Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Indian Journal of Surgical Oncology
Published in: Indian Journal of Surgical Oncology 3/2014

01-09-2014 | Review Article

Papillary Thyroid Cancer and Hashimoto’s Thyroiditis: An Association Less Understood

Authors: Akshay Anand, Kul Ranjan Singh, Jitendra Kumar Kushwaha, Nuzhat Hussain, Abhinav Arun Sonkar

Published in: Indian Journal of Surgical Oncology | Issue 3/2014

Login to get access

Abstract

Hashimoto’s thyroiditis (HT), part of the spectrum of autoimmune thyroid diseases is a major cause of thyroid hypofunction worldwide. Papillary thyroid carcinoma (PTC), the most prevalent of all thyroid carcinomas has been associated with HT. Literature on this association are based on preoperative FNA or post thyroidectomy histopathology reports, which are subject to potential biases. Molecular, hormonal and histopathalogical basis of this association has been hypothesized, however a definite causal association has not been proved till date. This review aims to study the basis of this association and clinical features and management of HT concurrent with PTC. There are no distinctive clinical or radiological features that categorically differentiates HT concurrent with PTC from PTC or which can pick up a nodule harboring PTC in setting of HT. Smaller nodule size and radiological features like hypoechogenecity; hyper vascularity and calcification in a clinical setting of hypothyroidism have a higher odds ratio for malignancy and merit further investigations. PTC associated with HT has been seen to be less aggressive with earlier presentation with lesser chances of extra thyroidal extension and lymph nodal metastasis. The management and follow up of PTC in HT is no different from that of PTC alone. The prognosis of PTC concurrent with HT is better compared to age and stage matched PTC in terms of lower recurrence and disease free and overall survival.
Literature
1.
Davies L, Welch HG (2006) Increasing incidence of thyroid cancer in the United States, 1973–2002. J Am Med Assoc 295(18):2164–2167
2.
Burgess JR, Tucker P (2006) Incidence trends for papillary thyroid carcinoma and their correlation with thyroid surgery and thyroid fine-needle aspirate cytology. Thyroid 16(1):47–53PubMedCrossRef
3.
Mazokopakis EE, Chatzipavlidou V (2007) Hashimoto’s thyroiditis and the role of selenium: current concepts. Hell J Nucl Med 10:6–8PubMed
4.
Mazokopakis EE, Papadakis JA, Papadomanolaki MG et al (2007) Effects of 12 months treatment with L-selenomethionine on serum anti-TPO levels in patients with Hashimoto’s thyroiditis. Thyroid 17:609–612PubMedCrossRef
5.
Dailey ME, Lindsay S, Skahen R (1955) Relation of thyroid neoplasms to Hashimoto disease of the thyroid gland. Arch Surg 70(2):291–297CrossRef
6.
Bojana J et al (2013) Hashimoto’s thyroiditis and papillary thyroid carcinoma: is there a correlation? J Clin Endocrinol Metab 98:474–482CrossRef
7.
Davies L, Welch HG (2006) Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 295:2164–2167PubMedCrossRef
8.
9.
Jayaram G, Iyengar KR, Sthaneshwar P et al (2007) Hashimoto’s thyroiditis—a Malaysian perspective. J Cytol 24(3):119–124
10.
Bloodworth JMB, Lechago J, Gould VE (1996) Bloodworth’s endocrine pathology, 3rd edn. Williams & Wilkins, Baltimore
11.
