Treatment and Outcome of Patients with Graves' Disease and Metastatic Differentiated Thyroid Cancer

Abstract

Background There are only limited data in the literature about treatment of patients who have Graves' disease (GD) and metastatic thyroid cancer. The aim of our study was to report on our experience about the treatment and outcome of patients with Graves' disease and metastatic thyroid cancer in our country. Methods Altogether, 28 patients (eight males, 20 females; 49–85 years of age; median 74 years) were treated because of differentiated thyroid cancer and distant metastasis at the time of diagnosis during a 10-year period (from 2010 to 2019) in the Republic of Slovenia. The subject of our retrospective study were four patients (three men, one female; 64–76 years of age, median 73 years) who had Graves' disease and metastatic thyroid cancer. Papillary carcinoma, Hürthle cell carcinoma, follicular and poorly differentiated thyroid carcinoma were diagnosed in 13, six, five and four patients, respectively. Graves’ disease was present in two patients with Hürthle cell carcinoma, one with papillary and one with poorly differentiated thyroid carcinoma. Results The mean age of patients without GD and with GD was 74 years and 71 years, respectively (p = 0.36). There was a trend for male predominance in patients with GD (p = 0.06). There was no statistical difference in size of primary tumors (p = 0.36), pT stage (p = 0.52) or pN stage (p = 1.00) between the group of patients without GD and with GD. Patients received multimodal treatment (total thyroidectomy N = 18, neck dissection N = 4, preoperative chemotherapy N = 3, ablation of thyroid remnant with radioiodine N = 18, therapy with radioiodine N = 18, external beam radiotherapy of the neck region N = 7 patients, external beam radiotherapy of other localisations N = 6, targeted therapy N = 10). Three patients (1/3 with GD) received only palliative treatment. The median length of follow-up was 3.33 years (range 0.04–7.83) and 5-year disease-specific survival was 51%. One of four patients with GD and 14 of 24 patients without GD died of thyroid cancer. There was no statistical difference in disease-specific survival between patients group of without GD and with GD (p = 0.59). Conclusion In our country, 14% of patients with metastatic differentiated thyroid carcinoma at the time of diagnosis had Graves’ disease. There was no difference in the treatment, outcome or survival of patients with GD in comparison to those without GD.