Coexisting Hashimoto's thyroiditis with differentiated thyroid cancer and benign thyroid diseases: indications for thyroidectomy
Dipartimento Chirurgico Materno-Infantile e di Scienze dell'Immagine, Centro di Studio per la Chirurgia Endocrina e Metabolica, University of Cagliari. Chirurgia italiana
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.
Available from: erc.endocrinology-journals.org
- "While some studies suggest that these two thyroid conditions are positively correlated, others failed to find an association (Segal et al. 1985, Ott et al. 1987, Eisenberg & Hensley 1989, Di Pasquale et al. 2001, Mechler et al. 2001, Pisanu et al. 2003). However, it is important to note that the caveat is most pronounced between studies using paraffin-embedded tissue (i.e. "
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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.
Available from: europepmc.org
- "The significance of molecular studies as an element of cytological diagnostics of thyroid lesions is confirmed by considerable differences in papillary thyroid cancer diagnoses in biopsy materials. According to literature [2, 16–21], histology-confirmed diagnoses of papillary thyroid cancer fall within an extremely wide range from 0.4 % in the reports by Matesa et al.  to 92 % in keeping with the data provided by Singh et al. [2, 21]. In our material, in 31 of 452 (6.9 %) HT patients, confirmation of the diagnosis of papillary thyroid carcinoma in material collected by targeted fine-needle aspiration biopsy was achieved, which accounted only for 29.2 % of all HT-PTC diagnoses established based on final histopathology. "
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Conflicting data have been reported with regard to Hashimoto thyroiditis (HT) and risk of malignancy. The aim of this study was to evaluate coexistence of papillary thyroid cancer (PTC) with HT.
Patients and methods
This is a retrospective cohort study in which HT was diagnosed in 452 (F/M ratio = 405:47, median age 53.5 ± 12.1 years) of 7,545 patients qualified for thyroidectomy throughout the years 2002 to 2010. Pathological reports were reviewed to identify prevalence of PTC in HT vs. non-HT patients.
PTC was diagnosed in 106 of 452 (23.5 %) HT patients vs. 530 of 7,093 (7.5 %) non-HT patients (p < 0.001). Metastases to level VI lymph nodes were observed in 81 of 106 (76.4 %) patients with PTC in HT vs. 121 of 530 (22.8 %) patients with PTC in non-HT disease (p < 0.001).
HT was associated with a threefold increase of PTC prevalence as compared to other non-HT thyroid diseases, and the spread of PTC to level VI lymph nodes was four times more frequent in HT than in non-HT patients.
Available from: Fernando Augusto Soares
- "An association between chronic lymphocytic thyroiditis (CLT), also known as Hashimoto's thyroiditis, and differentiated thyroid carcinoma (DTC), especially the papillary histotype, has long been recognized and supported by a series of epidemiological studies.1,2 Chronic inflammatory infiltrates and chronic inflammatory thyroiditis are observed in 20-50% of papillary thyroid carcinoma (PTC) cases.3,4 "
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ABSTRACT: The aim of this study was to investigate the role of the interleukin-18 +105A/C and interleukin-10 -1082A/G germline polymorphisms in the development and outcome of differentiated thyroid carcinoma associated or not with concurrent thyroiditis.
We studied 346 patients with differentiated thyroid carcinomas, comprising 292 papillary carcinomas and 54 follicular carcinomas, who were followed up for 12-298 months (mean 76.10 ± 68.23 months) according to a standard protocol. We genotyped 200 patients and 144 control individuals for the interleukin-18 +105A/C polymorphism, and we genotyped 183 patients and 137 controls for the interleukin-10 -1082A/G polymorphism.
Interleukin-18 polymorphisms were not associated with chronic lymphocytic thyroiditis or any clinical or pathological feature of tumor aggressiveness. However, there was an association between the presence of interleukin-10 variants and chronic lymphocytic thyroiditis. Chronic lymphocytic thyroiditis was present in 21.74% of differentiated thyroid carcinoma patients, most frequently affecting women previously diagnosed with Hashimoto's thyroiditis who had received a lower 131I cumulative dose and did not present lymph node metastases.
We conclude that the inheritance of a G allele at the interleukin-10 -1082A/G polymorphism may favor a concurrent thyroid autoimmunity in differentiated thyroid carcinoma patients, and this autoimmunity may favor a better prognosis for these patients.
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