Ankara Med J. 2020; 20(1): 234-241 | DOI: 10.5505/amj.2020.79553

Toksik nodüler ve multinodüler guatrlý hastalarda tirotropin reseptör antikoru tiroid kanseri ile iliþkili deðildir

Cevdet Aydýn¹, Husniye Baser¹, Neslihan Cuhaci¹, Didem Ozdemir¹, Abdussamed Yalcin², Elif Ozdemir³, Reyhan Ersoy¹, Bekir Cakir^1
1Ankara Yýldýrým Beyazýt Üniversitesi Týp Fakültesi, Endokrinolji ve Metabolizma Hastalýklarý Bilim Dalý, Ankara
²Ankara Yýldýrým Beyazýt Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Ankara
³Ankara Yýldýrým Beyazýt Üniversitesi Týp Fakültesi, Nükleer Týp Anabilim Dalý, Ankara

GÝRÝÞ ve AMAÇ: Graves hastalarýnda tiroid kanser sýklýðý ve agresifliði ile yüksek tirotropin reseptör antikor (TRAb) düzeyleri arasýnda iliþki bildirilmiþtir. Bu iliþki toksik nodüler guatr (TNG) ve toksik multinodüler guatrlý (TMNG) hastalarda araþtýrýlmamýþtýr. Biz, TNG ve TMNG’li hastalarda, tiroid kanseri ile TRAb arasýndaki iliþkiyi araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: TNG ve TMNG nedeniyle tiroidektomi olan hastalar retrospektif olarak deðerlendirildi. Toplam 370 hastadan, TRAb düzeyi mevcut olan 191 TMNG ve 30 TNG hastasý çalýþmaya dahil edildi.
BULGULAR: 221 TNG/TMNG’li hastanýn 24’ünde (%10,86) TRAb pozitif bulundu. Histopatolojik deðerlendirmede, 71 (%32,13) hasta malign, 150 (%67,87) hasta benigndi. 71 malign hastanýn 7’sinde (%9,86) ve 150 benign hastanýn 17’sinde (%11,33) TRAb pozitifti (p=0,742). Yaþ, cinsiyet, serum tirotropin, serbest triiodotironin, serbest tiroksin düzeyleri, anti-tiroid peroksidaz ve anti-tiroglobulin antikor pozitifliði ile histopatolojik tümör tipi açýsýndan TRAb pozitif ve negatif hastalar arasýnda fark yoktu (sýrasýyla p=0,393, p=0,401, p=0,403, p=0,903, p=0,877, p=0,788, p=0,540 ve p=0,357). TRAb pozitif 7 (%29,17) hastada ve TRAb negatif 57 (%28,93) hastada papiller tiroid kanseri (PTK) saptandý (p=0,357). Klasik varyant PTK, TRAb pozitif 5 (%71,43) hastada ve TRAb negatif 50 (%87,72) hastada mevcuttu (p=0,242).
TARTIÞMA ve SONUÇ: Bu çalýþmada, TMNG/TNG’li hastalarda TRAb pozitifliðinin malignite riskini artýrmadýðý görüldü.

Anahtar Kelimeler: tirotropin reseptör antikor, toksik nodüler guatr, toksik multinodüler guatr, tiroid kanseri

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Thyrotrophin receptor antibody is not associated with thyroid cancer in patients with toxic nodular and multinodular goiter

Cevdet Aydýn¹, Husniye Baser¹, Neslihan Cuhaci¹, Didem Ozdemir¹, Abdussamed Yalcin², Elif Ozdemir³, Reyhan Ersoy¹, Bekir Cakir^1
1Ankara Yildirim Beyazit University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
²Ankara Yildirim Beyazit University Faculty of Medicine, Department of General Surgery, Ankara, Turkey
³Ankara Yildirim Beyazit University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey

INTRODUCTION: Increased thyrotrophin receptor antibody (TRAb) was associated with thyroid cancer risk and aggressivity in patients with Graves disease. This relation was not investigated in patients with toxic nodular goiter (TNG) and toxic multinodular goiter (TMNG). We aimed to evaluate association between TRAb and thyroid cancer in patients with TNG and TMNG.
METHODS: Patients who underwent thyroidectomy with a preoperative diagnosis of TNG and TMNG were reviewed retrospectively. Among 370 patients, TRAb was available in 191 TMNG and 30 TNG patients.
RESULTS: TRAb was positive in 24 (10.86%) of 221 patients with TNG/TMNG. Histopathological result was malignant in 71 (32.13%) and benign in 150 (67.87%) patients. TRAb was positive in 7 (9.86%) of 71 malignant and 17 (11.33%) of 150 benign patients (p=0.742). Age, sex, serum thyrotrophin, free triiodothyronine, free thyroxine, anti-thyroid peroxidase and anti-thyroglobulin positivity, and histological tumor type did not differ between patients with positive and negative TRAb (p=0.393, p=0.401, p=0.403, p=0.903, p=0.877, p=0.788, p=0.540, and p=0.357, respectively). There was papillary thyroid cancer (PTC) in 7 (29.17%) patients with positive TRAb and 57 (28.93%) patients with negative TRAb (p=0.357). The variant of PTC was classical in 5 (71.43%) patients with positive and 50 (87.72%) patients with negative TRAb (p=0.242).
DISCUSSION AND CONCLUSION: In this study, we showed that TRAb positivity did not increase the risk of malignancy in patients with TNG/TMNG.

Keywords: thyrotrophin receptor antibody, toxic nodular goiter, toxic multinodular goiter, thyroid cancer

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