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Sweis NWG, Zayed AA, Jaberi MA, AlQirem L, Hyasat TB, Khraisat FA, Maaita W, Naser AM, Nimer A, Qatamin M, Sweis JJG, Sweis N, Al-Ani AT, Alghrabli AM, Haghighi A. Geographic variation in the association between Hashimoto's thyroiditis and Papillary thyroid carcinoma, a meta-analysis. Endocrine 2023; 81:432-449. [PMID: 37129757 DOI: 10.1007/s12020-023-03378-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/15/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE The association between papillary thyroid cancer (PTC) and Hashimoto's thyroiditis (HT) remains a matter of debate. Several genetic and environmental factors have been found to influence this association. Because of the variation in these factors among different populations, we conducted a country- and region-based meta-analysis to examine whether the geographic area influences this association. METHODS We searched PubMed and Web of Science databases for original articles that investigated the association between HT and PTC from February 1955 to February 28, 2023. The included studies were stratified according to their country and region of origin. Various subgroup analyses were conducted. The primary outcome was the pooled relative risk (RR) and its 95% confidence interval (CI) for each region and country. RESULTS Forty-six studies including a total of 93,970 participants met our inclusion criteria. They originated from 16 countries distributed in five regions. Significant variation was found among countries but not among regions. Upon analysis of all 46 included studies, countries were classified based on their RR and its 95% CI. Excluding countries with pooled sample sizes <500, Sri Lanka (RR 4.23, 95% CI 2.91-6.14), Poland (RR 3.16, 95% CI 2.79-3.57) and Japan (2.68, 2.14-3.36) showed the strongest association between HT and PTC while Greece (RR 1.06, 95% CI 1.00-1.13), Spain (RR 0.70, 95% CI 0.23-2.11), and Jordan (0.62, 0.32-1.32) showed no significant association. CONCLUSION Our findings revealed a variation in the association between HT and PTC among countries but not among regions. The country-to-country variation could be due to certain genetic and/or environmental factors subject to geographic variation that influence this association. These findings may help guide health policies aiming to mitigate the risk of PTC in the HT population by helping identify high-risk and low-risk countries.
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Affiliation(s)
- Nabil W G Sweis
- The University of Jordan School of Medicine, Amman, 11942, Jordan
| | - Ayman A Zayed
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, The University of Jordan School of Medicine, Amman, 11942, Jordan.
| | - Mira Al Jaberi
- The University of Jordan School of Medicine, Amman, 11942, Jordan
| | - Lina AlQirem
- The University of Jordan School of Medicine, Amman, 11942, Jordan
| | | | - Farah A Khraisat
- The University of Jordan School of Medicine, Amman, 11942, Jordan
| | - Ward Maaita
- The University of Jordan School of Medicine, Amman, 11942, Jordan
| | - Ahmad Moayad Naser
- Department of Internal Medicine, Jordan University Hospital, Amman, 11942, Jordan
| | - Abdullah Nimer
- The University of Jordan School of Medicine, Amman, 11942, Jordan
| | - Mamoon Qatamin
- The University of Jordan School of Medicine, Amman, 11942, Jordan
| | - Jaleel J G Sweis
- The University of Jordan School of Medicine, Amman, 11942, Jordan
| | - Nadia Sweis
- The University of Jordan School of Medicine, Amman, 11942, Jordan
| | - Abdallah T Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, 11941, Jordan
| | - Ahmad M Alghrabli
- Department of Internal Medicine, Jordan University Hospital, Amman, 11942, Jordan
| | - Alireza Haghighi
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Genetics, Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
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Remer LF, Linhares SM, Scola WH, Lew JI. Chronic Lymphocytic Thyroiditis May Limit the Utility of Molecular Testing in AUS/FLUS Thyroid Nodules. J Surg Res 2023; 289:229-233. [PMID: 37148856 DOI: 10.1016/j.jss.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 05/08/2023]
Abstract
INTRODUCTION Chronic lymphocytic thyroiditis (CLT) may increase the likelihood of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) results in thyroid nodules by fine needle aspiration (FNA). Gene expression classifier (GEC) and Thyroid Sequencing (ThyroSeq) may better stratify rate of malignancy (ROM) of AUS/FLUS thyroid nodules. This study compares the utility of molecular tests in determining malignancy in surgical patients with concomitant AUS/FLUS thyroid nodules and CLT. METHODS A retrospective review of 1648 patients with index thyroid nodules who underwent FNA and thyroidectomy at a single institution was performed. Patients with concomitant AUS/FLUS thyroid nodules and CLT were subdivided into three diagnostic groups: FNA only, FNA with GEC, and FNA with ThyroSeq. Patients with AUS/FLUS thyroid nodules without CLT were subdivided into similar groups. Final histopathology of the cohorts was further stratified into benignity and malignancy and analyzed using Chi-squared statistics. RESULTS Of 463 study patients, 86 had concomitant AUS/FLUS thyroid nodules and CLT with a 52% ROM, and the difference of ROM among FNA only (48%), suspicious GEC (50%), or positive ThyroSeq (69%) was not significant. In 377 patients with AUS/FLUS thyroid nodules without CL, ROM was 59%. ROM among these patients was significantly higher when molecular testing was used (FNA only 51%, suspicious GEC 65%, and positive ThyroSeq 68%; P < 0.05). CONCLUSIONS Molecular tests may have limited value in predicting malignancy in surgical patients with concomitant AUS/FLUS thyroid nodules and CLT.
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Affiliation(s)
- Lindsay F Remer
- Division of Endocrine Surgery, DeWitt Daughtry Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida.
| | - Samantha M Linhares
- Division of Endocrine Surgery, DeWitt Daughtry Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - William H Scola
- Division of Endocrine Surgery, DeWitt Daughtry Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - John I Lew
- Division of Endocrine Surgery, DeWitt Daughtry Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
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Suster D, Ronen N, Giorgadze T. Oncocytic nodular hyperplasia of the thyroid. Ann Diagn Pathol 2022; 61:152049. [PMID: 36162158 DOI: 10.1016/j.anndiagpath.2022.152049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/03/2022] [Accepted: 09/18/2022] [Indexed: 11/20/2022]
Abstract
Nodular hyperplasia of the thyroid is a process whereby the gland experiences growth by nodular expansion of thyroid parenchyma. We have encountered 45 patients in whom the process was caused by the growth of well-defined and sharply circumscribed but unencapsulated nodules composed of oncocytic thyroid follicular cells. The lesions arose in 39 women and 6 men, aged 25-69 years (mean = 50.3 years). The surrounding thyroid parenchyma showed features of chronic lymphocytic thyroiditis. The nodules varied from microscopic to 5 cm and appeared to compress the surrounding thyroid parenchyma. Most of the lesions lacked a well-defined capsule. In 26 tumors, the nodules displayed a predominantly follicular pattern of growth; in 8 cases there were admixtures of follicular and trabecular patterns with focal solid areas devoid of follicles. Clinical follow-up in 39 patients ranging from 7 to 22 years (median = 16 years) showed no evidence of recurrence, metastasis, or malignant transformation. One patient died of unknown causes 15 years after the diagnosis, and another patient died 4 years after diagnosis from metastatic colonic adenocarcinoma. Oncocytic nodular hyperplasia is a benign process associated with chronic lymphocytic thyroiditis that should be distinguished from benign and malignant oncocytic (Hurthle cell) tumors of the thyroid.
