ABSTRACT
A retrospective study of thyroid carcinoma with emphasis on the incidence of carcinoma in multiple thyroid nodules and surgical management was carried out. The study covered a 12 years period from June 1986 to May 1998. Details of the cases were obtained from the records of the Surgical Notes, Medical Records Dept of AL-Zahrra university Hospital-Cairo. and Hamad G. Hospital-Doha. There was a total of 56 [9.1%] cases of carcinoma out of 616 surgically treated thyroid diseases. Females accounted for 45 and the males 11 cases giving a female to male ratio of4.1:1. The peak age incidence was between the third and fifth decades. Thirty three patients presented with single nodule [59%], 20 with multiple nodules [35%] and 3 diffuse, [5.3%] giving an overall incidence of malignancy in single and multiple thyroid nodules of 5.6% and 3.8% respectively from the 585 patients who presented with nodules. Thirteen patients [23%] presented with cerivcal lymphadenopathy. Most of the patients had a preoperative Ultrasound, T. Scan and general laboratory investigations. Firm diagnosis was made by one of these; FNA, frozen section or paraffin section. The following procedures were performed as the definitive treatment [i]; Hemithyroidectomy [27 cases] [ii] subtotal thyroidectomy [4 cases]; [iii] Near Total thyroidectomy [7 cases]; [v] Total thyroidectomy [17 cases]; One case was inoperable. Papillary carcinoma was the most common thyroid carcinoma [80.4%] and followed by follicular carcinoma [12.5%], medullary 5.3% and anaplastic carcinoma 1.8%. Of the 20 patients who presented with multiple nodules, there were 14 papillary, 3 follicular 2 medullary and one anaplastic carcinoma. No deaths were recorded amongst the papillary and follicular carcinoma cases, over a maximum of twelve years follow up. There was one death each in cases of medullary and anaplastic carcinoma. The incidence of 3.8% malignancy in patients with multiple thyroid nodules would war rant interventional rather conservative surgery. Near total or total thyroidectomy is the best choice as initial or completion surgery for all types of differentiated thyroid carcinoma. Hemithyroidctmy could be accepted in some cases