# I. Introduction solitary thyroid nodule is a palpable discrete swelling within an otherwise apparently normal thyroid gland. Though it is a common disorder of the thyroid gland, it is less prevalent among children. Childhood thyroid nodules need special attention due to higher incidence of malignancy as compared to adults. Differential diagnosis of a thyroid nodule is crucial as malignancy necessitates surgery; while strict follow up is necessary in benign cases. 1 Fine needle aspiration cytology (FNAC) is a cost effective procedure that provides specific diagnosis rapidly with minimal complications. Our objectives were to study the demographic descriptions, clinical, cytological, histopathological profile and correlation of cytological finding with that of histological, of patients with solitary thyroid nodule attending our tertiary referral centre. # II. Materials and Methods Fifty consecutive patients irrespective of age, sex, religion and socio-economic status with solitary thyroid nodule admitted in the department of Otorhinolaryngology, Regional Institute of Medical Sciences, Imphal between August 2015 to September 2017 were prospectively studied. Every patient was meticulously worked up with a thorough history taking and clinical examination followed by routine laboratory investigations and investigations specific to thyroid like thyroid hormone assay, Fine needle aspiration cytology (FNAC) and Ultrasonography (USG) of the thyroid. Post operatively the thyroidectomy specimens were sent for Histopathological Examination (HPE). # III. Results and Observation The age of the patients ranged from 15 to 70 years. The youngest patient was a 15 year old male while the oldest was a 70 year male. The female to male ratio was 6.1:1.25; (50%) cases presented with swelling with duration of less than 1 year while 3(6%) cases had duration of 9-10 year. The shortest duration of swelling was 2 months which was diagnosed as follicular adenoma, while the longest was for 10 years which was diagnosed as colloid goiter. All the 50 patients came with chief complaint of swelling in front of the neck of whom 46(92%) had a gradual increase in size while in 4(8%) cases there was rapid increase in size. There was Dysphagia in 2(4%) cases. Associated pain, difficulty in breathing, hoarseness, decreased appetite, weight loss and cervical lymphadenopathy were seen in a 70 year old male patient who was diagnosed as papillary carcinoma. Firm consistency was observed in 38(78%) cases of which maximum were of colloid goiter while other varieties of consistency (soft/cystic) in follicular adenoma, papillary carcinoma, hashimoto's thyroiditis and Hurthle's neoplasm were also seen. One case had hard consistency with metastatic lymphadenopathy. In FNAC 30 (60%) cases were found to be colloid goiter while papillary carcinoma was seen in 9 (18%) cases. There were 7 (14%) cases with follicular neoplasm, 2 (4%) cases of Hurthle's neoplasm and 1 (2%) each of Hashimoto's and Lymphocytic thyroiditis. On Ultrasonography 30 (60%) cases were of cystic nature while 12 (24%) were solid and 8 (16%) cases were of suspicious malignancy. On Histopathological examination of the operated tissues 27 (54%) cases were colloid in nature, 11 (22%) cases were papillary carcinoma while 3 (6%) cases were of papillary-follicular variant. There was also a case of squamous carcinoma in a female patient of 26 years who was diagnosed as colloid nodule on FNAC. Most of the solid findings and suspicious cases of malignancy on ultrasonography were found to be papillary carcinoma and follicular adenoma on HPE. Majority of cystic findings on Ultrasonography were colloid goiter in nature. Out of 30 patients of colloid nodule on FNAC, 27 cases were found to be colloid goiter on HPE. The remaining turned out to be papillary carcinoma and squamous cell carcinoma in 1 case. All cases of papillary carcinoma on FNAC were diagnosed to be the same on HPE. Hashimoto's and