Toxic nodular goiter and cancer

A compelling case for thyroidectomy

J. Joshua Smith, Xi Chen, David F. Schneider, Ratnam Nookala, James T. Broome, Rebecca S. Sippel, Herbert Chen, Carmen C. Solorzano

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Recent American Thyroid Association guidelines call for thyroidectomy or 131I (Recommendation 31) in managing hyperthyroidism due to toxic nodular goiter (TNG). Concern for concomitant malignancy favors surgery. A 3 % thyroid cancer incidence in TNG patients has been reported, yet recent studies suggest this rate is underestimated. This multi-institutional study examined cancer incidence in TNG patients referred to surgery. Methods: Patients referred for thyroidectomy at three tertiary-care institutions were included (2002-2011). Patients with concurrent indeterminate or malignant diagnosis by fine-needle aspiration (FNA) were excluded. Cancer incidence in TNG patients was determined. Fisher's exact and chi-square tests and nonparametric t tests were used. Results: Among 2,551 surgically treated patients, 164 had TNG (6.4 %). Median age at presentation was 49.7 years, and 86 % were female. Overall cancer incidence was 18.3 % (30 of 164), and rates were not significantly different between institutions. A significantly greater cancer rate was noted in toxic multinodular goiter versus single toxic nodule patients (21 vs. 4.5 %, P < 0.05). Mean tumor size was 0.71 cm (range 0.1-1.5 cm; 23 % ≥1 cm). Most patients underwent total or near-total thyroidectomy. There were no significant differences in tumor sizes among institutions (P > 0.05). No significant cancer association was noted with age, preoperative dominant nodule size, lymphocytic thyroiditis or preoperative FNA (P > 0.05). Conclusions: These data demonstrate a higher than expected incidental cancer rate in TNG patients compared to historical reports (18.3 vs. 3 %). This higher cancer incidence may alter the risk/benefit analysis regarding TNG treatment. This information should be provided to TNG patients before decision making regarding treatment.

Original languageEnglish (US)
Pages (from-to)1336-1340
Number of pages5
JournalAnnals of Surgical Oncology
Volume20
Issue number4
DOIs
StatePublished - Apr 1 2013
Externally publishedYes

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Nodular Goiter
Poisons
Thyroidectomy
Neoplasms
Incidence
Fine Needle Biopsy
Autoimmune Thyroiditis
Goiter
Hyperthyroidism
Tertiary Healthcare
Chi-Square Distribution
Thyroid Neoplasms
Decision Making
Guidelines

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Smith, J. J., Chen, X., Schneider, D. F., Nookala, R., Broome, J. T., Sippel, R. S., ... Solorzano, C. C. (2013). Toxic nodular goiter and cancer: A compelling case for thyroidectomy. Annals of Surgical Oncology, 20(4), 1336-1340. https://doi.org/10.1245/s10434-012-2725-4

Toxic nodular goiter and cancer : A compelling case for thyroidectomy. / Smith, J. Joshua; Chen, Xi; Schneider, David F.; Nookala, Ratnam; Broome, James T.; Sippel, Rebecca S.; Chen, Herbert; Solorzano, Carmen C.

In: Annals of Surgical Oncology, Vol. 20, No. 4, 01.04.2013, p. 1336-1340.

Research output: Contribution to journalArticle

Smith, JJ, Chen, X, Schneider, DF, Nookala, R, Broome, JT, Sippel, RS, Chen, H & Solorzano, CC 2013, 'Toxic nodular goiter and cancer: A compelling case for thyroidectomy', Annals of Surgical Oncology, vol. 20, no. 4, pp. 1336-1340. https://doi.org/10.1245/s10434-012-2725-4
Smith, J. Joshua ; Chen, Xi ; Schneider, David F. ; Nookala, Ratnam ; Broome, James T. ; Sippel, Rebecca S. ; Chen, Herbert ; Solorzano, Carmen C. / Toxic nodular goiter and cancer : A compelling case for thyroidectomy. In: Annals of Surgical Oncology. 2013 ; Vol. 20, No. 4. pp. 1336-1340.
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AU - Broome, James T.

AU - Sippel, Rebecca S.

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