Thyroid malignancy rates and outcomes of TIRADS 3 and TIRADS 4A patients who have undergone elective thyroidectomy in a tertiary centre in Selangor.

Introduction:   
Thyroid nodule has 5-10% malignancy rate in Malaysia. TIRADS 3 and 4A category patients pose a challenge in terms of managing conservatively or surgically. This study aims to investigate the malignancy rates and outcomes of patients who have undergone elective thyroid surgery.  

Method:   
A cross-sectional study was performed using medical records of adult patients (age ≥18 years old ) who have undergone elective thyroid surgery from 1st January 2015 to 31st December 2020.   

Result:   
94 patients fulfilled the inclusion criteria, with TIRADS 3, n=43 and TIRADS 4A, n=51. Mean size of thyroid nodule for TIRADS 3 is 3.66 +/- 1.35cm, TIRADS 4 is 3.71+/- 1.86. 90% underwent FNAC procedure,and 46.8% went through at least 2 times of FNAC. 61% underwent hemi-thyroidectomy, with 70% indicated for suspicion of malignancy. Tirads 3 recorded 5.4% of malignancy in low BETHESDA category (1-3), 16.7% in high BETHESDA category (4-6), p value 0.315. TIRADS 4A reported 9.3% vs 62.5% malignancy rates,  in low vs high BETHESDA category, p value 0.001. Recurrent laryngeal nerve injury (RLNI) and haematoma were the highest post-operative complications recorded for TIRADS 3; for TIRADS 4A, it was hypocalcemia and RLNI.   

Discussion:  
Both TIRADS 3 and TIRADS 4A recorded low rates of malignancy (5.3% vs 9.3%) with low BETHESDA score (1-3). Molecular testing of FNAC samples and radionuclide scan should be considered prior to surgery in TIRADS 3.   

Conclusion:  
Malignancy rates are 7% in TIRADS 3, 17.6% in TIRADS 4A. RNI and hypocalcemia are common complications.  

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