Thyroid cancer with coexistent Hashimoto's thyroiditis. Clinical assessment and management
B. L. Eisenberg and S. D. Hensley
Department of Surgery, Wilford Hall USAF Medical Center, San Antonio, Tex.
Hashimoto's thyroiditis is a common thyroid disorder. Because of the
difficulty of diagnosing a coexisting thyroid cancer, its management
remains controversial. We reviewed 120 cases of thyroid cancer seen in our
institution during an 11-year period (1976 through 1986) and defined the
clinical characteristics of patients with both entities. Thirteen patients
had concomitant cancer and Hashimoto's thyroiditis. Six of the 13 patients
had a history of thyroiditis before the diagnosis of thyroid cancer. The
remaining seven patients had evidence of Hashimoto's thyroiditis on
histologic review of the thyroid specimen. The two most common
characteristics prompting surgical intervention were the presence of a
nonsuppressing dominant nodule and a cold area on thyroid scan. Twelve
patients underwent preoperative fine-needle aspiration cytologic
examination, but only in three were the results considered to be indicative
of cancer. All 13 patients remained disease free. Despite the apparent
indolence of thyroid cancer associated with Hashimoto's thyroiditis,
selective surgical treatment of patients with clinical thyroiditis is
indicated.
