The Relationship between Clinic Pathological Characteristics and Follicular Thyroid Lesion

ButhainahIbraheem Hameed Al-Ezzi¹*, Dr. Ban Jumaah Qasim², Dr. Wijdan Basheer Abid³, Dr. MuthannaIbraheemAl-Ezzi⁴

^1,4College of Pharmacy, Mustansiryah University, Baghdad, Iraq

²Department of Pathology, College of Medicine, Al-Nahrain University, Baghdad, Iraq

³Deprtment of Biology, College of Education for Pure Sciences (Ibn Al-Haitham), University of Baghdad, Baghdad, Iraq

*Corresponding Author E-mail: forever.1964@yahoo.com

ABSTRACT:

Study was done in the period between (2015-2017) in biology department in college of Education for pure science /Ibn Al-Haitham at Baghdad University and in Pathology department /college of medicine at Al-Nahrain University.The study was retrospectively designed.The clinicopathological parameters were obtained from patients’ admission case sheets and pathology reports (age, gender).The presents study included 120 patients having thyroid nodules, classified according to results of histopathology into 4 groups, 30 patients within each; the first group included patients with follicular adenoma, the second group included patients with follicular carcinoma, the third group included patients with follicular variant of papillary carcinoma (FVPC) and the last group included patients with follicular hyperplasia.The ratio of male to female in case with follicular carcinoma was 1:4,in case with follicular variant of papillary was 1:2.33, in case with follicular adenoma was 1:5 and in case with follicular hyperplasia.

KEYWORDS: Thyroid, Follicular lesion, Tumor, Iraq, papillary.

INTRODUCTION:

Thyroid gland is endodermal in origin .It developed in the form of median thyroid diverticulum which descends into the neck from the site of the future formamen cecum and divided into two lobes [1]. The thyroid gland is the biggest gland in the neck. It is situated in the anterior (front) neck below the skin and muscle layers [2]. The thyroid gland takes the shape of a butterfly consists of two lobes united by an isthmus, which wrap around the larynx and trachea [3]. The primary function of the thyroid gland is production of the hormones T₃, T₄ and calcitonin. Up to 80% of the T₄ is converted to T₃ by organs such as the liver, kidney and spleen.

T₃ hormone is several times more powerful than T₄ hormone_,which is largely a prohormone, perhaps four or even ten times more active [4]. Thyroid nodules present a challenge in their diagnosis, assessment, and management. Often these abnormal growths/lumps are huge in size and develop at the edge of the thyroid gland, with the goal that they are felt or seen as a lump in front of the neck. The prevalence of these nodules in a given population depends on a number of factors like age, sex, diet, iodine deficiency, and even therapeutic and environmental radiation exposure [5]. The solitary thyroid nodules (STN) can be arranged into benign and malignant nodules. Generally, most 90% thyroid nodules are benign and can be classified as adenomas, infectious nodules, colloid nodules, cysts, hyperplastic nodules, lymphocytic or granulomatous nodules, thyroiditis, and congenital abnormalities[6].All thyroid adenomas are follicular adenomas. Thyroid follicular adenomas can be described as cold, warm and hot depending on their level of function [7].A thyroid follicular adenoma might be clinically silent cold and warm adenoma), or it may be a useful tumor, creating producing excessive thyroid hormone (hot adenoma).It is about 10% of thyroid follicular adenomas, which it may result in symptomatic hyperthyroidism, and may be referred to as a toxic thyroid adenomas [8]. Thyroid cancer is rare and has a high cure rate. The treatment for thyroid cancer is surgery to remove most or all of the thyroid gland, followed by radioactive iodine in some cases. Patients may need to take levothyroxine (synthetic thyroid hormone) in a slightly higher than normal dose to replace body’s thyroid hormone production and to stop the cancer from recurring [9].

The national cancer institute indicates that thyroid cancer is the most common type of endocrine-related cancer and estimates 64,330 new cases in 2016. Thyroid cancer represents approximately 3.8% of all new cancer cases[10].There are divided into four main histologic subtypes: Papillary, follicular, anaplastic, medullary. Less common types are thyroid lymphoma and sarcoma [10]. Papillary thyroid carcinoma (PTC) the most widely recognized type of very much separated thyroid malignancy and the most common form of thyroid cancer to result from exposure to radiation.

