Abstract
The association between papillary thyroid carcinoma (PTC) and Hashimoto’s thyroiditis (HT) is controversial. In this study, we aimed to compare preoperative thyroid functions, ultrasonography (US) features, fine-needle aspiration biopsy (FNAB) results, and histopathological characteristics of PTC in patients with and without HT. Data of 919 PTC patients were reviewed retrospectively. The diagnosis of HT was based on histopathological examination and patients were grouped as HT and non-HT. There were 1321 PTC lesions in 919 patients among which 317 (34.5 %) had coexistent HT. There were no significant differences in nodule volume, longitudinal diameter, texture, echogenicity, marginal regularity, presence of microcalcification and hypoechoic halo, and peripheral vascularization in patients with and without HT (p > 0.05, for all parameters). Macrocalcification was observed more frequently in the non-HT group (p = 0.021). FNAB results were similar in the two groups (p = 0.105). Distribution of variants, capsule invasion, vascular invasion, and extrathyroidal extension were observed with similar rates in the HT and non-HT groups. Lymph node metastasis was significantly higher in patients without HT (p = 0.012). Of the carcinomas, 66.1 % (n = 874) were papillary thyroid microcarcinoma (PTMC). Tumor size was lower in PTMC lesions coexistent with HT (p = 0.026). We observed lower rates of capsule invasion, extrathyroidal extension, and lymph node metastases in PTMC with HT compared to without HT (p = 0.007, p = 0.003, and p = 0.015, respectively). This study showed that US features, FNAB results, and histopathological findings of PTC lesions are not influenced by the presence of HT. However, PTMC seems to be related with less aggressive histopathological behavior in HT.
Similar content being viewed by others
References
Mazzaferri EL, Young RL (1981) Papillary thyroid carcinoma: a 10 year follow-up report of the impact of therapy in 576 patients. Am J Med 70: 511–518
Hundahl SA, Fleming ID, Fremgen AM, Menck HR. A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985–1995 (1998) Cancer 83:2638–2648
Guarino V, Castellone MD, Avilla E, Melillo RM (2010) Thyroid cancer and inflammation. Mol Cell Endocrinol 321:94–102
Tamimi DM (2002) The association between chronic lymphocytic thyroiditis and thyroid tumors. Int J Surg Pathol 10:141–146
Schaffler A, Palitzsch KD, Seiffarth C, Höhne HM, Riedhammer FJ, Hofstädter F, Schölmerich J, Rüschoff J (1998) Coexistent thyroiditis is associated with lower tumour stage in thyroid carcinoma. Eur J Clin Invest 28:838–844
Antonaci A, Consorti F, Mardente S, Giovannone G (2009) Clinical and biological relationship between chronic lymphocytic thyroiditis and papillary thyroid carcinoma. Oncol Res 17:495–503
Wirtschafter A, Schmidt R, Rosen D, Kundu N, Santoro M, Fusco A, Multhaupt H, Atkins JP, Rosen MR, Keane WM, Rothstein JL (1997) Expression of the RET/PTC fusion gene as a marker for papillary carcinoma in Hashimoto’s thyroiditis. Laryngoscope 107:95–100
Cornetta AJ, Russell JP, Cunnane M, Keane WM, Rothstein JL (2002) Cyclooxygenase-2 expression in human thyroid carcinoma and Hashimoto’s thyroiditis. Laryngoscope 112:238–242
Matsubayashi S, Kawai K, Matsumoto Y, Mukuta T, Morita T, Hirai K, Matsuzuka F, Kakudoh K, Kuma K, Tmai H (1995) The correlation between papillary thyroid carcinoma and lymphocytic infiltration in the thyroid gland. J Clin Endocrinol Metab 80:3421–3424
Loh KC, Greenspan FS, Dong F, Miller TR, Yeo PP (1999) Influence of lymphocytic thyroiditis on the prognostic outcome of patients with papillary thyroid carcinoma. J Clin Endocrinol Metab 84:458–463
Singh B, Shaha AR, Trivedi H, Carew JF, Poluri A, Shah JP (1999) Coexistent Hashimoto’s thyroiditis with papillary thyroid carcinoma: impact on presentation, management, and outcome. Surgery 126:1070–1076
Del Rio P, Cataldo S, Sommaruga L, Concione L, Arcuri MF, Sianesi M (2008) The association between papillary carcinoma and chronic lymphocytic thyroiditis: does it modify the prognosis of cancer? Minerva Endocrinol 33:1–5.
