1. DTC was 8,5 times more often in the normothyroid group
Hyperthyroidism and differentiated thyroid cancer ( A prospective clinical study)
Dimitrios Askitis1, Eleni Eufraimidou1, Michael Karanikas1, Alexandros Mitrakas1, Grigorios Tripsianis1, Alexandros Polixronidis1, Nikolaos Liratzopoulos1 1 1st Department of Surgery, University General Hospital of Alexandroupolis,Greece
INTRODUCTION
The benign thyroid disorders which are characterised of the manifestation of hyperthyroidism can be cured operatively after an unsuccesful therapy with antithyroid drugs or ablation with I131.These disorders are:
Graves disease
Toxic multinodular goiter or Plummer’s disease (TMG)
Toxic adenoma
Many clinical studies worlwide have shown a relationship between Graves disease and the possibility of development of thyroid cancer, mainly of papilary carcinoma1-3 – the activity of TSIAbs could be a possible mechanism4.
The solitary hyperfunctioning “warm” nodule (toxic adenoma) is rarely malignant.
RESULTS
In 42 people with hyperthyroidism we found 1 man with Graves disease and papillary Ca.The patients with toxic adenoma and Plummer‘s disease had no malignancies. This patient constitutes a 10% of Basedow patients and a 2,4% of all the patients with functioning thyroid disorders.
In the group of 186 patients with non-functioning disorders we found 32 people with Ca,17,2 % of the total.
Analytically:
Diagnosis Number Ca %
Solitary nodule ,4
NMG ,8
AIM
HYPERTHYROIDS
The aim of our study was to identify the possibility of thyroid cancer development in patients with hyperthyroidism in comparison to patients without functioning thyroid disorders and to examine if hyperthyroidism is a positive or negative factor for the appearance of thyroid malignancy.
MATERIAL-METHODS
Between patients (182 females / 46 males ) underwent total thyroidectomy because of a variety of thyroid disorders.
42 individuals had hyperthyroidism,18,4% and 186 or 81,6% non functioning thyroid disorders
Figure: p=0,014, odds ratio 8,5, 95% ci 1,1-64,2
Preoperative diagnosis of hyperthyroid patients
Disorder Number % Graves disease ,8 Toxic adenoma ,3 Plummer’s disease ,9
Preoperative diagnosis of normothyroid patients
Diagnosis Number %
Solitary nodule ,3 NMG ,7
DTC was 8,5 times more often in the normothyroid group
CONCLUSIONS
In the material of our clinic the presence of hyperthyroidism possibly reduces significantly the potential of thyroid cancer appearance in comparison to normal multinodular goiter and non-functioning solitary nodule.Further analytic studies are required in order to establish a possible relationship between hyperthyroidism and reduced thyroid cancer prevalence.
REFERENCES: 1.Belfiore, A, Garofalo, M, Giuffrida, D, et al Increased aggressiveness of thyroid cancer in patients with Graves’ disease. J Clin Endocrinol Metab 70:830
2. Pellegriti, G, Belfiore, A, Giuffrida, D, Lupo, L, Vigneri, R Outcome of differentiated thyroid cancer in Graves’ patients. J Clin Endocrinol Metab 83:2805
3. Shapiro, S, Friedman, N, Perzik, S, Catz, B Incidence of thyroid carcinoma in Graves’ disease. Cancer 26:1261
4.Filetti, S, Belfiore, A, Amir, S, et al The role of thyroid-stimulating antibodies of Graves’ disease in differentiated thyroid cancer. N Engl J Med 318:753
All patients in normothyroid state underwent total thyroidectomy. The surgical specimens were analysed histologically,the histologic findings were compared and the prevalence rates of thyroid cancer in hyperthyroids and normothyroids were calculated.