Are There Predictors of Malignancy in Patients with Multinodular Goiter?1

Abstract

Background Multinodular goiters (MNG) have recently been shown to have an incidence of cancer that approaches that of solitary thyroid nodule. However, fine needle aspiration (FNA) of a MNG is limited due to the presence of multiple nodules. Therefore we sought to identify risk factors for malignancy in patients with MNG. Methods 1791 consecutive patients underwent thyroidectomy at a single academic institution between May 1994 and December 2009. 838 patients had a MNG, which we defined as ≥2 nodules on pre-operative ultrasound. The medical records of these patients were reviewed and analyzed. Results A final pathologic diagnosis of malignancy was found in 260 of 838 (31%) of MNG patients. Of the 260 patients with malignancy, 113 (44%) had a focus of cancer <1 cm. Of the patients with malignancy on final pathology, pre-operative FNA detected only 46% (n=120). Of the 140 cancers not recognized pre-operatively, 61 (44%) were >1 cm in size. On univariate analysis risk factors for malignancy were younger age and male gender. Patients with malignant nodules also had smaller nodules, smaller thyroids, and fewer nodules than those patients with benign findings on pathology. On multivariate analysis all predictors remained independently associated with malignancy with the exception of thyroid weight. Conclusion Risk factors for malignancy in a MNG included male gender, younger age, fewer nodules, and smaller nodule size. The low predictive value of FNA in our population suggests there needs to be better ways to predict malignancy in patients with MNG. Therefore, these clinical risk factors should be considered when consulting patients with MNG in regards to their risk of malignancy.

Association between neutrophil-to-lymphocyte ratio and differentiated thyroid cancer: a meta-analysis

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An intact parathyroid hormone–based protocol for the prevention and treatment of symptomatic hypocalcemia after thyroidectomy

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A Conservative Approach Is Reasonable in Patients with Non-Toxic Goitre: Results from an Observational Study during 30 Years

“…The incidence of thyroid carcinomas in thyroidectomy specimens from patients with benign goitre varies between 4 and 31% [16,20,21,22,23,24,25,26,27,28,29,30,31,32]. The risk of developing thyroid carcinoma in longstanding untreated goitre has been addressed in some previous, rather old studies [10,15,16,17,19] and they report on an annual incidence of 1.3-3.7 new cases per 1,000 goitre patients.…”