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Thyroid nodules increase cancer risk in Graves’ disease
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The preoperative detection of thyroid nodules was associated with a higher prevalence of thyroid cancer in patients with Graves’ disease, according to a meta-analysis of observational studies published in Clinical Endocrinology.
“It was previously thought that disorders characterized by hyperthyroidism, such as [Graves’ disease], were protective against thyroid cancer,” Anastasios Papanastasiou, MD, PhD, PharmD, of the department of surgery at AHEPA University Hospital and the Aristotle University of Thessaloniki Medical School in Greece, and colleagues wrote in the study background. “However, recent studies demonstrate an increased prevalence of thyroid cancer in patients with [Graves’ disease]. In addition, the natural history of thyroid cancer in patients with [Graves’ disease] is controversial: Some studies report a higher rate of lymph node metastasis and mortality, while others report the contrary.”
In a systematic review and meta-analysis, Papanastasiou and colleagues analyzed data from seven retrospective, observational studies with 2,582 patients assessing thyroid malignancy in Graves’ disease. All patients underwent total or near-total thyroidectomy; postoperative diagnosis of thyroid cancer was determined by histopathology. Researchers assessed the number of patients with Graves’ disease with and without preoperatively detected thyroid nodules accompanied by the prevalence of thyroid cancer. Researchers used a random-effects model to estimate ORs for thyroid cancer in Graves’ disease with thyroid nodules determined by clinical exam and ultrasonography.
Across studies, the frequency of thyroid cancer ranged from 3.8% to 29.2%; mean prevalence of thyroid malignancy was 11.5% (n = 297 patients). Researchers observed thyroid nodules in 968 patients (37.5%). Patients with Graves’ disease were stratified by preoperative detection of at least one thyroid nodule or no nodules. Patients in the thyroid nodule group had a markedly higher prevalence of cancer vs. the no-nodule group (22.2% vs. 5.1%), for an OR of 5.3 (95% CI, 2.4-11.6).
In sensitivity analyses excluding patients with malignant or suspicious cytology (n = 2,019; 647 patients with at least one thyroid nodule) results persisted, with those in the thyroid nodule group four times more likely to have thyroid malignancy (OR = 4.02; 95% CI, 1.24-12.99). There were no between-group differences in a separate subanalysis of four studies comparing malignancy rates in patients with a single nodule (n = 118) vs. multiple nodules (n = 512), according to researchers.
The researchers noted that the retrospective data of the selected studies had led to confounding bias and high heterogeneity.
“Consequently, further prospective research on cancer risk in patients with [Graves’ disease] is required to confirm this finding,” the researchers wrote. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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