Association Between Thyroid Nodules and Thyroid Cancer Risk in Graves’ Disease: A Surgical Cohort from an Iodine-deficient Region
Haseki Tip Bulteni, cilt.64, sa.2, ss.129-137, 2026 (ESCI, Scopus, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 64 Sayı: 2
- Basım Tarihi: 2026
- Doi Numarası: 10.4274/haseki.galenos.2026.96158
- Dergi Adı: Haseki Tip Bulteni
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, CINAHL, EMBASE, Directory of Open Access Journals, TR DİZİN (ULAKBİM), Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Sayfa Sayıları: ss.129-137
- Anahtar Kelimeler: Graves disease, nodular graves disease, thyroid nodule, papillary thyroid carcinoma, biopsy, fine-needle, hyperthyroidism
- Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Aim: The clinical relevance of thyroid nodules in Graves’ disease (GD) remains controversial, particularly in iodine-deficient regions where both nodularity and thyroid cancer are more prevalent. This study aimed to compare clinical, biochemical, ultrasonographic, cytological, and pathological characteristics between nodular and non-nodular GD (non-NGD) to clarify the oncologic significance of nodularity. Methods: This retrospective observational cohort study included 160 patients who underwent total thyroidectomy for GD between June 2020 and July 2025 at an endocrine surgery center. Patients were classified according to preoperative ultrasonography (US) as nodular or non-NGD. Demographic features, thyroid autoimmunity markers, ophthalmopathy, fine-needle aspiration biopsy (FNAB) results, and final pathology were recorded. Multivariate logistic regression analysis was performed to identify independent predictors of nodularity. Results: Sixty-three patients (39.4%) had nodular GD (NGD), and 97 patients (60.6%) had non-NGD. Nodular patients were older and had higher body mass index (BMI) (both p<0.05), whereas thyroid-stimulating immunoglobulin and anti-thyroid peroxidase levels and ophthalmopathy were significantly higher in non-nodular patients. Fine-needle aspiration biopsy was more frequently performed in the nodular group (57.1% vs. 20.6%). Overall, papillary thyroid carcinoma (PTC) was diagnosed in 31.8% of the cohort, with a markedly higher prevalence in NGD (52.4% vs. 18.5%, p<0.001). Tumors in nodular patients were larger and more likely to exhibit lymphatic invasion. In multivariate analysis, age and BMI remained independent predictors of nodularity. Conclusion: In this surgically treated GD cohort, nodularity identifies a structural phenotype with substantially increased PTC risk, while non-NGD reflects an autoimmune-dominant phenotype. High malignancy rates across Bethesda categories and even in non-biopsied patients indicate the need for vigilant US surveillance and a low threshold for FNAB of suspicious or dominant nodules.