Ergin Ahmet B, Saralaya Sparsha, Olansky Leann
Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH.
Hospital Medicine, Cleveland Clinic.
Am J Otolaryngol. 2014 Nov-Dec;35(6):784-90. doi: 10.1016/j.amjoto.2014.04.013. Epub 2014 May 6.
The prevalence and clinical significance of incidental differentiated thyroid cancer (DTC) in patients with Graves' disease (GD) remain uncertain. Thyroid stimulating antibody (TSI Ab)-titers were thought to be responsible for the potentially increased incidence or aggressiveness of PTC in that setting. The aim of this study was to compare the prevalence of incidental DTC among patients with GD and euthyroid goiter (EG), to assess the ability of TSI to predict DTC in GD and to investigate the clinical features that may predict incidental DTC in GD and EG.
Two hundred and forty eight patients with EG and 245 patients with GD patients who had undergone total thyroidectomy at our institution between 2005 and 2013 were retrospectively selected from our data base. An analysis of incidentally discovered DTC was conducted comparing GD group with EG group.
Incidental micro-papillary thyroid cancer (MPTC) was found in 28% in EG group, as compared to 26% in GD group. PTC Patients with GD were significantly younger (44 vs 59) and less likely to have compressive symptoms than with EG before surgery (p<0.001). In GD group, patients with MPTC were also significantly older (p=0.009) than those without, were more likely to have symptomatic goiter (p<0.001), and to have a nodular disease (p<0.001). TSI ab titer did not predict MPTC in GD group (The AUC curve was 0.55 (95% CI: 0.46, 0.64). Among patients with GD and incidental MPTC, 58% of patients had at least one nodule.
The prevalence of incidental DTC in GD is comparable to EG. Each is increased compared to general population. Age of presentation of PTC was significantly lower in GD suggesting an increased risk for MPTC in GD. Nodule size greater than 1cm predicted incidental DTC whereas TSI ab titers and disease duration did not.
格雷夫斯病（GD）患者中偶发性分化型甲状腺癌（DTC）的患病率及临床意义仍不明确。甲状腺刺激抗体（TSI Ab）滴度被认为是导致该情况下甲状腺乳头状癌（PTC）发病率或侵袭性潜在增加的原因。本研究旨在比较GD患者和甲状腺功能正常的甲状腺肿（EG）患者中偶发性DTC的患病率，评估TSI预测GD中DTC的能力，并研究可能预测GD和EG中偶发性DTC的临床特征。
回顾性从我们的数据库中选取2005年至2013年期间在我们机构接受全甲状腺切除术的248例EG患者和245例GD患者。对偶然发现的DTC进行分析，比较GD组和EG组。
EG组中偶发性微小乳头状甲状腺癌（MPTC）的发现率为28%，而GD组为26%。GD患者的PTC患者明显更年轻（44岁对59岁），且术前出现压迫症状的可能性低于EG患者（p<0.001）。在GD组中，MPTC患者也明显比无MPTC的患者年龄更大（p=0.009），更有可能出现有症状的甲状腺肿（p<0.001），且有结节性疾病（p<0.001）。TSI ab滴度不能预测GD组中的MPTC（AUC曲线为0.55（95%CI：0.46，0.64））。在患有GD和偶发性MPTC的患者中，58%的患者至少有一个结节。
GD中偶发性DTC的患病率与EG相当。与普通人群相比，两者的患病率均有所增加。GD中PTC的发病年龄明显更低，提示GD中MPTC的风险增加。结节大小大于1cm可预测偶发性DTC，而TSI ab滴度和病程则不能。
