Multinodular goitre – when should we operate?
Journal Title: Postępy Nauk Medycznych - Year 2014, Vol 27, Issue 1
Abstract
Introduction. Thyroid operation is one of the most frequently performed in the Surgical Ward of the Specialist Municipal Hospital in Toruń. In the period from April 2002 to May 2008, 873 thyroid operations were performed. The most common indication for surgery was non-toxic goitre. Amongst other indications, some patients were operated on because of cancer of the thyroid. Cancer of the thyroid was also diagnosed in patients who were not initially qualified for this reason for an operation. Cancer of the thyroid is the fifth most frequently occurring neoplasm in Poland. The multitude of histopathological forms of this neoplasm means that unequivocal pre-operative diagnosis can be difficult. There are, it is true, certain characteristic traits of neoplastic nodules in an ultrasound scan, but they refer to papillary thyroid cancer. Biopsy by fine needle aspiration (FNA), even guided by ultrasound, is not a 100% accurate diagnostic method. In operations initially qualified as nodular goitre, 5.3% were histopathologically diagnosed as thyroid cancer. In this regard, would it not be advisable to recognise strumectomy as a preventive method in the case of nodular goitre, making it possible to detect and treat early stages of thyroid cancer? Based on material presented in this paper, the broadening of indications for strumectomy to include this important aspect should be considered.Aim. To demonstrate the appropriateness of early thyroid resection in every case of multinodular thyroid goitre.Material and methods. 873 patients operated in Municipal Hospital In Toruń on between 2002 and 2008 were included in the research. Patients have been operated and excised biological material subjected to histopathological.Results. Thyroid cancers in the final histopathological analysis represented 7.03% of all those operated on. In the analysis of patients referred with a diagnosis of thyroid cancer (5.5% of all those operated on), the histopathological diagnosis was not confirmed in 1.71% of all those operated on (which represents 31.25% of patients referred with a diagnosis of thyroid cancer). Amongst patients referred with a diagnosis of goitre (94.27% of all those operated on), thyroid cancer was diagnosed in 4.98% (4.69% of the whole group of those operated on). The number of thyroid cancers found incidentally in the whole group of patients operated on was 4.69%, which represents 56.16% of all diagnosed thyroid cancers (32.88% of diagnoses were of microcarcinoma).Conclusions. The analysis of the above results, particularly the over 56% of the cancers found incidentally and confirmed histopathologically from among all the diagnoses of thyroid cancer, would seem to allow us to claim that every multinodular goitre should be operated on early.
Authors and Affiliations
Jan Szczepański, Hunert Juźków, Grzegorz Madycki, Walerian Staszkiewicz
Keywords
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