CLINICAL STUDY OF THYROID MALIGNACIES AND THE ROLE OF SERUM TSH IN PREDICTING MALIGNANCIES
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2013, Vol 2, Issue 43
Abstract
[b] BACKGROUND AND OBJECTIVE[/b]: Thyroid malignancies account for 90% of endocrinal malignancies. The incidence of thyroid malignancies has increased three fold over the past 3 decades. Many patients present to the surgical outpatient department with a thyroid nodule. However not all there are many methods to diagnose and predict malignancy in a thyroid nodule. A clinical examination is always the first step to assess a nodule. A thyroid profile is also essential. This is accompanied by certain tests which increase the rate of detection. Fine needle aspiration cytology (FNAC) is the present gold standard and primary tool for assessing risk of malignancy. Other tests include ultrasonography, thyroid scintigraphy, CT scan and MRI. Recent studies have found levels of serum TSH to be an independent predictor of malignancy in thyroid nodules. This biochemical marker could be used as a screening test for malignancy. In this study we investigated the utility of TSH in predicting malignancy and the common clinical presentation of thyroid malignancies. [b]METHODS[/b]: This prospective study included 50 patients presenting with thyroid swellings clinically suspicious of malignancy at the department of general surgery, Kempegowda Institute of Medical Sciences, Bangalore. Duration of study was June 2010 to June 2012 which included a 6 month follow up. [b]RESULTS[/b]: Majority of patients (92%) Presented with thyroid swelling, 25 patients (50%) presented with a solitary nodule of thyroid and 21 patients (42%) had a multinodular goitre. 4 patients presented with primary complaints other than a neck swelling. The next common complaint was pain and discomfort in the neck (8%). Only 3 patients presented with compressive symptoms. Papillary carcinoma was the most common (93%) histopathological variety of malignancy, Incidence of Follicular carcinoma was 7%. The mean TSH value was higher in histopathologically confirmed carcinoma of thyroid. (3.71±1.22mU/L) when compared with those with benign disease (1.80±1.03mU/L).[b] INTERPRETATION AND CONCLUSION[/b]: Thyroid malignancies have a varied clinical presentation. The commonest presentation being that of a solitary thyroid nodule. Though there are many predictors of thyroid malignancy, none of them can conclusively predict the nature of a thyroid nodule. In our study we evaluated the utility of preoperative serum TSH levels as a predictor of malignancy and it did show a statistically significant correlation (P=<0.01) between higher TSH levels and malignant nodules. However this relationship between higher TSH levels was not seen in those presenting with no primary thyroid swelling and only cervical lymph node metastasis. The utility of TSH in poorly differentiated carcinoma could not be assessed as all the patients in this series had well differentiated carcinoma.
Authors and Affiliations
Sathyanarayana B. A, Ramachandra J, Saurabh Sinha, Nandeesh kumar, Tejasvi Kumar
Keywords
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- EP ID EP117473
- DOI 10.14260/jemds/1472
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