Incidence of cancer in cold thyroid nodules

ABSTRACT

In 160 clinically solitary sold thyroid nodules incidence of cancer was 17.5%. Papillary carcinoma, consituted 57.14% of the malignant cases, most of them were young females, 37.5% cases of papillary carcinoma had unilateral cervical lymph node metastasis. The incidence of other malignancies were follicular carcinoma [14.28%], medullary carcinoma [7.14%], undifferentiated carcinoma [14.28%], malignant lymphoma [7.14%] malignancy was found in 19.67% sold cold nodules, 12.5% mixed and 9.09% cystic nodules. 31.81% males reporting with cold thyroid nodules were found to have malignancy compared to 13.06% females. 42.85% of malignant cases were in the third decade of life and more than half were below 30 years but relative frequency was more in the elderly age group. 50% of the nodules found in cases over 50 years of age were malignant compared to 17.02% in the younger [below 30 years] and 11.11% in middle aged [30 to 50 years] groups. Cold thryoid nodules are important for their malignant potential and incidence of malignancy in cold thyroid nodule in our country is not insignificant, this fact should be kept in mind during management of these cases and special attention should be given to all the elderly patients, men of all ages and women of younger age group. FNAC may add substantially in the management of the cases and should be called for wherever the facility is available. In absence of the procedure, surgery is indicated for all the cold thyroid nodules. The ideal procedure would be alobectomy and excision of the isthmus i.e. a hemithyroidectomy rather than a nodulectomy. This will suffice for all the benign lesions as well as intrathyroidal papillary carcinoma especially in the younger age group. The excised specimen should be routinely sent for histopathological examination