Graves Disease, Thyroid Cancer
Conditions
Keywords
Incidental thyroid cancer
Brief summary
The prevalence of incidental thyroid cancer (ITC) in Graves' Disease (GD) patients undergoing thyroidectomy appears higher than historically believed, potentially exceeding 10% in large contemporary series, although significant variability exists. The presence of nodules is a strong predictor, while the roles of age, sex, and BMI require clarification. Most ITCs are papillary thyroid microcarcinoma(PTMCs) with generally favorable prognoses, but concerns about aggressiveness persist. The purpose of the present study is to accurately evaluate the prevalence of incidental thyroid carcinoma (ITC), including microcarcinomas, in a prospectively enrolled cohort of patients undergoing total thyroidectomy for Graves' disease, utilizing standardized pathological examination protocols and secondary outcomes including predictors and histopathological characteristics.
Detailed description
Graves' disease (GD) is the most common cause of hyperthyroidism, affecting approximately 0.5% of the US population. While definitive treatment often involves radioactive iodine (RAI) or antithyroid drugs (ATDs), thyroidectomy is increasingly utilized, especially for patients with large goiters, compressive symptoms, coexisting suspicious nodules, or contraindications/failure of other therapies. However, numerous studies over the past few decades have challenged this notion, reporting varying rates of incidental thyroid carcinoma (ITC) discovered in thyroidectomy specimens from GD patients. Understanding the true prevalence and identifying predictors of incidental thyroid cancer (ITC) in this population is crucial for appropriate patient counseling, surgical decision-making, and determining the optimal extent of thyroidectomy. Identifying factors associated with an increased risk of incidental thyroid cancer in GD patients could help stratify risk and guide management. Several potential predictors in literatures reviews have been investigated, with some conflicting results: * Presence of Nodules: The presence of thyroid nodules within the diffuse goiter of GD is a consistently reported risk factor for ITC. * Age: Some studies suggest older age is a risk factor. However others, identified younger age as a predictor. This discrepancy requires further investigation. * Sex: Male sex has been identified as a risk factor in some studies, although GD is much more prevalent in females. * Body Mass Index (BMI): patients with cancer had a higher BMI. * Thyroid Autoantibodies and Thyroglobulin: thyroid peroxidase antibodies (TPOAbs), thyroglobulin antibody(TgAbs), and thyroglobulin(Tg) levels but found no statistically significant differences between benign and malignant groups in their cohort undergoing total thyroidectomy for benign diseases. The role of specific GD-related antibodies (e.g., thyroid-stimulating hormone (TSH) receptor antibodies) as predictors requires further study. The study will enroll approximately 280 patients , utilizing standardized data collection (demographics, clinical history, laboratory, imaging and operative data) and pathological examination protocols. The primary outcome is the prevalence of incidental thyroid cancer (ITC), secondary outcomes including predictors and histopathological characteristics.
Interventions
PROCEDURETotal thyroidectomy
Remove of both thyroid lobes and isthmus
Sponsors
Minia University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Age 18 years or older. * Confirmed diagnosis of Graves' disease based on clinical features (e.g., diffuse goiter, ophthalmopathy if present) and biochemical evidence (suppressed TSH, elevated free T4 and/or T3) and/or positive TSH receptor antibody (TRAb) test. * Indication for total thyroidectomy for Graves' disease, based on established guidelines: Relapse or persistence of hyperthyroidism after a course of antithyroid drugs (ATDs). Intolerance or adverse reaction to ATDs. Patient preference for surgery over radioactive iodine (RAI) or long-term ATDs. Presence of a large goiter causing compressive symptoms. Coexisting suspicious thyroid nodule(s) on preoperative evaluation. Moderate to severe active Graves' ophthalmopathy where RAI is relatively contraindicated. * Patient is scheduled for total thyroidectomy (near-total or subtotal thyroidectomy patients will be excluded). * Ability and willingness to provide written informed consent. * Ability to understand study procedures and requirements.
Exclusion criteria
* Age less than 18 years. * Previous thyroid surgery. * Previous neck irradiation. * Preoperative diagnosis of thyroid malignancy confirmed by fine-needle aspiration (FNA) cytology (Bethesda V or VI) , the focus is on incidental carcinoma. * Inability to provide informed consent (e.g., due to cognitive impairment). * Patients undergoing thyroidectomy primarily for reasons other than Graves' disease (e.g., primary indication is large non-toxic MNG). * Patients undergoing less than total thyroidectomy (e.g., lobectomy, subtotal thyroidectomy).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Prevalence of Incidental Thyroid Carcinoma (ITC) | Assessed at the time of final pathology report post-surgery (within 30 days post-operation).Histopathological examination of thyroidectomy specimens using standardized protocols. | The proportion of patients with histologically confirmed incidental thyroid carcinoma, including microcarcinomas, among those undergoing total thyroidectomy for Graves' disease. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Factors Associated with Incidental Thyroid Carcinoma (ITC) Risk. | Assessed at the time of data analysis, approximately 1 year after enrollment completion. | Identification of predictors for incidental thyroid carcinoma (ITC) through univariate and multivariate logistic regression analysis of preoperative clinical, laboratory, imaging, and demographic data. Factors to be assessed include, but are not limited to, presence of nodules, age, sex, and Body Mass Index (BMI). |
| Histopathological Characteristics of Incidental Thyroid Carcinoma. | Assessed at the time of final pathology report post-surgery (within 30 days post-operation). | Frequency and percentage of ITC characteristics (e.g., histological type, size, stage, multifocality). |
Countries
Egypt
Contacts
CONTACTSaleh K Saleh, MD
CONTACTRabeh K Saleh, MD
PRINCIPAL_INVESTIGATORSaleh K Saleh, MD
Minia University
Outcome results
None listed