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Hyperthyroidism with thyroid cancer: more common than expected?

Süleyman Özkan Aksoy, Ali İbrahim Sevinç, Merih Güray Durak

    Annali Italiani Di Chirurgia
    |March 18, 2020
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    The prevalence of thyroid cancer in hyperthyroid patients undergoing surgery is 22.6%, with most being small papillary microcarcinomas. Treatment for these microcarcinomas remains under discussion due to low invasion and metastasis rates.

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    Area of Science:

    • Endocrinology
    • Oncology
    • Surgical Pathology

    Background:

    • Hyperthyroidism encompasses various conditions with increasing rates of co-occurring thyroid cancer.
    • Common causes of hyperthyroidism include toxic multi-nodular goiter, Graves' disease, and toxic adenoma.
    • Thyroid cancer detection in hyperthyroid patients is a growing clinical concern.

    Purpose of the Study:

    • To determine the incidental thyroid cancer rate in patients surgically treated for hyperthyroidism.
    • To identify patient subgroups where surgical intervention for hyperthyroidism is most indicated.
    • To analyze the characteristics of thyroid cancer found in hyperthyroid patients.

    Main Methods:

    • Retrospective analysis of 591 patients who underwent thyroid surgery for hyperthyroidism.
    • Data collected between January 2007 and June 2017.
    • Histopathological examination of surgical specimens to identify thyroid cancer.

    Main Results:

    • Thyroid cancer was detected in 131 out of 591 patients (22.6%).
    • The most frequent underlying condition was toxic multi-nodular goiter (67.9% of cancers).
    • Thyroid micropapillary carcinoma was the most common histologic type (49.6% of cancers), often without lymphovascular invasion or significant lymph node metastasis.

    Conclusions:

    • The prevalence of thyroid cancer in hyperthyroid patients is significant and increasing.
    • Surgical treatment for hyperthyroidism reveals a high rate of incidental thyroid cancer.
    • The management of small, non-invasive thyroid microcarcinomas found in hyperthyroid patients requires further consideration.