Özet:

Objectives: Toxic nodular goiter (TNG) and toxic multinodular goiter (TMNG) are characterized by the presence of one or more autonomously functioninoning thyroid nodules that cause hyperthyroidism. In contrast to the previous thought that hyperthyroidism is protective against thyroid cancer, there is increasing evidence that the risk of thyroid cancer should not be underestimated in these patients and nodules should be assessed as being in other patients. We aimed to determine the prevalence of thyroid cancer in TNG/TMNG patients who underwent thyroidectomy and evaluate preoperative features that might be associated with cancer. Materials and Methods: Patients diagnosed with TNG or TMNG and operated between January 2017 and December 2014 were included. The patients were scanned retropectively and clinical features, laboratory findings, ultrasonography (US) reports, cytological and histopathological results were recorded. Clinical features of patients with benign and malignant histopathology, and preoperative US features and cytological results of benign and malignant nodules were compared. Results: There were 482 patients of which 335 (69.50%) were female and 147 (30.50%) were male and the median age was 56 (18-79). Preoperative diagnosis was TNG in 74 (15.35%) and TMNG in 408 (84.65%) patients. Histopathologically, 380 (78.84%) had benign and 102 (21.16%) had malignant disease. There was no significant difference in age, sex distribution, anti-thyroid use, antibody positivity and median nodule number in benign and malignant patients. Ultrasonographically the presence of thyroiditis in parenchyma was higher in malignant compared to benign patients (87.24% vs. 75.26%. by p<0.001. The ratio of patients operated for cytological diagnosis was higher in malignant, while patients operated for giant nodule were higher in benign patients. Among 1263 nodules with preoperative US data, 1222 (96.75%) were benign, 41 (3.25%) were malignant histopathologically. The rate of hypoechogenity was significantly higher in malignant than benign nodules. Other US features were similar in two groups. Among nodules with preoperative scintigraphy results, 406 (71.99%) of benign and 19 (67.86%) of malignant nodules were hot (p=0.853). Conclusion: In this study, the incidence of thyroid cancer in TNG/TMNG patients who underwent surgery was too high to be ignored. Preoperative US features of benign and malignant nodules were similar in these patients. We recommend that nodules in patients with TNG/TMNG should be evaluated by fine needle aspiration biopsy according to the same indications as for other nodules and when surgery is planned; total or near total thyroidectomy can be preferred in the presence of TMNG.

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