MON-573 Comparative Study between Clinical Examination and Ultrasonography of the Thyroid Gland as a Screening for Thyromegaly and/or Thyroid Nodules among Alexandria Population

Abstract

Abstract Background: Thyromegaly & thyroid nodules are commonly encountered problems in clinical practice. The most widely used method for the diagnosis of thyroid enlargement & thyroid nodules is palpation. However, large epidemiological studies have shown that ultrasonography (US) is a more sensitive tool. Accordingly, this study was designed to compare physical examination (PE) versus ultrasonography as screening methods of thyroid disorders namely thyromegaly and/or thyroid nodules among apparently healthy Alexandria population. Subjects & Methods: The study included 998 individuals; 543 females & 455 males with a mean age of 24.2±4.6 years, selected from the normal Alexandria population. Goiter is not considered endemic in our area. All cases were examined clinically by two examiners to avoid inter-observer variation. US evaluation of the thyroid gland was carried out by the same person. Enrolled cases were classified as normal, diffuse goiter, solitary & multinodular goiter according to PE & US. Serum TSH, TT3, TT4 & TPOAbs were withdrawn in cases with positive findings either by PE or/ & US. FNAB of thyroid nodules were done whenever indicated. Results: Two hundred and one cases had positive findings by PE (9.2%), US (19.7%) or both, with a superiority of US in the detection of abnormal morphological findings of 2.2 folds as compared to PE. It was observed that only 36.3% of cases with positive findings were consistent by the two modalities of examination, while 63.7 % of cases were either missed or misinterpreted by PE. 103 /175 nodules detected by US were missed by PE, the smaller, the higher the probability to be missed, even only 46 % of nodules > 2 cms were felt by thyroid palpation. Nineteen percent of cases with nodular thyroid by US suffered from subclinical hypothyroidism; ten cases were seropositive to TPOAbs. Nine percent of 998 cases had US features of thyroiditis; fifty-five cases suffered from hypothyroidism; 81% were seropositive to TPOAbs. Ten percent of cases had evidence of thyromegaly by US. 22/68 cases with thyroid nodules were candidates for FNAC. The incidence of differentiated thyroid cancer was 7% by gross pathology. Conclusions: Ultrasonography should be used as a complementary method to physical examination in the screening of thyroid disorders owing its added value. Initial diagnosis based on physical examination may be altered after performing US evidenced by 36.6% consistency of our results by PE & US, while 63.3% of cases were either missed or misinterpreted. Thyroid nodules are commonly missed by PE; the smaller the nodules the higher the probability to be missed. Thyroid hypoechogenicity & heterogenicity by US may serve as a marker for AITD and prediction of present & future thyroid dysfunction.