CLINICAL THYROIDOLOGY FOR PATIENTS
A publication of the American Thyroid Association
High risk of thyroid cancer in patients with multinodular goiter
Thyroid cancer is common and the incidence is increasing rapidly, especially in women. Thyroid cancer presents as a thyroid nodule. There has been controversy in the literature about the risk of thyroid cancer in patients with multiple thyroid nodules (multinodular goiter) as well as with Graves’ disease and toxic nodular goiters which are the most common causes of hyperthyroidism. Initially, studies suggested that patients with Graves’ disease, multinodular goiter and toxic nodular goiter carried a lower risk of thyroid cancer than patients with only a single thyroid nodule. However, recent studies suggested a higher risk of cancer in these patients (10-20%). This study looked at how frequently thyroid cancer was found in patients undergoing thyroid surgery because of Graves’ disease, multinodular goiter and toxic nodular goiter.
THE FULL ARTICLE TITLE:
Smith JJ et al. Cancer after thyroidectomy: a multi-institutional experience with 1,523 patients. J Am Coll Surg 2013;216:571-9. Epub February 8, 2013.
SUMMARY OF THE STUDY
This study reviewed studies from 3 centers in the United States. A total of 1523 patients underwent thyroid surgery between 2000 and 2011. All patients with cancer or indeterminate fine needle aspiration biopsy findings before the operation were excluded from this analysis. The risk of thyroid cancer was calculated and analysis was performed to identify the risk factors for thyroid cancer. The total risk of cancer was 16% in the studies and was similar in all 3 centers. The average cancer size was 1.1 cm and 39% of cancers were larger than 1 cm. Younger age, male sex and presence of nodules were associated with higher risk of thyroid cancer. The highest risk of cancer was found in toxic nodular goiter (18%) and the lowest risk in Graves’ disease (6%).
WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study suggests that the risk of thyroid cancer in patients with multiple nodules is high as nearly one in five patients with multiple nodules had thyroid cancer. However, this does represent a selected population as all of these patients went to surgery, so the results cannot be applied to all patients with multiple nodules. Despite this, it is clear that the risk of thyroid cancer in patients with multiple nodules is not less than those with single nodules. Further, this study confirms that patients with Graves’ disease to have a lower risk of thyroid cancer. Finally, this study does suggest that total thyroidectomy by an experienced surgeon should be more considered in patients with multiple nodules, especially in males and younger patients.
—Jamshid Farahiti, MD
ATA THYROID BROCHURE LINKS
Thyroid Nodules: http://www.thyroid.org/what-are-thyroid-nodules
Graves’ disease: http://www.thyroid.org/what-is-graves-disease
Thyroid cancer: http://www.thyroid.org/cancer-of-the-thyroid-gland
Thyroid Surgery: http://thyroid.org/patients/patient_brochures/surgery.html