The role of Graves' disease in the development of thyroid nodules and thyroid cancer.

IF 3.5 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

European Thyroid Journal Pub Date : 2023-07-12 DOI:10.1530/ETJ-23-0055

Marta Nascimento Soares, Marta Borges Canha, Celestino Neves, Joao Sergio Neves, Davide Carvalho

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Abstract

Aim: The prevalence of thyroid nodules and the risk of thyroid cancer in patients with Graves' disease is uncertain. We aimed to evaluate the prevalence of thyroid nodules and cancer in patients with Graves' disease.

Methods: Retrospective observational study of adult subjects with Graves' disease (positive autoantibodies thyrotropin receptor antibodies (TRAbs)) between 2017 and 2021 at our center was done. We evaluated the prevalence of thyroid nodules and cancer in this population and characterized the predictive factors for thyroid malignancy using linear and logistic regression models.

Results: We evaluated a total of 539 patients with Graves' disease during a median follow-up of 3.3 years (25th-75th percentiles 1.5-5.2 years). Fifty-three percent had thyroid nodules and 18 (3.3%) were diagnosed with thyroid cancer (12 papillary microcarcinomas). All tumors were classified using TNM classification as T1, and only one had lymph node metastasis; there were no recordings of distant metastasis. Sex, age, body mass index, smoking, TSH, and TRAbs levels were not significantly different between patients with and without thyroid cancer. Patients with multiple nodules on ultrasound (OR 1.61, 95%CI 1.04-2.49) and with larger nodules (OR 2.96, 95%CI 1.08-8.14, for 10 mm increase in size) had a greater risk of thyroid cancer diagnosis.

Conclusion: Patients with Graves' disease had a high prevalence of thyroid nodules and their nodules had a significant risk of thyroid cancer. The risk was higher in those with multiple and larger nodules. Most had low-grade papillary thyroid cancer. More studies are needed to clarify the clinical relevance of these findings.

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Graves病在甲状腺结节和甲状腺癌发展中的作用。

目的：Graves病患者甲状腺结节的患病率和患甲状腺癌症的风险尚不确定。我们旨在评估Graves病患者甲状腺结节和癌症的患病率。方法：对2017年至2021年我中心Graves病成年受试者（自身抗体促甲状腺激素受体抗体（TRAbs）阳性）进行回顾性观察研究。我们评估了该人群中甲状腺结节和癌症的患病率，并使用线性和逻辑回归模型对甲状腺恶性肿瘤的预测因素进行了表征。结果：我们对539名Graves病患者进行了评估，中位随访时间为3.3年（第25-75个百分位数1.5-5.2年）。50%以上患有甲状腺结节，18例（3.3%）被诊断为甲状腺癌症（12例乳头状微癌）。所有肿瘤均采用TNM分类为T1，只有一例有淋巴结转移；没有远处转移的记录。患有和不患有甲状腺癌症的患者的性别、年龄、体重指数、吸烟、TSH和TRAbs水平没有显著差异。超声检查多发结节（OR 1.61，95%CI 1.04-2.49）和较大结节（OR 2.96，95%CI 1.05-8.14，尺寸增加10mm）的患者诊断甲状腺癌症的风险更大。结论：Graves病患者甲状腺结节患病率高，其结节有明显的甲状腺癌症风险。多发性和较大结节患者的风险更高。大多数患者患有癌症。需要更多的研究来阐明这些发现的临床相关性。

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来源期刊

European Thyroid Journal Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

6.70

自引率

2.10%

发文量

156

期刊介绍： The ''European Thyroid Journal'' publishes papers reporting original research in basic, translational and clinical thyroidology. Original contributions cover all aspects of the field, from molecular and cellular biology to immunology and biochemistry, from physiology to pathology, and from pediatric to adult thyroid diseases with a special focus on thyroid cancer. Readers also benefit from reviews by noted experts, which highlight especially active areas of current research. The journal will further publish formal guidelines in the field, produced and endorsed by the European Thyroid Association.