Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item Incidence of carcinoma among THY3 lesions of the thyroid(Sri Lanka Medical Association, 2016) Kumarasinghe, K.A.P.R.; Pinto, M.D.P.; Munasinghe, B.N.L.; Dissanayake, D.M.C.D.; Abeyrathne, I.G.K.P.; Amaraweera, P.C.; Fernando, R.INTRODUCTION AND OBJECTIVES: Ultra Sound Scan (USS) and Fine Needle Aspiration Cytology (FNAC) of thyroid nodules are carried out in patients with goitre. THY3 lesions cause diagnostic difficulty and risk of malignancy in such lesions is 20%. The objective of this study was to determine the incidence of carcinoma among THY3 lesions and to relate the findings to the size of the nodule. METHOD: All the patients who underwent thyroidectomy at the University Surgical Unit, Colombo North Teaching Hospital from November 2002 to December 2015 were analysed retrospectively. Histological and ultrasonic data in patients with THY3 lesions were analysed. RESULTS: There were 29 (5.68%) THY3 patients among 510 patients who had thyroidectomy. Only 6 (20.7%) patients were histologically proven to be malignant (follicular carcinoma – 3, papillary carcinoma - follicular variant- 2, mixed medullary papillary carcinoma - 1). All patients were females (age range 17y -52y). Pre-operative USS nodule size in the malignant group ranged from 2.6 cm to 6.8 cm (average - 4.25cm). 20 patients (68.9%) had benign histology (MNG - 18, thyroiditis-2). USS nodule size in the benign group ranged from 2.3 cm to 2.5 cm. Three patients (8.7%) were lost to follow up. CONCLUSIONS: About 20.7% of THY3 lesions had thyroid carcinoma. Lesions larger than 4.25 cm were more likely to harbour a malignancy.Item Clnical presentation, characteristics and surgical outcome of retrosternally extending goitres versus goitres confined to neck: results from a case control study(Sri Lanka Medical Association, 2016) Munasinghe, B.N.L.; Dissanayake, D.M.C.D.; Rathnayake, R.M.G.K.; Pinto, M.D.P.; Kumarasinghe, K.A.P.R.; Fernando, F.R.INTRODUCTION: Goitres that extend beyond the thoracic inlet are defined as retro-sternally extending (RSE) goitres. These RSE goitres are a surgical challenge and their characteristics could be different to the goitres confined to the neck. METHOD: A retrospective case-control study. Patients were selected from the thyroid database maintained in our unit (from November 2002 to February 2016). Patients with RSE goitres (confirmed by imaging) were selected as study group (SG). Control group (CG) patients (with goitres confined to the neck) were systematically selected in a 1:2 ratio. The end points were: (i) incidence of RSE goitres, (ii) clinical presentation, (iii) degree of RSE (iv) thyroid status, (v) post operative complications and (vi) histological pattern. RESULTS: 527 consecutive patients (465 female: 62 male; median age 45 years, range 17 years to 71 years) were studied. For the case control study, there were 51 patients in the study group and 102 patients in the control group. Compression symptoms were not significantly high in the SG (27% vs 17%, p value <0.17). Majority had RSE of both lobes (78%). The median depth of extension into the mediastinum was 41.6mm (range 12mm - 95mm). A majority were euthyroid (SG 78% vs CG 82%). Post operative stridor was significantly high in the SG (7% vs 2%; P value = 0.015). Although a majority was colloid goitres, papillary carcinoma was significantly high in the CG (P value < 0.05). CONCLUSIONS: A majority of RSE goitres did not present with compression symptoms, but had significantly high post-operative stridor (p value <0.05). Incidence of cancer is not high in SG.Item Does the retrosternal extension of a goitre and its relationghip to the aortic arch determines the surgical approach(Sri Lanka Medical Association, 2016) Kumarasinghe, K.A.P.R.; Pinto, M.D.P.; Munasinghe, B.N.L.; Dissanayake, D.M.C.D.; Abeyrathne, I.G.K.P.; Amaraweera, P.C.; Fernando, R.INTRODUCTION: Retrosternal extension (RSE) is defined as the enlargement of the thyroid below the thoracic inlet. The greatest challenge in embarking on surgery in RSE is to decide whether to involve an intra-thoracic approach (sternotomy or thoracotomy) or not, as this approach accounts for added morbidity & mortality. OBJECTIVES: The aim of this study is to analyse whether the relationship of the retrosternal component of a goitre to the aortic arch decides the surgical approach of total thyroidectomy. METHOD: A total of 527 thyroidectomies were performed at Colombo North Teaching Hospital professorial unit during the period from November, 2002 to February, 2016. There were 51 patients with radiological evidence of retrosternal goitre (6.27%). These patients were categorized into 2 groups according to the degree of RSE. Groups were defined as extension of goitre above the arch of aorta (AA) and below AA. RESULTS: 50 (98%) patients had RSE above the AA and 1 patient had RSE below the AA. RSE was seen on the right side of the mediastinum in 3 (5.88%) patients, on the left in 8 (15.68%) patients and bilaterally in 40 (78.43%). Total thyroidectomy was undertaken in all 50 patients with RSE above the AA, through cervical approach without an added morbidity. The patient with RSE beyond the AA underwent total thyroidectomy with axillary thoracotomy. CONCLUSIONS: Majority of the RSE is above the AA, which can be dealt with a cervical approach and extension below the AA may need an intra-thoracic approach.Item Micronodularity is an important physical sign in chronic autoimmune thyroiditis(Sri Lanka Medical Association, 2011) Jayatunse, D.N.U.; Pinto, M.D.P.; Fernando, R.INTRODUCTION AND OBJECTIVES: Chronic autoimmune thyroiditis is the commonest inflammatory disorder of the thyroid. There is evidence that the prevalence of autoimmune thyroiditis is increasing in Sri Lanka. The clinical features of autoimmune thyroiditis have been described in text but micronodularity which is found frequently has not been well documented as a physical sign. Aim of this study was to assess whether micronodularity is an important physical sign in clinical diagnosis of chronic autoimmune thyroiditis. METHODS: Analysis of physical characteristics of goitres in 426 patients who were part of an island wide study on epidemiology of goitre. All physical characteristics were taken note of and micronodularity was taken as a screening test compared with biochemical and cytological evidence of chronic autoimmune thyroiditis.RESULT: From 5200 participants (mean age = 36.3 years) goitres' were detected in 426 participants (143 males, 283 females). Modularity was detected in 271. Micronodularity was present in 190 (70.1 %) whereas macronodularity was detected in 81 (29.9 %). Thyroid antibody status was available in 153 participants where 74 had micronodularity. 27 with micronodularity were test positive (sensitivity - 49.09% / specificity = 52.04% 7PPV = 36.48%/NPV = 64.55%). Cytology was available in 328 subjects where 146 had micronodularity. 54 with micronodularity were cytologically positive (sensitivity = 47.79% and specificity = 57.21% / PPV = 36.98% / NPV = 67.58%). CONCLUSIONS: Diagnosis of chronic autoimmune thyroiditis is based on clinical, biochemical and cytological evidence. Micronodularity is a useful physical sign in diagnosing chronic autoimmune thyroiditis