Coexisting Hashimoto's thyroiditis with differentiated thyroid cancer and benign thyroid diseases: indications for thyroidectomy.
ABSTRACT Hashimoto's thyroiditis is a medical disease that affects about 5% of the population. In cases of goitre, hashitoxicosis or associated differentiated thyroid cancer, surgical treatment is recommended. The aim of this study was to evaluate the indications for thyroidectomy in Hashimoto's thyroiditis, the frequency of coexistence of Hashimoto's thyroiditis and differentiated thyroid cancer, and the impact of Hashimoto's thyroiditis on the management of differentiated thyroid cancer. From January 1998 to May 2002, 344 patients underwent thyroidectomy in our department. Among 44 patients with HT, the authors carried out a retrospective comparative study of 33 patients with a cytological diagnosis of differentiated thyroid cancer (group A) and 11 patients with non-neoplastic conditions (group B). Surgical indications based on cytological findings and management characteristics were considered. The frequency of the association of Hashimoto's thyroiditis and differentiated thyroid cancer was 23.8% as compared to a 6.7% frequency of coexisting Hashimoto's thyroiditis and benign thyroid diseases (P = 0.000). The sensitivity of cytology in the diagnosis of papillary carcinoma in Hashimoto's thyroiditis was 92%. Cytological diagnosis of hyperplastic follicular and hyperplastic Hürthle cell nodules in Hashimoto's thyroiditis was impossible in some cases. Intraoperatively distinguishing between chronic lymph-node reactivity and tumour involvement was difficult, but the morbidity rate was not increased very much by Hashimoto's thyroiditis. In conclusion, an adequate follow up of patients with Hashimoto's thyroiditis may permit an early diagnosis of differentiated thyroid cancer and its appropriate management.
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ABSTRACT: Background: The reported incidence rate of occult thyroidcarcinoma in patients operated for benign thyroid pathologyhas been much higher than expected in the last years,especially for multinodular goitre, which raises the questionabout which should the proper surgical management forthese cases be.Aim: To assess the incidence rate of OTC in a single mediumvolume surgical center and to establish the correct indicationfor initial surgical management, as well as to identify thebenign thyroid pathology most frequently associated withOTC. We also reviewed the relevant scientific literature on thistopic.Material and Method: We conducted a retrospective study inthe General Surgery Clinic of âProf. dr. Agrippa IonescuâClinical Emergency Hospital, Bucharest, on a series of 145patients who underwent surgical interventions for preoperativelydiagnosed benign thyroid pathology over a ten yearperiod, between 1st January 2002 - 31st December 2012. Allcases of known thyroid cancer were excluded.Results: Incidence rate of occult thyroid carcinoma in our serieswas 6.9 % (10 out of 145 patients), 80 % of them beingdiagnosed with multinodular goitre and two cases (20 %) withHashimotoâs lymphocytic thyroiditis. 6.8 % of all patients withmultinodular goitre were found to present occult carcinoma,but this association was without statistical significance(p 0.05). Incidence rate of occult cancer among patients withHashimoto thyroiditis was proved to be as high as 28.6%,statistically significant (p=0.020). The mean size of postoperativelydiagnosed occult microcarcinoma was 7 mm, rangingbetween 3 mm and 14 mm, 90% of them being smaller than 1cm. Histologically, papillary microcarcinoma was found in allcases. The mean age of the patients diagnosed with occultmicrocarcinoma was 47.8 years with majority of the femalegender. The most frequent operation performed was totalthyroidectomy (70.8%). Overall morbidity in our series was6.9% with a 0.7 % mortality rate (1 case).Conclusions: In our opinion, primary total thyroidectomyshould be performed as the procedure of choice for the mostpart of preoperatively diagnosed benign thyroid pathology andparticularly for multinodular goitre and Hashimoto thyroiditis,in order to radically resect all possible foci of aggressive thyroidmicrocarcinomas.Abbreviations and Acronyms: OTC (Occult ThyroidCarcinoma), PTMC (Papillary Thyroid Microcarcinoma); TT(Total Thyroidectomy), MNG (Multinodular Goitre), GD(Graves disease), TNG (Toxic Nodular Goitre), FNAB(fine-needle aspiration biopsy).Chirurgia (Bucharest, Romania: 1990) 109(2):191-7. · 0.78 Impact Factor
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ABSTRACT: Immune responses by innate and adaptive immune cells are crucial for the suppression of carcinogenesis and tumor spread. Cytotoxic CD8+ T (CTL), natural killer (NK) and natural killer T cells (NKT) prevent tumor growth by their ability to induce apoptosis in cancer cells. To circumvent anti-tumor immunity, tumors commonly attract regulatory T (Treg) cells, which suppress the function of CTL and NKT cells in a contact- and cytokine-dependent manner. Recent findings in patients with thyroid cancer suggest that an imbalance between immune suppressive and anti-tumor cells occurs during thyroid carcinogenesis. However, the composition and regulation of immune responses in thyroid cancer are still elusive and a comprehensive immune profile of thyroid cancer is missing. In this issue of Endocrine Related Cancer Imam et al. compare immune profiles between patients with papillary thyroid carcinoma and autoimmune thyroiditis. Their data suggest that an imbalance between immunsuppressive T reg cells and effector T cells occurs during papillary thyroid carcinogenesis. Their study identified double negative (DN) T cells as a novel, key factor involved in this process. Future research is required to recapitulate these findings, to elucidate the mechanisms by which the immune response is regulated and to evaluate if this process might be utilized for the therapeutical management of thyroid cancer.Endocrine Related Cancer 05/2014; · 5.26 Impact Factor
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ABSTRACT: Thyroid disorders, including thyroid cancer and autoimmune thyroid diseases, have been closely associated with inflammation. This study aims to investigate the role of inflammation in thyroid disease by assessing serum cytokine levels in patients with malignant and benign thyroid conditions. Serum levels of ten interleukins (IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12 and IL-13) were quantitatively determined in 20 patients with thyroid cancer, 38 patients with benign thyroid disease and 50 healthy controls by multiplex technology. Serum IL-1β, IL-2, IL-4, IL-5 and IL-6 levels were strongly associated with each other. IL-10 and IL-12 correlated with IL-1β, IL-5, IL-6, and with each other. Age was inversely correlated with serum levels of IL-2, IL-4 and IL-13. A positive correlation between T3 and IL-13 levels was also observed. Significantly higher levels of IL-6, IL-7, IL-10 and IL-13, as well as significantly lower levels of IL-8 were observed in patients with benign and malignant thyroid disease compared to controls. The combination of IL-13 and IL-8 in a two-marker panel was highly efficient in discriminating thyroid disorders (AUC 0.90). Malignant and benign thyroid conditions are associated with altered expression levels of interleukins, supporting the association between thyroid disease and underlying inflammatory processes.Agents and Actions 05/2014; · 2.14 Impact Factor