Displaying all 17 publications

  1. Abd Rahim A, Muhammad R, Ismail F, Wong YP, Che Abdul Aziz R, Chong GY, et al.
    Malays J Pathol, 2023 Aug;45(2):275-283.
    PMID: 37658537
    Thyroid carcinoma is uncommon. Papillary thyroid carcinoma (PTC) represents the majority of differentiated thyroid carcinoma and is a recognised complication of prior exposure to ionizing radiation. Even more uncommon is the synchronous occurrence of PTC with Hodgkin lymphoma (HL) as multiple primary malignancies. We report a 33-year-old mother of three who developed asymptomatic thyroid nodule for four years, and neck swelling for the recent ten months. She denied constitutional symptoms or B symptoms, and thyroid profiles were normal. Initially, metastatic thyroid cancer was suspected based on ultrasound scan findings of enlarged left thyroid gland and enlarged supraclavicular lymph nodes (LN). However, fine needle aspiration examinations of the thyroid nodule were inconclusive, and the supraclavicular LN was suspicious of HL. Computerised tomography scan detected a large mass at the thyroid glands and lymphadenopathies in the mediastinal, hilar, subcarinal and axilla with dimensions up to 6 cm. Left hemi-thyroidectomy with left supraclavicular LN biopsy revealed PTC in the left thyroid lobe measuring 38 x 25 x 18 mm, and the left supraclavicular LN was not definitive of HL. Completion thyroidectomy on the right side, bilateral central neck dissection and excision biopsy of the right supraclavicular LN revealed the presence of HL in the right supraclavicular LN, and both HL and metastatic PTC in right central LN. After multidisciplinary discussions, the patient received chemotherapy at four weeks postoperatively and achieved complete remission. This report highlights the importance of patient-centered approach and multidisciplinary consensus within lack of established guidelines, given rarity of the case.
    Matched MeSH terms: Thyroid Nodule*
  2. Farihah AG, Nurismah MI, Husyairi H, Shahrun Niza AS, Radhika S
    Med J Malaysia, 2018 02;73(1):9-15.
    PMID: 29531197 MyJurnal
    AIM: This study aims to evaluate the reliability of the Ultrasound (U) Classification system in predicting thyroid malignancy by using pathology diagnosis as the reference standard.

    METHODS: It was a cross-sectional study carried out at Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Malaysia. Records of patients with focal thyroid nodules on ultrasound (US) for which US-guided fine needle aspiration cytology (FNAC) was performed and pathology results were available, from January 2014 to May 2016 were selected for review. Correlation of the U Classification with pathology results was assessed. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, predictive value, negative predictive value and accuracy were calculated in a conservative and non-conservative method. The threshold for statistical performance was set at 0.05. Each sonographic feature was also compared with its pathology results.

    RESULTS: A total of 91 patients with 104 nodules were eligible. 12 nodules out of 104 (11.5%) were malignant. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value and accuracy were 100%, 91.3%, 11.5, 0.0, 60%, 100% and 92.3%, and 100%, 91.4%, 11.7%, 0.0, 78.6%, 100% and 93.5%, for the non-conservative and conservative method of calculations respectively.

    CONCLUSION: The U Classification is reliable in predicting thyroid malignancy. More evidence is nevertheless necessary for widespread adaptation and use.

