Prognosis of Differentiated Thyroid Carcinoma in Patients with Graves Disease: A Systematic Review and Meta-Analysis

Mekraksakit, Poemlarp; Rattanawong, Pattara; Karnchanasorn, Rudruidee; Kanitsoraphan, Chanavuth; Leelaviwat, Natnicha; Poonsombudlert, Kittika; Kewcharoen, Jakrin; Dejhansathit, Siroj; Samoa, Raynald

doi:10.4158/ep-2019-0201

Cited by 22 publications

(37 citation statements)

References 61 publications

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“…A recent meta-analysis demonstrated an increased risk of distant metastasis at the time of cancer diagnosis in patients with differentiated thyroid cancer and GD in comparison to those without GD. [ 11 ] Furthermore, Pellegriti et al [ 12 ] found increased disease-specific mortality in patients with GD in comparison with matched euthyroid patients with thyroid cancer. Our case report confirms the data from the literature.…”

Section: Discussionmentioning

confidence: 99%

Graves disease and metastatic hormonal-active Hürthle cell thyroid cancer

et al. 2021

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Rationale: A hormone-active metastatic Hürthle cell thyroid carcinoma (HCTC) and Graves disease (GD) present a therapeutic challenge and is rarely reported. Patient concerns: We present a 64-year-old male patient, who had dyspnea and left hip pain lasting 4 months. He had clinical signs of hyperthyroidism and a tumor measuring 9 cm in diameter of the left thyroid lobe, metastatic neck lymph node and metastases in the lungs, mediastinum, and bones. Diagnosis: Laboratory findings confirmed hyperthyroidism and GD. Fine-needle aspiration biopsy and cytological investigation revealed metastases of HCTC in the skull and in the 8th right rib. A CT examination showed a thyroid tumor, metastatic neck lymph node, metastases in the lungs, mediastinum and in the 8th right rib measuring 20 × 5.6 × 4.5 cm, in the left acetabulum measuring 9 × 9 × 3 cm and parietooccipitally in the skull measuring 5 × 4 × 2 cm. Histology after total thyroidectomy and resection of the 8th right rib confirmed metastatic HCTC. Interventions: The region of the left hip had been irradiated with concomitant doxorubicin 20 mg once weekly. When hyperthyroidism was controlled with thiamazole, a total thyroidectomy was performed. Persistent T3 hyperthyroidism, most likely caused by TSH-R-stimulated T3 production in large metastasis in the 8th right rib, was eliminated by rib resection. Thereafter, the patient was treated with 3 radioactive iodine-131 (RAI) therapies (cumulative dose of 515 mCi). Unfortunately, the tumor rapidly progressed after treatment with RAI and progressed 10 months after therapy with sorafenib. Outcomes: Despite treatment, the disease rapidly progressed and patient died due to distant metastases. He survived for 28 months from diagnosis. Lessons: Simultaneous hormone-active HCTC and GD is extremely rare and prognosis is dismal. Concomitant external beam radiotherapy and doxorubicin chemotherapy, followed by RAI therapy, prevented the growth of a large metastasis in the left hip in our patient. However, a large metastasis in the 8th right rib presented an unresolved problem. Treatment with rib resection and RAI did not prevent tumor recurrence. External beam radiotherapy and sorafenib treatment failed to prevent tumor growth.

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Section: Discussionmentioning

confidence: 99%

Graves disease and metastatic hormonal-active Hürthle cell thyroid cancer

et al. 2021

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“…One study found that in patients with thyroid cancers <1 cm, GD patients had an excellent prognosis and longer disease-free survival compared to age, sex, and tumor sizematched non-GD patients [19]. However, a meta-analysis found increased multifocality and distant metastasis at the time of the differentiated thyroid carcinoma (DTC) diagnosis in GD patients compared to non-GD patients [42]. A small study with a relatively long follow-up period (median 165.6 months) observed that GD patients with coexisting DTC had a poorer prognosis compared with age, sex, and tumor size-matched non-GD patients [43].…”

Section: Article In Pressmentioning

confidence: 99%

Clinical Characteristics and Prognosis of Coexisting Thyroid Cancer in Patients with Graves’ Disease: A Retrospective Multicenter Study

et al. 2021

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Background:The association between Graves' disease (GD) and co-existing thyroid cancer is still controversial and most of the previously reported data have been based on surgically treated GD patients. This study investigated the clinicopathological findings and prognosis of concomitant thyroid cancer in GD patients in the era of widespread application of ultrasonography. Methods: Data of GD patients who underwent thyroidectomy for thyroid cancer between 2010 and 2019 in three tertiary hospitals in South Korea (

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“…In patients with Graves' disease, the likelihood of thyroid cancer increases in the presence of one or more thyroid nodules at ultrasound imaging, with a cancer risk rate of 22% compared with 5.1% in the absence of nodules [3]. To date there are few data on the co-presence of Graves' disease and DTC in children and adolescents [3][4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

“…In patients with Graves' disease periodic ultrasound followup is recommended to rule out nodular thyroid disease. In adult patients with hyperthyroidism, recent studies have shown an increase in the rate of differentiated thyroid cancer (DTC), with an incidence of 4.7-81.1%, especially in the presence of nodules; to date very few data are present for the pediatric age [3][4][5][6][7]. The most represented type of DTC is papillary microcarcinoma and the co-presence of Graves' disease does not appear to be associated with more aggressive tumor behaviour [5,6].…”

Section: Introductionmentioning

confidence: 99%

Papillary thyroid microcarcinoma in a boy with Graves’ disease: a case report and review of the literature

Tuli¹,

Munarin²,

Tessaris³

et al. 2022

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A 16-years old boy with diagnosis of Grave's disease was treated with methimazole for one year before radical total thyroidectomy treatment due to persistence of clinical hormonal hyperthyroidism. Histological analysis revealed the presence of a papillary microcarcinoma. The management of Grave's disease in pediatric age is still under discussion. Therefore, close monitoring of the disease is required, as well as case-by-case tailored decision on how to manage treatment and when to perform the radical one, taking into account the association of Grave's disease with differentiated thyroid cancer in adults and the higher malignancy of thyroid cancer in childhood.

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Prognosis of Differentiated Thyroid Carcinoma in Patients with Graves Disease: A Systematic Review and Meta-Analysis

Cited by 22 publications

References 61 publications

Graves disease and metastatic hormonal-active Hürthle cell thyroid cancer

Graves disease and metastatic hormonal-active Hürthle cell thyroid cancer

Clinical Characteristics and Prognosis of Coexisting Thyroid Cancer in Patients with Graves’ Disease: A Retrospective Multicenter Study

Papillary thyroid microcarcinoma in a boy with Graves’ disease: a case report and review of the literature

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