Analysis And Reflections On The Thyroid Surgical Cases

Objective To evaluate the changes and status quo of surgical management for thyroid diseases.Methods A retrospective analysis of thyroid surgical cases in 1999 and 2008 was performed to evaluate surgical indications, pathological results and the diagnose rate of pre-operative ultrasound.Results In 1999, the male to female ratio of thyroid surgical patients were 1:3.72, with a mean age of 48 (range14-76). Thyroid adenoma being the leading diagnosis (207 cases,81.18%), thyroid carcinoma and benign nodules consisted of 33(12.94%) and 15 cases (5.88%) respectively. However, when we reviewed the pathology sections of 1999 with revised standard, thyroid benign nodules turned out to be the leading diagnosis of all surgical cases (148 cases,58.04%).In 2008, the male to female ratio increased to 1:2.67, with a mean age of 50 (range 16-81). Thyroid nodules, thyroid carcinoma and adenoma make up of 305 (41.38%), 194 (26.32%) and 238 cases (32.29%) respectively.Pathology identified 4 of all 194 malignant cases being medullary carcinoma, with the rest being differentiated thyroid cancer:188 cases were papillary carcinoma (PTMC in 61 cases) 2 cases were follicular carcinoma. In those who are treated with surgery based on the surgeon's experience (with no clear clinical or ultrasound indication), only 50 (21.55%) of 232 cases were malignant, and 131 cases (42.95%) were overtreated.137 benign lesions were surgically removed because of surgical indications,37 of ultrasound indications.According to the revised pathology report, ultrasound diagnose rate in 1999 is 38.21%, and 67.87% in 2008. The highest diagnose rate of an ultrasound technician is 91.67%.Conclusion Benign thyroid nodules still consist of a large portion of surgical cases in 2008. The lack of thorough understanding of the current revised pathology standard could be one underlying cause. Surgical indications and surgeon's experience vary in different surgical team. Ultrasound manages to improve over time, and the diagnose rate of specialized technician is above average.