1 Endocrine Unit, Department of Pathophysiology, Laikon General Hospital, University of Athens Medical School, Athens, Greece .
Thyroid. 2014 Feb;24(2):347-54. doi: 10.1089/thy.2013.0133. Epub 2013 Sep 11.
Patients with Graves' disease (GD) and thyroid nodules have an elevated risk of developing thyroid carcinomas, which is primarily accounted for by well-differentiated tumors. Among these tumors, certain histological variants, such as the diffuse sclerosing and tall cell carcinoma, are characterized by a more aggressive behavior. The aim of this study was to evaluate the incidence, the clinical behavior in relation to histological variants, and the outcome of papillary thyroid carcinoma (PTC) in a cohort of patients with GD who had undergone thyroidectomy.
A total of 2188 patients who underwent total thyroidectomy participated in this retrospective, nonrandomized, population-based study at a General Hospital. Of these patients, 181 had GD. The parameters examined included the clinical characteristics of the tumor and the final pathological examination of the thyroid carcinoma.
PTC was diagnosed in 570 patients. Among the 61 with PTC GD-positive, 59.0% presented with the pure papillary variant, 19.7% with the follicular variant, 6.6% with the sclerosing variant, and 18.0% with the tall cell variant (TCV) of PTC. Among 509 PTC GD-negative, 80.6% had pure papillary variant, 9.0% follicular variant, 3.7% sclerosing variant, and 6.1% TCV. Patients with tumor size >5 and ≤10 mm demonstrated that lymph node metastasis (p=0.001) and TCV in histological examination (p=0.003) were statistically significantly associated with GD-positive PTC.
The incidence of PTC in GD-positive patients is higher than that in GD-negative patients. Aggressive variants of PTC, such as the TCV, were more frequent in nodular micro-PTC. These findings suggest that prompt and meticulous evaluation of nodules in any patient with GD associated with nodular alterations must be considered.
患有格雷夫斯病（GD）和甲状腺结节的患者发生甲状腺癌的风险增加，主要由分化良好的肿瘤引起。在这些肿瘤中，某些组织学变体，如弥漫性硬化和高细胞癌，具有更具侵袭性的行为。本研究旨在评估在接受甲状腺切除术的 GD 患者队列中，乳头状甲状腺癌（PTC）的发病率、与组织学变体相关的临床行为和结局。
共有 2188 名在综合医院接受全甲状腺切除术的患者参与了这项回顾性、非随机、基于人群的研究。其中 181 名患者患有 GD。检查的参数包括肿瘤的临床特征和甲状腺癌的最终病理检查。
诊断出 570 例 PTC。在 61 例 PTC GD 阳性患者中，59.0%为纯乳头状变体，19.7%为滤泡变体，6.6%为硬化变体，18.0%为 PTC 的高细胞变体（TCV）。在 509 例 PTC GD 阴性患者中，80.6%为纯乳头状变体，9.0%为滤泡变体，3.7%为硬化变体，6.1%为 TCV。肿瘤大小>5 且≤10mm 的患者中，淋巴结转移（p=0.001）和组织学检查中的 TCV（p=0.003）与 GD 阳性 PTC 有统计学显著关联。
GD 阳性患者中 PTC 的发生率高于 GD 阴性患者。PTC 的侵袭性变体，如 TCV，在结节微 PTC 中更为常见。这些发现表明，任何患有 GD 并伴有结节改变的患者，都必须考虑对结节进行及时和细致的评估。
