|Year : 2014 | Volume
| Issue : 3 | Page : 108-110
Pattern of thyroid carcinoma in Gizan region of Saudi Arabia
Subodh Banzal1, Abhishek Singhai2, Bhimsingh Shekhawat3, PG Raman4
1 Department of Medicine and Endocrinology, Madhya Pradesh, India
2 Department of Medicine, Sri Aurobindo Medical College, Indore, India
3 King Fahd Central Hospital, Gizan, Kingdom of Saudi Arabia
4 Department of Medicine, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
|Date of Web Publication||13-Aug-2014|
Department of Medicine, Sri Aurobindo Medical College, Sanwer Road, Indore 453 555, Madhya Pradesh, India
Source of Support: None, Conflict of Interest: None
Objective: To study the frequency, clinical features, and histopathological types of thyroid carcinoma in Gizan region of Saudi Arabia. Research Design and Methods: We analyzed the clinical features, laboratory data, histopathological reports, and outcome of 32 patients diagnosed with thyroid carcinoma out of 231 patients who underwent thyroidectomy at King Fahd Central Hospital (KFCH), Gizan and peripheral hospitals over a period of 6 years. Results: The papillary thyroid carcinoma (PTC) was present in 25 patients and follicular thyroid carcinoma (FTC) in 5 cases. Anaplastic cell variety was found in two cases. The mean (±SD) were significantly different (P = 0.015) when the groups with PTC and FTC were compared (43.1 ± 12.7 vs. 61.3 ± 15.4). Fine needle aspiration cytology (FNAC) was done in all 32 cases; it was negative in 11 cases. Conclusions: In Gizan, incidence of thyroid carcinoma is about 14% among total patients undergoing thyroidectomy. Painless thyroid nodule is the most common clinical feature. PTC is the most common variant. FNAC is a useful tool for diagnosis but it can be false negative also.
Keywords: Follicular carcinoma, papillary carcinoma, thyroid carcinoma
|How to cite this article:|
Banzal S, Singhai A, Shekhawat B, Raman P G. Pattern of thyroid carcinoma in Gizan region of Saudi Arabia. Thyroid Res Pract 2014;11:108-10
|How to cite this URL:|
Banzal S, Singhai A, Shekhawat B, Raman P G. Pattern of thyroid carcinoma in Gizan region of Saudi Arabia. Thyroid Res Pract [serial online] 2014 [cited 2019 Aug 18];11:108-10. Available from: http://www.thetrp.net/text.asp?2014/11/3/108/138555
| Introduction|| |
Thyroid carcinoma is not uncommon in certain areas of the Middle East. Thyroid carcinoma accounts for 1.1% of all malignancies, it accounts for 5-10.4% of total malignancy across Saudi Arabia. Thyroid carcinoma is the second most common carcinoma among Saudi women.  The incidence of this disease peaks in the third and fourth decades of life. Thyroid cancers are divided into papillary thyroid carcinomas (PTCs), follicular thyroid carcinomas (FTCs), medullary carcinomas, anaplastic carcinomas, primary thyroid lymphomas, and primary thyroid sarcomas. PTC represents 80% of all thyroid neoplasms. FTC is the second most common thyroid cancer, accounting for approximately 10% of cases. Medullary thyroid carcinoma represents 5-10% of neoplasms. Anaplastic carcinomas account for 1-2%. Primary lymphomas and sarcomas are rare. The aim of the current study is to report on the spectrum of patients diagnosed with thyroid cancer at King Fahd Central Hospital (KFCH) over a period of 6 years with regard to the frequency, stage of cancer at the time of diagnosis, clinicopathological characteristics, and survival.
