Objectives. Assess the prevalence of thyroid nodules and predictors of malignant origin in patients with autoimmune thyroid diseases. Patients and Methods. Retrospective study including 275 patients, 198 with Graves' disease and 77 with Hashimoto’s thyroiditis. Clinical and demographical data, ultrasonographical nodule characteristics, total thyroid volume and histological characteristics were recorded. Results. Graves’ disease: the prevalence of thyroid nodules and thyroid carcinoma were 27.78% and 5.05%, respectively. Older age (OR = 1.054; 95% CI = 1.029–1.080) and larger thyroid volumes (OR = 1.013; 95% CI = 1.003–1.022) increased the chance of nodules. Younger age (OR = 1.073; 95% CI = 1.020–1.128) and larger thyroid volume (OR = 1.018; 95% CI = 1.005–1.030) predicted thyroid carcinoma. Hashimoto’s thyroiditis: the prevalence of thyroid nodules and carcinomas were 50.7% and 7.8%, respectively. Nodules were predicted by thyroid volume (OR = 1.030; 95% CI = 1.001–1.062). We found higher number of nodules in patients with thyroid carcinoma than in those with benign nodules (3 versus 2; ). Patients with Hashimoto’s thyroiditis presented nodules more frequently than patients with Graves’ disease (50.65% versus 27.28%; ), while the prevalence of carcinoma was similar ( ). Conclusions. Larger goiter was associated with carcinoma in Graves’ disease and Hashimoto’s thyroiditis. Younger patients presented higher risk of papillary thyroid carcinoma in Graves’ disease. The prevalence of carcinoma was similar in both conditions. 1. Introduction Association between thyroid autoimmunity and nodules or carcinoma has been suggested in many previous works, but its clinical significance is still uncertain [1]. Whether all patients with autoimmune thyroid diseases are at increased risk for nodules and thyroid cancer or if there are certain individual characteristics that augment this risk is still debatable. In patients with Graves’ disease (GD), nodules are detected in 10–31% of cases [2], and approximately half will present nodules during followup [3]. Some studies have shown that around 17% of those nodules are malignant, whereas in the healthy population this estimate is 5% [4]. It is also known that 1.7–2.5% of patients with GD present malignant nodules, compared to 0.25% in the general population [5], evidencing a greater risk for thyroid carcinoma in this condition. There is a strong link between thyroid carcinoma and GD, which can be considered an adverse prognostic factor [6]. Hashimoto’s thyroiditis (HT) is frequently associated with small thyroid nodules,
References
[1]
L. E. Holm, H. Blomgren, and T. L？whagen, “Cancer risks in patients with chronic lymphocytic thyroiditis,” The New England Journal of Medicine, vol. 312, pp. 601–604, 1985.
[2]
F. Pacini, R. Elisei, G. C. Di Coscio et al., “Thyroid carcinoma in thyrotoxic patients treated by surgery,” The Journal of Endocrinological Investigation, vol. 11, no. 2, pp. 107–112, 1988.
[3]
L. Cantalamessa, M. Baldini, A. Orsatti, L. Meroni, V. Amodei, and D. Castagnone, “Thyroid nodules in graves disease and the risk of thyroid carcinoma,” Archives of Internal Medicine, vol. 159, no. 15, pp. 1705–1708, 1999.
[4]
K. Pazaitou-Panayiotou, K. Michalakis, and R. Paschke, “Thyroid cancer in patients with hyperthyroidism,” Hormone and Metabolic Research, vol. 44, no. 4, pp. 255–262, 2012.
[5]
G. P. Yu, J. C. L. Li, D. Branovan, S. McCormick, and S. P. Schantz, “Thyroid cancer incidence and survival in the national cancer institute surveillance, epidemiology, and end results race/ethnicity groups,” Thyroid, vol. 20, no. 5, pp. 465–473, 2010.
[6]
A. Belfiore, M. R. Garofalo, D. Giuffrida et al., “Increased aggressiveness of thyroid cancer in patients with Graves' disease,” Journal of Clinical Endocrinology and Metabolism, vol. 70, no. 4, pp. 830–835, 1990.
[7]
L. E. Holm, H. Blomgren, and T. Lowhagen, “Cancer risks in patients with chronic lymphocytic thyroiditis,” The New England Journal of Medicine, vol. 312, no. 10, pp. 601–604, 1985.
[8]
B. Singh, A. R. Shaha, H. Trivedi, J. F. Carew, A. Poluri, and J. P. Shah, “Coexistent Hashimoto's thyroiditis with papillary thyroid carcinoma: impact on presentation, management, and outcome,” Surgery, vol. 126, no. 6, pp. 1070–1077, 1999.
