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Incidental thyroid carcinoma after thyroidectomy in patients with Graves’ disease

  • Retrospective Clinical Study
  • Published:
Hellenic Journal of Surgery

Abstract

Aim–Background

The association between Graves’ disease (GD) and thyroid cancer (TC) has been studied over the years with controversial results. The aim of our study was to define the prevalence of incidental thyroid cancer (ITC) among patients operated for GD, present the rates found in our department and suggest an efficient treatment modality.

Methods

We retrospectively reviewed 206 patients who underwent total thyroidectomy for benign thyroid disease in our department over a 6.5-year period. GD was diagnosed in 31 cases with a median age of 55 years. Small non-palpable nodules in the thyroid parenchyma were observed in eight subjects. Patients with a malignant or inconclusive fine-needle aspiration biopsy (FNAB) result were excluded.

Results

The histological examination incidentally revealed six (19%) papillary thyroid microcarcinomas (PTMC) out of 31 specimens with GD. ITC presented within a nodule in 37.5% (3/8) of the subjects with nodular parenchyma. No local or distant invasion was reported.

Conclusions

The rates of ITC have been seen to range from 1% to 42% in recent studies. Patients with nodular parenchyma show a greater risk of carcinogenesis, particularly when nodules are palpable. Papillary carcinoma and microcarcinoma constitute most of the cases of ITC. In our department, the rate of ITC was 19%, malignancy had developed only in female patients and 50% of the tumours were within a nodule. Regarding the treatment options of GD, total thyroidectomy represents a prompt and valuable choice. Furthermore, total thyroidectomy emerges as the optimal treatment option when the disease is combined with nodules and/or young age, considering the risk of disguised malignancy.

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References

  1. Ellis H. Robert Graves: 1796-1852. Br J Hosp Med (Lond) 2006; 67:313

    Article  Google Scholar 

  2. Prasek K, Płazińska MT, Królicki L. Diagnosis and treatment of Graves' disease with particular emphasis on appropriate techniques in nuclear medicine. General state of knowledge. Nucl Med Rev Cent East Eur 2015; 18:110–6

    Article  PubMed  Google Scholar 

  3. Chen YK, Lin CL, Chang YJ, et al. Cancer risk in patients with Graves' disease: a nationwide cohort study. Thyroid. 2013; 23:879–84

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wei S, Baloch ZW, LiVolsi VA. Thyroid carcinoma in patients with Graves' disease: an institutional experience. Endocr Pathol 2015; 26:48–53

    Article  CAS  PubMed  Google Scholar 

  5. Tam AA, Kaya C, Kılıç FB, et al. Thyroid nodules and thyroid cancer in Graves' disease. Arq Bras Endocrinol Metabol 2014; 58:933–8

    PubMed  Google Scholar 

  6. Beahrs OH, Pemberton Jde J, Black BM. Nodular goiter and malignant lesions of the thyroid gland. J Clin Endocrinol Metab 1951; 11:1157–65

    Article  CAS  PubMed  Google Scholar 

  7. Sokal JE. Incidence of malignancy in toxic and nontoxic nodular goiter. JAMA 1954; 154:1321–5

    Article  CAS  Google Scholar 

  8. Shapiro SJ, Friedmam NB, Perzik SL, et al. Incidence of thyroid carcinoma in Graves’ disease. Cancer 1970; 26:1261–70

    Article  CAS  PubMed  Google Scholar 

  9. Slijepcevic N, Zivaljevic V, Marinkovic J, et al. Retrospective evaluation of the incidental finding of 403 papillary thyroid microcarcinomas in 2466 patients undergoing thyroid surgery for presumed benign thyroid disease. BMC Cancer 2015; 15:330

    Article  PubMed  PubMed Central  Google Scholar 

  10. Pazaitou-Panayiotou K, Michalakis K, Paschke R. Thyroid Cancer in Patients with Hyperthyroidism. Horm Metab Res 2012; 44:255–62

    Article  CAS  PubMed  Google Scholar 

  11. Pezzolla A, Lattarulo S, Milella M, et al. Incidental carcinoma in thyroid pathology: our experience and review of the literature. Ann Ital Chir 2010; 81:165–9

