Abstract
Data on the prevalence of benign and malignant nodular thyroid disease in patients with acromegaly is a matter of debate. In the last decade an increasing incidence of thyroid cancer has been reported. The aim of this study was to evaluate the prevalence of goiter, thyroid nodules and thyroid cancer in a large series of patients with acromegaly with a cross-sectional study with a control group. Six Spanish university hospitals participated. One hundred and twenty three patients (50% men; mean age 59±13 years; disease duration 6.7±7.2 years) and 50 controls (51% males, mean age 58±15 years) were studied. All participants underwent thyroid ultrasound and fine needle aspiration. Cytological analysis was performed in suspicious nodules between 0.5 and 1.0 cm and in all nodules greater than 1.0 cm. Goiter was more frequently found in patients than in controls (24.9 vs. 8.3%, respectively; p<0.001). Nodular thyroid disease as well as nodules greater than 1 cm were also more prevalent in acromegalic patients (64.6%, vs. 28.6%, p<0.05 and 53.3 vs. 28.6%, respectively; p<0.05), and all underwent fine needle aspiration. Suspicious cytology was detected in 4 patients and in none of the controls. After thyroidectomy, papillary thyroid carcinoma was confirmed in two cases (3.3% of patients with thyroid nodules), representing 1.6% of the entire group of patients with acromegaly (2.4% including a case with previously diagnosed papillary thyroid carcinoma). These data indicated that thyroid nodular disease and cancer are increased in acromegaly, thus justifying its routine ultrasound screening.
Highlights
Is an endocrine disorder characterized by growth hormone (GH) hypersecretion mainly due to a pituitary micro or macroadenoma [1]
A GH producing macroadenoma was the cause of acromegaly in 73.4% of the cases and in the remaining 16.6% a microadenoma
In our series of 123 acromegalic patients accurately explored for thyroid abnormalities, we found an increased prevalence of goiter and thyroid nodules and three cases of thyroid cancer
Summary
Is an endocrine disorder characterized by growth hormone (GH) hypersecretion mainly due to a pituitary micro or macroadenoma [1]. In the majority of patients GH excess produces an overgrowth of acral parts of the body Organs such as the liver or the heart may increase in size and joint articular cartilage thickness, vertebral fractures, left ventricular dysfunction, abnormal lipid profile, and obstructive apnea events may appear with different reported prevalence [2]. Nodular thyroid disease and goiter are frequent conditions in the general population, with an age-related increasing incidence reaching 30–50% in people over 50 years in ultrasound studies [5]. Most of these nodules are benign, but the overall reported malignancies rate is about 5–10% [6]. The age-standardized incidence of thyroid cancer is estimated to be 0.9% (females) and 0.2% (males) in developed countries and related to iodine deficiency status [7]
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