Tumor Biology

, Volume 37, Issue 6, pp 8037–8045 | Cite as

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

  • Youzhi Zhu
  • Ke Zheng
  • Huihao Zhang
  • Ling Chen
  • Jiajie Xue
  • Mingji Ding
  • Kunlin Wu
  • Zongcai Wang
  • Lingjun Kong
  • Xiangjin Chen
Original Article


This study aims to evaluate the difference of central lymph node metastases (LNM) in papillary thyroid carcinoma (PTC) associated with or without Hashimoto’s thyroiditis (HT) in predicting lateral node metastasis. A retrospective case control study was performed. Patients (1276) with PTC who underwent a total or near-total thyroidectomy with at least one lymph node dissection in our institution were retrospectively reviewed. All patients were divided into two groups (HT-group and non-HT group) according to the pathological diagnosis. In HT-group, the incidence of both central and lateral LNM was lower compared with non-HT group. The average of central metastatic lymph node radio (LNR) was also lower than that in Non-HT group. The multivariate analysis showed that the number of metastatic central LNs (HT ≥ 4, Non-HT ≥ 2) and the central LNR (HT ≥ 0.4, Non-HT ≥ 0.6) were independently associated with lateral LNM. Patients with HT need larger primary tumor size, more positive central LN and higher LNR to predict the presence of lateral LNM. HT may protect against central and lateral LNM in PTC. The number of positive central LNs and central LNR in PTC could be used to determine the presence of lateral LNM and inform postoperative follow-up.


Lymph node metastasis Papillary thyroid cancer Hashimoto’s thyroiditis Predictor 



This work was sponsored by Key Clinical Specialty Discipline Construction Program of Fujian, P.R.C and Fujian Province Middle and Young Teacher Education Science and Technology Project Funding (JA14146).

Compliance with ethical standards

Conflicts of interest



  1. 1.
    Hodgson N, Wohler-Torres B, Solarzano C. Thyroid cancer: is the incidence still increasing. Ann Surg Oncol. 2004;11(12):1093–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Weiping T, Zhongyan S, Xiaochun T, et al. Effect of iodine intake on thyroid diseases in China. N Engl J Med. 2006;354(26):2783–93.CrossRefGoogle Scholar
  3. 3.
    Teng X, Shan Z, Chen Y, et al. More than adequate iodine intake may increase subclinical hypothyroidism and autoimmune thyroiditis: a cross-sectional study based on two Chinese communities with different iodine intake levels. Eur J Endocrinol. 2011;164(6):943–50.CrossRefPubMedGoogle Scholar
  4. 4.
    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;20(4):230–1.Google Scholar
  5. 5.
    Zhu Y, Chen X, Zhang Z, et al. Clinical and pathological analysis of thyroid carcinoma coexistent with Hashimoto’s thyroiditis. Chin J Clin Oncol. 2012;39(4):217–20.Google Scholar
  6. 6.
    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. discussion 1076–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Kebebew E, Treseler PA, Ituarte PHG, et al. Coexisting chronic lymphocytic thyroiditis and papillary thyroid cancer revisited. World J Surg. 2001;25(5):632–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Cipolla C, Sandonato L, Graceffa G, et al. Hashimoto thyroiditis coexistent with papillary thyroid carcinoma. Am Surg. 2005;71(10):874–8.PubMedGoogle Scholar
  9. 9.
    Lee J H, Kim Y, Choi J W, et al. The association between papillary thyroid carcinoma and histologically-proven Hashimoto’s thyroiditis: a meta-analysis. Eur J Endocrinol. 2012;168(3).Google Scholar
  10. 10.
    Kouvaraki MA, Shapiro SE, Fornage BD, et al. Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery. 2003;134(6):946–54.CrossRefPubMedGoogle Scholar
  11. 11.
    Moo TAS, Umunna B, Kato M, et al. Ipsilateral versus bilateral central neck lymph node dissection in papillary thyroid carcinoma. Ann Surg. 2009;250(3):403–8.PubMedGoogle Scholar
  12. 12.
    Jong-Lyel R, Jae-Yong P, Il PC. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg. 2007;245(4):604–10.CrossRefGoogle Scholar
  13. 13.
    Goropoulos A, Karamoshos KA, Ntitsias T, et al. Value of the cervical compartments in the surgical treatment of papillary thyroid carcinoma. World J Surg. 2006;30(12):140.CrossRefGoogle Scholar
  14. 14.
    Roh JL, Kim JM, Chan IP. Central cervical nodal metastasis from papillary thyroid microcarcinoma: pattern and factors predictive of nodal metastasis. Ann Surg Oncol. 2008;15(9):2482–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Knecht H, Saremaslani P, Hedinger C. Immunohistological findings in Hashimoto’s thyroiditis, focal lymphocytic thyroiditis and thyroiditis de Quervain. Comparative study. Virchows Arch A Pathol Anat Histol. 1981;393(2):215–31.CrossRefPubMedGoogle Scholar
  16. 16.
    Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–4.CrossRefPubMedGoogle Scholar
  17. 17.
    Repplinger D, Bargren A, Zhang YW, et al. Is Hashimoto’s thyroiditis a risk factor for papillary thyroid cancer? J Surg Res. 2008;144(1):228.CrossRefGoogle Scholar
  18. 18.
    Tamimi DM. The association between chronic lymphocytic thyroiditis and thyroid tumors. Int J Surg Pathol. 2002;10(2):141–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Souza SL, Lv MDA, Ward LS. Impact of previous thyroid autoimmune diseases on prognosis of patients with well-differentiated thyroid cancer. Thyroid. 2003;13(5):491–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Chistiakov DA. Immunogenetics of Hashimoto’s thyroiditis. J Autoimmune Dis. 2005; 2.Google Scholar
  21. 21.
    Yip J, Orlov S, Orlov D, et al. Predictive value of metastatic cervical lymph node ratio in papillary thyroid carcinoma recurrence. Head Neck. 2012;35(4):592–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Nunes JHV, Clark JR, Kan G, et al. Prognostic implications of lymph node yield and lymph node ratio in papillary thyroid carcinoma. Thyroid. 2013;23(7):811–6.CrossRefGoogle Scholar
  23. 23.
    Schneider DF, Mazeh H, Chen H, et al. Lymph node ratio predicts recurrence in papillary thyroid cancer. Oncologist. 2013;172(2):236–7.Google Scholar
  24. 24.
    Ryu IS, Chan IS, Choi SH, et al. Lymph node ratio of the central compartment is a significant predictor for locoregional recurrence after prophylactic central neck dissection in patients with thyroid papillary carcinoma. Ann Surg Oncol. 2014;21(1):277–83.CrossRefPubMedGoogle Scholar
  25. 25.
    Soo KS, Joo LB, Choon LJ, et al. Coexistence of Hashimoto’s thyroiditis with papillary thyroid carcinoma: the influence of lymph node metastasis. Head Neck. 2011;33(9):1272–7.CrossRefGoogle Scholar
  26. 26.
    Zeng R, Zhang W, Gao E, et al. Number of central lymph node metastasis for predicting lateral lymph node metastasis in papillary thyroid microcarcinoma. Head Neck. 2014;36(1):101–6.CrossRefPubMedGoogle Scholar

Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2015

Authors and Affiliations

  • Youzhi Zhu
    • 1
  • Ke Zheng
    • 2
  • Huihao Zhang
    • 1
  • Ling Chen
    • 1
  • Jiajie Xue
    • 1
  • Mingji Ding
    • 1
  • Kunlin Wu
    • 1
  • Zongcai Wang
    • 1
  • Lingjun Kong
    • 1
  • Xiangjin Chen
    • 1
  1. 1.Department of Thyroid and Breast SurgeryThe First Affiliated Hospital of FuJian Medical UniversityFuZhou CityChina
  2. 2.Department of PathologyThe First Affiliated Hospital of FuJian Medical UniversityFuZhou CityChina

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