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Fallahi P, Ferrari SM, Elia G, Paparo SR, Patrizio A, Balestri E, Mazzi V, Gragnani L, Ferri C, Botrini C, Ragusa F, Antonelli A. Thyroid autoimmunity and SARS-CoV-2 infection: Report of a large Italian series. Clin Exp Rheumatol 2022; 21:103183. [PMID: 36007802 PMCID: PMC9395221 DOI: 10.1016/j.autrev.2022.103183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 01/09/2023]
Abstract
Since the beginning of the pandemic, numerous risk factors have been associated with SARS-CoV-2 infection and COVID-19 outcomes, such as older age, male sex, and the presence of comorbidities, such as hypertension, obesity, and diabetes. Preliminary data also suggest epidemiological association between SARS-CoV-2 infection and systemic autoimmune disease. For this reason, we investigated if patients affected by autoimmune thyroid disorders (AITD) are at risk of developing SARS-CoV-2 infection or COVID-19 disease. From April to September 2020, we have conducted a telephone survey that included 515 consecutive unselected patients with known thyroid disorders, of which 350 were affected by AITD. All 11 definitive diagnosis of COVID-19 (def-sympt-COVID-19) belonged to the AITD group, while the rest 14 cases highly suspected for COVID-19 (suspect-sympt-COVID-19) were equally detected in both group (7 in AITD and 7 in not-AITD). The overall prevalence of symptomatic COVID-19 (def-sympt-COVID-19 + suspect-sympt-COVID-19), recorded in the 350 AITD population was statistically significant higher compared to that reported in the Italian and Tuscan general population at the same time period of the present survey (18/350 = 5.14% vs 516/100000 = 0.51% [p < 0.001; OR = 10.45, 95% CI 6.45–16.92] and vs 394/100000 = 0.39% [p < 0.001; OR = 13.70, 95% CI 8.44–22.25], respectively). Therefore, our results suggest a higher prevalence of SARS-CoV-2 infection and COVID-19 disease in patients with AITD.
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Affiliation(s)
- Poupak Fallahi
- Department of Translational Research of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Giusy Elia
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Sabrina Rosaria Paparo
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Armando Patrizio
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Eugenia Balestri
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Valeria Mazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Laura Gragnani
- MASVE Interdepartmental Hepatology Center, Department of Experimental and Clinical Medicine, University of Florence Center, Center for Research and Innovation CRIA-MASVE, Firenze, Italy
| | - Clodoveo Ferri
- Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy; Rheumatology Clinic 'Madonna Dello Scoglio' Cotronei, Crotone, Italy
| | - Chiara Botrini
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Francesca Ragusa
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy.
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Ma B, Chen X, Zhao Z, Yin X, Ji Q, Zhou Y, Ma C, Wang J. Coexisting CLT in PTC is an independent predictor of tumor aggressiveness for patients aged under 55: a retrospective analysis of 635 patients. BMC Endocr Disord 2022; 22:55. [PMID: 35255870 PMCID: PMC8900407 DOI: 10.1186/s12902-022-00945-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 01/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study was aimed at investigating the potential role of chronic lymphocytic thyroiditis (CLT) in papillary thyroid cancer (PTC) aggressiveness for patients aged below 55, as well as to figure out factors influencing potential recurrence risk in different age groups. METHODS A total of 635 adult patients were retrospectively analyzed. 188 patients were diagnosed with coexistent CLT and the remaining 447 were classified as non-CLT. Then the characteristics of CLT-coexisted patients and non-CLT ones were compared respectively when patients were aged ≥ 55 years or below. The association among postoperative clinicopathological features were also analyzed using multivariate regression. In addition, the prognostic value of several variables relating to high-risk recurrence were estimated within different age groups. RESULTS When divided in two age groups (55 years as the borderline), non-CLT group (aged below 55 years) had a remarkable frequency of small size lesion (Dmax ≤ 1 cm) compared with CLT-coexisted patients (54.6% to 43.0%, p = 0.02). In addition, non-CLT patients tended to have intrathyroidal extension as opposed to those with coexistent CLT (20.2% to 28.2%, p = 0.05). In multivariate analysis, CLT still significantly acted as an independent risk factor of greater lesion size (Dmin > 1 cm) (OR = 1.7, p = 0.02) and mildly promoted gross extrathyroidal extension (ETE) (OR = 1.4, p = 0.06). However, associations didn't emerge in the characteristics mentioned above with CLT when patients were ≥ 55 years old. The prognostic value of CLT in high-risk recurrence was evident only in patients aged 35-44 years. (OR = 2.4, 95%CI:1.2-5.4, p = 0.02). Greater lesion size independently promoted gross ETE, no matter patients were aged above 55 years or not. Its prognostic value of high-risk recurrence was significant throughout all age groups. CONCLUSION These findings revealed that CLT coexistence might be the unfavorable factor of PTC aggressiveness in patients aged below 55 years. Its role as well as greater tumor size may potentially predict higher recurrence risk according to results figured out in the prediction model.
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Affiliation(s)
- Bing'e Ma
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, 210028, China
| | - Xiyi Chen
- The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing, 210029, China
| | - Zhengping Zhao
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, 210028, China
| | - Xiaoyang Yin
- The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Qin Ji
- The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Yifan Zhou
- The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Chaoqun Ma
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China.
| | - Jianhua Wang
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, China.
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, 210028, China.
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Lisco G, De Tullio A, Jirillo E, Giagulli VA, De Pergola G, Guastamacchia E, Triggiani V. Thyroid and COVID-19: a review on pathophysiological, clinical and organizational aspects. J Endocrinol Invest 2021; 44:1801-1814. [PMID: 33765288 PMCID: PMC7992516 DOI: 10.1007/s40618-021-01554-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/10/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Thyroid dysfunction has been observed in patients with COVID-19, and endocrinologists are requested to understand this clinical issue. Pandemic-related restrictions and reorganization of healthcare services may affect thyroid disease management. OBJECTIVE AND METHODS To analyze and discuss the relationship between COVID-19 and thyroid diseases from several perspectives. PubMed/MEDLINE, Google Scholar, Scopus, ClinicalTrial.gov were searched for this purpose by using free text words and medical subject headings as follows: "sars cov 2", "covid 19", "subacute thyroiditis", "atypical thyroiditis", "chronic thyroiditis", "hashimoto's thyroiditis", "graves' disease", "thyroid nodule", "differentiated thyroid cancer", "medullary thyroid cancer", "methimazole", "levothyroxine", "multikinase inhibitor", "remdesivir", "tocilizumab". Data were collected, analyzed, and discussed to answer the following clinical questions: "What evidence suggests that COVID-19 may induce detrimental consequences on thyroid function?"; "Could previous or concomitant thyroid diseases deteriorate the prognosis of COVID-19 once the infection has occurred?"; "Could medical management of thyroid diseases influence the clinical course of COVID-19?"; "Does medical management of COVID-19 interfere with thyroid function?"; "Are there defined strategies to better manage endocrine diseases despite restrictive measures and in-hospital and ambulatory activities reorganizations?". RESULTS SARS-CoV-2 may induce thyroid dysfunction that is usually reversible, including subclinical and atypical thyroiditis. Patients with baseline thyroid diseases are not at higher risk of contracting or transmitting SARS-CoV-2, and baseline thyroid dysfunction does not foster a worse progression of COVID-19. However, it is unclear whether low levels of free triiodothyronine, observed in seriously ill patients with COVID-19, may worsen the disease's clinical progression and, consequently, if triiodothyronine supplementation could be a tool for reducing this burden. Glucocorticoids and heparin may affect thyroid hormone secretion and measurement, respectively, leading to possible misdiagnosis of thyroid dysfunction in severe cases of COVID-19. High-risk thyroid nodules require a fine-needle aspiration without relevant delay, whereas other non-urgent diagnostic procedures and therapeutic interventions should be postponed. DISCUSSION Currently, we know that SARS-CoV-2 could lead to short-term and reversible thyroid dysfunction, but thyroid diseases seem not to affect the progression of COVID-19. Adequate management of patients with thyroid diseases remains essential during the pandemic, but it could be compromised because of healthcare service restrictions. Endocrine care centers should continuously recognize and classify priority cases for in-person visits and therapeutic procedures. Telemedicine may be a useful tool for managing patients not requiring in-person visits.
