title: Predictive factors of thyroid cancer in patients with Graves' disease.
abstract: BACKGROUND
  The best preoperative examination in Graves' disease with thyroid cancer still remains uncertain. The objectives of the present study were to investigate the prevalence of thyroid cancer in Graves' disease patients, and to identify the predictive factors and ultrasonographic features of thyroid cancer that may aid the preoperative diagnosis in Graves' disease.
  
  
  METHODS
  This retrospective study included 423 patients with Graves' disease who underwent surgical treatment from 2002 to 2012 at our institution. The clinical features and ultrasonographic findings of thyroid nodules were recorded. The diagnosis of thyroid cancer was determined according to the pathological results.
  
  
  RESULTS
  Thyroid cancer was discovered in 58 of the 423 (13.7 %) surgically treated Graves' disease patients; 46 of those 58 patients had thyroid nodules, and the other 12 patients were diagnosed with incidentally discovered thyroid carcinomas without thyroid nodules. Among the 58 patients with thyroid cancer, papillary microcarcinomas were discovered in 50 patients, and multifocality and lymph node involvement were detected in the other 8 patients. Multivariate regression analysis showed younger age was the only significant factor predictive of metastatic thyroid cancer. Ultrasonographic findings of calcification and intranodular blood flow in thyroid nodules indicate that they are more likely to harbor thyroid cancers.
  
  
  CONCLUSIONS
  Because the influencing factor of metastatic thyroid cancers in Graves' disease is young age, every suspicious nodule in Graves' disease patients should be evaluated and treated carefully, especially in younger patients because of the potential for metastasis.
authors.affiliation: Department of Endocrinology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, No.107 Yan jiang West Road, Guangzhou, 510120, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Ren
authors.forename: Mu Chao
authors.initials: MC
authors.lastname: Wu
authors.forename: Chang Zhen
authors.initials: CZ
authors.lastname: Shang
authors.forename: Xiao Yi
authors.initials: XY
authors.lastname: Wang
authors.forename: Jing Lu
authors.initials: JL
authors.lastname: Zhang
authors.forename: Hua
authors.initials: H
authors.lastname: Cheng
authors.forename: Ming Tong
authors.initials: MT
authors.lastname: Xu
authors.forename: Li
authors.initials: L
authors.lastname: Yan
mesh_terms: D000328:Adult; D005260:Female; D006111:Graves Disease / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D016606:Thyroid Nodule / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D013965:Thyroidectomy; D014463:Ultrasonography