Hashimoto's Thyroiditis in Patients With Normal TSH Levels
Hashimoto's Thyroiditis in Patients With Normal TSH Levels
The possibly increased risk of thyroid cancer in patients with thyroid inflammation is also of particular importance. It is still a matter of debate whether chronic inflammation could induce papillary thyroid carcinoma. Several epidemiological and morphological studies, however, strongly support an increased risk of papillary thyroid carcinoma for patients with HT. The immune infiltrate of the thyroid gland itself has been hypothesized to play a critical role in the regulation of carcinogenesis and in carcinoma progression. As a possible link between papillary thyroid cancer and HT, RET/PTC (rearranged in transformation/papillary thyroid carcinomas) gene rearrangement has been suggested. Various studies provided some evidence suggesting that it may be present in a subpopulation of cells in the thyroid glands affected by HT. RET/PTC is one of the most common molecular alterations in thyroid papillary carcinoma and is found in 20–40% of adult sporadic papillary carcinomas with an even higher prevalence in children and in patients exposed to radiation. Based on these data and on clinical observations it has been suggested that autoimmune reactions may be related to radiation exposure.
In a recent large study, a high prevalence of thyroid papillary carcinoma was found and the study authors recommended that an ultrasound of the thyroid gland should be performed at the time of the initial visit in patients with autoimmune thyroid disease in order to detect malignant thyroid tumors. However, other studies found low incidences of thyroid cancers in HT patients.
Thyroid Malignancy
The possibly increased risk of thyroid cancer in patients with thyroid inflammation is also of particular importance. It is still a matter of debate whether chronic inflammation could induce papillary thyroid carcinoma. Several epidemiological and morphological studies, however, strongly support an increased risk of papillary thyroid carcinoma for patients with HT. The immune infiltrate of the thyroid gland itself has been hypothesized to play a critical role in the regulation of carcinogenesis and in carcinoma progression. As a possible link between papillary thyroid cancer and HT, RET/PTC (rearranged in transformation/papillary thyroid carcinomas) gene rearrangement has been suggested. Various studies provided some evidence suggesting that it may be present in a subpopulation of cells in the thyroid glands affected by HT. RET/PTC is one of the most common molecular alterations in thyroid papillary carcinoma and is found in 20–40% of adult sporadic papillary carcinomas with an even higher prevalence in children and in patients exposed to radiation. Based on these data and on clinical observations it has been suggested that autoimmune reactions may be related to radiation exposure.
In a recent large study, a high prevalence of thyroid papillary carcinoma was found and the study authors recommended that an ultrasound of the thyroid gland should be performed at the time of the initial visit in patients with autoimmune thyroid disease in order to detect malignant thyroid tumors. However, other studies found low incidences of thyroid cancers in HT patients.
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