Abstract
The purpose is to delineate the clinico-pathologic features of papillary thyroid carcinoma (PTC) occurring in a background of Hashimoto’s thyroiditis (HT). A retrospective analysis of consecutive PTC patients who underwent surgery at an academic center between Jan. 2010 and Jan. 2020 was performed. The primary end point was to assess whether a background of HT implied a higher likelihood for postoperatively determined high-risk histopathologic features. Accordingly, its implication on initial surgical planning. Tumor high-risk features included aggressive histologic variants, lymphovascular invasion, extrathyroidal extension, multifocality, and positive nodal metastasis. To achieve the primary outcome of interest, a two group-designation was followed: group A (none-HT-group) and group B (HT-group). The two groups were also compared regarding postoperative complications as a secondary outcome of interest. In the specified period, 331 patients were found to have a histologically proven diagnosis of PTC. Group A accounted for 80% (265/331) of the study cohort, while group B accounted for the remainder 20%. PTC was significantly more prevalent in the absence of HT (p < 0.0001). Both groups were comparable in mean-patient-age. However, Group B demonstrated a considerably higher male:female ratio (1:10 vs. 1:3; p = 0.01). All postoperatively determined high-risk histopathologic features were comparable in both groups (p > 0.05). Nevertheless, transient hypoparathyroidism was considerably higher in group B (12% vs. 23%; p = 0.02). A background of HT does not seem to reflect a more aggressive cancerous biologic behavior. Therefore, it should not preclude the conservative surgical strategy adopted by the most recent clinical practice guidelines.
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All data and material analyzed in this study are available from the corresponding author upon request.
References
La Vecchia C, Malvezzi M, Bosetti C, Garavello W, Bertuccio P, Levi F, Negri E (2015) Thyroid cancer mortality and incidence: a global overview. Int J Cancer 136:2187–2195. https://doi.org/10.1002/ijc.29251
Spinelli C, Strambi S, Bakkar S, Nosiglia A, Elia G, Bertocchini A, Calani C, Leoni M, Morganti R, Materazzi G (2020) Surgical management of diffuse sclerosing variant of papillary thyroid carcinoma. Experience in 25 patients. World J Surg 44:152–162. https://doi.org/10.1007/s00268-019-05230-5
Nabhan F, Ringel MD (2017) Thyroid nodules and cancer management guidelines: comparisons and controversies. Endocr Relat Cancer 24:R13–R26. https://doi.org/10.1530/ERC-16-0432
Haugen BR, Alexander EK, Bible KC et al (2016) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid 26:1–133. https://doi.org/10.1089/thy.2015.00207
Miccoli P, Bakkar S (2017) Surgical management of papillary thyroid carcinoma: an overview. Updates Surg 69:145–150. https://doi.org/10.1007/s13304-017-0449-5
Bakkar S, Papavramidis TS, Aljarrah Q, Materazzi G, Miccoli P (2020) Energy-based devices in thyroid surgery: an overview. Gland Surg 9(Suppl 1):S14–S17. https://doi.org/10.21037/gs.2019.08.05
Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS, Sturgeon C (2007) Extent of surgery affects survival for papillary thyroid cancer. Ann Surg 246:375–381
Bakkar S, Macerola E, Aljarrah Q, Proietti A, Materazzi G, Basolo F, Miccoli P (2019) BRAFV600E mutation: a potential predictor of more than a Sistrunk’s procedure in patients with thyroglossal duct cyst carcinoma and a normal thyroid gland. Updates Surg 71:701–704. https://doi.org/10.1007/s13304-019-00684-7
Bakkar S, Al-Omar K, Al-Jarrah Q, Al-Dabbas M, Al-Dabbas N, Samara S, Miccoli P (2020) Impact of COVID-19 on thyroid cancer surgery and adjunct therapy. Updates Surg 72:867–869. https://doi.org/10.1007/s13304-020-00833-3
Avgoustou C, Avgoustou E (2017) Coexistence of Hashimoto’s thyroiditis and papillary thyroid carcinoma. Hellenic J Surg 89:73–78. https://doi.org/10.1007/s13126-017-0387-1
Uhliarova B, Hajtman A (2018) Hashimoto’s thyroiditis: an independent risk factor for papillary carcinoma. Braz J Otorhinolaryngol 84:729–735. https://doi.org/10.1016/j.bjorl.2017.08.012
Moon S, Chung HS, Yu JM, Yoo HJ, Park JH, Kim DS, Park YJ (2018) Associations between Hashimoto thyroiditis and clinical outcomes of papillary thyroid cancer: a meta-analysis of observational studies. Endocrinol Metab (Seoul) 33:473–484. https://doi.org/10.3803/EnM.2018.33.4.473
Kim SS, Lee BJ, Lee JC, Kim SJ, Jeon YK, Kim MR, Huh JE, Mok JY, Kim BH, Kim YK, Kim IJ (2011) Coexistence of Hashimoto’s thyroiditis with papillary thyroid carcinoma: the influence of lymph node metastasis. Head Neck 33:1272–1277. https://doi.org/10.1002/hed.21594
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Dr. Mahmoud Smadi’s, the department of Mathematics and Statistics at Jordan University of Science and technology, technical support is highly valued and appreciated.
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SH and SB: study concept and design, data interpretation, drafting, final approval, accountability for all aspects of the work. MB, HH, GQ, WA, NA, and HO: critical revision, data interpretation, final approval, and accountability for all aspects of the work. AA, YA, TM, MM, and MB: data collection and interpretation, final approval, accountability for all aspects of the work.
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All the procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This research holds ID no. 42/2021 at Jordan University of Science and Technology (JUST), and has obtained the Institutional Review Board (IRB) approval Ref. no. 39/138/2021, dated: 18.2.2021.
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Hamouri, S., Bakkar, S., Aljaafreh, A. et al. Implications of a background of Hashimoto’s thyroiditis on the current conservative surgical trend towards papillary thyroid carcinoma. Updates Surg 73, 1931–1935 (2021). https://doi.org/10.1007/s13304-021-01087-3
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DOI: https://doi.org/10.1007/s13304-021-01087-3