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Affiliation(s)
- G Lisco
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Apulia, Italy.
| | - A De Tullio
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Apulia, Italy
| | - E Jirillo
- Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Apulia, Italy
| | - V A Giagulli
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Apulia, Italy
| | - G De Pergola
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, Bari, Apulia, Italy
| | - E Guastamacchia
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Apulia, Italy
| | - V Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Apulia, Italy.
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Aydoğan Bİ, Mutlu ABB, Yüksel S, Güllü S, Emral R, Demir Ö, Şahin M, Gedik VT, Çorapçıoğlu D, Sak SD, Erdoğan MF. The Association of Histologically Proven Chronic Lymphocytic Thyroiditis with Clinicopathological Features, Lymph Node Metastasis, and Recurrence Rates of Differentiated Thyroid Cancer. Endocr Pathol 2021; 32:280-287. [PMID: 33188468 DOI: 10.1007/s12022-020-09653-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2020] [Indexed: 10/23/2022]
Abstract
The influence of chronic lymphocytic thyroiditis (CLT) on clinicopathological features and behavior of differentiated thyroid carcinoma (DTC) is still debated. In the present study, we aimed to evaluate the prognosis of DTC on the presence of CLT. A total of 649 total thyroidectomized patients (379 female, 270 male) with DTC, who had follow-up data for at least 36 months were included. Clinical, histopathological data, preoperative thyroid peroxidase antibody (TPO-ab), thyroglobulin antibody (Tg-ab), thyroid-stimulating hormone (TSH) levels, and presence of recurrent/persistent disease (R/PD) were evaluated retrospectively. Presence of CLT was defined by histopathology. Frequency of CLT was 32% (n = 208) among DTC patients. Mean tumor size (maximal diameter) was smaller in CLT group when compared to non-CLTs (p = 0.006). Capsular invasion, vascular invasion, tumor stage, risk groups, and R/PD were negatively associated with CLT (p < 0.01, p = 0.04, p = 0.03, p = 0.02, p < 0.01, respectively). Extrathyroidal extension was more frequent in non-CLT group when compared CLT (p = 0.052). Preoperative TSH level was positively associated with lymph node metastasis (LNM) and higher in patients with lateral LNM when compared to central LNM (p < 0.01). Central LNM, lateral LNM, stage 4 tumor, and intermediate- and high-risk tumor groups increased the risk of R/PH, 2.5-, 2.9-, 12.7-, 2.3-, and 4.2-fold, respectively. Presence of CLT was independently related with favorable outcomes, as the risk of R/PD was decreased by 0.49-fold. In conclusion, coexistence of CLT was negatively associated with tumor size, capsular invasion, vascular invasion, and tumor stage in DTC. Risk of R/PD was decreased by approximately half in patients with CLT.
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Affiliation(s)
- Berna İmge Aydoğan
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey.
| | | | - Seher Yüksel
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Sevim Güllü
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Rıfat Emral
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Özgür Demir
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Şahin
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Vedia Tonyukuk Gedik
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Demet Çorapçıoğlu
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serpil Dizbay Sak
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Murat Faik Erdoğan
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
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Vita R, Di Bari F, Capodicasa G, Perelli S, Bonanno AM, Ieni A, Moleti M, Vermiglio F, Tuccari G, Benvenga S. Rates of lymphocytic thyroiditis and ultrasound features of citologically-interrogated thyroid nodules based on the area of residence in a Sicily province. Endocrine 2021; 72:744-757. [PMID: 33063274 DOI: 10.1007/s12020-020-02521-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/03/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To verify the prevalence of autoimmune thyroiditis (AIT) and the ultrasound characteristics (composition and volume) of thyroid nodules with respect to the area of residence in the province of Messina, some areas having environmental issues. METHODS Fine-needle aspiration-interrogated nodules (n = 902) of 809 patients were evaluated upon stratification into 8 areas of residence. RESULTS Overall, women were younger than men (55.3 ± 14.0 vs. 58.6 ± 12.6 years, P = 0.0083). Patients residing in three areas (one hosting two garbage dumps, one hosting a petrochemical complex and a thermoelectrical power plant, and one hosting several ceramic factories [CFA]) were younger than those residing in the city of Messina (MEA) (52.9 ± 13.4 vs. 57.7 ± 13.6 years, P < 0.0001). Also, patients residing in those three areas had a greater rate of AIT, diagnosed either ultrasonographically/serologically (22.2% of patients) or cytologically (26.3% of nodules), compared with MEA (11.7% of patients, P = 0.0007 or 20.2% of nodules, P = 0.0815). Rates of AIT ranged 12.5-28.6% in the remaining four areas. Overall, nodules in women were smaller than in men (3.6 ± 5.7 vs. 6.1 ± 9.4 ml, P = 0.0006). Compared with the other seven areas, patients living in CFA had the largest nodules (6.8 ± 6.8 ml, P = 0.0040-0.0291), with the nodule volume being inversely correlated to patient's age (r = -0.4955, P = 0.0431). CONCLUSION Rates of AIT and associated ultrasound features of thyroid nodules vary in different areas of our province. Further studies correlating these rates and features with exposure to specific toxicants are warranted.
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Affiliation(s)
- Roberto Vita
- Department of Clinical and Experimental Medicine, University of Messina, Viale Gazzi, 98125, Messina, Italy.
| | - Flavia Di Bari
- Department of Clinical and Experimental Medicine, University of Messina, Viale Gazzi, 98125, Messina, Italy
| | - Giovanni Capodicasa
- Department of Clinical and Experimental Medicine, University of Messina, Viale Gazzi, 98125, Messina, Italy
| | - Sarah Perelli
- Department of Clinical and Experimental Medicine, University of Messina, Viale Gazzi, 98125, Messina, Italy
| | - Anna Maria Bonanno
- Department of Human Pathology of Adult and Evolutive Age Gaetano Barresi - Section of Pathological Anatomy, University of Messina, Viale Gazzi, 98125, Messina, Italy
| | - Antonio Ieni
- Department of Human Pathology of Adult and Evolutive Age Gaetano Barresi - Section of Pathological Anatomy, University of Messina, Viale Gazzi, 98125, Messina, Italy
| | - Mariacarla Moleti
- Department of Clinical and Experimental Medicine, University of Messina, Viale Gazzi, 98125, Messina, Italy
| | - Francesco Vermiglio
- Department of Clinical and Experimental Medicine, University of Messina, Viale Gazzi, 98125, Messina, Italy
- Interdepartmental Program on New Models of Multidisciplinary Management in Endocrinology, University Hospital, A.O.U. Policlinico G. Martino, Viale Gazzi, 98125, Messina, Italy
| | - Giovanni Tuccari
- Department of Human Pathology of Adult and Evolutive Age Gaetano Barresi - Section of Pathological Anatomy, University of Messina, Viale Gazzi, 98125, Messina, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Viale Gazzi, 98125, Messina, Italy
- Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Viale Gazzi, 98125, Messina, Italy
- Interdepartmental Program of Molecular & Clinical Endocrinology and Women's Endocrine Health, University Hospital, A.O.U. Policlinico G. Martino, Viale Gazzi, 98125, Messina, Italy
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Osorio C, Ibarra S, Arrieta J, Sarmiento M, Barrios D, Sierra L, Redondo K, Francisco Herrera. Association between chronic lymphocytic thyroiditis and papillary thyroid carcinoma: A retrospective study in surgical specimens. Rev Esp Patol 2020; 53:149-157. [PMID: 32650966 DOI: 10.1016/j.patol.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/25/2019] [Accepted: 07/18/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The hypothesis of an association between papillary thyroid carcinoma (PTC) and chronic lymphocytic thyroiditis (CLT) continues to generate debate. Retrospective studies suggest that there is a greater probability of diagnosing a PTC in surgical specimens with CLT; however, prospective studies suggest that there is no true increase in risk. METHODS An analytical, cross-section measurement and retrospective study was carried out considering gender, age and diagnosis of CLT and PTC in surgical specimens. A binary logistic regression model was proposed to predict the probability of carrying out the diagnosis of PTC based on the diagnosis of CLT, gender and age. RESULTS The study population consisted of 1136 patients, 1047 (92.2%) women and 89 (7.8%) men, with an average age of 47.5±14.3 years. The prevalence of CLT and PTC was 14.9% and 16.1% respectively. Coexistence between PTC and CLT was found in 44 patients, corresponding to 3.9% of the population. Our logistic regression model suggests that the probability of diagnosing PTC in surgical specimens of male patients under 40 years old and with CLT is 53.8%. CONCLUSIONS We suggest that there is a greater probability of diagnosing PTC in surgical specimens with confirmatory histological data for CLT; in addition, in males under 40 years old this probability increases.
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Affiliation(s)
- Carlos Osorio
- Scalpellum Research Group, General Surgery Resident, Faculty of Medicine, Universidad de Cartagena, Cartagena, Colombia.
| | - Sebastián Ibarra
- Scalpellum Research Seedbed, Undergraduate Student, Faculty of Medicine, Universidad de Cartagena, Cartagena, Colombia
| | - Jorge Arrieta
- Scalpellum Research Seedbed, Undergraduate Student, Faculty of Medicine, Universidad de Cartagena, Cartagena, Colombia
| | - Michelle Sarmiento
- Scalpellum Research Seedbed, Undergraduate Student, Faculty of Medicine, Universidad de Cartagena, Cartagena, Colombia
| | - Diego Barrios
- Scalpellum Research Seedbed, Undergraduate Student, Faculty of Medicine, Universidad de Cartagena, Cartagena, Colombia
| | - Lorena Sierra
- Scalpellum Research Seedbed, Undergraduate Student, Faculty of Medicine, Universidad de Cartagena, Cartagena, Colombia
| | - Katherine Redondo
- Scalpellum Research Group, Professor, Faculty of Medicine, Universidad de Cartagena, Cartagena, Colombia; Pathological Anatomy Service, E.S.E. Hospital Universitario del Caribe, Cartagena, Colombia
| | - Francisco Herrera
- Scalpellum Research Group, Associate Professor, Faculty of Medicine, Universidad de Cartagena, Cartagena, Colombia; Head and Neck Surgery Service, E.S.E. Hospital Universitario del Caribe, Cartagena, Colombia
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Ryu YJ, Yoon JH. Chronic lymphocytic thyroiditis protects against recurrence in patients with cN0 papillary thyroid cancer. Surg Oncol 2020; 34:67-73. [PMID: 32891356 DOI: 10.1016/j.suronc.2020.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 02/15/2020] [Accepted: 03/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic lymphocytic thyroiditis (CLT) frequently coexists with papillary thyroid carcinoma (PTC) that exhibits normal thyroid function. However, few studies have investigated the relationship between CLT and clinically lymph node (LN)-negative PTC. The aim of this study was to evaluate the relationship between subclinical central LN metastasis and CLT, and to assess the impact of CLT on the recurrence of clinically LN-negative PTC. METHODS We investigated the medical records of 850 patients with PTC who underwent prophylactic bilateral central neck dissection as well as total thyroidectomy between 2004 and 2010; the median follow-up time was 95.5 months (range, 12-158 months). RESULTS CLT was observed in 480 patients (56.5%). Female sex, a preoperative thyroid-stimulating hormone level >2.5 mU/L, a primary tumor ≤1 cm, no gross extrathyroidal extension, high number of harvested LNs, low number of metastatic LNs, and positive anti-thyroglobulin (Tg) antibody at 1 year post-initial treatment were significantly associated with the presence of CLT. Multivariate analysis revealed that patients with N1a stage (vs. N0 stage; hazard ratio [HR], 3.255; 95% confidence interval [CI], 1.290-8.213; p = 0.012) and positive anti-Tg antibody at 1 year post-initial treatment (vs. negative anti-Tg antibody; HR, 5.118; 95% CI, 2.130-12.296; p < 0.001) had poorer recurrence-free survival (RFS), while those with CLT (vs. no CLT; HR, 0.357; 95% CI, 0.157-0.812; p = 0.014) had favorable RFS outcomes. CONCLUSIONS CLT is associated with less aggressive tumor characteristics and LN metastasis. Clinically LN-negative PTC patients with CLT experience longer RFS intervals than those without CLT.
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Affiliation(s)
- Young Jae Ryu
- Department of Surgery, Chonnam National University Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea.
| | - Jung Han Yoon
- Department of Surgery, Chonnam National University Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea.
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Ren CP, Sun L, Liu FC, Zuo CL, Liu M, Gao W, Shen JJ. Potential role of IL-37 signaling pathway in feedback regulation of autoimmune Hashimoto thyroiditis. Histochem Cell Biol 2019; 152:467-73. [PMID: 31584126 DOI: 10.1007/s00418-019-01820-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2019] [Indexed: 02/06/2023]
Abstract
IL-37, the anti-inflammatory cytokine of the IL-1 family, plays several key roles in the regulation of autoimmune diseases. Yet, its role in Hashimoto's thyroiditis (HT) is not clear. In the present study, we found that, in tissues from HT patients, most of the follicular epithelial cells were positive for both IL-37 and single Ig IL-1-related receptor (SIGIRR) by immunohistochemical staining, while the infiltrating lymphocytes and other inflammatory cells hardly expressed any. Meanwhile, mRNA expression levels of IL-37 in peripheral blood mononuclear cells (PBMC) of HT patients were significantly higher than those in normal controls measured by quantitative real-time PCR. Finally, we studied the possible role of IL-37 in IFN-γ-stimulated rat FRTL-5 cells. The results showed that IL-1β, TNF-α, and MCP-1 mRNA levels were significantly decreased, while the expression of IL-4 mRNA was dramatically up-regulated in IFN-γ-stimulated rat thyroid cell line FRTL-5 pre-treated with IL-37. The current study, for the first time, demonstrated that the IL-37 network is involved in Hashimoto's thyroiditis, and IL-37 signaling pathway may ameliorate the excessive autoimmune responses in this chronic lymphocytic thyroiditis.
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Borowczyk M, Janicki A, Dworacki G, Szczepanek-Parulska E, Danieluk M, Barnett J, Antonik M, Kałużna M, Bromińska B, Czepczyński R, Bączyk M, Ziemnicka K, Ruchała M. Decreased staging of differentiated thyroid cancer in patients with chronic lymphocytic thyroiditis. J Endocrinol Invest 2019; 42:45-52. [PMID: 29619749 PMCID: PMC6304183 DOI: 10.1007/s40618-018-0882-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/24/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE The biological association between chronic lymphocytic thyroiditis (CLT) and differentiated thyroid cancer (DTC) has not been elucidated yet. The aim of the study was to assess whether the presence of CLT exerts any influence on clinical or histological presentation of DTC. METHODS Nine hundred and seven consecutive patients with DTC treated in the years 1998-2016 were divided into two groups according to the presence or absence of concomitant CLT. The statistical differences were analysed. RESULTS Out of 907 patients included in the study, 331 were diagnosed with DTC and CLT (studied group), while 576 patients with DTC but without CLT constituted a control group. The distribution of papillary and follicular thyroid cancer did not differ. In CLT group, the prevalence of pT1 was greater than for pT2-pT4 DTC (P = 0.0003; OR = 1.69, 95% CI 1.27-2.24) compared to controls (68.3 vs. 56.1%, respectively). The presence of multifocal lesions was similar. The thyroid capsule infiltration without extrathyroidal invasion (P < 0.0001; OR = 0.21, 95% CI 0.14-0.31) was more frequent in the studied group, unlike extracapsular invasion, which was significantly more often present in patients with DTC but without CLT (P = 0.004; OR = 1.66; 95% CI 1.17-2.34) as well as nodal involvement (P = 0.048; OR = 0.65, 95% CI 0.42-0.99). CONCLUSIONS The collected data indicate a protective role of CLT in preventing the spread of the DTC. The presence of CLT might limit tumour growth to the primary site.
