A. Noel1, M.R. Guido2, E.A. Todd2, C. Saghira3, A.C. Cioci4, T.M. Vaghaiwalla4, J.I. Lew4 1Spelman College, Atlanta, GA, USA 2University Of Miami, Miami, FL, USA 3University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA 4Division of Endocrine Surgery DeWitt Daughtry Department of Surgery, University of Miami, Miami, FL, USA
Introduction:
Nontoxic multinodular goiter (MNG) is commonly referred for surgical excision. Thyroidectomy may be indicated for patients with compression symptoms, thyroid gland enlargement, or concern for malignancy. Although not suspected in many patients with nontoxic MNG, thyroid malignancy may be discovered incidentally on final histopathology after thyroidectomy for other reasons. This study investigates the rate of occult thyroid malignancy for patients who undergo thyroidectomy for nontoxic MNG.
Methods:
A retrospective review of prospectively collected data of 1,892 patients who underwent total thyroidectomy from 2009 to 2022 at a single institution was performed. Study patients had a diagnosis of nontoxic MNG and underwent surgical excision for compressive symptoms (e.g. dysphagia, dyspnea while lying in the supine position), cosmesis and/or patient preference. Patients were excluded if they were <18 years of age, had prior FNA and/or prior thyroid surgery. Patient demographics, preoperative laboratory and radiologic evaluations were compared between patients with and without occult thyroid malignancy based on final histopathology.
Results:
Of 244 patients who underwent thyroidectomy for nontoxic MNG, the majority were women (82%, n=240) with a mean age of 51 years. Of the entire MNG group, 53 patients (21.7%) had incidentally discovered thyroid malignancy on final histopathology, whereas 191 patients (78.3%) had benign thyroid disease. The majority of patients with occult malignancy (96.2%; n=51) had papillary thyroid carcinoma (PTC) on final histopathology. Of the remaining patients, one had follicular thyroid carcinoma (FTC) and the other had Hürthle cell carcinoma (HCC). Preoperative neck ultrasound (US) was performed in most patients (94.6% n=231/244). Among patients with occult thyroid malignancy, average tumor size on final histopathology was 1.63cm (range: 0.1 to 5.5cm) with 54.5% of patients having a tumor size >1 cm and 45.5% of patients having a tumor <1 cm. There were no statistical differences between the occult thyroid malignancy and benign groups.
Conclusions:
Occult thyroid cancer was identified on final histopathology for 21.7% of patients who underwent thyroidectomy for nontoxic MNG without preoperative FNA. PTC was the most common occult thyroid malignancy identified, and >50% of patients had clinically relevant tumors >1 cm rather than papillary microcarcinomas <1 cm. In patients who undergo thyroid surgery for presumed benign nontoxic MNG, this high rate of occult thyroid malignancy highlights the need for complete preoperative evaluation prior to surgical treatment.