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Hashimoto's thyroiditis pathology and risk for thyroid cancer.
Thyroid 2014; 24(7):1107-14T

Abstract

BACKGROUND

Hashimoto's thyroiditis (HT) has been found to coexist with differentiated thyroid cancer (DTC) in surgical specimens, but an association between the two conditions has been discounted by the medical literature. Therefore, we performed this study to determine any potential relationship between HT and the risk of developing DTC.

METHODS

We collected data for thyrotropin (TSH), thyroxine (T4), thyroid peroxidase antibody (TPO-Ab) titers, surgical pathology, and weight-based levothyroxine (LT4) replacement dose for patients who were referred for thyroid surgery. Patients with HT at final pathology were studied further. To estimate thyroid function, patients with preoperative hypothyroid HT (Hypo-HT) were divided into three equal groups based on their LT4 replacement: LT4-Low (<0.90 μg/kg), LT4-Mid (0.90-1.43 μg/kg), and LT4-High (>1.43 μg/kg). A group of preoperatively euthyroid (Euth-HT) patients but with HT by pathology was also studied. All subjects were also grouped based on their TPO-Ab titer in TPO-high (titer >1:1000) or TPO-low/negative (titer <1:1000 or undetectable) groups. The relationship of HT and DTC was studied extensively.

RESULTS

Of 2811 subjects, 582 had HT on surgical pathology, 365 of whom were Euth-HT preoperatively. DTC was present in 47.9% of the Euth-HT, in 59.7% of LT4-Low, 29.8% of LT4-Mid, and 27.9% of LT4-High groups. The relative risk (RR) for DTC was significantly elevated for the Euth-HT and LT4-Low groups (p<0.001), but not for the LT4-Mid or LT4-High replacement dose groups. TPO-low/negative status conferred an increased RR in the Euth-HT and LT4-Low replacement dose groups (p<0.001 both), while TPO-high status decreased it in Euth-HT group (p<0.05) and made it nonsignificant in the LT4-Low group.

CONCLUSIONS

HT pathology increases the risk for DTC only in euthyroid subjects and those with partially functional thyroid glands (LT4-Low) but not in fully hypothyroid HT (LT4-Mid and LT4-High). High TPO-Ab titers appear to protect against DTC in patients with HT.

Authors+Show Affiliations

1 Endocrine Autoimmunity Unit, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison , Madison, Wisconsin.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

24708347

Citation

Paparodis, Rodis, et al. "Hashimoto's Thyroiditis Pathology and Risk for Thyroid Cancer." Thyroid : Official Journal of the American Thyroid Association, vol. 24, no. 7, 2014, pp. 1107-14.
Paparodis R, Imam S, Todorova-Koteva K, et al. Hashimoto's thyroiditis pathology and risk for thyroid cancer. Thyroid. 2014;24(7):1107-14.
Paparodis, R., Imam, S., Todorova-Koteva, K., Staii, A., & Jaume, J. C. (2014). Hashimoto's thyroiditis pathology and risk for thyroid cancer. Thyroid : Official Journal of the American Thyroid Association, 24(7), pp. 1107-14. doi:10.1089/thy.2013.0588.
Paparodis R, et al. Hashimoto's Thyroiditis Pathology and Risk for Thyroid Cancer. Thyroid. 2014;24(7):1107-14. PubMed PMID: 24708347.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hashimoto's thyroiditis pathology and risk for thyroid cancer. AU - Paparodis,Rodis, AU - Imam,Shahnawaz, AU - Todorova-Koteva,Kristina, AU - Staii,Anca, AU - Jaume,Juan Carlos, Y1 - 2014/06/05/ PY - 2014/4/9/entrez PY - 2014/4/9/pubmed PY - 2015/3/31/medline SP - 1107 EP - 14 JF - Thyroid : official journal of the American Thyroid Association JO - Thyroid VL - 24 IS - 7 N2 - BACKGROUND: Hashimoto's thyroiditis (HT) has been found to coexist with differentiated thyroid cancer (DTC) in surgical specimens, but an association between the two conditions has been discounted by the medical literature. Therefore, we performed this study to determine any potential relationship between HT and the risk of developing DTC. METHODS: We collected data for thyrotropin (TSH), thyroxine (T4), thyroid peroxidase antibody (TPO-Ab) titers, surgical pathology, and weight-based levothyroxine (LT4) replacement dose for patients who were referred for thyroid surgery. Patients with HT at final pathology were studied further. To estimate thyroid function, patients with preoperative hypothyroid HT (Hypo-HT) were divided into three equal groups based on their LT4 replacement: LT4-Low (<0.90 μg/kg), LT4-Mid (0.90-1.43 μg/kg), and LT4-High (>1.43 μg/kg). A group of preoperatively euthyroid (Euth-HT) patients but with HT by pathology was also studied. All subjects were also grouped based on their TPO-Ab titer in TPO-high (titer >1:1000) or TPO-low/negative (titer <1:1000 or undetectable) groups. The relationship of HT and DTC was studied extensively. RESULTS: Of 2811 subjects, 582 had HT on surgical pathology, 365 of whom were Euth-HT preoperatively. DTC was present in 47.9% of the Euth-HT, in 59.7% of LT4-Low, 29.8% of LT4-Mid, and 27.9% of LT4-High groups. The relative risk (RR) for DTC was significantly elevated for the Euth-HT and LT4-Low groups (p<0.001), but not for the LT4-Mid or LT4-High replacement dose groups. TPO-low/negative status conferred an increased RR in the Euth-HT and LT4-Low replacement dose groups (p<0.001 both), while TPO-high status decreased it in Euth-HT group (p<0.05) and made it nonsignificant in the LT4-Low group. CONCLUSIONS: HT pathology increases the risk for DTC only in euthyroid subjects and those with partially functional thyroid glands (LT4-Low) but not in fully hypothyroid HT (LT4-Mid and LT4-High). High TPO-Ab titers appear to protect against DTC in patients with HT. SN - 1557-9077 UR - https://www.unboundmedicine.com/medline/citation/24708347/Hashimoto's_thyroiditis_pathology_and_risk_for_thyroid_cancer_ L2 - https://www.liebertpub.com/doi/full/10.1089/thy.2013.0588?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -