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Toxic Nodular Goiter and Cancer: A Compelling Case for Thyroidectomy

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Recent American Thyroid Association guidelines call for thyroidectomy or 131I (Recommendation 31) in managing hyperthyroidism due to toxic nodular goiter (TNG). Concern for concomitant malignancy favors surgery. A 3 % thyroid cancer incidence in TNG patients has been reported, yet recent studies suggest this rate is underestimated. This multi-institutional study examined cancer incidence in TNG patients referred to surgery.

Methods

Patients referred for thyroidectomy at three tertiary-care institutions were included (2002–2011). Patients with concurrent indeterminate or malignant diagnosis by fine-needle aspiration (FNA) were excluded. Cancer incidence in TNG patients was determined. Fisher’s exact and chi-square tests and nonparametric t tests were used.

Results

Among 2,551 surgically treated patients, 164 had TNG (6.4 %). Median age at presentation was 49.7 years, and 86 % were female. Overall cancer incidence was 18.3 % (30 of 164), and rates were not significantly different between institutions. A significantly greater cancer rate was noted in toxic multinodular goiter versus single toxic nodule patients (21 vs. 4.5 %, P < 0.05). Mean tumor size was 0.71 cm (range 0.1–1.5 cm; 23 % ≥1 cm). Most patients underwent total or near-total thyroidectomy. There were no significant differences in tumor sizes among institutions (P > 0.05). No significant cancer association was noted with age, preoperative dominant nodule size, lymphocytic thyroiditis or preoperative FNA (P > 0.05).

Conclusions

These data demonstrate a higher than expected incidental cancer rate in TNG patients compared to historical reports (18.3 vs. 3 %). This higher cancer incidence may alter the risk/benefit analysis regarding TNG treatment. This information should be provided to TNG patients before decision making regarding treatment.

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Authors and Affiliations

  1. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    J. Joshua Smith MD, PhD, Ratnam Nookala MBBS, James T. Broome MD & Carmen C. Solorzano MD

  2. Vanderbilt Medical Scientist Training Program, Clinical Investigator Track, Vanderbilt University Medical Center, Nashville, TN, USA

    J. Joshua Smith MD, PhD

  3. Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA

    Xi Chen PhD, James T. Broome MD & Carmen C. Solorzano MD

  4. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    Xi Chen PhD

  5. Division of General Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    David F. Schneider MD, Rebecca S. Sippel MD & Herbert Chen MD

  6. Division of Surgical Oncology, Vanderbilt University Medical Center, Nashville, TN, USA

    James T. Broome MD & Carmen C. Solorzano MD

  7. Division of Endocrine Surgery, University of Miami Miller School of Medicine, Miami, FL, USA

    Carmen C. Solorzano MD

Authors
  1. J. Joshua Smith MD, PhD
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  2. Xi Chen PhD
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  3. David F. Schneider MD
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  4. Ratnam Nookala MBBS
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  5. James T. Broome MD
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  6. Rebecca S. Sippel MD
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  7. Herbert Chen MD
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  8. Carmen C. Solorzano MD
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Corresponding author

Correspondence to Carmen C. Solorzano MD.

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Smith, J.J., Chen, X., Schneider, D.F. et al. Toxic Nodular Goiter and Cancer: A Compelling Case for Thyroidectomy. Ann Surg Oncol 20, 1336–1340 (2013). https://doi.org/10.1245/s10434-012-2725-4

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  • DOI: https://doi.org/10.1245/s10434-012-2725-4

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