Singh B, Shaha AR, Trivedi H et al (1999) Coexistent Hashimoto’s thyroiditis with papillary thyroid carcinoma: impact on presentation, management, and outcome. Surgery 126(6):1070–1077
12.
Ward LS, Assumpcao LVM (2007) The impact of gender in differentiated thyroid cancer. Clin Endocrinol 66(5):752–753CrossRef
13.
Kilfoy BA, Zheng T, Holford TR et al (2009) International patterns and trends in thyroid cancer incidence, 1973–2002. Cancer Causes Control 20(5):525–531PubMedCentralPubMedCrossRef
14.
Cheema Y, Olson S, Elson D et al (2006) What is the biology and optimal treatment for papillary microcarcinoma of the thyroid? J Surg Res 134:160–162PubMedCrossRef
15.
Cheema Y, Repplinger D, Elson D et al (2006) Is tumor size the best predictor of outcome for papillary thyroid cancer? Ann Surg Oncol 13:1524–1528PubMedCrossRef
16.
Bloodworth JMB, Lechago J, Gould VE (1997) Bloodworth’s endocrine pathology. Williams & Wilkins, Baltimore, The thyroid; pp. 178–181, pp. 197–206
17.
Kollur SM, El Sayed S, El Hag IA (2003) Follicular thyroid lesions coexisting with Hashimoto’s thyroiditis: incidence and possible sources of diagnostic errors. Diagn Cytopathol 28(1):35–38PubMedCrossRef
18.
Wijayawardena MA, Gunawardane HD, Sheriffdeen AH et al (2004) Medullary carcinoma of the thyroid gland associated with Hashimoto’s thyroiditis. Ceylon Med J 49(3):96PubMed
19.
Wartofsky L (2010) Increasing world incidence of thyroid cancer: increased detection or higher radiation exposure? Horm 9(2):103–108CrossRef
20.
Ostroumova E, Brenner A, Oliynyk V et al (2009) Subclinical hypothyroidism after radioiodine exposure: Ukrainian- American cohort study of thyroid cancer and other thyroid diseases after the chornobyl accident (1998–2000). Environ Health Perspect 117(5):745–750PubMedCentralPubMedCrossRef
21.
Gomez Segovia I, Gallowitsch HJ, Kresnik E et al (2004) Descriptive epidemiology of thyroid carcinoma in Carinthia, Austria: 1984–2001. Histopathologic features and tumor classification of 734 cases under elevated general iodination of table salt since 1990: population-based age stratified analysis on thyroid carcinoma incidence. Thyroid 14(4):277–286PubMedCrossRef
22.
Lee JH, Kim Y, Choi JW et al (2013) The association between papillary thyroid carcinoma and histologically proven Hashimoto’s thyroiditis: a meta-analysis. Eur J Endocrinol 168(3):343–349PubMedCrossRef
23.
Laurberg P, Cerqueira C, Ovesen L et al (2010) Iodine intake as a determinant of thyroid disorders in populations. Best Pract Res 24(1):13–27CrossRef
24.
Nikiforov YE (2006) RET/PTC rearrangement—a link between Hashimoto’s thyroiditis and thyroid cancer…or not. J Clin Endocrinol Metab 91(6):2040–2042PubMedCrossRef
25.
26.
Anil C, Goksel S, Gursoy A (2010) Thyroglobulin antibody is associated with increased cancer risk in thyroid nodules. Thyroid 20(8):885–891CrossRef
27.
Boi F, Lai ML, Marziani B et al (2005) High prevalence of suspicious cytology in thyroid nodules associated with positive thyroid autoantibodies. Eur J Endocrinol 153(5):637–642PubMedCrossRef
28.
Fiore E et al (2011) Hashimoto’s thyroiditis is associated with papillary thyroid carcinoma: role of TSH and of treatment with L-thyroxine. Endocr Relat Cancer 18(4):429–437PubMedCrossRef
29.
Fiore E, Rago T, Scutari M et al (2009) Papillary thyroid cancer, although strongly associated with lymphocitic infiltration on histology, is only weakly predicted by serum thyroid autoantibodies in patients with nodular thyroid diseases. J Endocrinol Investig 32(4):344–351CrossRef
