Hashimotos Thyroiditis and Thyroid Cancer
Hashimotos Thyroiditis and Thyroid Cancer
Thyroid cancer (TC) is the most common endocrine malignancy. The association between
 inflammation and cancer is well established but the association between thyroiditis
 (inflammation of thyroid gland) especially Hashimoto's thyroiditis (HT) and thyroid cancer
 remains controversial. Chronic inflammation leads to a repeated cycle of cellular damage and
 subsequent healing which contributes to inappropriate cell proliferation and subsequent
 neoplastic transformation. One of the most common forms of Thyroiditis is Hashimoto's
 thyroiditis which is a chronic autoimmune inflammatory disease affects almost 5% of the
 population and is more common in women. For the first time, Dailey and Lindsay reported in
 1955 an increased association between Hashimoto's Thyroiditis (HT) and thyroid cancer. They
 reported 35 thyroid cancers in 278 patients with Hashimoto's Thyroiditis, a prevalence of
 17.7% which they considered higher than the general population . Since then, various studies
 have been done, some studies have reported an increased risk of malignancy in Hashimoto's
 thyroiditis; others have failed to find an association. Most of the studies that have been
 done to identify the association between Hashimoto's thyroiditis and thyroid cancer are
 retrospective. The purpose of this pilot case-control study is to identify the association of
 Hashimoto's thyroiditis and thyroid cancer, to determine if the presence of Hashimoto's
 thyroiditis has any affect on the complication of thyroidectomy and prognostic factors of
 thyroid cancer.
AIM1: To identify the association between Hashimoto's Thyroiditis and thyroid cancer by
 comparing the prevalence of thyroid cancer in patients with Hashimoto's Thyroiditis and
 patients without Hashimoto's Thyroiditis who undergoing Thyroidectomy for a variety of
 indications in UTMB in 12 months period of the study.

 AIM2: Compare Ultrasound (US) characteristics preoperatively in two groups of patients with
 thyroid cancer and Hashimoto's thyroiditis and patients with thyroid cancer but without
 Hashimoto's thyroiditis.

 AIM3: compare prognostic factors including tumor diameter, vascular and capsular invasion,
 extra thyroid invasion, lymph node metastasis, distant metastasis in two groups of patients
 including patients with thyroid cancer and Hashimoto's thyroiditis and patients with thyroid
 cancer but without Hashimoto's thyroiditis.

 AIM4: Compare the complication of surgery in patients with thyroid cancer and Hashimoto's
 Thyroiditis and patients with thyroid cancer but without Hashimoto's thyroiditis.

 AIM5: Compare inflammatory factors in two group of patient with thyroid cancer and
 Hashimoto's Thyroiditis and patients with thyroid cancer but without Hashimoto's thyroiditis.

 Coordinator in the ear, nose and throat (ENT) clinic will notify the assigned investigator
 about any patient admitted to UTMB for thyroidectomy. The investigator will meet and
 interview the patient to obtain the consent and fill out a data collection sheet which will
 include demographic data, history of thyroid disease, history of thyroid medications, history
 of radiotherapy of head and neck or radioactive iodine therapy, family history of thyroid
 disease or thyroid cancer. Patients meeting the inclusion criteria will be given the
 opportunity to participate in the study. All patients will have blood drawn. Blood samples
 will be stored in Endocrinology lab to measure Anti-TPO, Ca, PTH and inflammatory factors at
 the end of study. A chart review of all enrolled patients will be performed to obtain details
 of the preoperative thyroid U/S characteristics including echogenicity, texture,
 calcification, vascularity and TSH and Free T4 level. Postoperative histopathology evaluation
 will be done by a pathologist experienced in thyroid pathology. The diagnosis of Hashimoto's
 thyroiditis (HT ) will be made based on histopathology finding and AntiTPO level. The
 histopathology criteria for Hashimoto's thyroiditis (HT) must be seen in a normal region of
 the thyroid gland, distinct from the site of thyroid cancer. UTMB Subjects will be divided to
 two groups, subjects with Hashimoto's Thyroiditis and subjects without Hashimoto's
 Thyroiditis (control group).The prevalence of thyroid cancer will be compared in these two
 groups.
Inclusion Criteria:

 -  All patients undergoing thyroidectomy for a variety of indications at University of
 Texas Medical Branch in Galveston between June 2011-May 2012

 -  Age 18-80 years old

 Exclusion Criteria:

 History of previous radiotherapy to head and neck and History of radioactive iodine therapy