European Journal of Cardiovascular Medicine

The thyroid gland is an important organ that has a diverse and essential physiological role in the body. All body organs are impacted by thyroid hormones, which are essential for preserving body integrity and equilibrium. Nowadays thyroid conditions are very common. ¹

Thyroid lesion is a common prevalent clinical finding that affect 4-7% of people. Developmental, inflammatory, hyperplastic, and neoplastic thyroid abnormalities are all common. Thyroid gland disorders range from a single, isolated lesion to systemic illness, which may include a tumour mass. Less than 5% of thyroid lesion are cancerous, and the great majority are non-neoplastic lesions.^2,3,4

Thyroid lesion is defined as distinct lesions within the thyroid gland by the American Thyroid Association (ATA). In terms of radiography, it is different from the thyroid parenchyma surrounding it. Solid, cystic, single or multiple  lesions can be present.^5,6

Thyroid gland lesions are a common occurrence that can be found with a physical examination in 5%–7% of adults. Yet, among patients without a prior thyroid condition diagnosis, autopsy data have revealed a 50% frequency of thyroid lesion bigger than one centimetre.^7,8

Thyroid lesion is linked to a wide range of illnesses, from benign to malignant diseases that can have slow growing or extremely aggressive clinical histories. In a multinodular goitre, a dominating lesion is present in about 23% of cases.^9,10

The two mostly used diagnostic methods for determining the thyroid lesion's cytopathology are fine-needle capillary

sampling (FNC) and FNA. The Bethesda classification, which divides cytologic results into six main categories and indicates varying post-diagnostic and post-treatment therapy, is advised by the National Cancer Institute.^11,12

Thus, the present study was done to classify the cytomorphology of thyroid lesions by FNAC and to determine its correlation with thyroid hormone profile and radiology.

This retrospective study was conducted in Department of Pathology at newly started Government Medical College, Udhampur for a period of 01 year from January, 2023 to December, 2023. The approval for study was taken from the institutional ethical committee. A total of 73 thyroid patients who were subjected to cytology were included in the study as per following inclusion and exclusion criteria:

Inclusion Criteria:

All patients of any age and sex having thyroid lesions and referred for cytological study from ENT/ Surgery Department.

Exclusion Criteria:

Patients not willing for FNAC of thyroid lesions even after explaining the importance and consequence of the procedure were excluded.

In each patient detailed clinical history was obtained before procuring sample for cytological study using case pre-defined proforma. Thyroid function tests were also documented. Radiological (ultrasonography/USG of thyroid) investigation report was documented wherever done with special mention of nodularity status on USG. After USG of thyroid, cytology was done.

Prior to aspiration, size, shape, mobility of thyroid swelling with swallowing, nodularity and clinical complaints were assessed. FNAC was done using 23 G needle attached to a 10 ml syringe which was further attached to syringe holder. In each case, Papanicolaou (PAP) and May-Grunwald-Giemsa (MGG) staining of smeared slides were done.

The statistical analysis was done using SPSS (Statistical Package for the Social Sciences, SPSS Inc., v.16). The descriptive statistics were calculated as mean and standard deviation for quantitative data and as frequency and percentage for qualitative data. The association between two categorical variables were calculated using chi-square. The level of significance for the present study was set at P value of less than 0.05.

Table 1. Age-wise distribution of cases

A total of 73 cases of thyroid swellings were analyzed. Demographic variables such as age and sex distribution were explained in Table-1. In this study, total number of females was 58 (79.5%) and males were 15 (20.5%). The mean age of patients in this study was 39.7±17.4 years and age range was 7-71 years. Age of the youngest patient was 7 years.

In this study, we found that most of the patients were females and most common age group affected was 21- 30yrs with 16 (21.9%) affected participants (Table-1).

Table 2. Site of involvement

Table-2 depicts the site of involvement among the study participants. Most of the lesions were diffuse 33 (45.2%) followed by right thyromegaly in 17 (23.3%) cases, left thyromegaly in 10 (13.7%) cases and midline in 13 (17.8%) cases.

Fig. 1: Site of involvement

Table 3. Radiological characteristics

Radiological examination of the study participants is shown in Table-3. Colloid cyst was the predominant diagnosis (15.1%) followed by nodular goiter (13.7%), TIRADS 2 (9.6%) and TIRADS 3 (8.2%). Radiological examination was not available for 30 (41.1%) participants.

Table 4. Distribution of cases according to Cytodiagnosis

Distribution of cases according to cytodiagnosis is explained in Table-4. Colloid goiter with cystic degeneration was the predominant diagnosis (41.0%) followed by colloid goiter in (36.98%) and Thyroglossal Cyst in 6 (8.2%) cases.

