Endocrine Abstracts

Introduction

The most common endocrine tumor is thyroid cancer. Follicular Thyroid Carcinoma (FTC) accounts for 5%–10% of all thyroid cancers. Patients with FTC frequently present with more advanced stage diseases and a higher occurrence of distant metastases because of the propensity of vascular invasion. FTC are mainly treated with surgery while radioactive iodine therapy (RAI) is main adjuvant therapy as per ATA guidelines. In many developing countries surgical facilities and RAI are in short supply therefore understanding the trends of FTC may help developing countries to plan and use resources more effectively.

Methodology

It was a retrospective observational study of FTC patients of age 18 years and above conducted at Aga Khan University Hospital, Karachi from 1st January 2010 to 31st December 2019.

Results

There were total of 404 patients of thyroid carcinoma out of which forty (10.1%) were FTC. 50% of the patients were in age group of 41–60 years and female to male ratio was 1.5 : 1. 60% presented with complain of neck swelling followed by bony, lung metastasis (20%) and compressive symptoms (20%). The pre-operative thyroglobulin level was done in six out of eight metastatic patients (75%) in which it was elevated. This emphasizes the importance of checking thyroglobulin level in unusual presentation (bone pain, fractures) of patient having neck swelling also. On FNAC, 50% (20 patients) had Bethesda category III-IV nodules while 10% ( 4 patients ) had Bethesda category II. In sixteen patients FNAC was not done as they presented with compressive symptoms or metastasis. Fifty percent had total thyroidectomy and 50% had subtotal followed by completion thyroidectomy plus ten patients had lymph node dissection out of which seven had histopathological lymph node involvement. On histopathology twenty three patients (57.5%) had minimally invasive while seventeen (42.5%) had widely invasive FTC. In our study 65% of the patients had clinical stage 1 disease while 25% had stage 2 and 10% had clinical stage 4. Seventeen patients (42.5%) had received RAI 30–100 mCi while ten patients (25%) received more than 100 mCi.

Conclusion

FTC demographic and clinicopathological presentation are same in Pakistan as compared to other countries. Surgery followed by RAI are the main stay of treatment. Thus understanding the trend of FTC and proper planning and utilization of the resources will help the developing countries in effectively treating the FTC.