title: Hashimoto's thyroiditis is associated with papillary thyroid carcinoma: role of TSH and of treatment with L-thyroxine.
abstract: The possible association between Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC) is a still debated issue. We analyzed the frequency of PTC, TSH levels and thyroid autoantibodies (TAb) in 13 738 patients (9824 untreated and 3914 under l-thyroxine, l-T(4)). Patients with nodular-HT (n=1593) had high titer of TAb and/or hypothyroidism. Patients with nodular goiter (NG) were subdivided in TAb-NG (n=8812) with undetectable TAb and TAb+NG (n=3395) with positive TAb. Among untreated patients, those with nodular-HT showed higher frequency of PTC (9.4%) compared with both TAb-NG (6.4%; P=0.002) and TAb+NG (6.5%; P=0.009) and presented also higher serum TSH (median 1.30 vs 0.71 μU/ml, P<0.001 and 0.70 μU/ml, P<0.001 respectively). Independently of clinical diagnosis, patients with high titer of TAb showed a higher frequency of PTC (9.3%) compared to patients with low titer (6.8%, P<0.001) or negative TAb (6.3%, P<0.001) and presented also higher serum TSH (median 1.16 vs 0.75 μU/ml, P<0.001 and 0.72 μU/ml, P<0.001 respectively). PTC frequency was strongly related with serum TSH (odds ratio (OR)=1.111), slightly related with anti-thyroglobulin antibodies (OR=1.001), and unrelated with anti-thyroperoxidase antibodies. In the l-T(4)-treated group, when only patients with serum TSH levels below the median value (0.90 μU/ml) were considered, no significant difference in PTC frequency was found between nodular-HT, TAb-NG and TAb+NG. In conclusion, the frequency of PTC is significantly higher in nodular-HT than in NG and is associated with increased levels of serum TSH. Treatment with l-T(4) reduces TSH levels and decreases the occurrence of clinically detectable PTC.
authors.affiliation: Department of Endocrinology, Department of Surgery, University of Pisa, Italy. e.fiore@ao-pisa.toscana.it
authors.forename: E
authors.initials: E
authors.lastname: Fiore
authors.forename: T
authors.initials: T
authors.lastname: Rago
authors.forename: F
authors.initials: F
authors.lastname: Latrofa
authors.forename: M A
authors.initials: MA
authors.lastname: Provenzale
authors.forename: P
authors.initials: P
authors.lastname: Piaggi
authors.forename: A
authors.initials: A
authors.lastname: Delitala
authors.forename: M
authors.initials: M
authors.lastname: Scutari
authors.forename: F
authors.initials: F
authors.lastname: Basolo
authors.forename: G
authors.initials: G
authors.lastname: Di Coscio
authors.forename: L
authors.initials: L
authors.lastname: Grasso
authors.forename: A
authors.initials: A
authors.lastname: Pinchera
authors.forename: P
authors.initials: P
authors.lastname: Vitti
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood; D002291:Carcinoma, Papillary / Q000150:complications*; D005260:Female; D006044:Goiter, Nodular / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D050031:Hashimoto Disease / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007037:Hypothyroidism / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D008297:Male; D011379:Prognosis; D013964:Thyroid Neoplasms / Q000150:complications*; D013967:Thyroiditis, Autoimmune / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D013972:Thyrotropin / Q000097:blood*; D013974:Thyroxine / Q000627:therapeutic use*
chemical_list: D001323:Autoantibodies; D013972:Thyrotropin; D013974:Thyroxine