Title:Thyroid Cancer and Nodules in Graves’ Disease: A Single Center Experience
Volume: 21
Issue: 11
Author(s): Claudio Casella, Riccardo Morandi*, Apollonia Verrengia, Alessandro Galani, Sarah Molfino, Dhimiter Cuka, Giacomo Groppo, Carlo Cappelli and Nazario Portolani
Affiliation:
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia,Italy
Keywords:
Thyroid, nodules, Graves’ disease, cancer, surgery, thyroidectomy.
Abstract:
Background: The existence of a link between Graves’ Disease (GD) and Thyroid Cancer
(TC) has long been investigated, however a clear pathogenic correlation is yet to be found.
Objective: We verified the presence of TC in patients submitted to surgery for GD, both with and
without thyroid nodules (TN).
Methods: In this study we analyzed retrospectively a cohort of 151 patients treated at our clinic
with total thyroidectomy between 2013 and 2018. All the patients were symptomatic at the time of
surgery, preoperatively ultrasonographic (US) study was performed to evaluate the presence of nodules
and their distribution. All patients reached euthyroid state before surgery.
Results: Nodules were detected in 53% of cases, above 60 years of age, at least one nodule was
found; however, younger patients were mostly nodules free. Bilateral diffusion of nodules appeared
with increasing age. Cancer was found in 19 of 151 subjects (12.5%), all were papillary carcinomas,
and among them 93% were microcarcinomas. Among cancer-proven patients, 14 had thyroid
nodules while 5 were nodule-free. During the follow up period, no cancer recurrence was recorded.
The most common complication after surgery was transient hypocalcemia (36%).
Conclusions: Graves’ patients are burdened by major incidence of TC in the context of their TN.
Pre-operative assessment in GD patients should consider the risk of cancer, US scan can help in
rapid evaluation of nodules and new rising frontiers in molecular biomarkers analysis may help
defining pathogenic basis of Graves’ neoplastic development.
