Follicular neoplasm involving one lobe of thyroid: is hemithyroidectomy the adequate initial procedure?

AIM

Ultrasound-guided fine-needle aspiration cytology (FNAC), intraoperative frozen section, elastography and molecular markers have been tried to predict malignancy in indeterminate thyroid lesions. However, only histopathological evidence of capsular and vascular invasion can confirm malignancy. The aim of this study is to determine the effectiveness of hemithyroidectomy (HT) as an adequate surgical intervention in patients having cytologically proven follicular neoplasm limited to one lobe of the thyroid in a resource-limited country like India.

MATERIALS AND METHODS

A retrospective study was conducted. The data of all patients operated for FNAC-proven follicular neoplasm (2008-2011) were analysed.

RESULTS

A total of 123 cases had FNAC-proven follicular neoplasm. Fourteen were male and 109 female. Forty-six patients with multiple nodules involving both lobes (MNG) underwent total thyroidectomy (TT), whereas 77 who had solitary thyroid nodule (STN) underwent HT. Among patients who had HT (n = 77), histopathology revealed malignancy in 3.6% (n = 3). Patients who needed completion thyroidectomy (CT) were older females (p = 0.02) with higher TSH levels (p = 0.0001), shorter duration of goitre (p = 0.01) and smaller nodules (p = 0.04).

CONCLUSIONS

Hemithyroidectomy is an adequate initial surgical procedure for FNAC-proven follicular neoplasm. The incidence of carcinoma is 3.9%. Older subjects with high normal TSH are likely to have malignancy. Routine employment of intraoperative frozen section, elastography and molecular markers is not necessary if locally unavailable, since the incidence of malignancy in FNAC-proven follicular neoplasm is low.