Thyroid disorders are prevalent in clinical practice, standing out as the most common among various endocrinal disorders. A discrete swelling representing an impalpable thyroid gland is termed a solitary thyroid nodule, constituting a frequent manifestation of thyroid diseases. Positioned in the lower portion of the front and sides of the neck, the thyroid gland operates as a vital endocrine gland. Its primary functions encompass regulating the basal metabolic rate, promoting somatic and psychic growth, and playing a crucial role in calcium metabolism [1, 2]. The credit for recognizing the solitary thyroid nodule as a distinct entity should be attributed to Colles WH et al., who observed a significantly higher incidence of malignancy in comparison to multinodular goiters. Thyroid disorders continue to be a frequently encountered endocrine issue in clinical practice, with a higher prevalence among females. Thyroid nodules are widespread, with estimated prevalence rates ranging from 4% when detected by palpation to as high as 68% when identified through ultrasonography. Furthermore, autopsy studies have revealed that 50% of adults have nodules, the majority of which are impalpable [3, 4]. A solitary nodule represents a clinical diagnosis rather than a pathological one. Virtually all thyroid conditions have the potential to manifest clinically as a solitary nodule. Benign origins of thyroid nodules encompass colloid nodules and dominant nodules within a multinodular goiter. On occasion, nodularity is observed in individuals with Hashimoto’s thyroiditis and Graves’ disease. Conversely, malignant etiologies of nodules include differentiated thyroid cancers (such as papillary and follicular), medullary carcinoma, and undifferentiated cancers like anaplastic carcinoma [5].

The pivotal concern lies in discerning the benign or malignant nature of the nodule. Fine Needle Aspiration Cytology (FNAC) has emerged as the cornerstone of the initial assessment for thyroid nodules, complemented by ultrasound scanning and thyroid profile analysis [6, 7]. This study’s primary objective is to investigate the distribution of solitary nodules and to evaluate the risk factors associated with malignancies in patients presenting with solitary thyroid nodules.

This is a hospital-based study conducted over a span of three years, focusing on patients diagnosed with solitary thyroid nodules as the sample population. All individuals in the study were admitted to the hospital, and a total of 50 cases were included in the research.

Inclusion criteria encompassed individuals meeting the following conditions;

1. presence of a single, visible, or palpable nodule located in one lobe of the thyroid or at the junction of one lateral lobe and the isthmus,
2. individuals with a single nodule exhibiting any pathology upon Fine Needle Aspiration Cytology (FNAC),
3. individuals with a single nodule displaying features of thyroid toxicity (toxic nodule) or hypothyroidism.

Exclusion criteria encompassed the following:

1. visibility or palpability of nodules in the opposite lobe of the thyroid,
2. presence of multinodularity.

Data collection was conducted among patients admitted with a diagnosis of solitary thyroid nodule using a pretested semi-structured questionnaire. This questionnaire covered various aspects, including sociodemographic information, details about the solitary nodule, malignancy-related data, and clinical examination findings. All patients underwent a comprehensive set of routine and specific investigations. Treatment plans were formulated once a definitive diagnosis of solitary thyroid nodule was reached. The study participants provided informed written consent, and strict measures were implemented to maintain the confidentiality of their information.

In every case, a neck ultrasound was performed to rule out the presence of multinodular goiter. Additionally, Fine Needle Aspiration Cytology (FNAC) was conducted as the primary investigation for assessing the solitary nodule. Furthermore, clinically diagnosed cases of thyroid conditions were subjected to a comprehensive evaluation in accordance with the specified proforma.

The current study involved approximately 50 patients diagnosed with thyroid pathology, comprising 20 males and 30 females. The female population outnumbered the male population with a ratio of 1:4. The age range of the study participants spanned from 20 to 50 years. Upon analyzing and presenting the collected data, it became evident that solitary thyroid nodules were most frequently observed in individuals in their second and fourth decades of life. The youngest patient in the study was 20 years old, while the oldest was 50 years old. Among the 50 patients included in the study, all of them presented with swelling in the thyroid region. However, 11 of these patients also reported experiencing swelling along with pain. None of the patients exhibited symptoms such as changes in voice, pressure symptoms, or signs of thyroid toxicity.

