10.14639/0392-100X-N1081
Objective. We retrospectively investigated whether there is a relationship between Hashimoto’s thyroiditis (HT) and papillary thyroid carcinoma and studied the effect of HT on prognostic factors.Methods. 1080 patients, who underwent thyroidectomy in our hospital and received a diagnosis of papillary thyroid carcinoma, were included in the study. In histopathological specimens, the diagnosis of papillary thyroid carcinoma was reconfirmed and non-neoplastic areas in the same specimen were evaluated in terms of HT. Results. HT was detected in non-neoplastic areas of specimens in 36.1% (n = 390) of 1080 patients with a diagnosis of papillary thyroid carcinoma whereas HT was not observed in 63.9% (n = 690). There was a significant positive correlation between presence of HT and multifocal location (p &lt; 0.05, χ2 = 38.5). There was no significant relationship between extrathyroidal tissue invasion and HT (p &gt; 0.05). Conclusions. We assume that patients with HT developing papillary thyroid carcinoma have an increased risk of having multifocal tumour, and thus surgical intervention should be tailored according to this risk.
application/xml
1827-675X
1081
en
Ozgen Arslan Solmaz
https://creativecommons.org/licenses/by-nc-nd/4.0
ACTA Otorhinolaryngologica Italica
thyroidectomy
Hashimoto’s thyroiditis in papillary thyroid carcinoma: a 22-year study
Text.Serial.Journal
https://www.actaitalica.it/
41
Thyroid
2021-05-14
2020-08-25
2021-05-17
2021-05-17
142-145
1
Ozgen Arslan Solmaz
2021/05/14
10.14639/0392-100X-N1081
142
Elazig Fethi Sekin City Hospital, Department of Pathology, Elazig, Turkey
1827-675X
thyroidectomy
145
Hashimoto’s thyroiditis in papillary thyroid carcinoma: a 22-year study
https://www.actaitalica.it/article/download/1081/576
41
ACTA OTORHINOLARYNGOLOGICA ITALICA 2021;41:142-145; doi: 10.14639/0392-100X-N1081




Thyroid


Hashimoto’s thyroiditis in papillary thyroid carcinoma:
a 22-year study
Tiroidite di Hashimoto nel carcinoma papillare della tiroide: studio di 22 anni
Fatih Mehmet Hanege1, Ozan Tuysuz1, Serdal Celik1, Oner Sakallıoglu2, Ozgen Arslan Solmaz3
1
 Istanbul Medeniyet University, School of Medicine, Department of Otorhinolaryngology and Head & Neck Surgery, Goztepe Training
and Research Hospital, Istanbul, Turkey; 2 Elazıg Health Practices and Research Center, Department of Otorhinolaryngology and
Head & Neck Surgery, Elazıg, Turkey; 3 Elazig Fethi Sekin City Hospital, Department of Pathology, Elazig, Turkey


