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Thyroid carcinoma in Graves' disease.

L M Farbota, D B Calandra, A M Lawrence

    Surgery
    |December 1, 1985
    PubMed
    Summary

    Graves' disease patients show a 5.1% thyroid carcinoma incidence, significantly higher than the general population. This suggests human thyroid-stimulating immunoglobulin (HTSI) may play a role in thyroid cancer development.

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    Area of Science:

    • Endocrinology
    • Oncology
    • Pathology

    Background:

    • The prevailing theory links thyroid-stimulating hormone (TSH) to thyroid cancer genesis.
    • Graves' disease, an autoimmune hyperthyroid condition, is mediated by human thyroid-stimulating immunoglobulin (HTSI), not TSH.
    • Previous reports suggest a possible association between Graves' disease and thyroid carcinoma.

    Purpose of the Study:

    • To investigate the incidence of thyroid carcinoma in patients with Graves' disease.
    • To explore a potential role for HTSI in thyroid carcinogenesis, analogous to TSH.

    Main Methods:

    • Retrospective review of 117 consecutive patients operated on for Graves' disease between 1961 and 1984.
    • Analysis of patient demographics, medical history (including head and neck irradiation), and pathological findings.
    • Follow-up assessment for carcinoma recurrence and patient outcomes.

    Main Results:

    • Six out of 117 patients (5.1%) were diagnosed with thyroid carcinoma (four papillary, two follicular).
    • Two of four patients (50%) with a history of head and neck irradiation developed carcinoma.
    • Mean follow-up of 8.1 years showed no carcinoma recurrences; all affected patients remain well.

    Conclusions:

    • The observed 5.1% carcinoma incidence in Graves' disease patients is substantially higher than the 0.1%-0.2% in autopsy series.
    • This finding supports the hypothesis that HTSI may have a carcinogenic role in the thyroid.
    • Further research is warranted to elucidate the specific mechanisms of HTSI-induced thyroid carcinogenesis.

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