Fig. 2: Distribution of cases according to Cytodiagnosis

Table 5. Association between radiodiagnosis and hormonal status

Chi-square=28.973, P=0.024

Table 5 shows the hormonal status of the study subjects and its association with radiological diagnosis. The majority of patients (50.7%) were in euthyroid state, followed by hypothyroid state (28.8%) and least in hyperthyroid state (20.5%). Statistical analysis using Chi-square test showed that there was a statistically significant association between participants’ radiodiagnosis and hormonal status (Chi-square=28.973, P=0.024).

Table 6. Association between cytodiagnosis and hormonal status

    Chi-square=33.084, P=0.061

Table 6 shows the hormonal status of the study subjects and its association with cytodiagnosis. Statistical analysis using Chi-square test showed that there was no statistically significant association between participants’ cytodiagnosis and hormonal status (Chi-square=33.084, P=0.061).

The most accurate and reliable method for determining surgical candidates and identifying tumours in the thyroid is fine needle aspiration (FNA) , especially when it is carried out with ultrasound guidance.¹³ In our study FNAC thyroid gland was done for 73 thyroid patients who were subjected for cytology.  There was female predominance. Patients in this study ranged in age from 7 to 71 years, with a mean age of 39.7±17.4. The youngest patient was seven years old. These outcomes are comparable with the study conducted by Nandekar SS. et al. (2018) found that there was female predominance with female to male ratio 4.2:1. The age of study participants ranged from 2 years to 87 years and the mean age of the study subjects was 37.6 years.¹⁴ Similarly, Handa U et al. (2008) reported the mean age of the study subjects with a mean age of 37.69 ± 14.93 years and a female to male ratio of 6.35:1, the patients' ages ranged from 5 to 80 years.¹⁵

The majority of patients (50.7%) were in euthyroid state, followed by hypothyroid state (28.8%) and least in hyperthyroid state (20.5%). There was a statistically significant association between participants’ radiodiagnosis and hormonal status. Diffuse lesions accounted for 33 (45.2%) of the lesions, with right thyromegaly accounting for 17 (23.3%), left thyromegaly for 10 (13.7%), and midline for 13 (17.8%) cases. Colloid cyst was the predominant diagnosis (15.1%) followed by nodular goiter (13.7%), TIRADS 2 (9.6%) and TIRADS 3 (8.2%). Radiological examination was not available for 30 (41.1%) participants.  Colloid goiter with cystic degeneration was the predominant diagnosis (41.0%) followed by colloid goiter in (36.98%) and Thyroglossal Cyst in 6 (8.2%) cases. These study outcomes are similar to the study performed by Chittawadagi BB et al. (2018) observed that follicular neoplasm was more common than papillary carcinoma in the neoplastic group, whereas the predominant group among nonneoplastic lesions was followed by Hashimoto's thyroiditis, lymphocytic thyroiditis, cystic lesions, and de Quervain thyroiditis. Out of 100 patients, 71 patients (71%) were classified as euthyroid, hypothyroid, and least amount as hyperthyroid. In the non-neoplastic group, euthyroid patients make up a larger proportion of colloid goitre patients (74.1%), and among patients with neoplastic lesions, 3 of 4 cases of follicular neoplasms were euthyroid, and 1 was hypothyroid. Euthyroid papillary carcinomas occurred in both cases. Each of the 100 patients had a radiological evaluation. 88 of the 100 cases had benign, hyperechoic lesions. Twelve hypoechoic lesions—ten benign and two malignant. 98 of the 100 lesions were benign and had well-defined margins. Two were malignant and lacked well defined borders. 67 benign lesions with macro-calcification were found out of 100 cases. Thirty-one benign lesions did not exhibit calcification, while two cases had characteristic micro-calcification and were malignant.¹⁶ In other study done by carried out by Nandedkar SS et al. (2018) reported that goitre was diagnosed in more than half of the cases in the current investigation (57.41%). This included nodular goitre and goitre with cystic degeneration or other secondary changes. Colloid cysts accounted for 10.34 % of all diagnostic lesions, one of which was an infected cystic lesion. Adenomatous goiter/hyperplastic nodule 6.9%, thyroglossal cyst 3.28%, Hashimoto's thyroiditis 2.59%, and granulomatous thyroiditis 1.21% were among the other benign lesions. Among these, lymphocytic thyroiditis accounted for 8.10%. Of the cases with malignant lesions, follicular neoplasms (FN) accounted for 7.07%, papillary carcinoma (n = 13), medullary carcinoma (n = 3), and anaplastic carcinoma (n = 2) were detected.¹⁴

The present retrospective study concluded that when evaluating thyroid nodules early and reasonably, FNAC is a crucial diagnostic technique. Which can aid in choosing the best course of action, whether surgical or non-surgical

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