CLINICAL THYROIDOLOGY FOR PATIENTS
A publication of the American Thyroid Association
Thyroid cancer exhibits aggressive behavior in Graves’ disease
ABBREVIATIONS & DEFINITIONS
Hyperthyroidism: a condition where the thyroid gland is overactive and produces too much thyroid hormone. Hyperthyroidism may be treated with antithyroid meds (Methimazole, Propylthiouracil), radioactive iodine or surgery.
Graves’ disease: the most common cause of hyperthyroidism in the United States. It is caused by antibodies that attack the thyroid and turn it on.
Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. While most thyroid nodules are non-cancerous (Benign), ~5% are cancerous.
There has been some controversy about the aggressiveness of thyroid cancer diagnosed in patients with active Graves’ disease. A previous study by the same authors reported that thyroid cancer is more aggressive and has a poorer prognosis in patients with Graves’ disease. This study investigates the long-term disease-specific mortality of thyroid cancer in patients with active Graves’ disease as compared with thyroid cancer in patients who do not have Graves’ disease and are not hyperthyroid.
THE FULL ARTICLE TITLE:
Pellegriti G et al, Increased mortality in patients with differentiated thyroid cancer associated with Graves’ disease. J Clin Endocrinol Metab 2013; 98:1014-21. Epub January 24, 2013.
SUMMARY OF THE STUDY
A total of 21 patients with thyroid cancer and active Graves’ disease were compared with 70 patients with thyroid cancer but without Graves’ disease and with normal thyroid function. All patients underwent total thyroidectomy and were followed according to a standardized protocol. After a period of follow-up ranging from 50 to 364 months (average 166 months) patients were evaluated for persistent/recurrent cancer and overall survival. Persistent/recurrent cancer was significantly more common in patients with Graves’ disease than in control patients. A total of 9 of 21 patients with Graves’ disease (42.9%) had persistent/recurrent cancer as compared to only 9 of 70 control patients (12.9%). Disease specific mortality was also significantly higher in patients with Graves’ disease (6 of 21, 28.6%) compared to the control group (2 of 70, 2.9%).
WHAT ARE THE IMPLICATIONS OF THIS STUDY?
The findings of this study suggest that patients with Graves’ disease should be followed carefully for thyroid nodules and that those patients with thyroid cancer and active Graves’ disease be treated more aggressively than those thyroid cancer patients without active Graves’ disease.
— Frank Crantz, M.D., FACP, FACE
ATA THYROID BROCHURE LINKS
Graves’ disease: http://www.thyroid.org/what-is-graves-disease
Thyroid cancer: http://www.thyroid.org/cancer-of-the-thyroid-gland
Thyroid nodules: http://www.thyroid.org/what-are-thyroid-nodules