|LETTER TO EDITOR
|Year : 2022 | Volume
| Issue : 3 | Page : 799
Is surgery necessary in benign thyroid lesions?
Pushkar Chaudhary, Naseem Noorunnisa
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 Submission||14-Mar-2019|
|Date of Decision||21-Oct-2019|
|Date of Acceptance||27-Jan-2020|
|Date of Web Publication||2-Nov-2022|
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
Source of Support: None, Conflict of Interest: None
|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
Thyroid diseases have a substantial burden worldwide, and around 42 million people in India are suffering. 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. 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. FNAC reports should be given using the standard Bethesda system which categorizes results in six categories.
Nondiagnostic cases are approached again for FNA with USG guidance following 3-month waiting time to reduce the false-negative results. This waiting period should be followed unless a very high suspicion of malignancy reported in USG. 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. 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.
Surgery is indicated in growing nodules having size more than 4 cm causing compressive symptoms. 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.
In India, most of the thyroidectomy surgeries turn out to be benign and could be avoided., 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.
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