Original article
Prevalence of thyroid cancer in Graves’ disease: a retrospective study of a cohort of 103 patients treated surgically

https://doi.org/10.1016/S0953-6205(03)00105-5Get rights and content

Abstract

Background: Thyroid nodules in patients with Graves’ disease (GD) are common, and the incidence of coexisting thyroid carcinoma is a much debated subject, which is addressed in this study. Methods: In order to determine the incidence rate of coexisting malignancy, a retrospective study was conducted on 103 patients who underwent surgery for GD between 1990 and 2000 at the Cliniques Universitaires Saint-Luc in Brussels, Belgium. The patients were classified into groups. Those in group I had a solitary palpable nodule (4.9%), those in group II multiple palpable nodules (12.6%), group IIIa had nodule(s) revealed by imaging techniques (incidentalomas: 17.5%), and group IIIb had diffuse non-nodular goiter (65%). Results: Patients with nodules (groups I, II, and IIIa) were found to have significantly more thyroid carcinomas than those with diffuse non-nodular goiters (P=0.02), and the rate of malignancy was significantly increased when the nodules were palpable (groups I and II; P=0.03). Eight patients (7.8%) were diagnosed as having coexisting carcinomas, all but one being microcarcinomas. Conclusions: Well-differentiated papillary carcinomas are found to coexist with GD surgically treated (7.8%) and occur most frequently in GD with palpable nodular lesions (35%). Even though the majority (88%) of coexisting carcinomas are microcarcinomas, the presence of palpable nodules justifies further evaluation and follow-up.

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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