Increased Mortality in Patients With Differentiated Thyroid Cancer Associated With Graves' Disease

Pellegriti, Gabriella; Mannarino, Celestina; Russo, Marco; Terranova, Rosa; Marturano, Ilenia; Vigneri, Riccardo; Belfiore, Antonino

doi:10.1210/jc.2012-2843

Cited by 64 publications

(53 citation statements)

References 32 publications

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“…However, the risk of differentiated thyroid cancer in Graves patients remains as a controversial issue. The malignancy rate in these nodules varies between 10% and 46% (10). This rate is approximately 5% in the general population (12).…”

Section: Resultsmentioning

confidence: 98%

“…The prevalence is lower when only clinical examination and scintigraphy are performed compared to ultrasonography (9). Palpable thyroid nodules are observed with a rate of 5% in the general population and with a rate of approximately 15% in Graves' disease (1,10). When more sensitive echographic imaging is used, thyroid nodules are found more frequently in Graves' disease compared to the general population (10).…”

Section: Discussionmentioning

confidence: 99%

“…TRAbs and TSH activate the same intracellular pathway and both of them have mitogenic and antiapoptotic effects on thyroid follicular cells. TRAbs stimulate angiogenesis, which has a critical role in the growth and development of the tumor in the thyroid, by upregulating vascular endothelial growth factor and placental growth factor (2,10,13,18).…”

Section: Discussionmentioning

confidence: 99%

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Thyroid nodules and thyroid cancer in Graves’ disease

Tam

Kaya

Kılıç

et al. 2014

Arq Bras Endocrinol Metab

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Objective: The frequency of thyroid nodules accompanying Graves' disease and the risk of thyroid cancer in presence of accompanying nodules are controversial. The aim of this study was to evaluate the frequency of thyroid nodules and the risk of thyroid cancer in patients operated because of graves' disease. Subjects and methods: Five hundred and twenty-six patients in whom thyroidectomy was performed because of Graves' disease between 2006 and 2013 were evaluated retrospectively. Patients who had received radioactive iodine treatment and external irradiation treatment in the neck region and who had had thyroid surgery previously were not included in the study. Results: While accompanying thyroid nodule was present in 177 (33.6%) of 526 Graves' patients, thyroid nodule was absent in 349 (66.4%) patients. Forty-two (8%) patients had thyroid cancer. The rate of thyroid cancer was 5.4% (n = 19) in the Graves' patients who had no nodule, whereas it was 13% (n = 23) in the patients who had nodule. The risk of thyroid cancer increased significantly in presence of nodule (p = 0.003). Three patients had recurrence. No patient had distant metastasis. No patient died during the follow-up period. Conclusions: Especially Graves' patients who have been decided to be followed up should be evaluated carefully during the follow-up in terms of thyroid cancer which may accompany. Arq Bras Endocrinol Metab. 2014;58(9):933-8 Keywords Graves' disease; thyroid nodules; thyroid cancer RESUMO Objetivo: A frequência da ocorrência de nódulos tiroidianos acompanhando a doença de Graves e o risco de câncer de tiroide na presença desses nódulos é controversa. O objetivo deste estudo foi avaliar a frequência de nódulos tiroidianos e o risco de câncer de tiroide em pacientes operados por doença de Graves. Sujeitos e métodos: Quinhentos e vinte e seis pacientes anteriormente submetidos à tiroidectomia por doença de Graves entre 2006 e 2013 foram avaliados retrospectivamente. Os pacientes que receberam tratamento com iodo radioativo e irradiação externa da região do pescoço e que anteriormente passaram por cirurgia de tiroide não foram incluídos no estudo. Resultados: Enquanto os nódulos de tiroide se apresentaram em 177 (33,6%) dos 526 pacientes com doença de Graves, eles estiveram ausentes em 349 (66,4%) pacientes. Um total de 42 (8%) dos pacientes teve câncer de tiroide. A ocorrência de câncer de tiroide foi 5,4% (n = 19) nos pacientes com doença de Graves que não apresentaram nódulos, e 13% (n = 23) nos pacientes com nódulos. O risco de câncer de tiroide aumentou significativamente na presença de nódulos (p = 0,003). Três pacientes apresentaram recidivas. Nenhum paciente apresentou metástase distante e nenhum paciente veio a óbito durante o período de acompanhamento. Conclusões: Pacientes com doença de Graves devem ser avaliados cuidadosamente no acompanhamento para a possível ocorrência de câncer de tiroide. Arq Bras Endocrinol Metab. 2014;58(9):933-8 Descritores Doença de Graves; nódulos tiroidianos; câncer de tiroide

