The Effects of Hashimoto Thyroiditis on Lymph Node Metastases in Unifocal and Multifocal Papillary Thyroid Carcinoma

Abstract

The purpose of this study was to investigate the risk factors for central and lateral neck lymph node metastases in papillary thyroid carcinoma (PTC) and multifocal papillary thyroid carcinoma (MPTC), particularly when associated with Hashimoto thyroiditis (HT).A retrospective analysis of 763 consecutive patients who underwent total thyroidectomy with bilateral central neck dissection in the First Affiliated Hospital, College of Medicine, Zhejiang University between October 2011 and October 2014 was conducted. All patients had formal histological diagnoses of HT. Multivariable logistic regression analysis was performed to identify risk factors of neck lymph node metastases.Our study identified 277 PTC patients with HT and showed comparatively low rates of central lymph node metastases (CLNM) compared with the PTC patients without HT (37.2% versus 54.7%, P < 0.001). There were no statistically significant differences in lateral lymph node metastases (LLNM) (P = 0.656). Neck lymph node metastases were histologically proven in 127 (45.8%) patients with PTC with HT, including 103 CLNM and 24 LLNM. There were no significant differences in LLNM between the MPTC-associated HT and classic MPTC cases; however, a significantly reduced risk of CLNM was observed in the MPTC-associated HT compared with the MPTC cases (35.7% versus 72.4%, respectively, P < 0.001). In the multivariate analysis, HT was identified as an independent alleviating factor for CLNM in all PTC patients (odds ratio, 0.369; 95% confidence interval (CI), 0.261 to 0.521; P < 0.001) and in MPTC patients (odds ratio, 0.227; 95% CI, 0.126–0.406; P < 0.001). A cut-off of thyroid peroxidase antibody >140 IU/mL was established as the most sensitive and specific level for the prediction of MPTC based on receiver operating characteristic curve analyses. Thyroid peroxidase antibody, age, tumor size, and multifocality exhibited the ability to predict CLNM in PTC with HT patients with an area under the curve of 81.1% based on a multivariate model.Hashimoto thyroiditis was associated with increased prevalences of multifocality and capsular invasion. In contrast, HT was associated with a reduced risk of CLNM in PTC and MPTC patients, which indicated a potential protective effect. We found that the prognostic prediction model was applicable for predicting multifocality and CLNM in PTC patients with HT.

Prognostic value of preoperative anti‐thyroglobulin antibody in differentiated thyroid cancer

“…One case report showed that the appearance of TgAb may indicate the presence of metastatic LNs, but only in a limited number of subjects . These findings differed from those of a recent study by Zhu et al., which conducted a retrospective survey of 763 patients to examine the risk factors for central and lateral neck LN metastases in PTC associated with HT. A total of 277 (36.3%) patients with PTC and HT had a lower central LN metastasis rate than those with PTC and non‐HT, indicating a protective effect.…”

Possible Mechanisms of the Association of Thyroiditis and Papillary Carcinoma of the Thyroid Gland

“…Частота діагносту-вання хронічного тиреоїдиту одночасно з ПК за об'єднаними даними літератури становить від 0,5 до 85 % [4,6,31,32]. Такі значні від-мінності, ймовірно, відображають як особли-вості патоморфологічного визначення, так і інтерпретації хронічного тиреоїдиту.…”

“…Мишуніна, М.Д. Тронько заперечували думку, що тиреоїдит Хашимото не визначає, а затримує розвиток раку, бо ци-ркулюючі антитіла перешкоджають прогресії пухлин [26,32,38,61].…”

“…У хворих з тиреоїдитом Хашимото приб-лизно вдвічі частіше, ніж «класична» зуст-річається мультифокальна ПК [32]; у 3 рази -її Warthin-подібний варіант, за якого му тації BRAF відбуваються рідше, ніж у «кла сичній» [64]. Слід також відмітити, що у пацієнтів з хронічним тиреоїдитом у два рази частіше, ніж у хворих без такого реєстрували фолікулярну будову ПК [14], а її дифузно-склерозуючий варіант, який є однією з найагресивніших форм цього раку, як правило, супроводжується двобічним тиреоїдитом Хашимото [65].…”

Clinical value of ultrasonic elastography in diagnosing thyroid carcinoma

“…Given its slow development and lack of clinical specificity, thyroid cancer can be hardly detected in the early period [2]. Currently, ultrasonic elastography has emerged as a new type of ultrasonoscopy technology with a wide array of applications [3]. In ultrasonic elastography, an external force is first exerted on tissues to cause distortion and deformation.…”