Surgical therapy for hyperthyroidism and concurrent thyroid carcinoma

Objective To evaluate the diagnosis and surgical treatment of primary hyperthyroidism concurrent with thyroid carcinoma.Methods The clinical data 48 cases with hyperthyroidism complicating with thyroid carcinoma,confirmed by pathology in Peking Union Medical College Hospital from January 1983 to July 2009 was retrospectively analyzed.Results The incidence of thyroid carcinoma was 2.02% (48/2378) in hyperthyroidism,and the incidence of hyperthyroidism was 3.03% (48/1584) in thyroid carcinoma.The diagnostic accuracy of ultrasound and radionuclide imaging were 61.3%and 62.5% respectively.Thyroidectomy was performed in 48 patients (37 women and 9 men),including 43 papillary carcinomas,4follicular carcinomas and 1 follicular papillary carcinomas.Subtotal thyroidectomy (31 patients),homolateral total thyroidectomy and contralateral subtotal thyroidectomy with neck dissection (6 patients),and total thyroidectomy with neck dissection or radical neck dissection (11 patients) were performed.Lung metastasis and bone metastasis were found in 2 cases in the second year after surgery.40 cases were followed up from 1 to 264 months (mean 130.5 months) postoperatively and there was no hyperthyroidism recurrence.Conclusions The diagnosis of occult thyroid cancer complicated with hyperthyroidism is very difficult,most of which were diagnosed by pathology.Ultrasound and radionuclide imaging are of much importance for the establishment of diagnosis.The postoperative prognosis of thyroid papillary carcinoma complicated with hyperthyroidism is satisfactory. Key words: Hyperthyroidism; Thyroid neoplasms; Diagnosis; Surgical procedures,operative