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Prospective Study Summary
- 3. WHAT IS HASHIMOTO’S THYROIDITIS? • Patients who have one or more elevated thyroid antibodies (TPOAb, TgAb) have Hashimoto’s thyroiditis • On ultrasound, patients with an inflamed thyroid gland also may have Hashimoto’s thyroiditis, even if the antibodies are not yet detectable on labwork
- 4. Hashimoto's disease, an autoimmune condition, is the most common cause of hypothyroidism. In this case the immune system mistakenly targets and damages the thyroid gland, so not enough hormones are produced. Hashimoto’s disease is often inherited. Source: http://www.medicinenet.com l
- 5. NORMAL THYROID GLAND VS. HASHIMOTO GLAND A normal thyroid gland has a smooth texture and Hashimoto gland has a rough and irregular texture
- 6. WHY IS HASHIMOTO’S THYROIDITIS IMPORTANT? • It is the most common cause for hypothyroidism • Due to probable link with thyroid cancer
- 8. WHAT IS THIS PROSPECTIVE STUDY ABOUT? • It investigates the possibility that the link between Hashimoto’s thyroiditis and thyroid cancer is antibody specific • Prospective studies are the gold standard in medicine
- 9. HYPOTHESIS • 2 retrospective studies reported an association between Hashimoto’s disease and thyroid cancer in patients with thyroid nodules • These studies demonstrated a link between TgAb and thyroid cancer • TPOAb is not a link even though it’s a more sensitive marker for Hashimoto’s • Hypothesis: Hashimoto’s thyroiditis’ link with thyroid cancer is antibody specific
- 10. DETAILS OF THE STUDY • 2100 patients initially in the study • Patients had single or multiple thyroid nodules ≥5 mm • 18+ years old • Prior to FNA, bloodwork was done to obtain TSH, Free T4, Free T3, TgAb and TPOAb levels
- 11. AFTER THE THYROID NODULE BIOPSY… • 2023 patients remained in the study • Surgery recommended for patients with FNA results that were positive for malignancy, highly suspicious for follicular neoplasm, or follicular cells of undetermined significance Surgery also recommended for patients with 2 non-diagnostic or benign FNAs with 2 or more ultrasound features suggestive of thyroid cancer or increased size • 461 had a thyroidectomy and, of these, 233 diagnosed with thyroid cancer
- 12. • Statistical analysis was performed on the 2023 patients (2699 nodules) that were included in the study • Data for the 1790 patients with no cancer was compared with that of the 233 patients with thyroid cancer STATISTICAL ANALYSIS
- 13. STATISTICAL RESULTS • Thyroglobulin Antibody (TgAb) was an independent risk factor for thyroid cancer • Elevated TgAb found in 20.6% of malignant nodules compared to 10.2% of benign • This means that if you have thyroid nodules AND elevated Tg antibody, you are at 2.5 times higher risk for thyroid cancer
- 14. RESULTS OF THE STUDY • Examining the 233 patients diagnosed with thyroid cancer showed: Elevated TgAb found in 20.6% of malignant nodules compared to 10.2% of benign Thyroid Peroxidase Antibody (TPOAb) had little variation (31.33% malignant vs 26.7% benign)
- 15. ADDITIONAL RESULTS • TSH >1 µlU/ml was predictor for higher risk of cancer • Young age: malignant patients average 45.33 years old • Gender not statistically significant: while males tested positive for thyroid cancer more often than females, 84% of the study’s subjects were female • 41% of thyroid cancer nodules <10 mm in diameter
- 16. CONCLUSIONS • While this study suggests association between Hashimoto’s and thyroid cancer is antibody specific, the cause of this is not known • Larger study would determine if a TgAb threshold exists • The relationship between thyroid cancer and inflammation is still not fully understood, this study demonstrated TgAb levels and TSH ≥1 µlU/ml can serve as significant predictors for thyroid cancer. • TgAb may lead to nodule formation or be closely related to a specific inflammatory response. Further investigation into antibody specificity may lead to a better understanding of nodule production
Editor's Notes
- This is a short presentation that goes over our latest manuscript. In our paper, as you can see from the title, we looked at the connection between Hashimoto’s and Thyroid Cancer.
- First of all, before we talk about the study, let’s answer a few questions: first… We hear about Hashimoto’s a lot here in the office, but what is it? Inflammation… and it leads to hypothyroidism, where the gland has stopped working all together.
- Medicine Net did a good job of depicting how the white blood cells attack the thyroid gland. Immune system, specifically TgAb and TPO antibodies, sees the thyroid gland as a threat and attacks, slowly killing the thyroid’s function.
- A little background – This is also what we looked at in our first paper back in 2011. Our 2011 paper, “Autoimmune Thyroid Disease: A Risk Factor for Thyroid Cancer,” looked at the same data, but it was collected retrospectively. Prospective studies have more value because they tend to be less biased - researchers do not know who will have cancer when the data is collected.
- Our retrospective study, plus another by Kim et al., found a link between patients with Hashimoto’s and thyroid cancer.
- Once we compiled all of that data into our big spreadsheets, excluded patients who moved or didn’t come back for follow-up, we divided remaining patients into cancer and no cancer and crunched numbers for all of the variables we collected at their initial biopsy appointments. This means that if you have thyroid nodules AND elevated Tg antibody, you are at 10% higher risk for thyroid cancer.
- Some additional interesting results. TSH >1 predictor for higher risk – Michelle says that some patients will ask her about this! Our patients DO read our papers, and this might even concern them. The older you get, the lower your risk for thyroid cancer. Makes you look forward to your next birthday a little more! Gender was not significant, but if you’re a guy with nodules, your chance is a little higher. (Sorry Chris) And my favorite, almost half of the malignant nodules in our study were less than 10mm. This is a big deal considering the ATA guidelines only recommend biopsy for patients with nodules >10mm. Over 40% of the malignant nodules from this study group of patients could have been missed completely had they not been patients here at Wilmington Endo.