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Year : 2022  |  Volume : 17  |  Issue : 3  |  Page : 799

Is surgery necessary in benign thyroid lesions?

Department of Pathology, Shri Sathya Sai Medical College and Research Institute, (A Constituent College of Sri Balaji Vidyapeeth, Puducherry), Chengalpet, Tamil Nadu, India

Date of Submission14-Mar-2019
Date of Decision21-Oct-2019
Date of Acceptance27-Jan-2020
Date of Web Publication2-Nov-2022

Correspondence Address:
Dr. Pushkar Chaudhary
1st Floor, Department of Pathology, Shri Sathya Sai Medical College and Research Institute, Ammapettai Village, Thiruporur - Guduvancherry Main Road, Sembakkam Post, Chengalpet - 603 108, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdmimsu.jdmimsu_58_19

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How to cite this article:
Chaudhary P, Noorunnisa N. Is surgery necessary in benign thyroid lesions?. J Datta Meghe Inst Med Sci Univ 2022;17:799

How to cite this URL:
Chaudhary P, Noorunnisa N. Is surgery necessary in benign thyroid lesions?. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2023 Feb 1];17:799. Available from: http://www.journaldmims.com/text.asp?2022/17/3/799/360228


Thyroid diseases have a substantial burden worldwide, and around 42 million people in India are suffering.[1] Thyroid swellings are approached in an algorithmic manner starting with serum thyrotropin (TSH) measurement, ultrasonography (USG) followed by fine-needle aspiration cytology (FNAC), and surgery. Each modality of the management is required only if it meets certain criteria as per the standard guidelines.[2] Serum TSH levels and USG thyroid should be performed in all the patients with suspected thyroid nodules. Fine-needle aspiration (FNA) for cytology is strongly recommended for most of the thyroid swellings unless it is purely cystic or <1 cm.[2] FNAC reports should be given using the standard Bethesda system which categorizes results in six categories.[3]

Nondiagnostic cases are approached again for FNA with USG guidance following 3-month waiting time to reduce the false-negative results.[2] This waiting period should be followed unless a very high suspicion of malignancy reported in USG.[2] Furthermore, rapid on-site evaluation must be used to increase the yield of FNA sample. Immediate treatment is not required in benign swellings, whereas primary thyroid malignancy and suspected malignancy are treated similarly by surgery.[2] Most of the nondiagnostic thyroid nodules are benign, and no surgery is needed. The patient with benign thyroid conditions diagnosed after FNA should be on a continuous follow-up monitored by USG once in a year and twice in suspicious cases. Surgical intervention is not needed in asymptomatic benign thyroid nodules.[2]

Surgery is indicated in growing nodules having size more than 4 cm causing compressive symptoms.[2] In FNA cases with atypia of undetermined significance, the current recommendation is repeated FNAC and molecular diagnosis to rule out malignancy. A molecular diagnosis is not feasible in all cases in a developing country like India. In follicular neoplasm/suspicious for follicular neoplasm, also molecular testing is recommended. If molecular testing is either not performed or inconclusive, surgical excision may be considered.[2]

In India, most of the thyroidectomy surgeries turn out to be benign and could be avoided.[4],[5] To conclude, the thyroidectomy procedure should only be used following standard guidelines and recommendations to save a patient's thyroid gland and to avoid unnecessary agonizing complications.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Unnikrishnan AG, Menon UV. Thyroid disorders in India: An epidemiological perspective. Indian J Endocrinol Metab 2011;15:S78-81.  Back to cited text no. 1
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016;26:1-133.  Back to cited text no. 2
Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid 2017;27:1341-6.  Back to cited text no. 3
Mehrotra D, Anita AM, Andola SK, Patil AG. Thyroid cytology evaluation based on the Bethesda system with clinico-morphological correlation. Ann Pathol Lab Med 2016;3:347-55.  Back to cited text no. 4
Agarwal S, Jain D. Thyroid cytology in India: Contemporary review and meta-analysis. J Pathol Transl Med 2017;51:533-47.  Back to cited text no. 5


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