High prevalence of papillary thyroid carcinoma in nodular Hashimoto’s thyroiditis at the first diagnosis and during the follow-up
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The association between Hashimoto’s thyroiditis (HT) and papillary thyroid carcinoma (PTC) remains to be elucidated.
Materials and methods
A total of 484 HT patients were retrospectively subdivided into two groups: 243 without thyroid nodules, TNs (HTN−) and 241 with TNs (HTN+). Fine-needle aspiration cytology was available in 152 HTN+ patients. This group was compared to a group of 161 patients with nodular goiter (NG) without HT. Finally, 70 HTN+ and 37 NG patients underwent surgery.
A very high prevalence of suspicious/malignant cytology (Thy 4–5) at the first diagnosis (38/124; 31%) and during the follow-up (6/28; 22%) was found in HTN+ group. In HTN- group, 22/130 (17%) patients developed TN, but none showed malignant features during the follow-up. HTN+ patients had higher prevalence of Thy 4–5 (44/152 = 28.9%) compared to NG patients (12/161 = 7.4%, p < 0.0001). Increased independent odds ratio (OR) for malignancy was conferred by serum TSH > 1.0 μUI/ml, [OR 1.93, 95% confidence interval (CI) 1.41–2.64, p < 0.0001], male sex (OR 3.44, CI 1.48–8.02, p = 0.004) and HT (OR 3.14; CI 1.08–9.31, p < 0.05). Malignant histology (mostly PTC) was confirmed higher in HTN+ (48/70, 68.6%) compared to NG (15/37, 40.5%; p < 0.05). Higher prevalence of extrathyroidal infiltration (24/48, 50%) and vascular invasion (25/48, 52%) was found in HTN+ vs NG (2/15, 1.3% p < 0.01), (3/16, 1.8% p < 0.05), respectively.
This study confirms higher prevalence of suspicious/malignant cytology and PTC at histology in nodular HT compared to NG, without evidence of malignancy in non-nodular HT patients during the follow-up.
KeywordsHashimoto’s thyroiditis TSH Thyroid nodules Thyroid cytology Papillary thyroid carcinoma
The authors thank Dr Nicolò Arisci, Dr Chiara Satta, Dr Chiara Serafini and Dr Stefania Casula from Endocrinology Unit, University of Cagliari, for the data collection of the present study.
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
This work was partially supported by PRIN 2012 (Research Grant: #2012Z3F7HE, from “Ministero Università e Ricerca”, Roma, Italy) and by funds of the University of Cagliari (Contributo di Ateneo della Ricerca) to Prof. Stefano Mariotti.
All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional ethics 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.
- 5.Iliadou PK, Effraimidis G, Konstantinos M, Grigorios P, Mitsakis P, Patakiouta F, Pazaitou-Panayiotou K (2015) Chronic lymphocytic thyroiditis is associated with invasive characteristics of differentiated thyroid carcinoma in children and adolescents. Eur J Endocrinol 173:827–833CrossRefPubMedGoogle Scholar
- 7.Fiore E, Rago T, Provenzale MA, Scutari M, Ugolini C, Basolo F, Di Coscio G, Berti P, Grasso L, Elisei R, Pinchera A, Vitti P (2009) Lower levels of TSH are associated with a lower risk of papillary thyroid cancer in patients with thyroid nodular disease: thyroid autonomy may play a protective role. Endocr Relat Cancer 16:1251–1260CrossRefPubMedGoogle Scholar
- 10.Boi F, Minerba L, Lai ML, Marziani B, Figus B, Spanu F, Borghero A, Mariotti S (2013) Both thyroid autoimmunity and increased serum TSH are independent risk factors for malignancy in patients with thyroid nodules. J Endocrinol Investig 36:313–320Google Scholar
- 12.Fiore E, Rago T, Latrofa F, Provenzale MA, Piaggi P, Delitala A, Scutari M, Basolo F, Di Coscio G, Grasso L, Pinchera A, Vitti P (2011) Hashimoto’s thyroiditis is associated with papillary thyroid carcinoma: role of TSH and of treatment with l-thyroxine. Endocr Relat Cancer 18:429–437CrossRefPubMedGoogle Scholar
- 14.Fiore E, Rago T, Scutari M, Ugolini C, Proietti A, Di Coscio G, Provenzale MA, Berti P, Grasso L, Mariotti S, Pinchera A, Vitti P (2009) Papillary thyroid cancer, although strongly associated with lymphocytic infiltration on histology, is only weakly predicted by serum thyroid auto-antibodies in patients with nodular thyroid diseases. J Endocrinol Investig 32:344–351CrossRefGoogle Scholar
- 17.Castagna MG, Belardini V, Memmo S, Maino F, Di Santo A, Toti P, Carli AF, Caruso G, Pacini F (2014) Nodules in autoimmune thyroiditis are associated with increased risk of thyroid cancer in surgical series but not in cytological series: evidence for selection bias. J Clin Endocrinol Metab 99:3193–3198CrossRefPubMedGoogle Scholar
- 23.British Thyroid Association (2007) Royal College of Physicians: Guidelines for Management of Thyroid Cancer. Report of the thyroid cancer guidelines update group, 2nd edn. London, Royal College of Physicians, pp 1–106Google Scholar
- 24.Baloch ZW, LiVolsi VA, Asa SL, Rosai J, Merino MJ, Randolph G, Vielh P, DeMay RM, Sidawy MK, Frable WJ (2008) Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol 36:425–437CrossRefPubMedGoogle Scholar
- 27.Fiore E, Rago T, Provenzale MA, Scutari M, Ugolini C, Basolo F, Di Coscio G, Miccoli P, Grasso L, Pinchera A, Vitti P (2010) l-thyroxine-treated patients with nodular goiter have lower serum TSH and lower frequency of papillary thyroid cancer: results of a cross-sectional study on 27 914 patients. Endocr Relat Cancer 18:231–239CrossRefGoogle Scholar
- 29.Loviselli A, Oppo A, Velluzzi F, Atzeni F, Mastinu GL, Farci P, Orgiana G, Balestrieri A, Cocco PL, Mariotti S (1999) Independent expression of serological markers of thyroid autoimmunity and hepatitis virus C infection in the general population: results of a community-based study in north-western Sardinia. J Endocrinol Investig 22:660–665CrossRefGoogle Scholar
- 30.Cucca F, Dudbridge F, Loddo M, Mulargia AP, Lampis R, Angius E, De Virgiliis S, Koeleman BP, Bain SC, Barnett AH, Gilchrist F, Cordell H, Welsh K, Todd JA (2001) The HLA-DPB1-associated component of the IDDM1 and its relationship to the major loci HLA-DQB1,-DQA1, and -DRB1. Diabetes 50:1200–1205CrossRefPubMedGoogle Scholar