Yah Wui, Choo
(2015)
The prevalence and the associate factors for thyroid malignancy in large goiters results from six years’ experience in Hospital Raja
Perempuan Zainab II.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background:
Large goiters are very common and it is frequently encountered by endocrine surgeons
especially in developing countries. Rarely, issues regarding large goiters have been
discussed, particularly the association between large goiter and thyroid cancers. The
objectives of this study are to analyze the associate factors of thyroid malignancy in large
goiters as well as the surgical complications in performing resection for large goiters.
Methods:
Patients who had primary thyroid surgery between June 2007 and May 2013 were
retrospectively reviewed. Patients who underwent thyroidectomy with a resected specimen
of ≥ 50g in hemithyroidectomy or ≥ 100g in total thyroidectomy were recruited in the
study. The associate factors for thyroid cancer in large goiters (age, gender, thyroid
function status, compression symptom and, nodularity) were analyzed. The surgical
complications namely temporary hypocalcaemia, permanent hypoparathyroidism, RLN
injury, post-operative haemorrhage, surgical site infection, local structures injury and
mortality associated with thyroid surgery were recorded.
Results:
A total of 611 patients who had capsular dissection thyroid surgeries were recruited in the
study. The prevalence of large goiter was 410 (67.1%) and the prevalence of thyroid
malignancy in large goiters was 115 (28.0%). The patients with large goiters had higher
chance to have thyroid malignancies with OR of 1.52 (1.02, 2.28). Multiple Logistic
Regression Analysis revealed that the significant associate factors for thyroid malignancy
in large goiters were age and STN with OR of 1.02 (1.01, 1.04) and 1.80 (1.10, 2.94),
respectively. There were 82 (25.5%) temporary hypocalcaemia, 9 (2.8%) permanent
hypoparathyroidism, 4 (1.2%) RLN injuries, 8 (2.5%) post-operative haemorrhages, 4
(1.2%) local structure injuries and 1 (0.3%) death after thyroid surgery for large goiters.
Conclusions:
The high prevalence of large goiters in the developing countries necessitates the different
approach in the management of thyroid disease. Large goiters are associated with higher
prevalence for thyroid malignancy. With the doubt of sensitivity in detecting thyroid
malignancy from FNAC in large goiter, surgeons should consider removing the goiter
early especially in older patients and those with STN. Nevertheless, the risks of surgery for
large goiter should be deliberated and the surgery should only be performed by expert
personal.
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