Abstract

Background: Thyroid nodule is a common disease in the general population as well as Graves’disease. Thyroid nodules in Graves' disease increase the risk of thyroid cancer many times compared with Graves' disease without thyroid nodules. Objectives: To determine the prevalence of thyroid nodules and comment on clinical and subclinical characteristics of thyroid nodules in patients with Graves’ disease in euthyroidism at the National Hospital of Endocrinology. Subjects and methods: 255 patients with Graves’ disease in euthyroidism underwent clinical examination and thyroid ultrasound. The thyroid nodules were clinically examined and evaluated for thyroid ultrasound features, and risk of thyroid cancer according to the TIRADS of the American Society of Radiology (ACR) 2017. The nodules were indicated fine-needle aspiration cytology (FNAC) based on the their TIRADS grade and size. Results: 70/255 patients with Graves’ disease in euthyroidism were found to have nodule(s) on ultrasound, accounting for 27.5%. The characteristics of patients with Graves' disease and thyroid nodule(s): The females accounted for the majority with a female/male ratio of 10.6/1; average age of 40.5 ± 14.6; age 31-60 accounted for 80%; 70% of the nodules were detected at the same time as Graves’ disease diagnosis; the majority had neither clinical symptoms (80%) nor were palpable on clinical examination (78.6%); multi-nodular goiter accounted for the majority (62.9%); the majority of the nodules were ≤ 10mm (65.7%) and most have 20mm (88.6%); solid, hypoechoic/very hypoechoic, lobulated, high > wide and microcalcification with 42.9%, 38.6%, 5.7%, 4.3% and 10% respectively and all they were associated with increased risk of thyroid cancer; TIRADS grade 1, 2, 3, 4 and 5 accounted for 17.1%, 27.1%, 38.6%, 10.0% and 7.1, respectively. 19 patients underwent FNAC, of which 5patients (26.3%) were diagnosed with cancer –  Bethesda group VI, all had TIRADS grade 5, and the diagnosis of thyroid cancer was confirmed by pathological examination after surgery in all. The cancer rate in the patients with Graves’ disease and thyroid nodule(s) was 7.1%. Conclusions: Thyroid nodule(s) were present in 27.5% of the patients with Graves' disease, that was detected at or after the diagnosis of the latter; multinodular goiter accounted for the majority and most nodules were < 20mm in size. Thyroid cancer was present in 7.1% of the patients with Graves’ disease and the nodule(s), associated with the nodule ultrasound features and TIRADS grade. It is necessary to screen for thyroid nodules in patients with Graves' disease and for thyroid cancer in those with thyroid nodules among them.