Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato (CA), Italy.
Istituto Pancreas, Policlinico Borgo Roma, AOUI Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
J Otolaryngol Head Neck Surg. 2018 Jan 22;47(1):6. doi: 10.1186/s40463-018-0254-2.
Hyperthyroidism is associated with high incidence of thyroid carcinoma; furthermore, tumors arisen in hyperthyroid tissue show an aggressive behavior. Thyroid Stimulating Hormone (TSH) and Thyroid-stimulating antibodies, present in Graves's disease, seem to play a key role in carcinogenesis and tumoral growth.
We retrospectively reviewed our series of patients who underwent thyroidectomy for thyroid carcinoma. We compared pathological features and surgical outcomes of hyperthyroid versus euthyroid patients.
From 2007 to 2015, 909 thyroidectomies were performed at our institution for thyroid cancer: 87 patients were hyperthyroid and 822 euthyroid. We observed, in hyperthyroid patients, a higher rate of transient hypoparathyroidism (28.1% vs 13.2%; p < 0.01) and of node metastases (12.6% vs 6.1%; p = 0.03); also local recurrence rate was higher (5.7% vs 2.5%) even if not statistically significant (p = 0.17). Five-year disease free survival rate was significant lower in the same group (89.1% vs 96.6%; p = 0.03).
Thyroid cancers in hyperthyroid patients have an aggressive behavior, with high incidence of local invasion and a worse prognosis than euthyroid patients. All hyperthyroid patients should undergo a careful evaluation with ultrasound and scintigraphy; in case of suspicious nodules, an aggressive approach, including thyroidectomy and lymphectomy, is justified. In patients with toxic adenoma, thyroid cancer is uncommon, thus a loboisthmectomy can be safely performed.
Research registry n. 2670 registered 19 June 2017 (retrospectively registered).
甲状腺功能亢进症与甲状腺癌的发病率高有关；此外，在甲状腺组织中发生的肿瘤表现出侵袭性的行为。促甲状腺激素（TSH）和促甲状腺抗体存在于格雷夫斯病中，似乎在肿瘤发生和肿瘤生长中发挥关键作用。
我们回顾性地审查了我们在甲状腺癌患者中进行甲状腺切除术的系列患者。我们比较了甲状腺功能亢进症和甲状腺功能正常患者的病理特征和手术结果。
在 2007 年至 2015 年期间，我们机构共进行了 909 例甲状腺切除术治疗甲状腺癌：87 例为甲状腺功能亢进症，822 例为甲状腺功能正常。我们观察到甲状腺功能亢进症患者中，暂时性甲状旁腺功能减退症（28.1%对 13.2%；p<0.01）和淋巴结转移的发生率更高（12.6%对 6.1%；p=0.03）；局部复发率也较高（5.7%对 2.5%），尽管无统计学意义（p=0.17）。同一组患者的 5 年无病生存率显著降低（89.1%对 96.6%；p=0.03）。
甲状腺功能亢进症患者的甲状腺癌具有侵袭性，局部侵犯发生率高，预后比甲状腺功能正常患者差。所有甲状腺功能亢进症患者均应通过超声和闪烁显像进行仔细评估；在可疑结节的情况下，包括甲状腺切除术和淋巴结切除术在内的积极方法是合理的。在毒性腺瘤患者中，甲状腺癌并不常见，因此可以安全地进行叶切除术。
研究注册表 n.2670 于 2017 年 6 月 19 日（回顾性注册）注册。
