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Marongiu A, Nuvoli S, De Vito A, Rondini M, Spanu A, Madeddu G. A Comparative Follow-Up Study of Patients with Papillary Thyroid Carcinoma Associated or Not with Graves' Disease. Diagnostics (Basel) 2022; 12:diagnostics12112801. [PMID: 36428861 PMCID: PMC9689017 DOI: 10.3390/diagnostics12112801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Whether papillary carcinoma (PC) behavior is more aggressive in Graves’ disease (GD) patients than PC cases without GD is controversial. We retrospectively enrolled 33 thyroidectomized PC/GD patients during long-term follow-up, 23/33 without risk factors at surgery, and 18/33 microcarcinomas; 312 PC euthyroid-matched patients without risk factors served as controls. A total of 14/33 (42.4%) PC/GD patients, 4 with and 10 without risk factors at diagnosis, 6 with microcarcinoma, underwent metastases during follow-up. In controls, metastases in 21/312 (6.7%) were ascertained. Considering 10/23 PC/GD patients and 21/312 controls without risk factors who developed metastases, univariate analysis showed that there was an increased risk of metastasis appearance for PC/GD cases (p < 0.001). Disease-free survival (DFS) was significantly (p < 0.0001, log-rank test) shorter in PC/GD patients than in controls. Significantly more elevated aggressiveness in 6/18 PC/GD patients with microcarcinoma than in controls was also ascertained with shorter DFS. Thus, in the present study, PC/GD had aggressive behavior during follow-up also when carcinoma characteristics were favorable and some cases were microcarcinomas. GD and non-GD patient comparison in the cases without risk factors at diagnosis showed an increased risk to develop metastases in GD during follow-up, suggesting that GD alone might be a tumor aggressiveness predictive factor in these cases.
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Affiliation(s)
- Andrea Marongiu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Susanna Nuvoli
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Maria Rondini
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
- Correspondence:
| | - Giuseppe Madeddu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
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2
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You E, Mascarella MA, Al Jassim A, Forest VI, Hier MP, Tamilia M, Pusztaszeri M, Payne RJ. Prevalence and aggressiveness of papillary thyroid carcinoma in surgically-treated graves' disease patients: a retrospective matched cohort study. J Otolaryngol Head Neck Surg 2019; 48:40. [PMID: 31462328 PMCID: PMC6714443 DOI: 10.1186/s40463-019-0364-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Reported rates of thyroid cancer in Graves’ disease (GD) vary widely. The aim of this study was to evaluate the prevalence of papillary thyroid carcinoma (PTC), including aggressive forms, in GD compared to matched controls undergoing thyroidectomy. Furthermore, it seeks to elucidate any patient- or tumour-associated factors predictive of malignancy or an aggressive course. Methods We performed a matched cohort study of GD patients undergoing thyroidectomy at our institution between 2006 to 2018. Clinicodemographic factors, preoperative characteristics, surgical factors, final histopathology as well postoperative course were collected. Aggressive PTC was defined as evidence of lymph node metastasis, extrathyroidal extension, gross vascular invasion and/or aggressive histologic variants. Prevalence of PTC was compared with sex, age and nodule size-matched euthyroid patients that underwent thyroidectomy in the same time period. Results A total of 132 patients were included in the study with a mean age of 46 (±14) years. Malignancy was identified in 36/66 (55%) patients with GD; 20/66 (30%) were incidental carcinomas and 9/66 (14%) were associated with aggressive pathologic features. In the aggressive group, lymph node metastasis to the central compartment was present in 8 (12%) cases, extrathyroidal extension in 4 (6%) cases and one (1.5%) patient had a diffuse sclerosing tumor variant. No significant differences in outcome were found between the two groups. GD patients were more likely to have incidental carcinomas (p = 0.035). Adjusting for baseline patient characteristics, GD patients demonstrated an increased likelihood of harbouring a malignancy (odds ratio (OR) = 2.67; 95% confidence interval (CI) 1.00–7.18) compared to controls. Conclusion More than half of patients with GD undergoing thyroidectomy had concurrent thyroid malignancy with aggressive features present in 14% of patients. GD may confer a heightened risk of thyroid cancer; thyroid nodules should therefore be carefully investigated.
