Clinicopathological study of asymptomatic thyroid swelling and its correlation with thyroid function tests

Anuja Bhargava, Syed M. Faiz, M. Shakeel, Nafas J. Singh, Saloni Singh


Background: Thyroid swelling without symptomatic manifestation is common occurrence and could affect 5 to 20% patients in endemic areas. Majority of them are non neoplastic and may not require surgery. Less than 5% of thyroid nodules are malignant.

Methods: Present study was conducted to correlate clinical findings, HRUSG findings, thyroid profile and FNAC findings in patients of asymptomatic thyroid swelling.  

Results: Proportion of euthyroid patients was higher compared to hyperthyroid and hypothyroid diagnosed as colloid goiter on FNAC findings (82.4% vs. 0.0% and 12.9%). Proportion of hypothyroid was higher compared to euthyroid and hyperthyroid diagnosed as Follicular adenoma (3.2% vs. 0.0% and 1.2%) and colloid goiter with cystic changes (48.4% vs. 0.0% and 10.6%). Proportion of hyperthyroid compared to hypothyroid and euthyroid patients were higher diagnosed as thyroiditis (75.0% vs. 32.3% and 5.9%) and papillary/medullary CA (25.0% vs. 3.2 and 0.0%). A statistically significant association of FNAC diagnosis and thyroid profile of patients with asymptomatic thyroid swelling was found.

Conclusions: The present study showed that thyroid dysfunction could play a significant role in determining the underlying pathology behind thyroid swelling and must be evaluated at the earliest using thyroid function tests as the first line of diagnostic tool. In case of suspected thyroid profile; USG neck and FNAC should be done. In view of lack of studies correlating thyroid and clinicopathological profiles of thyroid swellings, further studies to potentiate the present study findings are recommended.


Ultrasonography, Thyroid function tests, Asymptomatic diseases, Fine-needle aspiration

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UK guidelines for the use of thyroid function tests (British thyroid association), 2015.

Allen E, Bhimji SS, Anatomy, Neck, Thyroid. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2018. Available from: https://www.ncbi. 470452/. Accessed on 13 December 2017.

Brent G. Thyroid hormones. In: Conn PM, Melmed S, eds. Endocrinology Basic and Clinical Principles. Totowa, NJ: Humana Press; 1997: 291-306.

Cibas ES, Ali SZ. NCI Thyroid FNA State of the Science Conference. The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2009;132:658–65.

Gharia AA, Agravat AH, Dhruva GA. Thyroid Cytology Evaluation By Bethesda System A Two Year Prospective Study. Int J Res Med. 2016;5(3);1-6.

Alkabban FM, Patel BC. Goiter, Nontoxic. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2018. Available at: https://www.ncbi. Accessed on 13 December 2017.

Krohn K, Fuhrer D, Bayer Y, Eszlinger M, Brauer V, Neumann S. Molecular pathogenesis of euthyroid and toxic multinodular goiter. Endocr Rev. 2005.26:504–24.

Sclabas GM, Staerkel GA, Shapiro SE. Fine Needle Aspiration thyroid and correlation with histopathology in a contemporary series of 240 patients. Am J Surg. 2003;186:702–10.

Makwana C, Lakum NR, Makwana H, Joshi J, Agnihotri A. Clinicopathological corelation of serum TSH level in patients with thyroid nodul. Int J Med Sci Public Health. 2016;5(2):332-6.

Unnikrishnan AG, Mennon UV. Thyroid disorder in India: An epidemiological perspective. Indian J Endocrino Metabolism. 2011;15:S78-81.

Mamun A, Alam Z, Haque R, Hasan DM. Study of Pathological Variations of Solitary Thyroid Nodule. Global J Med Res. 2014;24(3):9-16.

Yeung MJ, Serpell JW. Management of the solitary thyroid nodule. Oncologist. 2008;13(2):105–12.

Makwana NR, Shah VR, Unadkat S, Shah HD, Yadav S. Goiter prevalence and current iodine deficiency status among school age children years after the universal salt iodization in Jamnagar district, India. Thyroid Res Pract. 2012;9:40-4.

Geisin KR, Stanley MW, Raab SS, Silverman JF, Abati A. Modern Cytopathology, Churchill Livingstone, 2004.

