European Journal of Cardiovascular Medicine

The thyroid gland is an important endocrine organ that controls metabolism by producing thyroid hormones. Thyroid disorders, including both benign and malignant conditions, are among the most common endocrine problems worldwide.1,2 Thyroid lesions may present as small, asymptomatic nodules or as palpable swellings causing compressive symptoms or hormonal imbalance such as hyperthyroidism or hypothyroidism. With the increasing detection of thyroid nodules, accurate diagnosis has become essential to differentiate benign from malignant lesions and to plan appropriate treatment.3

Fine needle aspiration cytology (FNAC) is widely used as the first-line investigation for palpable thyroid lesions because it is simple, cost-effective, and reliable. It provides important cytomorphological details that help classify lesions using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC).4-6 However, FNAC has certain limitations, especially in indeterminate categories such as atypia of undetermined significance and follicular neoplasms, where a definite diagnosis may not always be possible.7,8.

Ultrasonography (USG) is a useful non-invasive imaging method that helps assess thyroid nodules based on size, structure, margins, calcifications, and vascularity. The Thyroid Imaging Reporting and Data System (TI-RADS) helps in risk stratification of nodules and improves the prediction of malignancy.9,10 In addition, thyroid function tests (TFTs), including serum T3, T4, and thyroid-stimulating hormone (TSH), provide information about the functional status of the thyroid and help identify hyperfunctioning and hypofunctioning nodules.11

Each of these diagnostic methods has its own limitations when used alone. Therefore, combining cytological, sonographic, and biochemical findings provides a more accurate and reliable diagnosis.12 The present study aims to analyze the cytomorphological spectrum of palpable thyroid lesions and correlate these findings with sonographic and biochemical parameters to improve diagnostic accuracy and guide better patient management.

Study Design

This study was a prospective observational study

Study Setting and Study Area

The study was carried out in the Department of Pathology in collaboration with the Department of General Surgery at K.M. Medical College and Hospital.

Study Duration

The study was conducted over a period of two years.

Study Population and Sample Size

A total of 96 patients presenting with palpable thyroid lesions were included. Patients attending the outpatient department who fulfilled the inclusion criteria were consecutively enrolled until the required sample size was achieved.

Inclusion Criteria

•              Patients with palpable thyroid nodules or goiter

•              Patients providing informed written consent

Exclusion Criteria

•              Patients who did not consent

•              Patients with previously treated thyroid malignancy

•              Patients with bleeding disorders or on anticoagulant therapy

Study Procedure

All patients underwent detailed clinical evaluation, and relevant history was recorded. Fine needle aspiration cytology (FNAC) was performed under aseptic conditions using a 22-gauge needle attached to a 10 mL syringe. The aspirated material was smeared onto glass slides and stained with May-Grünwald-Giemsa and Papanicolaou stains. Cytomorphological findings were categorized according to the Bethesda System for Reporting Thyroid Cytopathology. Ultrasonographic examination was carried out using a high-resolution linear transducer (7.5–12 MHz), and thyroid nodules were assessed for size, echogenicity, composition, margins, calcifications, and vascularity. Based on these features, nodules were categorized according to their risk profile. Thyroid function tests, including serum T3, T4, and thyroid-stimulating hormone (TSH), were measured using chemiluminescence immunoassay. Patients were classified as euthyroid, hypothyroid, or hyperthyroid. Correlation was performed between cytological findings, sonographic features, and biochemical parameters.

Statistical Analysis

Data were analyzed using SPSS software (version 20.0 and 26.0). Continuous variables were expressed as mean ± standard deviation, and categorical variables as frequencies and percentages. The chi-square test and correlation analysis were applied, with p < 0.05 considered statistically significant.

In Table 1, most patients were aged 20–50 years, indicating higher prevalence in middle age. The majority were euthyroid, while hypothyroidism was relatively common. A small proportion was hyperthyroid, and some cases lacked biochemical data.

Table 1: Age Distribution and Thyroid Function Status (n = 96)

Table 2 shows that colloid goitre was the most common diagnosis clinically and radiologically. Thyroiditis was the next frequent finding. Radiology showed more unspecified cases, indicating variability in imaging reporting compared to clinical assessment.

