The most prevalent thyroid condition, which is more frequent as people age, is thyroid nodules. The newly perceptible nodules grow at a pace of around 0.1% annually. Five to ten percent of thyroid nodules are cancerous, but the majority of thyroid nodules are benign. It is the most prevalent endocrine tumour with regional variation. Although reports of the female to male ratio range from 1.2:1 to 4.3:1, women are reported to get nodules at a higher rate than males. Thyroid nodules are more likely to occur in groups exposed to ionising radiation (10–1500 cGy), particularly in early life. Thirty percent of children who are exposed to radiation develop thyroid nodules, of which thirty percent are shown to be cancerous. In isolated thyroid nodules, the cancer incidence is 14%. A single thyroid nodule is indicative of more worrying than many thyroid nodules. To rule out malignancy, a dominating nodule or a nodule that changes in size in the context of numerous nodular goitre should be examined. Distinguishing the small number of individuals with thyroid cancer from the greater number of patients with benign nodules is the aim of all diagnostic procedures.

Globally, the most typical sign that warrants a thyroidectomy is a single, potentially cancerous nodule. Only those whose cancer has been diagnosed, is suspected, or whose chances cannot be ruled out should consider surgery. Other possible candidates for surgery include a young girl experiencing difficulty owing to cosmetic areas, a rare patient with an autonomous poisonous nodule, and nodules exhibiting pressure sensations. A more conservative approach is recommended when malignancy can be ruled out. An organised approach involving a thorough clinical history, a careful physical examination, and any necessary step-by-step investigation, as well as biochemical assessment, scintigraphy, ultrasonography, CT scan, FNAC, and tumour marker estimation, remain the cornerstones for guiding the clinician in determining the patient's necessary and justifiable course of treatment.

A complete lobectomy and isthmectomy is the proper first surgery for a single nodule suspected of being malignant. The scope of surgery—lobectomy vs. entire thyrodectomy—is a topic of controversy. Patients with confirmed differentiated thyroid cancer should have it done, primarily because their prognosis is favourable regardless of the surgical approach4.With a particular focus on the association between thyroid nodules and cancer, the current effort aims to investigate thyroid nodules, including their clinical presentation, pathology, diagnosis, surgery and its consequences, biopsy, and postoperative and non-surgical patient follow-up. With any luck, this effort will provide some light on the current state of research on thyroid nodules and how they are managed.

In a normal state, the thyroid gland weighs between 20 and 25 grammes. Because of its topological similarity to the laryngeal thyroid cartilage, which resembles a shield, the name "thyroid" is derived from the Greek word "Thyreoides," which meaning shield.The left and right lobes of the thyroid gland are joined by a small isthmus. Each lobe has a pear-shaped base that is located at the level of the fourth and fifth tracheal rings, and an oblique line on the thyroid cartilage lamina at the top.Across the midline, in front of the second, third, and fourth tracheal rings, lies the isthmus. Frequently seen, a pyramidal lobe rises from the isthmus and is typically located to the left of the midline. An elongated The hyoid bone and pyramidal lobe are often connected by a fibrous or muscular band known as the levator glandulae thyroideae.

After obtaining written informed consent, all patients with thyroid nodules who visited M. K. C. G. Medical College and Hospital were included in the study, provided that they agreed to attend for regular follow-up visits at least every six months to record any side effects or recurrence that may have resulted from the treatment used to treat the thyroid nodules. Patients with other major disabling disorders and those with thyroid nodules who could not be followed up for six months were excluded from the trial. The period of the study is September 2008–May 2010.

The patients were examined following the tentative diagnosis in order to support our clinical judgement. Every patient had a routine T3, T4, and TSH calculation to determine their precise thyroid function status. Radio Immuno Assay is typically used to measure it. This technique has now been superseded with a more advanced immunometric test that uses monoclonal antibodies to target two different locations on the TSH molecule, enhancing specificity. FNAC was performed in every instance from the nodule. A cushion is placed beneath the neck to support the expansion of the neck while using a 22G needle in a supine position. On a spotless glass slide, three streaks are ready. Papanicolaou stain is used for staining and pure alcohol is used for fixing. A chest and neck X-ray was performed in each case to look for retrosternal extension. or alteration in the trachea.routine blood count with fasting and postprandial sugar levels, Hb%, TLC, DC, and ESR included. BT, CT was often performed. Serum urea and creatinine levels were measured to evaluate renal function. A chest x-ray and an ECG were recommended for every patient. In each patient, an indirect laryngoscopy was performed to assess the vocal cord status.

