Endocr Pathol (2015) 26:48–53 DOI 10.1007/s12022-014-9343-6
Thyroid Carcinoma in Patients with Graves’ Disease: an Institutional Experience Shuanzeng Wei & Zubair W. Baloch & Virginia A. LiVolsi
Published online: 21 October 2014 # Springer Science+Business Media New York 2014
Abstract Graves’ disease (GD) is an autoimmune disorder characterized by diffuse hyperplasia and excessive production of thyroid hormone. The association between thyroid carcinoma and GD is controversial. The prevalence of thyroid carcinoma was investigated in patients with GD who underwent thyroidectomy for thyroid nodular lesions or GD from 1994 to 2013 at our institution. Three hundred and forty-seven patients were placed into two groups: Graves’ disease with nodular lesions group (group GN) included 85 patients who had thyroidectomy for nodular lesion, and Graves’ disease group (group G) included 262 patients who had thyroidectomy for hyperthyroidism. There were 59 patients with thyroid carcinomas in the 85 patients (69 %) of group GN, including 3 follicular carcinomas (5 %), 1 poorly differentiated carcinoma (2 %), and 55 papillary thyroid carcinomas (93 %). Among the 55 papillary thyroid carcinomas, 19 cases were papillary thyroid microcarcinomas (34 %); and 5 cases of tall cell variant (9 %) were identified. There were 8 cases with lymph node metastasis (14 %), 6 cases with lymphovascular invasion (10 %), and 12 cases with extrathyroidal invasion (20 %). In addition, 24 carcinomas showed multiple foci of tumor (41 %). In contrast, 51 patients (19 %) of 262 patients in group G had carcinoma, including 2 follicular carcinomas (4 %) and 49 papillary thyroid carcinomas (96 %). In the 49 cases of papillary thyroid carcinomas, 47 cases were microcarcinomas (96 %); and 2 cases of tall cell variant S. Wei (*) : Z. W. Baloch : V. A. LiVolsi Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6th Floor Founders Building, Philadelphia, PA 19104, USA e-mail: [email protected] Z. W. Baloch e-mail: [email protected] V. A. LiVolsi e-mail: [email protected]
(4 %) were found. There were no lymph node metastasis or lymphovascular and extrathyroidal invasion, but 11 cases (22 %) demonstrated multiple carcinoma foci. In conclusion, thyroid nodular lesions in patients with GD should raise a high suspicion of carcinoma, and these lesions are frequently clinically significant tumors. Incidental thyroid carcinomas in patients with GD are not uncommon, but most of them are low-risk papillary thyroid microcarcinoma without lymph node metastasis or lymphovascular and extrathyroidal invasion. Keywords Thyroid carcinoma . Graves’ disease
Introduction Graves’ disease is an autoimmune disorder characterized by diffuse follicular cell hyperplasia and excessive production of thyroid hormone which is stimulated by antithyroidstimulating hormone receptor (TSHR) antibodies [1]. In the USA, Graves’ disease is commonly treated with antithyroid medications and radioiodine. Near-total or total thyroidectomy is the choice for patient who prefers surgery or who were considered unsuitable for medication or radioiodine therapy. Though the classic presentation is diffuse enlargement of the thyroid, it is not uncommon to find nodular lesions in patients with Graves’ disease (GD). Palpable thyroid nodules occur in approximately 15 % of these patients [2]. In the era of ultrasound, thyroid nodules are found in 28.5–53.0 % of cases [3–8]. Nodular lesions in GD would be managed similar to the patients without this disorder, that is, fine-needle aspiration (FNA) of the nodules sonographically suspicious and preferably hypofunctioning nodules. For FNA diagnosis of papillary thyroid carcinoma (PTC) and suspicious for PTC, total thyroidectomy would be performed. For patients with
Endocr Pathol (2015) 26:48–53
follicular lesion/neoplasm, a total or near-total thyroidectomy is also considered because of the accompanying GD. The association between thyroid carcinoma and GD is controversial. In a recent population-based study, Chen found the incidence of thyroid cancer in the GD cohort was 4.92 per 1000 person-years and was 1.37-fold higher than the control cohort (p
