Published: 2016-12-19

Analytical study of the incidence of papillary carcinoma in thyroiditis cases and assessing the risk

Santhosh P. V., Vinodh M., Prasad R. V., Joy Augastine


Background: The association between thyroid carcinoma and thyroiditis remains controversial in medical bibliography. Therefore, the present study was designed to investigate the incidence of papillary carcinoma in diagnosed cases of thyroiditis patients who underwent surgery and analyze the risk of carcinoma in thyroiditis patients.

Methods: Patients of both sexes, age more than 13 with symptomatic thyroid swelling and diagnosed as any sub types of thyroiditis with FNAC/USG/Antibody titer in Government Medical College, Thrissur, India. 41females and 3 male patients were studied to assess risk of carcinoma in thyroiditis cases, analyzing the age, symptoms, clinical presentations and FNAC results.

Results: 17 out of 44 cases showed post-operative biopsy as papillary carcinonoma.15 out of 17 papillary carcinoma cases diagnosed were above 36 years, with 6times increased risk, 95% CI = (1.142, 31.532). 10 out of 17 carcinoma cases have rapid increase in size (p=0.00). 82.4% of carcinoma cases have obstructive symptoms (p=0.00). FB sensation is more frequently seen in postoperative benign thyroiditis. 59% of the papillary carcinoma cases were diagnosed pre operatively as colloid with thyroiditis.

Conclusions: Females aged more than 36years and all adult males with a rapid increase in size of the thyroid swelling and/or obstructive symptoms like dyspnoea/dysphagia, who’s FNAC suggestive of colloid with features of thyroiditis have a high malignant potential for papillary carcinoma, and total/near total thyroidectomy may be considered as an appropriate operative treatment.


Papillary carcinoma, Thyroidectomy, Thyroiditis

Full Text:



Arif S, Blanes A, Diaz-Cano SJ. Hashimoto’s thyroiditis shares features with early papillary thyroid carcinoma. Histopathology. 2002;(10)1:25-9.

Harach HR, Ceballos GA. Thyroid cancer, thyroiditis and dietary iodine: A review based on the salta, argentina model. Endocrine Pathology. 2008;12(2):90-8.

Okayasu I, Fujiwara M, Hara Y, Tanaka Y, Rose NR. Association of chronic lymphocytic thyroiditis and thyroid papillary carcinoma: A study of surgical cases among Japanese, and white and African Americans. Cancer. 1995;76(11):2312-8.

Hempelmann LH, Hall WJ, Phillips M, Cooper RA, Ames WR. Neoplasms in persons treated with X-rays in infancy: fourth sur- vey in 20 years. JNatl Cancerlnsf. 1975;55:519-30.

Doniasch I, Williams ED. Biologic effects of radiation on the thyroid. In: Ingbar SH, Braverman LE, editors. Werner’s the thyroid. 5th ed. Philadelphia: JB Lippincott. 1986;432-44.

Juhasz F, Balazs G, Stenszky V, Kozma L, Farid NR. The relation of susceptibility to and biologic behavior of thyroid epithelial cell cancer to HLA-DR1. Cancer. 1986;58:52-4.

Ohshima M, Ward JM. Promotion of N-Methyl-N-Nitrosourea- induced thyroid tumors by odine ciency in F344/NCr rats. Natl Cnncer lnst. 1984;73:289-96.

Kamma H, Fujii K, Ogata T. Lymphocytic infiltration in juvenile thyroid carcinoma. Cancer 1988;62:1988-93.

Rosai J, Carcangiu ML, DeLellis RA. Papillary carcinoma. In: At- las of Tumor Pathology, Tumor of the Thyroid Gland. 3rd series. Washington. AFIP. 1992;65-121.

Mazokopakis EE, Tzortzinis AA, Dalieraki-Ott EI, Tsartsalis AN, Syros PK, Karefilakis CM, et al. Coexistence of Hashimoto's thyroiditis with papillary thyroid carcinoma. A retrospective study. Hormones (Athens). 2010;9:312-8.

Cipolla C1, Sandonato L, Graceffa G, Fricano S, Torcivia A, Vieni S, et al. Hashimoto thyroiditis coexistent with papillary carcinoma. Am Surg. 2005;71:874-8.

Anderson L, Middleton WD, Teefey SA, Reading CC, Langer JE, Desser T, et al. Hashimoto thyroiditis. Part 2: sonographic analysis of benign and malignant nodules in patients with diffuse Hashimoto thyroiditis. Am J Roentgenol. 2010;195:216-22.

Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA. 2006;295:2164-7.

Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87:489-99.

Dailey ME, Lindsay S, Skahen R. Relation of thyroid neoplasms to Hashimoto disease of the thyroid gland. Arch Surg. 1955;70:291-7.

Crile GJ, Hazard JB. Incidence of cancer in struma lymphomatosa. Surg Gynecol Obstet. 1962;115:101-3.

Crile GJ. Struma lymphomatosa and carcinoma of the thyroid. Surg Gynecol Obstet. 1978;147:350-52.

Holm LE, Blomgren H, Lowhagen T. Cancer risks in patients with chronic lymphocytic thyroiditis. N Engl J Med. 1985;312:601-4.

Carson H, Castelli M, Gattuso P. Incidence of neoplasia in Hashimoto's thyroiditis: a fine-needle aspiration study. Diagn Cytopathol. 1996;14:38-42.

Erdogan M, Erdem N, Cetinkalp S, Ozgen AG, Saygılı F, Yilmaz C, et al. Demographic, clinical, laboratory, ultrasonographic, and cytological features of patients with Hashimoto's thyroiditis: a result of a university hospital of 769 patients in Turkey. Endocrine. 2009;36:486-90.

Matesa-Anić D, Matesa N, Dabelić N, Kusić Z. Coexistence of papillary carcinoma and Hashimoto's thyroiditis. Acta Clin Croat. 2009;48:9-12.

Anil C, Goksel S, Gursoy A. Hashimoto's thyroiditis is not associated with increased risk of thyroid cancer in patients with thyroid nodules: a single-center prospective study. Thyroid. 2010;20:601-6.

Mukasa K, Noh JY, Kunii Y, Matsumoto M, Sato S, Yasuda S, et al. Prevalence of malignant tumors and adenomatous lesions detected by ultrasonographic screening in patients with autoimmune thyroid disease. Thyroid. 2011;21:37-41.

Boi F, Lai ML, Minerba L, Faa G, Mariotti S. High prevalence of suspicious cytology in thyroid nodules associated with positive thyroid autoantibodies. Eur J Endocrinol. 2005;153:637-42.

Singh B, Shaha AR, Trivedi H, Carew JF, Poluri A, Shah JP. Coexistent Hashimoto's thyroiditis with papillary thyroid carcinoma: impact of presentation, management and outcome. Surgery. 1999;126:1070-7.