1. Coexistence of chronic lymphocytic thyroiditis and well-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 Hospital of Alexandroupolis,Greece
INTRODUCTION
RESULTS
CLT+Ca
CLT
Thyroid cancer constitutes the 90% of the endocrine system cancers and 1% of all malignant tumors. The rate between
women and men is 2-3: 1.
Classification and frequency of thyroid malignant tumors:
Well-differentiated or DTC:
Papillary % Decade
Follicular % Decade
Medullary % Decade
Anaplastic % Decade
Other * 1%
*lymphoma, inosarkoma, malignant endothelioma, teratoma, metastases from other organs
Etiology of DTC :
1.Radiation of the head and collum for a variety of illnesses,mainly at child- and adolescent age
2. Iodine deficiency
3. Gene mutations-activation of oncogenes or loss of the function of genes,which inhibit the activity of oncogenes.
On the other hand the chronic lymphocytic thyroiditis (CLT) is
the most usual autoimmune thyroid disorder and main cause of hypothyroidism in children and adults.
Women /men rate 7:1
Many international clinical studies have shown a connection between chronic lymphocytic thyroiditis and well differentiated thyroid cancer in a 2-4%1-3.
Of the 228 patients 56 or 24,6% had elements of chronic lymphocytic thyroiditis and on the contrary 172 or 75,4% presented without lymphocytic infiltrations. Average age 49 years with Hashimoto and 50 years without CLT (p = 0,758) Ca
Without CLT
Figure 2: Comparison of Ca existence in appearance and non-appearance of CLT-p= 0,477, odd ratio 1,4 , 95% ci 0,6-3,6
In a population of 31 patients with DTC there were 6 people or 19,3% with coincident appearance of Hashimoto thyroiditis elements.
Respectively in the group of 195 people without Ca (average age 50 years) the prevalence of CLT (50 patients) was 25,6%.
Figure 1: Rate between patients with and without elements of Hashimoto thyroiditis
Histological analysis for malignancy
Ca TYPE NUMBER PERCENTAGE
DTC ,6%
Medullary ,4%
Αnaplastic ,4%
Without Ca ,6%
AIM
The aim of our study was to investigate the hypothesis that Hashimoto thyroiditis could increase the possibility of thyroid cancer development by examining the connection between DTC and Hashimoto thyroiditis.
CLT
Without Ca
Ca + CLT Ca
Figure 3: Comparison of CLT existence with DTC and with benignancy-p= 0,451, odds ratio 1,4, 95% ci 0,6-3,7 There was no statistically significant difference in accordance with the age (p= 0,677)
MATERIAL-METHODS
At the Hashimoto specimens we found 6 ( 5 females /1 male) with coexistence of well differentiated thyroid cancer,10,7% from all the patients who were diagnosed with Hashimoto. Respectively in 172 patients without CLT we found 25 people with DTC,14,5% and average age 47 years (p= 0,25 as far as the age between the groups Ca+CLT and only Ca is concerned).
CONCLUSIONS
More clinical studies are required to establish the relationship – if it exists- of the 2 disorders. Because of the results we conclude that it is essential to examine carefully and with details clinically and biochemically the patients, mainly the females , with Hashimoto thyroiditis because of the future posibility of manifestating thyroid cancer.
Between patients (182 women / 46 men - 79,8% / 20,2%) underwent total thyroidectomy because of functioning and non-functioning thyroid disorders. The thyroid specimens were histologically analyzed and we examined the coexistence of chronic lymphocytic thyroiditis and thyroid cancer.
REFERENCES:
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2.Costanzo M, Caruso LA, Testa R, Marziani A, Cannizzaro MA, 2006 Hashimoto thyroiditis. Possible cause or consequence of a malignant thyroid tumor. Ann Ital Chir 77:
3. Repplinger D, Bargren A, Zhang YW, Adler JT, Haymart M, Chen H, 2008 Is Hashimoto’s thyroiditis a risk factor for papillary thyroid cancer? J Surg Res 150: