Hashimoto's Thyroiditis is associated with smaller tumor size and a lower prevalence of lymph node metastasis in patients with Differentiated Thyroid Cancer, but HT is not an independent predictor of pathological tumor aggressiveness after adjustment for tumor size.
Abstract
Background
The association between Hashimoto's Thyroiditis (HT) and the clinicopathological behavior of Differentiated Thyroid Cancer (DTC) remains controversial. In particular, whether coexisting autoimmune thyroiditis independently influences invasive tumor characteristics after adjustment for tumor-related factors remains unclear. This study aimed to evaluate the relationship between HT and clinicopathological features of DTC, with a focus on tumor size, lymph node metastasis, and pathological indicators of tumor aggressiveness.
Methods
This retrospective observational study included 198 patients with histologically confirmed DTC who underwent thyroidectomy between June 2023 and March 2025. Patients were stratified according to the presence or absence of Hashimoto's Thyroiditis. Tumor size, lymph node metastasis, capsular invasion, and extrathyroidal extension were compared between groups. Tumor aggressiveness was defined as capsular invasion and/or extrathyroidal extension. Multivariate logistic regression analysis was performed to assess independent associations. Model performance was evaluated using receiver operating characteristic (ROC) analysis and nomogram visualization.
Results
Patients with coexisting HT presented with significantly smaller tumors compared with those without HT (median tumor size: 9 mm vs. 12 mm; p = 0.003). Lymph node metastasis was observed less frequently in the HT group than in the non-HT group (4.1% vs. 46.8%; p < 0.001). In multivariate analysis, tumor size was independently associated with tumor aggressiveness (odds ratio [OR] = 1.49, 95% confidence interval [CI]: 1.11-1.99; p = 0.008), whereas HT was not independently associated with aggressive pathological features (OR = 1.10, 95% CI: 0.70-1.73; p = 0.692). The predictive model demonstrated limited discriminative ability (AUC = 0.587), although calibration was acceptable.
Conclusions
Hashimoto's Thyroiditis is associated with smaller tumor size and a lower prevalence of lymph node metastasis in patients with Differentiated Thyroid Cancer. However, HT is not an independent predictor of pathological tumor aggressiveness after adjustment for tumor size. These findings suggest that HT may influence disease presentation but should not be considered a standalone prognostic factor for invasive tumor behavior.
TRIAL REGISTRATION
Not applicable. This study was a retrospective observational cohort study and did not involve prospective clinical trial registration.
Objective To investigate the impact of Hashimoto’s thyroiditis (HT) on central lymph node metastasis (CLNM) patterns and identify independent risk factors for CLNM in patients with papillary thyroid carcinoma (PTC). Methods This retrospective study enrolled 668 cN0 PTC patients who underwent initial surgery at Huizhou Central People’s Hospital between August 2024 and July 2025. Patients were stratified into an HT-PTC group (n = 117) and a PTC-only group (n = 551) based on postoperative histopathological findings. Clinicopathological features and CLNM characteristics were systematically compared. Multivariable logistic regression was utilized to identify independent risk factors for CLNM in patients with HT-PTC, and the predictive efficacy of the resulting model was validated using ROC curves. Results The HT-PTC group exhibited significantly higher rates of multifocality and central lymph node dissection, alongside lower BMI and serum thyroglobulin (Tg) levels, compared with the PTC-only group (all P < 0.05). While the incidence of CLNM did not differ significantly between groups (35.0% vs. 33.9%, P = 0.819), the metastatic lymph node ratio (LNR) was significantly lower in the HT-PTC group (P < 0.001). Multivariate analysis identified tumor diameter > 1 cm as an independent risk factor for CLNM among HT-PTC patients (OR = 3.678; 95% CI: 1.587–8.520, P = 0.002). The predictive model demonstrated moderate efficacy (AUC = 0.649). Notably, the incidence of CLNM in HT-PTC patients with microcarcinoma (≤ 1 cm) was only 25.9%. Conclusion Concomitant HT is associated with a reduced metastatic burden rather than an increased prevalence of CLNM in patients with PTC. Tumor diameter > 1 cm serves as an independent predictor of CLNM. For HT-PTC patients with tumors ≤ 1 cm and no other high-risk factors, the necessity of prophylactic central lymph node dissection warrants individualized assessment combining clinical data and intraoperative observations to avoid overtreatment.
