Current issues relating to diagnostics and treatment of papillary thyroid cancer with coexistent autoimmune thyroiditis

Authors

DOI:

https://doi.org/10.14739/2310-1210.2020.5.214740

Keywords:

autoimmune thyroiditis, papillary thyroid carcinoma

Abstract

 

Recent studies have shown that papillary thyroid cancer (PTC) associated with autoimmune thyroiditis (AIT) has a higher percentage of malignant nodes. However, it has not been studied how AIT affects the development and course of PTC.

The aim was to determine the incidence of autoimmune thyroiditis in papillary thyroid cancer and study the frequency of its metastasis.

Materials and methods. A retrospective analysis of 63 case histories of patients diagnosed with PTC who received treatment in the Surgery Department of “VIZUS” LLC from January 2018 to December 2019 was performed. The mean age of the patients was 53.1 ± 10.4 years. There were 56 (88.9 %) women and 7 (11.1 %) men among the patients. All the patients underwent surgical treatment. An inclusion criterion for the main group was pathohistologically confirmed PTC and AIT – 33 patients (52.4 %). The comparison group included patients with PTC without AIT – 30 (47.6 %).

Results. Hypothyroidism was detected in 5 (15.2 %) persons of the main group, and the other patients were diagnosed with euthyroidism – 28 (84.8 %). All the comparison group patients - 30 (100 %) were in a state of euthyroidism. Elevation of antibodies to thyroperoxidase (AT-TPO) was found in 14 (42.4 %) persons in the main group, while no increase in this indicator was found among the comparison group patients. The specific to AIT changes in the ultrasonographic characteristics of the thyroid parenchyma were detected in 13 patients (39.4 %) of the main group and in 9 (30.0 %) patients of the comparison group, P = 0.3714. Following the cytological examination results of thyroid nodule aspirates, follicular neoplasia was detected in 6 (18.2 %) patients of the main group and in 2 (6.7 %) of the comparison group, P = 0.0473. The pathohistological examination revealed a combination of PTC with AIT in 33 (52.4 %) patients. Cancer metastasis to the regional lymph nodes was observed in 14 (42.4 %) patients with AIT and 10 (33.3 %) patients of the comparison group, P < 0.0356.

Conclusions. The results of ultrasound, fine-needle aspiration biopsy and measurement of serum thyroid hormone levels are not sufficiently informative to diagnose AIT. The specific to AIT changes in the thyroid parenchyma impede the diagnosis of malignancies. The metastasis frequency in PTC with coexistent AIT is higher than without it.

References

Bothra, N., Shah, N., Goroshi, M., Jadhav, S., Padalkar, S., Thakkar, H., Toteja, G. S., Shivane, V., Lila, A., & Bandgar, T. (2017). Hashimoto's thyroiditis: relative recurrence risk ratio and implications for screening of first-degree relatives. Clinical Endocrinology, 87(2), 201-206. https://doi.org/10.1111/cen.13323

Kutlu Kaya, C., Gümrükçü, S., Saraç, A. S., & Kök, F. N. (2020). A multifunctional long-term release system for treatment of hypothyroidism. Journal of Biomedical Materials Research, 108A(3), 760-769. https://doi.org/10.1002/jbm.a.36855

Sheremet, M. I. (2019). Optymizatsiia diahnostyky, khirurhichnoho likuvannia ta prohnozuvannia perebihu vuzlovoho endemichnoho zoba na tli avtoimunnoho tyreoidytu z urakhuvanniam molekuliarno-henetychnykh predyktoriv. (Dis… dokt. med. nauk). [Optimization of diagnostics, surgical treatment and prognosis of the course of nodular endemic goiter on the background of autoimmune thyroiditis, taking into account molecular genetic predictors]. (Dr. med. sci. diss.). Ternopil. [in Ukrainian].

Ragusa, F., Fallahi, P., Elia, G., Gonnella, D., Paparo, S. R., Giusti, C., Churilov, L. P., Ferrari, S. M., & Antonelli, A. (2019). Hashimotos' thyroiditis: Epidemiology, pathogenesis, clinic and therapy. Best Practice & Research Clinical Endocrinology & Metabolism, 33(6), Article 101367. https://doi.org/10.1016/j.beem.2019.101367

Gabalec, F., Srbova, L., Nova, M., Hovorkova, E., Hornychova, H., Jakubikova, I., Ryska, A., & Cap, J. (2016). Impact of Hashimoto's thyroiditis, TSH levels, and anti-thyroid antibody positivity on differentiated thyroid carcinoma incidence. Endokrynologia Polska, 67(1), 48-53. https://doi.org/10.5603/EP.a2016.0022

Sheremet, M. I., Sydorchuk, L. P., Shidlovskyi, V. O., Bedeniuk, A. D., Kurochkin, G. S., & Levitsky, A. V. (2017). Polimorfizm heniv APO-1/Fas, CTLA-4 ta BCL-2 u patsiientiv, operovanykh iz pryvodu vuzlovoi patolohii shchytopodibnoi zalozy [APO-1/Fas, CTLA-4 and BCL-2 genes polymorphism in patients, operated on nodular thyroid pathology]. Shpytalna khirurhiia. Zhurnal imeni L. Ya. Kovalchuka, (2), 13-20. https://doi.org/10.11603/2414-4533.2017.2.7949 [in Ukrainian].