30.
Boelaert K, Horacek J, Holder RL et al (2006) Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J Clin Endocrinol Metab 91(11):4295–4301PubMedCrossRef
31.
Rago T, Di Coscio G, Ugolini C et al (2007) Clinical features of thyroid autoimmunity are associated with thyroiditis on histology and are not predictive of malignancy in 570 patients with indeterminate nodules on cytology who had a thyroidectomy. Clin Endocrinol 67(3):363–369CrossRef
32.
Fiore E, Rago T, Provenzale MA et al (2009) Lower levels of TSH are associated with a lower risk of papillary thyroid cancer in patients with thyroid nodular disease: thyroid autonomy may play a protective role. Endocr Relat Cancer 16(4):1251–1260PubMedCrossRef
33.
Crile G Jr, Fisher ER (1953) Simultaneous occurrence of thyroiditis and papillary carcinoma; report of two cases. Cancer 6(1):57–62PubMedCrossRef
34.
Hirabayashi RN, Lindsay S (1965) The relation of thyroid carcinoma and chronic thyroiditis. Surg Gynecol Obstet 121:243–252PubMed
35.
Schlicke CP, Hill JE, Schultz GF (1960) Carcinoma in chronic thyroiditis. Surg Gynecol Obstet 111:552–556PubMed
36.
Clark OH, Greenspan FS, Dunphy JE (1980) Hashimoto’s thyroiditis and thyroid cancer: indications for operation. Am J Surg 140(1):65–71PubMedCrossRef
37.
Lindsay S, Dailey ME, Friedlander J, Yee G et al (1952) Chronic thyroiditis: a clinical and pathologic study of 354 patients. J Clin Endocrinol Metab 12(12):1578–1600
38.
Meier DW, Woolner LB, Beahrs OH, McConahey WM, (1959) Parenchymal findings in thyroidal carcinoma: pathologic study of 256 cases. J Clin Endocrinol Metab 19:162–171
39.
Kebebew E, Treseler PA, Ituarte PHG et al (2001) Coexisting chronic lymphocytic thyroiditis and papillary thyroid cancer revisited. World J Surg 25(5):632–637PubMedCrossRef
40.
Lu H, Ouyang W, Huang C (2006) Inflammation, a key event in cancer development. Mol Cancer Res 4(4):221–233
41.
42.
Kang DY, Kim KH, Kim JM et al (2007) High prevalence of RET, RAS, and ERK expression in Hashimoto’s thyroiditis and in papillary thyroid carcinoma in the Korean population. Thyroid 17(11):1031–1038PubMedCrossRef
43.
Colotta F, Allavena P, Sica A et al (2009) Cancer-related inflammation, the seventh hallmark of cancer: links to genetic instability. Carcinogenesis 30(7):1073–1081PubMedCrossRef
44.
Crawford S, Belajic D, Wei J et al (2008) A novel B-RAF inhibitor blocks interleukin-8 (IL-8) synthesis in human melanoma xenografts, revealing IL-8 as a potential pharmacodynamics biomarker. Mol Cancer Ther 7(3):492–499PubMedCrossRef
45.
Unger P, Ewart M, Wang B et al (2003) Expression of p63 in papillary thyroid carcinoma and in Hashimoto’s thyroiditis: a pathological link? Hum Pathol 34:764–769PubMedCrossRef
46.
Asioli S, Erickson LA, Lloyd RV (2009) Solid cell nests in Hashimoto’s thyroiditis sharing features with papillary thyroid microcarcinoma. Endocr Pathol 20:197–203PubMedCrossRef
47.
Burstein DE (2004) Immunohistochemical detection of p53 homolog p63 in solid cell nests, papillary thyroid carcinoma, and Hashimoto’s thyroiditis: a stem cell hypothesis of papillary carcinoma oncogenesis. Hum Pathol 35(4):465–473PubMedCrossRef
48.
Cameselle-Teijeiro J et al (2009) BRAF mutation in solid cell nest hyperplasia associated with papillary thyroid carcinoma. A precursor lesion? Hum Pathol 40:1029–1035PubMedCrossRef
