Detection Rate of Thyroid Papillary Micro-carcinoma in Multinodular Goiter Surgery.

OBJECTIVE: To determine the frequency of papillary thyroid micro-carcinoma (PTMC) in multinodular goiter (MNG) surgery, as well as in opposite thyroid lobule of the dominant nodule. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: General Surgery Department, Abant Izzet Baysal University Hospital, between January 2010 and December 2016. METHODOLOGY: The data of 1300 patients who underwent thyroidectomy analyzed. Patients with single nodule in preoperative sonography, and patients with malignancy or suspected malignancy in fine needle aspiration cytology were excluded. PTMC was labelled as less than 10 mm in diameter. RESULTS: After exclusion of such patients, 1,197 subjects with benign MNG were included in the study. There were 1,134 patients in benign group and 63 subjects in PTMC group, according to the postoperative pathology results. In PTMC group, 53 (84%) of subjects had one tumor and 10 (16%) has more than one cancerous nodules. Thirty-six (57%) of cancers in PTMC group were right sided and 27 (43%) were left sided. Cancer and dominant nodule were in the same thyroid lobe in 62% (n = 39) subjects in PTMC group. However, 24 subjects had cancer in the lobe opposite to the largest nodule. CONCLUSION: Total bilateral thyroidectomy should be preferred in MNG surgery due to high probability of multicentric disease.

Neutrophil to Lymphocyte Ratio is Useful in Differentiation of Malign and Benign Thyroid Nodules.

OBJECTIVE: Significant amount of thyroid nodules are malignant. Inflammation plays crucial role in the pathogenesis of many disorders, including cancer. Neutrophil to lymphocyte ratio (NLR), has been suggested as an index of inflammatory response and association between increased NLR and cancer has also been reported. In this retrospective analysis, we aimed to study NLR levels in patients with malign and benign thyroid nodules and healthy control subjects. METHODS: The patients who underwent surgery for nodular goiter in general surgery clinics of our university hospital between June 2012 and June 2015 and 68 healthy volunteers were included. Patients with thyroid nodules divided into malign or benign nodule groups according to the pathology report. Thyroid carcinomas other than micropapillary tumor were excluded. Preoperative hemogram parameters of these groups were compared. RESULTS: Mean NLR of malign nodule group (2.1±0.9%) was significantly higher than both those in benign nodule (1.7±0.9%) and control groups (1.7±0.6%). CONCLUSION: We suggest that elevated NLR in patients with thyroid nodules in preoperative period may be an indicator of underlying malign nodular disease. Increased NLR in such patients should encourage physician to perform cancer screening in thyroid gland.

Could Red Cell Distribution Width be a Marker of Thyroid Cancer?

OBJECTIVE: To study red cell distribution width (RDW) values, a novel inflammatory marker in routine hemogram, of patients with benign or malignant thyroid nodules and to compare with healthy population. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Abant Izzet Baysal University Hospital, Bolu, Turkey, from November 2015 and February 2017. METHODOLOGY: The hemogram values of patients undergone thyroid surgery for thyroid nodule between November 2015 and February 2017 were retrospectively analyzed, and compared to those in healthy subjects. Subjects with infectious or inflammatory diseases were excluded. Patients' characteristics and laboratory data were obtained from institutional computerized database. Preoperative hemogram values of thyroid nodule patients were recorded. One-way ANOVAand Kruskal-Wallis tests were performed to compare variables with significance at p<0.05. RESULTS: Median RDW of malignant nodule group was 15.8 (12.9-19.5) and was significantly higher than both of those in benign nodule (15) and control groups (14), (p<0.001). CONCLUSION: Elevated RDW in patients with thyroid nodules in preoperative period should alert the physician for possible malignancy and this cost-effective marker also can help support other modalities (ultrasound scan, and fine needle aspiration biopsy) to distinguish malignant from benign nodules.