Abstract
The coexistence of Graves' disease with thyroid cancer is well-known and total thyroidectomy is recommended in such cases. However, Graves' disease might be dormant at the time of surgery and diagnosed after lobectomy for thyroid cancer. We assessed the incidence and clinicopathological characteristic of newly developed Graves' disease after lobectomy for thyroid cancer between 2010 and 2019. In all, 11043 patients underwent lobectomy for thyroid cancer during the study period, and 26 (0.2%) were diagnosed with Graves' disease during follow-up. The median age was 43.8 years, 88.5% were female, and all were euthyroid before surgery. The median time from lobectomy to the diagnosis of Graves' disease was 3.3 years. Half of the patients were diagnosed based on thyroid function tests during routine follow-up, and others were diagnosed due to symptoms of thyrotoxicosis. Among patients who had checked preoperative thyroid autoantibodies, 61.1% showed positivity. Twenty-one (80.8%), and 2 (7.7%) patients received antithyroid drugs and radioactive iodine therapy, respectively, and 3 (11.5%) underwent completion thyroidectomy. Although rare, Graves' disease can occur in the remnant thyroid after lobectomy. Such patients are more likely to have autoantibodies. An appropriate workup is required when hyperthyroidism is found during the follow-up of patients after lobectomy.
Highlights
Graves’ disease (GD) is an autoimmune disorder and is considered the most common cause of hyperthyroidism, followed by toxic multinodular goiter and toxic adenoma [1, 2]
An appropriate workup is required when hyperthyroidism is found during the follow-up of patients after lobectomy
We retrospectively reviewed the medical records of patients who underwent lobectomy for thyroid cancer between 2010 and 2019 at a tertiary medical center in Korea and were diagnosed with GD after thyroid lobectomy (Fig 1)
Summary
Graves’ disease (GD) is an autoimmune disorder and is considered the most common cause of hyperthyroidism, followed by toxic multinodular goiter and toxic adenoma [1, 2]. Among 847 patients with GD who underwent thyroidectomy, the incidence of coexistent thyroid cancer was 4.3%, and 68.2% were papillary microcarcinomas (PTMC) [6]. The probable mechanism of increased prevalence of thyroid cancer in patients with GD is primarily the binding of TRAb to thyrotropin receptor, which promotes tumor formation, angiogenesis, and further progression of the invasiveness of cancer [7–9]. Near-total or total thyroidectomy is recommended in patients having thyroid cancer with underlying GD [3]. The incidence of newly diagnosed GD after thyroid lobectomy is not well known. The coexistence of Graves’ disease with thyroid cancer is well-known and total thyroidectomy is recommended in such cases. Graves’ disease might be dormant at the time of surgery and diagnosed after lobectomy for thyroid cancer
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