49.
Crile GJ, Hazard JB (1962) Incidence of cancer in struma lymphomatosa. Surg Gynecol Obstet 115:101–103PubMed
50.
Mukasa K, Noh JY, Kunii Y et al (2011) Prevalence of malignant tumors and adenomatous lesions detected by ultrasonographic screening in patients with autoimmune thyroid disease. Thyroid 21:37–41PubMedCrossRef
51.
Okayasu I, Fujiwara M, Kara Y, Tanaka Y, Rose NR (1995) Association of chronic lymphocytic thyroiditis and thyroid papillary carcinoma. Cancer 76:2312–2318PubMedCrossRef
52.
McLeod DS, Watters KF, Carpenter AD, Ladenson PW, Cooper DS, Ding EL (2012) Thyrotropin and thyroid cancer diagnosis: a systematic review and dose-response meta-analysis. J Clin Endocrinol Metab 97:2682–2692PubMedCrossRef
53.
Daniel R (2008) Is Hashimoto’s thyroiditis a risk factor for papillary thyroid cancer? J Surg Res 150(1):49–52CrossRef
54.
Yeh HC, Futterweit W, Gilbert P (1996) Micronodulation: ultrasonographic sign of Hashimoto thyroiditis. J Ultrasound Med 15:813–819PubMed
55.
Simeone JF, Daniels GH, Mueller PR et al (1982) High-resolution real-time sonography of the thyroid. Radiology 145:431–435PubMedCrossRef
56.
Butch RJ, Simeone JF, Mueller PR et al (1985) Thyroid and parathyroid ultrasonography. Radiol Clin N Am 23:57–71PubMed
57.
Pedersen OM, Aardal NP, Larssen TB et al (2000) The value of ultrasonography in predicting autoimmune thyroid disease. Thyroid 10:251–259PubMedCrossRef
58.
59.
Baloch ZW, Cibas ES, Clark DP et al (2008) The national cancer institute thyroid fine needle aspiration state of the science conference: a summation. Cyto J 5:6
60.
Frates MC, Benson CB, Doubilet PM, Cibas ES, Marqusee E (2003) Can color doppler sonography aid in the prediction of malignancy of thyroid nodules? J Ultrasound Med 22:127–131PubMed
61.
Cooper DS, Doherty GM, Haugen BR et al (2006) Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16:109–142PubMedCrossRef
62.
Gharib H, Papini E, Valcavi R et al (2006) AACE/AME task force on thyroid nodules. American association of clinical endocrinologists and associazione Medici endocarinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 12:63–102PubMedCrossRef
63.
Nariko O et al (2007) Ultrasonographic findings of papillary thyroid carcinoma with Hashimoto’s thyroiditis. Intern Med Tokyo Jpn 46(9):547–550CrossRef
64.
Makhdoomi R et al (2013) Coexistent papillary carcinoma of thyroid and Hashimoto’s thyroiditis—diagnosis on fine needle aspiration cytology. Int J Endocrinol Metab 11(3):191–194PubMedCentralPubMedCrossRef
65.
Su DH, Liao KM, Hsiao YL et al (2004) Determining when to operate on patients with Hashimoto’s thyroiditis with nodular lesions: the role of ultrasound-guided fine needle aspiration. Acta Cytol 48:622–629PubMedCrossRef
66.
Rosai J, Carcangiu ML, DeLellis RA (1992) Tumors of the thyroid gland. Armed Forces Institute of Pathology, Washington
67.
Baloch Z, LiVolsi VA (2003) Diagnostic dilemmas in thyroid pathology: follicular variant of papillary thyroid carcinoma and classic papillary thyroid carcinoma arising in lymphocytic thyroiditis. Pathol Case Rev 8:47–56CrossRef
68.
Baloch ZW, LiVolsi VA (2000) Warthin-like papillary carcinoma of the thyroid. Arch Pathol Lab Med 124:1192–1195PubMed
69.
V. Krishna (2014) Textbook: Pathology of Thyroid gland p 1901–1909
70.