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Section: Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Thyroid nodules and thyroid cancer in Graves’ disease

Tam

Kaya

Kılıç

et al. 2014

Arq Bras Endocrinol Metab

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“…Both conditions are characterized by pathological thyroid enlargement, seen in 77% and 93%, respectively (Hegedus et al 1983, Beck-Peccoz et al 2009). Additionally, chronic exposure to TSI has been associated with increased disease-specific mortality in thyroid cancer in some, but not all, studies (Belfiore et al 1990, Pellegriti et al 2013. Recently, multiple large cohort studies have found that increased levels of serum TSH are associated with increased subsequent risk of thyroid cancer (Nieto & Boelaert 2016).…”

Section: Tshr Stimulation and Thyroid Growthmentioning

confidence: 99%

Targeting the TSH receptor in thyroid cancer

Rowe¹,

Paul²,

Gedye³

et al. 2017

Endocrine-Related Cancer

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Recent advances in the arena of theranostics have necessitated a re-examining of previously established fields. The existing paradigm of therapeutic thyroid-stimulating hormone receptor (TSHR) targeting in the post-surgical management of differentiated thyroid cancer using levothyroxine and recombinant human thyroid-stimulating hormone (TSH) is well understood. However, in an era of personalized medicine, and with an increasing awareness of the risk profile of longstanding pharmacological hyperthyroidism, it is imperative clinicians understand the molecular basis and magnitude of benefit for individual patients. Furthermore, TSHR has been recently re-conceived as a selective target for residual metastatic thyroid cancer, with pilot data demonstrating effective targeting of nanoparticles to thyroid cancers using this receptor as a target. This review examines the evidence for TSHR signaling as an oncogenic pathway and assesses the evidence for ongoing TSHR expression in thyroid cancer metastases. Priorities for further research are highlighted.

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“…Moreover, the clinical course of thyroid cancer in nodular GD appears to be more aggressive than that in the general populace. Specifically, such cancers have a higher chance of being multifocal, are locally invasive with greater nodal and distant metastases, and are associated with less favorable outcomes, as evidenced by higher rates of persistent disease and cancer-related deaths [22][23][24]. In contrast, to the best of our knowledge, there have been no studies exclusively looking at the prevalence or behavior of thyroid cancers in children with GD.…”

Section: Thyroid Cancer In Gdmentioning

confidence: 99%

Marine-Lenhart syndrome in two adolescents, including one with thyroid cancer: a case series and review of the literature

Sharma

2017

Journal of Pediatric Endocrinology and Metabolism

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Background: The coexistence of functional thyroid nodules and Graves' disease (GD) is a rare condition known as Marine-Lenhart syndrome. Thyroid cancer has been described in several adults, but never in children, with Marine-Lenhart syndrome. This paper discusses the challenges in diagnosis and the unique management of this condition in children, in the context of extant literature. Content: In this case report, two adolescent female patients with Marine-Lenhart syndrome, aged 15 and 16 years, exhibited biochemical evidence of hyperthyroidism, and were found to have unilateral hyperfunctioning thyroid nodules via thyroid scintigraphy. Additionally, both patients showed elevated thyroid-stimulating immunoglobulins (TSI) and increased glandular activity, confirming background GD. Notably, one patient was also diagnosed with intranodular thyroid cancer upon preoperative examination. Both patients were treated via surgical resection. Summary and outlook: Diagnosis of Marine-Lenhart syndrome can be made in patients with functional thyroid nodules and increased glandular activity on thyroid scintigraphy. Standard doses of radioiodine ablation are not effective in the majority of patients and should be avoided due to the increased risk for thyroid cancer, making thyroidectomy the preferred treatment.

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Increased Mortality in Patients With Differentiated Thyroid Cancer Associated With Graves' Disease

Abstract: Nonoccult DTCs occurring in patients with GD cause increased disease-specific mortality compared with DTCs in matched euthyroid control patients. These findings emphasize the need for early diagnosis and aggressive treatment of nonoccult DTCs in patients with GD.

Cited by 64 publications

References 32 publications

Thyroid nodules and thyroid cancer in Graves’ disease

Thyroid nodules and thyroid cancer in Graves’ disease

Targeting the TSH receptor in thyroid cancer

Marine-Lenhart syndrome in two adolescents, including one with thyroid cancer: a case series and review of the literature

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