Clinical Significance of Coexistence of Hashimoto Thyroiditis and Graves’ Disease with Differentiated and Medullary Thyroid Cancer

Abstract

The association of Hashimoto thyroiditis and Graves’ disease with papillary, follicular, and medullary thyroid cancer has not been comprehensively investigated until now. This comparative clinicopathological study of consecutive patients thyroidectomized at a surgical referral center aimed to explore interdependencies between chronic autoimmune thyroiditis and thyroid cancer. Altogether, there were 852 (58.4%) patients with papillary thyroid cancer, 181 (12.4%) patients with follicular thyroid cancer, and 426 (29.2%) patients with sporadic medullary thyroid cancer, of whom 75 (5.1%) patients also had Hashimoto thyroiditis and 40 (2.7%) patients also had Graves’ disease. Patients with papillary (medians of 42 vs. 48 years; P =0.008) and follicular (medians of 33 vs. 63 years; P=0.022) thyroid cancer, unlike patients with medullary thyroid cancer (medians of 57.5 vs. 57 years; P=0.989), were younger at thyroidectomy when they had Hashimoto thyroiditis concomitantly. No such associations were seen with Graves’ disease. Primary thyroid cancers tended to be more localized in conjunction with Hashimoto thyroiditis, and less so with Graves’ disease, although patterns were not consistent across tumor types. In conclusion, Hashimoto thyroiditis, but not Graves’ disease, may be associated with differentiated (papillary and follicular) thyroid cancer but not with medullary thyroid cancer.

Key words

Hashimoto's thyroiditis - Graves' disease - autoimmune thyroiditis - papillary thyroid cancer - follicular thyroid cancer - medullary thyroid cancer

Publication History

Received: 25 June 2021

Accepted: 20 July 2021

Article published online:
13 September 2021

• References

• 1 Guarino V, Castellone MD, Avilla E. et al. Thyroid cancer and inflammation. Mol Cell Endocrinol 2010; 321: 94-102
• 2 Ehlers M, Kuebart A, Hautzel H. et al. Epitope-specific antitumor immunity suppresses tumor spread in papillary thyroid cancer. J Clin Endocrinol Metab 2017; 102: 2154-2161
• 3 Dailey ME, Lindsay S, Skahen R. Relation of thyroid neoplasms to Hashimoto disease of the thyroid gland. AMA Arch Surg 1955; 70: 291-297
• 4 Lee JH, Kim Y, Choi JW. et al. The association between papillary thyroid carcinoma and histologically proven Hashimoto’s thyroiditis: a meta-analysis. Eur J Endocrinol 2013; 168: 343-349
• 5 Ehlers M, Schott M. Hashimoto’s thyroiditis and papillary thyroid cancer: are they immunologically linked?. Trends Endocrinol Metab 2014; 25: 656-664
• 6 Resende de Paiva C, Grønhøj C, Feldt-Rasmussen U. et al. Association between Hashimoto's thyroiditis and thyroid cancer in 64 628 patients. Front Oncol 2017; 7: 53
• 7 Dralle H, Musholt TJ, Schabram J. et al. German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors. Langenbecks Arch Surg 2013; 398: 347-375
• 8 Mizukami Y, Michigishi T, Kawato M. et al. Chronic thyroiditis: thyroid function and histologic correlations in 601 cases. Hum Pathol 1992; 23: 980-988
• 9 Paparodis RD, Karvounis E, Bantouna D. et al. Incidentally discovered papillary thyroid microcarcinomas are more frequently found in patients with chronic lymphocytic thyroiditis than with multinodular goiter or Graves’ disease. Thyroid 2020; 30: 531-535
• 10 McLeod DS, Watters KF, Carpenter AD. et al. Thyrotropin and thyroid cancer diagnosis: a systematic review and dose-response meta-analysis. J Clin Endocrinol Metab 2012; 97: 2682-2692
• 11 Völzke H, Lüdemann J, Robinson DM. et al. The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area. Thyroid 2003; 13: 803-810