The clinical importance of the thyroid nodules during anti-tumor necrosis factor therapy in patients with axial spondyloarthritis
The clinical importance of the thyroid nodules in patients with axial spondyloarthritis (ax-SpA) rests with the need to exclude thyroid malignancy. The aim of this study is to assess the risk of thyroid malignancy in ax-SpA patients receiving anti-TNF therapy. From September 2015 until December 2015, 70 patients diagnosed with ax-SpA were included in the research. Forty of the patients had received anti-TNF therapy, and 30 of the patients were anti-TNF naive. All cases were screened for the presence of nodules in the thyroid gland with ultrasound. Of the patients that received anti-TNF therapy, 15 (37.5%); and of the anti-TNF naive patients, 11 (36.7%) had thyroid nodule(s). Four patients from the anti-TNF group underwent fine needle aspiration biopsy of the nodules, and two of them were diagnosed with papillary thyroid carcinoma. None of the nodules in anti-TNF naive patients required biopsy. When compared to the normal population, the standardized incidence ratio (SIR) was found to be increased in both male (SIR 2.03, 95% CI 1.9 to 18) and female (SIR 2.7, 95% CI 2.6 to 24) cases. It is not yet established whether the development of cancer during the treatment process is the effect of the treatment or if it is a part of the natural course of the disease or if it is coincidental. We saw a mild increase in thyroid malignancies in ax-SpA patients who received anti-TNF therapy. Therefore, we believe that the thyroid gland should also be taken into consideration while screening for malignancy before anti-TNF therapy.
KeywordsAnti-TNF agent Axial spondyloarthritis Thyroid malignancy
Compliance with ethical standards
All procedures performed in study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 12.Gültekin M, Güledal B. (2014) Cancer statistics Turkey. Ministry of Health, Public Health Agency of TurkeyGoogle Scholar
- 14.Haugen BR, Alexander EK, Bible KC et al (2015) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid 26:1–133Google Scholar
- 15.Ward MM, Deodhar A, Akl EA et al (2016) American College of Rheumatology/spondylitis Association of America/Spondyloarthritis research and treatment network 2015 recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis & Rheumatology 68:282–298CrossRefGoogle Scholar
- 20.Tarhan F, Oruk G, Niflioglu O et al (2013) Thyroid involvement in ankylosing spondylitis and relationship of thyroid dysfunction with anti-TNF α treatment. Rheumatol Int 33:853–857Google Scholar
- 22.Pascart T, Ducoulombier V, Roquette D et al (2014) Autoimmune thyroid disorders during anti-TNF alpha therapy: coincidence, paradoxical event or marker of immunogenicity? Joint Bone Spine 81:369–370Google Scholar
- 26.Nannini C, Cantini F, Niccoli L et al (2009) Single-center series and systematic review of randomized controlled trials of malignancies in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis receiving anti–tumor necrosis α therapy: is there a need for more comprehensive screening procedures? Arthrit Care Res 61:801–812CrossRefGoogle Scholar