Grani, G., Carbotta, G., Nesca, A., D'Alessandri, M., Vitale, M., Del Sordo, M., & Fumarola, A. (2015). A comprehensive score to diagnose Hashimoto's thyroiditis: a proposal. Endocrine, 49(2), 361-365. https://doi.org/10.1007/s12020-014-0441-5

Sheremet, M. I, Shidlovskiy, V. O., & Sidorchuk, L. P. (2014). Avtoimunnyi tyreoidyt. Suchasni pohliady na patohenez ta likuvannia (ohliad literatury) [Autoimmune thyroiditis.Modern views on the pathogenesis and treatment (literature review)]. Endokrynolohiia, 19(3), 227-235. [in Ukrainian].

Tkachenko, V. I., & Rimar, Ya. Yu. (2018). Suchasnyi pohliad na faktory ryzyku zloiakisnykh novoutvoren shchytopodibnoi zalozy: systemnyi analiz [Modern view on the risk factors for malignant tumors of the thyroid gland: a systematic review]. Simeina medytsyna, (3), 57-66. [in Ukrainian].

Molnár, C., Bádon, E. S., Mokánszki, A., Mónus, A., Beke, L., Győry, F., Nagy, E., & Méhes, G. (2020). High Genetic Diversity and No Evidence of Clonal Relation in Synchronous Thyroid Carcinomas Associated with Hashimoto's Thyroiditis: A Next-Generation Sequencing Analysis. Diagnostics, 10(1), Article 48. https://doi.org/10.3390/diagnostics10010048

Silva de Morais, N., Stuart, J., Guan, H., Wang, Z., Cibas, E. S., Frates, M. C., Benson, C. B., Cho, N. L., Nehs, M. A., Alexander, C. A., Marqusee, E., Kim, M. I., Lorch, J. H., Barletta, J. A., Angell, T. E., & Alexander, E. K. (2019). The Impact of Hashimoto Thyroiditis on Thyroid Nodule Cytology and Risk of Thyroid Cancer. Journal of the Endocrine Society, 3(4), 791-800. https://doi.org/10.1210/js.2018-00427

Bogdanova, T., Zurnadzhy, L., Masiuk, S., Burko, S., Degtyaryova, T., Kovalenko, A., Bolgov, M., Chernyshov, S., Gulevatyi, S., Thomas, G., & Tronko, M. (2019). Histopathological characteristics and post-operative follow-up of patients with potentially radiogenic papillary thyroid carcinoma depending on oncocytic changes availability in the tumor cells. Experimental Oncology, 41(3), 235-241. https://doi.org/10.32471/exp-oncology.2312-8852.vol-41-no-3.13554

Tessler, F. N., Middleton, W. D., Grant, E. G., Hoang, J. K., Berland, L. L., Teefey, S. A., Cronan, J. J., Beland, M. D., Desser, T. S., Frates, M. C., Hammers, L. W., Hamper, U. M., Langer, J. E., Reading, C. C., Scoutt, L. M., & Stavros, A. T. (2017). ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. Journal of the American College of Radiology, 14(5), 587-595. https://doi.org/10.1016/j.jacr.2017.01.046

Alshaikh, S., Harb, Z., Aljufairi, E., & Almahari, S. A. (2018). Classification of thyroid fine-needle aspiration cytology into Bethesda categories: An institutional experience and review of the literature. CytoJournal, 15, Article 4. https://doi.org/10.4103/cytojournal.cytojournal_32_17

Kapan, M., Onder, A., Girgin, S., Ulger, B. V., Firat, U., Uslukaya, O., & Oguz, A. (2015). The reliability of fine-needle aspiration biopsy in terms of malignancy in patients with Hashimoto thyroiditis. International Surgery, 100(2), 249-253. https://doi.org/10.9738/INTSURG-D-13-00209.1

Haugen, B. R., Alexander, E. K., Bible, K. C., Doherty, G. M., Mandel, S. J., Nikiforov, Y. E., Pacini, F., Randolph, G. W., Sawka, A. M., Schlumberger, M., Schuff, K. G., Sherman, S. I., Sosa, J. A., Steward, D. L., Tuttle, R. M., & Wartofsky, L. (2016). 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 26(1), 1-133. https://doi.org/10.1089/thy.2015.0020

Shirley, L. A., Jones, N. B., & Phay, J. E. (2017). The Role of Central Neck Lymph Node Dissection in the Management of Papillary Thyroid Cancer. Frontiers in Oncology, 7, Article 122. https://doi.org/10.3389/fonc.2017.00122

How to Cite

1.
Zavhorodnyi SM, Zymnia KO, Rylov AI, Danyliuk MB, Kubrak MA. Current issues relating to diagnostics and treatment of papillary thyroid cancer with coexistent autoimmune thyroiditis. Zaporozhye Medical Journal [Internet]. 2020Oct.20 [cited 2024Dec.26];22(5). Available from: http://zmj.zsmu.edu.ua/article/view/214740

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Original research