Jameson JL. Disorders of the thyroid gland. In: Harrison's Principles of Internal Medicine, Fauci AS, Branunwald E, Kasper DL, eds. McGraw-Hill, New York, NY, USA, 17th edition, 2008: 2224–2247

Guidelines on National Iodine Deficiency Disorders Control Programme. New Delhi: Directorate General of Health Services Ministry of Health and Family Welfare, Government of India; 2006. National Rural Health Mission IDD and Nutrition Cell. Revised Policy Available at: http://www. Accessed on 25 December 2017.

UK guidelines for the use of thyroid function tests (British thyroid association), 2006.

Carvalho GD. The clinical use of thyroid function tests. Arq Bras Endocrinol Metab. 2013;57(3):193-204.

Ladenson PW. Optimal laboratory testing for diagnosis and monitoring of thyroid nodules, goiter, and thyroid cancer. Clin Chem. 1996;42(1):183-7.

Chaudhary V, Bano S. Thyroid Ultrasound. Indian J Endocrinol Metab. 2013;17(2):219–27.

Solbiati L, Charboneau JW, Osti V, James EM, Hay ID, Rumack CM, et al. The thyroid gland and Diagnostic Ultrasound. 3rd ed. Vol. 1. St. Louis, Missouri: Elsevier Mosby. 2005: 735–770.

Esmaili HA, Taghipour H. Fine-Needle Aspiration in the Diagnosis of Thyroid Diseases: An Appraisal in Our Institution. ISRN Pathology. 2012;912728:1-4.

Baloch ZW, Sack MJ, Yu GH, Livolsi VA, Gupta PK. Fine needle aspiration (FNA) and cytology. Thyroid 2003;13:80-86.

Rains AJH, Charles VM. Baily's and Love's short practice of surgery. 20th ed. ELBS, London, 1988: 660-693.

Bamanikar S, Soraisham P, Jadhav S, Kumar H, Jadhav P, Bamanikar A. Cyto-histology and clinical correlation of thyroid gland lesions: A 3 year study in a tertiary hospital. Clin Cancer Investig J 2014;3:208-12.

Siddegowda MS, Kaur JK, Shivakumar S. Cytomorphological Assessment and Thyroid Function Analysis – A Dual Approach to Diagnose Thyroid Lesions. National J Lab Med. 2016;5(3):PO16-PO21.

Poudel S, Regmi S, Shahi A, Samdurkar A. Cytopathological evaluation of thyroid by fine needle aspiration cytology and correlation with T3 T4 and TSH levels. J Universal Coll Med Sci. 2015;3(4):37-41.

Kamra HT, Agarwal R, Rana P, Kalra R, Kaur S, et al. Evaluation Profile of Thyroid Nodule by FNAC in the Rural Population of KhanpurKalan, Sonepat, Haryana. J ClinDiagn Res. 2014;8(10):FC16–FC18.

Sood N, Nigam JS. Correlation of Fine Needle Aspiration Cytology Findings with Thyroid Function Test in Cases of Lymphocytic Thyroiditis. J Thyroid Res. 2014;430510.

Prabhu Shankar S, Sundaravadanan BS, Sudarshan PB. Analysis of pattern of thyroid disorders in a tertiary care hospital and evaluating the accuracy of preoperative fine needle aspiration with postoperative histopathological examination. Int Surg J. 2017;4(4):1267-71.

Poudel A, Jain SK. Study of thyroid lesions by fine needle aspiration cytology and its correlation with thyroid function test. J Lumbini Med Coll. 2013;1(1):28-30.

Hafez AM, Sheta YS, Elmessallamy FA, Elgohary EA, Mursy M. Highlights in the Diagnostic Dilemma of Solitary Thyroid Nodule; Fine Needle Aspiration Cytology in Comparison of Isotope Thyroid Scan. Int J Sci Res. 2015;4(9):1386-91.

Nazir I, Singh M, Rasool SS, Peer S, Gojwari T. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) 2017;16(5):108-11.

Hassan MQ, Hasanat MA, Fariduddin M, Emran MS, Mustari-M, Jahan-S, et al. Fine Needle Aspiration Cytological Diagnosis of Thyroid Nodule with lts Clinical Correlation. BSMMU J 2013;6(2):108-11.

Marwaha RK, Tandon N, Kanwar R, Ganie MA, Bhattacharya V. Evaluation of the Role of Ultrasonography in Diagnosis of Autoimmune Thyroiditis in Goitrous Children. Indian Pediatr. 2008;45:279-84.

Singh GR, Singh KK, Kumar A, Singh S, Prasad U. To evaluate diagnostic utility of FNAC for palpable thyroid lesion and comparison with Ultrasound and Thyroid Profile. Indian J Public Health Res Develop. 2017;8(3):235-40.