    Matched MeSH terms: Thyroid Nodule
  3. Krishnappa P, Ramakrishnappa S, Kulkarni MH
    J Environ Pathol Toxicol Oncol, 2013;32(2):149-55.
    PMID: 24099428
    Fine-needle aspiration (FNA) cytology of the thyroid is usually performed on an outpatient basis. The results of FNA are operator dependent and may be affected by the lesion characteristics and the aspiration technique. In current practice ultrasound (US) is widely used to guide the needle for aspiration of nondominant nodules. Our study aimed to compare the free-hand FNA with US-guided FNA in the evaluation of thyroid nodules. A total of 91 cases of thyroid lesions were studied at the Department of Pathology, Karnataka Institute of Medical Sciences, Hubli, India. All the cases underwent free-hand and US-guided FNA. The cytological samples from both procedures were analyzed for adequacy, cytological features, and possible diagnosis. The results were correlated with histopathological diagnosis whenever possible. Of 91 aspirates, 89 were satisfactory and 2 were unsatisfactory on US-guided FNA, whereas 85 were satisfactory and 6 were unsatisfactory in free-hand FNA. Of 91 cases 68 (74.7%) were nonneoplastic lesions and 21 (23.1%) were neoplastic lesions in US-guided FNA, whereas 67 cases (73.6%) were nonneoplastic and 18 cases (19.8%) were neoplastic in free-hand FNA. Histopathological study was possible in 25 patients, among whom 15 lesions were nonneoplastic and 10 were neoplastic. Sensitivity and specificity of US-guided FNA to detect neoplastic lesions were 81.81% and 92.85%, respectively, compared with free-hand FNA, for which the sensitivity and specificity were 54.54% and 92.85%, respectively. The diagnostic accuracy of guided FNA was 88% against the 76% accuracy rate of free-hand FNA. US-guided FNA provides a better representative sample and has a higher diagnostic rate in the evaluation of thyroid lesions.
    Matched MeSH terms: Thyroid Nodule/pathology; Thyroid Nodule/ultrasonography
  4. Kuan YC, Tan FH
    QJM, 2014 Jun;107(6):475-6.
    PMID: 24106316 DOI: 10.1093/qjmed/hct204
    Matched MeSH terms: Thyroid Nodule/diagnosis*
  5. Loo CH, Khoo ACH, Tan WC, Khor YH, Tang JJ, Tang MM, et al.
    World J Nucl Med, 2020 08 22;20(1):32-37.
    PMID: 33850487 DOI: 10.4103/wjnm.WJNM_33_20
    Hidradenitis suppurativa (HS) is known to have association with systemic diseases with chronic inflammation such as psoriasis. We aim to describe the concomitant systemic inflammation in patients with HS using 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) scan. This was a case-control study conducted in three tertiary hospitals in Northern Malaysia from January to December 2017, involving HS patients aged 18 years and above. Thirty-two HS patients with age- and sex-matched controls were recruited with a mean age of 31.4 years (range: 18-56). Numerous cutaneous inflammatory foci were detected on FDG-PET/CT scan in clinically unapparent sites (27/32, 84.4%). Approximately 90.6%, 93.8%, and 50.0% of the patients had significantly higher cutaneous uptake over nasal, mandibular, and scalp regions, respectively (P < 0.0001). PET/CT scan did not detect any systemic inflammation unlike those found in psoriasis. Three (9.4%) patients had thyroid nodules with high uptake (maximum standard uptake values ranging from 2.9 to 11.3). Two of them were confirmed to have papillary thyroid carcinoma, while the third patient has inconclusive finding. 18F-FDG PET/CT scan may be useful to map disease burden of HS. Nonlesional inflammatory foci on the skin of the nose, mandibular, and scalp are probably significant. The association of thyroid carcinoma in HS warrants further evaluation.
    Matched MeSH terms: Thyroid Nodule
  6. Meah FA, Qureshi MA
    Med J Malaysia, 1998 Dec;53(4):453-6; quiz 457-8.
    PMID: 10971996
    Solitary thyroid nodules are commonly seen in surgical outpatient clinics. A detailed history and a careful physical examination are essential. In the management of the solitary thyroid nodule, fine needle aspiration cytology has become the cornerstone investigation. Ultrasound cannot differentiate between benign and malignant nodules, however is useful in the follow-up period to identify any further nodular growth. As thyroid malignancy occurs in both hot and cold nodules, radionuclide scans are not useful in the management of solitary thyroid nodules. We have attempted to outline the process of managing the solitary thyroid nodule and discuss the options available.
    Matched MeSH terms: Thyroid Nodule/pathology; Thyroid Nodule/surgery*
  7. Nurismah, M.I., Sharifah, N.A., Usama, A.E., Rohaizak, M., Naqiyah, I., Jasmi, A.
    Medicine & Health, 2007;2(1):58-65.
    Thyroid nodules are common but thyroid malignancies are not. Fine needle aspiration (FNA) cytology is a diagnostic tool used to screen patients with thyroid nodules who require surgery. We study the diagnostic accuracy of FNA as the initial diagnostic modality in the clinical assessment of thyroid nodules. Between January 1995 until December 2000, 2131 FNA of thyroid nodules were performed. Four hundred and forty-one (20.7%) of these were unsatisfactory and 1690 (79.3%) cases were satisfactory for cytological evaluation. Histopathological diagnosis were available for 361 cases. Cyto-histopathological correlation was carried out  for these cases. Our results showed a diagnostic accuracy of 96.2% with sensitivity and specificity rates of 87.7% and 98.4% res- pectively. Our positive predictive value is  93.4% and our negative  predictive value is 96.8%.  From this study, we conclude that fine needle aspiration is an important initial screening diagnostic tool for the investigation of thyroid nodules.           
    Matched MeSH terms: Thyroid Nodule
  8. Palo S, Biligi DS
    Malays J Pathol, 2017 Apr;39(1):55-67.
    PMID: 28413206
    OBJECTIVE: Due several overlapping histomorphological features and pitfalls in thyroid pathology, there is need to establish a panel of immunomarkers that would aid in proper diagnosis. This study was carried out to investigate the ability of HBME-1, CK19, and S100 in differentiating between hyperplastic, benign and malignant thyroid lesions.

