Advertisement

Hellenic Journal of Surgery

, Volume 89, Issue 2, pp 73–78 | Cite as

Coexistence of Hashimoto’s thyroiditis and papillary thyroid carcinoma

  • C. AvgoustouEmail author
  • Eirini Avgoustou
Endocrine Surgery

Abstract

Aim

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.

Methods

We herein review previous pertinent literature on the subject of concomitant HT and PTC, with respect to epidemiology, clinical presentation, carcinogenesis, and appropriate treatment.

Results

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.

Conclusions

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 words

Hashimoto’s thyroiditis papillary thyroid carcinoma epidemiology clinical presentation carcinogenesis treatment 

Abbreviations

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

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Lal G, Clark OH. Textbook of endocrine surgery. Philadelphia: Saunders; Chronic Thyroiditis 2005;38–40.Google Scholar
  2. 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. 3.
    Kumar V, Robbins SL. Robbins basic pathology. Philadelphia, PA: Saunders/Elsevier: The endocrine system; 2007. pp. 731–2, 735–6.Google Scholar
  4. 4.
    Carhill A, Cabanillas M, Jimenez C, et al. The oninvestigestional use of tyrosine kinase inhibitors in thyroid cancer: establishing a standard for patient safety and monitoring. J Clin Endocrinol Metab 2013;98:31–42.CrossRefPubMedGoogle Scholar
  5. 5.
    Rajhbeharrysingh U, Taylor M, Milas M. Medical therapy for advanced forms of thyroid cancer. Surg Clin N Am 2014;94:541–71.CrossRefPubMedGoogle Scholar
  6. 6.
    Dailey ME, Lindsay S, Skahen R. Relation of thyroid neoplasms to Hashimoto’s disease of the thyroid gland. Arch Surg 1955;70:291–7.CrossRefGoogle Scholar
  7. 7.
    Ott RA, McCall AR, McHenry C, et al. The incidence of thyroid carcinoma in Hashimoto’s thyroiditis. Am Surg 1987;53:442–5.PubMedGoogle Scholar
  8. 8.
    Eisenberg BL, Hensley SD. Thyroid cancer with coexistent Hashimoto’s thyroiditis. Clinical assessment and management. Arch Surg 1989;124:1045–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Matsubayashi S, Kawai K, Matsumoto Y, et al. The correlation between papillary thyroid carcinoma and lymphocytic infiltration in the thyroid gland. J Clin Endocrinol Metab 1995;80:3421–4.PubMedGoogle Scholar
  10. 10.
    Schäffler A, Palitzsch KD, Seiffarth C, et al. Coexistent thyroiditis is associated with lower tumor stage in thyroid carcinoma. Eur J Clin Invest 1998;28:838–44.CrossRefPubMedGoogle Scholar
  11. 11.
    Singh B, Shaha AR, Trivedi H, et al. Coexistent Hashimoto’s thyroiditis with papillary thyroid carcinoma: impact on presentation, management, and outcome. Surgery 1999;126:1070–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Kebebew E, Treseler PA, Ituarte PH, et al. Coexisting chronic lymphocytic thyroiditis and papillary thyroid cancer revisited. World J Surg 2001;25:632–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Pisanu A, Piu S, Cois A, et al. Coexisting Hashimoto’s thyroiditis with differentiated thyroid cancer and benign thyroid diseases: indications for thyroidectomy. Chir Ital 2003;55:365–72.PubMedGoogle Scholar
  14. 14.
    Kurukahvecioglu O, Taneri F, Yuksel O, et al. Total thyroidectomy for the treatment of Hashimoto’s thyroiditis coexisting with papillary thyroid carcinoma. Advances in Therapy 2007;24:510–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Kim EY, Kim WG, Kim WB, et al. Coexistence of chronic lymphocytic thyroiditis is associated with lower recurrence rates in patients with papillary thyroid carcinoma. Clinical Endocrinology 2009;71:581–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Mazokopakis EE, Tzortzinis AA, Dalieraki-Ott EI, et al. Coexistence of Hashimoto’s thyroiditis with papillary thyroid carcinoma. A retrospective study. Hormones 2010;9:312–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Kim HS, Choi YJ, Yun JS. Features of papillary thyroid microcarcinoma in the presence and absence of lymphocytic thyroiditis. Endocrine Pathology 2010;21:149–53.CrossRefPubMedGoogle Scholar
