Endocrine Abstracts

Introduction: The prevalence of palpable thyroid nodules in Graves’ disease (GD) is approximately 15%. Cytopathologic interpretation in GD is challenging due to frequent cytomorphologic changes, namely after radioactive iodine (RAI) therapy. Some of the few published studies regarding fine-needle aspiration (FNA) in patients with GD, suggest an increased risk of malignancy of thyroid nodules arising in GD patients. However, the results are inconsistent, and there is no consensus.

Objective: To characterize FNA results of thyroid nodules in GD patients and analyze if there is a higher rate of malignancy.

Methods: We conducted a retrospective review that included all patients who underwent FNA between 01/09/2021 and 01/09/2022 at our center. Statistical analysis was done using SPSS Statistics v.29.0. A P-value <0.05 was considered statistically significant.

Results: We analyzed 1281 FNA results from 1015 patients with an average age of 61.76±12.12 years. There were 852 women (83.9%) and 163 men (16.1%). FNA results were nondiagnostic (ND) in 480 cases (37.5%), benign in 660 (51.5%), follicular lesion of undetermined significance (FLUS) in 102 (8.0%), follicular neoplasm (FN) in 13 (1.0%), suspicious for malignancy (SM) in 9 (0.7%) and malignant in 17 (1.3%). Thirteen patients included (1.3%) had GD and their cytopathological results were: ND in 7 (41.2%), benign in 7 (41.2%), FLUS in 2 (11.8%) and malignant in 1 (5.9%). None of the nodules in patients with GD was diagnosed as SM or FN. The patient with a malignant result underwent total thyroidectomy, and histological examination revealed papillary carcinoma. One of the patients with FLUS underwent total thyroidectomy, and histological examination was benign. One of the patients with GD had FNA done after RAI, and the result was ND. We found no significant difference between FNA results in patients with or without GD (P=0.393). In a subanalysis of patients with only benign or malignant cytological diagnosis, there was no significant difference in the rate of malignancy between patients with or without GD (12,5 vs. 2,4%, P=0,19).

Conclusion: In this study, there was no significant difference in the malignancy rate of thyroid nodules in patients with or without GD. These findings are inconsistent with some published studies suggesting that GD is associated with a higher risk of thyroid cancer. However, this study is limited by the small number of GD patients with thyroid nodules requiring FNA. This reinforces the need for robust studies to clarify the risk of thyroid malignancy in GD.