Crile GJ (1978) Struma lymphomatosa and carcinoma of the thyroid. Surg Gynecol Obstet 147:350–352PubMed
71.
Holm LE, Blomgren H, Lowhagen T (1985) Cancer risks in patients with chronic lymphocytic thyroiditis. N Engl J Med 312:601–604PubMedCrossRef
72.
Carson H, Castelli M, Gattuso P (1996) Incidence of neoplasia in Hashimoto’s thyroiditis: a fine-needle aspiration study. Diagn Cytopathol 14:38–42PubMedCrossRef
73.
Erdogan M, Erdem N, Cetinkalp S et al (2009) 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 36:486–490PubMedCrossRef
74.
Matesa-Anic’ D, Matesa N, Dabelic’ N, Kusic’ Z (2009) Coexistence of papillary carcinoma and Hashimoto’s thyroiditis. Acta Clin Croat 48:9–12
75.
Anil C, Goksel S, Gursoy A (2010) Hashimoto’s thyroiditis is not associated with increased risk of thyroid cancer in patients with thyroid nodules: a single-center prospective study. Thyroid 20:601–606PubMedCrossRef
76.
Mazakopakis E, Tzortzinis A, Dalieraki-Ott E et al (2010) Coexistence of Hashimoto’s thyroiditis with papillary thyroid carcinoma. A retrospective study. Horm (Athens) 9:312–318CrossRef
77.
Cipolla C, Sandonato L, Graceffa G et al (2005) Hashimoto thyroiditis coexistent with papillary carcinoma. Am Surg 71:874–878PubMed
78.
Larson SD, Jackson L, Riall T et al (2007) Increased incidence of well-differentiated thyroid cancer associated with Hashimoto’s thyroid- itis and the role of the PI3K/AKT pathway. J Am Coll Surg 204:764–775PubMedCentralPubMedCrossRef
79.
Kurukahvecioglu O, Taneri F, Yuksel O, Aydin A, Tezel E, Onuk E (2007) Total thyroidectomy for treatment of Hashimoto’s thyroiditis coexisting with papillary thyroid carcinoma. Adv Ther 24:510–516PubMedCrossRef
80.
Bradly D, Reddy V, Prinz RA, Gattuso P (2009) Incidental papillary carcinoma in patients treated surgically for benign thyroid diseases. Surgery 146:1099–1104PubMedCrossRef
81.
Siriweera EH, Ratnatung NV (2010) Profile of Hashimoto’s thyroiditis in Sri Lankans: is there an increased risk of ancillary pathologies in Hashimoto’s thyroiditis. J Thyroid Res 2010:124264
82.
Ott RA, Calandra DB, McCall A, Shah KH et al (1985) The incidence of thyroid carcinoma in patients with Hashimoto’s thyroiditis and solitary cold nodules. Surgery 98:1202–1206PubMed
83.
Nguyen GK, Ginsberg J, Crockford PM, Villanueva RR (1997) Hashimoto’s thyroiditis: cytodiagnostic accuracy and pitfalls. Diagn Cytopathol 16:531–536PubMedCrossRef
84.
Ravinsky E, Safneck JR (1988) Differentiation of Hashimoto’s thyroiditis from thyroid neoplasms in fine needle aspirates. Acta Cytol 32:854–861PubMed
85.
Kumarasinghe MP, De Silva S (1999) Pitfalls in cytological diagnosis of autoimmune thyroiditis. Pathology 31:1–7PubMedCrossRef
86.
MacDonald L, Yazdi HM (1999) Fine needle aspiration biopsy of Hashimoto’s thyroiditis. Sources Diagn Acta Cytol 43:400–406CrossRef
87.
Seifman M, Grodski S, Bailey M, Yeung M, Serpell J (2011) Surgery in the setting of Hashimoto’s thyroiditis. ANZ J Surg 81:519–523PubMedCrossRef
88.
Eisenberg BL, Hensley SD (1989) Thyroid cancer with coexistent Hashimoto’s thyroiditis. Clinical assessment and management. Arch Surg 124:1045–1047PubMedCrossRef
89.
Hall FT, Freeman JL, Asa SL et al (2003) Intra-tumoral lymphatics and lymph node metastasis in papillary thyroid carcinoma. Archives of Otolaryngology—Head and Neck. Surgery 129(7):716–719
90.