SUMMARY
Objective. We retrospectively investigated whether there is a relationship between Hashi-
moto’s thyroiditis (HT) and papillary thyroid carcinoma and studied the effect of HT on
prognostic factors.
Methods. 1080 patients, who underwent thyroidectomy in our hospital and received a diag-
nosis of papillary thyroid carcinoma, were included in the study. In histopathological speci-
mens, the diagnosis of papillary thyroid carcinoma was reconfirmed and non-neoplastic
areas in the same specimen were evaluated in terms of HT.
Results. HT was detected in non-neoplastic areas of specimens in 36.1% (n = 390) of 1080
patients with a diagnosis of papillary thyroid carcinoma whereas HT was not observed in
63.9% (n = 690). There was a significant positive correlation between presence of HT and
multifocal location (p < 0.05, χ2 = 38.5). There was no significant relationship between
                                                                                                  Received:August 25, 2020
extrathyroidal tissue invasion and HT (p > 0.05).
                                                                                                  Accepted: December 30, 2020
Conclusion. We assume that patients with HT developing papillary thyroid carcinoma have
an increased risk of having multifocal tumour, and thus surgical intervention should be
                                                                                                  Correspondence
tailored according to this risk.
                                                                                                  Fatih M. Hanege
KEY WORDS: Hashimoto’s thyroiditis, thyroid cancer, papillary, thyroidectomy                      Istanbul Medeniyet University, School of Medicine,
                                                                                                  Department of Otorhinolaryngology and Head
                                                                                                  & Neck Surgery, Goztepe Training and Research
RIASSUNTO                                                                                         Hospital, Istanbul, Turkey
Obiettivo. Ci siamo proposti di indagare retrospettivamente una relazione tra tiroidite di        Tel. +90 532 502 6239. Fax +90 216 566 6614
Hashimoto e carcinoma papillare della tiroide e di studiare l’effetto della tiroidite di Hashi-   E-mail: hanege@hotmail.com
moto (HT) sui fattori prognostici.
Metodi. Sono stati inclusi nello studio 1080 pazienti, che sono stati sottoposti a tiroidecto-    Funding
mia nel nostro ospedale e hanno ricevuto la diagnosi di carcinoma papillare della tiroide.        None.
Nei campioni istopatologici dei pazienti è stata riconfermata la diagnosi di carcinoma
papillare della tiroide e sono state valutate le aree non neoplastiche dello stesso campione      Conflict of interest
in termini di HT.                                                                                 The Authors declare no conflict of interest.
Risultati. La tiroidite di Hashimoto è stata rilevata in aree non neoplastiche dei campioni
nel 36,1% (n = 390) dei pazienti con diagnosi di carcinoma papillare della tiroide mentre           How to cite this article: Hanege FM, Tuysuz O,
la tiroidite di Hashimoto non è stata osservata nel 63,9% (n = 690). L’analisi ha rivelato          Celik S, et al. Hashimoto’s thyroiditis in papil-
una correlazione statisticamente significativa tra la presenza della tiroidite di Hashimoto         lary thyroid carcinoma: a 22-year study. Acta
e la localizzazione multifocale (p < 0,05, χ2 = 38,5). Non c’era alcuna relazione statisti-         Otorhinolaryngol Ital 2021;41:142-145. https://
camente significativa tra l’invasione del tessuto extratiroideo e la tiroidite di Hashimoto         doi.org/10.14639/0392-100X-N1081
(p > 0,05).
Conclusioni. Presumiamo che i pazienti con tiroidite di Hashimoto che sviluppano un car-          © Società Italiana di Otorinolaringoiatria
cinoma papillare della tiroide abbiano un aumentato rischio di avere un tumore multifoca-         e Chirurgia Cervico-Facciale
le, quindi, l’intervento chirurgico dovrebbe essere personalizzato in base a questo rischio.
                                                                                                                 OPEN ACCESS
PAROLE CHIAVE: tiroidite di Hashimoto, cancro della tiroide, papillare, tiroidectomia
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                                                                                                  ning the license, but only for non-commercial purposes and
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                                                                                                Hashimoto thyroiditis and papillary carcinoma




