The Proportion of Patients with Thyroid Malignancy detected after undergoing Thyroidectomy for Multinodular Goitre

Background: Even though thyroid nodules within a multinodular goiter (MNG) were traditionally regarded as less likely to harbor thyroid cancer compared with solitary nodules, recent studies have questioned this belief. Our study was conducted to estimate the proportion of thyroid carcinoma in patients with MNG, using histopathological examination as the gold standard. We also studied the type of malignancy in patients with MNG who have undergone thyroidectomy and studied the agreement between Ultrasound (USG) guided fine needle aspiration cytology (FNAC) and histopathology in patients who have undergone thyroidectomy. Materials and Methods: It was a prospective, observational study from April 2023 to April 2024 on all the patients above 18 years admitted to the general surgery department with a clinical diagnosis of MNG. A total of 139 cases of thyroid swellings were evaluated in detail by taking history, doing clinical examination, USG, US-Guided FNAC and histopathology. After thyroidectomy surgery, histopathology reports were followed up and correlated with US-guided FNAC. Results: We found that the highest prevalence of cases was observed in the age group of 41–50 years, with a mean age of 47.55 ± 12.79, constituting 30.2% within this age group, the incidence of malignancies was 50%. However, the highest incidence of malignancies was found in patients under 30 years of age, with a striking 77.8% of these cases being malignant. Gender distribution showed that MNG is more common in females, with 82% compared to 18% in males. Amongst male patients, 68% had malignant conditions, whereas 32% had benign cases. In contrast, amongst female patients, 47.4% had malignant cases, whereas 52.6% were benign. 48.9% had benign thyroid conditions and 51.1% had malignancies. Conclusion: Our study sheds light on the frequency of thyroid cancer in patients with MNG higher in younger patients and males were at a higher risk compared to females. The study reveals that greater incidence of malignancy in MNG compared to benign conditions, with papillary carcinoma being the most common type of malignancy. Although FNAC is effective at accurately identifying benign cases, it has limitations in detecting all malignant cases and is not always reliable in ruling out malignancy when the results are negative.