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Affiliation(s)
- Eunice You
- McGill University, Montreal, Quebec, Canada
| | - Marco A Mascarella
- McGill Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,McGill Department of Epidemiology, Biostatistics and Occupational Health, Montreal, Quebec, Canada
| | - Abrar Al Jassim
- McGill University, Montreal, Quebec, Canada.,Western Otolaryngology - Head and Neck Surgery, London, Ontario, Canada
| | - Veronique-Isabelle Forest
- McGill University, Montreal, Quebec, Canada.,McGill Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Michael P Hier
- McGill University, Montreal, Quebec, Canada.,McGill Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Michael Tamilia
- McGill University, Montreal, Quebec, Canada.,Division of Endocrinology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Marc Pusztaszeri
- McGill University, Montreal, Quebec, Canada.,Department of Pathology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Richard J Payne
- McGill University, Montreal, Quebec, Canada. .,McGill Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.
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3
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Mekraksakit P, Rattanawong P, Karnchanasorn R, Kanitsoraphan C, Leelaviwat N, Poonsombudlert K, Kewcharoen J, Dejhansathit S, Samoa R. PROGNOSIS OF DIFFERENTIATED THYROID CARCINOMA IN PATIENTS WITH GRAVES DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS. Endocr Pract 2019; 25:1323-1337. [PMID: 31412224 DOI: 10.4158/ep-2019-0201] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective: It is still controversial whether differentiated thyroid carcinoma (DTC) in patients with Graves disease (GD) can be more aggressive than non-Graves DTC. We conducted a systematic review and meta-analysis to examine the association between GD and prognosis in patients with DTC. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to March 2019. We included published studies that compared the risk of mortality and prognosis between DTC patients with GD and those with non-GD. Data from each study were combined using the random-effects model. Results: Twenty-five studies from February 1988 to May 2018 were included (987 DTC patients with GD and 2,064 non-Graves DTC patients). The DTC patients with GD had a significantly higher risk of associated multifocality/multicentricity (odds ratio, 1.45; 95% confidence interval, 1.04 to 2.02; I2, 6.5%; P = .381) and distant metastasis at the time of cancer diagnosis (odds ratio, 2.19; 95% confidence interval, 1.08 to 4.47; I2, 0.0%; P = .497), but this was not associated with DTC-related mortality and recurrence/persistence during follow-up. Conclusion: Our meta-analysis demonstrates a statistically significant increased risk of multifocality/multicentricity and distant metastasis at the time of cancer diagnosis in DTC patients with GD than those without GD. Abbreviations: CI = confidence interval; DTC = differentiated thyroid carcinoma; GD = Graves disease; LN = lymph node; OR = odds ratio; PTC = papillary thyroid carcinoma; TC = thyroid carcinoma; TSAb = thyroid-stimulating antibody; TSH = thyroid-stimulating hormone.
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4
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Christakis I, Dimas S, Kafetzis ID, Roukounakis N. Risk stratification of 282 differentiated thyroid cancers found incidentally in 1369 total thyroidectomies according to the 2015 ATA guidelines; implications for management and treatment. Ann R Coll Surg Engl 2018; 100:357-365. [PMID: 29484944 PMCID: PMC5956592 DOI: 10.1308/rcsann.2018.0017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2017] [Indexed: 12/19/2022] Open
Abstract
Introduction The purpose of this study was to evaluate the incidence of incidental differentiated thyroid carcinoma in thyroid operations for a benign preoperative diagnosis, to identify the risk factors involved and to risk stratify the cancer patients according to the 2015 American Thyroid Association (ATA) guidelines. Materials and methods The study was a retrospective review of all thyroidectomy operations performed in a single institution (January 2004 to January 2009). We excluded patients with a preoperative diagnosis of thyroid malignancy. Results Incidental differentiated thyroid carcinoma was diagnosed in 282/1369 patients (21%). The incidental group had a significantly higher number of males (19% vs 14%, P = 0.033) and a higher number of patients with histopathological evidence of thyroiditis (35% vs 25%, P = 0.004). There was a higher number of lymph nodes present in the incidental group but numbers did not reach statistical significance (17% vs 13%, P = 0.079). There were 270 cases in the ATA low-risk group (96%) and 12 cases in the ATA intermediate-risk group (4%). Patients with an ATA intermediate risk had a statistically higher number of capsule invasion, extrathyroidal extension and angioinvasion (P < 0.001, P < 0.001 and P < 0.001, respectively). Overall, 22% of patients with an incidental differentiated thyroid carcinoma should be considered for radioactive iodine 131I treatment. 29 of the 191 patients in American Joint Committee on Cancer stage I should be considered for radioactive iodine treatment (15%). Conclusions Males and patients with thyroiditis are at a higher risk for an incidental differentiated thyroid carcinoma. One of every five of patients diagnosed with cancer will need radioactive iodine treatment, even some patients with stage I disease.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/epidemiology
