Original articlePrevalence of thyroid cancer in Graves’ disease: a retrospective study of a cohort of 103 patients treated surgically
Introduction
Diffuse goiter is a classic feature of Graves’ disease (GD). In addition, thyroid nodules can be found in approximately 10–31% of cases [1], [2], [3], [4], [5], [6], [7], [8]. Some [3], [10], [11], [12], but not all, authors [2], [4], [13], [14] have suggested that the prevalence of aggressive thyroid cancers could be elevated in this group. In view of this controversy, the aim of our study was to determine the prevalence of thyroid nodules in a cohort of subjects with GD treated surgically. This represents at most 10% of all GD patients [15]. We also sought to analyze the frequency of thyroid cancer in this group according to the presence or absence of nodules.
Section snippets
Patients and design
We conducted a retrospective study on 103 subjects (14 males, 89 females), aged 15–69 years, who underwent surgical treatment for hyperthyroidism due to GD between 1990 and 2000 at the Cliniques Universitaires Saint-Luc in Brussels, one of the main Belgian university teaching hospitals and referral centers for thyroid pathology. Every patient had clinical, biochemical, scintigraphic, and ultrasonographic thyroid evaluations, and none had a positive family history of thyroid cancer. None of the
Results
In the total cohort of 103 patients treated surgically, we found eight cases of well-differentiated thyroid papillary carcinomas (7.8%). Their main clinical and biological characteristics are shown in Table 1. All carcinoma patients were females. Only four of them had cold nodules at scintigraphy, and Tg levels varied between 8 and 1340 ng/ml. Table 2 shows that there were no significant differences in clinical characteristics between patients with thyroid cancer and those with benign nodules.
Discussion
Our study shows that 35% of the patients (36/103) who had undergone surgery for GD had thyroid nodules. This relatively high prevalence, when compared with other reports [1], [2], [3], [4], [5], [6], could have been due to the design of our investigation, as the nodules were not only detected by palpation but also by imaging techniques, in particular scintigraphy and/or high-resolution, real-time ultrasound.
The incidence of thyroid cancer in the cohort was 7.8%, a finding that is in agreement
Acknowledgments
The authors thank Dr C. Beguin, Department of Medical Archives, for help with the statistical analysis and S. Meerkens for her excellent technical assistance.
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