Thyroid cancer in systemic lupus erythematosus: a case-control study

J Clin Endocrinol Metab. 2010 Jan;95(1):314-8. doi: 10.1210/jc.2009-0677. Epub 2009 Nov 11.


Context: Although advances in treatment have permitted patients with systemic lupus erythematosus (SLE) to live longer, the rates of several types of cancers in these patients appear to be increasing.

Objective: We used a prospective study to investigate the prevalence and features of thyroid cancer in SLE patients.

Design and patients: The prevalence of thyroid cancer in 153 unselected SLE patients was compared with that in two population-based, gender- and age-matched control groups: 1) 459 subjects from an iodine-deficient area (iodine-deficient control) and 2) 459 subjects from an iodine-sufficient area (iodine-sufficient control). Thyroid function was assessed by measuring circulating thyroid hormones and autoantibodies, thyroid ultrasonography, and where necessary, fine-needle aspiration cytology.

Main outcome and results: The levels of circulating TSH, and anti-thyroglobulin and anti-thyroperoxidase antibodies were significantly higher in SLE patients (P < 0.001 for all). In addition, patients with SLE also exhibited a higher prevalence of hypothyroidism (P < 0.001). Five cases of papillary thyroid cancer were detected among SLE patients, whereas no cases were observed among iodine-deficient controls (P = 0.001), and only one case was observed among iodine-sufficient controls (P = 0.001). Among SLE patients with confirmed thyroid cancer, 80% showed evidence of thyroid autoimmunity, whereas only 31% of SLE patients without thyroid cancer exhibited evidence of thyroid autoimmunity (P = 0.02).

Conclusions: These data suggest that the prevalence of papillary thyroid cancer in SLE patients is higher than in age-matched controls, particularly in patients with thyroid autoimmunity. Consequently, careful thyroid surveillance is recommended during the follow-up of these patients.

MeSH terms

  • Adult
  • Carcinoma, Papillary / complications
  • Carcinoma, Papillary / epidemiology*
  • Case-Control Studies
  • Female
  • Humans
  • Hyperthyroidism / complications
  • Hyperthyroidism / epidemiology
  • Hypothyroidism / complications
  • Hypothyroidism / epidemiology
  • Lupus Erythematosus, Systemic / complications
  • Lupus Erythematosus, Systemic / epidemiology*
  • Male
  • Middle Aged
  • Prevalence
  • Thyroid Function Tests
  • Thyroid Neoplasms / complications
  • Thyroid Neoplasms / epidemiology*
  • Young Adult