title: Increased aggressiveness of thyroid cancer in patients with Graves' disease.
abstract: To evaluate whether coexistence of Graves' disease affects the prognosis of thyroid cancer we examined the clinical and pathological characteristics of 22 differentiated thyroid carcinomas concomitant with hyperthyroidism; 13 were associated with Graves' disease, and 9 with autonomous thyroid nodules. Carcinomas were identified in a consecutive series of 359 hyperthyroid patients (132 with Graves' disease and 227 with autonomous thyroid nodules) who underwent surgery during a 6-yr period. One hundred and thirty-seven thyroid carcinomas were found in the 582 euthyroid patients operated on in the same period. In Graves' patients, carcinomas were more often multifocal (46.1% vs. 0%), locally invasive (61.5% vs. 11.1%), and metastatic to lymph nodes (61.5% vs. 11.1%) or to distant sites (23.0% vs. 0%) than in patients with autonomous thyroid nodules. In addition, carcinomas concomitant with Graves' disease were larger (3.3 +/- 1.8 vs. 1.0 +/- 0.7 cm) than the ones associated with autonomous thyroid nodules and showed a high recurrence rate. In euthyroid patients, aggressiveness of thyroid cancer was intermediate. Serum TSH levels were suppressed in all hyperthyroid patients with thyroid cancer. However, circulating thyroid-stimulating antibodies were present in 12 of 13 cancer patients with Graves' disease, but were absent in patients with autonomous thyroid nodules. Our study suggests, therefore, that TSAb may play a role in determining the high aggressiveness of thyroid cancer in Graves' disease patients and indicates that a vigorous treatment should be pursued in this subgroup of patients.
authors.affiliation: Cattedra di Endocrinologia e Patologia Costituzionale, Ospedale Garibaldi, Catania, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Belfiore
authors.forename: M R
authors.initials: MR
authors.lastname: Garofalo
authors.forename: D
authors.initials: D
authors.lastname: Giuffrida
authors.forename: F
authors.initials: F
authors.lastname: Runello
authors.forename: S
authors.initials: S
authors.lastname: Filetti
authors.forename: A
authors.initials: A
authors.lastname: Fiumara
authors.forename: O
authors.initials: O
authors.lastname: Ippolito
authors.forename: R
authors.initials: R
authors.lastname: Vigneri
mesh_terms: D006111:Graves Disease / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006801:Humans; D013964:Thyroid Neoplasms / Q000150:complications* / Q000473:pathology