    MATERIALS AND METHODS: Immunohistochemical analysis of 60 thyroidectomy specimens (10 hyperplastic nodules, 14 follicular adenomas and 36 malignant thyroid neoplasms) was carried out. The extent and intensity of HBME-1, CK19, and S100 immunoreactivity was assessed in each case.

    RESULTS: HBME-1 positivity was noted in 86.1% of malignant cases while the majority of the benign lesions were negative. Diffuse strong CK19 positivity was documented in 27/31 papillary carcinoma whereas all cases of follicular carcinoma and medullary carcinoma were negative. Most of the hyperplastic nodules and follicular adenomas were also CK19 negative, although focal weak staining was noted in a few cases. S100 was positive only in medullary carcinoma. HBME-1 was most sensitive (86.1%) and specific (87.5%) in distinguishing between benign and malignant thyroid lesions. The diagnostic accuracy was further increased when HBME-1 was used simultaneously with CK19/S100/CK19+S100. The sequential use of HBME-1 and CK19 also proved beneficial in discriminating between the various follicular-patterned thyroid lesions.

    CONCLUSION: HBME-1 immunolabeling suggests malignancy, whereas strong diffuse CK19 positivity substantiates papillary differentiation. The utilization of these markers (alone or in combination) along with histomorphological evaluation is helpful in the differential diagnosis. S100 has minimal utility in this regard.

    Matched MeSH terms: Thyroid Nodule/pathology
  9. Pillay B, Thambi Dorai CR, Sharma K, Yap SK
    Family Physician, 1990;2:33-37.
    Matched MeSH terms: Thyroid Nodule
  10. Rohaizak M, Meah FA
    Med J Malaysia, 2002 Jun;57(2):218-20.
    PMID: 24326656
    Schwannomas are rare tumours arising from peripheral nerve linings. A case of a schwannoma arising from cervical sympathetic chain is presented. The clinical presentation was that of a right solitary thyroid nodule. Intra-operatively, a 3 x 3 cm encapsulated lesion was seen arising posterior to the vagas nerve and attached to the cervical sympathetic trunk. The lesion was excised together with part of the nerve. Post-operatively, the patient developed Horner's syndrome that persisted. Unitil 2000, less that 50 cased of cervical sympathetic schwannoma have been described in the Englidh literature. A brief description of the pathology, presentation, diagnosis and treatment of this condition is presented.
    Matched MeSH terms: Thyroid Nodule*
  11. Rohaizak, M., Aman Fuad, Y., Naqiyah, I., Saladina, J.J., Shahrun Niza, A.S.
    Background: Thyroid swelling or goitre is a common condition, either asymptomatic or symptomatic. The
    diagnosis is usually established by ultrasound or fine needle aspiration cytology (FNAC) as a gold standard.
    The sensitivity of the test is inversely related to increasing size of the nodule. The objective of this study is
    to evaluate the accuracy of FNAC especially in cases of large goitre.

