Evaluation of diagnostic procedures and outcomes in thyroid surgery: the experience of Al-Amiri hospital

ABSTRACT

To evaluate the ability of different diagnostic procedures in predicting thyroid malignancy, and to highlight outcomes of thyroid surgery Al-Amiri Hospital, 1990-95 Retrospective review of surgical records. 1.4% of all surgical interventions performed during that period [N=210] were thyroid cases. Surgical indications were solitary cold nodule [58%], multinodular goitre [36%] and hyperthyroidism [5%]. Following surgery, only 10% [n = 21] were histopathologically malignant. Based on postoperative findings, malignancy could have been predicted by thyroid isotopic scanning in no more than 11% of cases, and by ultrasounds [U/S] in 9% of solid lesions. Fine needle aspiration [FNA] accurately predicted 87% of cases. Only 26 patients [13%] developed post-operative complications, of which the most common was voice change [n = 8], mostly transient [6/8]. In this series, most patients [77%] stayed in-hospital for 3-5 days. The predictive value of malignancy in thyroid nodule[s] using fine needle aspiration is by far higher than that of ultrasound or thyroid scans. U/S may be preferred to visualise sub-clinical nodules. At this point in time, FNA is always recommended to diagnose malignancy, and the adjunct use of U/S helps in locating all potentially active nodules. In the presence of U/S. thyroid scans may be of lesser value. Thyroid surgery is generally safe, and should become an outpatient procedure. Hospital stays should be determined by the extent of surgery and/or the appearance of complications