A Clinical Review of Surgically Treated Thyroid Nodules

Cheun, Haeng Ok; Kim, Ki Hwan; Kang, Yong Ik; Kong, Sang Ki

Abstract

Thyroid nodules are the most common endocrine disease requiring surgical management. Various techniques for evaluating thyroid nodules have been developed and are being utilized, but it is difficult to differentiate the few malignant lesions from the numerous benign nodules. We reviewed 187 patients with thyroid nodules who were admitted to and operated on at the Department of General Surgery, Buchon Sejong General Hospital, from January 1990 to December 1996. The results are summarized as follows: 1) The incidence of benign nodules was 83.9%, and that of malignant nodules was 16.0% among the 187 cases of thyroid nodules. 2) The sexual distribution revealed female preponderance of 6.5:1 for benign nodules and 14:1 for malignant nodules. 3) The peak-incidence was in the 4th decade to both patients with benign nodules and patients with malignant nodules. 4) As to the duration of illness, 39.6% of cases were resolved within 3 months, 77.5% of cases within 1 year. 5) The most common subjective symptoms were a palpable mass (100%), fatigue, palpitation, and headache, in order of frequency. 6) Eight four percent (84%) of the nocules were unilateral, 46.5% were on the right, 37.4% were on the left, and 12.8% were bilateral. 7) The most common (36.9%) nodule size was 2~3 cm. 8) There was a single nodule in 142 (75.9%) cases and multiple nodules in 45 (24.1%) cases. There was no difference in the incidence of cancer between single and multiple nodules. Also, 35.7% of the benign tumors and 80.0% of the malignant ones were solid. 9) On thyroid scanning, 86.0% of the benign nodules and 93.3% of the malignant nodules were cold nodules. 10) The histopathologic classifications of the benign nodules in decreasing order of frequency were adenomatous goiter, 121 cases (77.1%); follicular adenoma, 20 cases (12.7%); Graves' disease, 6 cases (3.8%); Hashimoto's thyroiditis, 6 cases (3.8%), cyst, 3 cases (1.9%); and subacute thyroiditis, 1 case (0.6%). The malignant diseases were papillary carcinoma, 26 cases (86.7%); follicular carcinoma, 3 cases (10.0%); and medullary carcinoma, 1 case (3.3%). 11) Benign nodules were treated with a lobectomy (69.4%), a lobectomy with isthmectomy (17.8%), a near total thyroidectomy (11.5%) or a total thyroidectomy (1.3%). Malignant nodules were treated with a lobectomy (23.3%), a lobectomy with isthmectomy (20.0%), a total thyroidectomy (20%), a total thyroidectomy with radical neck dissection (20%) a near total thyroidectomy (13.3%), or a near total thyroidectomy with radical neck disection(RND) or modified RND (3.3%). 12) The postoperative complications were transient hypocalcemia (6.4%), permanent hypocalcemia (2.1%), transient hoarseness (1.6%), permanent hoarseness (0.5%), and hematoma (0.5%).