FREQUENCY OF CARCINOMA

IN NON-TOXIC
MULTI NODULAR GOITRES
(MNGs)
Presenter: Muhammad Saaiq
Authors:
Muhammad Saaiq , Khushal Khan, Syed Aslam Shah,
DEPARTMENT OF SURGERY, PIMS , ISLAMABAD,
PAKISTAN
PIMS , ISLAMABAD.
Presented at: PIMS Symposium 2004. Pakistan Institute of
Medical Sciences (PIMS),
Islamabad. May 09, 2004.
 SETTING:
• PIMS, Islamabad .
• Two hundred consecutive patients.
• From October 2000 to Sept 2002.
• Without any obvious symptoms and
signs of malignant disease.
• Pre-op. assessed for non-toxic MNGs .
• Histopathological examination performed
after subtotal-thyroidectomies (STT)
 OBJECTIVE:
To assess the frequency of
Carcinoma in patients with
non-toxic Multi nodular goitres.
(MNGs)
 INCLUSION
CRITERIA:
• All patients above the age of 14.
• All patients with multinodular
goitres.
• All clinically and biochemically
euthyroid patients.
 EXCLUSION
CRITERIA:
• Clinically solitary nodule.
• Clinically diffuse goitre.
• Cases of thyroid carcinoma
diagnosed pre-operatively on
clinical basis or FNAC.
 METHODS:
• Preoperatively pts were assessed by :
History
Physical examination
Investigations (TFTs, FNAC of dominant
nodules and IDL).
• All patients underwent Subtotal -
thyroidectomies.
• All surgical specimens were subjected to
Histopathological examinations .
RESULTS
 SEX DISTRIBUTION (n=200)

200

180
160

140
120
Female 182
100
Male 18
80
60

40
20

0
 AGE DISTRIBUTION (n=200)

90
80
70
60
50
40
30
20
10
0
10-20 21-30 31-40 41-50 51-60 61-70
 Residence (n=200)
S.NO REGIONS NO. OF %
PATIENTS

1. ISLAMABAD 80 40%

2. .
RAWALPINDI 56 28%

3. AJK 35 17.5%

4. NWFP. 12 6%

5. FATA 10 5%

6. NORTHERN AREAS 7 3.5%

 COMMON SYMPTOMS OF
PATIENTS (n=200)

S.N. SYMPTOMS NO OF %
PATIENTS

1. SWELLING IN 200 100%

FRONT OF NECK.
2. DYSPHAGIA 30 15%
3. DYSPNOEA 20 10%
4. HOARSENESS OF 3 1.5%
VOICE.
 CLINICAL FINDINGS:
• Enlargement was bilateral in 142
pts (71%) .
• Enlargement was unilateral in 58
pts (29%).
• Consistency was firm / rubbery in
98% of the patients.
 Clin.findings contd:
• Dominant nodule……... 61 patients
(30%)
• Hard nodule …………… 4 patients
(2%)
• Retrosternal extension …. 9 pts (4.5%)
• Tracheal deviation…….. 5 patients
(2.5%)
• FIXITY/NODAL ENLARGEMENT……. NONE
 FREQUENCY OF
CARCINOMA:

• Out of 200 patients

operated
for non-toxic MNGs
19 ( 9.5 % )
had carcinoma.
Sex distribution of patients with
Carcinoma

Male
16%

Female
84%
 AGE & SEX DISTRIBUTION OF PATIENTS
WITH MALIGNANCY (n=19)

8
7
6
5
MALE
4
FEMALE
3
2
1
0
10 - 20 21 -30 31 - 40 41 - 50 51 - 60 61 - 70
TYPES OF THYROID MALIGNANCY
IN MNGs (n=19)
S.No. NO. OF PATIENTS %
TYPE

1. PAPILLARY 11 57.89
FOLLICULAR
2. 4 21.05
ANAPLASTIC
3. 3 15.78
MEDULLARY
4. 1 5.26
 FREQUENCY OF CARCINOMA
IN MNGs IN DIFFERENT
STUDIES
No Study No. Of %
patients

1. STOFFER et al 400 13%

2. LAWAL O et al 279 12.9%

3. PELIZZO MR 539 7.6%

4. PRESENT STUDY 200 9.5%

SHAH S A et al
 POST-OPERATIVE
COMPLICATIONS (n=200)

S.NO. NO. OF %
COMPLICATIONS PATIENTS

1. TEMPORARY HOARSENESS. 08 4%

2. HYPOPARATHYROIDISM. 02 1%

3. WOUND INFECTION 05 2.5%

 contd:
S.NO. NO. OF %
COMPLICATIONS PATIENTS

4. HAEMORRHAGE (NEEDED 0 0%
RE-EXPLORATION)
5. PERMANENT HOARSENESS. 00 0%

6. HYPOTHYROIDISM. 00 0%

7. DEATH 00 0%
 CONCLUSIONS
• 1) MNG may harbour malignancy.
• 2)Surgery is imperative in MNGs.
• 3)All surgical specimens of MNGs
should be subjected to histology
to diagnose otherwise undetected
carcinoma.
• 4)Regular periodic follow-up of
MNGs is mandatory.
Thank You