    Material and methods: This is a
    retrospective study on patients who underwent thyroidectomy between January 2000 to December 2007 for
    solitary or dominant nodular goitre. The analysis was made only on those patients with complete data on
    FNAC and histology.

    Result: There were 235 patients, but only 161 patients were analysed after excluding
    the suspicious and inadequate sample. The patients’ mean age was 42.1 year old (21 to 60). The size of the
    thyroid nodule ranged from 2.1 to 5.0 cm (mean = 3.9 cm). The overall sensitivity was 67.4% and the overall
    accuracy was 86.3%. The accuracy of FNAC according to the sizes above and below the value were as
    follows; 2 cm (72.2% vs. 88.1%); 3 cm (88.0% vs. 87.4%) ; 4 cm (86.6% vs. 84.4%) ; 5 cm (87.3% vs. 78.8%).
    This was most obvious in the sensitivity of the FNA which also showed reducing trend as the nodules
    increased in size.

    Conclusion: FNAC is an essential diagnostic tool in the management of nodular goitre.
    Our study showed that the accuracy of FNAC decreased as the size of the nodule getting bigger. Cautious
    approach should be taken in the management of large goitre and decision should not be based only on the
    result of FNAC.
    Matched MeSH terms: Thyroid Nodule
  12. Saniasiaya J, Mohamad I
    Oman Med J, 2016 Sep;31(5):384-6.
    PMID: 27602195 DOI: 10.5001/omj.2016.76
    Patients with anterior neck masses commonly present to otorhinolaryngology clinics, but there are limited differential diagnoses for such lesions. Common ones include thyroid nodule and thyroglossal duct cyst. In an elderly patient, a differentiated thyroid carcinoma should be suspected especially if it moves with swallowing. We encountered a typical presentation of a solitary thyroid nodule-like mass with the exception of pulsation in a 65-year-old female. Further investigation, using neck ultrasonography, revealed that it was a variant of right common carotid artery arising from the left common carotid artery. Knowledge of such variants is of great importance as ignorance of such a variation may lead to inadvertent surgical complications during procedures.
    Matched MeSH terms: Thyroid Nodule
  13. Subha ST, Bakri MA, Salleh H, Doi M, Nordin AJ
    Iran J Otorhinolaryngol, 2018 Jan;30(96):49-54.
    PMID: 29387664
    Introduction: Papillary thyroid carcinoma (PTC) constitutes 75-85% of all thyroid cancers. PTC usually presents as a subtle, commonly slow-growing, painless thyroid mass or a solitary nodule in the neck. This presentation of a cystic neck lump, without the presence of a thyroid nodule, may imitate the course of a benign disease, thus delaying diagnosis and proper treatment.

    Case Report: Three cases that had been initially presented as a cystic neck lesion in which a benign etiology was considered primarily were compiled in this study. PTC was only diagnosed after surgical excision of these cystic neck lesions in the first two cases, and after performing fine needle aspiration cytology (FNAC) and an 18fluorine-fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG-PET CT) scan in the latter case.

    Conclusion: PTC can sometimes present as a cystic neck mass; a presentation which is usually related to a benign lesion. This case series emphasizes that patients who appear to have a solitary cystic neck mass must be treated with a high index of clinical suspicion. Although not a first-line imaging modality, 18F-FDG-PET can be extremely useful in assessing patients with a cystic neck lesion, where diagnosis is still uncertain after standard investigations such as ultrasonography and FNAC have been performed.

    Matched MeSH terms: Thyroid Nodule
  14. Tan L, Tan YS, Tan S
    Clin Imaging, 2020 Sep;65:133-137.
    PMID: 32470834 DOI: 10.1016/j.clinimag.2020.04.029
    BACKGROUND: Thyroid Imaging Reporting Data System (TI-RADS) is used to characterize thyroid nodules while reducing unnecessary FNAC. Over the years, several versions of TI-RADS have been developed but there is no consensus on which TI-RADS is the best system. This study aimed to compare the diagnostic accuracy and ability of ACR TI-RADS, EU TI-RADS, K TI-RADS, AI TI-RADS to eliminate unnecessary FNAC.