    PubMed  Google Scholar 

  12. Phitayakorn R, McHenry CR. Incidental thyroid carcinoma in patients with Graves' disease. Am J Surg 2008; 195:292–7; discussion 297

    Article  PubMed  Google Scholar 

  13. Senyurek Giles Y, Tunca F, Boztepe H, et al. The risk factors for malignancy in surgically treated patients for Graves' disease, toxic multinodular goiter, and toxic adenoma. Surgery 2008; 144:1028–36; discussion 1036-7

    Article  PubMed  Google Scholar 

  14. Miccoli P, Minuto MN, Galleri D, et al. Incidental thyroid carcinoma in a large series of consecutive patients operated on for benign thyroid disease. ANZ J Surg 2006; 76:123–6

    Article  PubMed  Google Scholar 

  15. Nechaĭ OP, Larin OS, Cheren'ko SM, et al. "Incidental" thyroid carcinoma among patients in surgical treatment for nontumors thyroid desease. Klin Khir 2012; (7):9–11

    PubMed  Google Scholar 

  16. Gelmini R, Franzoni C, Pavesi E, et al. Incidental thyroid carcinoma (ITC): a retrospective study in a series of 737 patients treated for benign disease. Ann Ital Chir 2010; 81:421–7

    PubMed  Google Scholar 

  17. Smith JJ, Chen X, Schneider DF, et al. Cancer after thyroidectomy: a multi-institutional experience with 1,523 patients. J Am Coll Surg 2013; 216:571–7; discussion 577-9

    Article  PubMed  Google Scholar 

  18. Kunjumohamed FP, Al-Busaidi NB, Al-Musalhi HN, et al. The prevalence of thyroid cancer in patients with hyperthyroidism. Saudi Med J 2015; 36:874–7

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ren M, Wu MC, Shang CZ, et al. Predictive factors of thyroid cancer in patients with Graves' disease. World J Surg 2014; 38:80–7

    Article  PubMed  Google Scholar 

  20. Boutzios G, Vasileiadis I, Zapanti E, et al. Higher incidence of tall cell variant of papillary thyroid carcinoma in Graves' Disease. Thyroid 2014; 24:347–54

    Article  PubMed  Google Scholar 

  21. Balci MK, Koyuncu BU, Arık S, et al. Differentiated thyroid carcinoma prevalence in the Graves' disease; Akdeniz University experience. Endocrine Abstracts (2015) 37 EP916 doi:10.1530/endoabs.37.EP916

    Google Scholar 

  22. Mssrouri R, Benamr S, Essadel A, et al. Thyroid cancer in patients with Grave's Disease. J Chir (Paris) 2008; 145:244–6

    Article  Google Scholar 

  23. Erbil Y, Barbaros U, Ozbey N, et al. Graves' disease, with and without nodules, and the risk of thyroid carcinoma. J Laryngol Otol. 2008; 122:291–5

    CAS  PubMed  Google Scholar 

  24. Dănilă R, Karakas E, Osei-Agyemang T, et al. Outcome of incidental thyroid carcinoma in patients undergoing surgery for Graves' disease. Rev Med Chir Soc Med Nat Iasi 2008; 112:115–8

    PubMed  Google Scholar 

  25. Gerenova J, Buysschaert M, de Burbure CY, et al. Prevalence of thyroid cancer in Graves' disease: a retrospective study of a cohort of 103 patients treated surgically. Eur J Intern Med 2003; 14:321–5

    Article  PubMed  Google Scholar 

  26. Kraimps JL, Bouin-Pineau MH, Mathonnet M, et al. Multicentre study of thyroid nodules in patients with Graves' disease. Br J Surg 2000; 87:1111–3

    Article  CAS  PubMed  Google Scholar 

  27. Ozaki O, Ito K, Kobayashi K, et al. Thyroid carcinoma in Graves' disease. World J Surg 1990; 14:437–40; discussion 440-1

    Article  CAS  PubMed  Google Scholar 

  28. Belfiore A, Garofalo MR, Giuffrida D, et al. Increased aggressiveness of thyroid cancer in patients with Graves' disease. J Clin Endocrinol Metab 1990; 70:830–5