Introduction
Hashimoto’s thyroiditis (HT) is a common autoimmune
disorder of the thyroid gland. It can be encountered in all
age groups. It is 10-20 times more common in females than
in males. Although its aetiology is not fully elucidated, it is
known that it is related to the release of cytokines, which
damage thyroid follicle cells, following the activation of
the helper T lymphocytes. Hypothyroidism is found in the
majority of patients with HT 1.
HT has two major components from a histopathological
point of view. The first is lymphoplasmacytic cell infiltra-
tion into stroma. In addition, histiocytes and scattered mult-
inucleated giant cells may be also observed. The second
                                                                  Figure 1. Lymphoid follicular and Hurthle cells surrounding the papillary car-
main feature is oxyphilic changes in the epithelium paving        cinoma.
the thyroid follicles. These cells, also called as Askanazy
or Hurthle cells, have nuclei that are larger than normal,
as well as prominent nucleoli and wide acidophilic and            this examination, first the diagnosis of PTC was confirmed
granular cytoplasm. In addition, similar to that in papillary     and secondly the non-neoplastic fields in the same speci-
thyroid carcinoma (PTC), cells may contain optically clear        men were evaluated for the presence of HT. Regarding HT,
nuclei, which tend to overlap follicle epithelium. In HT,         the presence of Hurthle cells and lymphocytic inflamma-
the number of the thyroid follicles decrease in parallel with     tion with a germinal centre in the thyroid parenchyma and
increased inflammatory infiltration. Follicles with an intact     stroma were the main findings looked for (Fig. 1). Moreo-
appearance are usually smaller than normal and contain less       ver, tumour size, extrathyroidal tissue infiltration and mul-
colloid than normal. Limited fibrosis in the thyroid glands       tifocality in PTC fields were evaluated.
is observed in pathological examinations of patients with
                                                                  IBM SPSS Statistics 22 (IBM SPSS, Turkey) program was
HT. However, in the fibrous variant of the disease, connec-
                                                                  used to evaluate data. Fisher’s Exact and Chi-square tests
tive tissue constitutes more than 30% of the thyroid and this
                                                                  were used to compare data. Significance was set at 0.05.
variant is encountered in 12% of all patients 2,3.
Following the first description of the relationship between
inflammation and cancer by Virchow in 1863, the relation-         Results
ship of cancer with inflammation of organs such as the            57.5% of patients (n = 621) were female and 42.5%
lung, stomach, bowel and skin has been investigated 4. The        (n = 459) were male. The mean age of patients was 47 ± 14
relationship between HT and PTC was first reported by             years (23-78 years). HT was observed in non-neoplas-
Dailey and colleagues in 1955 5. Although this relationship       tic fields in 36.1% of 1080 patients diagnosed with PTC
was investigated in several studies, consensus has not yet        (n = 390). The remaining 690 patients (63.9%) had no HT
been achieved 6-9.
                                                                  findings. 56.5% of female patients with PTC (n = 351)
In this retrospective study, in which archived data of the
                                                                  were HT-negative and 43.5% (n = 270) were HT-positive,
last 22 years were screened, our objective was to investi-
                                                                  whereas 73.8% of males (n = 339) were evaluated as HT-
gate the presence of HT in PTC and the effect of HT on
                                                                  negative and 26.2% (n = 120) as positive.
prognostic factors.
                                                                  Of 690 HT-negative patients, 83.5% had PTC with unifo-
                                                                  cal involvement and 16.5% had multifocal PTC. On the
Materials and methods                                             other hand, of 390 HT-positive patients, 53% had unifocal
The study protocol was approved by the local Ethics Com-          PTC and 47% had multifocal PTC. The correlation analy-
mittee (2017-14/24). Patient approval was not necessary           sis showed a significantly positive correlation between HT
because this is a retrospective study. We included 1080 pa-       presence and multifocality (p < 0.05, χ2 = 38.5).
tients whose pathology specimens were available for review        Evaluation of extrathyroidal tissue invasion showed that
and diagnosed with PTC who underwent thyroidectomy                there was extrathyroidal infiltration in 13.9% of HT-posi-
between 1995 and 2017 in our hospital. The examination            tive and 16.9% of HT-negative specimens. No significant
of haematoxylin-eosin-stained histopathological materials         relationship was found between extrathyroidal tissue inva-
of these patients was repeated by a single pathologist. With      sion and HT (p > 0.05).



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F.M. Hanege et al.




Moreover, there was no significant relationship of HT pres-        Conclusions
ence with age, tumour size and lymphovascular infiltration
                                                                   Biopsy of all suspected nodes will increase the probability
in patients diagnosed with PTC (p > 0.05).
                                                                   of making the correct diagnosis in patients scheduled for
                                                                   fine needle aspiration biopsy. Lobectomy can be performed
Discussion                                                         as an option in patients who are diagnosed with PTC and
Despite developments in surgical techniques, the underly-          have small and single nodules. Since the risk of having
ing causes of PTC have not yet been fully elucidated. It has       multifocal disease is high in HT patients developing PTC,
not been clearly demonstrated whether papillary carcinoma          total thyroidectomy should be planned and a selective neck
is a reactive response to HT or if HT is a precursor to PTC        dissection should be carried out in lymph node-positive pa-
development 8. A number of studies have been conducted to          tients.
answer this question 10-16. In the first study conducted by Dai-
ley, the incidence of PTC in patients with HT was 35% 5. In        Acknowledgements
subsequent studies, Schäffler reported the lowest rate (8%)
                                                                   This study was presented at XI Balkan congress of ORL,
and Repplinger reported the highest rate (63%) 10,17. Matesa-
                                                                   Varna, Bulgaria, 31 May-3 June 2018.
Anić et al. 11, in their study on 10,580 subjects, which is the
largest study on this topic, found an incidence of 42%. In
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