Thyroid Malignancy - Our Experience

Thyroid carcinoma is the most common endocrine cancer, with increasing detection due to advances in imaging and cytology. Differentiated types generally have good prognosis, while aggressive variants present treatment challenges. Resource-limited settings require tailored management protocols. This study reports a 10-year experience from a tertiary center in India, focusing on clinical presentation, management, surgical findings, complications, and outcomes. This retrospective study included 118 patients with histologically confirmed thyroid carcinoma who underwent thyroidectomy from January 2013 to December 2022. Data on clinical features, imaging (ultrasonography, contrast-enhanced CT), FNAC (Bethesda classification), intraoperative findings, surgical approach, histopathology, adjuvant therapy, and follow-up were analyzed. Patients with benign thyroid disease were excluded. The cohort comprised predominantly females (74.6%) with a mean age of 39.4 years; the most common presenting complaint was neck swelling (92%). Papillary thyroid carcinoma accounted for 79.7% of cases, followed by medullary (10.2%) and follicular carcinoma (8.5%). Most nodules were solitary (52%) and classified as TIRADS IV or V (90%), with Bethesda V/VI cytology in 50%. Stage I disease predominated (71.2%), and total thyroidectomy (with or without neck dissection) was performed in 81% of patients. Zuckerkandl's tubercle was identified in 75% of lobes, and anatomical variations of the recurrent and superior laryngeal nerves were carefully documented. Postoperative complications were limited to 4.2%, including one case each of permanent hypocalcemia and transient recurrent laryngeal nerve palsy. Kaplan-Meier analysis showed 10-year recurrence-free survival rates exceeding 90% for Stage I patients. Statistically significant associations were found between FNAC Bethesda category and final histopathology (p = 0.0019), and with TNM stage (p = 0.0436). This study highlights distinct demographic and pathological features of thyroid malignancies in a resource-constrained Indian center, including younger age and diverse histologies. Strong FNAC-pathology concordance supports cytology's diagnostic value when combined with imaging. Standardized surgical protocols with careful anatomical dissection resulted in excellent functional outcomes and low complication rates. Favorable long-term survival underscores the effectiveness of individualized, risk-adapted management. These findings stress the importance of early diagnosis, precise surgery, and context-specific care to optimize outcomes.