Nodules in Autoimmune Thyroiditis Are Associated With Increased Risk of Thyroid Cancer in Surgical Series But Not in Cytological Series: Evidence for Selection Bias

Castagna, Maria Grazia; Belardini, Valentina; Memmo, Silvia; Maino, Fabio; Santo, Andrea Di; Toti, Paolo; Carli, Anton Ferdinando; Caruso, Giuseppe; Pacini, Furio

doi:10.1210/jc.2014-1302

Cited by 42 publications

(37 citation statements)

References 25 publications

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“…The authors underline that a selection bias may account for the higher prevalence of PTC in HT in histological series, because in the vast majority of these patients, the indication for surgery is the presence of nodules suspicious for malignancy, while it is more commonly the size of goiter or the presence of compressive symptoms in patients with nodular goiter. These findings were confirmed by Castagna et al [47] who reported that the prevalence of malignant cytology in patients with nodular HT diagnosed on clinical grounds was similar (4.5%) to that found in nodular goiter with or without TAb and in nodular Graves' disease (GD). When the same analysis was performed in the subgroup of patients submitted to thyroid surgery, the prevalence of PTC was significantly higher in patients with nodular HT (67.8%) compared with the other groups (36.9, 37.2 and 40%, respectively).…”

Section: Thyroid Autoimmunity and Ptcsupporting

confidence: 75%

Iodine, Thyroid Autoimmunity and Cancer

2015

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This review focuses on two different topics: (a) iodine and autoimmune thyroid disease (AITD) and (b) AITD and papillary thyroid carcinoma (PTC). Iodine intake modifies the expression of thyroid diseases and has been associated with induction of AITD. Thyroglobulin (Tg) is an important target in iodine-induced autoimmune response due to post-translational modifications of iodinated Tg, as suggested in animal models. We have shown that the unmasking of a cryptic epitope on Tg contributes to iodine-induced thyroid autoimmunity in humans. The relationship between AITD and PTC has been suggested in many studies. The presence of two different mechanisms has been hypothesized, one typical of AITD and the other of an immune reaction to PTC. We have shown that in AITD, the pattern of Tg recognition by anti-Tg antibodies (TgAb) is ‘restricted' to the immunodominant regions of Tg, while in patients with non-AITD, such as nodular goiter and PTC devoid of thyroid lymphocytic infiltration at histology, TgAb show a less restricted epitopic pattern and bind also to other regions of Tg. Thyroid function may also affect the frequency of PTC, the risk of cancer increasing with serum TSH levels. We have shown that this mechanism, rather than thyroiditis per se, plays a major role in the association of PTC with Hashimoto's thyroiditis, as a consequence of the autoimmune process leading to a progressive increase of serum TSH in these patients.

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Section: Thyroid Autoimmunity and Ptcsupporting

confidence: 75%

Iodine, Thyroid Autoimmunity and Cancer

2015

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“…Some retrospective cytological studies analyzed by Castagna et al [55] and Matesa-Anić et al [56] did not find an increased risk of thyroid cancer in patients with HT. In the latter study, the prevalence of PTC was lower in HT patients (1.9%) than in patients without HT (2.7%); the same result was also confirmed by a previous FNAC prospective study [57].…”

Section: Association Of Ptc and Ht: Clinical Studiesmentioning

confidence: 99%

Thyroid Autoimmunity and Thyroid Cancer: Review Focused on Cytological Studies

Boi¹,

Pani²,

Mariotti³

2017

Eur Thyroid J

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The association between Hashimoto thyroiditis (HT) and papillary thyroid carcinoma (PTC) has been originally suggested by retrospective pathological studies and has recently been re-evaluated and proposed on the basis of several fine-needle aspiration cytology (FNAC) studies. In FNAC studies, the association between HT and PTC is based on the comparison of anti-thyroid autoantibodies (ATA) (anti-thyroperoxidase [TPOAb] and anti-thyroglobulin [TgAb]), thyroid function (TSH), and cytology with histology of thyroid nodules and lymphocytic thyroid infiltration (LTI) of operated thyroid glands. Most of the pathological studies found a high prevalence rate of PTC in HT. In most FNAC studies, the risk ratio of PTC in HT patients was evaluated using multivariate statistical analysis: increased TSH levels represented the main and common independent risk factor of malignancy, although it resulted not consistently related to HT. On the other hand, several studies provided a positive relationship between ATA and PTC, particularly with TgAb. Two recent FNAC studies from the same referral center clearly demonstrated an independent risk for thyroid malignancy conferred by both TPOAb and TgAb, confirming the role of increased TSH levels, and found a significant association between PTC and ATA and diffuse LTI at histology. These studies are consistent with the hypothesis that autoimmune thyroid inflammation and increased serum TSH concentration may be involved in thyroid tumor growth. The complex relationship between HT and PTC, which involves immunological/hormonal pathogenic links, needs to be further investigated with prospective studies.

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“…However, this relationship was not reported in a limited number of studies (10,11). In large part of the studies based on the cytological examination results of FNAB, it is reported that incidence of PTC is not increased in HT patients and HT is not a risk factor for PTC (12,13). In a literature review performed at 2013, coexistence of HT with PTC was reported as 27.56% in studies based on histopathologic results of thyroidectomy specimens, and 1.2% in studies based on cytological results of FNAB.…”

Section: Discussionmentioning

confidence: 99%

Coexistence of hashimotos thyroiditis with papillary thyroid carcinoma: a single center experience

Kutlutürk¹,

Ünal²,

Çetin³

2017

J Turgut Ozal Med Cent

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Aim: A positive correlation between Hashimoto's thyroiditis (HT) and papillary thyroid cancer (PTC) is determinated in studies based on histopathological examination of the thyroidectomy materials, but this correlation is not determinated in studies based on Fine Niddle Aspiration Biopsy (FNAB). In this study, the histopathologic results of bilateral total thyroidectomy (TT) specimens were studied for outcomes of PTC association with HT and its relationship with clinical and pathological prognostic factors. Material and Methods: Demographic data, thyroidectomy indications and pathology results of 568 patients with performed TT between April 2009 March 2016 were collected. PTC identified patients, were evaluated in terms of HT association. In these patients, the prognostic factors were evaluated according to coexistence of HT. Results: The average age of the patients was 48.9 years and M / F ratio was 1: 3.5. HT was detected in 36 patients and PTCin 121 patients by histopathological examinations. PTC incidence in HT group was higher than non-HT group. (p = 0.025). HT incidence in PTC group was higher than non-PTC group (p = 0.025).When compared in terms of demographic and prognostic data of PTC patiens,no statistically significant difference was detected between PTC with and without HT groups. Conclusion: PTC detection rate in patients with HT, who has indication for thyroidectomy is higher than non-HT patients. HT patients (especially female sex), should be followed closely, in terms of the development of malignant nodules.

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Nodules in Autoimmune Thyroiditis Are Associated With Increased Risk of Thyroid Cancer in Surgical Series But Not in Cytological Series: Evidence for Selection Bias

Cited by 42 publications

References 25 publications

Iodine, Thyroid Autoimmunity and Cancer

Iodine, Thyroid Autoimmunity and Cancer

Thyroid Autoimmunity and Thyroid Cancer: Review Focused on Cytological Studies

Coexistence of hashimotos thyroiditis with papillary thyroid carcinoma: a single center experience

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