Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Endocrinol Metab (Seoul). 2021 Dec;36(6):1268-1276. doi: 10.3803/EnM.2021.1227. Epub 2021 Nov 26.
The association between Graves' disease (GD) and co-existing thyroid cancer is still controversial and most of the previously reported data have been based on surgically treated GD patients. This study investigated the clinicopathological findings and prognosis of concomitant thyroid cancer in GD patients in the era of widespread application of ultrasonography.
Data of GD patients who underwent thyroidectomy for thyroid cancer between 2010 and 2019 in three tertiary hospitals in South Korea (Asan Medical Center, Chonnam National University Hwasun Hospital, and Pusan National University Hospital) were collected and analyzed retrospectively. In the subgroup analysis, aggressiveness and clinical outcomes of thyroid cancer were compared nodular GD and non-nodular GD groups according to the presence or absence of the thyroid nodules other than thyroid cancer (index nodules).
Of the 15,159 GD patients treated at the hospitals during the study period, 262 (1.7%) underwent thyroidectomy for coexisting thyroid cancer. Eleven patients (4.2%) were diagnosed with occult thyroid cancer and 182 patients (69.5%) had microcarcinomas. No differences in thyroid cancer aggressiveness, ultrasonographic findings, or prognosis were observed between the nodular GD and non-nodular GD groups except the cancer subtype. In the multivariate analysis, only lymph node (LN) metastasis was an independent prognostic factor for recurrent/persistent disease of thyroid cancer arising in GD (P=0.020).
The prevalence of concomitant thyroid cancer in GD patients was considerably lower than in previous reports. The clinical outcomes of thyroid cancer in GD patients were also excellent but, more cautious follow-up is necessary for patients with LN metastasis in the same way as for thyroid cancer in non-GD patients.
格雷夫斯病（GD）与并存甲状腺癌之间的关联仍存在争议，并且大多数之前报道的数据都是基于手术治疗的 GD 患者。本研究在超声广泛应用的时代，调查了 GD 患者中同时存在的甲状腺癌的临床病理发现和预后。
收集并回顾性分析了 2010 年至 2019 年在韩国三家三级医院（Asan 医疗中心、全南国立大学 Hwasun 医院和釜山国立大学医院）因甲状腺癌接受甲状腺切除术的 GD 患者的数据。在亚组分析中，根据除甲状腺癌以外的甲状腺结节（索引结节）的存在与否，比较了结节性 GD 和非结节性 GD 组的甲状腺癌的侵袭性和临床结果。
在研究期间，在医院接受治疗的 15159 例 GD 患者中，有 262 例（1.7%）因并存甲状腺癌而行甲状腺切除术。11 例（4.2%）被诊断为隐匿性甲状腺癌，182 例（69.5%）为微癌。除癌症亚型外，结节性 GD 和非结节性 GD 组之间在甲状腺癌侵袭性、超声表现或预后方面均无差异。多变量分析显示，只有淋巴结（LN）转移是 GD 患者甲状腺癌复发/持续存在的独立预后因素（P=0.020）。
GD 患者并存甲状腺癌的患病率明显低于以往报道。GD 患者甲状腺癌的临床结局也很好，但与非 GD 患者的甲状腺癌一样，对于 LN 转移的患者需要更加谨慎的随访。
