donderdag 5 juni 2014

Mogelijk betere prognose bij schildklierkanker en ziekte van Hashimoto

Evaluation of surgical specimens suggests that patients with Hashimoto thyroiditis (HT) have a higher prevalence of differentiated thyroid cancer. Although patients with HT are reported to present with earlier stage disease, there is controversy as to whether these patients have better prognosis when adjusted for histology and stage at presentation.

Patients with thyroid cancer and Hashimoto’s thyroiditis have a better prognosis than those without thyroiditis
Clinical Thyroidology for patients

Patients with differentiated thyroid cancer and coexistent Hashimoto’s thyroiditis have a better prognosis than those without thyroiditis
Jerome M. Hershman, Clinical Thyroidology

Differentiated thyroid cancer is associated with less aggressive disease and better outcome in patients with coexisting Hashimotos thyroiditis
S Dvorkin, E Robenshtok, D Hirsch, Y Strenov, I Shimon, CA Benbassat

Objective of the study was to investigate differences between patients with differentiated thyroid cancer patients and without HT for aggressiveness of disease and clinical outcome, and the decline rate of antithyroglobulin antibodies titers over time.

Methods

A retrospective study using the Rabin Medical Center Thyroid Cancer Registry. Seven hundred fifty-three patients were included and divided into 2 groups of patients with and without HT at diagnosis. Disease severity at presentation was evaluated using the entire cohort, whereas a control group matched for age, gender, histology, and stage was used to evaluate disease course and outcome.

Results

HT was present in 14.2% (n = 107) of included patients and was associated with smaller primary tumor and less lymph node involvement at presentation. When matched groups were compared, patients with HT received less additional radioactive iodine (RAI) treatments and showed lower rates of persistence at 1 year and higher rates of disease remission at the end of follow-up. On multivariate analysis HT was predictive of a lower rate of lymph nodes involvement and persistent disease at the end of follow-up. Antithyroglobulin antibodies slowly disappeared in most patients with no evidence of disease.

Conclusion

Our study demonstrates that HT is associated with a less aggressive form of differentiated thyroid cancer and a better long-term outcome.

The rate of thyroid cancer is increasing, especially in women. Hashimoto’s thyroiditis, the most common cause of hypothyroidism, is also common in women. Over 30% of patients who undergo surgery for thyroid cancer are found to also have Hashimoto’s thyroiditis. Some prior studies have showed that thyroid cancer is less aggressive in patients with Hashimoto’s thyroiditis. The aim of this study was to evaluate whether thyroid cancer patients who also have Hashimoto’s thyroiditis have a better prognosis compared to thyroid cancer patients without Hashimoto’s thyroiditis.

This study shows that patients with thyroid cancer who also have Hashimoto’s thyroiditis have a less aggressive form of cancer and a better long-term prognosis. A possible explanation for these findings would be that the antibodies that attack the thyroid gland in patients with Hashimoto’s thyroiditis also attack the cancer. Persistence of antithyroglobulin antibodies has been associated with persistent cancer. However, this study suggest that this is not the case if the patient also has Hashimoto’s thyroiditis and can, therefore, suggest a better prognosis.


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