Graves hastalığında tiroid kanser sıklığının değerlendirilmesi

Hakan Yabanoğlu; İlker Murat Arer; Nazım Emrah Koçer; Abdirahman Sakulen Hargura; Tevfik Avcı

doi:10.19161/etd.512517

EN TR

Evaluation of thyroid cancer prevalence in patients with graves disease

Abstract

Aim: Although Graves’ disease and thyroid cancer are commonly occurring diseases, simultaneous occurence is rare. Hyperthyroidism is believed to be protective against thyroid cancer hence the rare simultaneous occurrence. In our study we intend to evaluate thyroid cancer prevalence in patients operated for Graves’ disease in our center.

Materials and Methods: Files of 210 patients who underwent total thyroidectomy for Graves’ disease between 2009- 2018 were retrospectively reviewed. Demographic and clinical features of 38 patients with thyroid cancer diagnosis in the pathology report were evaluated.

Results: In our study 25 (65.8%) of the patients were women, 13 (34.2%) were men and the average age was 40 (17-68). In ultrasonographic imaging 20% (43/210) of the patients had thyroid nodules, while 57% (22/38) of patients with confirmed carcinoma in the pathologic evaluation had thyroid nodules. Functional neck dissection was performed on1 patient secondary to thyroidectomy. 12 of the patient received radioactive iodine treatment. Our average followup period was 30 (3-108) months. During the follow-up 2 (5.2%) patients had recurrence of papillary cancer in the thryoidectomy area at 12th and 18th months. Both patients received RAI treatment. There was no subsequent recurrence in the follow-up of both the patients.

Conclusion: Although simultaneous occurrence of Graves’ disease and thyroid cancer is rare, fine needle aspiration biopsy should be performed on Graves’ disease patients where ultrasound imaging during follow-up reveals findings of thyroid nodules. Moreover, surgery should be a priority option as treatment modality in Graves’ disease accompanied by thyroid nodules.

Keywords

Graves’ disease,thyroid cancer,nodule.

Graves hastalığında tiroid kanser sıklığının değerlendirilmesi

Öz

Amaç: Graves hastalığı ve tiroid kanserleri sık görülen hastalıklar olmasına rağmen her iki hastalığın birlikteliği nadir bir durum olarak karşımıza çıkmaktadır. Bu durumun nadir olmasında hipertiroidinin, tiroid kanserine karşı koruyucu bir etkisinin olduğunu düşündürmektedir. Çalışmamızda graves hastalığı nedeni ile total tiroidektomi uyguladığımız hastalardaki tiroid kanser sıklığını belirlemeyi amaçladık.

Gereç ve Yöntem: 2009-2018 yılları arasında graves hastalığı nedeni ile total tiroidektomi yapılan 210 hastanın dosyası geriye dönük olarak incelendi ve patoloji sonucunda tiroid kanseri tanısı alan 38 hasta demografik ve klinik özellikleri açısından değerlendirildi.

Bulgular: Hastaların 25’i (%65,8) kadın, 13’ü (%34,2) erkek ve ortalama yaşları 40 (17-68) idi. Ultrasonografik incelemede tüm hastaların (43/210) %20’ de tiroid bezinde nodül varken, patoloji sonucunda karsinom tespit edilen hastaların (22/38) %57’sinde nodül mevcuttu. Tiroidektomi yapılan hastaların patolojik incelemelerinde 38 (%18) hastada tiroid kanseri mevcuttu. Tiroidektomi sonrası 1 hastaya boyun diseksiyonu uygulandı. On iki hastaya radyoaktif iyot tedavisi uygulandı. Ortalama takip süresi 30 (3-108) ay idi. Takiplerde 2 (%5,2) hastada 12. ve 18. aylarda tiroidektomi lojunda papiller kanser nüksü görüldü. Her iki hastaya da RAİ tedavisi uygulandı. Takiplerde nüks izlenmedi.

Sonuç: Graves hastalığı ve tiroid kanser birlikteliği nadir olsa da özellikle graves hastalığı nedeni ile takip edilen ve yapılan ultrasonografide nodül bulunan hastalarda mutlaka ince iğne aspirasyon biyopsisi yapılmalıdır. Tiroid dokusunda nodül içeren graves hastalarında cerrahi tedavi seçeneği daha ön planda düşünülmelidir.

Anahtar Kelimeler

Graves hastalığı,tiroid kanseri,nodül.

Kaynakça

Behar R, Arganini M, Wu TC, et al. Graves' disease and thyroid cancer. Surgery 1986;100(6):1121-7.
Bradley EI, Liechty RD. Modified subtotal thyroidectomy for Graves' disease: A two-institution study. Surgery 1983;94(6):955-8.
Gabriele R, Letizia C, Borghese M, et al. Thyroid cancer in patients with hyperthyroidism. Horm Res 2003;60(2):79-83.
Gerenova J, Buysschaert M, de Burbure CY, Daumerie C. Prevalence of thyroid cancer in Graves' disease: A retrospective study of a cohort of 103 patients treated surgically. Eur J Intern Med 2003;14(5):321-5.
Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R. Worldwide increasing incidence of thyroid cancer: Update on epidemiology and risk factors. J Cancer Epidemiol 2013;2013:965212.
Farbota L, Calandra D, Lawrence A, Paloyan R. Thyroid carcinoma in Graves’ disease. Surgery 1985;98(6):1148-52.
Hales IB, McElduff A, Crummer P, et al. Wiseman. Does Graves' disease or thyrotoxicosis affect the prognosis of thyroid cancer? J Clin Endocrinol Metab 1992;75(3):886-9.
Pazaitou-Panayiotou K, Michalakis K, Paschke R. Thyroid cancer in patients with hyperthyroidism. Horm Metab Res 2012;44(4):255-62.

