DOI: http://dx.doi.org/10.18203/2349-2902.isj20193345

Analyzing the relationship between differentiated thyroid cancer and thyroid autoimmunity: an exploratory study from tertiary care center in South India

Zahir Hussain, Rakesh Chandru Kaharin, Muhamed Faizal Ayub, Jabamalai Ferdinant, Smitha S. Rao

Abstract


Background: Differentiated thyroid cancer (DTC) is the most common endocrine malignancy. There is a rising incidence of DTC over the past few decades. This dramatic increase in incidence may be due to increased detection rate or because of factors like thyroid stimulating hormone (TSH) or thyroid autoantibodies which remains unclear. Our study aims to analyze the association between DTC and thyroid autoimmunity.

Methods: This was a retrospective study over 1 year conducted at the department of endocrine surgery, Madras medical college, a tertiary care center in South India. During the study period, 364 total thyroidectomies were performed which includes 292 benign and 72 malignant cases. Among malignancies, 15 non-DTC cases were excluded from the study. Finally, we included 57 patients with DTC and 114 patients with benign disease (randomly chosen age and sex-matched controls) for analysis. Demographic data, TSH levels, antithyroglobulin (anti-TG), and anti-thyroid peroxidase (anti-TPO) antibody levels, histopathology were recorded and analyzed.

Results: Histopathological examination revealed 47.4% of DTC and 63.2% of benign cases has associated thyroiditis. In our study elevated anti-TPO and anti-TG antibodies were not significantly associated with DTC (anti-TPO positivity 75.4% in DTC group vs. 74.6% in benign group, p=0.90, anti-TG antibody positivity 66.7% in DTC vs. 67.5% in benign group, p=0.90). Also, no significant association established between elevated TSH and DTC.

Conclusions: Association between thyroid autoantibodies and DTC has been evaluated in several studies with inconsistent results. The present study did not show any significant associations between elevated thyroid autoantibodies, TSH levels, and DTC.


Keywords


Anti-thyroglobulin, Thyroid peroxidase, TSH, Thyroid cancer, Thyroiditis

Full Text:

PDF

References


Dailey ME, Lindsay S, Skahen R. Relation of thyroid neoplasms to Hashimoto disease of the thyroid gland. AMA Arch Surg. 1955;70:291–7.

Kim KW, Park YJ, Kim EH, Park SY, Park DJ, Ahn SH, et al. Elevated risk of papillary thyroid cancer in Korean patients with Hashimoto’s thyroiditis. Head Neck 2011;33:691–5.

Chen YK, Lin CL, Cheng FT, Sung FC, Kao CH. Cancer risk in patients with Hashimoto’s thyroiditis:a nationwide cohort study. Br J Cancer. 2013;29:2496–501.

Boelaert K, Horacek J, Holder RL, Watkinson JC, Sheppard MC, Franklyn JA. Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J Clin Endocrinol Metab. 2006;91(11):4295-301.

Azizi G, Malchoff CD. Autoimmune thyroid disease: a risk factor for thyroid cancer. Endocrine Practice 2011;17:201–9.

Meza R, Chang JT. Multistage carcinogenesis and the incidence of thyroid cancer in the US by sex, race, stage and histology. BMC Public Health. 2015;15(1):789.

Jankovic B, Le KT, Hershman JM. Hashimoto’s thyroiditis and papillary thyroid carcinoma:is there a correlation? J Clin Endocrinol Metabol. 2013;98:474–82.

Siriweera EH, Ratnatung NV. Profile of Hashimoto’s thyroiditis in Sri Lankans:is there an increased risk of ancillary pathologies in Hashimoto’s thyroiditis. J Thyroid Res. 2010;1:1–5.

Mazokopakis EE, Tzortzinis AA, Dalieraki-Ott EI, Tsartsalis AN, Syros PK, Karefilakis CM et al. Coexistence of Hashimoto’s thyroiditis with papillary thyroid carcinoma. A retrospective study. Hormones. 2010;9:312–7.

Azizi G, Keller JM, Lewis M, Piper K, Puett D, Rivenbark KM, Malchoff CD. Association of Hashimoto’s thyroiditis with thyroid cancer. Endocrine- Related Cancer. 2014;21:845–52.

Kim ES, Lim DJ, Baek KH, Lee JM, Kim MK, Kwon HS, et al. Thyroglobulin antibody is associated with increased cancer risk in thyroid nodules. Thyroid. 2010;20:885–91.

Lee JH, Kim Y, Choi JW, Kim YS. The association between papillary thyroid carcinoma and histologically proven Hashimoto's thyroiditis: a meta-analysis. Eur J Endocrinol. 2013;168:343–9.

Huang BY, Hseuh C, Chao TC, Lin KJ, Lin JD. Well-differentiated thyroid carcinoma with concomitant Hashimoto's thyroiditis present with less aggressive clinical stage and low recurrence. Endocr Pathol. 2011;22:144–9.

Kim EY, Kim WG, Kim WB, Kim TY, Kim JM, Ryu JS, et al. Coexistence of chronic lymphocytic thyroiditis is associated with lower recurrence rates in patients with papillary thyroid carcinoma. Clin Endocrinol (Oxf). 2009;71:581–6.

Matsubayashi S, Kawai K, Matsumoto Y, Mukuta T, Morita T, Hirai K, et al. The correlation between papillary thyroid carcinoma and lymphocytic infiltration in the thyroid gland. J Clin Endocrinol Metab. 1995;80:3421–4.

Souza SL, Montalli da Assumpc LV, Ward LS. Impact of previous thyroid autoimmune diseases on prognosis of patients with well-differentiated thyroid cancer. Thyroid. 2003;13:491–5.

Smooke-Praw S, Ro K, Levin O, Ituarte PH, Harari A, Yeh MW. Thyroglobulin antibody levels do not predict disease status in papillary thyroid cancer. Clin Endocrinol (Oxf). 2014;81(2):271-5.

Castro MR, Espiritu RP, Bahn RS, Henry MR, Gharib H, Caraballo PJ, et al. Predictors of malignancy in patients with cytologically suspicious thyroid nodules. Thyroid. 2011;21(11):1191-8.

Zhang Q, Liu SZ, Zhang Q, Guan YX, Chen QJ, Zhu QY. Meta-analyses of association between BRAF(V600E) muta¬tion and clinicopathological features of papillary thyroid carcinoma. Cell Physiol Biochem. 2016;38:763-76.