Thyroid disease

Hyperthyroidism: More Thyroidectomy Recipients May Have Underlying Cancer Than Previously Thought

The proportion of patients with hyperthyroidism undergoing thyroidectomy who have malignancy may be clinically significant, despite previous reports suggesting the rate of thyroid cancer in this patient population is rare, suggest new findings published in the Journal of Surgical Research.

Although patients with toxic thyroid nodules do not routinely undergo fine needle aspiration (FNA), the authors of the study concluded that, “Patients with distinct thyroid nodules in the presence of hyperthyroidism may have the highest rates of malignancy and should undergo appropriate workup with ultrasound and FNA to exclude underlying malignancy. In cases with suspicious ultrasound features and/or FNA cytopathology, surgical treatment should be considered as initial management.”

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They arrived at their conclusion after conducting a retrospective review of prospectively collected data on 138 patients with hyperthyroidism who underwent thyroidectomy at a single institution. All patients included in the study had received biochemical confirmation of hyperthyroidism with thyroid-stimulating hormone of less than 0.1 mIU/L and a clinical diagnosis made by a referring physician. No patients who had previously undergone thyroid surgery were included in the study.

Patients were categorized based on the presence of Graves’ disease (n = 80), toxic multinodular goiter (n = 46), or toxic solitary nodule (n = 12).

Results of the study showed that 31 (22%) of 138 patients had malignancy on final pathology. Of those with malignancy, approximately 50% had toxic solitary nodule, 24% had toxic multinodular goiter, and 16% had Graves’ disease.

“[T]he present study examined surgical patients with hyperthyroidism and demonstrated a higher than expected rate of underlying malignancy,” the researchers wrote. “Moreover, hyperthyroid patients with structural nodular disease had the highest rates of thyroid cancer and displayed higher rates of aggressive tumor histopathology.”

—Christina Vogt

Alvarez AL, Mulder, M, Handelsman RS, Lew JI, Farra JC. High rates of underlying thyroid cancer in patients undergoing thyroidectomy for hyperthyroidism. J Surg Res. 2020;245:523-528.