A care plan was created for every patient following all of these methodical examinations. Patients who meet the criteria for surgery were ready for euthyroid surgery and for surgery itself. The macroscopical results of the operation, as well as the identification and isolation of the parathyroid glands and recurrent laryngeal nerves, were meticulously documented. Furthermore highlighted was the condition of the draining lymph nodes. including the postoperative phase. Be alert for any issues that arise, whether they are early or late, and know how to handle them. Following a near-total or sub-total thyroidectomy, there was a noticeable increase in thyroid activity. A thyroidectomy was planned for some instances, with the timing of the procedure varying based on the histology of the removed material. Patients were monitored for one, two, three, and six months following their release from the hospital. The following characteristics were sought after: changes in voice, recurrence, local and distant metastases, hypoparathyroidism, hypo/hyperthyroidism, and therapy response.

The present study has included 45 cases of Thyroid Nodules which includes both solitary and multi nodular goiter admitted to M. K. C.G. Medical College , Berhampur from September 2008 to May 2010. After FNAC study of each nodule, they were segregated into benign nodules, follicular neoplasms and malignant (which includes mainly papillary) . The present study mainly deals with

Table – 1: Management of Thyroid Nodules with Special Reference to Malignancy—A Prospective Study’’.

Thyroid Nodule

Age wise distribution of all the 45 cases of thyroid nodules and malignant nodules in our study shows that maximum incidence of thyroid nodules is in 2nd and 3rd decades of life. But the malignancy in the thyroid nodule increases with age and is maximum in 5th and 6th decade. Starting from the adolescent to old patients of all age group have suffered and taken into account. The youngest patient was 18 years female and he oldest patient was 65 year old lady.

Table-2 Sex Distribution

In the present series the ratio of female to male regarding the incidence of thyroid nodules is 4:1. Out of 45 patients 36 are female and 9 are male. And out of 8 malignant nodules 6 are female and 2 are male and the female to male ratio  is F: M= 3:1.

Table 3 Nodularity

Out of 45 cases 35 are solitary thyroid nodule and 10 are multinodular goiter. Out of 6 malignancy diagonised by FNAC study 4 are from solitary thyroid nodule and 2 are from multinodular goiter and out of 8 malignancy diagnosed and confirmed by histopathology, 5 are from solitary thyroid nodule and 3 are from multinodular goiter. About 14.28% of solitary thyroid nodules are malignant and 30% of multi nodular goiter are malignant.

Table-4 Size Of The Nodule

 Most of the thyroid nodules are <4 cm in size and are mainly solitary nodules. The most of MNG are ³ 4 cm and the largest nodule was (7.5 cm MNG) a follicular carcinoma.

Table-5: Thyroid Status

Majority of cases of thyroid nodules are Euthyroid. Only 2 cases of thyroid nodule are hypothyroid which came out as Hashimoto’s thyroiditis after histopathological study.

Table 6: Cytodiagnosis Of Thyroid Nodules By FNAC

The above table shows cytodiagnosis categorization of 45 patients with thyroid nodules. After FNAC study 60% are diagnosed as benign which includes mostly colloid goiters, simple cysts and thyroiditis. About 26.66% nodules are diagnosed as follicular neoplasms with suspicious cytological study and 6 cases (13.33%) are diagnosed as papillary thyroid carcinoma. None of the cases were diagnosed as anaplastic or medullary carcinoma.

45 patients with thyroid nodules were included in the study, which was conducted at the M.K.C.G. Medical College's surgery department in Berhampur. The cases were chosen for the research following screening from our outpatient clinic and the conclusion of all phase-by-phase examinations. Sorting the benign nodules from the malignant lesions was our first priority. On FNAC, several instances that turned out to be benign had cosmetic surgery.

Age and Gender According to reports, most patients with thyroid nodules are between the ages of thirty and fifty-five (Hamming et al., 1990; Caruso and Mazzaferri, 1991). The majority of participants in our research, who are benign, are between the ages of 21 and 40. However, patients with malignant thyroid nodules are often between the ages of 51 and 60. According to Jackson and Thompson (1987), nodules typically have an age of 43 years, whereas malignant nodules typically have an average age of 66 years. There are more females than men in each groups.In our current dataset of 45 thyroid nodule patients, there were 36 females and 9 men with a F: M ratio of 4:1. The figures on world literature are comparable to our outcomes. The F: M ratio is 3:1 among the eight malignant cases. Similar to our work, Rao (1991) reported that the F:M ratio of all nodules was 4.6:1. According to Jackson and Thompson, the F:M ratio for cancer is 1.5:1. Rate of occurrenceThirty-five out of 45 thyroid nodules are solitary. In our analysis, only 10 instances are recorded as MNG. Eight (17.0%) of the 45 cases are malignant nodules, of which 3 are MNG and 5 are STN. According to reports by Welker M.J. et al. (2003) and McKenzie et al. (2004), 5% of all palpable nodules are cancerous. This disparity resulted from the small number of instances that our analysis considered.The thyroid nodule was separated into STN and MNG mostly on clinical foundation. as radioisotope scanning of the thyroid is not readily available and ultrasonographic examination of the neck is not usually advised.with a single nodule, the malignancy rate was 14.28%, compared to almost 30% with MNG. This is nearly identical to the Stojanovic D et al. (2003) research, which indicates that 15% of patients have cancerous STN nodules.

