITY/NODAL ENLARGEMENT……. NONE

FREQUENCY OF CARCINOMA:

• Out of 200 patients operated for non-toxic MNGs 19 ( 9.5 % ) had carcinoma.

Sex distribution of patients with Carcinoma
Male 16%

Female 84%

AGE & SEX DISTRIBUTION OF PATIENTS WITH MALIGNANCY (n=19)
8 7 6 5 4 3 2 1 0 10 - 20 21 -30 31 - 40 41 - 50 51 - 60 61 - 70 MALE FEMALE

TYPES OF THYROID MALIGNANCY IN MNGs (n=19)
S.No.

TYPE
PAPILLARY
FOLLICULAR ANAPLASTIC MEDULLARY

NO. OF PATIENTS

%

1. 2. 3. 4.

11 4 3 1

57.89 21.05 15.78 5.26

FREQUENCY OF CARCINOMA IN MNGs IN DIFFERENT STUDIES
No Study No. Of patients 400 279 539
STUDY

%

1. 2. 3. 4.

STOFFER et al LAWAL O et al PELIZZO MR
PRESENT

13% 12.9% 7.6% 9.5%

200

SHAH S A et al

POST-OPERATIVE COMPLICATIONS (n=200)
S.NO.

COMPLICATIONS
TEMPORARY HOARSENESS. HYPOPARATHYROIDISM. WOUND INFECTION

NO. OF PATIENTS

%

1. 2. 3.

08 02 05

4% 1% 2.5%

contd:
S.NO.

COMPLICATIONS
HAEMORRHAGE (NEEDED RE-EXPLORATION) PERMANENT HOARSENESS. HYPOTHYROIDISM. DEATH

NO. OF PATIENTS 0

%

4.

0%

5. 6. 7.

00 00 00

0% 0% 0%

CONCLUSIONS
• 1) MNG may harbour malignancy. • 2)Surgery is imperative in MNGs. • 3)All surgical specimens of MNGs should be subjected to histology to diagnose otherwise undetected carcinoma. • 4)Regular periodic follow-up of MNGs is mandatory.

Thank You

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