Clinicopathological Profile, Histopathological Spectrum, Prevalence, and Factors Associated with Malignancy in Solitary Thyroid Nodules

Abstract

Objective: To determine the frequency and histopathological spectrum of malignancy among surgically treated solitary thyroid nodules (STNs) and assess associated clinical, sonographic, and cytological features. Study Design & Setting: Descriptive cross-sectional study. Department of General Surgery, Surgical Ward 2, Jinnah Postgraduate Medical Centre (JPMC), Karachi, from 25 August 2025 to 25 February 2026. Methodology: Fifty-eight consecutive patients aged 16–70 years with STNs who underwent thyroid surgery were included. Clinical and ultrasonographic findings, preoperative Bethesda cytology, and final histopathology were recorded. Categorical variables were analysed using Fisher's exact or Fisher-Freeman-Halton exact tests, as appropriate. A p-value < 0.05 was considered significant. Data were analysed using SPSS version 26. Results: Of 58 patients, 45 (77.6%) were female and 13 (22.4%) were male; mean age was 43.24 ± 16.46 years. Malignancy was found in 22 (37.9%) patients. Papillary carcinoma was most common (72.7%), followed by follicular (18.2%), medullary (4.5%), and poorly differentiated carcinoma (4.5%). Female sex was associated with malignancy (p = 0.001); microcalcifications, irregular margins, and Bethesda category were also associated (all p < 0.001). Malignancy occurred in 6/17 (35.3%) Bethesda IV nodules and all Bethesda V and VI nodules. Conclusion: Malignancy was found in 22/58 (37.9%) surgically treated STNs. Microcalcifications, irregular margins, and higher Bethesda categories were strongly associated with malignant histopathology. Female sex was an observed association and should be interpreted cautiously.