Thyroid nodules as a risk factor for thyroid cancer in patients with Graves’ disease: A systematic review and meta‐analysis of observational studies in surgically treated patients

Abstract

ObjectiveGraves’ disease (GD) is an autoimmune thyroid disorder characterized by hyperthyroidism. The incidence of thyroid cancer in patients with GD varies from 0.15% to 15%. There is conflicting evidence on the role of thyroid nodules as a risk factor for thyroid cancer in patients with GD.DesignThree electronic databases (PubMed, Cochrane Library, Scopus) as well as grey literature sources were searched, from inception until 25 February 2019, for observational studies about the prevalence of thyroid cancer in patients with GD.PatientsClinical and ultrasonographic examination was necessary preoperatively for all patients to be classified depending on the presence/absence of thyroid nodules.MeasurementsPrimary outcome was the incidence of thyroid cancer. The latter was determined after total or near‐total thyroidectomy by the histopathologic report. Statistical analysis was performed with revman 5.3 software.ResultsThe systematic review and meta‐analysis included 7 studies with 2582 patients overall. The prevalence of any thyroid cancer was 11.5%. The presence of at least one thyroid nodule in patients with GD was associated with higher risk for thyroid cancer (odds ratio [OR] 5.3, 95% confidence interval [CI] 2.4‐11.6, I2 83%). A subgroup analysis showed no difference in thyroid cancer risk in patients with GD according to the number of nodules (solitary versus multiple) (OR 1.4, 95% CI 0.9‐2.3, I2 0%).ConclusionsThe presence of thyroid nodules is positively associated with the prevalence of thyroid cancer in surgically treated patients with GD. However, further prospective research is needed as the heterogeneity among the studies is high.

Clinical Characteristics and Prognosis of Coexisting Thyroid Cancer in Patients with Graves’ Disease: A Retrospective Multicenter Study

“…A previous review and meta-analysis found that the presence of thyroid nodules increases the risk of thyroid cancer [4,13]. Up to half of GD patients with coexisting thyroid cancer have a nodular goiter on preoperative US [9], and we also found that 80 of the 262 GD patients had other thyroid nodule other than www.e-enm.org page 7 of 9…”

“…Use of screening US for thyroid disease increases the probability of detecting thyroid nodules and patients with thyroid nodules may be at an increased risk for thyroid cancer [12]. A review and meta-analysis of surgically treated GD patients revealed that thyroid nodules are a risk factor of thyroid cancer [13], but the real incidence of thyroid cancer in GD patients who are treated with or without surgery is uncertain.…”

Short-Term Outcomes of Surgery for Graves’ Disease in Germany

“…Total thyroidectomy as surgical treatment for GD is considered to be a fast, consistent and permanent treatment to restore and sustain euthyroidism [ 7 , 8 ] and a postoperative hormonal therapy is necessary. Total thyroidectomy is considered to be the preferred surgical treatment for GD in a variety of clinical scenarios namely when involving nodules, suspicions of malignancy, severe endocrine orbitopathy (EO), large goiters or, in the case of pregnancy and GD, hyperthyroidism [ 9 , 10 ]. Different kinds of subtotal resections were the preferred surgical procedures for GD until approximately the 21st century [ 9 ] and three former RCTs reported lower rates of hypoparathyroidism after bilateral subtotal thyroidectomy than after total thyroidectomy [ 11 , 12 , 13 ].…”

Microcalcifications without a thyroid nodule as the sole sign of papillary thyroid carcinoma

“…Worth noting is the fact that two out of our three patients with PTC diagnosis had underlying Graves’ disease. When found in concomitance with thyroid nodules, Graves’ disease likely confers an increased risk for thyroid carcinoma ( 11 ). Therefore, the implementation of routine USS in all patients with Graves’ disease has been proposed ( 12 ).…”

“…It could be argued that this practice would incur extra costs or subject patients to unnecessary medical interventions but as in the aforementioned cases, it could lead to the early detection of signs of malignancy. A systematic review and meta-analysis of seven retrospective studies involving 2528 patients with Graves’ disease demonstrated that 11.5% (297) had thyroid cancer ( 11 ). Screening can, therefore, benefit a substantial proportion of Graves’ disease patients with an early cancer diagnosis which may impact the management strategy of hyperthyroidism.…”