Hurthle's cases were almost same in both examinations. All except one case of follicular neoplasm on FNAC turned out to be follicular adenoma on HPE. There was significantly more occurrence of malignancy at both the extremes of age, a rate of 42.85% below 20 years and 33.33% above 60 years. The youngest patient was a 15 year old male and the oldest 70 year old patient and both were diagnosed as papillary carcinoma. # IV. Discussion In the present study, the maximum number of cases occur in the age group of 30-39 years, i.e. 4 th decade of life. Other studies also reported a higher incidence in the 3 rd and 4 th decade age group. 2,3,4 Several studies have highlighted the greater risk of malignancy in thyroid nodules in younger age group and older age-group people. 5,6 Several studies have highlighted the greater risk of malignancy in thyroid nodules in younger age group and older age-group people. Similar findings noted in our study. Female: Male ratio was 6.1:1, comparable to other literature. 2,3,7 The overall malignancy rate was 32%, similar to older literature. 8,9 The diagnostic assessment by FNAC in this study produces a sensitivity of 92.71%, specificity of 78.26%, a positive predictive value of 83.33% and negative predictive value of 90%.The accuracy of FNAC found to be 86%. This finding was comparable to other studies. 6,12 Histopathological examination (HPE) revealed a colloid occurrence in 54%, papillary carcinoma in 28%, follicular adenoma in 12%, 2% each in Hashimoto's and Hurthle's. These findings tally with that of other studies. The percentage of malignancy in our study was 29% whereas other series reported 8-37%. 12,13 The most common finding in FNAC in our study is colloid goiter which accounts for almost 60%, which is consistent with the other studies. 14 Out of total 14 cases of papillary carcinoma cases diagnosed from HPE, almost 9(64.3%) cases were identified in FNAC also. This shows there is a chance of false negativity for papillary carcinoma, should always be kept in mind. It is consistent with the # V. Conclusion The incidence is highest in the 4 th decade of life. The rates of malignancy in extremes of age group are significantly higher than other general population. The incidence of a solitary thyroid nodule is much higher in female (F: M-6.1:1). The most common mode of presentation is swelling in the neck with a majority of (92%) patients giving a history of gradual progression of size. Location of the nodule was slightly more on the right (44%) as compared to the left lobe and isthmus and most nodules presented with a firm consistency. FNAC was found to be not only an easy and inexpensive mode of diagnosis but, also a highly accurate means of investigation with an accuracy of 86% in this study. Histopathological examination remains the gold standard for the final correct diagnosis of a solitary thyroid nodule. 211![Fig. 2: FNAC smear under high magnification (40x) shows benign follicular cells arranged in clusters in a background of thin and thick colloid; suggestive of colloid goiter](image-2.png "Fig. 2 : 1 JAFig. 1 :") 1Age DistributionAge in yearsNo. of casesPercentages (%)0-900%10-19714%20-29816%30-391734%40-49816%50-5948%60-69510%70 & above12%Sex DistributionSexNo. of casesPercentage (%)Male714%Female4386%Duration of SwellingDuration (months)No. of casesPercentage (%)0-122550%13-241020%25-36612%37-4848%49-6012%61-7212%73-10800%109-12036%Symptoms of PatientSymptomsNo. of casesPercentage (%)Swelling50100%Gradual progression4692%Rapid progression48%Associated pain12%Dysphagia24%Difficulty in breathing12%Hoarseness12%Decrease appetite12%Weight loss12%Lymphadenopathy12%Location of SwellingLocationNo. of casesPercentage (%)Right lobe2244%Left lobe1836%Isthmus1020%Consistency of SwellingConsistencyNo. of casesPercentage (%)Cystic36%Soft816%Firm3876%Hard12% 2FNAC ResultsCytologyNo. of cases Percentage (%)Colloid Goiter3060%Papillary Carcinoma918%Follicular Carcinoma714%Hashimoto's