Thyroid Cancer and Hyperthyroidism

Abstract

Objectives:

(1) Present a case series of patients with hyperthyroidism and thyroid cancer. (2) Look at the clinical characteristics and outcomes of these patients to determine which patients require further investigation.

Methods:

Retrospective review of case notes of all patients with a histopathological diagnosis of thyroid cancer and biochemical evidence of hyperthyroidism treated at a thyroid cancer center between January 2006 and October 2013.

Results:

During the study period, 66 patients were diagnosed with thyroid cancer. Eight patients had biochemical evidence of hyperthyroidism (12.1%). The mean age of these patients was 56.1 years (range, 29-87 years). All patients were female. Of these patients, 3 patients were diagnosed with Graves’ disease, 1 patient with toxic multinodular goiter, and 4 patients with an autonomously functioning toxic nodule (AFTN). Five patients had suspicious features on their preoperative ultrasound. All patients were diagnosed with papillary thyroid carcinoma. The mean size of the tumor in patients with an AFTN was significantly larger than those with Graves’ disease (38.1 ± 7.9 vs 4.6 ± 1.3 mm, P = .001). All 3 patients with Graves’ disease had papillary microcarcinoma, while those patients with AFTN had a poorer prognosis, with 2 patients with extracapsular invasion and lymph node metastases, and 1 patient dying from disease.

Conclusions:

The incidence of hyperthyroidism in thyroid cancer patients is high. In contrast to previous literature, patients with AFTN seem to have more aggressive disease with poorer outcomes when compared to patients with Graves’ disease. Any suspicious nodule associated with hyperthyroidism should be evaluated carefully.