Staniforth Joy U L, Erdirimanne Senarath, Eslick Guy D
The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia.
The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia.
Int J Surg. 2016 Mar;27:118-125. doi: 10.1016/j.ijsu.2015.11.027. Epub 2015 Nov 26.
The incidence of thyroid carcinoma is increasing worldwide. Graves' disease is the most common hyperthyroid disease. Studies have suggested an increased risk of thyroid malignancy in Graves' disease: there has not yet been a meta-analysis to allow quantitative comparison. The purpose of this study was to determine the risk of thyroid carcinoma in Graves' disease, and to gather information on the histological subtypes of carcinoma and the co-existence of thyroid nodules.
Several databases and article reference lists were searched. Inclusion criteria included appropriate diagnostic criteria for thyroid conditions and a diagnoses of carcinoma based on histology.
33 studies were selected, all reporting on surgically-resected specimens. The event rate of thyroid carcinoma in Graves' disease was 0.07 (95% CI 0.04 to 0.12). There was no data to allow comparison with patients without hyperthyroid diseases. There was no increase in the odds of developing carcinoma in Graves' disease compared to toxic multinodular goitre and toxic uninodular goitre. 88% of thyroid carcinomas in Graves' disease were papillary, with solitary papillary micro-carcinoma (diameter 10 mm or less) comprising 23% of all detected thyroid carcinomas. Patients with Graves' disease and co-existing thyroid nodules were almost 5 times more likely to be diagnosed with thyroid carcinoma than those without nodules.
Thyroid malignancy in Graves' disease requiring surgical treatment should be considered as likely as in other hyperthyroid diseases needing surgical treatment. Clinicians should consider screening selected patients with Graves' disease for nodules whilst being aware of potentially over-diagnosing papillary micro-carcinoma.
甲状腺癌的发病率在全球范围内呈上升趋势。格雷夫斯病是最常见的甲状腺功能亢进疾病。研究表明格雷夫斯病患者患甲状腺恶性肿瘤的风险增加：但尚未进行荟萃分析以进行定量比较。本研究的目的是确定格雷夫斯病患者患甲状腺癌的风险，并收集有关癌组织学亚型及甲状腺结节共存情况的信息。
检索了多个数据库及文章参考文献列表。纳入标准包括甲状腺疾病的适当诊断标准以及基于组织学的癌诊断。
共选择了33项研究，均报告了手术切除标本的情况。格雷夫斯病患者甲状腺癌的发生率为0.07（95%可信区间0.04至0.12）。没有数据可用于与非甲状腺功能亢进疾病患者进行比较。与毒性多结节性甲状腺肿和毒性单结节性甲状腺肿相比，格雷夫斯病患者发生癌的几率没有增加。格雷夫斯病患者中88%的甲状腺癌为乳头状癌，孤立性乳头状微癌（直径10毫米或更小）占所有检测到的甲状腺癌的23%。伴有甲状腺结节的格雷夫斯病患者被诊断为甲状腺癌的可能性几乎是非结节患者的5倍。
需要手术治疗的格雷夫斯病患者发生甲状腺恶性肿瘤的可能性应被视为与其他需要手术治疗的甲状腺功能亢进疾病一样。临床医生应考虑对部分格雷夫斯病患者进行结节筛查，同时要意识到可能存在对乳头状微癌的过度诊断。
