Abstract
The relationship between Hashimoto's thyroiditis (HT) and thyroid cancer (TC) is a controversial topic; it remains unclear if HT acts as a risk factor of TC. The aim of our study was to compare the presence of HT and thyroid function in patients with TC and benign nodules. We analyzed 2571 patients after fine needle aspiration biopsy of thyroid nodule. Totally, 91 patients with primary TC and 182 sex- and age-matched controls were included. Positive antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-Tg) antibodies were associated with TC (anti-TPO 44% in TC vs. 27% in controls, P = 0.005, anti-TG 35% in TC group vs. 21% in controls, P = 0.018), and the TC group had significantly higher TSH (median 1.88 mIU/l vs. 1.21 mIU/l, P < 0.001). Using multiple logistic regression, positive anti-TPO was identified as an independent risk factor (OR 2.21, P = 0.018), while spontaneously suppressed TSH < 0.5 mIU/l was a protective factor (OR 0.3, P = 0.01) against TC. In conclusion, nodules in subjects with positive antithyroid antibodies could be considered to have a higher risk of malignancy. However, based on our results, it is not possible to declare that TC is triggered by HT.
Highlights
Thyroid cancer (TC) is the most common endocrine malignancy
The aim of this study was to compare the prevalence of antithyroid antibodies, thyroid dysfunction, and thyroid texture and volume measured by ultrasound in patients with TC and benign nodules recruited from subjects undergoing fine needle aspiration biopsy (FNAB) of thyroid nodules in our outpatient departments
The overall risk of malignancy among patients with thyroid nodules undergoing FNAB reached 4.4% in our study, which is to a small extent lower than the value posted in the latest guidelines of the American Thyroid Association for thyroid nodules (7–15%) [15]
Summary
Thyroid cancer (TC) is the most common endocrine malignancy. It is still a rare disease, its incidence is growing rapidly in the last years, with approximately 14.3 new cases per 100,000 per year [1]. The most frequent histomorphological type is papillary thyroid cancer (PTC), which represents 84% of thyroid malignancies [2]. TC pathogenesis remains largely unclear with the relationship between TC and Hashimoto thyroiditis (HT) being a frequently discussed issue. HT is characterized by T-lymphocyte infiltration of the thyroid gland, destruction of thyroid follicles, and their replacement by fibrotic tissue. The presence of antithyroid autoantibodies [against thyroid peroxidase (anti-TPO) or against thyroglobulin (anti-Tg)] and the typical thyroid ultrasound morphology (nonhomogeneous and hypoechoic ultrasound pattern of thyroid tissue, with increased vascularization) are the diagnostic markers of HT. HT is the most common cause of hypothyroidism in iodine-sufficient areas [4]
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