- Adenocarcinoma, Follicular/surgery
- Adenocarcinoma, Follicular/therapy
- Adenoma, Oxyphilic/diagnosis
- Adenoma, Oxyphilic/epidemiology
- Adenoma, Oxyphilic/surgery
- Adenoma, Oxyphilic/therapy
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Carcinoma/diagnosis
- Carcinoma/epidemiology
- Carcinoma/surgery
- Carcinoma/therapy
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/epidemiology
- Carcinoma, Papillary/surgery
- Carcinoma, Papillary/therapy
- Female
- Humans
- Incidence
- Incidental Findings
- Male
- Middle Aged
- Neoplasm Invasiveness
- Practice Guidelines as Topic
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Thyroid Cancer, Papillary
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/epidemiology
- Thyroid Neoplasms/surgery
- Thyroid Neoplasms/therapy
- Thyroidectomy
- Young Adult
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Affiliation(s)
- I Christakis
- Department of Endocrine Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Dimas
- Department of Endocrine Surgery, Mediterraneo Hospital, Athens, Greece
| | - ID Kafetzis
- Department of Endocrine Surgery, Errikos Dunant Hospital Center, Athens, Greece
| | - N Roukounakis
- First Department of General Surgery and Transplantation, ‘Evangelismos‘ General Hospital, Athens, Greece
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5
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Ren M, Wu MC, Shang CZ, Wang XY, Zhang JL, Cheng H, Xu MT, Yan L. Predictive Factors of Thyroid Cancer in Patients with Graves’ Disease. World J Surg 2013; 38:80-7. [DOI: 10.1007/s00268-013-2287-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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6
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Abstract
Thyroid cancer with concomitant hyperthyroidism is rare. Most foci of malignancy are small and seen postoperatively as incidental findings after surgery for hyperthyroidism. Thyroid masses with clinical features of malignancy and concomitant hyperthyroidism are less-commonly reported. We report two cases of multinodular toxic goitre or Plummer's disease with clinical features of malignancy. Both patients had large multinodular goitres with evidence of metastasis to the manubrium for the first patient and to the lymph node and lungs for the second patient. Both were clinically euthyroid but with free hormone excess and suppressed thyroid stimulating hormone (TSH) on laboratory testing. Both patients received methimazole prior to thyroidectomy. Histopathology revealed follicular variant of papillary cancer with metastasis to the manubrium for the first patient and follicular thyroid cancer with lymph node metastasis for the second. While rare, thyrotoxicosis can occur with malignancy, Plummer's disease may harbour cancer and behave aggressively.
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Affiliation(s)
- Queenie Guinto Ngalob
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines.
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7
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Kuo SF, Lin SF, Chao TC, Hsueh C, Lin KJ, Lin JD. Prognosis of multifocal papillary thyroid carcinoma. Int J Endocrinol 2013; 2013:809382. [PMID: 24489543 PMCID: PMC3892555 DOI: 10.1155/2013/809382] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/09/2013] [Accepted: 12/11/2013] [Indexed: 01/06/2023] Open
Abstract
This study was to investigate the clinical features and therapeutic outcomes of multifocal papillary thyroid microcarcinoma (PTMC). A total of 2,418 papillary thyroid carcinoma (PTC) patients had undergone thyroidectomy in one medical center between 1977 and 2010. There were 483 (20.0%) diagnosed with multifocal PTC. The percentage of multifocal PTC was higher in PTMC patients (22.0%) than in non-PTMC patients (19.5%). Demographic and clinical characteristics of PTMC and multifocal PTC in PTC patients were traced. Multifocal PTC patients presented with smaller tumors at an older age, and a higher percentage underwent total or complete thyroidectomy. These patients also showed a higher incidence of postoperative disease progression than did unifocal PTC patients. Comparison of 483 patients with multifocal PTMC and non-PTMC tumors showed a higher incidence of postoperative disease progression in patients with non-PTMC; otherwise, there was no statistical difference in disease-specific and total mortality between these two groups. In conclusion, the incidence of multifocal PTMC was not lower than that of non-PTMC, and postoperative therapies were necessary for both multifocal PTMC and non-PTMC patients.
