Frequency of Thyroid Cancer in Multinodular Goiter Undergoing Thyroidectomy in Tertiary Care Centre in Pakistan: A...

Goiter is a common condition in the northwest regions of Pakistan, with multinodular goiter (MNG) being a frequent presentation of thyroid diseases. Multinodular goiter (MNG) is common worldwide, with variable reported risks of malignancy. Data from South Asia, particularly Pakistan, remains limited and somewhat outdated. This study highlights important expectations regarding suspicion of malignancy and emphasizes the prevalence of different types of malignancies in MNG patients.

A retrospective cross-sectional study was conducted with data collected from patient records who underwent thyroidectomy in the Department of Surgery from June 2019 to April 2024 in Karachi, Pakistan. A total of 520 patients aged 30-70 years undergoing total thyroidectomy for clinically and radiologically diagnosed MNG were included. Suspicious nodules were identified preoperatively by ultrasound and/or FNAC (Bethesda V-VI). Histopathology confirmed carcinoma. Patients with recurrent goiter, solitary nodules, thyroid crisis, pre-existing malignancy, or significant comorbidities were excluded. Descriptive statistics, Chi-square testing, and multivariate logistic regression were applied using SPSS version 25, with p-values below 0.05 considered statistically significant.

A total of 520 patients with MNG were included, of whom 84 (16%) had thyroid carcinoma. The mean age of carcinoma patients was 49.2 ± 9.4 years, and 76.9% were female. Histological subtypes included papillary carcinoma (64.2%), follicular carcinoma (23.8%), and anaplastic carcinoma (11.9%). In multivariate analysis, smoking (OR 2.41, 95% CI 1.08-5.38, p = 0.03) and urban residence (OR 1.89, 95% CI 1.03-3.47, p = 0.04) were independent predictors of papillary carcinoma.

Thyroid carcinoma was present in 16% of MNG cases, predominantly papillary type. Smoking and urban residence emerged as significant risk factors for papillary thyroid carcinoma. Preoperative ultrasound and FNAC remain critical for risk stratification. Larger multicenter studies with molecular profiling are warranted.