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Affiliation(s)
- M Borowczyk
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - A Janicki
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - G Dworacki
- Department of Clinical Immunology, Poznan University of Medical Sciences, 5D, Rokietnicka Street, 60-806, Poznan, Poland
| | - E Szczepanek-Parulska
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - M Danieluk
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - J Barnett
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - M Antonik
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - M Kałużna
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - B Bromińska
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - R Czepczyński
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - M Bączyk
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - K Ziemnicka
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland.
| | - M Ruchała
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
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Ren BX, Liu XL, Liu DS, Jing GW, Han S, Xiong L, Zhou CY, Zhang DC. [ Chronic lymphocytic thyroiditis accompanied with primary osteosarcoma of thyroid : a case report and literature review]. Zhonghua Zhong Liu Za Zhi 2018; 40:967-8. [PMID: 30605988 DOI: 10.3760/cma.j.issn.0253-3766.2018.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Although the incidence of some malignancy has decreased over the recent years, this is not the case of papillary thyroid microcarcinoma (PTMC), whose incidence has increased worldwide. Most PTMC are found incidentally after histological examination of specimens from surgery for benign thyroid disease. Hashimoto's thyroiditis, whose incidence has also increased, coexists in about one in three PTMC patients. Three different mechanisms have been proposed to clarify the association between chronic lymphocytic thyroiditis and PTMC, namely tumor development/growth by: (i) TSH stimulation, (ii) expression of certain proto-oncogenes, (iii) chemokines and other molecules produced by the lymphocytic infiltrate. Whether Hashimoto's thyroiditis protects against lymph node metastasis is debated. Overall, autommune thyroiditis seems to contribute to the favorable prognosis of PTMC. Major limitations of the studies so far performed include: (i) retrospective design, (ii) limited statistical power, (iii) high risk of selection bias, (iv) and predominant Asian ethnicity of patients. Full genetic profiling of both diseases and identification of environmental factors capable to trigger them, as well as well-powered prospective studies on different ethnical groups, may help understand their causal association and why their frequencies are continuing raising.
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Affiliation(s)
- Roberto Vita
- Department of Clinical and Experimental Medicine, University of Messina, Viale Gazzi, 98125, Messina, Italy
| | - Antonio Ieni
- Department of Human Pathology of Adult and Evolutive Age "Gaetano Barresi"-Section of Pathological Anatomy, University of Messina, Viale Gazzi, 98125, Messina, Italy
| | - Giovanni Tuccari
- Department of Human Pathology of Adult and Evolutive Age "Gaetano Barresi"-Section of Pathological Anatomy, University of Messina, Viale Gazzi, 98125, Messina, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Viale Gazzi, 98125, Messina, Italy.
- Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Viale Gazzi, 98125, Messina, Italy.
- Interdepartmental Program of Molecular & Clinical Endocrinology and Women's Endocrine Health, University Hospital, A.O.U. Policlinico G. Martino, Viale Gazzi, 98125, Messina, Italy.
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Arena S, Benvenga S. Gender-specific correlation of intranodular chronic lymphocytic thyroiditis with thyroid nodule size, echogenicity, and histologically-verified cytological class of malignancy risk. J Clin Transl Endocrinol 2018; 14:39-45. [PMID: 30416974 PMCID: PMC6216079 DOI: 10.1016/j.jcte.2018.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 12/31/2022]
Abstract
No data are available on the cytologically and histologically demonstrated presence of intranodular chronic lymphocytic thyroiditis (ICLT) and on the ICLT relationship with thyroid nodule characteristics such as size, echotexture and nature (benign or malignant). We wished to fill this gap by analyzing data in a gender-specific fashion. We studied 408 thyroid nodules from 408 consecutive persons (325 females and 83 males). Nodules were isoechoic (n = 268) or hypoechoic (n = 140), ICLT +ve (n = 113 [27.7%]) or ICLT -ve (n = 295), cytologically low-risk (n = 197) or high-risk (n = 211), histologically benign (n = 263) or malignant (n = 145). ICLT prevailed in females (97/113) and in hypoechoic nodules (58/140 [41.4%] vs 55/268 [20.5%], P < 0.0001). Compared to males, females had (i) smaller nodules (18.5 ± 9.4 vs 23.3 ± 13.4 mm, P = 0.0002), a difference due to the isoechoic nodules (21.1 ± 9.8 vs 26.6 ± 14.1 mm, P = 0.0006), (ii) lower rates of high-risk nodules (161/325 [49.5%] vs 50/83 [60.2%], P = 0.082) and malignant nodules (110/325 [33.8%] vs 35/83 [42.2%] P = 0.16). ICLT +ve nodules were smaller than the ICLT -ve ones (15.4 ± 6.9 vs 20.9 ± 11.2 mm, P < 0.0001), a difference due to the isoechoic nodules (17.5 ± 6.5 vs 23.6 ± 11.7 mm, P = 0.0003). The smallest nodules were hypoechoic, cancerous and ICLT +ve nodules in males (9.5 ± 4.0 mm); the largest were isoechoic, cytologically risky and ICLT -ve in males (29.1 ± 13.2 mm). Compared to ICLT -ve nodules, malignancy prevailed in ICLT +ve nodules (55/113 [48.7%] vs 90/295 [30.5%], P = 0.0006), both in hypoechoic (37/58 [63.8%] vs 41/82 [50.0%]) and isoechoic nodules (18/55 [32.7%] vs 49/213 [23.0%]). ICLT +ve hypoechoic nodules of females and ICLT -ve hypoechoic nodules of males had the greatest rate of malignancy (67% both), while ICLT -ve isoechoic nodules of females had the lowest (19%). In conclusion, presence/absence of ICLT is associated with some sexually dimorphic characteristics of thyroid nodules. Adding the specification of ICLT positivity/negativity in cytological reports may help improving the risk of malignancy at least in some groups of thyroid nodules.