Jo VY, Stelow EB, Dustin SM, Hanley KZ (2010) Malignancy risk for fine-needle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol 134:450–456
Cibas ES, Ali SZ (2009) The Bethesda System for Reporting Thyroid Cytopathology. Thyroid 19:1159–1165
Weetman AP (2004) Cellular immune responses in autoimmune thyroid disease. Clin Endocrinol 61:405–413
Cipolla C, Sandonato L, Graceffa G, Fricano S, Torcivia A, Vieni S, Latteri S, Latteri MA (2005) Hashimoto thyroiditis coexistent with papillary carcinoma. Am Surg 71:874–878
Larson SD, Jackson L, Riall T, Uchida T, Thomas RP, Qiu S, Evers BM (2007) Increased incidence of well-differentiated thyroid cancer associated with Hashimoto’s thyroiditis and the role of the PI3K/AKT pathway. J Am Coll Surg 204:764–775
Erdogan M, Erdem N, Cetinkalp S, Ozgen AG, Saygılı F, Yilmaz C, Tuzun M, Kabalak T (2009) Demographic, clinical, laboratory, ultrasonographic, and cytological features of patients with Hashimoto’s thyroiditis: a result of a university hospital of 769 patients in Turkey. Endocrine 36:486–490
Repplinger D, Bargren A, Zhang YW, Adler JT, Haymart M, Chen H (2008) Is Hashimoto’s thyroiditis a risk factor for papillary thyroid cancer. J Surg Res 150:49–52
Anil C, Goksel S, Gursoy A (2010) Hashimoto’s thyroiditis is not associated with increased risk of thyroid cancer in patients with thyroid nodules: a single-center prospective study. Thyroid 20:601–606
Matesa-Anic’ D, Matesa N, Dabelic’ N, Kusic’ Z (2009) Coexistence of papillary carcinoma and Hashimoto’s thyroiditis. Acta Clin Croat 48:9–12.
Bradly D, Reddy V, Prinz RA, Gattuso P (2009) Incidental papillary carcinoma in patients treated surgically for benign thyroid diseases. Surgery 146:1099–1104
Kwak HY, Chae BJ, eom YH, Hong YR, Seo JB, Lee SH, Song BJ, Jung SS, Bae JS (2015) Does papillary thyroid carcinoma have a better prognosis with or without Hashimoto thyroiditis? Int J Clin Oncol 20:463–473
Lun Y, Wu X, Xia Q, Han Y, Zhang X, Liu Z, Wang F, Duan Z, Xin S, Zhang J (2013) Hashimoto’s thyroiditis as a risk factor of papillary thyroid cancer may improve cancer prognosis. Otolaryngol Head Neck Surg 148:396–402
Tae HJ, Lim DJ, Baek KH, Park WC, Lee YS, Choi JE, Lee JM, Kang MI, Cha BY, Son HY, Lee KW, Kang SK (2007) Diagnostic value of ultrasonography to distinguish between benign and malignant lesions in the management of thyroid nodules. Thyroid 17: 461–466
Solbiati L, Livraghi T, Ballarati E, et al. (1995) Thyroid gland. In: Solbiati L, Rizzatto G. Ultrasound of Superficial Structure: London: Churchill, Livingstone, 45: 85, 1995 SA ed. Thyroid disease: Endocrinology, Surgery, Nuclear Medicine and Radiology Lippincott-Raven, Philadelphia, 65–104
LiVolsi VA (1997) Pathology of thyroid disease. In: Thyroid Disease: Endocrinology, Surgery, Nuclear Medicine and Radiology, Falk SA, Eds. Lippincott-Raven, Philadelphia, 65–104
Yeh HC, Futterweit W, Gilbert P (1996) Micronodulation: ultrasonographic sign of Hashimoto Thyroiditis. J Ultrasound Med 15: 813–819
Trimboli P, Nasrollah N, Amendola S, Rossi F, Ramacciato G, Romanelli F, Aurella P, Crescenzi A, Laurenti O, Condorelli E, Ventura C, Valabrega S (2012) Should we use ultrasound features associated with papillary thyroid cancer in diagnosing medullary thyroid cancer? Endocr J 59:503–508
Das DK, Sheikh ZA, George SS, Al-Baquer T, Francis IM (2008) Papillary thyroid carcinoma: evidence for intracytoplasmic formation of precursor substance for calcification and its release from well-preserved neoplastic cells. Diagn Cytopathol 36:809–812
Kim EK, Parl CS, Chung WY, Oh KK, Kim DI, Lee JT, Yoo HS (2002) New sonographic criteria for recommends fine-needle aspiration biopsy of nonpalpable solid nodule of the thyroid. A JR Am J Roentgenol 178:687–691
Ohmori N, Miyakawa M, ohmori K, Takano K (2007) Ultrasonographic findings of papillary thyroid carcinoma with Hashimoto’s thyroiditis. Intern Med 46:547–550
Nguyen GK, Ginsberg J, Crockford PM, Villanueva RR (1997) Hashimoto’s thyroiditis: cytodiagnostic accuracy and pitfalls. Diagn Cytopathol 16:531–536.
