ABSTRACT
Thyroidectomy is one of the most common operations performed throughout the world, with solitary thyroid nodules being one of the more common indications for surgery. Though conventional open thyroidectomy is considered extremely safe and remains the treatment of choice, it is associated with an undesirable scar. Endoscopic thyroidectomy has the distinct advantage of limiting external scarring and having better cosmetic results. It moreover is associated with reduced post-operative pain, and enhanced postoperative recovery. Methods: It was a hospital based non randomized prospective descriptive study carried out in department of general surgery at tertiary hospital in which 39 patients with benign thyroid lesions were included on the basis of a predefined inclusion and exclusion criteria. Detailed history, clinical and local examination was done in all the cases. Thyroid function tests, FNAC under ultrasound guidance, indirect laryngoscopy and imaging of thyroid gland was done in all the cases. All patients underwent endoscopic thyroid surgery (Total, near total, subtotal or hemithyroidectomy). Patients were followed up for 6 months after surgery. P value less than 0.05 was taken as statistically significant. Results: Out of 39 studied cases there were 35 males and 4 females with a M:F ratio of 1:8.75. Most common age group was found to be 30-40 years with a mean age of 32 yrs. Average size of thyroid nodule was 3.20 cms and right lobe was predominantly involved (69.23%). Predominant Pathology on FNAC was found to be colloid goiter (71.79%). All patients underwent endoscopic thyroidectomy. Mean duration of surgery was 55 minutes. Most common surgery undertaken was hemithyroidectomy (84.62%) followed by total thyroidectomy (10.16%) and completion total thyroidectomy (5.13%). Average total blood loss was significantly less (36 ml). Mean visual analogue score at 24 and 48 hours post-operatively were 4.14 and 2.85. Mean duration of hospital stay was 3.3 days. Majority of the patients (89.75%) were extremely satisfied with the cosmetic results. Conclusion: Endoscopic thyroidectomy for Benign thyroid lesion is associated with less blood loss during surgery, comparatively less severe pain, decreased mean duration of hospital stay and satisfactory cosmetic results.
ABSTRACT
@#Introduction: Thyroid cancer is the most common endocrine malignancy with more than 95% originating from follicular epithelial cells. Diagnostic dilemma may arise in occasional cases such as when an encapsulated nodule with a follicular growth pattern exhibits clear nuclei with grooves making it difficult to distinguish a follicular adenoma from encapsulated follicular variant papillary thyroid carcinoma. This study aimed to evaluate the diagnostic utility of an immunohistochemical marker, CD56, to distinguish between benign and malignant thyroid lesions. Materials and Methods: We retrospectively studied CD56 expression in 54 benign and 54 malignant thyroid lesions using archival formalin fixed paraffin-embedded tissue blocks for the study period from January 2010 to December 2015, diagnosed in a tertiary hospital. Results: CD56 was expressed in 52/54 (96.3%) of benign specimens and only 24/54 (44.4%) of malignant ones. The malignant specimens comprised 31 (57.4%) papillary thyroid carcinomas (PTC), 11 (20.3%) follicular carcinomas (FC), seven (13%) medullary thyroid carcinomas (MC), one (1.9%) poorly differentiated carcinoma (PC) and four (7.4%) anaplastic carcinomas (AC). CD56 was not expressed in 28/31 (90.3%) of the PTCs, 1/11 (9.1%) FCs, 1/4 (25%) of ACs while all MCs and the PD were positive. The benign group comprised nodular hyperplasias (29/54), lymphocytic thyroiditis (10/54), follicular adenomas (FA) (14/54) and one hyalinising trabecular tumour. CD56 was expressed in all the benign cases except one FA and one nodular hyperplasia. Thirteen of the 14 FAs were CD56 positive. The difference in expression between benign and malignant tumours was statistically significant as the p value was <0.01. Conclusion: CD56 is a potentially good immunohistochemical marker for differentiating papillary thyroid carcinoma from other benign follicular lesions of the thyroid especially in differentiating follicular variant PTC from FA in equivocal cases.
ABSTRACT
Background: To establish diagnosis of thyroid lesions using USG as the modality of choice, sonographically characterize those lesions as regards to their nature (benign v/s malignant), to define the spatial extent of these lesions and their relationship to the surrounding structures using USG and CT scan and to guide FNAC of these lesions whenever indicated and establish their pathological correlation. Aim: To estimate the role of USG and CT in evaluation of thyroid lesions Material and methods: The present study was a prospective and observational (non interventional) type of study. This study aimed at evaluating patients came to the Radiology Department of Dhiraj General Hospital, by using USG and CT scan. This study comprised of 97 patients, sonographic evaluation was carried out in all 97 patients while CT scan was used in evaluation of 22 patients. Sonography with color doppler examination was carried out by PhILIPS HD9 AND GE LOGIC P5 and using 7.5 MHZ transducers. CT Scanning was done by using Siemens 16 slice CT Scanner. Results: Largest group of patients were in 31-40 years with sex ratio of M: F = 1:4.7. The most common clinical feature that patient complained of was asymptomatic lump in the neck (55%), which correlates with the most common pathology which was Goiter. The largest group comprised of non toxic goitre followed by thyroid neoplasms. ALL patients of grave 's diseas had diffusely hypoechoeic thyroid gland with prominent thyroid septae and capsule, the gland was enlarged in 4 cases and of normal size in one patient. Colour Doppler study showed all patients exhibited increased vascularity reffered to as thyroid inferno pattern at colour flow imaging. Conclusion: High resolution USG is recommended as the primary imaging modality in the evaluation of thyroid diseases. It has a high sensitivity and specificity in the diagnosis of thyroid diseases. CT scan plays a role in evaluation of retrotracheal and retrosternal goiters, large thyroid masses and staging of thyroid malignancies.