BACKGROUND
Graves’ disease is the most common cause of hyperthyroidism in the United States. Treatment options include antithyroid medication to control hyperthyroidism, surgery to remove the thyroid and radioactive iodine therapy to destroy the thyroid. All three treatments are effective options, but only surgery can determine if thyroid cancer be identified in patients with Graves’ disease.

Since Graves’ disease is caused by an antibody that attacks and turns on the thyroid, making it overactive, there has always been a concern that the antibody may increase the development of thyroid cancer. Fortunately, the presence of thyroid cancer in patients with Graves’ disease has been reported to be very low (about 2%). However, the rate of diagnosis of thyroid cancer has increased in recent years in the general population. Because of this, these authors wanted to re-assess the rate of thyroid cancer among patients treated surgically for Graves’ disease.

THE FULL ARTICLE TITLE
Moronta S, et al. Incidental thyroid cancer in patients with Graves’ disease: not as rare as we previously believed. J Surg Res 2025;308:122-128; doi: 10.1016/j. jss.2025.02.024. PMID: 40101333.

SUMMARY OF THE STUDY
This study used a patient data set from the American College of Surgeons National Surgical Quality Improvement Program’s (NSQIP) which anonymously collects information from multiple hospitals. Adult patients were selected who had a total thyroidectomy for Graves’ disease and were excluded if they had preexisting thyroid cancer or were missing data needed for analysis.

A total of 3,193 patients with Graves’ disease were identified who underwent total thyroidectomy between 2013 and 2021. The average age was 42 years (range, 18–93); 82.3% of patients were female and 49.7% were White. Thyroid cancer was found in 406 patients (12.7%).

Almost all the patients were found to have papillary thyroid cancer (95%) or follicular thyroid cancer (3%), the most common types of thyroid cancer. Most patients had thyroid cancer limited to within the thyroid (343 patients (84.5%), and 26 had spread of the cancer to the lymph nodes in the neck (6.4%) disease. Cancers were solitary in 250 (61.6%), followed by 78 (19.2%) patients with multifocal cancer in both thyroid lobes followed by 51 (12.6%) with multifocal cancer only in 1 lobe. Patients with thyroid cancer tended to be older (average age, 47 years vs. 42 years) and had a higher body-mass index (28.9 vs. 27.8).

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
The authors concluded that the rate of undiagnosed thyroid cancer in patients with Graves’ disease who undergo total thyroidectomy was much higher than previously reported and suggested that this information should be considered when counseling patients regarding treatment options for Graves’ disease. However, there are several caveats to this recommendation. Since this is a database analysis based on patients that were already treated, so there is no data on why the patients underwent thyroidectomy for their Graves’ disease or of the rate of thyroid cancer in those patients with Graves’ disease who did not have surgery. All this needs to be considered when discussing treatment options for Graves’ disease with patients. Hopefully future studies will shed more light on this issue.

— Marjorie Safran, MD

Table of Contents | PDF File for Saving and Printing