To evaluate the incidence of thyroid carcinoma in patients operated on for Graves' disease, to identify criteria which may predict malignancy, and to develop a practical approach to determine the extensiveness of thyroidectomy.
Retrospective study of all patients who underwent thyroidectomy for Graves' disease between 1995 and 2005.
547 patients underwent subtotal thyroidectomy for Graves' disease during this period. Post-operative pathology examination revealed six cases of thyroid cancer (1.1%). All six cases had differentiated thyroid carcinoma (papillary carcinoma in 3 cases, follicular carcinoma in 2 cases and papillo-follicular carcinoma in 1 case). The indication for initial thyroidectomy was a palpable thyroid nodule in 3 cases (50%), failure of medical treatment for Grave's disease in 2 cases (33%), and signs of goiter compression in 1 case (17%). Five patients underwent re-operative total thyroidectomy.
This study shows that while malignancy in Grave's disease is uncommon, the presence of thyroid nodule(s) in patients with Grave's disease may be considered as an indication for radical surgery. The most adequate radical surgery in this situation is to perform a total thyroidectomy.
"Figure 1 | Worldwide prevalence of papillary thyroid cancer in patients with Graves' disease (Graves) and Hashimoto's thyroiditis (Hashi), corresponding to the sum of the data reported to date in the literature. References: Australia (Graves: Hales et al., 1992; Barakate et al., 2002); Austria (Graves: Rieger et al., 1989); China (Graves: Chou et al., 1993; Lin et al., 2003); Corea (Graves: Kim et al., 2004); Egypt (Hashimoto: Tamimi, 2002); France (Graves: Melliere et al., 1988; Ozoux et al., 1988; Kraimps et al., 1998; Kraimps, 2000; Mssrouri et al., 2008); Germany (Graves: Wahl et al., 1982); Great Britain (Graves: Hancock et al., 1977); Greece (Graves: Linos et al., 1997); Italy (Graves: Pacini et al., 1988; Belfiore et al., 1990; Miccoli et al., 1996; Pellegriti et al., 1998; Cantalamessa et al., 1999; Zanella et al., 2001; Gabriele et al., 2003; Cappelli et al., 2006; Hashimoto: Fiore et al., 2011); Turkey (Graves: Terzioglu et al., 1993); Japan (Graves: Kasuga et al., 1990; Ozaki et al., 1990; Yano et al., 2007; Hashimoto: Matsubayashi et al., 1995; Ohmori et al., 2007); Poland (Graves: Pomorski et al., 1996); Serbia (Graves: Zivaljevicét al., 2008); Spain (Hashimoto: Pino Rivero et al., 2004); USA (Graves: Shapiro et al., 1970; Dobyns et al., 1974; Bradley and Liechty, 1983; Farbota et al., 1985; Behar et al., 1986; Razack et al., 1997; Carnell and Valente, 1998; Weber et al., 2006; Boostrom et al., 2007; Phitayakorn and McHenry, 2008; Hashimoto: Loh et al., 1999; Gupta et al., 2001; Kebebew et al., 2001; Larson et al., 2007). "
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