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Affiliation(s)
- Salvatore Arena
- A.S.P. 8 Siracusa, Section of Endocrinology and Metabolic Diseases, Department of Internal Medicine, Umberto I Hospital, Siracusa, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Interdepartmental Program of Molecular & Clinical Endocrinology, and Women's Endocrine Health, AOU Policlinico G. Martino, Messina, Italy.,Master Program of Childhood, Adolescent and Women's Endocrine Health, University of Messina, Italy
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Babli S, Payne RJ, Mitmaker E, Rivera J. Effects of Chronic Lymphocytic Thyroiditis on the Clinicopathological Features of Papillary Thyroid Cancer. Eur Thyroid J 2018; 7:95-101. [PMID: 29594061 PMCID: PMC5869368 DOI: 10.1159/000486367] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 12/01/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The effects of chronic lymphocytic thyroiditis (CLT) on the presentation and outcome of papillary thyroid carcinoma (PTC) have long been a topic of controversy. OBJECTIVE To evaluate the effect of coexistent CLT on the clinicopathological features of PTC. DESIGN Retrospective study. PATIENTS All patients with PTC who had been followed by the 2 co-investigators (Juan Rivera and Richard J. Payne) between 2006 and 2011 were included. RESULTS CLT was present in 35% (166) of the included patients and was associated with a higher proportion of patients with TNM stage I (p = 0.027) and fewer patients with persistent disease (p = 0.014) in comparison with the PTC-only group. Analysis of the data based on age (<45 or >45 years) revealed that in the older group, the presence of CLT was associated with fewer patients with persistent disease (p = 0.03) and capsular invasion (p = 0.05). However, in patients <45 years of age, the presence of CLT was associated with more capsular invasion (p = 0.003) and extrathyroidal extension (p = 0.004) compared with the PTC-only group. CONCLUSIONS CLT in patients with PTC was associated with lower-stage disease and less disease persistence in patients >45 years of age. In patients <45 years, the presence of CLT appeared to be associated with unfavorable pathological features.
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Affiliation(s)
- Saleha Babli
- Division of Endocrinology and Metabolism, Department of Medicine, Montreal General Hospital, McGill University, Montreal, Québec, Canada
- Department of Endocrinology and Diabetes, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- *Saleha Babli, PO Box 20026, 31911 Qateef (Saudi Arabia), E-Mail
| | - Richard J. Payne
- Department of Otolaryngology, Royal Victoria Hospital, McGill University, Montreal, Québec, Canada
| | - Elliot Mitmaker
- Department of Surgery, Montreal General Hospital, McGill University, Montreal, Québec, Canada
| | - Juan Rivera
- Division of Endocrinology and Metabolism, Department of Medicine, Montreal General Hospital, McGill University, Montreal, Québec, Canada
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Kim WW, Ha TK, Bae SK. Clinical implications of the BRAF mutation in papillary thyroid carcinoma and chronic lymphocytic thyroiditis. J Otolaryngol Head Neck Surg 2018; 47:4. [PMID: 29316976 PMCID: PMC5759356 DOI: 10.1186/s40463-017-0247-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/15/2017] [Indexed: 11/30/2022] Open
Abstract
Background The purpose of this study was to examine the possible prognostics and clinicopathologic characteristics underlying the BRAFV600E mutation and papillary thyroid carcinoma (PTC) coexisting or in absence of chronic lymphocytic thyroiditis (CLT). Methods This study was conducted on 172 patients who had undergone total thyroidectomy or unilateral total thyroidectomy for PTC; the patients were then examined for the BRAFV600E mutation using specimens obtained after their surgery from January 2013 to August 2015. Results BRAF mutations were found in 130 of 172 patients (75.6%). CLT was present in 27.9% of patients (48/172). The incidence of the BRAFV600E mutation was significantly increased in the group with no CLT (P = 0.001). The findings of the multivariate analysis pertaining to the coexistence of CLT and PTC showed no significant correlation other than the BRAFV600E mutation. No significant difference was noted in the clinicopathologic factors between the two groups based on the coexistence of CLT in univariate and multivariate analyses. Conclusions The BRAFV600E mutation is less frequent in PTC coexisting with CLT presumably because CLT and the BRAFV600E mutation operate independently in the formation and progression of thyroid cancer.
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Affiliation(s)
- Woon Won Kim
- Department of General Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Tae Kwun Ha
- Department of General Surgery, Busan Paik Hospital, Inje University College of Medicine, 75, Bokji-ro, Busanjin-gu, 614-735, Busan, Republic of Korea.
| | - Sung Kwon Bae
- Department of Medical Management, Kosin University, Busan, Republic of Korea
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Yu L, Zhou L, Xu E, Bi Y, Hu X, Pei X, Jin G. Levothyroxine monotherapy versus levothyroxine and selenium combination therapy in chronic lymphocytic thyroiditis. J Endocrinol Invest 2017; 40:1243-1250. [PMID: 28534148 DOI: 10.1007/s40618-017-0693-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 05/12/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE New strategies are needed for prevention and treatment of chronic lymphocytic thyroiditis (CLT). This study aimed to assess whether combination of levothyroxine treatment and selenium (Se) supplementation results in improved therapeutic effects in CLT compared with levothyroxine monotherapy. METHODS An open-label, randomized controlled study was performed in 60 CLT patients assigned to two groups. Levothyroxine group (LT) patients (n = 24) received levothyroxine alone for 3 months; meanwhile, the combination (LTSS) group (n = 36) was administered levothyroxine with selenium yeast capsule. Blood selenium concentrations, anti-thyroid peroxidase (TPO) and anti-thyroglobulin (Tg) antibody levels, and inflammatory cytokine amounts were compared between both groups before and after treatment. RESULTS At baseline, similar values were obtained in both groups for all the parameters assessed (p > 0.05). After treatment, significantly increased blood selenium levels (µg/L) [90.05 (80.69, 107.76) vs. 39.64 (29.42, 51.10), p < 0.001] and decreased anti-TPO antibody (23.63 ± 9.31 vs. 32.00 ± 10.41%, p = 0.002), anti-Tg antibody (35.84 ± 15.21 vs. 45.47 ± 14.24%, p = 0.015) and IL-2 amounts (pg/mL) [159.29 (124.54, 189.70) vs. 226.48 (190.74, 266.56), p < 0.001] were observed in the LTSS group compared with the LT group post-treatment; meanwhile, similar IL-10 concentrations [23.14 (21.65, 28.56) pg/mL vs. 24.68 (21.71, 29.67) pg/mL] were obtained in both groups. Subgroup analysis of patients with hypothyroidism showed the same trend observed in the whole population; in patients with normal thyroid function, only Se and IL-2 amounts differed between the two treatment groups. Correlation analysis of of the indexes: in HT patients, the basal serum selenium concentration was positively correlated with TT4 (r = 0.294, p < 0.05), significantly negatively correlated with TSH (r = -0.343, p < 0.01), and had no significant correlation with TT3 (p > 0.05). CONCLUSIONS These findings indicated that levothyroxine and selenium combination results in improved therapeutic effects than the levothyroxine monotherapy in preventing CLT progression.
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Affiliation(s)
- L Yu
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical College, No. 287 Changhuai Road, Bengbu, 233004, Anhui, China
| | - L Zhou
- Department of Endocrinology, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, Anhui, China
| | - E Xu
- Room of Physical Diagnostics, Bengbu Medical College, Bengbu, 233030, Anhui, China
| | - Y Bi
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical College, No. 287 Changhuai Road, Bengbu, 233004, Anhui, China
| | - X Hu
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical College, No. 287 Changhuai Road, Bengbu, 233004, Anhui, China
| | - X Pei
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical College, No. 287 Changhuai Road, Bengbu, 233004, Anhui, China
| | - G Jin
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical College, No. 287 Changhuai Road, Bengbu, 233004, Anhui, China.
