Adults with Graves’ disease treated with antithyroid drugs at higher risk for some cancers
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Key takeaways:
- The risk for biliary tract/pancreatic, thyroid, prostate and ovarian cancer is higher for Korean adults with Graves’ disease vs. controls.
- More studies are needed to examine cancer risks in other countries.
Adults with Graves’ disease treated with antithyroid drugs have a higher risk for multiple types of cancer compared with the general population, according to findings published in Thyroid.
“Patients with Graves’ disease who received antithyroid drugs as initial treatment exhibited elevated risks of biliary tract and pancreatic, prostate, ovarian and thyroid cancers,” Seo Young Sohn, MD, PhD, associate professor in the division of endocrinology and metabolism, department of internal medicine at Myongji Hospital, Hanyang University College of Medicine in South Korea, and colleagues wrote. “The increased risk remained significant after excluding the first year of follow-up and continued to be significant 5 years after the diagnosis of Graves’ disease.”
Researchers collected data from the National Health Information Database of South Korea of 29,502 adults aged 20 years and older diagnosed with Graves’ disease from 2005 to 2012 who received antithyroid drug therapy for more than 60 days. Adults with Graves’ disease were matched 1:2 by age, sex and index year, with a control group of 57,173 adults without Graves’ disease. Incidences of cancer were obtained from diagnosis codes.
During a mean follow-up of 12.4 years, 16.5% of adults with Graves’ disease and 9.7% of adults in the control group were diagnosed with cancer. In multivariable analyses, those with Graves’ disease had a higher risk for developing liver cancer (HR = 1.26; 95% CI, 1.13-1.41), biliary tract or pancreatic cancer (HR = 1.48; 95% CI, 1.32-1.67), thyroid cancer (HR = 18.45; 95% CI, 14.76-23.08), prostate cancer (HR = 1.56; 95% CI, 1.35-1.79) and ovarian cancer (HR = 1.23; 95% CI, 1.07-1.41).
“Our findings regarding risk of thyroid cancer should be interpreted with caution, considering the epidemiological features related to overdiagnosis of thyroid cancer,” the researchers wrote. “In Korea, a national screening program for other common malignancies implemented in the early 2000s has contributed to increased opportunistic examinations for thyroid cancer. Thus, the increase in thyroid cancer incidence in many countries, including Korea, may be attributable to the increased use of ultrasound and imaging tools, enhancing the detection of indolent tumors.”
In a sensitivity analysis excluding the first year of follow-up, adults with Graves’ disease continued to have a significantly higher risk for biliary tract and pancreatic cancer (HR = 1.41; 95% CI, 1.24-1.6), thyroid cancer (HR = 15.51; 95% CI, 12.29-19.57), prostate cancer (HR = 1.48; 95% CI, 1.28-1.71) and ovarian cancer (HR = 1.31; 95% CI, 1.13-1.52) compared with controls. After 5 or more years of follow-up, the risk for biliary tract and pancreatic cancer (HR = 1.48; 95% CI, 1.28-1.72), thyroid cancer (HR = 15.86; 95% CI, 11.93-21.07), prostate cancer (HR = 1.41; 95% CI, 1.19-1.68) and ovarian cancer (HR = 1.39; 95% CI, 1.17-1.64) remained higher for adults with Graves’ disease than those without Graves’ disease.
The researchers cautioned that the study findings may not be generalizable to other populations since it consisted of people living in South Korea. More studies are needed to assess whether the findings change in populations with different genetics or those exposed to different environmental factors, the researchers wrote.
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