title: The risk factors for malignancy in surgically treated patients for Graves' disease, toxic multinodular goiter, and toxic adenoma.
abstract: BACKGROUND
  The impact of age, gender, and coexisting cold nodules on the frequency of thyroid carcinoma in hyperthyroid patients in an endemic iodine-deficient region was investigated.
  
  
  METHODS
  The medical records of 817 patients who underwent operations for Graves' disease (GD) (n= 342), toxic multinodular goiter (TMG) (n = 299), and toxic adenoma (TA) (n = 176) between January 1988 and April 2006 were reviewed.
  
  
  RESULTS
  Cold nodules were found in 293 (36%) of the patients, and 524 (64%) patients had no cold nodules. The incidence of thyroid carcinoma was 6.5% (53/817).The frequency of carcinoma was 3.8% in GD, 6.4% in TMG, and 12% in TA. The frequency of carcinoma in older patients (>/=50 years) was significantly higher than in younger patients (10.2% vs 4.3%, P = .001). The presence of cold nodules significantly increased the frequency of carcinoma (13% vs 2.9%, P = .001). A tumor was discovered within a cold nodule in 45% of the patients with thyroid carcinoma.
  
  
  CONCLUSIONS
  Cold nodules are frequent in hyperthyroid patients in endemic iodine-deficient regions. Older patients (>/=50 years) and cold nodules are significant risk factors for malignancy in patients with hyperthyroidism. Surgical treatment may be suitable for those particular patients if malignancy can not be excluded.
authors.affiliation: Department of General Surgery, Istanbul Medical Faculty, Istanbul, Turkey. ygiles@superonline.com
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Senyurek Giles
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Giles Senyurek
authors.forename: Faith
authors.initials: F
authors.lastname: Tunca
authors.forename: Tunca
authors.initials: T
authors.lastname: Fatih
authors.forename: Harika
authors.initials: H
authors.lastname: Boztepe
authors.forename: Boztepe
authors.initials: B
authors.lastname: Harika
authors.forename: Yersu
authors.initials: Y
authors.lastname: Kapran
authors.forename: Kapran
authors.initials: K
authors.lastname: Yersu
authors.forename: Tarik
authors.initials: T
authors.lastname: Terzioglu
authors.forename: Terzioglu
authors.initials: T
authors.lastname: Tarik
authors.forename: Serdar
authors.initials: S
authors.lastname: Tezelman
authors.forename: Tezelman
authors.initials: T
authors.lastname: Serdar
mesh_terms: D000236:Adenoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D005260:Female; D006042:Goiter / Q000473:pathology* / Q000601:surgery; D006111:Graves Disease / Q000473:pathology* / Q000601:surgery; D006801:Humans; D006980:Hyperthyroidism / Q000473:pathology* / Q000601:surgery; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000453:epidemiology*; D013965:Thyroidectomy