Frequency of Malignancy in Patients with Solitary Thyroid Nodule
DOI:
https://doi.org/10.52206/jsmc.2025.15.4.1348Abstract
Background: The thyroid gland is the largest endocrine gland in the human body and the most frequent site of primary endocrine malignancies. Solitary thyroid nodules (STNs) are clinically significant because of their malignant potential, with reported global malignancy risks ranging between 5% and 30%.
Objective: This study aimed to determine the frequency of malignancy in patients with STNs presenting at a tertiary care hospital in Swat, Pakistan.
Methodology: A cross-sectional study was conducted in the ENT Department of Saidu Group of Teaching Hospital, Swat, between January 2024 and May 2025. A total of 164 patients aged 20–65 years with ultrasonographically confirmed STNs (TIRADS ≥3) who underwent thyroid surgery were included. Fine-needle aspiration cytology (FNAC) was performed and classified using the Bethesda System, while histopathology of surgical specimens served as the diagnostic gold standard. Data were analyzed using SPSS v21, with chi-square tests applied for associations and logistic regression performed to adjust for confounders.
Results: The mean age of patients was 40.1 ± 11.4 years, with females comprising 68.9% of the cohort. Histopathology confirmed benign nodules in 82.3% (n=135) and malignancy in 17.7% (n=29). Among benign cases, colloid goiter (32.9%), follicular adenoma (26.2%), and nodular goiter (23.2%) were most frequent. Papillary carcinoma (13.4%) was the predominant malignant subtype, followed by follicular carcinoma (3.7%) and anaplastic carcinoma (0.6%). No statistically significant associations were observed between malignancy and patient age (p=0.109), gender (p=0.188), or residence (p=0.477). Bethesda categories V/VI were strongly predictive of malignancy.
Conclusion: Malignancy was identified in nearly one-fifth of surgically managed STNs, with papillary carcinoma being the most common subtype. These findings underscore the importance of FNAC and ultrasound-based risk stratification in preoperative evaluation to avoid unnecessary surgeries and optimize patient management.
Keywords: Fine-needle aspiration cytology, Papillary carcinoma, Solitary thyroid nodule, Thyroid malignancy.
References
Tai JD, Yang JL, Wu SC, Wang BW, Chang CJ. Risk factors for malignancy in patients with solitary thyroid nodules and their impact on the management. Journal of cancer research and therapeutics. 2012 Jul 1;8(3):379-83. https://doi.org/10.4103/0973-1482.103516
Harshvardhan R, Jorwal V, Gupta S, Sharma V, Sehra R, Agarwal S. Assessment of accuracy of fine needle aspiration cytology and ultrasonography in relation to histopathology in cases of solitary thyroid nodule. Indian Journal of Otolaryngology and Head & Neck Surgery. 2020 Oct 13:1-8. https://doi.org/10.1007/s12070-020-02215-
Manzoor A, Khan F, Jamal S. Frequency of malignancy in multi-nodular goiter: A tertiary care hospital experience. Journal of Islamabad Medical & Dental College (JIMDC). 2015;4(2):64-7.
Melak T, Mathewos B, Enawgaw B, Damtie D. Prevalence and types of thyroid malignancies among thyroid enlarged patients in Gondar, Northwest Ethiopia: a three years institution based retrospective study. BMC cancer. 2014 Dec 2;14(1):899. https://doi.org/10.1186/1471-2407-14-899
Uludag M, Unlu MT, Kostek M, Aygun N, Caliskan O, Ozel A, et al. Management of thyroid nodules. The Medical Bulletin of Sisli Etfal Hospital. 2023 Sep 29;57(3):287. https://doi.org/10.14744/SEMB.2023.06992
Ajarma KY, Al-Faouri AF, Al Ruhaibeh MK, Almbaidien FA, Nserat RT, Al-Shawabkeh AO, et al. The risk of thyroid carcinoma in multinodular goiter compared to solitary thyroid nodules: A retrospective analysis of 600 patients. medical journal armed forces india. 2020 Jan 1;76(1):23-9. https://doi.org/10.1016/j.mjafi.2018.05.001
Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. Journal of cancer epidemiology. 2013;2013(1):965212. https://doi.org/10.1155/2013/965212
Menon U, Sundaram KR, Unnikrishnan AG, Jayakumar RV, Nair V, Kumar H. High prevalence of undetected thyroid disorders in an iodine sufficient adult south Indian population. Journal of the Indian Medical Association. 2009 Feb 1;107(2):72-7.
Iqbal M, Mehmood Z, Rasul S, Inamullah, Shah SS, Bokhari I. Carcinoma thyroid in multi and uninodular goiter. Journal of the College of Physicians and Surgeons Pakistan (JCPSP). 2010;20(5):310–2. https://doi.org/10.2008/JCPSP.310312
Jaheen H, Sakr M. Predictors of malignancy in patients with solitary and multiple thyroid nodules. J Surg. 2016;12(3):105-3. https://doi.org/10.7438/1584-9341-12-3-3
Naz Akhtar. Majeed Ullah Buzdar, M Amjad Khan. Frequency of Malignancy in Solitary Thyroid Nodule. PJMHS. 2015:9.(3).98-3
Alzahrani HA. Malignancy in a Solitary Thyroid Nodule: A Retrospective Histopathological Evaluation. International Journal of General Medicine. 2024 Dec 31:135-40. https://doi.org/10.2147/IJGM.S445734
Brito JP, Gionfriddo MR, Al Nofal A, Boehmer KR, Leppin AL, Reading C, et al. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism. 2014 Apr 1;99(4):1253-63. https://doi.org/10.1210/jc.2013-2928
Haugen BR. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: what is new and what has changed?. Cancer. 2017 Feb 1;123(3):372-81. https://doi.org/10.1002/cncr.30360
El Sayed Ibrahim MM, Omar W, Elhofy A. Prospective study evaluating malignancy in solitary thyroid nodule. The Egyptian Journal of Surgery. 2019 Jul 1;38(3). https://doi.org/10.4103/ejs.ejs_8_19.
Molinaro E, Romei C, Biagini A, Sabini E, Agate L, Mazzeo S, et al. Anaplastic thyroid carcinoma: from clinicopathology to genetics and advanced therapies. Nature Reviews Endocrinology. 2017 Nov;13(11):644-60. https://doi.org/10.1038/nrendo.2017.76
Vanderpump MP. The epidemiology of thyroid disease. British medical bulletin. 2011 Sep 1;99(1). https://doi.org/10.1093/bmb/ldr030
Dean DS, Gharib H. Epidemiology of thyroid nodules. Best practice & research Clinical endocrinology & metabolism. 2008 Dec 1;22(6):901-11. https://doi.org/10.1016/j.beem.2008.09.019
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 The authors retain the copyrights. Authors are permitted and encouraged to post their work online (e.g. in institutional repositories or on their website), as it can lead to productive exchanges, as well as greater citation of published work.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
