Original ArticleAutoimmune Thyroid Disease: A Risk Factor for Thyroid Cancer
Section snippets
INTRODUCTION
Chronic tissue inflammation is associated with an increased risk of tissue-specific malignant disease (1, 2). Multiple mechanisms may contribute to inflammation-induced tumorigenesis (1., 2., 3.).
Autoimmune thyroid diseases (Hashimoto disease and Graves disease) cause chronic thyroid inflammation, and their prevalence in the general population is about 10% (4). The association between autoimmune thyroid diseases and the risk of thyroid carcinoma is controversial. Some retrospective pathology
Study Subjects
The patient population was 2, 500 consecutive patients with at least one ultrasonography-confirmed thyroid nodule with an indication for FNAB, as described in the subsequent material. All patients underwent assessment in the office of a single endocrinologist in North Carolina from January 1, 2004, to October 1, 2009. The Institutional Review Board of the New Hanover Regional Medical Center, Wilmington, North Carolina, approved this study.
Investigations
All patients with a known or suspected thyroid disorder
RESULTS
In a total of 2, 500 patients, there were 3, 658 thyroid nodules that met the criteria for FNAB, and FNAB was performed on all 3, 658 nodules. A total of 550 patients underwent thyroidectomy, 253 of whom had thyroid cancer. Thyroid cancer was found in the nodule (or nodules) under investigation in 202 of these patients. In an additional 51 patients undergoing thyroidectomy, a thyroid cancer was found that was less than 0.5 cm in diameter and had not been suspected preoperatively. These lesions
DISCUSSION
Our first goal was to test the hypothesis that an association exists between thyroid cancer and clinical markers of autoimmune thyroid disease. The statistical power of finding such a relationship was enhanced by investigating an endocrine referral population with a higher prevalence of autoimmune thyroid disease than that of about 10% observed in unselected populations (4). The thyroid cancer cohort included all patients with thyroid cancer in the nodule under investigation plus all patients
CONCLUSION
In patients with ultrasonography-confirmed thyroid nodules, elevated levels of TgAb were associated with an increased risk of any thyroid cancer as well as clinically significant thyroid cancer. Elevated TPOAb levels were not associated with an increased risk of thyroid cancer. These results are consistent with the hypothesis that thyroid inflammation is tumorigenic, but other interpretations may explain this relationship. If these results can be confirmed in a prospective study of an
DISCLOSURE
The authors have no multiplicity of interest to disclose.
ACKNOWLEDGMENT
For performing the statistical analysis and for expert statistical advice, we acknowledge Maggie N. Kuchibhatla, PhD, Associate Professor of Biostatistics, Duke University Department of Statistics, Durham, North Carolina. For advice about presenting and interpreting our results, we are grateful to Dr. Lewis E. Braverman. We also thank the Wilmington Endocrinology staff, especially Brandy Lundberg, Karly Rivenbark, and Jessica Burcham, for their tireless effort and assistance in helping with
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