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Objectives. This is a diagnostic test research study to evaluate the various existing methods of thyroid examination and their comparison with the novel modified Rose method. It also aims to measure inter-examiner variation in clinical findings based on the level of education and training, as compared to ultrasonography.
Methodology. This cross-sectional study was conducted at a tertiary care hospital with eighty-three patients presenting to surgery OPD with neck swelling. Each patient was examined by one trained Junior Resident and a Surgery Consultant with all the four methods and with ultrasonography. Data was analysed by Stata-14, agreement between the two categorical variables was assessed by Kappa. In case of continuous variable agreement was assessed by Intra class correlation and Bland-Altman plot.
Results. Modified Rose method by the consultant has the highest sensitivity (98%) and diagnostic odds (210) as compared to others but its specificity ranges from 46.7- 91.1% to diagnose retro-sternal extension of a goiter. It has 93.98% agreement for identification of nodules. It has a high specificity (Consultant -100%, Resident – 95.5%) with relatively lower sensitivity (Consultant -94%, Resident – 86.8%) to diagnose solitary thyroid nodule (STN) but the sensitivity and specificity for diagnosing a multinodular goitre (MNG) was high. However, the highest sensitivity to diagnose STN was highest with Crile’s method, but specificity was low. Lahey’s method was a better clinical method to palpate lymph nodes compared to the other three.
Conclusion. Examination in modified Rose’s position is a better method of clinical examination of thyroid especially in patients with occult substernal extension. Lahey’s method is a better method to examine cervical lymph nodes.
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Unnikrishnan AG, Menon UV. Thyroid disorders in India: An epidemiological perspective. Indian J Endocrinol Metab. 2011;15(Suppl 2):S78-81. https://pubmed.ncbi.nlm.nih.gov/21966658. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169866. https://doi.org/10.4103/2230-8210.83329.
Guerra G, Cinelli M, Mesolella M, et al. Morphological, diagnostic and surgical features of ectopic thyroid gland: A review of literature. Int J Surg. 2014;12 Suppl 1:S3-11. https://pubmed.ncbi.nlm.nih.gov/24887357. https://doi.org/10.1016/j.ijsu.2014.05.076.
Noussios G, Anagnostis P, Goulis DG, Lappas D, Natsis K. Ectopic thyroid tissue: Anatomical, clinical, and surgical implications of a rare entity. Eur J Endocrinol. 2011;165(3):375-82. https://pubmed.ncbi.nlm.nih.gov/21715415. https://doi.org/10.1530/EJE-11-0461.
Chung WY, Chang HS, Kim EK, Park CS. Ultrasonographic mass screening for thyroid carcinoma: A study in women scheduled to undergo a breast examination. Surg Today. 2001;31(9):763-7. https://pubmed.ncbi.nlm.nih.gov/11686552. https://doi.org/10.1007/s005950170044.
Rugiu M, Piemonte M. Surgical approach to retrosternal goitre: Do we still need sternotomy? Acta Otorhinolaryngol Ital. 2009;29(6):331–8. https://pubmed.ncbi.nlm.nih.gov/20463839. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868211.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-74. https://pubmed.ncbi.nlm.nih.gov/843571.
Walker HK, Hall WD, Hurst JW, eds. Clinical methods: The history, physical, and laboratory examinations, 3rd ed. Boston: Butterworths; 1990.
Lahey FH. A method of palpating the lobes of the thyroid. JAMA. 1926;86(12):813-4. https://doi.org/10.1001/jama.1926.02670380003002
Knudsen N, Bols B, Bülow I, et al. Validation of ultrasonography of the thyroid gland for epidemiological purposes. Thyroid. 1999;9(11):1069-74. https://pubmed.ncbi.nlm.nih.gov/10595454. https://doi.org/10.1089/thy.1999.9.1069.
Marqusee E, Benson CB, Frates MC, et al. Usefulness of ultrasonography in the management of nodular thyroid disease. Ann Intern Med. 2000;133(9):696–700. https://pubmed.ncbi.nlm.nih.gov/11074902. https://doi.org/10.7326/0003-4819-133-9-200011070-00011.
Tan GH, Gharib H, Reading CC. Solitary thyroid nodule. Comparison between palpation and ultrasonography. Arch Intern Med. 1995;155(22):2418–23. https://pubmed.ncbi.nlm.nih.gov/7503600. https://doi.org/10.1001/archinte.155.22.2418.
Schneider AB, Bekerman C, Leland J, et al. Thyroid nodules in the follow-up of irradiated individuals: Comparison of thyroid ultrasound with scanning and palpation. J Clin Endocrinol Metab. 1997;82(12):4020–7. https://pubmed.ncbi.nlm.nih.gov/9398706. https://doi.org/10.1210/jcem.82.12.4428.
Middleton WD, Teefey SA, Reading CC, et al. Multiinstitutional analysis of thyroid nodule risk stratification using the American College of Radiology Thyroid Imaging Reporting and Data System. AJR Am J Roentgenol. 2017;208(6):1331-41. https://pubmed.ncbi.nlm.nih.gov/28402167. https://doi.org/10.2214/AJR.16.17613.
Bickham WS. Misconception, in America, as to the Rose position. JAMA. 1931;96(26):2185-7. https://doi.org/10.1001/jama.1931.02720520013004
Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1–133. https://pubmed.ncbi.nlm.nih.gov/26462967. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4739132. https://doi.org/10.1089/thy.2015.0020.