MULTINODULAR GOITER AND RISK OF MALIGNANCY, SURGERY OR FOLLOW UP ?

Nodular goiter is one of the most common presentation of thyroid gland diseases. The risk of development of thyroid cancer is relatively rare (1%) of all types of tumors, however, it is the most common endocrine malignancy, and usually presented as multinodular goiter. Fine needle aspiration cytology (FNAC) considered as the golden tool in the diagnosis of thyroid nodule though, it still has false negative rate which is variable depending on the experience and the technique being used. This means that even if the FNAC done prior to surgery shows negative finding, this doesn't exclude the presence of carcinoma, especially in multinodular goiter where it is possible not to sample the involved area. In this prospective study which was done in Almawanee Teaching Hospital between 2012-2018, 69 patients with Multinodular goiter where considered for the risk of harboring an incidental malignancy. The results of patients with multinodular goiter of benign origin was 57 patients (82.86%) while multinodular goiter which has an incidental malignancy was 12 patients (17.14%). Conclusion: due to relatively high risk of malignancy in multinodular goiter especially with non-compliance for follow-up from patients and risk of missing incidental malignancy by FNAC in multinodular goiter, it is preferable to do total or near total thyroidectomy.