Ravinsky E, Safneck JR (1988) Differentiation of Hashimoto’s thyroiditis from thyroid neoplasms in fine needle aspirates. Acta Cytol 32:854–861
Kumarasinghe MP, De Silva S (1999) Pitfalls in cytological diagnosis of autoimmune thyroiditis. Pathology 31:1–7
Spencer CA (2011) Clinical review: Clinical utility of thyroglobulin antibody (TgAb) measurements for patients with differentiated thyroid cancers (DTC). J Clin Endocrinol Metab 96:3615–3627
Vasileiadis I, Boutzios G, Charitoudis G, Koukoulioti E, Karatzas T (2014) Thyroglobulin antibodies could be a potential predictive marker for papillary thyroid carcinoma. Ann Surg Oncol 21:2725–2732
Paparodis R, Imam S, Todorova-Koteva K, Staii A, Jaume JC (2014) Hashimoto’s thyroiditis pathology and risk for thyroid cancer. Thyroid 24:1107–1114
Yoon YH, Kim HJ, Lee JW, Kim JM, Koo BS (2012) The clinicopathologic differences in papillary thyroid carcinoma with or without co-existing chronic lymphocytic thyroiditis. Eur Arch Otorhinoloaryngol 269:1013–1017
Lee JH, Kim Y, Choi JW, Kim YS (2013) The association between papillary thyroid carcinoma and histologically proven Hashimoto’s thyroiditis: a meta-analysis. Eur J Endocrinol 168:343–349
Singh S, Singh A, Khanna AK (2012) Thyroid incidentalomas. Indian J Surg Oncol 3:173–181
Roti E, delgi Uberti EC, Bondanelli M, Braverman LE (2008) Thyroid papillary microcarcinoma: a descriptive and meta-analysis study. Eur J Endocrinol 159:659–673
Noguchi S, Yamashita H, Uchino S, Watanabe S (2008) Papillary microcarcinoma. World J Surg 32:747–753
Lee HS, Park HS, Kim SW, Choi G, Park HS, Hong JC, Lee SG, Baek SM, Lee KD (2013) Clinical characteristics of papillary thyroid microcarcinoma less than or equal to 5 mm on ultrasonography. Eur Arch otorhinolaryngol 270:2969–2974
Page C, Biet A, Boute P, Cuvelier P, Strunski V (2009) ‘Aggressive papillary’ thyroid microcarcinoma. Eur Arch Otorhinolaryngol 266:1959–1963
Ross DS, Litofsky D, Ain KB, Bigos T, Brierley JD, Cooper DS, Haugen BR, Jonklaas J, Ladenson PW, Magner J, et al. (2009) Recurrence after treatment of micropapillary thyroid cancer. Thyroid 19:1043–1048
Mantinan B, Rego-Iraeta A, Larranaga A, Fluiters E, Sanchez-Sobrino P, Garcia-Mayor RV (2012) Factors influencing the outcome of patients with incidental papillary thyroid microcarcinoma. J Thyroid Res 2012:469397
Gallo M, Pesenti M, Valcavi R (2003) Ultrasound thyroid nodule measurement: the “gold standard” and its limitations in clinical decision making. Endocr Pract 9:194–199
Hegedüs L (1990) Thyroid size determined by ultrasound. Influence of physiological factors and non-thyroidal disease. Dan Med Bull 37:249–263
Knudsen N, Bols B, Bülow I, Jørgensen T, Perrild H, Ovesen L, Laurberg P (1999) Validation of ultrasonography of the thyroid gland for epidemiological purposes. Thyroid 9:1069–1074
Baloch ZW, LiVolsi VA (1999) Post fine-needle aspiration histologic alterations of thyroid revisited. Am J Clin Pathol 112:311–316
Yoon YH, Kwon KR, Kwak SY, Ryu KA, Choi B, Kim JM, Koo BS (2014) Tumor size measured by preoperative ultrasonography and postoperative pathologic examination in papillary thyroid carcinoma: relative differences according to size, calcification and coexisting thyroiditis. Eur Arch Otorhinolaryngol 271:1235–1239
Bachar G, Buda I, Cohen M, Hadar T, Hilly O, Schwartz N, Shpitzer T, Segal K (2013) Size discrepancy between sonographic and pathological evaluation of solitary papillary thyroid carcinoma. Eur J Radiol 82: 1899–1903
Xing M, Clark D, Guan H, Ji M, Dackiw A, Carson KA, Kim M, Tufaro A, Ladenson P, Zeiger M, Tufano R (2009) BRAF mutation testing of thyroid fine-needle aspiration biopsy specimens for preoperative risk stratification in papillary thyroid cancer. J Clin Oncol 27:2977–2982
Howell GM, Nikiforova MN, Carty SE, Armstrong MJ, Hodak SP, Stang MT, McCoy KL, Nikiforov YE, Yip L (2013) BRAF V600E mutation independently predicts central compartment lymph node metastasis in patients with papillary thyroid cancer. Ann Surg Oncol 20:47–52
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Local ethical committee approval was obtained in accordance with the ethical standards of Helsinki Declaration.
Conflict of interest
The authors declare that they have no competing interests.
Rights and permissions
About this article
Cite this article
Baser, H., Ozdemir, D., Cuhaci, N. et al. Hashimoto’s Thyroiditis Does Not Affect Ultrasonographical, Cytological, and Histopathological Features in Patients with Papillary Thyroid Carcinoma. Endocr Pathol 26, 356–364 (2015). https://doi.org/10.1007/s12022-015-9401-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12022-015-9401-8