CLINICAL REPORTS   

Chirurgia 1999 April;12(2):135-8

Copyright © 1999 EDIZIONI MINERVA MEDICA

language: Italian

Hyperthyroidism and thyroid cancer

Cataldi M., Bianchi M., Castelli A.

Although the association between hyperthyroidism and thyroid cancer has been known for many years, it is only recently that this combination has been regarded, not as a curious fact, but rather a clinical problem with real diagnostic and therapeutic implications. The latest series report mean incidences of 4-6% for this correlation. In our experience, out of 128 patients operated for hyperfunctioning thyroid disease, carcinoma was found in 5 (3.9%). The etiopathogenetic mechanisms underlying this association are not yet clear, but it is now certain that thyroid hormones do not provide any protection against carcinoma on the thyroid gland parenchyma, as was thought in the past. Females are most frequently affected, whereas the most common age appears to be 40-60 years old. Histopathological analysis usually shows that the neoplasms are well differentiated, with a prevalence of the papilliferous histotype compared to the follicular type; in this series the papillary carcinoma was the most frequent form. Carcinoma is more commonly found in multinodular toxic goitre (up to 21%) and in diffuse toxic goitre (8%), yet it may reach 22% in Basedow's disease if a cold palpable nodule is present. Contrary to the findings reported in the literature, we observed a high incidence of cancer in patients suffering from toxic adenoma (3 cases; 2.3%). The consequence of this potential association should argue in favour of a diagnostic approach open to this possibility, using all the possible diagnostic means at our disposal, including FNAB. Lastly, from a therapeutic point of view, radical surgery should be preferred, such as total thyroidectomy or, but only in Plummer's disease, total isthmolobectomy, allowing for the possible subsequent radicalisation where cancer is diagnosed in the operated part, a therapeutic approach which we share.