Thyroid disease and cancer in kidney transplantation: a single-center analysis

Abstract

Background: Thyroid diseases are frequent in patients with end-stage renal disease, but data on renal transplant recipients are conflicting. This study evaluated the incidence of thyroid disease and cancer in a population of kidney transplant recipients performed in a single center. Methods: Seven hundred sixty patients receiving a kidney transplantation between January 2000 and October 2017 were followed with thyroid ultrasonography to determine nodules together with thyroid hormone levels. Ultrasound-guided fine-needle aspiration citology (FNAc) was performed to the nodules > 10 mm. Results: Two hundred four patients (26.8%) patients demonstrated functional or morphologic changes in the thyroid gland compared with pre-transplant period. Among the 204 patients with newly diagnosed thyroid disease, 165 patients had single or multiple nodular lesions less than 1 cm in diameter, and were followed yearly. Nodule size progression was observed in 23 patients (13.9%), and they underwent a FNAc. A total of sixty-two patients (30.3%) underwent FNAc. The biopsy samples were cytologically interpreted as benign in 20 patients (32.2%), suspicious in 40 patients (64.5%), or at high risk of cancer in 2 patients (3.2%). Forty-two patients underwent total thyroidectomy. At histological examination, 18 patients had a thyroid cancer (papillary cancer in 17 patients, follicular cancer in one). Thyroid cancer was more frequent in male patients with a mean time from transplant to diagnosis of 5.6 years. At a mean follow-up was 8 ± 1.2 years, all patients are alive with a normal functioning graft. Conclusions: Thyroid diseases are common in transplant recipients. Thyroid disease may evolve after transplantation, probably as a consequence of immunosuppression. A complete evaluation of thyroid disease is mandatory in kidney transplant recipients because early diagnosis and appropriate treatment of thyroid disease and cancer may significantly decrease the morbidity and mortality in these patients.

Thyroid cancer in the age of COVID-19

“…Long-term immunosuppression is linked with various complications including cancer incidence. In patients following renal transplants, there is a higher incidence of thyroid cancer thought to be due to the prolonged immunosuppression (Karamchandani et al 2010, Veroux et al 2019. The synchronous appearance of Hashimoto's thyroiditis and thyroid cancer has long connected a dysfunctional immune system with the development of malignancy (Ehlers & Schott 2014).…”

Simultaneous intrathyroidal parathyroid adenomas and multifocal papillary thyroid carcinoma in a patient with kidney transplantation: a case report

“…In total, 3% of patients have occult papillary carcinoma, and the incidence increases with age [19]. The incidence of thyroid papillary carcinoma in kidney transplant recipients is low, some studies evaluated that the incidence of thyroid cancer was 0.22–2.3% [20, 21]. Although the hyperechoic line on the ventral surface of the nodule is an important clue for diagnosing IPA, our patient had no characteristic imaging features [22].…”

De Novo Cancer Incidence after Kidney Transplantation in South Korea from 2002 to 2017

“…The overdiagnosis of thyroid cancer via overutilization of ultrasonography in South Korea may be associated with this high incidence [26]. However, some studies found that the incidence of thyroid cancer was elevated in KT recipients [27,28]. Even in patients with ESRD, thyroid diseases such as hypothyroidism or thyroid nodules were commonly noted due to altered hormone excretion and transport [29,30].…”