Incidence of Thyroid Cancer in Patients Operated for Hyperthyroidism: Our 10-year Experience

INTRODUCTION: Hyperthyroidism is a clinical condition caused by inappropriate secretion of excess thyroid hormone (t4 and t3) from the thyroid gland. It is characterized by high t4, t3, and suppressed thyroid-stimulating hormone levels. In addition, studies conducted in recent years have shown that the rates of thyroid cancer with especially aggressive histology in-crease in patients with hyperthyroidism. The aim of this study is to determine the incidence of thyroid cancer in patients who underwent surgery for hyperthyroidism and to determine the patient groups that should be evaluated more carefully before surgery.
METHODS: The study was designed as a retrospective and cohort study. A total of 301 patients who underwent surgery for hyperthyroidism between January 2012 and February 2022. The patients were divided into three groups: Graves’ disease (GD), TMG, and toxic adenoma (TA). Age, gender, type of surgery, post-operative pathology results, tumor characteristics, and post-operative complications of the patients were recorded.
RESULTS: Thyroid cancer was detected in 65 (22%) patients. The incidence of thyroid carcinoma in GD, TMNG, and TA was 16%, 24%, and 50%, respectively. The final pathology results of patients with malignancy were as follows: Classical variant of papillary thyroid carcinoma (PTC) in 23% (n=15) of patients, follicular variant of PTC in 63% (n=41) of the patients, diffuse sclerosing variant of PTC in 7% (n=4) of patients, and 7% (n=5) of patients had papillary thyroid microcarcinoma. Overall, multifocality (39%) was the most common finding, followed by lymphovascular invasion (13%) and finally extrathyroidal invasion (6%).
DISCUSSION AND CONCLUSION: The results of our study show that the risk of thyroid cancer is not low in patients with hyperthyroidism. The risk of malignancy should not be ignored during the evaluation and management of patients with hyperthyroidism. Therefore, careful histopathological examination may help reveal an incidental tumor located in a hyperfunctional nodule or extranodular thyroid tissue.

Hipertiroidi Nedeniyle Ameliyat Edilen Hastalarda Tiroid Kanseri Ýnsidansý: 10 Yýllýk Deneyimimiz

GÝRÝÞ ve AMAÇ: Hipertiroidizm, tiroid hormonunun tiroid bezi tarafýndan aþýrý sentezlenip salgýlandýðý patolojik bir hastalýktýr. Son yýllarda yapýlan çalýþmalar hipertiroidili hastalarda tiroid kanseri oranlarýnýn arttýðýný ve bu hastalarda görülen malignitenin agresif histolojik özelliklere sahip olduðunu göstermiþtir. Bu çalýþmanýn amacý, hipertiroidizm nedeniyle ameliyat edilen hastalarda tiroid kanseri görülme sýklýðýný belirlemek ve ameliyat öncesi daha dikkatli deðerlendirilmesi gereken hasta gruplarýný belirlemektir.
YÖNTEM ve GEREÇLER: Çalýþma retrospektif bir kohort çalýþmasý olarak tasarlandý. Ocak 2012 ile Þubat 2022 tarihleri arasýnda hipertiroidizm nedeniyle ameliyat edilen toplam 301 hasta çalýþmaya katýldý. Hastalar GD (graves hastalýðý), TMG (toksik multinoduler guatr) ve TA (toksik adenom) olmak üzere üç gruba ayrýldý. Hastalarýn yaþý, cinsiyeti, cerrahi tipi, postoperatif patoloji sonuçlarý, tümör özellikleri ve postoperatif komplikasyonlarý kaydedildi.
BULGULAR: Hastalarýn 65’inde (%22) tiroid kanseri saptandý. GD, TMNG ve TA’da tiroid karsinomu insidansý sýrasýyla %16, %24 ve %50 idi. Maligniteli hastalarýn nihai patoloji sonuçlarý þöyleydi: Hastalarýn %23’ünde (n=15) PTC’nin klasik varyantý, %63’ünde (n=41) PTC’nin foliküler varyantý, %7’sinde (n=4) diffüz sklerozan PTC varyantý ve %7’sinde (n=5) papiller tiroid mikrokarsinomu vardý. Genel olarak, multifokalite (%39) en yaygýn bulguydu, bunu lenfovasküler invazyon (%13) ve son olarak tiroid dýþý invazyon (%6) izledi.
TARTIÞMA ve SONUÇ: Çalýþmamýzýn sonuçlarý hipertiroidisi olan hastalarda tiroid kanseri riskinin düþük olmadýðýný göstermektedir. Hipertiroidili hastalarýn deðerlendirilmesi ve yönetimi sýrasýnda malignite riski göz ardý edilmemelidir. Bu nedenle, dikkatli histopatolojik inceleme, hiperfonksiyonel bir nodül veya ekstranodüler tiroid dokusunda yer alan rastlantýsal bir tümörü ortaya çýkarmaya yardýmcý olabilir.