Endocrine Abstracts

Introduction: Graves’ disease (GD) is an autoimmune disorder characterized by diffuse hyperplasia and excessive production of thyroid hormone. The association between thyroid carcinoma and GD is controversial. Thyroid nodular lesions in patients with GD should raise a high suspicion of carcinoma. The aim of this study is to focus on the possibility of an association between hyperthyroidism and thyroid Carcinoma.

Materials and Methods: This is a retrospective study about 7 cases of differentiated thyroid cancer out of 52 patients operated for Graves’ disease in ENT department of Fattouma Bourguiba Hospital of Monastir during a 20-year period (2000-2020).

Results: All patients were female. The average age was 50 years [17-68]. Preoperative thyroid ultrasound revealed a nodular goiter in all cases, suspicious nodules in 4 cases. Indications for surgery included the following: resistance to medical treatment in 2 cases and nodular goiter with suspicious nodules in 4 cases. Frozen histological examination disclosed the presence of carcinoma in 5 cases. These patients underwent a total thyroidectomy, associated to bilateral central neck lymph node dissection. The histology concluded to the diagnosis of a papillary carcinoma in all cases. Among them, there were 2 cases of microcarcinoma. None of the cases showed lymph node metastasis. Surgical treatment was followed by radioactive iodine therapy in all cases. With a mean follow-up of 4 years, there was no distant metastasis or cancer recurrence.

Conclusion: Thyroid nodular lesions in patients with GD are not uncommon. Thus, careful evaluation of all thyroid nodules in GD patients is essential. It seems reasonable to check GD patients for the development of possible thyroid carcinoma, even if they are nodule free.