High prevalence of papillary thyroid carcinoma in nodular Hashimoto’s thyroiditis at the first diagnosis and during the follow-up
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.
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