Thyroid Cancer in Thyrotoxic Patients: Clinicopathological Features and Outcomes: A Propensity Score Analysis

Abstract

Background: Over the past few decades, the incidence of differentiated thyroid cancer (DTC) has continued to rise, largely attributed to advances in diagnostic imaging and increased surveillance. Whether the presence of concomitant thyrotoxicosis alters the behavior or prognosis of DTC remains uncertain and continues to be debated. We conducted a retrospective matched cohort study to address this question.

Methods: We retrospectively analyzed 11 patients with thyrotoxicosis and DTC and compared them with 415 euthyroid DTC patients treated between 2010 and 2020. To minimize confounding, a 1:4 propensity score matching analysis was performed. Risk stratification and outcomes were assessed according to the 2015 American Thyroid Association (ATA) guidelines.

Results: Papillary thyroid carcinoma was the predominant type in both groups (90.9% in thyrotoxic vs. 89.6% in euthyroid/hypothyroid). Among thyrotoxic patients, six out of 11 (54.5%) had papillary microcarcinomas. After matching, no significant differences were found between the groups in ATA risk category (P = 0.12), or disease outcome at 1 year (P = 0.29).

Conclusions: These findings may suggest that thyrotoxicosis facilitates earlier detection of DTC, reflected by the higher proportion of microcarcinomas, but it does not appear to substantially influence tumor behavior or short-term outcomes.