Endocrine Abstracts (2009) 20 P99

The prevalence and the significance of nodular thyroid disease (NTD) in thyroid autoimmune disease (TAD)

Ioana Zosin1, Marioara Cornianu2, Mihaela Vlad1, Melania Balas1, Ioana Golu1, Daniela Amzar1 & Roland Schmidt1

1Department of Endocrinology, University of Medicine and Pharmacy, Timisoara, Romania; 2Department of Morphopathology, University of Medicine and Pharmacy, Timisoara, Romania.

The aim of this study was to analyze retrospectively (2003–2007) the coexistence of NTD with TAD (Graves’ and Hashimoto’s diseases) in an iodine-replete area.

The first study group included 381 cases with Graves’ hyperthyroidism, not previously treated with surgery or radioiodine therapy. The second group comprised 213 patients with hyperplasic Hashimoto’s disease and heterogeneous functionality.

NTD was diagnosed by: clinical examination, thyroid ultrasonography (performed at the time of diagnosis and repeated annually) and fine-needle aspiration (FNA – repeated after 2 years).

About 7.34% of Graves’ patients presented NTD at the time of first examination.

FNA performed in the nodules showed the following types of smears: 23 benign, 3 indeterminate and one non-diagnostic. The morphopatological diagnosis in patients with indeterminate cytological aspect showed 2 follicular carcinomas. Among other 6 operated cases (compressive signs), 2 presented papillary hyperplasia and 4 colloid goiters, one associated with a micropapillary carcinoma.

Among the cases with goitrous chronic autoimmune thyroiditis (CAT), 7.98% presented NTD.

The cytological examination revealed the following types of smears: 6 benign (5 of them with specific aspect of CAT), 5 indeterminate and 6 malignant. The morphopathological diagnosis in cases with indeterminate smears was as following: follicular adenomas with CAT (4 cases) and an oxyphilic adenoma with a papillary microcarcinoma and CAT.

The histological analysis showed in malignant smears 6 papillary carcinomas (2 classical forms, 1 multicentric form, 3 papillary carcinomas, follicular variant, all associated with CAT).

Clinical and mainly ultrasonographical evidence of NTD was frequently observed among patients with TAD.

The ultrasonography and the cyto-morphological examination showed in TAD a large variety of nodular lesions, with a relative high incidence of malignancy.

NTD associated with TAD poses sometimes difficult diagnostic problems, imposing in correctly selected cases an aggressive therapeutic approach.

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