  18. 18.
    Kim KW, Park YJ, Kim EH, et al. Elevated risk of papillary thyroid cancer in Korean patients with Hashimoto’s thyroiditis. Head & Neck 2011;33:691–5.CrossRefGoogle Scholar
  19. 19.
    Yoon YH, Kim HJ, Lee JW, et al. The clinicopathologic differences in papillary thyroid carcinoma with or without coexisting chronic lymphocytic thyroiditis. European Archives of Oto-Rhino-Laryngology 2012;269:1013–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Paulson LM, Shindo ML, Schuff KG. Role of chronic lymphocytic thyroiditis in central node metastasis of papillary thyroid carcinoma. Otolaryngol Head Neck Surg 2012;147:444–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Lee JH, Kim Y, Choi JW, et al. The association between papillary thyroid carcinoma and histologically proven Hashimoto’s thyroiditis: a meta-analysis. Eur J Endocrinol 2013;168:343–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Lun Y, Wu X, Xia Q, et al. Hashimoto’s thyroiditis as a risk factor of papillary thyroid cancer may improve cancer prognosis. Otolaryngol Head Neck Surg 2013;148:396–402.CrossRefPubMedGoogle Scholar
  23. 23.
    Girardi FM, Barra MB, Zettler CG. Papillary thyroid carcinoma: does the association with Hashimoto’s thyroiditis affect the clinicopathological characteristics of the disease? Braz J Otorhinolaryngol 2015;81:283–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Qu N, Zhang L, Lin DZ, et al. The impact of coexistent Hashimoto’s thyroiditis on lymph node metastasis and prognosis in papillary thyroid microcarcinoma. Tumor Biol 2016;37:7685–92.CrossRefGoogle Scholar
  25. 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
  26. 26.
    Sclafani AP, Valdes M, Cho H. Hashimoto’s thyroiditis and carcinoma of the thyroid: optimal management. Laryngoscope 1993;103:845–49.CrossRefPubMedGoogle Scholar
  27. 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
  28. 28.
    Bradly DP, Reddy V, Prinz RA, et al. Incidental papillary carcinoma in patients treated surgically for benign thyroid diseases. Surgery 2009;146:1099–104.CrossRefPubMedGoogle Scholar
  29. 29.
    Gul K, Dirikoc A, Kiyak G, et al. The association between thyroid carcinoma and Hashimoto’s thyroiditis: the ultrasonographic and histopathologic characteristics of malignant nodules. Thyroid 2010;2:873–8.CrossRefGoogle Scholar
  30. 30.
    Consorti F, Loponte M, Milazzo F, et al. Risk of malignancy from thyroid nodular disease as an element of clinical management of patients with Hashimoto’s thyroiditis. European Surgical Research 2010;45:333–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Zhang L, Li H, Ji QH, et al. The clinical features of papillary thyroid cancer in Hashimoto’s thyroiditis patients from an area with a high prevalence of Hashimoto’s disease. BMC Cancer 2012;12:610.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Kapan M, Onder A, Girgin S, et al. The reliability of fineneedle aspiration biopsy in terms of malignancy in patients with Hashimoto thyroiditis. Int Surg 2015;100:249–53.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 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
  34. 34.
    Anand A, Singh KR, Kushwaha JK, et al. Papillary Thyroid Cancer and Hashimoto’s Thyroiditis: An Association Less Understood. Indian J Surg Oncol 2014;5:199–204.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Zhu Y, Zheng K, Zhang H, et al. The clinicopathologic differences of central lymph node metastasis in predicting lateral lymph node metastasis and prognosis in papillary thyroid cancer associated with or without Hashimoto’s thyroiditis. Tumor Biol 2016;37:8037–45.CrossRefGoogle Scholar