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Affiliation(s)
- Sheng-Fong Kuo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Shu-Fu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Tzu-Chieh Chao
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Chuen Hsueh
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Kun-Ju Lin
- Department of Nuclear Medicine; Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Jen-Der Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
- *Jen-Der Lin:
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8
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Affiliation(s)
- C. Gopalakrishnan Nair
- Department of Surgery, Surgical Endocrinology Division, Amrita School of Medicine, Kochi, Kerala, India
| | - Pradeep Jacob
- Department of Surgery, Surgical Endocrinology Division, Amrita School of Medicine, Kochi, Kerala, India
| | - Misha Babu
- Department of Surgery, Surgical Endocrinology Division, Amrita School of Medicine, Kochi, Kerala, India
| | - Riju Menon
- Department of Surgery, Surgical Endocrinology Division, Amrita School of Medicine, Kochi, Kerala, India
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9
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Rosário PW, Salles DS, Bessa B, Purisch S. Contribution of scintigraphy and ultrasonography to the prediction of malignancy in thyroid nodules with indeterminate cytology. ACTA ACUST UNITED AC 2010; 54:56-9. [PMID: 20414549 DOI: 10.1590/s0004-27302010000100010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Accepted: 10/16/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the contribution of (131)I scintigraphy and ultrasonography to the prediction of malignancy in thyroid nodules with indeterminate cytology in euthyroid patients. SUBJECTS AND METHODS The sample consisted of 102 patients with thyroid nodules, submitted to FNAC and presenting an indeterminate cytological diagnosis (follicular neoplasm). RESULTS Malignancy was observed in 19/25 (76%) nodules with suspicious ultrasonographic characteristics versus 5/77 (6.5%) without suspicious findings. When (131)I scintigraphy showed a cold or hot nodule, the chance of malignancy was 38.5% and 2.5%, respectively. This exam was inconclusive in 10% of the patients. CONCLUSIONS Surgery is indicated when a thyroid nodule with indeterminate cytology exhibits suspicious ultrasonographic characteristics. Otherwise, (131)I scintigraphy can exclude thyroidectomy when reveals uptake in the nodule, which is observed in half the cases.
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Affiliation(s)
- Pedro Weslley Rosário
- Programa de Pós-graduação, Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brasil.
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10
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Azevedo MF, Casulari LA. Hyperfunctioning thyroid cancer: a five-year follow-up. ACTA ACUST UNITED AC 2010; 54:78-80. [PMID: 20414552 DOI: 10.1590/s0004-27302010000100013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 10/16/2009] [Indexed: 11/22/2022]
Abstract
Differentiated thyroid cancer rarely occurs in association with hyperfunctioning nodules. We describe a case of a 47-year-old woman who developed symptoms of hyperthyroidism associated with a palpable thyroid nodule. Thyroid scintigraphy showed an autonomous nodule, and fine-needle aspiration biopsy was suggestive of papillary carcinoma. Laboratorial findings were consistent with the diagnosis of hyperthyroidism. The patient underwent thyroidectomy and a papillary carcinoma of 3.0 x 3.0 x 2.0 cm, follicular variant, was described by histological examination. The surrounding thyroid tissue was normal. Postoperatively, the patient received 100 mCi of (131)I, and whole body scans detected only residual uptake. No evidence of metastasis was detected during five years of follow-up. Hot thyroid nodules rarely harbor malignancies, and this case illustrated that, when a carcinoma occurs the prognosis seems to be very good with no evidence of metastatic dissemination during a long-term follow-up.