The relationship between Hashimoto thyroiditis (HT) and papillary thyroid carcinoma (PTC) remains controversial. This study aimed to evaluate the clinicopathologic characteristics and prognostic impact of coexisting HT in patients with PTC.
A total of 6581 patients who underwent surgery for PTC were retrospectively analyzed. Patients were classified into control (n = 5396) and HT (n = 1185) groups based on histopathologic diagnosis. Clinicopathologic features, molecular profiles, surgical extent, and recurrence-free survival (RFS) were compared. Multivariate logistic regression analysis was performed to identify factors associated with coexisting HT. RFS was analyzed using the Kaplan–Meier method.
Patients with HT were more likely to be female and younger (both P < .001). Total thyroidectomy and central lymph node dissection were more frequently performed in the HT group (P = .005 and P = .003, respectively). HT was associated with higher rates of multifocality (P < .001) but showed no significant differences in tumor size, vascular invasion, lymphatic invasion, extrathyroidal extension, or lateral lymph node metastasis. The HT group demonstrated a lower prevalence of BRAF mutation (72.2% vs 84.7%, P < .001), while TERT mutation rates were comparable. Preoperative TSH, thyroglobulin, and anti-thyroglobulin antibody levels were significantly higher in patients with HT (all P < .001). On multivariate analysis, female sex, younger age, multifocal disease, absence of extrathyroidal extension, absence of BRAF mutation, and higher preoperative anti-thyroglobulin antibody levels were independently associated with coexisting HT. During follow-up, recurrence rates did not differ significantly between groups (3.2% vs 3.4%, P = .726), and Kaplan–Meier analysis showed no significant difference in RFS (P = .73).
Coexisting Hashimoto thyroiditis in PTC is associated with distinct clinicopathologic and molecular characteristics, including female predominance, multifocality, and lower BRAF mutation rates. However, HT does not appear to influence recurrence-free survival. These findings suggest that while HT affects tumor presentation, it has limited prognostic impact on long-term outcomes in PTC.
Solji An, Joonseon Park, Kwang-Seog Kim et al.· European Journal of Endocrin...· 0 citations
Objective This study aimed to evaluate the impact of coexisting autoimmune thyroiditis (HT) on the clinicopathological characteristics and prognosis of patients with papillary thyroid carcinoma (PTC). Subjects and methods This prospective study included patients diagnosed with papillary thyroid carcinoma who underwent thyroid surgery. Patients were divided into two groups according to the presence or absence of histologically confirmed thyroiditis. Demographic data, tumor characteristics, pathological features, and postoperative outcomes were analyzed. Statistical comparisons were performed to assess differences between the two groups. Results Thyroiditis was observed in a significant proportion of patients with PTC. Patients with associated thyroiditis showed smaller tumors and more favorable clinicopathological characteristics compared to those without thyroiditis. However, no significant differences were observed in major oncological outcomes. Recurrence rates were lower in the thyroiditis group. The presence of thyroiditis was associated with more favorable prognostic features. Conclusion The coexistence of thyroiditis in patients with PTC was associated with more favorable clinicopathological features. However, no significant differences were observed in major oncological outcomes, and the short follow-up period limits the assessment of long-term prognosis. These findings suggest an association with less aggressive initial presentation rather than a definitive prognostic impact.
A. Bouchenna, A. Tibouk, B. Ghennam et al.· Archives of Endocrinology an...· 0 citations
This retrospective study aimed to investigate the predictive value of conventional ultrasonographic features combined with clinical factors for capsular invasion in patients with papillary thyroid carcinoma (PTC) with concurrent Hashimoto's thyroiditis (HT). A total of 262 patients with pathologically confirmed PTC and concurrent HT who underwent surgery at our institution from January 2018 to June 2024 were included as the training cohort. Patients were divided into capsular invasion and non-capsular invasion groups according to postoperative pathological findings. Clinical characteristics, conventional ultrasonographic features, and preoperative serum thyroid-stimulating hormone (TSH) levels were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of capsular invasion, and a nomogram model was constructed based on the selected variables. The predictive performance of the model was evaluated using receiver operating characteristic curves, calibration curves, decision curve analysis, and clinical impact curves. Univariate analysis showed that age, tumor diameter, postoperative lymph node metastasis, lesion margin, and blood flow signal were significantly associated with capsular invasion. Multivariate logistic regression analysis further identified age ≥55 years, larger tumor diameter, ill-defined lesion margin, and abundant blood flow signal as independent predictors of capsular invasion. The combined nomogram model achieved an area under the curve of 0.706 in the training cohort and 0.804 in the external validation cohort, showing better predictive performance than any single factor alone. Calibration curves, decision curve analysis, and clinical impact curves suggested acceptable model calibration and potential clinical utility. These findings indicate that a nomogram incorporating age, tumor diameter, lesion margin, and blood flow signal may provide a practical preoperative tool for estimating the risk of capsular invasion in patients with PTC and HT.
