Coexistence of Hashimoto’s thyroiditis and papillary thyroid carcinoma
The coexistence of Hashimoto’s thyroiditis (HT) and papillary thyroid carcinoma (PTC) has been a widely debated issue. In view of the current controversy, as well as the high prevalence of both diseases, the objective of the present paper is to evaluate the association between them and to propose the proper therapeutic management.
We herein review previous pertinent literature on the subject of concomitant HT and PTC, with respect to epidemiology, clinical presentation, carcinogenesis, and appropriate treatment.
Studies to date establish 6.5-43.8% of patients with PTC and coexisting HT, while 11-58.3% of all HT patients will develop PTC. Coexistence of the diseases is significantly related to younger women. Malignant lesions tend to be microcarcinomas, at times multifocal (13.5-44%) and occasionally metastasising to the central cervical compartment (10.8-49%). Mostly, patients have a good prognosis with total thyroidectomy, accompanied by central compartment node dissection in cases with nodal involvement. Many issues, including molecular biological characteristics of carcinogenesis in Hashimoto’s thyroiditis, remain to be clarified and further studies need to be undertaken.
The close relationship between HT and PTC lends credence to the hypothesis that autoimmune thyroiditis is a predisposing factor to the development of thyroid carcinoma but patients tend to have favorable clinicopathological characteristics and long recurrence-free survival. A careful surveillance of these patients is required for an early detection of malignant lesions, which should constitute indication for radical surgical treatment.
Key wordsHashimoto’s thyroiditis papillary thyroid carcinoma epidemiology clinical presentation carcinogenesis treatment
- AGES scoring system
Age of the patient, histological Grade of the tumor, Extent of the tumor (extrathyroidal invasion or distant metastases), Size of the primary tumor
- AMES scoring system
Age of the patient, presence of distant Metastases, Extent of the primary tumor, Size of the primary cancer
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- 1.Lal G, Clark OH. Textbook of endocrine surgery. Philadelphia: Saunders; Chronic Thyroiditis 2005;38–40.Google Scholar
- 2.Bloodworth JMB, Lechago J, Gould VE. Bloodworth’s endocrine pathology. Baltimore, Md: Williams & Wilkins: The thyroid 1997. pp. 178–81, 197–206.Google Scholar
- 3.Kumar V, Robbins SL. Robbins basic pathology. Philadelphia, PA: Saunders/Elsevier: The endocrine system; 2007. pp. 731–2, 735–6.Google Scholar
- 25.Chesky VE, Hellwig CA, Welch JW. Cancer of the thyroid associated with Hashimoto’s disease: an analysis of forty eight cases. Am Surg 1961;28:678–85.Google Scholar
- 27.Avgoustou C, Schizas V, Sioros Ch, et al. Hashimoto thyroiditis in benign and malignant surgical diseases of the thyroid gland. Abstracts of the 26th Hellenic Congress of Surgery and International Surgical Forum. Hell J Surg, Supplementary Issue 2008;80:140–1.Google Scholar
- 33.Ma H, Yan J, Zhang C, et al. Expression of papillary thyroid carcinoma-associated molecular markers and their significance in follicular epithelial dysplasia with papillary thyroid carcinoma-like nuclear alterations in Hashimoto’s thyroiditis. Int J Clin Exp Pathol. 2014;7:7999–8007.PubMedPubMedCentralGoogle Scholar
- 40.Cyniak-Magierska A, Wojciechowska-Durczyńska K, Krawczyk-Rusiecka K, et al. Assessment of RET/PTC1 and RET/PTC3 rearrangements in fine-needle aspiration biopsy specimens collected from patients with Hashimoto’s thyroiditis. Thyroid Res 2011;10:4–5.Google Scholar
- 49.Alecu L, Bărbulescu M, Ursuţ B, et al. Occult thyroid carcinoma in our experience—should we reconsider total thyroidectomy for benign thyroid pathology? Chirurgia (Bucur) 2014;109:191–7.Google Scholar