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11
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12
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Tfayli HM, Teot LA, Indyk JA, Witchel SF. Papillary thyroid carcinoma in an autonomous hyperfunctioning thyroid nodule: case report and review of the literature. Thyroid 2010; 20:1029-32. [PMID: 20718686 PMCID: PMC2933378 DOI: 10.1089/thy.2010.0144] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Whereas thyroid nodules are less common among children than among adults, the anxiety generated by the finding of a thyroid nodule is high because 20% of nodules found in children contain thyroid cancer. Discovery of a nodule in the context of hyperthyroidism is usually comforting due to the presumption that the nodule represents a benign toxic adenoma. SUMMARY An 11-year-old girl presented with heavy menses, fatigue, and a right thyroid mass. Laboratory evaluation revealed elevated triiodothyronine and undetectable thyroid-stimulating hormone. Thyroid ultrasonography revealed a 3.5 cm nonhomogenous nodule, and scintigraphy was consistent with an autonomous hyper-functioning nodule. Fine-needle aspiration biopsy could not rule out malignancy, and patient underwent right hemithyroidectomy and isthmusectomy. Pathology was consistent with papillary thyroid carcinoma. CONCLUSIONS We report the discovery of papillary thyroid carcinoma in an autonomously hyperfunctioning nodule in an 11-year-old girl. Detection of an autonomously functioning thyroid nodule in children and adolescents does not exclude the possibility of thyroid carcinoma and warrants careful evaluation and appropriate therapy.
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Affiliation(s)
- Hala M. Tfayli
- Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Lisa A. Teot
- Division of Pathology, Children's Hospital, Boston, Massachusetts
| | - Justin A. Indyk
- Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Selma Feldman Witchel
- Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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13
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Hyperfunctioning solid/trabecular follicular carcinoma of the thyroid gland. JOURNAL OF ONCOLOGY 2010; 2010. [PMID: 20847957 PMCID: PMC2935180 DOI: 10.1155/2010/635984] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 05/14/2010] [Accepted: 06/17/2010] [Indexed: 11/23/2022]
Abstract
A 68-year-old woman with solid/trabecular follicular thyroid carcinoma inside of an autonomously functioning thyroid nodule is described in this paper. The patient was referred to our clinic for swelling of the neck and an increased pulse rate. Ultrasonography showed a slightly hypoechoic nodule in the right lobe of the thyroid. Despite suppressed TSH levels, the 99mTc-pertechnetate scan showed a hot area corresponding to the nodule with a suppressed uptake in the remaining thyroid tissue. Histopathological examination of the nodule revealed a solid/trabecular follicular thyroid carcinoma. To the best of our knowledge, this is the first case of hyperfunctioning follicular solid/trabecular carcinoma reported in the literature. Even if a hyperfunctioning thyroid carcinoma is an extremely rare malignancy, careful management is recommended so that a malignancy will not be overlooked in the hot thyroid nodules.
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14
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Concomitant Hyperthyroidism in Patients With Thyroid Carcinoma and the Effects of Iodine Supplementation in an Iodine-Deficient Area. Clin Nucl Med 2008; 33:769-72. [DOI: 10.1097/rlu.0b013e318187eeb2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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SHAIKH IA, MUTHUKUMARSAMY G, VIDYADHARAN R, ABRAHAM SJ. High incidence of thyroid cancer in toxic multinodular goiters. Asia Pac J Clin Oncol 2007. [DOI: 10.1111/j.1743-7563.2007.00108.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Erbil Y, Barbaros U, Ozbey N, Kapran Y, Tükenmez M, Bozbora A, Ozarmağan S. Graves' disease, with and without nodules, and the risk of thyroid carcinoma. The Journal of Laryngology & Otology 2007; 122:291-5. [PMID: 17697433 DOI: 10.1017/s0022215107000448] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:Thyroid nodules are frequently present in Graves' disease. The aim of this study was to evaluate the risk of thyroid carcinoma in Graves' disease patients, with and without ultrasonographically identified nodules, who subsequently underwent surgical treatment.Design:The study group included 150 consecutive patients with diagnosed Graves' disease who subsequently underwent surgery.Subjects:The patients were divided into two groups according to whether the pre-operative ultrasound scan showed diffuse parenchyma (group one; n = 70) or nodules (group two; n = 80).Results:Of the 150 patients, 18 (12 per cent) were found to have papillary thyroid carcinoma. Papillary carcinoma was found in seven patients (10 per cent) in group one and in 11 patients (1.7 per cent) in group two. After evaluating the overall groups, the incidence of carcinoma in the parenchyma outside a nodule was 67 per cent, whereas the incidence of carcinoma in a nodule was 33 per cent.Conclusion:Carcinoma can occur in Graves' disease patients without nodules, and the absence of nodules on ultrasonographic examination does not reduce the risk of malignancy.
