BASEDOW DISEASE AND HASHIMOTO'S DISEASE WITH NODULES

Author: Bogdan(Cocos) Izabela-DianaCoordinator:  Szántó Zsuzsanna, lecture, Department of Endocrinology, University of Medicine and Pharmacy Targu-Mureș

INTRODUCTION

Grave’s disease is an autoimmune disease, is a common cause of hyperthyroidism, which causes enlargement of the thyroid and others symthoms such as exophthalmia, weight loss , anxiety etc.

http://www.physio-pedia.com/Grave's_Disease

INTRODUCTION

Hashimoto’s chronic autoimmune thyroiditis is a common cause of hypothyroidism, which causes enlargement and inflamation of the thyroid and others sympthoms such as weight gain, fatigue, depression, etc.

http://endocrinesurgery.ucla.edu/patient_education_adm_chronic_thyroiditis.html

INTRODUCTION

Thyroid nodules and thyroid cancer rarely appear in Graves’ disease.

In contrast, in Hashimoto’s thyroiditis is commonly nodular goiter, and described the association of thyroid cancer often.

http://sjccfthynet.blogspot.ro/2011/04/diagnosing-pediatric-thyroid-cancer_08.html

INTRODUCTION: TYPES OF THYROID CANCER

http://www.dasmaninstitute.org/cancer/thyroid-cancer/thyroid-cancer

AIMS

Evaluation of thyroid morphology in Graves’ and Hashimoto’s diseases .

To study the frequency of thyroid malignant processes in Basedow-Graves’ disease.

Evaluation of possible correlation between the antithyroid treatment and nodular goiter in Basedow-Graves’ disease.

MATERIAL

The retrospective study included 145 patients with Graves’ disease and 100 with Hashimoto’s hospitalized in Clinic of Endocrinology, Department of Targu-Mures, between January 2009 and December 2013.

METHODS

We followed: Hormonal assessment: TSH, free-T4, free-T3 Antithyroid antibodies: TRAb , anti-TPO The results of: -thyroid ultrasonography

(US) - fine needle aspiration biopsy - histopathological examination Specific treatment followed.

RESULTS AND DISCUSSION:

1. EVALUATION OF THYROID MORPHOLOGY IN GRAVES’ AND HASHIMOTO’S DISEASES

BASEDOW

2. EVALUATION OF THYROID MORPHOLOGY IN GRAVES AND HASHIMOTO DISEASES

HASHIMOTO

3. EVALUATION OF THYROID MORPHOLOGY IN GRAVES AND HASHIMOTO DISEASES

4. EVALUATION OF THYROID MORPHOLOGY IN GRAVES AND HASHIMOTO DISEASES

5A. ANTITHYROID TREATMENT AND GRAVES’DISEASE WITH NODULAR GOITER

6. THE FREQUENCY OF THYROID MALIGNANT PROCESSES

6. THE FREQUENCY OF THYROID MALIGNANT PROCESSES

 At one time, thyroid cancer in Basedow-Graves’ disease was considered to be extremely rare, but this perception is beginning to change. Several studies have reported both an increased incidence of nodules and of thyroid cancer in patients with Graves' disease, with cancer rates varying from as low as 1% to as high as 9% of casesUltrasonographic screening for detection of thyroid cancer in patients with Graves' disease.Clin Endocrinol (Oxf). 2004 Jun;60(6):719-25.

Thyroid nodule in Basedow-Graves disease and thyroid cancer: experience in 6 patients. Rev Med Chil. 1995 Nov;123(11):1402-8. Spanish.

Recent outcome of Graves' disease patients with papillary thyroid cancer.Eur J Endocrinol. 2007 Sep;157(3):325-9.

9. US FEATURES ASSOCIATED WITH THYROID CANCER

Nodule size Hypoechogenicity Presence of microcalcifications Predominantly solid composition Intranodular vascularity Irregular margins Absence of a halo

Mortensen jD, Woolner LB, Bennedback FN. Management of simple nodular goiter: current status and future perspectives. Endocr. Rev 2003;24:102-132.

10. US FEATURES ASSOCIATED WITH THYROID CANCER

The feature with the highest sensitivity, in the range of 69.0%-75.0% , is solid composition.

The feature with the highest positive predictive value, 41.8%-94.2% , is the presence of microcalcifications.

The combination of factors improves the positive value to some extend.

CONCLUSIONS

However thyroid nodules appear rarely in Graves’ disease, in our cohort it was met rather frequent, a possible explanation could be the methimazole therapy.

Thyroid nodules in Graves’ disease present a lower rate of malignancy.

Nodular goiter in Hashimoto’s thyroiditis appeared more frequently.

BIBLIOGRAPHY

(1) Mortensen jD, Woolner LB, Bennedback FN. Management of simple nodular goiter: current status and future perspectives. Endocr. Rev 2003;24:102-132.

(2) Aslan A, Sancak S, Aslan M, Cimsit NC, Güllüoglu BM, Ahiskali RA, Akalin NS, Aribal ME.Ultrasonography and Duplex Doppler Ultrasonography Based Indices in Nodular Thyroid Disease.Acta Endo (Buc) 2013 9: 575-588 doi: 10.4183/aeb.2013.575.

 http://www.dasmaninstitute.org/cancer/thyroid-cancer/thyroid-cancer http://www.physio-pedia.com/Grave's_Disease http://

endocrinesurgery.ucla.edu/patient_education_adm_chronic_thyroiditis.html Ultrasonographic

screening for detection of thyroid cancer in patients with Graves' disease.Clin Endocrinol (Oxf). 2004 Jun;60(6):719-25.

Thyroid nodule in Basedow-Graves disease and thyroid cancer: experience in 6 patients. Rev Med Chil. 1995 Nov;123(11):1402-8. Spanish.

Recent outcome of Graves' disease patients with papillary thyroid cancer.Eur J Endocrinol. 2007 Sep;157(3):325-9.

Thank you !