    Article  CAS  PubMed  Google Scholar 

  29. Belfiore A, Russo D, Vigneri R, et al. Graves' disease, thyroid nodules and thyroid cancer. Clin Endocrinol (Oxf) 2001; 55:711–8

    Article  CAS  Google Scholar 

  30. Knox MA. Thyroid nodules. Am Fam Physician 2013; 88:193–6

    PubMed  Google Scholar 

  31. Lima PC, Moura Neto A, Tambascia MA, et al. Risk factors associated with benign and malignant thyroid nodules in autoimmune thyroid diseases. ISRN Endocrinol 2013; 25; 2013:673146. doi: 10.1155/2013/673146.

    Google Scholar 

  32. Cantalamessa L, Baldini M, Orsatti A, et al. Thyroid nodules in Graves disease and the risk of thyroid carcinoma. Arch Intern Med 1999; 159:1705–8

    Article  CAS  PubMed  Google Scholar 

  33. Kikuchi S, Noguchi S, Yamashita H, et al. Prognosis of small thyroid cancer in patients with Graves' disease. Br J Surg 2006; 93:434–9

    Article  CAS  PubMed  Google Scholar 

  34. Bilha S, Repede I, Gatu A, et al. The association between Graves' disease and thyroid cancer: coincidence or causality? Case report. Endocrine Abstracts (2015) 37 EP1269 DOI:10.1530/endoabs.37.EP1269

    Google Scholar 

  35. Bojic T, Paunovic I, Diklic A, et al. Total thyroidectomy as a method of choice in the treatment of Graves’ disease-analysis of 1432 patients. BMC Surg 2015; 15:39

    Article  PubMed  PubMed Central  Google Scholar 

  36. Bahn Chair RS, Burch HB, Cooper DS, et al. American Thyroid Association; American Association of Clinical Endocrinologists. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011; 21:593–646

    Article  PubMed  Google Scholar 

  37. Efremidou EI, Papageorgiou MS, Liratzopoulos N, et al. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg 2009; 52: 39–44

    PubMed  PubMed Central  Google Scholar 

  38. Veyseller B, Aksoy F, Demirhan H, et al. Total thyroidectomy in benign thyroid diseases. Kulak Burun Bogaz Ihtis Derg 2009; 19:299–303

    PubMed  Google Scholar 

  39. Friguglietti CU, Lin CS, Kulcsar MA. Total thyroidectomy for benign thyroid disease. Laryngoscope 2003; 113:1820–6

    Article  PubMed  Google Scholar 

  40. Phitayakorn R, Morales-Garcia D, Wanderer J, et al. Surgery for Graves' disease: a 25-year perspective. Am J Surg 2013; 206:669–73

    Article  PubMed  Google Scholar 

  41. Basedow Barbuscia M, Querci A, Tonante A, et al. Total thyroidectomy in Basedow-Graves' disease treatment: our experience. G Chir 2015; 36:117–21

    PubMed  Google Scholar 

  42. Tamatea JA, Tu'akoi K, Conaglen JV, et al. Thyroid cancer in Graves' disease: is surgery the best treatment for Graves' disease? ANZ J Surg 2014; 84:231–4

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Surgical Clinic, Naousa Health Unit, Imathia General Hospital, via Afoi Lanara & Pexlivanou 3, 50100, Naousa, Imathia, Greece

    Saad Al Mogrampi, E. Demertzidou, A. Polyzos, M. Verroiotou, A. Krexi, N. Papoulidis & I. Fardellas

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  1. Saad Al Mogrampi
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  2. E. Demertzidou
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  3. A. Polyzos
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  4. M. Verroiotou
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  5. A. Krexi
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  6. N. Papoulidis
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  7. I. Fardellas
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Correspondence to Saad Al Mogrampi.

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Al Mogrampi, S., Demertzidou, E., Polyzos, A. et al. Incidental thyroid carcinoma after thyroidectomy in patients with Graves’ disease. Hellenic J Surg 88, 163–167 (2016). https://doi.org/10.1007/s13126-016-0308-8

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  • DOI: https://doi.org/10.1007/s13126-016-0308-8

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