MATERIALS AND METHODS:

The study was done in the period between (2015-2017) in the department of Biology/ College of Education for Pure Science /Ibn-Haitham /Baghdad University and in the department of Pathology college of medicine / Al-Nahrain University. Paraffin blocks of thyroid tissues samples used in this study were collected from laboratories of Baghdad Teaching Hospital, Al-Khadhmiya Teaching Hospital, Al-Yarmouk Teaching Hospital, Al-Kindi Teaching Hospital, Al-Karama Teaching Hospital, Ghazi Al-Hariri Hospital for surgical specialist in Baghdad, Al-Hussein Hospital (Kerbala Health Office) in Karbala, Al-Sadder Medical City in Al-Najaf , Al-Sadder Teaching Hospital(Al-Ashraf/pathology unit) in Basra, Rizgary Teaching Hospital in Erbil, Kalar Educational Hospital in Al- Sulaymaniyah and private laboratories, for the years (2006-2016)..The clinicopathological parameters were obtained from patients’ admission case sheets and pathology reports, including age, gender. The total number of the thyroid samples used in this study was 120 paraffin blocks,these include 30 thyroid follicular carcinoma,30 follicular variant of papillary carcinoma, 30 follicular adenoma and 30 follicular hyperplasia.

Statistical analysis:

Data were collected, summarized, analyzed and presented using three statistical software programs: the statistical package for social science (SPSS version 22).Categorical variables were presented as number and percentage whereas numeric variables were presented either as mean and standard deviation (SD) or median and interquartile range (IQR), according to the results of Kolmogrov Smirnov test of normality distribution for numeric variables. The association between categorical variables was assessed using Chi-square test and correction was done as needed. Comparison of mean values between two groups was carried out using either independent samples-t test or Mann Whitney U test, while comparison of mean values among more than two groups was carried out using either one way analysis of variance (ANOVA) test or Kruskal Wallis tests. Correlation was evaluated using Spearman correlation test.

RESULTS:

The presents study included 120 patients having thyroid nodules, classified according to results of histopathology into 4 groups, 30 patients within each; the first group included patients with follicular adenoma, the second group included patients with follicular carcinoma, the third group included patients with follicular variant of papillary carcinoma (FVPC) and the last group included patients with follicular hyperplasia. Mean age of all patients enrolled in the present study was 38.63±10.39 years, and because the study included various forms of thyroid gland pathology, the age range was relatively wide being 19-74 years. The number and percentage of cases according to 10 years intervals is shown in table(1), together with a comparison of mean age among the four categories.

Table (1): Number and proportion of cases according to 10 years age intervals

Age (Years)	Follicular Carcinoma n (%)	Follicular Variant of Papillary Carcinoma n (%)	FollicularAdenoma n (%)	Follicular Hyperplasia n (%)
< 20 y	0 (0.00)	0 (0.00)	0 (0.00)	1 (3.33)
20-29 y	6 (20.00)	1 (3.33)	3 (10.00)	5 (16.67)
30-39 y	18 (60.00)	15 (50.00)	14 (46.67)	11 (36.67)
40-49 y	2 (6.67)	9 (30.00)	10 (33.33)	8 (27.67)
50-59 y	2 (6.67)	4 (13.33)	1 (3.33)	1 (3.33)
60-69 y	1 (3.33)	1 (3.33)	2 (6.67)	3 (10.00)
≥ 70 y	1 (3.33)	0 (0.00)	0 (0.00)	1 (3.33)
Total	30 (100.0)	30 (100.0)	30 (100.0)	30 (100.0)
Mean age (year) *	43.00 ±11.18	40.03 ±8.11	37.40 ±8.94	40.07 ±12.80
Age range (year)	22 -74	25 -60	20 -63	19 -73

