Microcarcinomas more likely found in chronic lymphocytic thyroiditis vs. other thyroid disorders
Adults who undergo thyroid surgery for noncancerous indications are more likely to have incidental findings of papillary thyroid cancer if they have chronic lymphocytic thyroiditis than either multinodular goiter or Graves’ disease, according to findings published in Thyroid.
“Incidentally discovered thyroid microcarcinomas are more common in patients with Hashimoto thyroiditis — also known as chronic lymphocytic thyroiditis — than in patients with multinodular goiters, while patients with Graves’ disease present with a lower incidence compared with both groups,” Juan Carlos Jaume, MD, professor of medicine, chief of the division of endocrinology, diabetes and metabolism, and director of the Center for Diabetes and Endocrine Research at the University of Toledo in Ohio, told Healio. “These data support previously published findings that euthyroid Hashimoto thyroiditis favors carcinogenesis, while Graves’ disease may have a protective role.”
Jaume and colleagues determined the percentage of patients with multinodular goiter (n = 2,933), chronic lymphocytic thyroiditis (n = 617) or Graves’ disease (n = 359) who had papillary thyroid microcarcinomas in a cohort of 3,909 adults who were not diagnosed with thyroid cancer prior to thyroid surgery (mean age, 49.1 years; 79.3% women). The researchers used surgical pathology results to determine the presence of papillary thyroid microcarcinomas.
Among the entire cohort, 14.6% had a papillary thyroid microcarcinoma, including 23.2% of those with chronic lymphocytic thyroiditis, 13.3% of those with multinodular goiter and 10.3% of those with Graves’ disease.
“No one expected microcarcinomas to be found in the background of chronic lymphocytic thyroiditis at such a rate,” Jaume said.
Participants with chronic lymphocytic thyroiditis had greater odds of having a papillary thyroid microcarcinoma than those with multinodular goiter (OR = 1.75; 95% CI, 1.42-2.16). In addition, participants with chronic lymphocytic thyroiditis had more than double the odds of papillary thyroid microcarcinoma than those with Graves’ disease (OR = 2.25; 95% CI, 1.53-3.3).
“These findings suggest that the various forms of autoimmune responses could have different effects on their ability to promote or suppress tumorigenesis,” the researchers wrote. “Some studies have identified an imbalance between cytotoxic and regulatory T lymphocytes in the peritumoral microenvironment in patients with chronic lymphocytic thyroiditis, which may affect the tumor-specific immune response. Therefore, the specific type of inflammatory cells ... could determine the fate of a thyroid cancer.” – by Phil Neuffer
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Juan Carlos Jaume, MD, can be reached at juan.jaume@utoledo.edu.
Disclosures: The authors report no relevant financial disclosures.