The prognosis of patients with Graves’
disease found to have a small thyroid carcinoma at thyroidectomy
is excellent
(July 2006)
The background of the study. Some patients with
hyperthyroidism caused by Graves’ disease who are treated
by thyroidectomy are found at surgery to have a thyroid carcinoma.
In this study, the prognosis of patients with Graves’ hyperthyroidism
who had a small incidentally detected thyroid carcinoma was compared
with that of patients with other thyroid disorders found to have
an incidental carcinoma.
How the study was done. The study subjects were
509 patients with Graves’ hyperthyroidism and 509 age- and
sex-matched patients with other thyroid disorders (benign nodules,
adenomas, thyroiditis) who were found to have a ≤1.0 cm carcinoma
(microcarcinoma) at the time of thyroidectomy. No additional treatment
was given.
The results of the study. The types and size of
the carcinoma in the two groups were similar, as was the frequency
of multifocal tumors. In contrast, lymph-node metastases and invasion
of adjacent tissue were more common in the non–Graves’
disease group.
The mean duration of follow-up was 13 years, during which 3 of
the 509 patients with Graves’ disease (1 percent) had a recurrence
of thyroid carcinoma, as compared with 17 (3 percent) of the non–Graves’
disease patients. The 20-year survival rate was 99 percent in the
Graves’ disease patients and 93 percent in the non–Graves’
disease patients.
The conclusions of the study. Patients with Graves’
hyperthyroidism who are found to have a microcarcinoma at the time
of thyroidectomy have an excellent prognosis.
The original article. Kikuchi S, Noguchi S, Yamashita
H, Uchino S, Kawamoto H. Prognosis of small thyroid cancer in patients
with Graves’ disease. Br J Surg 2006;93:434-9.
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