* One way ANOVA test; P=0.522 (not significant at P≤ 0.05); n= number of cases

Only a single case of follicular hyperplasia was reported below 20 years of age. Age interval of 30-39 year witnessed the highest percentage of cases among all four groups, 18 (60.00%), 15 (50.00 %), 14 (46.67 %) and 11 (36.67 %) in follicular carcinoma, follicular variant of papillary carcinoma (FVPC), follicular adenoma and follicular hyperplasia, respectively, the mean age of follicular carcinoma, follicular variant of papillary carcinoma, follicular adenoma and follicular hyperplasia was 43.00±11.18, 40.08±8.11, 37.40±8.94 and 40.07±12.80 respectively, and the difference was not significant (P =0.522) in mean age among all four groups (table1). The group of follicular carcinoma included 6 males (20.00%) and 24 females (80.00%) with a male to female ratio of 1:4. The group of follicular variant of papillary carcinoma included 9 males (30.00%) and 21 females (70.00%), with a male to female ratio of 1: 2.33. The group of follicular adenoma included 5 males (16.67%) and 25 females (83.33%), with a male to female ratio of 1:5. The group of follicular hyperplasia included 6 males (20.00%) and 24 females (80.00%) with a male to female ratio of 1:4. There was no significant difference in male to female ratio among all four groups included in the current study (P= 0.622), as demonstrated in table (2).

Table (2): Number and proportion of cases according to gender

Gender	Cases of Study Groups
Gender	Follicular Carcinoma n (%)	Follicular variant of papillary carcinoma n (%)	Follicular Adenoma n (%)	Follicular Hyperplasia n (%)	P-value
Male	6 (20.00)	9 (30.00)	5 (16.67)	6 (20.00)	0.622*
Female	24 (80.00)	21 (70.00)	25 (83.33)	24 (80.00)
Total	30 (100.0)	30 (100.0)	30 (100.0)	30 (100.0)
Male: Female	1:4	1:2.33	1:5	1:4

*Chi-square test (not significant at P≤ 0.05); n= number of cases

DISCUSSION:

The present study showed that the mean age of patients with thyroid nodule was 38.63 years. Additionally, patients with follicular carcinoma, follicular variant of papillary carcinoma, follicular adenoma and follicular hyperplasia showed mean age of 43.00±11.18years, 40.03±8.11years, 37.40±8.94 years and 40.07±0.7 years, respectively. Added to that, it was recorded, by the current study, that majority of the cases, regardless of the pathology, was encountered in the fourth decade of patient's life. Substantial portion of published literatures revised the mean age and the most frequent age interval at which a patient with thyroid nodule can be seen. It is out of scope of the discussion paragraph to review all these literatures; however, most of the reviewed papers were in accordance with the results obtained by the current work. For instance, it was reported that the incidence of malignant Fine needle aspiration (FNA) samples for women peaked in their 30s whereas the incidence of malignant FNA samples for men peaked 10 years later in their 40s (12.1%), according to a study conducted on 3,981 consecutive patients who underwent thyroid FNA between 2002 and 2009[11]. In another study, that included a sample size of 167 patients with thyroid nodules, the mean age was 41.56 years and that malignancy was seen in patients with a mean age of 34.93±11.86 years [12]. It is worth to mention that [13] evaluated the US data and the clinical and laboratory characteristics of 944 patients with thyroid nodules and noted an association between malignant solid nodules and patient age younger than 45 years. Also it was reported that Majority of the patients with solitary thyroid nodules were females (n = 113, 69.7%), their mean age was 36.8 ± 13.3 years, with a wide range (8–76 years) [14]. The finding of the presents study, concerning age of patients, can be summarized as following: carcinoma in a thyroid nodule in seen at young age group, below 40 years, the mean presentation age of thyroid nodule in general was seen at the fourth decade and that there was a wide range of age presentation pertaining to the diversity of pathologic lesions. These results are in agreement with the findings of the above mentioned literatures [12, 13, 14]. It is very well known to medical professionals that diseases of the thyroid gland are more frequent among women than men [15, 16, 17].The present results showed that male to female ratio ranged from 1: 2.23 to 1:5 in accordance with most published literatures [15, 16, 17].

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Received on 17.11.2017 Modified on 20.12.2017

Research J. Pharm. and Tech 2018; 11(2):741-744.

DOI: 10.5958/0974-360X.2018.00139.7