Table 2: Distribution of Clinical and Radiological Diagnoses

In Table 3, Benign lesions predominated, with colloid goitre as the most common finding. Inflammatory lesions, mainly thyroiditis, also formed a significant proportion, indicating that non-neoplastic conditions are more frequent than malignant lesions.

Table 3: Cytological Diagnosis

Table 4: FNAC Findings (n = 96)

In Table 5, Bethesda category II was most common and correlated well with benign ultrasound features. Higher categories (V and VI) were associated only with hypoechoic nodules with microcalcifications, indicating strong agreement between suspicious ultrasound features and malignant cytology.

Table 5: Distribution of FNAC Findings According to The Bethesda System for Reporting Thyroid Cytopathology – 3rd Edition (2023)

The present study analyzed the cytomorphological spectrum of palpable thyroid lesions and correlated these findings with sonographic and biochemical parameters to improve diagnostic accuracy.

In the present study, the majority of patients belonged to the 20–50 years age group (68.8%), indicating that thyroid lesions predominantly affect young and middle-aged individuals. This finding is consistent with Akshatha N et al. (2019)6, who reported 68.4% cases in the same age group, and Begum Z et al. (2024)13, who observed peak incidence in the third and fourth decades. Similarly, Yadav R (2023)14 reported that 60% of neoplastic lesions occurred in the 21–40 years age group, with minimal cases in younger individuals.

Regarding thyroid function, most patients were euthyroid (54.2%), followed by hypothyroid (20.8%) and hyperthyroid (2.1%) cases, indicating that functional status is often normal in patients with thyroid nodules. Comparable findings were reported by Yadav R (2023)14 (76% euthyroid), Akshatha N et al. (2019)6 (53.4% euthyroid), and Begum Z et al. (2024)13 (75.7% euthyroid), whereas Kaur N et al. (2025)15 reported hypothyroidism as the most common dysfunction (44%), possibly due to population differences.

Colloid goitre was the most common diagnosis both clinically (67.7%) and radiologically (41.7%) in the present study, followed by thyroiditis. Similar observations were made by Akshatha N et al. (2019)6, who also reported colloid goitre as the predominant lesion (67.3% clinically, 42.5% radiologically). Radiological evaluation in the present study identified slightly more cases of thyroiditis and cystic changes, but also showed a higher proportion of unspecified diagnoses, highlighting variability in imaging interpretation.

Cytologically, benign lesions constituted the majority (45.8%), with colloid goitre being the most frequent finding, followed by inflammatory lesions (33.3%). These findings are in agreement with Akshatha N et al. (2019)6, who reported 46.5% benign lesions, and Kaur R et al. (2025)15, who also observed predominance of non-neoplastic lesions, indicating that benign thyroid conditions are far more common than malignant ones.

Most nodules in the present study were classified as low-risk TIRADS categories, particularly TIRADS 1 (69.8%), with no cases in TIRADS 5. This trend is comparable to Begum Z et al. (2024)13, who reported predominance of TIRADS 2 nodules (77%), and Kaur N et al. (2025)15, who observed most nodules in TIRADS 2 (52%), confirming that most thyroid nodules are benign on imaging.

FNAC findings revealed adenomatous nodules as the most common diagnosis (50%), followed by lymphocytic thyroiditis, with relatively few indeterminate and malignant cases. Yadav R (2023)14 demonstrated high diagnostic accuracy of FNAC with strong cyto-histopathological concordance, supporting its reliability as a primary diagnostic tool.

Correlation with the Bethesda classification showed that benign categories corresponded well with benign ultrasound features, while higher categories (V and VI) were associated with hypoechoic nodules with microcalcifications. Similar findings were reported by Adil Z et al. (2025)16, who observed predominance of Bethesda category II (82%) with a small proportion of malignant lesions.

The present study concluded that most palpable thyroid lesions are benign and occur predominantly in euthyroid, middle-aged individuals. Fine needle aspiration cytology, interpreted using the Bethesda system, is a reliable and cost-effective diagnostic tool. Ultrasonography with TIRADS classification aids in risk stratification and identification of suspicious features. Thyroid function tests help assess hormonal status but have limited role in predicting malignancy. An integrated approach combining cytology, imaging, and biochemical assessment improves diagnostic accuracy and guides appropriate clinical management.

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