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Journal of Clinical Endocrinology & Metabolism Vol. 70, No. 4 830-835
doi:10.1210/jcem-70-4-830
Copyright © 1990 by the Endocrine Society.
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Increased Aggressiveness of Thyroid Cancer in Patients with Graves' Disease*

ANTONINO BELFIORE, MARIA RITA GAROFALO{dagger}, DARIO GIUFFRIDA, FILIPPO RUNELLO, SEBASTIANO FILETTI{ddagger}, ANTONINO FIUMARA, ORAZIO IPPOLITO and RICCARDO VIGNERI

Cattedra di Endocrinologia e Patologia Costituzionale, Ospedale Garibaldi, USL 34, Cattedra di Tecniche Chirurgiche Complementari in Terapia Oncologica, Università di Catania (O.I.), and Seruizio di Anatomia Patologica, Ospedale Vittorio Emanuele (A.F.) Catania, Italy

Address all correspondence and requests for reprints to: Antonino Belfiore, M.D., Cattedra di Endocrinologia, Università di Catania, Ospedale Garibaldi, Piazza S. Maria di Gesù, 95124 Catania, Italy.

To evaluate whether coexistence of Graves' disease affects the prognosis of thyroid cancer we examined the clinical and pathological characteristics of 22 differentiated thyroid carcinomas concomitant with hyperthyroidism; 13 were associated with Graves' disease, and 9 with autonomous thyroid nodules. Carcinomas were identified in a consecutive series of 359 hyperthyroid patients (132 with Graves' disease and 227 with autonomous thyroid nodules) who underwent surgery during a 6-yr period. One hundred and thirty-seven thyroid carcinomas were found in the 582 euthyroid patients operated on in the same period.

In Graves' patients, carcinomas were more often multifocal (46.1% vs. 0%), locally invasive (61.5% vs. 11.1%), and met-astatic to lymph nodes (61.5% vs. 11.1%) or to distant sites (23.0% vs. 0%) than in patients with autonomous thyroid nodules. In addition, carcinomas concomitant with Graves' disease were larger (3.3 ± 1.8 vs. 1.0 ± 0.7 cm) than the ones associated with autonomous thyroid nodules and showed a high recurrence rate. In euthyroid patients, aggressiveness of thyroid cancer was intermediate.

Serum TSH levels were suppressed in all hyperthyroid patients with thyroid cancer. However, circulating thyroid-stimulating antibodies were present in 12 of 13 cancer patients with Graves' disease, but were absent in patients with autonomous thyroid nodules. Our study suggests, therefore, that TSAb may play a role in determining the high aggressiveness of thyroid cancer in Graves' disease patients and indicates that a vigorous treatment should be pursued in this subgroup of patients.

* This work was supported in part by Grants 105/M and 102/M from Regione Siciliana.

{dagger} Recipient of a fellowship from the Associazione Italiana per la Ricerca sul Cancro.

{ddagger} Present address: Cattedra di Endocrinologia, Università di Reggio Calabria, Catanzaro, Italy.

Received June 9, 1989.




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