A Comparative Follow-Up Study of Patients with Papillary Thyroid Carcinoma Associated or Not with Graves’ Disease

Abstract

Whether papillary carcinoma (PC) behavior is more aggressive in Graves’ disease (GD) patients than PC cases without GD is controversial. We retrospectively enrolled 33 thyroidectomized PC/GD patients during long-term follow-up, 23/33 without risk factors at surgery, and 18/33 microcarcinomas; 312 PC euthyroid-matched patients without risk factors served as controls. A total of 14/33 (42.4%) PC/GD patients, 4 with and 10 without risk factors at diagnosis, 6 with microcarcinoma, underwent metastases during follow-up. In controls, metastases in 21/312 (6.7%) were ascertained. Considering 10/23 PC/GD patients and 21/312 controls without risk factors who developed metastases, univariate analysis showed that there was an increased risk of metastasis appearance for PC/GD cases (p < 0.001). Disease-free survival (DFS) was significantly (p < 0.0001, log-rank test) shorter in PC/GD patients than in controls. Significantly more elevated aggressiveness in 6/18 PC/GD patients with microcarcinoma than in controls was also ascertained with shorter DFS. Thus, in the present study, PC/GD had aggressive behavior during follow-up also when carcinoma characteristics were favorable and some cases were microcarcinomas. GD and non-GD patient comparison in the cases without risk factors at diagnosis showed an increased risk to develop metastases in GD during follow-up, suggesting that GD alone might be a tumor aggressiveness predictive factor in these cases.

Minimal Extrathyroid Extension (mETE) as the Only Risk Factor in Patients with Papillary Thyroid Carcinoma (PC): Its Clinical Impact on Recurrence and Outcome during Long-Term Follow-Up

“…The identification of metastases during follow-up is typically achieved through the use of traditional and highly sophisticated diagnostic imaging procedures, and in all patients, 131 I SPECT/CT has been included with high performance, confirming the reliable results of this procedure reported in the literature [42][43][44][45] also in patients with PC associated to thyroid autoimmune diseases [46,47].…”

Hashimoto’s Thyroiditis and Papillary Thyroid Carcinoma: A Follow-Up Study in Patients with Absence of Aggressive Risk Factors at the Surgery of the Primary Tumor

“…However, it is a matter of controversy whether the behavior of the carcinomas is more aggressive when the two diseases are associated with thyroid cancer. It has been observed that the appearance of metastatic lesions during follow-up is more frequent in patients with PC/GD [34][35][36][37] and PC/HT [21,22,30,31] than in PC patients without these autoimmune diseases. However, other studies have observed no difference in the outcome in the patients with or without GD and HT [15,38,39], while others have suggested that the two diseases may be factors of a more favorable disease course [3,8,[10][11][12][13]20,40,41].…”

Overweight as a biomarker for concomitant thyroid cancer in patients with Graves’ disease

“…In addition, Marongju et al. revealed a higher degree of aggressiveness in some patients with microcarcinoma and GD compared to controls, even when tumor characteristics were favorable, which conflicts with other studies ( 45 ). The presence of both thyroid cancer and GD is a surgical indication, regardless of the size of the cancer.…”

“…In a study by Hales et al., the average size of thyroid cancer in patients with GD was 0.91 cm, which was significantly smaller than the average size in the euthyroid group (0.91 vs. 2.33 cm) ( 44 ). However, previous studies demonstrated a more aggressive thyroid cancer phenotype in patients with GD ( 9 , 45 ). In addition, Marongju et al.…”