  36. 36.
    Konturek A, Barczyński M, Nowak W, et al. Risk of lymph node metastases in multifocal papillary thyroid cancer associated with Hashimoto’s thyroiditis. Langenbecks Arch Surg 2014;399:229–36.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Souza SL, da Assumpção LVM, Ward LS. Impact of previous thyroid autoimmune diseases on prognosis of patients with well-differentiated thyroid cancer. Thyroid 2003;13:491–5.CrossRefPubMedGoogle Scholar
  38. 38.
    Siassakos D, Gourgiotis S, Moustafellos P, et al. Thyroid microcarcinoma during thyroidectomy. Singapore Med J 2008;49:23–5.PubMedGoogle Scholar
  39. 39.
    Feldt-Rasmussen U, Rasmussen AK. Autoimmunity in differentiated thyroid cancer: significance and related clinical problems. Hormones 2010;9:109–17.CrossRefPubMedGoogle Scholar
  40. 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
  41. 41.
    Wirtschafter A, Schmidt R, Rosen D, et al. Expression of the RET/PTC fusion gene as a marker of papillary carcinoma in Hashimoto’s thyroiditis. Laryngoscope 1997;107:95–100.CrossRefPubMedGoogle Scholar
  42. 42.
    Sheils OM, O’Leary JJ, Uhlmann V, et al. RET/PTC-1 activation in Hashimoto thyroiditis. J Surg Pathol 2000;8:185–9.CrossRefGoogle Scholar
  43. 43.
    Arif S, Blanes A, Diaz-Cano SJ. Hashimoto’s thyroiditis shares features with early papillary thyroid carcinoma. Histopathology 2002;41:357–62.CrossRefPubMedGoogle Scholar
  44. 44.
    Unger P, Ewart M, Wang BY, et al. Expression of p63 in papillary thyroid carcinoma and in Hashimoto’s thyroiditis: a pathobiologic link? Hum Pathol 2003;34:764–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Larson SD, Jackson LN, Riall TS, et al. Increased incidence of well-differentiated thyroid cancer associated with Hashimoto’s thyroiditis and the role of the PI3k/Akt pathway. J Am Coll Surg 2007;204:764–73, discussion 773-5.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Burstein DE, Nagi C, Wang BY, et al. Immunohistochemical detection of p53 homolog p63 in solid cell nests, papillary thyroid carcinoma, and hashimoto’s thyroiditis: A stem cell hypothesis of papillary carcinoma oncogenesis. Hum Pathol 2004;35:465–73.CrossRefPubMedGoogle Scholar
  47. 47.
    Barczyński M, Konturek A, Hubalewska-Dydejczyk A, et al. Five-year follow-up of a randomised clinical trial of total thyroidectomy versus Dunhill operation versus bilateral subtotal thyroidectomy for multinodular nontoxic goiter. World J Surg 2010;34:1203–13.CrossRefPubMedGoogle Scholar
  48. 48.
    Barczyński M, Konturek A, Stopa M, et al. Total thyroidectomy for benign thyroid disease: is it really worthwhile? Ann Surg 2011;254:724–9.CrossRefPubMedGoogle Scholar
  49. 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
  50. 50.
    Chow SM, Law SC, Chan JK, et al. Papillary microcarcinoma of the thyroid—prognostic significance of lymph node metastasis and multifocality. Cancer 2003;98:31–40.CrossRefPubMedGoogle Scholar
  51. 51.
    Mercante G, Frasoldati A, Pedroni C, et al. Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: results of a study in 445 patients. Thyroid 2009;19:707–16.CrossRefPubMedGoogle Scholar
  52. 52.
    So YK, Son YI, Hong SD, et al. Subclinical lymph node metastasis in papillary thyroid microcarcinoma: a study of 551 resections. Surgery 2010;148:526–31.CrossRefPubMedGoogle Scholar
  53. 53.
    McHenry C, Stulberg J. Prophylactic central compartment neck dissection for papillary thyroid cancer. Surg Clin N Am 2014;94:529–40.CrossRefPubMedGoogle Scholar

Copyright information

© Hellenic Surgical Society and Springer-Verlag GmbH Austria 2017

Authors and Affiliations

  1. 1.Surgical DepartmentGeneral Hospital of N. Ionia “Constantopoulion - Aghia Olga”AthensGreece
  2. 2.Medical School GraduateNational and Kapodistrian University of AthensAthensGreece

Personalised recommendations