Öz
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.
Anahtar Kelimeler
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.
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
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 Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Haziran 2019 |
| Gönderilme Tarihi | 26 Nisan 2018 |
| Yayımlandığı Sayı | Yıl 2019 |