In this study, it was observed that 30 patients had solitary nodules located in the right lobe, while 20 patients had swelling in the left lobe of the thyroid. None of the patients had any involvement of the isthmus connecting the two lobes. The consistency of the nodules in this series varied, ranging from soft to firm and hard. Notably, all of the hard swellings were ultimately diagnosed as papillary carcinoma of the thyroid.

The most frequent FNAC diagnosis among the study participants was a benign lesion, which was identified in 35 patients. Malignant lesions were diagnosed in 10 patients, while 4 patients received a diagnosis categorized as suspicious. In one patient of the study, the FNAC yielded a non-diagnostic result.

The diagnostic approach in this study involved the utilization of Fine Needle Aspiration Cytology (FNAC). The details of the diagnostic findings are presented in Table 1. FNAC is a minimally invasive diagnostic technique widely employed in clinical settings for evaluating cellular changes and identifying abnormalities. This method involves the extraction of tissue or fluid using a fine-gauge needle, allowing for microscopic examination of the cellular material. The findings obtained through FNAC provide valuable insights into the nature of the lesion, aiding in the accurate diagnosis and subsequent management decisions. Following the surgical interventions, the occurrence of complications was systematically documented and is summarized in Table 2. Surgical procedures, while essential for treating various conditions, may be associated with certain risks and complications. Monitoring and reporting these post-surgery complications contribute to a comprehensive understanding of the outcomes and potential challenges associated with the implemented interventions. The data presented in Table 2 offer a detailed overview of the complications observed in the postoperative phase, providing valuable information for clinical evaluation and future considerations.

The results obtained in this series were compared with findings from various other studies. This comparison encompassed several aspects, including FNAC results, the type of surgical procedures performed, and the incidence of malignancies.

In the present study, all patients presented with a common complaint of swelling in the thyroid region. However, they sought medical advice for different reasons, including the presence of pressure symptoms such as dysphagia, dyspnea, and changes in voice. Notably, the gender distribution showed a female-to-male ratio of 4:1, with the peak incidence occurring in the 20-30 years age group.

The majority of patients initially present as euthyroid, indicating that their thyroid function is within the normal range. Fine Needle Aspiration Cytology (FNAC) is the preferred initial diagnostic investigation. Ultrasonography (USG) serves as a valuable diagnostic tool. For patients diagnosed with papillary carcinoma and those who have lymph node metastasis postoperatively, modified neck dissection is recommended for the removal of enlarged nodes.

Interestingly, most patients with thyroid carcinoma and benign thyroid nodules tend to present with asymptomatic thyroid nodules. In recent times, the primary method of detection has shifted from physical examination to incidental findings during radiological studies. This shift aligns with the recommendations provided in evidence-based guidelines published by professional societies for the evaluation and management of patients with thyroid nodules. These guidelines emphasize the importance of starting with a thorough history and physical examination, followed by appropriate diagnostic testing and therapeutic recommendations [8, 9, 10].

Ultrasonography plays a crucial role not only in determining whether a clinically palpable nodule is cystic or solid but also in assessing the overall condition of the thyroid gland. It helps distinguish whether the clinical solitary nodule is indeed a true solitary nodule or simply a dominant nodule within a multinodular goiter. Fine Needle Aspiration Cytology (FNAC) and thyroid profile assessments are pivotal diagnostic investigations that contribute significantly to the diagnosis.

Hemi-thyroidectomy is considered the most suitable and cost-effective surgical procedure for the treatment of solitary thyroid nodules. It involves the removal of one half (either the right or left lobe) of the thyroid gland and is generally preferred when dealing with such cases.

This research paper received no external funding.

The authors declare no conflicts of interest.

All authors contributed equally to this paper. They have all read and approved the final version.

Informed consent was obtained from all participates in the study as needed.

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