title: Differentiated thyroid cancer is associated with less aggressive disease and better outcome in patients with coexisting Hashimotos thyroiditis.
abstract: BACKGROUND
  Evaluation of surgical specimens suggests that patients with Hashimoto thyroiditis (HT) have a higher prevalence of differentiated thyroid cancer. Although patients with HT are reported to present with earlier stage disease, there is controversy as to whether these patients have better prognosis when adjusted for histology and stage at presentation.
  
  
  OBJECTIVE
  To investigate differences between patients with differentiated thyroid cancer patients and without HT for aggressiveness of disease and clinical outcome, and the decline rate of antithyroglobulin antibodies titers over time.
  
  
  METHODS
  A retrospective study using the Rabin Medical Center Thyroid Cancer Registry. Seven hundred fifty-three patients were included and divided into 2 groups of patients with and without HT at diagnosis. Disease severity at presentation was evaluated using the entire cohort, whereas a control group matched for age, gender, histology, and stage was used to evaluate disease course and outcome.
  
  
  RESULTS
  HT was present in 14.2% (n = 107) of included patients and was associated with smaller primary tumor (17.9 vs 21.2 mm, P = .01) and less lymph node involvement (23% vs 34%, P = .02) at presentation. When matched groups were compared, patients with HT received less additional radioactive iodine (RAI) treatments (1.24 vs 1.45, P = .03) and showed lower rates of persistence at 1 year (13% vs 26%, P = .04) and higher rates of disease remission at the end of follow-up (90% vs 79%, P = .05). On multivariate analysis HT was predictive of a lower rate of lymph nodes involvement (odds ratio 0.34, 95% confidence interval 0.17-0.66) and persistent disease at the end of follow-up (odds ratio 0.48, 95% confidence interval 0.24-0.93). Antithyroglobulin antibodies slowly disappeared in most patients with no evidence of disease.
  
  
  CONCLUSIONS
  Our study demonstrates that HT is associated with a less aggressive form of differentiated thyroid cancer and a better long-term outcome.
authors.affiliation: Endocrine Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100, Israel.
authors.forename: Shelleg
authors.initials: S
authors.lastname: Dvorkin
authors.forename: Eyal
authors.initials: E
authors.lastname: Robenshtok
authors.forename: Dania
authors.initials: D
authors.lastname: Hirsch
authors.forename: Yulia
authors.initials: Y
authors.lastname: Strenov
authors.forename: Ilan
authors.initials: I
authors.lastname: Shimon
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Benbassat
mesh_terms: D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood; D005260:Female; D050031:Hashimoto Disease / Q000276:immunology*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000276:immunology / Q000473:pathology* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D001323:Autoantibodies; C006606:anti-thyroglobulin