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Thyroid carcinoma in Graves' disease: A meta-analysis
Joy U L Staniforth1, Senarath Erdirimanne1, Guy D Eslick1
1The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia.
International Journal of Surgery (London, England)
|December 3, 2015
Summary
Graves' disease patients have a 7% incidence of thyroid carcinoma, similar to other hyperthyroid conditions. Co-existing nodules significantly increase cancer risk, warranting careful screening for thyroid malignancy.
Area of Science:
- Endocrinology
- Oncology
- Public Health
Background:
- Global incidence of thyroid carcinoma is rising.
- Graves' disease is the most common hyperthyroid condition.
- Previous studies suggest a link between Graves' disease and increased thyroid malignancy risk.
Purpose of the Study:
- Quantify the risk of thyroid carcinoma in Graves' disease.
- Investigate histological subtypes of carcinoma.
- Examine the role of co-existing thyroid nodules.
Main Methods:
- Systematic literature search of multiple databases.
- Inclusion of studies with established diagnostic criteria for thyroid conditions and histological confirmation of carcinoma.
- Analysis of 33 studies reporting on surgically-resected specimens.
Main Results:
- The incidence rate of thyroid carcinoma in Graves' disease was 0.07 (95% CI 0.04–0.12).
- Papillary thyroid carcinoma constituted 88% of malignancies, with micro-carcinoma accounting for 23%.
- Patients with Graves' disease and nodules had a nearly 5-fold higher risk of carcinoma.
Conclusions:
- Thyroid malignancy risk in Graves' disease requiring surgery is comparable to other hyperthyroid conditions.
- Screening for nodules in selected Graves' disease patients is advised.
- Awareness of potential over-diagnosis of papillary micro-carcinoma is necessary.
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