Pazaitou-Panayiotou K, Perros P, Boudina M, et al. Mortal¬ity from thyroid cancer in patients with hyperthyroidism: The Theagenion Cancer Hospital experience. Eur J Endocri¬nol 2008;159(6):799-803.
Hayes F J, Sheaham K, Heffernan A, McKenna T J. Ag¬gressive thyroid cancer associated with toxic nodular goi¬tre. Eur J Endocrinol 1996;134(3):366-70.
Habra M A, Hijazi R, Verstovsek G, Marcell M. Medullary thyroid carcinoma associated with hyperthyroidism: A case report and review of the literature. Thyroid 2004;14(5):391-6.
Alagöl F, Tanakol R, Boztepe H, et al. Anaplastic thyroid cancer with transient thyrotoxicosis: Case report and litera¬ture review. Thyroid 1999;9(10):1029-32.
Cappelli C, Braga M, De Martino E, et al. Outcome of pa¬tients surgically treated for various forms of hyperthyroid¬ism with differentiated thyroid cancer: Experience at an en¬docrine center in Italy. Surg Today 2006;36(2):125-30.
Cantalamessa L, Baldini M, Orsatti A, et al. Thyroid nodules in Graves’ disease and the risk of thyroid carcinoma. Arch Intern Med 1999;159(15):1705-8.
Kasuga Y, Sugenoya A, Kobayashi S, et al. The outcome of patients with thyroid carcinoma and Graves’ disease. Surg Today 1993;23(1):9-12.
Augusti T, Codegone A, Pallerito R, Favero A. Thyroid can¬cer prevalence after radioiodine treatment of hyperthyroid¬ism. J Nucl Med 2000;41(6):1006-9.
Lividas D, Psarras A, Koutras D. Malignant cold thyroid nodules in hyperthyroidism. Br J Surg 1976;63(9):726-8.
Tam AA, Kaya C, Kılıç FB, Ersoy R, Çakır B. Thyroid nodules and thyroid cancer in Graves' disease. Arq Bras Endocrinol Metabol 2014;58(9):933-8.
Erbil Y, Barbaros U, Ozbey N, et al. Graves' disease, with and without nodules, and the risk of thyroid carcinoma. J Laryngol Otol 2008;122(3):291-5.
Staniforth JU, Erdirimanne S, Eslick GD. Thyroid carcinoma in Graves' disease: A meta-analysis. Int J Surg 2016;27:118-25.
Wells SA Jr, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid 2015;25(6):567-610.
Belfiore A, Russo D, Vigneri R, Filetti S. Graves’ disease, thyroid nodules and thyroid carcinoma. Clin Endocrinol 2001;55(6):711-8.
Carnell NE, Valente WA. Thyroid nodules in Graves’ disease: Classification, characterization, and response to treatment. Thyroid 1988;8(7):571-6.
Kraimps JL, Bouin-Pineau MH, Mathonnet M, et al. Multicentre study of thyroid nodules in patients with Graves’ disease. Br J Surg 2000;87(8):1111-3.
Mishra A, Mishra S. Thyroid nodules in Graves’ disease: Implications in an endemically iodine deficient area. J Postgrad Med 2001;47(4):244-7.
Silver RJ, Parangi S. Management of thyroid incidentalomas. Surg Clin North Am 2004;84(3):907-20.
Ren M, Wu MC, Shang CZ, et al. Predictive factors of thyroid cancer in patients with Graves’ disease. World J Surg 2014;38(1):80-7.

Ayrıntılar

Birincil Dil

Türkçe

Konular

Sağlık Kurumları Yönetimi

Bölüm

Araştırma Makalesi

Yazarlar

Hakan Yabanoğlu ^*
0000-0002-1161-3369
Türkiye

İlker Murat Arer
0000-0001-9880-3570
Türkiye

Nazım Emrah Koçer
0000-0003-3636-8109
Türkiye

Abdirahman Sakulen Hargura
0000-0003-4266-2881
Türkiye

Tevfik Avcı
0000-0001-5225-959X
Türkiye

Yayımlanma Tarihi

28 Haziran 2019

Gönderilme Tarihi

26 Nisan 2018

Kabul Tarihi

5 Haziran 2018

Yayımlandığı Sayı

Yıl 2019 Cilt: 58 Sayı: 2

DOI

https://doi.org/10.19161/etd.512517

IZ

https://izlik.org/JA86HP93SA

Kaynak Göster

RIS / Bibtex

Vancouver

1.Hakan Yabanoğlu, İlker Murat Arer, Nazım Emrah Koçer, Abdirahman Sakulen Hargura, Tevfik Avcı. Graves hastalığında tiroid kanser sıklığının değerlendirilmesi. ETD. 01 Haziran 2019;58(2):166-9. doi:10.19161/etd.512517