Machens A, Hinze R, Thomusch O, Dralle H (2002) Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg 26(1):22–28PubMedCrossRef
91.
Gimm O, Rath FW, Dralle H (1998) Pattern of lymph node metastases in papillary thyroid carcinoma. Br J Surg 85(2):252–254PubMedCrossRef
92.
Noguchi S, Noguchi A, Murakami N (1970) Papillary carcinoma of the thyroid. I. Developing pattern of metastasis. Cancer 26(5):1053–1060PubMedCrossRef
93.
Loh KC et al (1999) Influence of lymphocytic thyroiditis on the prognostic outcome of patients with papillary thyroid carcinoma. J Clin Endocrinol Metab 84(2):458–463PubMedCrossRef
94.
Kim SS (2011) Coexistence of Hashimoto’s thyroiditis with papillary thyroid carcinoma: the influence of lymph node metastasis. Head Neck Vol 33(9):1272–1277CrossRef
95.
Kim EY et al (2009) Coexistence of chronic lymphocytic thyroiditis is associated with lower recurrence rates in patients with papillary thyroid carcinoma. Clin Endocrinol (Oxford) 71(4):581–586CrossRef
96.
97.
Matsubayashi S, Kawai K, Matsumoto Y et al (1995) The correlation between papillary thyroid carcinoma and lymphocytic infiltration in the thyroid gland. J Clin Endocrinol Metab 80(12):3419–3424
98.
Kashima K, Yokoyama S, Noguchi S et al (1998) Chronic thyroiditis as a favorable prognostic factor in papillary thyroid carcinoma. Thyroid 8(3):197–202PubMedCrossRef
99.
Schaffler A, Palitzsch KD, Seiffarth C et al (1998) Coexistent thyroiditis is associated with lower tumour stage in thyroid carcinoma. Eur J Clin Investig 28(10):838–844CrossRef
100.
Ozaki O, Ito K, Mimura T, Sugino K et al (1996) Papillary carcinoma of the thyroid. Tall-cell variant with extensive lymphocyte infiltration. Am J Surg Pathol 20(6):695–698PubMedCrossRef
101.
Segal K, Ben-Bassat M, Avraham A (1985) Hashimoto’s thyroiditis and carcinoma of the thyroid gland. Int Surg 70(3):205–209PubMed
102.
Dongbin A et al (2011) Clinical relationship between Hashimoto’s thyroiditis and papillary thyroid cancer. Acta Oncol 50(8):1228–1234CrossRef
103.
Huang BY et al (2011) Well-differentiated thyroid carcinoma with concomitant Hashimoto’s thyroiditis present with less aggressive clinical stage and low recurrence. Endocr Pathol 22(3):144–149PubMedCrossRef
Metadata
Title
Papillary Thyroid Cancer and Hashimoto’s Thyroiditis: An Association Less Understood
Authors
Akshay Anand
Kul Ranjan Singh
Jitendra Kumar Kushwaha
Nuzhat Hussain
Abhinav Arun Sonkar
Publication date
01-09-2014
Publisher
Springer India
Published in
Indian Journal of Surgical Oncology / Issue 3/2014
Print ISSN: 0975-7651
Electronic ISSN: 0976-6952
DOI
https://doi.org/10.1007/s13193-014-0325-4

Other articles of this Issue 3/2014

Indian Journal of Surgical Oncology 3/2014 Go to the issue

Case Report

Breast Cancer Associated with Von Recklinghausen's Disease: Case Report and Review of Literature

Original Article

Prospective Randomized Study Comparing Robotic-Assisted Hysterectomy and Regional Lymphadenectomy with Traditional Laparotomy for Staging of Endometrial Carcinoma –Initial Indian Experience

Original Article

Primary Peritoneal Carcinoma: Regional Cancer Institute Experience

Original Article

A Prospective Study on Sentinel Lymph Node Biopsy in Early Oral Cancers Using Methylene Blue Dye Alone

Case Report

Breast as an Unusual Site of Metastasis- Series of 3 Cases and Review of Literature

Case Report

Sporadic Giant Mesenteric Fibromatosis