Does Hyperthyroidism Worsen Prognosis of Thyroid Carcinoma? A Retrospective Analysis on 2820 Consecutive Thyroidectomies

J Otolaryngol Head Neck Surg. 2018 Jan 22;47(1):6. doi: 10.1186/s40463-018-0254-2.

Abstract

Background: Hyperthyroidism is associated with high incidence of thyroid carcinoma; furthermore, tumors arisen in hyperthyroid tissue show an aggressive behavior. Thyroid Stimulating Hormone (TSH) and Thyroid-stimulating antibodies, present in Graves's disease, seem to play a key role in carcinogenesis and tumoral growth.

Methods: We retrospectively reviewed our series of patients who underwent thyroidectomy for thyroid carcinoma. We compared pathological features and surgical outcomes of hyperthyroid versus euthyroid patients.

Results: From 2007 to 2015, 909 thyroidectomies were performed at our institution for thyroid cancer: 87 patients were hyperthyroid and 822 euthyroid. We observed, in hyperthyroid patients, a higher rate of transient hypoparathyroidism (28.1% vs 13.2%; p < 0.01) and of node metastases (12.6% vs 6.1%; p = 0.03); also local recurrence rate was higher (5.7% vs 2.5%) even if not statistically significant (p = 0.17). Five-year disease free survival rate was significant lower in the same group (89.1% vs 96.6%; p = 0.03).

Conclusion: Thyroid cancers in hyperthyroid patients have an aggressive behavior, with high incidence of local invasion and a worse prognosis than euthyroid patients. All hyperthyroid patients should undergo a careful evaluation with ultrasound and scintigraphy; in case of suspicious nodules, an aggressive approach, including thyroidectomy and lymphectomy, is justified. In patients with toxic adenoma, thyroid cancer is uncommon, thus a loboisthmectomy can be safely performed.

Trial registration number: Research registry n. 2670 registered 19 June 2017 (retrospectively registered).

Keywords: Graves’ disease; Hyperthyroidism; Thyroid carcinoma; Thyroidectomy.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Case-Control Studies
  • Comorbidity
  • Disease Progression
  • Female
  • Humans
  • Hyperthyroidism / epidemiology*
  • Hyperthyroidism / pathology
  • Hyperthyroidism / surgery*
  • Incidence
  • Male
  • Middle Aged
  • Monitoring, Physiologic / methods
  • Positron-Emission Tomography / methods
  • Prognosis
  • Reference Values
  • Retrospective Studies
  • Risk Assessment
  • Thyroid Function Tests
  • Thyroid Neoplasms / epidemiology*
  • Thyroid Neoplasms / pathology
  • Thyroid Neoplasms / surgery*
  • Thyroidectomy / methods*
  • Ultrasonography, Doppler / methods