Health Care

By:Ibrahim Machiwala

Discussion:

The demographic characteristics of our patients are comparable to western literature, however clinical presentation is somewhat different and more aggressive. Thyroid Carcinoma is prevalent in females with the male to female ratio of 1:2.2 which is comparable to the study conducted by L.M Zuberi and et al with male to female ratio of 1:2.5 reported from USA20 and the study conducted by Sajid H. Shah and et al18 which is in contrast with the study by Ahmed et al which revealed relatively low male to female ratio of 1.01:1.08108 the highest female to male ratio of 9:1 to 13:1 has been reported in the series published from Japan109,110. Age of the patients with thyroid carcinoma ranged from 15-75 years with the mean age of 42 years which is in comparison with study conducted by S Akhtar and et al30 and Tariq Sarfraz and his colleagues from Army Medical College, Rawalpindi in which average age of presentation was 42.2 years with the overall range of age was 16 years to 70 years111

In this study the highest prevalence of thyroid carcinoma was obseved in 2nd, 3rd and 4th decade which is comparable to the study conducted by Ahmed et al and Sajid and his colleagues at Aga Khan University Hospital, Karachi18 which showed highest prevalence in 3rd, 4th and 5th decade of life112

In this study most of the patients with thyroid carcinoma belonged to urdu speaking 34.5% followed by sindhi (18.2%) and punjabi (16.4%) speaking patients while pathan (3.6%) and balochi (5.5%) have lowest number of thyroid carcinoma patients while the rest (21%) of the thyroid carcinoma patients belonged to other class including Northern areas and Afghanistan.

In the present study papillary thyroid carcinoma was the most frequent histological type of thyroid tumor in both males and females and it comprises 80% of all thyroid malignant tumors which is comparable to USA where 90% of all thyroid carcinomas are papillary thyroid carcinoma112,113,114. Ahmed et al from Saudi Arabia also reported 80% of papillary thyroid carcinoma in their series112 while in another local series by Khan et al from Rawalpindi reported 60% of papillary thyroid carcinoma115. In the present study, follicular thyroid carcinoma constitute 10.9% which can be compared with the study done by Sajid H et al Karachi in which follicular carcinoma is second most common type of thyroid carcinoma contituting 11.6%18 this was also shown by the study done in Rawalpindi by Tariq Sarfraz and his colleagues but the percentage was higher 23.8% for follicular thyroid carcinoma29. Medullary thyroid carcinoma constitute 3.6% compared to the study conducted by Sajid H et al Karachi18. The medullary thyroid carcinoma comprised about 1.8% in this study in contrast to the study conducted by Tariq Sarfraz and his colleagues at Rawalpindi which showed 4.8% of medullary thyroid carcinoma29 and the study conducted by Sajid and his colleagues at Karachi which showed 9.7% of thyroid medullary carcinoma18.

The most common presentation of our patients was neck swelling/mass which was present in 54 (98.2%) of patients which was also true for the study conducted by Zuberi and her colleagues at AKUH Karachi3. A series from Riyadh, Saudi Arabia reports similar findings of mass/goitre as the most frequent presentation in patients with thyroid cancer. It was present in three-quarters of their patients116. Goitre is common, occurring in 3.2-6.5% of western population26,117,118

Histological Type Shah’s Study% Our Study %
Papillary Carcinoma 69 80
Follicular Carcinoma 11.6 10.9
Medullary Carcinoma 9.7 3.6
Anaplastic Carcinoma 5.9 1.8

Presentation Zuberi’s Study % Our Study %
Mass in Neck 31 98.2
Weight Loss - 61.8
dysphagia <5>
Hoarseness/ Recent Change of voice <5>
Cervical Lymphadenopathy 33.3 50.9
Shortness of Breath <5>

Presentation Sarfraz’s Study % Our Study %
Mass in Neck(Solitary Nodule/ Multinodular mass 90.4 98.2
Cervical Lymphadenopathy 14.2 50.9
Breathing difficulty 4.7 21.8

Conclusions:
Thyroid carcinoma was more common in females. Papillary carcinoma was the most common histological type of thyroid carcinoma in females as well as in males. Thyroid carcinoma was more prevalent in third and fourth decades of life and it is more common in urdu speaking followed by sindhi, Punjabi and balochi and pushto speaking (Pathan) population. The most common presentation was the mass in anterior neck and weight loss and cervical lymphadenopathy, dyspnea and dysphagia