Graves’ disease and papillary thyroid carcinoma: case report and literature review of a single academic center

Abstract

Background Graves’ disease (GD) and papillary thyroid cancer (PTC) can be concomitant. The existence of a link between these entities has long been investigated, but a clear correlation hasn’t been established. We report a case of GD resistant to medical treatment in which surgery revealed unsuspected PTC and we aim to study the prevalence of PTC in Graves’ disease, its clinical characteristics and review of the literature. Case presentation Report of a 32 yo man who presented with weight loss and was found to be biochemically hyperthyroid. Antibodies were positive. Incremental doses of methimazole provided no improvement in thyroid tests. Hypervascularity and a spongiform nodule were noted on ultrasound. Thyroid uptake and scan showed 70.2% uptake. Thyroidectomy was performed due to inadequate therapeutic response. Pathology revealed PTC with extrathyroidal extension and positive lymph nodes. A retrospective review (2000–2021) and literature review of PTC in GD was performed. Clinical data were reviewed. Statistical analysis was calculated to identify correlations. 243 GD patients had total thyroidectomy at an academic center, 50 (20%) had PTC, 14% were microcarcinomas. 76% of cases were less than 55yo, 82% female, 78% stage 1, PTC diagnosis was incidental in 48%, hyperthyroidism was difficult to treat in 10% and only 2% had recurrence of PTC. There was no correlation between demographic or clinical data. Conclusions Evidence is controversial with some studies showing GD does not affect PTC prognosis. PTC may not be well recognized in GD, pre-operative assessment should consider risk of cancer.

Comparison of Surgical Outcomes of Transoral Versus Open Thyroidectomy for Graves Disease

“…Therefore, even in Graves surgery, maintaining specimen integrity is crucial. In previous studies, 33,34 a fragmented specimen could cause tumor seeding or compromise the pathologic examination 35,36 . Our series used a 1- to 2-cm wound at the right axillary skin fold to remove the larger specimen and maintain the oncologic principle of surgery without compromising the patient’s esthetic appearance.…”

Global research landscape and emerging trends in Graves’ disease: A bibliometric analysis

“…[ 75 ] These conclusions are consistent with those of other studies. [ 76 , 77 ] However, the mechanisms underlying the development of thyroid nodules and cancer in patients with GD remain unclear. Some studies have proposed a crucial role of thyroid-stimulating immunoglobulin in this process.…”

“…However, there is an ongoing debate regarding whether TRAb levels positively or negatively correlate with the incidence of thyroid cancer in patients with GD. [ 75 , 77 , 78 ] Future research should provide evidence to substantiate this correlation and unveil the underlying mechanisms to achieve early prediction, diagnosis, and treatment.…”

Multifocal papillary thyroid cancer in Graves’ disease: A case report

“…Notably, research from the University of Chicago indicated that among patients with GD who underwent total thyroidectomy, 20% were diagnosed with both GD and thyroid cancer. These cases were primarily middle-aged females with positive TSI, and most of them presented with unifocal microcarcinomas[ 12 ]. Local data at Saudi Arabia showed that majority of patients with GD underwent total thyroidectomy because of failed antithyroid drugs and severe ophthalmopathy[ 13 ], while a retrospective study in Saudi Arabia demonstrated that only 5% of patients with thyroid cancer undergoing thyroidectomies were identified as hyperthyroid, with limited details regarding cancer characteristics[ 14 ].…”