Chronic Lymphocytic Thyroiditis Does Not Worsen Early Surgical Outcomes in Papillary Thyroid Cancer.

Abstract

Background: Chronic lymphocytic thyroiditis (CLT), an autoimmune thyroid disorder that most commonly causes hypothyroidism in women, may confer a higher surgical risk for patients undergoing thyroidectomy for papillary thyroid carcinoma (PTC). This study evaluates surgical treatment outcomes for patients with a diagnosis of PTC with and without CLT.

Methods: A retrospective review of prospectively collected data for patients who underwent thyroidectomy from 2009 to 2020 at a tertiary institution was performed. Patients ≥ 18 years of age were subdivided into 2 groups: patients with CLT and PTC and patients with PTC alone. Sociodemographic factors, tumor characteristics, final histopathology, thyroidectomy-specific outcomes, and postoperative course were evaluated. Chi-squared tests were used for categorical variables and comparisons based on t-tests.

Results: Of 1073 patients with PTC, most were women n = 872 (81%), Caucasian n = 933 (87%) with a mean of 48 (± 13) years of age, mean tumor size of 1.8 cm (± 1.3 cm), and low stage disease I/II n = 1049 (98%). Among patients with PTC n = 167 (16%) had a concurrent diagnosis of CLT. When comparing patients with PTC and CLT to PTC alone, there were no significant differences in age, race, or tumor size, respectively. When comparing patients with PTC and CLT to PTC alone, there were no significant differences in permanent recurrent laryngeal nerve injury (1.2% [n = 2] vs. 0.2% [n = 2]), bleeding and/or return to OR (0.6% [n = 1] vs. 0.7% [n = 6]), persistent hypocalcemia (0% [n = 0] vs. 0.33% [n = 3]), wound infection (0.6% [n = 1] vs. 0.4% [n = 4]), and radioactive iodine therapy (35.9% [n = 60] vs. 31.2% [n = 283]). Rates of lymph node positivity (26.9% [n = 45] vs. 30.1% [n = 273]), extrathyroidal extension (14.3% [n = 24] vs. 16.5% [n = 150]), and PTC recurrence (4.19% [n = 7] vs. 4.75% [n = 43]) were similar between groups.

Conclusion: Of those undergoing total thyroidectomy for PTC, 16% of patients have concurrent underlying CLT. Underlying CLT is not associated with more aggressive tumor biology, higher rates of surgical complications, or PTC recurrence when performed by high-volume thyroid surgeons.