Chengcheng Yu, Xiaojie Liu, Borui Yu et al.· American Journal of Cancer R...· 0 citations
Objective: The rising incidence of papillary thyroid carcinoma (PTC) parallels the global obesity epidemic. Chronic low-grade inflammation, a hallmark of obesity, has been hypothesized to promote tumor aggressiveness. This study aimed to determine whether elevated body mass index (BMI) and preoperative inflammatory indices are associated with aggressive clinicopathological features in PTC.
Material and methods: We conducted a retrospective study including 486 patients who underwent total thyroidectomy for histologically confirmed PTC at Hassan II University Hospital, Fez, between 2022 and 2026. Preoperative complete blood counts were used to calculate NLR, PLR, and MLR. BMI was classified according to WHO criteria. Pathological reports were reviewed for tumor size, lymph node (LN) metastasis, extrathyroidal extension (ETE), multifocality, BRAF V600E mutation, and ATA risk stratification. Statistical analyses included Chi-square, Mann-Whitney U, multivariate logistic regression, and ROC curve analysis.
Results: Among 486 patients (67.9% female, mean age 43 years), 52% had BMI ≥ 25 kg/m². Overall, lymph node metastasis was present in 214 patients (44%) and extrathyroidal extension (ETE) in 155 patients (32%). Overweight/obese patients (BMI ≥ 25) had significantly higher rates of tumor size >20 mm (51% vs. 28%, p=0.018), LN metastasis (55% vs. 32%, p=0.024), ETE (41% vs. 22%, p=0.031), multifocality (57% vs. 38%, p=0.042), and high ATA risk (29% vs. 12%, p=0.038). On multivariate analysis, BMI ≥ 25 independently predicted LN metastasis (OR 2.3, p=0.024) and ETE (OR 2.8, p=0.031). Regarding inflammatory indices, NLR >2.5 (AUC 0.74) predicted LN metastasis and ETE, while PLR >120 (AUC 0.68) predicted multifocality and larger tumor size. BRAF V600E status was available for 30.9% of patients, where an MLR >0.28 (AUC 0.65) was significantly associated with BRAF V600E positivity and disease recurrence
Conclusion: Elevated BMI and preoperative NLR, PLR, and MLR are independently associated with aggressive pathological features in PTC. These low-cost, routine biomarkers may improve preoperative risk stratification after external validation.
Khawla Salhi, S. Berghazi, M. Essafi et al.· World Journal of Advanced Re...· 0 citations
Objective To identify clinicopathologic predictors independently associated with cervical lymph node metastasis in pediatric papillary thyroid carcinoma. Subjects and methods We performed a retrospective cohort including patients younger than 18 years who underwent total thyroidectomy for papillary thyroid carcinoma (PTC) (2013-2023) at a tertiary pediatric hospital in Brazil. Clinical and histopathologic variables were reviewed per World Health Organisation Classification 5th edition (2022) and the College of American Pathologists protocol (2023). Multivariable associations with cervical lymph node metastasis (LNM) were estimated using Firth’s penalized logistic regression; discrimination was summarized by the area under the ROC curve (AUC) with 95% bootstrap confidence intervals. Results Thirty-two patients were included (median age, 14 years; 81% female). Cervical LNM occurred in 78%. Extrathyroidal extension (ETE) was associated with cervical lymph node metastasis in bivariate analysis (100% vs 59%; p = 0.007) and remained independently associated with cervical lymph node metastasis after adjustment for tumor T stage and lymphatic invasion (OR, 14.29; 95% CI, 1.28-2028.82; p = 0.028). Conclusion ETE was independently associated with cervical lymph node metastasis in pediatric PTC and may justify closer postoperative surveillance.
Mário Sérgio Rocha Macedo, R. Honório, Willer Feitosa Menezes et al.· Archives of Endocrinology an...· 0 citations
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