Thyroid Cancer and Nodules in Graves’ Disease: A Single Center Experience

Abstract

Background: The existence of a link between Graves’ Disease (GD) and Thyroid Cancer (TC) has long been investigated, however a clear pathogenic correlation has still to be found. Methods: In this study we analyzed retrospectively a cohort of 151 patients treated at our Clinic with total thyroidectomy between 2013 and 2018. All patients were symptomatic at the time of surgery, preoperatively ultrasonographic (US) study was performed to evaluate the presence of nodules and their distribution. All patients reached euthyroid state before surgery. Objective: We verified the presence of TC in patients submitted to surgery for GD, both with and without thyroid nodules (TN). Results: Nodules were detected in 53% of cases, above 60 y.o. at least one nodule was found, younger patients more frequently were nodules free. Bilateral diffusion of nodules appeared with increasing age. Cancer was found in 19 of 151 subjects (12.5%), all were papillary carcinomas, among them 93% were microcarcinomas. Among cancer-proven patients, 14 had thyroid nodules while 5 where nodule-free. During the follow up period no cancer recurrence was recorded. The most common complication after surgery was transient hypocalcemia (36%). Conclusions: Graves’ patients are burdened by major incidence of TC in the context of their TN. Pre-operative assessment in GD patients should consider the risk of cancer, US scan can help in rapid evaluation of nodules and new rising frontiers in molecular biomarkers analysis may help defining pathogenic basis of Graves’ neoplastic development.

Phenotype and genotype of 197 British patients with McArdle disease: An observational single‐centre study

“…The finding of thyroid papillary carcinoma affecting three patients in our cohort was unexpected. In fact, papillary thyroid cancer is rare and it has been shown to be more common in people who have Graves' disease 33 …”

“…In fact, papillary thyroid cancer is rare and it has been shown to be more common in people who have Graves' disease. 33 With regard to PRD, 15 out of 41 (36.6%) patients who underwent an ophthalmic screening were found to manifest signs of this retinal dystrophy. Of note, 4 of the 15 patients with PRD have been previously described by Mahroo et al 16 The term PRD is a historic one, used to describe a retinal phenotype that is characterized by foci of pigment deposition in the retina.…”

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

“…Unlike most previous studies investigating the prevalence of thyroid cancer in GD patients who underwent thyroidectomy, the present study enrolled all GD patients with thyroid cancer who were treated at three tertiary hospitals. Data from previous studies regarding the prevalence of coexisting thyroid cancer in GD patients assessed preoperatively by US are summarized in Supplemental Table S2 [9,16,[22][23][24][25][26][27][28][29][30]. Studies using US to find thyroid nodules reported varying rates of concomitant thyroid cancer in GD patients were reported (3.3% to 28.2%).…”

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

“…The incidence of PTC in GD has been increasing overtime and the rate of cancer in GD is higher when compared to euthyroid controls [4,6,7,13]. The possible mechanism behind remains to be elucidated, some studies report that antibodies may be the reason behind this association.…”

“…The incidence of PTC has increased worldwide and most recently reported to be 2-17% [4]. Malignancy rate of palpable thyroid nodules in GD patients has reported to be as low as 2.3% to up to 45.8% [5].…”