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Affiliation(s)
- Y Erbil
- Department of General Surgery, Istanbul Medical Faculty, Istanbul University, Turkey.
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17
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Pucci A, Suppo M, Lucchesi G, Celeste A, Viberti L, Pellerito R, Papotti M. Papillary thyroid carcinoma presenting as a solitary soft tissue arm metastasis in an elderly hyperthyroid patient. Case report and review of the literature. Virchows Arch 2006; 448:857-61. [PMID: 16568308 DOI: 10.1007/s00428-006-0187-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Accepted: 03/06/2006] [Indexed: 11/30/2022]
Abstract
A case of papillary thyroid carcinoma (PTC) presenting as a solitary metastasis in the right arm muscle is described in an elderly hyperthyroid male patient. A 2-cm nodule in the right bycipites muscle was found to be a papillary carcinoma of thyroid origin and a primary, 3.5-cm tumor was subsequently found in the left lobe of a hyperfunctioning gland due to toxic goiter. Both tumors were well differentiated PTC, follicular variant. No high grade features, nor extrathyroidal spread, nor regional lymph node metastases were found, but histology evidenced intrathyroidal vascular invasion. After radical surgery and radioiodine therapy, the patient is currently disease-free 4 years after diagnosis. This is the third reported case of PTC manifesting as a single soft tissue metastasis and the first associated with hyperthyroidism. Hematogenous spread of differentiated PTC is rare, although less unusual in PTC follicular variant. Histological vascular invasion, hypervascularity and increased blood flow in the hyperfunctioning thyroid gland might have facilitated the dissemination of malignant tumor cells through the bloodstream. Literature data indicate that PTC in elderly patients is increasing and is often clinically aggressive. Radical surgical and radiometabolic treatments are required also in this age group to improve clinical outcome.
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Affiliation(s)
- Angela Pucci
- Division of Pathology of Regina Margherita Hospital, Torino, Italy.
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18
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Kikuchi S, Noguchi S, Yamashita H, Uchino S, Kawamoto H. Prognosis of small thyroid cancer in patients with Graves' disease. Br J Surg 2006; 93:434-9. [PMID: 16523447 DOI: 10.1002/bjs.5279] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
Background
To find the best ways to follow up patients with small thyroid cancer (STC; 1 cm or less in diameter) and concomitant Graves' disease, this study examined whether such patients had the same excellent prognosis as those with STC without Graves' disease.
Methods
Between 1970 and 1996, 2199 patients were diagnosed as having STC by pathology after thyroidectomy. Of those, 509 patients (33 males and 476 females, mean age 43·5 years) underwent thyroidectomy for Graves' disease. Control patients with STC without Graves' disease were matched for age, sex, treatment year and tumour size (33 males and 476 females, mean age 44·0 years).
Results
Patients with STC and Graves' disease had a longer disease-free survival than those with STC alone (99 and 93 per cent at 20 years' follow-up, respectively; P < 0·001). The Cox's proportional hazard analysis showed that concomitant Graves' disease and age at surgery are more significant factors for predicting disease-free survival than surgical procedures.
Conclusion
Patients who undergo thyroidectomy for Graves' disease and are found to have STC have an excellent prognosis and longer disease-free survival than patients with STC alone.