| Subjects and methods|| |
All patients diagnosed as thyroid carcinoma in KFCH and peripheral hospitals during 6 years were subjects of the study. KFCH is a 500-bedded hospital, a referral center for whole Gizan region. Following data were retrieved from case sheets namely age, sex, nationality, clinical presentation, laboratory data, histopathological reports, and clinical course. All thyroid carcinoma were histologically proved by biopsy. Histopathological diagnosis of papillary carcinoma was based on strict criteria of cytological features and is defined according to World Health Organization (WHO) classification as a malignant epithelial tumor with characteristic nuclear changes (ground glass, large size, pale irregular outline with deep grooves, and intranuclear pseudo inclusions).  When the cytological features of papillary carcinoma were lacking, the diagnosis of other carcinomas was made and confirmed by immunohistochemical staining as appropriate. Total thyroidectomy was performed for all patients with preoperative diagnosis of thyroid cancer except for two patients with a clinical picture suggestive of anaplastic carcinoma, excisional biopsy was carried out. Ultrasonography and computed tomography (CT) scan used to evaluate soft-tissue extension of thyroid carcinoma into the neck, trachea, or esophagus and to assess metastases to the cervical lymph nodes. Qualitative variables were tested using Chi-square test and P values were calculated between two groups. P ≤ 0.05 was considered statistically significant. Averages were expressed between groups as mean ± standard deviation or percentage.
| Results|| |
Of the 231 patients, 32 (13.6%) patients who had thyroidectomy were subjects of this study. These comprised 7 males and 25 females aged between 18 and 90 years with a mean (±SD) of 49.6 (±15.8). A total of 22 cases (68.8%) were diagnosed who were aged more than 40 years; 19 of them were papillary, 1 was follicular, and 2 were of anaplastic type [Table 1].
PTC was present in 25 patients (18 females, 7 males) and FTC was present in 5 cases. Anaplastic cell variety was found in two cases [Table 2]. The mean (±SD) were significantly different (P = 0.015) when the groups with PTC and FTC were compared (43.1 ± 12.7 vs 61.3 ± 15.4). Histologically PTC was more common and it was seen more in females. FTC in the present study was diagnosed exclusively in females. There were only two cases of anaplastic carcinoma, seen only in women.
The main clinical features were thyroid masses or nodules (32 cases), pain (6 cases), dysphagia (3 cases), and hoarseness of voice (3 cases). Neck pain was universally present in all cases, both PTC and FTC. Mass or nodule is more common with FTC compared with PTC. Pressure symptoms like Stridor, hoarseness, and dysphagia were present only in patients with PTC [Table 3].
Fine needle aspiration cytology (FNAC) was done in all 32 cases; it was negative in 11 cases, in 12 cases it was PTC, in 8 it was FTC, and in 1 it was anaplastic. Thus FNAC helped only in 21 cases.
Capsular adhesion was seen in 20 cases in PTC and 3 of them showed distant metastasis to bone [Table 4].
| Discussion|| |
Thyroid carcinoma is the most common malignancy of endocrine system. Thyroid carcinomas arise from the two cell types present in the thyroid gland. The endodermally derived follicular cell gives rise to papillary, follicular, and probably anaplastic carcinomas. The neuroendocrine-derived calcitonin-producing C cell gives rise to medullary carcinomas. Radiation exposure significantly increases the risk for thyroid malignancies, particularly PTC. , Low dietary intake of iodine does not increase the incidence of thyroid cancers overall. However, populations with low dietary iodine intake have a high proportion of follicular and anaplastic carcinomas.
Thyroid carcinoma most commonly manifests as a painless, palpable, solitary thyroid nodule. PTC causes more pressure effects like stridor, hoarseness, dysphagia, and weight loss. While FTC presented with neck mass and neck pain. FNAC is useful in the preoperative diagnosis of thyroid carcinoma. However, the false negative results vary from 2.6% to 31.4%. In the present study, it was negative in 11 cases, which were subsequently proved from postoperative thyroid biopsy.
Prognosis is good if identified early. Anaplastic has poor prognosis as it is aggressive and responds poorly to treatment.  Incidence increases with age. Prognosis in young and old are worse. It is twice more common in females than in males. Poor prognostic factors include childhood radiation to head and neck, large nodule, evidence of tumor fixation or invasion into lymph nodes, distant metastasis, and vocal cord paralysis. 
Al-Zahrani and Ravichandran  found in their study, during the 5-year period (1998-2002), 549 male and 1898 female thyroid cancers were diagnosed in all the Gulf Cooperation Council (GCC) states. Papillary carcinoma is the predominant histological type followed by follicular carcinoma in both genders. Among females, Qatar has the highest incidence with an age standardized incidence rate of 13.5 per 100,000 followed by Kuwait (7.7), Bahrain (7.6), Emirates (6.0), Oman (5.9), and Saudi Arabia (5.0). There were at least 2.6 female thyroid cancer cases (in Kuwait) for each male thyroid cancer case and this goes up to 6.6 in Bahrain. Incidence of thyroid cancer in the GCC states is closer or higher than that of some of the developed countries.
