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2014 ; 24
(7
): 1107-14
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Hashimoto s thyroiditis pathology and risk for thyroid cancer
#MMPMID24708347
Paparodis R
; Imam S
; Todorova-Koteva K
; Staii A
; Jaume JC
Thyroid
2014[Jul]; 24
(7
): 1107-14
PMID24708347
show ga
BACKGROUND: Hashimoto's thyroiditis (HT) has been found to coexist with
differentiated thyroid cancer (DTC) in surgical specimens, but an association
between the two conditions has been discounted by the medical literature.
Therefore, we performed this study to determine any potential relationship
between HT and the risk of developing DTC. METHODS: We collected data for
thyrotropin (TSH), thyroxine (T4), thyroid peroxidase antibody (TPO-Ab) titers,
surgical pathology, and weight-based levothyroxine (LT4) replacement dose for
patients who were referred for thyroid surgery. Patients with HT at final
pathology were studied further. To estimate thyroid function, patients with
preoperative hypothyroid HT (Hypo-HT) were divided into three equal groups based
on their LT4 replacement: LT4-Low (<0.90 ?g/kg), LT4-Mid (0.90-1.43 ?g/kg), and
LT4-High (>1.43 ?g/kg). A group of preoperatively euthyroid (Euth-HT) patients
but with HT by pathology was also studied. All subjects were also grouped based
on their TPO-Ab titer in TPO-high (titer >1:1000) or TPO-low/negative (titer
<1:1000 or undetectable) groups. The relationship of HT and DTC was studied
extensively. RESULTS: Of 2811 subjects, 582 had HT on surgical pathology, 365 of
whom were Euth-HT preoperatively. DTC was present in 47.9% of the Euth-HT, in
59.7% of LT4-Low, 29.8% of LT4-Mid, and 27.9% of LT4-High groups. The relative
risk (RR) for DTC was significantly elevated for the Euth-HT and LT4-Low groups
(p<0.001), but not for the LT4-Mid or LT4-High replacement dose groups.
TPO-low/negative status conferred an increased RR in the Euth-HT and LT4-Low
replacement dose groups (p<0.001 both), while TPO-high status decreased it in
Euth-HT group (p<0.05) and made it nonsignificant in the LT4-Low group.
CONCLUSIONS: HT pathology increases the risk for DTC only in euthyroid subjects
and those with partially functional thyroid glands (LT4-Low) but not in fully
hypothyroid HT (LT4-Mid and LT4-High). High TPO-Ab titers appear to protect
against DTC in patients with HT.
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