Thyroiditis12%Hurthle's Neoplasm24%Lymphocytic Thyroiditis12%Ultrasound ResultsUltrasoundNo. of cases Percentage (%)Cystic3060%Solid1224%Suspected Malignancy816%Histopathological Results (HPE)HPENo. of cases Percentage (%)Colloid Goitre2754%Papillary Carcinoma1428%Follicular Adenoma612%Follicular Carcinoma00Hashimoto's Thyroiditis12%Hurthle's Carcinoma12%Squamous Cell Carcinoma12% 3TypeFNAC (%)SubdivisionHPE%Colloid Goitre30 (60%)2754%Papillary Carcinoma9 (18%)1428%Follicular Neoplasm7 (14%)Follicular Adenoma612%Follicular Carcinoma0Hashimoto's Thyroiditis1 (2%)12%Hurthle's Neoplasm2 (4%)Hurthle's Carcinoma12%Lymphocytic Thyroiditis1 (2%)Squamous Carcinoma12% 4FemaleNo. of casesPercentage %MaleNo. of cases Percentage %Malignant1330.2%Malignant342.8%Benign3069.8%Benign457.2%Age groupTotal casesMalignancyPercentage< 20 years7342.85%>60 years6233.33%20-60 years37616.21% © 2018 Global Journals ( )J * Thyroid nodulestepwise diagnosis and management APStergiois KMarina AAuraam Hormones 6 2 2007 * Fine needle aspiration cytology, sonography and radionuclide scanning in solitary thyroid nodule AKumar MmsAhuja TKChattopadhya AKPadhya AKGupta KKapila AKGoel MGKarmakar JAssocPhysicians1992 40 * Role of fine needle aspiration cytology as the initial modality in the investigation of thyroid nodules SrsMandrekar NSNadkarni RgwPinto SMenezee Acta 39 5 Cytol1995 * Problems and limitatins with FNAC of solitary thyroid nodules NAnanthakrishnan MadhavaRao KNarashima RVeliath AJ ANZ J Surg 60 1 2008 * Endocrinology, Surgery, Nuclear medicine and Radiotherapy. Philadelphia: Lippincott Raven publishers LafGeorge GLVictor Stephen A, Falk editor 1997 Thyroid disease * Kelsebew editor, Textbook of Endocrine surgery RMPaul HWMalcolm Clark-Duh- 1996 Elsevier Saunders Publishers Philadelphia Approach to thyroid nodules * Surgical management of the thyroid nodule, patient selection based on the results of fine needle aspiration cytology MBouvet JIFeldman GNGill WHDillman AMNahum VRussack KTRobbins Laryngoscope 102 1992 * Controversies in management of thyroid nodule RSAshok Laryngoscope 110 2000 * A comparative study of FNAC, USG and Radio nucleotide scan in the management of solitary thyroid nodule: A prospective analysis of 50 cases KKamaljit SNishi ASBapna MPradeep Indian JOtolaryngolHead Neck Surg 54 2 96 2002 * Management of solitary thyroid nodule IAmjad IMuhammed ANisar AJaved ZJaved Postgrad MedJ 19 1 2005 * Fine needle aspiration of multiple thyroid nodule justified? JEBarroeta HWang NShiina PKGupta LivolsiVa ZWBaloch EndocrPathol 17 1 2006 * Management of Isolated thyroid swelling: a perspective six year study of fine needle aspiration cytology in diagnosis ELCusick CAMac-Intosh HKZygmunt VMWilliams NAMatheson Brit MedJ 301 1990 * New insight into the diagnosis and management of thyroid nodules ZAli ShirazEMedJ 6 2005 * Associated pain with hoarseness, weight loss, difficulty in breathing, decreased appetite, and cervical lymphadenopathy was seen in 70 -year -old patient with papillary carcinoma. All these clinical indicators suggestive of malignancy reported in other studies. 8,11 The presence of nodule on the right lobe was in 22 (44%) cases, 18 (36%) in the left lobe and 10 (20%) in the isthmus. Similar findings reported by another author. 10 Firm consistency felt in 38 (76%) cases The most common presenting feature was swelling in the neck seen in all 50 cases (100%) This correlates with the observance made by other authors. 4,7,10 There was a gradual increase in size of the solitary thyroid nodule in 46 (92%) cases, while 4 (8%) cases had rapid progression. Dysphagia noted in 2 cases of papillary carcinoma and follicular adenoma. cystic in 3 (6%) cases and soft in 8 (16%) cases. An elderly * Fine Needle Aspiration Cytology of Thyroid Lesions and its Correlation with histopathology in a series of 248 patients RSukumaran JKattor KRPillai PTRamadas NNayak TSomanathan NAGeorge PSebastian Indian J SurgOncol 5 3 2014