Multicentre study of thyroid nodules in patients with Graves' disease

Background: The association of Graves' disease with thyroid nodules and thy roid carcinoma is rarely reported. The incidence seems to be increasing acc ording to recent literature. The aim of this multicentre study was to revie w patients who had surgery for Graves' disease associated with thyroid nodu les, and to evaluate the risk of thyroid carcinoma. Methods: A retrospective study was made of 557 consecutive patients who und erwent operation for Graves' disease between 1991 and 1997 in five endocrin e surgery departments, Each patient underwent clinical, biochemical, ultras onographic and scintigraphic evaluation. None of the patients had had previ ous radioactive iodine therapy or external irradiation. Surgery consisted o f either a subtotal or total thyroidectomy. Results: Nodules were observed before operation in 140 patients (25.1 per c ent). Thyroid carcinoma was diagnosed in 21 patients (15.0 per cent), alway s inside a nodule. The incidence of thyroid carcinoma associated with Grave s' disease was 3.8 per cent (21 of 557 patients): 20 papillary and one foll icular carcinoma. The carcinoma was multifocal in two patients. Tumour diam eter ranged from 2 to 25 mm. A nodule was palpable in four patients. Conclusion: This multicentre study of patients having thyroidectomy for Gra ves' disease showed that 3.8 per cent had a carcinoma; the rate of carcinom a in cold nodules was 15.0 per cent. Surgery should be advised in any patie nt with Graves' disease and a thyroid nodule; the operation should be total thyroidectomy.