RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE-2

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1. NAME OF THE
CANDIDATE AND
ADDRESS / Dr Praveen Kumar.R. Bhat
Post Graduate in General Surgery,
Bowring and LadyHospital,
BMC&RI,Bangalore
2. NAME OF THE
INSTITUTION / BangaloreMedicalCollege & Research
Institute, Bangalore
3.COURES OF STUDY AND
SUBJECT / M.S. in General Surgery
4. DATE OF ADMISSION TO
THE COURSE / 07th March 2009
5. TITLE OF THE TOPIC / “Clinico-pathological study of solitary
nodule of thyroid gland and its management”.

6.BRIEF RESUME OF INTENDED WORK:

6.1: NEED FOR THE STUDY:

The thyroid disorder is the most common endocrine disorder seen in clinical practice.Lesions of thyroid are predominantly confined to females, in the ratio of5:1, and this has been attributed to variation of thyroid hormone demand during female reproductive functions and physiological events such as puberty, pregnancy and lactation.

Solitary nodule of thyroid is a common clinical entity, though varying in incidence in different geographical regions. It has aroused interest because of its potential to become malignant and also possibility of toxicity and complications like hemorrhage and pressure effects.

6.2 : REVIEW OF LITERATURE:

  • Discrete thyroid swellings are common and are present in 3-4 % of adult population About 70% of discrete thyroid swellings are clinically isolated/solitary and about 30% dominant.1
  • Majority of patients with solitary thyroid nodule will have a benign lesion; however, thyroid cancer is a definite possibility in all patients.2
  • FNAC has become the single most important test in evaluation of thyroid masses and can be performed with or without ultrasound guidance.3
  • High resolution real time R-mode ultrasound scanning equipment using 10 MHz transducer is used to access solitary thyroid nodule. It can accurately detect subclinical nodularity, estimate the size of nodule and volume of goiter, and differentiate simple cysts which have a low risk of being malignant, from solid nodules or from mixed cystic and solid nodules which have a 5% risk of being malignant.5
  • Radio isotope scanning is of principle value in toxic patients with a nodule or nodularity of the thyroid. Radionuclide scans are also useful in patients with indeterminate cytology results or suspicious for follicular lesions because in such patients functioning nodules are almost always benign.6
  • The least extensive surgery recommended for a solitary thyroid nodule is a hemithyroidectomy i.e. lobectomy and isthmusectomy.7
  • Generally, any nodule suspected of being a carcinoma should be completely removed along with surrounding tissues; thus in well differentiated thyroid carcinomas presenting as a solitary nodule, total thyroidectomy is the treatment of choice 4,8
  • The most important complications of surgery are post procedure hypocalcaemia secondary to devascularization of the parathyroid and significant hoarseness caused by recurrent laryngeal nerve injury induced by either traction or division,9

6.3 OBJECTIVES

  1. To enrich the existing information in the field of thyroid gland diseases and to study the incidence of solitary thyroid nodule in relation to age, sex and clinical presentation in our setup.
  2. To study incidence of multinodular goiter, adenoma, carcinoma and thyroiditis as cause of solitary thyroid nodule and to study the incidence of different types of malignancies in solitary thyroid nodule.
  3. To study FNAC vs histopathological correlation of solitary thyroid nodule and study preoperative evaluation and surgical management of solitary thyroid nodule.

7.MATERIALS AND METHODS:

7.1SOURCE OF DATA:

Patients from Bowring and LadyCurzonHospital & VictoriaHospitals attached to Bangalore Medical College & Research Institute, Bangalore

7.2METHOD OF COLLECTION OF DATA:

It is a prospective study. Study size is 50 cases starting from September 2009 to November 2011. Data collected from patients by their clinical history, examination with appropriate investigations on those patients who are admitted from out patient department. Postoperative follow up will be done to note the complications both in hospital and after discharge for at least 6 months.

INCLUSION CRITERIA:

Patients found to have solitary thyroid nodule on clinical examination including autonomous toxic nodules.