[9]
M. L. Shih, J. A. Lee, C. B. Hsieh et al., “Thyroidectomy for Hashimoto's thyroiditis: complications and associated cancers,” Thyroid, vol. 18, no. 7, pp. 729–734, 2008.
[10]
W. Shabana, E. Peeters, and M. De Maeseneer, “Measuring thyroid gland volume: should we change the correction factor?” American Journal of Roentgenology, vol. 186, no. 1, pp. 234–236, 2006.
[11]
B. M. Dobyns, G. E. Sheline, and J. B. Workman, “Malignant and benign neoplasms of the thyroid in patients treated for hyperthyroidism: a report of the cooperative thyrotoxicosis therapy. Follow up study,” Journal of Clinical Endocrinology and Metabolism, vol. 38, no. 6, pp. 976–998, 1974.
[12]
A. Belfiore, D. Russo, R. Vigneri, et al., “Graves' disease, thyroid, nodules and thyroid cancer,” Clinical Endocrinology, vol. 55, no. 6, pp. 711–718, 2001.
[13]
W. B. Kim, S. M. Han, T. Y. Kim et al., “Ultrasonographic screening for detection of thyroid cancer in patients with Grave's disease,” Clinical Endocrinology, vol. 60, no. 6, pp. 719–725, 2004.
[14]
S. Filetti, A. Belfiore, S. M. Amir et al., “The role of thyroid-stimulating antibodies of Graves' disease in differentiated thyroid cancer,” The New England Journal of Medicine, vol. 318, no. 12, pp. 753–759, 1988.
[15]
E. L. Mazzaferri, “Management of a solitary thyroid nodule,” The New England Journal of Medicine, vol. 328, no. 8, pp. 553–559, 1993.
[16]
W. B. Kim, S. M. Han, T. Y. Kim, et al., “Ultrassonographic screening for detection of thyroid cancer in patients with Graves' disease,” Clinical Endocrinology, vol. 60, no. 6, pp. 719–725, 2004.
[17]
T. Rago, E. Fiore, M. Scutari et al., “Male sex, single nodularity, and young age are associated with the risk of finding a papillary thyroid cancer on fine-needle aspiration cytology in a large series of patients with nodular thyroid disease,” European Journal of Endocrinology, vol. 162, no. 4, pp. 763–770, 2010.
[18]
Y. S. Giles, T. Fatih, B. Harika, K. Yersu, T. Tarik, and T. Serdar, “The risk factors for malignancy in surgically treated patients for Graves' disease, toxic multinodular goiter, and toxic adenoma,” Surgery, vol. 144, no. 6, pp. 1028–1037, 2008.
[19]
N. E. Carnell and W. A. Valente, “Thyroid nodules in Graves' disease: classification, characterization, and response to treatment,” Thyroid, vol. 8, no. 7, pp. 571–576, 1998.
[20]
Y. Erbil, U. Barbaros, N. Ozbey, et al., “Graves' disease, with and without nodules, and the risk of thyroid carcinoma,” The Journal of Laryngology & Otology, vol. 122, pp. 291–295, 2008.
[21]
L. Anderson, W. D. Middleton, S. A. Teefey et al., “Hashimoto thyroiditis: part 2, sonographic analysis of benign and malignant nodules in patients with diffuse Hashimoto thyroiditis,” American Journal of Roentgenology, vol. 195, no. 1, pp. 216–222, 2010.
[22]
K. Gul, A. Dirikoc, G. Kiyak et al., “The association between thyroid carcinoma and Hashimoto's thyroiditis: the ultrasonographic and histopathologic characteristics of malignant nodules,” Thyroid, vol. 20, no. 8, pp. 873–878, 2010.
[23]
S. Takashima, F. Matsuzuka, T. Nagareda, N. Tomiyama, and T. Kozuka, “Thyroid nodules associated with Hashimoto thyroiditis: assessment with US,” Radiology, vol. 185, no. 1, pp. 125–130, 1992.
[24]
F. M. Solivetti, D. Bacaro, P. Cecconi, R. Baldelli, and F. Marandino, “Small hyperechogenic nodules in thyroiditis: usefulness of cytological characterization,” Journal of Experimental and Clinical Cancer Research, vol. 23, no. 3, pp. 433–435, 2004.
[25]
C. Anil, S. Goksel, and A. Gursoy, “Hashimoto's thyroiditis is not associated with increased risk of thyroid cancer in patients with thyroid nodules: a single-center prospective study,” Thyroid, vol. 20, no. 6, pp. 601–606, 2010.