Thyroid Carcinoma in Patients with Graves’ Disease: an Institutional Experience Shuanzeng Wei & Zubair W. Baloch & Virginia A. LiVolsi
Published online: 21 October 2014 # Springer Science+Business Media New York 2014
Abstract Graves’ disease (GD) is an autoimmune disorder characterized by diffuse hyperplasia and excessive production of thyroid hormone. The association between thyroid carcinoma and GD is controversial. The prevalence of thyroid carcinoma was investigated in patients with GD who underwent thyroidectomy for thyroid nodular lesions or GD from 1994 to 2013 at our institution. Three hundred and forty-seven patients were placed into two groups: Graves’ disease with nodular lesions group (group GN) included 85 patients who had thyroidectomy for nodular lesion, and Graves’ disease group (group G) included 262 patients who had thyroidectomy for hyperthyroidism. There were 59 patients with thyroid carcinomas in the 85 patients (69 %) of group GN, including 3 follicular carcinomas (5 %), 1 poorly differentiated carcinoma (2 %), and 55 papillary thyroid carcinomas (93 %). Among the 55 papillary thyroid carcinomas, 19 cases were papillary thyroid microcarcinomas (34 %); and 5 cases of tall cell variant (9 %) were identified. There were 8 cases with lymph node metastasis (14 %), 6 cases with lymphovascular invasion (10 %), and 12 cases with extrathyroidal invasion (20 %). In addition, 24 carcinomas showed multiple foci of tumor (41 %). In contrast, 51 patients (19 %) of 262 patients in group G had carcinoma, including 2 follicular carcinomas (4 %) and 49 papillary thyroid carcinomas (96 %). In the 49 cases of papillary thyroid carcinomas, 47 cases were microcarcinomas (96 %); and 2 cases of tall cell variant S. Wei (*) : Z. W. Baloch : V. A. LiVolsi Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6th Floor Founders Building, Philadelphia, PA 19104, USA e-mail: [email protected] Z. W. Baloch e-mail: [email protected] V. A. LiVolsi e-mail: [email protected]
(4 %) were found. There were no lymph node metastasis or lymphovascular and extrathyroidal invasion, but 11 cases (22 %) demonstrated multiple carcinoma foci. In conclusion, thyroid nodular lesions in patients with GD should raise a high suspicion of carcinoma, and these lesions are frequently clinically significant tumors. Incidental thyroid carcinomas in patients with GD are not uncommon, but most of them are low-risk papillary thyroid microcarcinoma without lymph node metastasis or lymphovascular and extrathyroidal invasion. Keywords Thyroid carcinoma . Graves’ disease
Introduction Graves’ disease is an autoimmune disorder characterized by diffuse follicular cell hyperplasia and excessive production of thyroid hormone which is stimulated by antithyroidstimulating hormone receptor (TSHR) antibodies [1]. In the USA, Graves’ disease is commonly treated with antithyroid medications and radioiodine. Near-total or total thyroidectomy is the choice for patient who prefers surgery or who were considered unsuitable for medication or radioiodine therapy. Though the classic presentation is diffuse enlargement of the thyroid, it is not uncommon to find nodular lesions in patients with Graves’ disease (GD). Palpable thyroid nodules occur in approximately 15 % of these patients [2]. In the era of ultrasound, thyroid nodules are found in 28.5–53.0 % of cases [3–8]. Nodular lesions in GD would be managed similar to the patients without this disorder, that is, fine-needle aspiration (FNA) of the nodules sonographically suspicious and preferably hypofunctioning nodules. For FNA diagnosis of papillary thyroid carcinoma (PTC) and suspicious for PTC, total thyroidectomy would be performed. For patients with
Endocr Pathol (2015) 26:48–53
follicular lesion/neoplasm, a total or near-total thyroidectomy is also considered because of the accompanying GD. The association between thyroid carcinoma and GD is controversial. In a recent population-based study, Chen found the incidence of thyroid cancer in the GD cohort was 4.92 per 1000 person-years and was 1.37-fold higher than the control cohort (p