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Bai Y, Niu D, Huang X, Jia L, Kang Q, Dou F, Ji X, Xue W, Liu Y, Li Z, Feng Q, Lin D, Kakudo K. PD-L1 and PD-1 expression are correlated with distinctive clinicopathological features in papillary thyroid carcinoma. Diagn Pathol 2017; 12:72. [PMID: 28974264 PMCID: PMC5627454 DOI: 10.1186/s13000-017-0662-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 09/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immune checkpoint blockade targeting PD-1/PD-L1 has shown efficacy in several types of cancers. However, the correlation between PD-L1/PD-1 expression and the specific clinicopathological features in papillary thyroid carcinoma (PTC) has not been investigated. METHODS We examined the immunohistochemical expression of PD-L1, PD-1, and BRAF V600E on whole-tissue sections from 126 cases of primary PTC more than 1 cm in size. The correlation between the PD-L1/PD-1 expression and the clinicopathological features was evaluated. RESULTS PD-L1 was positively expressed in 53.2% PTCs, and its expression was positively correlated with rich tumor-infiltrating lymphocytes (TILs), background chronic lymphocytic thyroiditis (CLT), female gender, absence of psammoma bodies, and PD-1 expression. Among these parameters, rich TILs, female gender, and absence of psammoma bodies were independent factors affecting PD-L1 expression on the multivariate logistic regression analysis. PD-1 expression was detected in the TILs and was positively correlated with rich TILs, background CLT, and absence of stromal calcification. Lack of stromal calcification was an independent factor affecting PD-1 expression. Neither PD-L1 nor PD-1 expression showed significant correlation with BRAF V600E expression. CONCLUSIONS Our results show that the distinctive pathological features of PTCs, including TILs, background CLT, female gender, psammoma bodies, and stromal calcification, are useful parameters for predicting PD-L1 or PD-1 expression.
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Affiliation(s)
- Yanhua Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China.
| | - Dongfeng Niu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Xiaozheng Huang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Ling Jia
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Qiang Kang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Fangyuan Dou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Xinqiang Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Medical Statistics, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Weicheng Xue
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Yiqiang Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Zhongwu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Qin Feng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Dongmei Lin
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Kennichi Kakudo
- Department of Pathology, Nara Hospital, Kindai University Faculty of Medicine, Ikoma-city, Nara, 630-0293, Japan
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Nakamura Y, Ohsawa I, Goto Y, Tsuji M, Oguchi T, Sato N, Kiuchi Y, Fukumura M, Inagaki M, Gotoh H. Soy isoflavones inducing overt hypothyroidism in a patient with chronic lymphocytic thyroiditis: a case report. J Med Case Rep 2017; 11:253. [PMID: 28870235 PMCID: PMC5583972 DOI: 10.1186/s13256-017-1418-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many people have thyroid conditions that make them susceptible to hypothyroidism. If the foods they eat may interfere with the production of thyroid hormone, which can lead to development of serious hypothyroidism. The danger of health drinks should always be noted. CASE PRESENTATION A 72-year-old Japanese woman was previously diagnosed with chronic lymphocytic thyroiditis caused by a goiter and had an elevated thyroid-stimulating hormone level (6.56 μIU/ml), a high anti-thyroid peroxidase antibody level (>600 IU/ml), and a high antithyroglobulin level (> 4000 IU/ml) but normal levels of free triiodothyronine (3.08 pg/ml) and thyroxine (1.18 ng/ml). She presented to our hospital with sudden-onset general malaise, edema, and hoarseness with an elevated thyroid-stimulating hormone (373.3 μIU/ml) level and very low triiodothyronine (< 0.26 pg/ml) and thyroxine (0.10 ng/ml) levels. It was determined that for 6 months she had been consuming a processed, solved health drink ("barley young leaf") in amounts of 9 g/day, which included soybean and kale powder extract. Hypothyroidism might be affected by ingredients of health drinks. She discontinued consumption of the health drink immediately and began taking 12.5 μg of levothyroxine. The amount of levothyroxine was gradually increased every 3 days up to 100 μg. At day 61, her thyroid-stimulating hormone level had decreased (6.12 μIU/ml), her free triiodothyronine (2.69 pg/ml) and thyroxine (1.56 ng/ml) levels had increased, and her general condition was improved. Among risky foods lowering thyroid function, some experimental studies have revealed that isoflavones reduce thyroid function. Therefore, we measured the presence of isoflavones in the patient's frozen serum with thin-layer chromatography. After she discontinued consumption of the health drink, two components quickly disappeared, and the other three components gradually decreased. On the basis of developing solvent composition and a positive ferric chloride reaction in thin-layer chromatography experiment, the five ingredients that disappeared or decreased were highly suspected to be soy isoflavones. CONCLUSIONS This case emphasizes that consuming health drinks that include soy isoflavone powder extracts can lead to severe hypothyroidism.
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Affiliation(s)
- Yuya Nakamura
- Department of Internal Medicine, Saiyu Soka Hospital, 1-7-22 Matsubara, Soka City, Saitama 344-0041 Japan
- Department of Pharmacology, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
| | - Isao Ohsawa
- Department of Internal Medicine, Saiyu Soka Hospital, 1-7-22 Matsubara, Soka City, Saitama 344-0041 Japan
| | - Yoshikazu Goto
- Department of Internal Medicine, Saiyu Soka Hospital, 1-7-22 Matsubara, Soka City, Saitama 344-0041 Japan
| | - Mayumi Tsuji
- Department of Pharmacology, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
| | - Tatsunori Oguchi
- Department of Pharmacology, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
| | - Naoki Sato
- Department of Pharmacology, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
| | - Yuji Kiuchi
- Department of Pharmacology, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
| | - Motonori Fukumura
- Division of Natural Medicine and Therapeutics, Department of Clinical Pharmacy, School of Pharmacy, Showa University, Shinagawa-ku, Tokyo, Japan
| | - Masahiro Inagaki
- Department of Chemistry, College of Arts and Sciences, Showa University, Fujiyoshida City, Yamanashi Japan
| | - Hiromichi Gotoh
- Department of Internal Medicine, Saiyu Soka Hospital, 1-7-22 Matsubara, Soka City, Saitama 344-0041 Japan
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Côrtes MCS, Rosario PW, Mourão GF, Calsolari MR. Influence of chronic lymphocytic thyroiditis on the risk of persistent and recurrent disease in patients with papillary thyroid carcinoma and elevated antithyroglobulin antibodies after initial therapy. Braz J Otorhinolaryngol 2017. [PMID: 28625809 PMCID: PMC9449248 DOI: 10.1016/j.bjorl.2017.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION In patients with papillary thyroid carcinoma who have negative serum thyroglobulin after initial therapy, the risk of structural disease is higher among those with elevated antithyroglobulin antibodies compared to patients without antithyroglobulin antibodies. Other studies suggest that the presence of chronic lymphocytic thyroiditis is associated with a lower risk of persistence/recurrence of papillary thyroid carcinoma. OBJECTIVE This prospective study evaluated the influence of chronic lymphocytic thyroiditis on the risk of persistence and recurrence of papillary thyroid carcinoma in patients with negative thyroglobulin but elevated antithyroglobulin antibodies after initial therapy. METHODS This was a prospective study. Patients with clinical examination showing no anomalies, basal Tg<1ng/mL, and elevated antithyroglobulin antibodies 8-12 months after ablation were selected. The patients were divided into two groups: Group A, with chronic lymphocytic thyroiditis on histology; Group B, without histological chronic lymphocytic thyroiditis. RESULTS The time of follow-up ranged from 60 to 140 months. Persistent disease was detected in 3 patients of Group A (6.6%) and in 6 of Group B (8.8%) (p=1.0). During follow-up, recurrences were diagnosed in 2 patients of Group A (4.7%) and in 5 of Group B (8%) (p=0.7). Considering both persistent and recurrent disease, structural disease was detected in 5 patients of Group A (11.1%) and in 11 of Group B (16.1%) (p=0.58). There was no case of death related to the disease. CONCLUSION Our results do not support the hypothesis that chronic lymphocytic thyroiditis is associated with a lower risk of persistent or recurrent disease, at least in patients with persistently elevated antithyroglobulin antibodies after initial therapy for papillary thyroid carcinoma.
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Affiliation(s)
| | - Pedro Weslley Rosario
- Santa Casa de Belo Horizonte, Serviço de Endocrinologia, Belo Horizonte, MG, Brazil.
