Thyroid cancer associated with adenomatous goiter: An analysis of the incidence and clinical factors

Abstract

We evaluated the incidence of thyroid cancer in patients with adenomatous goiter and investigated the clinical factors distinguishing patients with occult thyroid cancer, defined as a tumor size smaller than or equal to 10 mm, from those with clinical thyroid cancer, defined as a tumor size larger than 10 mm. Of 835 patients with histologically confirmed adenomatous goiter, 256 (30.7%) also had thyroid cancer, being occult in 137 patients and clinical in 119 patients. There was no correlation between the maximum size of the thyroid cancer tumor and the age of the patient, and the percentage of patients with thyroid cancer in each group was not influenced by age. There were no significant differences in age, sex, the serum concentrations of free triiodothyronine, free thyroxine, thyrotropin, and thyroglobulin, or the urinary iodine creatinine ratio. The frequency of calcified lesions being detected by ultrasonography (US) and/or neck X-ray in the patients with clinical thyroid cancer was significantly greater than that in those with occult cancer at 83% vs 57%, respectively (P < 0.0001). This study disclosed a high prevalence of thyroid cancer associated with adenomatous goiter, and the results suggest that a considerable number of associated carcinomas remain occult. The detection of calcification in the thyroid gland is one of the surgical indications for patients with adenomatous goiter.

Association of Different Pathologic Processes of the Thyroid Gland in Fine Needle Aspiration Samples

“…[9][10][11]13,[15][16][17] These observations were confirmed to some extent by the present study; in fact, as reported above, 103 of 10,039 cases revealed double pathology (1%), but considering just the 1,330 cases with a multinodular presentation, the percentage of double pathology rises to 7.7. Therefore, despite the clinical presentation, we think that investigation of all palpable nodules may improve diagnostic accuracy and the sensitivity of the method.…”

“…However, incidence was statistically significant between the different types of thyroiditis and nodular goiter with all tumor (benign and malignant) nodules. Therefore, as suggested by other authors, 9,42 it seems that the presence of any thyroid pathology, mainly nodular goiter and/or thyroiditis, increases the risk of a second pathologic process in the same gland. Thus, while there may be no statistically significant associations between the single pathologies diagnosed, it seems that being affected by one pathology increases the risk of developing another.…”

“…All tests were performed using < .05 as the probability level. RESULTS: Simultaneous pathologic processes observed were: goiter and chronic lymphocytic thyroiditis (32), goiter and Hashimoto's thyroiditis (21), goiter and subacute granulomatous thyroiditis (8), goiter and follicular neoplasm (9), and goiter and papillary carcinoma (14). In 12 cases we found goiter and Hürthle cell tumor, goiter and medullary thyroid carcinoma (2), papillary thyroid carcinoma and Hashimoto's thyroiditis (2), Graves' disease and lymphocytic thyroiditis (2), and follicular neoplasm and lymphocytic thyroiditis (1).…”

Diagnostic Value of Dynamic Contrast Medium–Enhanced Magnetic Resonance Imaging in Preoperative Detection of Thyroid Carcinoma

“…Although rates higher than 30% have been reported previously, the incidence of thyroid carcinoma in multinodular goiter is approximately 10%. [22][23][24] In patients with multinodular goiter, thyroid carcinoma was documented as primarily located in dominant nodules, and presence of a dominant cold nodule has been determined to be an important risk factor for thyroid carcinoma. 3 Our study included consecutive patients, but most had single dominant cold nodules.…”

Doença nodular tireóidea: avaliação clínica e laboratorial

“…Apesar da presença de multinodularidade à palpação ser, usualmente, interpretada como indicativa de benignidade, têm sido registradas freqüências semelhantes de câncer em nódulos únicos ou múltiplos (12); dados mais recentes indicam incidência de câncer variável entre 5% a 10% (16). Outro estudo demonstrou 31% de incidência de câncer tireóideo associado ao bócio multinodular, mas esta prevalência elevada pode ser atribuída à eficiente seleção dos pacientes (17). Portanto, um nódu-lo dominante, que apresenta consistência diferente de outros existentes, deve ser avaliado de maneira semelhante ao nódulo solitário.…”