Every patient with a thyroid nodule had a thyroid hormone test performed, and the majority of those nodules were found to be euthyroid. In our investigation, one out of every twelve follicular neoplasm and one out of every twenty-seven benign nodules had hypothyroidism, which was later confirmed by a histological examination.Euthyroid patients constituted the majority. Malignant instances might be hypothyroid or euthyroid, but seldom hyperthyroid, as demonstrated by Kapur et al. (1982). Every malignant nodule in our investigation turns out to be euthyroid.

All patients in our research who had thyroid nodules had cytological evaluations performed by FNAC, a rapid, easy, and safe treatment. In 2004 Mackenzie et al. 50 to 97% accuracy is the range (Asheroft et al., 1985). It is now the most crucial diagnostic method used to choose individuals who will undergo surgery. Twenty years ago, following scintigraphy examination and a suppression trial, the incidence of cancer in individuals with thyroid nodules chosen for surgery was around 30%. The frequency of cancer in nodules has increased over the past ten years due to the widespread use of FNAC, which has reduced the suspicion of carcinoma to 50%. According to one survey, surgical exploration was avoided for approximately 80% of individuals with thyroid nodules because

FNAC research. It took the position of USG and Radio Iodine Scintiscan as the main diagnostic method for evaluating thyroid nodules due to its accuracy, ease of use, and affordability. Woeber, Kennetha A. et al., 1995).

Out of the 45 thyroid nodules examined by FNAC, six instances were found to be papillary carcinoma, twelve to be follicular neoplasms, and the other cases were found to be benign. Anaplastic carcinoma or meduallary carcinoma was not identified in any of the cases. According to FNAC, the study's malignancy rate was 13.33%. In a series by Roab et al., the FNAC diagnosed malignancy rate was 18% (1995).

Twelve follicular neoplasms and six papillary carcinomas that were all cytologically identified are scheduled for surgery. One complete thyroidectomy is planned for one of the twelve patients with follicular neoplasms, and two of the six patients with papillary carcinomas. The remaining fifteen patients had isthmusectomy and unilateral lobectomy. According to Ardito G et al. (2004), individuals with thyroid gland lesions that include follicular structures may find that DL (Diagnostic Lobectomy) is a safe and appropriate surgical technique.

Thyroid nodules are rather frequent. The possibility of cancer exacerbates the issue and presents a challenge to the surgeon in terms of the best course of action and the effectiveness of the procedure. Resecting every nodule is no longer necessary; instead, a targeted surgical approach should be used. The first line, gold standard research is still FNAC. When a nodule appears in an elderly or very young person, there is a possibility that it is cancerous. Strong clinical suspicion, a history of head and neck radiation, a family history, and a FNAC report are sufficient indicators in and of themselves to warrant surgery.

It is acknowledged that papillary tumours less than 1 centimetre in size and free of lymphatic or systemic metastases are suitable candidates for lobectomy and isthmusectomy. Patients with papillary carcinoma that measure more than 1 cm may also be eligible for lobectomy with isthmusectomy if they are deemed to have a decreased risk of death or recurrence. For the treatment of papillary carcinoma with a higher risk, total thyroidectomy is universally recognised. Furthermore, because of the high frequency of carcinoma at locations other than nodules and the increased lifetime risk of thyroid cancer in the remaining thyroid gland, individuals who have had Head and Neck irradiation should undergo a complete thyroidectomy.

Due to the indolent nature of the disease and the relatively normal survival rate of patients, lobectomy and isthmusectomy are also suitable treatments for minimally invasive follicular carcinoma. With the exception of a little amount of capsular penetration, a benign follicular adenoma and a minimally invasive tumour are nearly identical. Patients with invasive follicular carcinoma, which is more aggressive and is characterised by substantial capsular invasion and angioinvasion, are treated with a near complete or total thyroidectomy. For individuals with thyroid cancer, lobectomy and isthmusectomy are the preferable treatments due to the decreased risk of recurrent laryngeal nerve damage, the potential for persistent hypoparathyroidism, the decreased likelihood of cancer recurrence in the thyroid bed, and the surgical cure for 50% of the local recurrences. Moreover, there is no clinical importance to tumour multicentricity.

Since total thyroidectomy has the lowest incidence of local and regional recurrence, it is recommended for patients with DTC. Having a complete thyroidectomy makes it easier to use serum Tg for early metastatic disease identification and therapy, as well as radioiodine ablation and radioiodine detection for metastatic illness. In addition, it prevents future reoperative surgery, which has a higher risk of complications, and the 1% chance of anaplastic transformation of cancer that persists in the residual lobe.

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