Toksik Nodüler ve Multinodüler Guatrlı Hastalarda Tiroid Kanser Sıklığı

Öz

Amaç: Toksik nodüler (TNG) ve toksik multinodüler guatr (TMNG), bir veya birden fazla otonom

fonksiyone tiroid nodülünün varlığı ile karakterize hipertiroidiye yol açan hastalıklardır. Hipertiroidinin

tiroid kanserine karşı koruyucu olduğu inancına karşın son yıllarda bu hastalarda da tiroid kanser

riskinin azımsanmayacak kadar olduğu ve nodüllerin diğer hastalarda olduğu gibi değerlendirilmesi

gerektiği yönünde yayınlar çoğalmaktadır. Bu çalışmanın amacı TNG/TMNG nedeniyle cerrahi

uygulanan hastalarda tiroid kanser sıklığını belirlemek ve kanser ile ilişkili olabilecek preoperatif

özellikleri değerlendirmektir.

Materyal ve Metot: Çalışmaya Ocak 2017 ile Aralık 2014 arasında TNG veya TMNG nedeniyle

tiroidektomi yapılan hastalar alınmıştır. Retrospektif olarak taranan hastaların klinik özellikleri,

laboratuar ve ultrasonografi (US) sonuçları, sitolojik ve histopatolojik bulguları kayıt edilmiştir.

Histopatolojik sonucu benign ve malign saptanan hastaların klinik özellikleri, nodüllerin preoperatif US

özellikleri ve sitolojik sonuçları karşılaştırılmıştır.

Bulgular: Çalışmaya alınan 482 hastanın 335’i (%69,50) kadın, 147’si (%30,50) erkekti ve ortanca yaş 56

(18‐79) idi. 74 (%15,35) hastada TNG, 408 (%84,65) hastada TMNG vardı. Histopatolojik olarak 380

(%78,84) hastada benign, 102 (%21,16) hastada malign patoloji saptandı. Benign ve malign hastalarda yaş,

cinsiyet dağılımı, antitiroid kullanımı, antikor pozitifliği, nodül sayısı açısından fark yoktu. Malign

hastalarda ultrasonografik olarak parankimde tiroidit varlığı anlamlı şekilde yüksekti (%75,26 ve %87,24;

p<0,001). Malign hastalarda sitoloji sonuçları nedeniyle tiroidektomi uygulanan hasta oranı benign

hastalara oranla yüksekti. Benign hastalarda ise dev nodül nedeniyle tiroidektomi yapılan hasta oranı

malign hastalara oranla yüksekti. Preoperatif US verileri incelenen 1263 tiroid nodülünün 1222’si

(%96,75) histopatolojik olarak benign, 41’i (%3,25) malign idi. Malign nodüllerde hipoekojenite oranı

benign nodüllere göre anlamlı şekilde yüksekti. Benign ve malign nodüller arasında diğer US özellikleri

açısından fark saptanmadı. Sintigrafik değerlendirmesi olan nodüllerden benign olanların 406’sı

(%71,99), malign olanların 19’u (%67,86) sintigrafik olarak aktifti (p=0,853).

Sonuç: Bu çalışmada TNG/TMNG nedeniyle cerrahi uygun görülen hastalarda tiroid kanser sıklığı ihmal

edilemeyecek oranda saptanmıştır. Bu hastalarda malign ve benign nodüllerin US özellikleri benzer

bulunmuştur. TNG/TMNG’lı hastalardaki nodüllerde, nodül aktif dahi olsa, ince iğne aspirasyon biyopsi

endikasyonunun diğer hastalarda olduğu gibi konulması, cerrahi planlandığında özellikle TMNG

varlığında total veya totale yakın tiroidektomi tercih edilmesi önerilir.

Anahtar Kelimeler

• Toksik nodüler guatr,toksik multinodüler guatr,tiroid kanseri

Thyroid Cancer Incidence in Patients with Toxic Nodular and Multinodular Goiter

Abstract

Objectives: Toxic nodular goiter (TNG) and toxic multinodular goiter (TMNG) are characterized by the presence of one or more autonomously functinoning thyroid nodules that causes hyperthyroidism. In contrary to the previous thought that hyperthyroidism is protective against thyroid cancer, there is increasing evidence that the risk of thyroid cancer should not be underestimated in these patients and nodules should be assessed as being in other patients. We aimed to determine the prevalence of thyroid cancer in TNG/TMNG patients that underwent thyroidectomy and evaluate preoperative features that might be associated with cancer.

Materials and Methods: Patients diagnosed with TNG or TMNG and operated between January 2017 and December 2014 were included. The patients were scanned retropectively and clinical features, laboratuary findings, ultrasonography (US) reports, cytological and histopathological results were recorded. Clinical features of patients with benign and malignant histopathology, and preoperative US features and cytological results of benign and malignant nodules were compared.

Results: There were 482 patients of which 335 (69.50%) were female and 147 (30.50%) were male and the median age was 56 (18-79). Preoperative diagnosis was TNG in 74 (15.35%) and TMNG in 408 (84.65%) patients. Histopathologically, 380 (78.84%) had benign and 102 (21.16%) had malignant disease. There was no significant difference in age, sex distribution, antithyroid usage, antibody positivity and median nodule number in benign and malignant patients. Ultrasonographically presence of thyroiditis in parenchyma was higher in malignant compared to benign patients (87.24% vs 75.26%. p<0.001). Ratio of patients operated for cytological diagnosis was higher in malignant, while patients operated for giant nodule was higher in benign patients. Among 1263 nodules with preoperative US data, 1222 (96.75%) were benign, 41 (3.25%) were malignant histopathologically. Rate of hypoechogenity was significantly higher in malignant than benign nodules. Other US features were similar in two groups. Among nodules with preoperative scintigraphy results, 406 (71,99%) of benign and 19 (67.86%) of malignant nodules were hot (p=0.853).

Conclusion: In this study, the incidence of thyroid cancer in TNG/TMNG patients who underwent surgery was too high to be ignored. Preoperative US features of benign and malignant nodules were similar in these patients. We recommend that nodules in patients with TNG/TMNG should be evaluated by fine needle aspiration biopsy according to the same indications as for other nodules and when surgery is planned; total or near total thyroidectomy can be preferred particularly in the presence of TMNG.

Keywords

• Toxic nodular guatr,toxic multinodular goiter,thyroid cancer

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