EXCLUSION CRITERIA:

1.Patients with previous thyroid surgery.

2.Patients with non thyroidal lesions such as parathyroid cyst, thyroglossal cyst, aneurysm, cystic hygroma, laryiigocoele, bronchocoele which may appear in the area.

7.3:DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTION TO BE CONDUCTED ON HUMANS OR ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY:

1.It doesn't require any intervention on animals.

2.Investigations only on patients with their consent.

(a) Routine blood & urine pre-operative investigations (b) Thyroid profile

(c) FNAC, HPE, USG & radio nucleotide scanning,

(d) ECG& Chest X-Ray

(e) Indirect laryngoscopy.

(f) Other relevant investigations necessary for the case

7.4: HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3

Yes

8. LIST OF REFERENCES:

8.1: TEXT BOOK REFERENCES:

  1. Norman S Williams, Christopher J K Bulstrode arid Ronan O'Connell, "The thyroid and parathyroid glands", Bailey and Love's Short Practice of Surgery, Hodder Arnold, 25th Edition 2008; 779-782.
  2. Mark Evers,Courtney M Townsent, Daniel Beanchamp R, John B. Hanks et.al. "Thyroid" chapter 36, Sabiston Textbook of Surgery, Elsevier, 18th Edition 2003; 930-934.
  3. Geeta Lah, Orlo H. Clark, "Thyroid, parathyroid and adrenals", chapter 37,
    Schwartz's Principles of Surgery, 8,h edition, 2005; 1397-1429.
  4. Edvin L. Kaplan, Kenneth L. Becker, "Thyroid gland", chapter 44, Principles
    and Practice of Endocrinology and Metabolism; Lippincott Williams & Wilkins,
    3rd Edition 2001; 440-444.

8.2: JOURNAL REFERENCES:

  1. Marquess E, Benson C B, Frates M C, et al. Usefulness of Ultrasonography In The Management of Nodular Thyroid Disease, Ann Intern Med 2000; Vol 133: 696-700.
  2. Meier D A, Kaplan M M, Radioiodine uptake and thyroid scintiscanning, Endocrinol Metab Clin North Am 2001; vol 30(2): 291-313.
  3. Namon Kim, Pierre Lavertu, Evaluation of Thyroid Nodule, Otolaryngol Clin Narth Am 2003; vol 36: 17-33.
  4. Sherman SI: Thyroid carcinoma. Lancet 2003, 361: 501-511.
  5. Kahky MP, Weber RS: Intraoperative problems: Complications of surgery of the thyroid and parathyroid glands. Surg Clin North Am 1993, 73:307.

9.SIGNATURE OF THE CANDIDATE:

DR. PRAVEEN KUMAR .R. BHAT

POST GRADUATE STUDENT IN GENERAL SURGERY,

BOWRING AND LADYCURZONHOSPITAL,

BMC&RI, BANGALORE.

10.REMARKS OF THE GUIDE:

Recommended to do the study.

11.NAME AND DESIGNATION OF (IN BLOCK LETTERS):

11.1: GUIDE:

DR. SYEDIQBALULLA SHA KHADRI

PROFESSOR AND HEAD

DEPARTMENT OF SURGERY,

BOWRING AND LADYCURZONHOSPITAL,

BMC& RI, BANGALORE

SIGNATURE & SEAL :

11.2 HEAD OF THE DEPARTMENT :

DR. SHIVASWAMY B. S.

PROFESSOR AND HEAD

DEPARTMENT OF SURGERY,

BMC & RI, BANGALORE

SIGNATURE & SEAL

11.3CO-GUIDE : DR.VANI RAVIKUMAR

DR.VANI RAVIKUMAR ASSISTANT PROFESSOR OF PATHOLOGY,

BMC & RI, BANGALORE

SIGNATURE & SEAL :

12.REMARKS OF THE DIRECTOR AND DEAN:

12.1SIGNATURE AND SEAL :

DR.G.T.SUBHAS

DIRECTOR AND DEAN,

BMC & RI, BANGALORE

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