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Affiliation(s)
- S Kikuchi
- Japanese Self Defense Force Hanshin Hospital, Hyogo, Japan
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Majima T, Komatsu Y, Doi K, Shigemoto M, Takagi C, Fukao A, Kojima M, Tamaki H, Ito J, Nakao K. Anaplastic thyroid carcinoma associated with Graves' disease. Endocr J 2005; 52:551-7. [PMID: 16284432 DOI: 10.1507/endocrj.52.551] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This report concerns a 79-year-old woman with coexisting anaplastic thyroid carcinoma (ATC) and Graves' disease (GD). The patient was referred to our clinic because of palpitation and a palpable mass on the left side of her neck. Thyroid function tests showed hyperthyroidism with elevated thyroid-stimulating antibodies. Ultrasonography of the thyroid demonstrated an adenomatous nodule-like marcated nodule (27.6 x 26.5 x 36.4 mm) with cystic degeneration inside the left lobe. (123)I thyroid scintigraphic imaging showed a cold area corresponding to the nodule with continuous uptake in the remaining thyroid tissue despite suppressed TSH levels. These findings led to a diagnosis of GD. On the other hand, the thyroid nodule could not be definitely diagnosed even after fine needle aspiration biopsy (FNAB) which produced findings suggestive of both papillary thyroid carcinoma and ATC. Open biopsy of the nodule showed an ATC. Regional lymph node metastases as well as multiple lung metastases, which could not be found at the initial visit, had been already developed by that time. Our case is pathophysiologically interesting because it suggests that GD or thyroid-stimulating antibodies (TSAb) may stimulate malignant transformation of differentiated carcinoma. It is also clinically important because it indicates that all thyroid nodules, particularly palpable cold nodules, associated with GD require careful management to detect malignancy because they are at higher risk of harboring malignancy.
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Affiliation(s)
- Takafumi Majima
- Department of Endocrinology and Metabolism, Rakuwakai Otowa Hospital, Kyoto, Japan
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Majima T, Doi K, Komatsu Y, Itoh H, Fukao A, Shigemoto M, Takagi C, Corners J, Mizuta N, Kato R, Nakao K. Papillary thyroid carcinoma without metastases manifesting as an autonomously functioning thyroid nodule. Endocr J 2005; 52:309-16. [PMID: 16006725 DOI: 10.1507/endocrj.52.309] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 59-year-old woman with papillary thyroid carcinoma inside of an autonomously functioning thyroid nodule is described in this report. The patient was referred to our clinic because of rapid weight loss and swelling on the left side of the neck. Ultrasonography of the thyroid demonstrated a nonhomogeneous nodule in the lower part of an enlarged left lobe. Both 99mTc and 123I thyroid scintigraphic imaging showed a hot area corresponding to the nodule with lower uptake in the remaining thyroid tissue. Histopathological examination of the nodule revealed papillary adenocarcinoma, and the immunohistochemistry proved weak but positive staining for triiodothyronine and thyroxine. Based on these findings, the nodule was diagnosed as a functioning papillary adenocarcinoma. Although thyroid carcinoma manifesting as a hot nodule on the radionuclide isotope scan is an extremely rare occurrence, the current case is clinically important because it suggests that the diagnosis of a hot nodule cannot always rule out thyroid carcinoma in the nodule, and that even a hot nodule requires careful management so that the malignancy is not overlooked.
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Affiliation(s)
- Takafumi Majima
- Department of Endocrinology and Metabolism, Rakuwakai Otowa Hospital, Kyoto, Japan
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Chao TC, Lin JD, Chen MF. Surgical Treatment of Thyroid Cancers With Concurrent Graves Disease. Ann Surg Oncol 2004; 11:407-12. [PMID: 15070601 DOI: 10.1245/aso.2004.06.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Thyroid cancers with concurrent Graves disease are relatively rare. Accordingly, the natural history and optimal surgical treatment of thyroid cancers with Graves disease are controversial. METHODS Sixty-one thyroid cancers with concurrent Graves disease were retrospectively reviewed. Histopathologic diagnoses included 58 papillary thyroid carcinomas (95.1%), 1 follicular carcinoma (1.6%), 1 medullary carcinoma (1.6%), and 1 Hürthle cell carcinoma (1.6%). RESULTS The sample included 54 females and seven males. Subjects' ages ranged from 20 to 73 years (mean +/- SD, 35.9 +/- 10.6 years; median, 37 years). Average tumor size was 10.7 +/- 15.9 mm (range, 1-70 mm). Forty-nine tumors (80.3%) were 10 mm or smaller. Surgical procedures included subtotal thyroidectomy (40 patients), total thyroidectomy (16 patients), total thyroidectomy plus neck dissection (2 patients), near-total thyroidectomy (1 patient), and lobectomy with contralateral subtotal lobectomy (1 patient). Thirty-seven patients (60.7%) underwent postoperative 131I ablation for thyroid remnant. Neck lymph node metastases occurred in three patients and lung metastases in two patients. Patients who developed metastases were younger and had significantly larger tumors and higher pretreatment serum T3 level than those who did not develop metastases. No deaths occurred during the 6.2 +/- 4.1 year follow-up period (range, 1 year and 2 months to 18 years and 11 months). CONCLUSIONS Most thyroid cancers with concurrent Graves disease were 10 mm or smaller. Subtotal thyroidectomy is adequate for patients with Graves disease with concurrent carcinoma 10 mm or smaller.
