| Objective: Analysis of the clinical symptoms and pathological features of thyroid cancer in Hashimoto’s disease patients’ before and after salt iodization. And also, to determine the provoking factors behind lymph node metastasis and their respective clinical features in those patients as well as to understand the effect of iodine in thyroid cancer.Methods: In a retrospective study covering the periods from January 1991 to December1995 and January 2009 to December 2013 in the General Surgery department of the Second Affiliated Hospital of Dalian Medical University, thyroid cancer and Hashimoto’s disease patients were screened and their clinical symptoms and pathological features were recorded. Among 109 cases recorded, there were 14 male cases and 95 female cases. All patients underwent routine thyroid ultrasound and thyroid function tests in the pre-operative stage.All patients had post-operative pathological diagnosis of thyroid cancer combined with Hashimoto’s disease.Pre-operative auto-antibodies profile and thyroid stimulating hormones(TSH) levels were recorded in the patients who were screened between January 2009 to December2013 as well as intra-operative central lymph node dissection or(and) functional neck dissection was performed. Patients screened between 1991 and 1995 included 25 cases, with age range 17-67 years old, mean age 47 years old, among whom there were22 cases of papillary carcinoma(pre-iodization group), 2 cases of follicular carcinoma,and 1 case of medullar carcinoma. Patients screened between 2009 and 2013 included84 cases, with age range 14-68 years old, mean age 44 years old, among whom therewere 78 cases of papillary carcinoma(post-iodization group), 4 cases of follicular carcinoma, and 2 cases of medullar carcinoma. Gender, age, tumor size, multiple lesions particularities, as well as tumor invasion and capsule location factors between the two groups were analyzed. 42 cases without lymph node metastasis were recorded among which 2 cases were male and 40 cases were female, with their age range extending from19 to 68 and a median age of 47 years old. 36 cases with lymph node metastasis were recorded among which 5 cases were male and 31 cases were female,with their age range extending from14 to 62 and a median age of 44 years old. Gender,age, tumor size, multiple lesions particularities, capsule invasion and conditions,location of the tumor, blood TSH and auto-antibodies levels were also recorded. The measured data were analyzed through t test and X2 cross tabulation and the clinical and pathological features of both groups were compared. Furthermore, the data were compared with previous literature for any significance through the multivariate conditional logistic regression, which would prove that thyroid cancer and Hashimoto’s disease are provocative factors in lymph nodes metastasis.Results:Analysis of the above mentioned parameters between the pre-iodization and post-iodization groups showed that tumor diameter had statistical significance(p <0.05),while the other parameters bore no statistical meaning. Among all the factors measured above, which can potentially influence lymph node metastasis, only age, TSH and tumor size showed statistical significant(p <0.05). The values were p = 0.039, p =0.040 and p = 0.000 respectively. These three parameters, combined with other multivariate logistic regression analysis, showed that TSH and tumor size are related to lymph node metastasis in Hashimoto’s disease patients with thyroid cancer. TSH and tumor size are potential risk factors(p = 0.102 and 0.002 respectively, and OR values=1.232 and 4.056 respectively).Conclusion:1.Only tumor diameter of Hashimoto’s disease patients with thyroid cancer in both groups before and after salt iodization has some significance. gender, age and those who had accompanying nodular goiter and capsular invasion had no significant influence.2.Tumor size and TSH influence cervical lymph nodes metastasis, each to a different extent in Hashimoto’s disease patients with thyroid cancer, are risk factors for lymph node metastasis.For those thyroid papillary carcinoma with hashimoto thyroiditis patients,> 1.0 cm in diameter and TSH > 2.5 μIU/mL,lymph node cleaning operation is of great significance,do the fast pathologic examination of lymph node within the operation when necessary is equally important.This suggests us to plan the right operation scheme.3.Age influence cervical lymph nodes metastasis, each to a different extent in Hashimoto’s disease patients’ with thyroid cancer. Younger patients is more easyer appear to lymph node metastasis,so we should focus on its follow-up and prognosis of the younger Hashimoto’s disease patients’ with thyroid cancer.4.Those who had accompanying nodular goiter, capsular invasion and multifocal tumors had no significant influence to lymph node metastasis of Hashimoto’s disease patients’ with thyroid cancer,but the p value is smaller, it is necessary to enlarge the sample size, further explore its effect on clinical patients with lymph node metastasis. |
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