Differentiated Thyroid Carcinoma Associated with Graves' Disease: A Series of Six Cases and Review of the Literature

Abstract Introduction: Graves’ disease is an autoimmune disorder characterized by hyperthyroidism related to the presence of thyroid-stimulating hormone receptor antibodies. Long considered protective against thyroid cancer, it is now recognized as potentially associated with differentiated thyroid carcinomas, mainly papillary carcinoma. Objective: To describe the clinical, histological, therapeutic, and outcome characteristics of thyroid carcinomas occurring in patients with Graves’ disease. Patients and Methods: A retrospective descriptive study including six patients followed for Graves’ disease who underwent total thyroidectomy, in whom histopathological examination revealed differentiated thyroid carcinoma. Results: The mean age of the patients was 38.2 years, with a male predominance (5 men, 1 woman). Cervical ultrasound showed multinodular goiter in four patients, a suspicious nodule classified as EU-TIRADS V in one patient, and a simple goiter in one patient. Histological examination revealed five papillary carcinomas (83.3%) and one follicular carcinoma (16.7%). TNM staging showed predominantly localized forms. All patients underwent total thyroidectomy, associated with central lymph node dissection in one case. Radioiodine ablation was performed in five patients. Outcome was favorable in all cases, with no recurrence or distant metastasis. Conclusion: Graves’ disease does not exclude the occurrence of thyroid cancer. The presence of nodules, even in a hyperthyroid context, should raise suspicion of associated malignancy. The prognosis of differentiated thyroid carcinomas associated with Graves’ disease is generally favorable, provided appropriate management.