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Affiliation(s)
- Tzu-Chieh Chao
- Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Lin CH, Chiang FY, Wang LF. Prevalence of thyroid cancer in hyperthyroidism treated by surgery. Kaohsiung J Med Sci 2003; 19:379-84. [PMID: 12962424 DOI: 10.1016/s1607-551x(09)70480-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The reported prevalence of thyroid cancer with concurrent hyperthyroidism varies from 0.21% to 9.0%. This variability may be due to multiple factors, such as indications for surgery and histopathologic accuracy. However, this condition is not rare and its prevalence has increased in recent surveys, perhaps as a result of more detailed examinations. The aim of this retrospective study was to determine the prevalence of thyroid cancer in hyperthyroid patients at surgery. Forty-five patients, 34 women and 11 men, underwent surgery for hyperthyroidism in our department between 1989 and 2000. Ages ranged from 14 to 67 years. There were 42 cases of Graves' disease, one of functional multinodular goiter, and two of single toxic nodules. Forty-three patients underwent total thyroidectomy and two underwent total lobectomy. Six cases (13.3%) of thyroid cancer were found, two men and four women with ages ranging from 19 to 48 years. Final histologic examination revealed three papillary carcinomas, one follicular carcinoma, one follicular carcinoma combined with clear-cell carcinoma, and one clear-cell carcinoma. Thus, in our department, the prevalence of thyroid cancer in hyperthyroidism treated using surgery was 13.3%. Our study showed that even a single toxic nodule may occur with concurrent thyroid cancer. Careful evaluation of such patients is needed to exclude the presence of associated malignancy and to determine the most appropriate therapeutic plan.
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Affiliation(s)
- Chih-Hsin Lin
- Department of Otorhinolaryngology, Kaohsiung Medical University, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan.
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Bitton RN, Sachmechi I, Tabriz MS, Murphy L, Wasserman P. Papillary carcinoma of the thyroid with manifestations resembling Graves' disease. Endocr Pract 2001; 7:106-9. [PMID: 11421555 DOI: 10.4158/ep.7.2.106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe a case of papillary carcinoma of the thyroid that mimicked a diffuse toxic goiter. METHODS We present a detailed case report, review related cases in the literature, and discuss the possible role of autoantibodies in promoting the growth of papillary thyroid tumor. RESULTS A 28-year-old woman had a 6-month history of weight loss, palpitations, increased anxiety, and enlargement of her thyroid gland. Laboratory studies confirmed the presence of hyperthyroidism. A 1-cm nodule was identified at the left upper pole of the thyroid. Fine-needle aspiration biopsy of this nodule revealed papillary carcinoma of the thyroid. Total thyroidectomy and a modified radical neck dissection were performed. Microscopic examination showed that the entire gland was replaced by a papillary carcinoma with a predominantly follicular pattern of growth. Of 44 lymph nodes tested, 31 were positive for metastatic papillary thyroid carcinoma. The presence of thyroid antibodies may have had a role in the aggressiveness of the patient's disease. CONCLUSION To our knowledge, this is the first published report of a papillary thyroid cancer with manifestations resembling Graves' disease.
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Affiliation(s)
- R N Bitton
- Department of Medicine, Division of Endocrinology and Metabolism, Long Island Jewish Medical Center, New Hyde Park, New York, USA
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