    METHODS: In this prospective study, thyroid nodules were characterized by using the four TI-RADS systems and US-guided FNAC was done for nodule with the highest ACR TI-RADS score. Correlation between TI-RADS and FNAC results were analyzed.

    RESULTS: Out of 244 thyroid nodules, 100 nodules with either size <1 cm (43 nodules) non-diagnostic or inconclusive FNAC results (57 nodules) were excluded. Seven nodules (4.9%) were confirmed to be malignant on FNAC. K TI-RADS showed 100% sensitivity and NPV but the lowest specificity (40.2%). EU TI-RADS had the highest specificity (83.2%) but the lowest sensitivity (57.1%) and NPV (97.4%). ACR TI-RADS had an average sensitivity (85.7%) and NPV (98.6%). The specificity of ACR TI-RADS (51.1%) was lower than EU TI-RADS but higher than K TI-RADS. AI TI-RADS showed higher specificity (61.8% vs 51.1%, p thyroid could be prevented by applying AI TI-RADS.

    Matched MeSH terms: Thyroid Nodule/diagnosis
  15. Vijendren A, Ladha N, Hilger AW
    Med J Malaysia, 2014 Aug;69(4):187-8.
    PMID: 25500848
    Spontaneous thyroid haemorrhages are rare. There are reported cases occurring in thyroid nodules and cysts but none in thyroid malignancies. We describe a 48 year old who presented to the on-call ENT team with a rapidly progressing neck swelling that was interfering with his airway. After resuscitation, the patient underwent a right lobectomy to stop the bleeding. Histology showed a thyroid follicular carcinoma. As per the regional multidisciplinary team discussion, he underwent a completion thyroidectomy followed by radioactive iodine treatment. We conclude that spontaneous haemorrhages of the thyroid gland can occur in malignancies and stress the importance of early histological diagnosis.
    Matched MeSH terms: Thyroid Nodule
  16. Wong YP, Sharifah NA, Tan GC, Gill AJ, Ali SZ
    Diagn Cytopathol, 2016 May 26.
    PMID: 27229757 DOI: 10.1002/dc.23493
    Oxyphilic (oncocytic) parathyroid lesions are very uncommon and their cytological features are rarely described. Due to the similarities in anatomical location and indistinguishable cytomorphological features, these lesions are easily confused with neoplastic and non-neoplastic thyroid lesions on fine needle aspiration (FNA). The diagnosis becomes more challenging in cases of unusual intrathyroidal location of the parathyroid lesions in the absence of clinical evidence of hyperparathyroidism, which simulate thyroid nodules clinically. We describe a case of intrathyroidal oxyphilic parathyroid carcinoma in a 66-year-old female, who presented with a dominant left "thyroid" nodule. FNA smears were cellular, comprising predominantly of oxyphilic cells arranged in papillary-like architecture with occasional nuclear grooves, which was mistaken for oncocytic variant of papillary carcinoma of the thyroid. The histological diagnosis of oxyphilic parathyroid "adenoma" was made following total thyroidectomy. The tumor, unfortunately, recurred 7 years later with associated multiple lung metastases. When dealing with thyroid lesions comprising predominantly of oncocytic cells, one should consider oxyphilic parathyroid neoplasms as one of the differential diagnosis. In difficult equivocal cases, a panel of immunocytochemical stains (PTH, GATA3, TTF-1, PAX8, and thyroglobulin) can be helpful. In addition, a combination of valuable clinical, radiological, and laboratory data, including serum calcium and parathyroid hormone levels are key to arriving at an accurate cytological diagnosis. Diagn. Cytopathol. 2016. © 2016 Wiley Periodicals, Inc.
    Matched MeSH terms: Thyroid Nodule
  17. Citation: Clinical Practice Guideline: Management of Thyroid Disorders. Putrajaya: Ministry of Health, Malaysia; 2019

    Quick reference: http://www.acadmed.org.my/view_file.cfm?fileid=968

    Keywords: CPG
    Matched MeSH terms: Thyroid Nodule
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