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Carvalho MS, Rosario PW, Mourão GF, Calsolari MR. Chronic lymphocytic thyroiditis does not influence the risk of recurrence in patients with papillary thyroid carcinoma and excellent response to initial therapy. Endocrine 2017; 55:954-958. [PMID: 27878772 DOI: 10.1007/s12020-016-1185-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 11/15/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study evaluated the recurrence in patients with papillary thyroid cancer and an excellent response to initial therapy, comparing those with and without chronic lymphocytic thyroiditis. METHODS This was a prospective study. Patients who met the following criteria were selected: diagnosis of papillary thyroid cancer; submitted to total thyroidectomy followed or not by ablation with 131I; and neck ultrasonography without abnormalities, nonstimulated thyroglobulina (Tg) ≤0.2 ng/ml, and undetectable antithyroglobulin antibodies (TgAb) 12-18 months after initial therapy. The patients were divided into two groups: group A, with chronic lymphocytic thyroiditis on histology; group B, without chronic lymphocytic thyroiditis on histology. RESULTS Groups A and B were similar in terms of sex and age of the patients, characteristics of the tumor, tumor-node-metastase stage and risk category. The time of follow-up ranged from 24 to 120 months (median 66 months). During follow-up, 5 patients of group A (2.6 %) and 9 patients of group B (2 %) developed recurrence (p = 0.77). Patients with chronic lymphocytic thyroiditis were more likely to progress to persistently borderline TgAb. No patient had positive TgAb (above the reference value) during follow-up. Recurrences occurred in 12/588 patients (2 %) with undetectable TgAb in all measurements, in 1/32 (3.1 %) with detectable TgAb on some occasion but that returned to undetectable spontaneously, and in 1/13 (7.7 %) with persistently borderline TgAb. These rates did not differ significantly (p = 0.25). CONCLUSION The results of the present study showed the absence of an association between chronic lymphocytic thyroiditis and recurrence risk at least in patients with an excellent response to initial therapy.
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Affiliation(s)
- Marina S Carvalho
- Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Rua Domingos Vieira, 590, Santa Efigênia, CEP 30150-240, Belo Horizonte, MG, Brazil
| | - Pedro W Rosario
- Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Rua Domingos Vieira, 590, Santa Efigênia, CEP 30150-240, Belo Horizonte, MG, Brazil.
| | - Gabriela F Mourão
- Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Rua Domingos Vieira, 590, Santa Efigênia, CEP 30150-240, Belo Horizonte, MG, Brazil
| | - Maria R Calsolari
- Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Rua Domingos Vieira, 590, Santa Efigênia, CEP 30150-240, Belo Horizonte, MG, Brazil
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Pruthi A, Choudhury PS, Gupta M, Taywade S. Does the intensity of diffuse thyroid gland uptake on F-18 fluorodeoxyglucose positron emission tomography/computed tomography scan predict the severity of hypothyroidism? Correlation between maximal standardized uptake value and serum thyroid stimulating hormone levels. Indian J Nucl Med 2015; 30:16-20. [PMID: 25589800 PMCID: PMC4290060 DOI: 10.4103/0972-3919.147528] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Context: F-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) scan and hypothyroidism. Aims: The aim was to determine whether the intensity of diffuse thyroid gland uptake on F-18 FDG PET/CT scans predicts the severity of hypothyroidism. Materials and Methods: A retrospective analysis of 3868 patients who underwent F-18 FDG PET/CT scans, between October 2012 and June 2013 in our institution for various oncological indications was done. Out of them, 106 (2.7%) patients (79 females, 27 males) presented with bilateral diffuse thyroid gland uptake as an incidental finding. These patients were investigated retrospectively and various parameters such as age, sex, primary cancer site, maximal standardized uptake value (SUVmax), results of thyroid function tests (TFTs) and fine-needle aspiration cytology results were noted. The SUVmax values were correlated with serum thyroid stimulating hormone (S. TSH) levels using Pearson's correlation analysis. Statistical Analysis Used: Pearson's correlation analysis. Results: Clinical information and TFT (serum FT3, FT4 and TSH levels) results were available for 31 of the 106 patients (27 females, 4 males; mean age 51.5 years). Twenty-six out of 31 patients (84%) were having abnormal TFTs with abnormal TSH levels in 24/31 patients (mean S. TSH: 22.35 μIU/ml, median: 7.37 μIU/ml, range: 0.074-211 μIU/ml). Among 7 patients with normal TSH levels, 2 patients demonstrated low FT3 and FT4 levels. No significant correlation was found between maximum standardized uptake value and TSH levels (r = 0.115, P > 0.05). Conclusions: Incidentally detected diffuse thyroid gland uptake on F-18 FDG PET/CT scan was usually associated with hypothyroidism probably caused by autoimmune thyroiditis. Patients should be investigated promptly irrespective of the intensity of FDG uptake with TFTs to initiate replacement therapy and a USG examination to look for any suspicious nodules.
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Affiliation(s)
- Ankur Pruthi
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Partha Sarathi Choudhury
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Manoj Gupta
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sameer Taywade
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Canberk S, Griffin AC, Goyal A, Wang H, Montone K, Livolsi V, Baloch Z. Oncocytic follicular nodules of the thyroid with or without chronic lymphocytic thyroiditis: An institutional experience. Cytojournal 2013; 10:2. [PMID: 23599721 PMCID: PMC3623453 DOI: 10.4103/1742-6413.106686] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 01/24/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Oncocytic follicular (OF) cells can be a prominent component of fine needle aspiration (FNA) specimens from neoplasms (adenomas and carcinomas) and nodules arising in multinodular goiter and chronic lymphocytic thyroiditis (CLT). Because OF cells can be present in non-neoplastic and neoplastic thyroid lesions it can be challenging to differentiate between these two in FNA specimens. The aims of this study were to determine the risk of malignancy in cases diagnosed as either oncocytic follicular neoplasm (OFN) or hyperplastic/adenomatoid nodule with OF on FNA and to identify clinicopathologic features that may help in predicting malignancy in such cases, especially the presence or absence of CLT. DESIGN We retrospectively searched the computerized laboratory information system at our institution between 1998 and 2009 for thyroid US guided FNA specimens in which the term "oncocytic/oncocytes" was mentioned in the final cytopathologic diagnosis. A total of 340 cases were selected for this study. The following data points were collected: Patient demographics, site of thyroid biopsy, size of lesion, FNA diagnosis, histopathologic follow-up and presence of CLT. Surgical pathology follow-up (SPFU) was available in 269 (79%) cases. RESULTS Two hundred and sixty patients were females and 80 males (average age 53 years). The lesion size was <3.0 cm in 241 (71%) and ≥ 3.0 cm in 99 (29%) cases. Cytologic diagnoses included: Follicular neoplasm with oncocytic features (FNOF) 321 and suggestive of FNOF 19 cases; a secondary cytologic diagnosis of CLT was made in 20 cases. SPFU was available in 269 (79%) cases; it was benign in 213 (213/267 = 79%) and malignant in 56 (56/269 = 21%) cases. The background thyroid showed CLT in 67 (25%) cases; 24% (48/196) neoplasms occurred with versus 76% (147/196) without CLT. The rate of malignancy was lower in nodules measuring less than 3.0 cm as compared to those equal or greater than 3.0 cm in size (17% vs. 28% respectively). The presence of CLT did not significantly alter the rate of malignancy in both FNA and surgical pathology specimens. CONCLUSIONS Based on this study, nodule size and not CLT appears to be an important clinicopathologic features in the management of thyroid FNA specimens diagnosed as OFN.
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Affiliation(s)
- Sule Canberk
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Perelman School of Medicine, Philadelphia, Pennsylvania, 19104, USA
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