Clinicopathological Features And Treatment Outcomes Of Thyroid Cancer

a Retrospective And Prospective Study

Abstract

Background: The incidence of differentiated thyroid cancers (DTC), including papillary (PTC) and follicular (FTC) variants, is increasing exponentially over the past years throughout the world with a wide geographic variation. Thyroid cancer is the eighth most common endocrine cancer, representing 3.8% of all new cancer cases in the United States and is the ninth most common cancer overall Over a decade, the incidence rate of thyroid cancer in India in women increased from 2.4 (95% confidence interval (CI) 2.2- 2.7) to 3.9 (95%CI 3.6-4.2) 

Objectives: To study the Clinical picture of Thyroid Malignancies.

• To study the Pre op-FNAC of thyroid swelling.
• To study the Post-operative Histopathology of thyroid Malignancies.
• To study the treatment outcome of various procedures.

Study Design: Retrospective And Prospective observational study

Participants: 456 patients from age group 18 to 70

Methods: The socio-demographic, clinical, radiological, and histopathological findings were retrieved onto a structured proforma. The other details included the type of treatment provided, the occurrence of various postoperative complications, and the management of the same.

Results: Thyroid Cancers are more common in Females. The mean age at the time of Diagnosis was 35.62 Years and the range was from 18 to 70 years. Neck swelling was the most common presenting symptom. Neck Pain is the second most common presenting symptom. Voice Change was the least common presenting Symptom among the cases. 33(7.2%) of cases had no presenting symptoms and were incidentally diagnosed. Papillary Thyroid Carcinoma was the most common diagnosis on FNAC followed by Follicular Neoplasm. The majority of the patients 252 (55.2%) underwent Total Thyroidectomy, 76 (16.6%) patients underwent Total Thyroidectomy with total Neck Dissection, 61 (13.3%) underwent Hemi-Thyroidectomy, 36 (7.8%) underwent total thyroidectomy with central Compartment Dissection,21(4.6%) underwent Completion Thyroidectomy, 10 (2.1%) underwent Total thyroidectomy with Sternal Swelling excision. Seroma developed in 21 patients which are less than 5%. Hematoma occurred in Only 3 cases (0.65%). Two cases needed manual evacuation of Hematoma. One was managed conservatively.  11(2.4%) patients developed wound infection. 94 (20.6 %) cases developed Transient Hypoparathyroidism. One-fourth i.e 114 (25%) cases developed Transient Hypocalcemia of which 75 (65.7%) were females and 39(34.2%) were males. Unilateral RLN injury occurred in 3 cases and all three were males.

Conclusion: Papillary thyroid was the most common malignancy among the patients followed by follicular and medullary, Hurthle cell cancer being the fourth most common of all thyroid cancers. Complications associated with thyroid surgery are directly proportional to the extent of thyroidectomy and inversely proportional to the experience of the operating surgeon. They occur less frequently with good surgical technique and a better understanding of surgical anatomy and include wound healing and infections (seroma, hematoma, and wound infection), nerve injury, hypoparathyroidism, hypothyroidism, postoperative hemorrhage, and respiratory obstruction.