Non Toxic Goiter: Cytology, Histological Analysis: A Study in Mosul

Abstract

Objective: To determine the histological findings observed in non toxic goiter of the resected thyroid tissue in Mosul city & compare them with the results of Fine Needle Aspiration Cytology in order to assess the role of this method in the early diagnosis & correct management of both multinodular goiter & solitary thyroid nodule. Specimens were obtained from Al-Jumhuri Teaching Hospital & histological analysis was performed in the Department of Anatomy, College of Medicine, University of Mosul from January 2010 to June 2010.Patients & Methods: Patients were classified according to the preoperative clinical diagnosis into those with non toxic multinodular goiter & those with solitary thyroid nodules, preoperative clinical diagnosis was confirmed by Fine Needle Aspiration Cytology in which patient lies supine with extended neck, the skin over the most prominent point of the goiterous thyroid is treated with antiseptics. A 10 ml syringe is used with a (21gauge) needle, gentle suction was applied & material was aspirated into the lumen of the syringe then the needle was disconnected & specimen was ejected onto a glass slide then smeared by sliding across another slide then fixed by spraying with fixative solution & examined & cytological reports of all the cases were prepared to be compared later with the histopathological reports of the removed thyroid tissue after operation.Postoperatively the biopsies were fixed in 10% formaline, processed & stained with Haematoxylline & Eosin for histological analysis. Statistical analysis of the histological findings was conducted using Chi-square test. Results: non toxic goiter is more common in female than male. Fine needle aspiration cytology is a well established technique in the preoperative investigation of thyroid diseases. Specimens obtained from patients presented with multinodular goiter showed variable sized thyroid follicles, huge follicles were filled with colloid and lined by flattened epithelial cells; most of the nodules were not encapsulated. Specimens obtained from follicular adenoma showed well developed microfollicles with intact fibrous thin capsule. Degenerative changes in the stromal tissue such as haemorrhge , fibrosis & even calcification were present in some of the cases. Discrete thyroid swellings (solitary thyroid nodules) are present in 3–4% of the adult population; If hyperthyroidism associated with a discrete swelling it indicates a manifestation of toxic multinodular goiter. Solitary thyroid nodule was observed as a hard, irregular swelling with apparent unusual fixity associated with scanty normal follicular cells together with colloid.Keywords: Goiter, Follicular adenoma, Solitary thyroid nodule.