During a 3-year period, 233 patients with papillary thyroid cancer were seen at King Faisal Specialist Hospital (KFSH) (79% were female; 94% were national subjects). Pathology revealed 88% pure papillary carcinoma and 12% mixed papillary and follicular carcinoma, 7% microfocus, 18% well encapsulated 24% capsular invasion, and 51% soft tissue invasion.  Our study results are similar to these studies.
In another study,  516 patients were operated for different thyroid lesions. Ninety-two lesions (17.8%) were malignant (20 males and 72 females). Mean age for males was 41.35±15.52 years compared with 36.59±13.28 years for females. Papillary carcinoma constituted 50%, while follicular carcinoma formed only 4.3% of malignant cases. Lymphoma ranked third with only 1.1% of all malignant thyroid lesions. No cases of medullary carcinoma were found. Of 92 patients, 75 reported for follow-up. The recurrence rate for follow-up patients was 29 (31.5%). In Gizan, thyroid carcinoma accounts for 1.35% of all solid tumors; this is less than reported from other regions of Saudi Arabia. It is possible that environmental conditions and dietary habits (diet rich in fish) may be of particular benefit to this population.
| Conclusion|| |
The data presented here reflect the current epidemiological features of thyroid carcinoma in Gizan region of Saudi Arabia. In Gizan, incidence of thyroid carcinoma is about 14% among total patients undergoing thyroidectomy. Painless thyroid nodule is the most common clinical feature. PTC is the most common variant. FNAC is a useful tool for diagnosis but it can be false negative in some cases.
| Acknowledgment|| |
The authors acknowledge Dr. Jamal Ashraf, Dr. Faz ul Rahman, and Dr. Mohd. al Hazmi for their contributions in preparation and review of manuscript.
| References|| |
|1.||Al-Sobhi S. The current pattern of thyroid surgery in Saudi Arabia and how to improve it. Ann Saudi Med 2002;22:256-7. |
|2.||Younes N, Robinson B, Delbridge L. The etiology, investigation and management of surgical disorders of the thyroid gland. Aust N Z J Surg 1996;66:481-90. |
|3.||Mayr B, Pötter E, Goretzki P, Rüschoff J, Dietmaier W, Hoang-Vu C, et al. Expression of Ret/PTC1, -2, -3, -delta3 and -4 in German papillary thyroid carcinoma. Br J Cancer 1998;77:903-6. |
|4.||Bounacer A, Wicker R, Caillou B, Cailleux AF, Sarasin A, Schlumberger M, et al. High prevalence of activating protooncogene rearrangements, in thyroid tumors from patients who had received external radiation. Oncogene 1997;15:1263-73. |
|5.||Ain KB. Anaplastic thyroid carcinoma: Behavior, biology, and therapeutic approaches. Thyroid 1998;8:715-26. |
|6.||Barney BM, Hitchcock YJ, Sharma P, Shrieve DC, Tward JD. Overall and cause-specific survival for patients undergoing lobectomy, near-total, or total thyroidectomy for differentiated thyroid cancer. Head Neck 2011;33:645-9. |
|7.||Al-Zahrani AS, Ravichandran K. Epidemiology of thyroid cancer: A review with special reference to Gulf Cooperation Council (GCC) states. Gulf J Oncolog 2007;1:17-28. |
|8.||Al-Nuaim AR, Ahmed M, Bakheet S, Abdul Kareem AM, Ingmenson S, al-Ahmari S, et al. Papillary thyroid cancer in Saudi Arabia. Clinical, pathologic, and management characteristics. Clin Nucl Med 1996;21:307-11. |
|9.||Refeidi AA, Al-Shehri GY, Al-Ahmary AM, Tahtouh MI, Alsareii SA, Al-Ghamdi AG, et al. Patterns of thyroid cancer in Southwestern Saudi Arabia. Saudi Med J 2010;31:1238-41. |
[Table 1], [Table 2], [Table 3], [Table 4]