The association between thyroid malignancy and chronic lymphocytic thyroiditis: should it alter the surgical approach?

Oktay Büyükaşık; Ahmet Oğuz Hasdemir; Erol Yalçın; Bahadır Celep; Serkan Şengül; Kemal Yandakçı; Gündüz Tunç; Tevfik Küçükpınar; Seval Alkoy; Cavit Çöl

Vol 62, No 4 (2011)

Original paper

Submitted: 2013-02-15

Published online: 2011-08-30

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The association between thyroid malignancy and chronic lymphocytic thyroiditis: should it alter the surgical approach?

Oktay Büyükaşık, Ahmet Oğuz Hasdemir, Erol Yalçın, Bahadır Celep, Serkan Şengül, Kemal Yandakçı, Gündüz Tunç, Tevfik Küçükpınar, Seval Alkoy, Cavit Çöl

Endokrynol Pol 2011;62(4):303-308.

Vol 62, No 4 (2011)

Original Paper

Submitted: 2013-02-15

Published online: 2011-08-30

Abstract

Background: The relation between thyroid neoplasms and chronic lymphocytic thyroiditis (CLT) is controversial. While it is accepted that focal lymphocytic thyroiditis develops secondarily to malignancy, it is not clear whether diffuse lymphocytic thyroiditis has a tendency to develop into thyroid cancer. The aim of this study was to investigate the relation between CLT and malignant tumours of the thyroid and evaluate the surgical approach to CLT cases.
Material and methods: In this study, 917 patients operated on for thyroid diseases were investigated retrospectively. Seventy-seven (8.4%) patients histopathologically diagnosed as having CLT (either non-specific or Hashimoto’s thyroiditis) were investigated for any concurrent malignant neoplasm. Fifteen patients in whom CLT and thyroid malignancy were coexisting were included in the study.
Results: In the pathological evaluation of 917 cases, malignancy in the thyroid was found in 97 (10.6%) cases. Seventy-seven cases were categorised as CLT. Of these 77, 16 (20.8%) were Hashimoto’s thyroiditis (specific CLT) and the other 61 (79.2%) were non-specific CLT. In 15 cases, thyroid malignancy was found to be concurrent with CLT. Of the malignities, nine (60%) were papillary carcinoma, three (20%) medullar carcinoma, one (6.6%) follicular carcinoma, one (6.6%) Hurthle cell carcinoma, and one (6.6%) lymphoma. In our series, the rate of the development of malignancy against the background of CLT was 19.48%, while the rate in the groups without CLT was 9.76%, with a statistically significant difference between the groups (p = 0.008).
Conclusions: CLT cases should be evaluated more carefully in terms of malignancy. If a nodule is detected on thyroiditis, the minimal surgical intervention should be lobectomy. Total thyroidectomy should be considered as preferable to subtotal thyroidectomy because of its many advantages such as controlling thyroiditis, removing the probability of reoperation, and hormonal stability.
(Pol J Endocrinol 2011; 62 (4): 303–308)