The purpose of the present study was to evaluate the prevalence of thyroid cancer in patients who had thyroidectomy for MNG, and analyze patient-related parameters to identify type and risk factors associated with incidental thyroid malignancy.

Multinodular goiter (MNG) is a common thyroid disorder characterized by the presence of multiple nodules in the thyroid gland. It is a benign condition, but a proportion of patients with MNG have risk of developing thyroid cancer .

Thyroid carcinoma is one of the most frequent types of endocrinological cancers, and its occurrence has been on the rise globally. Total thyroidectomy is regarded as the most effective surgical treatment for MNG and is also advised for patients with diagnosed thyroid cancer.

Several studies have revealed a greater incidence of thyroid cancer in MNG. Published data regarding the prevalence of thyroid cancer within a multinodular goitre (MNG) have demonstrated a wide distribution of cancer rates, ranging from 3 to 35 percent.

Although fine-needle aspiration (FNA) is the most accurate and cost effective method of thyroid nodule evaluation, benign cytological -diagnosis is associated with false-negative. Further complicating this topic, FNA cytology may be non-diagnostic in up to 25 per cent of patients with nodular thyroid disease, and its performance in the setting of MNG presents other difficulties, including deeply located thyroid nodules that may be more challenging to aspirate as well as reliably evaluating all suspicious nodules.

Incidental thyroid cancer (ITC) is sometimes detected in the final pathological examination, the incidence of ITC after surgery varies widely in literature, ranging from 2% to 30%.

Certain risk factors, such as sex, age, history of neck irradiation, family history, calcifications observed during imaging studies, size of the thyroid tumor and thyroid-stimulating hormone (TSH) levels, may be related to ITC; however, this remains controversial. Although previous studies have focused on clinical factors related to cancer, the knowledge on pathologic characteristics of ITC is limited.

Inclusion Criteria:

• Male or Female patients with multinodular goiter Patients with normal thyroid function tests Patients with FNAC negative for malignancy Patients who are fit for general anesthesia

Exclusion Criteria:

• patient suspicious nodule on ultrasound imaging patients in whom distant metastases occurred preoperatively but FNAC was negative for malignancy patients with a history of thyroidectomy Patients with severe comorbid conditions with high risk for general anesthesia

Patient with inclusion criteria of various ages ,sex and BMI