1. Author: Bogdan(Cocos) Izabela-Diana Coordinator: Szántó Zsuzsanna, lecture, Department of Endocrinology, University of Medicine and Pharmacy Targu-Mure

2.  Grave’s disease is an autoimmune disease, is a common cause of hyperthyroidism, which causes enlargement of the thyroid and others symthoms such as exophthalmia, weight loss, anxiety etc. http://www.physio- pedia.com/Grave's_Disease heart palpitations, hand tremors, problems sleeping, hot insensitivity, palpitationstremors

3.  Hashimoto’s chronic autoimmune thyroiditis is a common cause of hypothyroidism, which causes enlargement and inflamation of the thyroid and others sympthoms such as weight gain, fatigue, depression, etc. http://endocrinesurgery.ucla.edu/ patient_education_adm_chronic_t hyroiditis.html, bradycardia, tachycar dia, constipation, migraines, memory loss, vision problems, infertility bradycardiatachycar dia

4.  Thyroid nodules and thyroid cancer rarely appear in Graves’ disease.  In contrast, in Hashimoto’s thyroiditis is commonly nodular goiter, and described the association of thyroid cancer often. http://sjccfthynet.blogspot.ro/2011/04/diag nosing-pediatric-thyroid-cancer_08.html

5. http://www.dasmaninstitute.org/cancer/thyroid-cancer/thyroid-cancer

6.  Evaluation of thyroid morphology in Graves’ and Hashimoto’s diseases.  To study the frequency of thyroid malignant processes in Basedow-Graves’ disease.  Evaluation of possible correlation between the antithyroid treatment and nodular goiter in Basedow-Graves’ disease.

7. The retrospective study included 145 patients with Graves’ disease and 100 with Hashimoto’s hospitalized in Clinic of Endocrinology, Department of Targu-Mures, between January 2009 and December 2013.

8. We followed:  Hormonal assessment: TSH, free-T4, free-T3  Antithyroid antibodies: TRAb, anti-TPO  The results of: -thyroid ultrasonography (US) - fine needle aspiration biopsy - histopathological examination  Specific treatment followed.

10. BASEDOW Thyroid morphology in graves disease. 35% was nodular goiter and 65% diffuse goiter

11. HASHIMOTO

12. In basedow, 30% of the nodular goiter was uninodular, and 70% multinodular.

14. It is possible to be a correlation between the antithyroid treatment and the forming of nodular goiter. In our study, 64% of the pacients with nodular goiter received chronic antithyroid treatment

15. In our study, 2% of the thyroid nodules was malignant. And the type of thyroid cancer was in 100% papillary carcinoma thyroid.

16.  At one time, thyroid cancer in Basedow-Graves’ disease was considered to be extremely rare, but this perception is beginning to change. Several studies have reported both an increased incidence of nodules and of thyroid cancer in patients with Graves' disease, with cancer rates varying from as low as 1% to as high as 9% of cases Ultrasonographic screening for detection of thyroid cancer in patients with Graves' disease. Clin Endocrinol (Oxf). 2004 Jun;60(6):719-25. Thyroid nodule in Basedow-Graves disease and thyroid cancer: experience in 6 patients. Rev Med Chil. 1995 Nov;123(11):1402-8. Spanish. Recent outcome of Graves' disease patients with papillary thyroid cancer. Eur J Endocrinol. 2007 Sep;157(3):325-9.

17.  Nodule size  Hypoechogenicity  Presence of microcalcifications  Predominantly solid composition  Intranodular vascularity  Irregular margins  Absence of a halo Mortensen jD, Woolner LB, Bennedback FN. Management of simple nodular goiter: current status and future perspectives. Endocr. Rev 2003;24:102-132. Many studies have been published in wich the ability to predict whether a thyroid nodule is benign or malignant on the basis of US findings was evaluated. There is no evidence in the literature to suggest that malignancy is based on nodule size.. In our study we found a nodule size of less than 1 cm to be significant for malignancy.( 1) Several US features have been foun to be associated with an increased risk of thyroid cancer, including the presence of microcalcification...... However, the sensitivities, specificities and negative and positive predictive values for these criteria are extremely variable from study to study..

18.  The feature with the highest sensitivity, in the range of 69.0%-75.0%, is solid composition.  The feature with the highest positive predictive value, 41.8%-94.2%, is the presence of microcalcifications.  The combination of factors improves the positive value to some extend.

19.  However thyroid nodules appear rarely in Graves’ disease, in our cohort it was met rather frequent, a possible explanation could be the methimazole therapy.  Thyroid nodules in Graves’ disease present a lower rate of malignancy.  Nodular goiter in Hashimoto’s thyroiditis appeared more frequently. Our study supports the results of others recent studies.

20.  (1) Mortensen jD, Woolner LB, Bennedback FN. Management of simple nodular goiter: current status and future perspectives. Endocr. Rev 2003;24:102-132.  (2) Aslan A, Sancak S, Aslan M, Cimsit NC, Güllüoglu BM, Ahiskali RA, Akalin NS, Aribal ME.Ultrasonography and Duplex Doppler Ultrasonography Based Indices in Nodular Thyroid Disease.Acta Endo (Buc) 2013 9: 575-588 doi: 10.4183/aeb.2013.575.  http://www.dasmaninstitute.org/cancer/thyroid-cancer/thyroid-cancer  http://www.physio-pedia.com/Grave's_Disease http://www.physio-pedia.com/Grave's_Disease  http://endocrinesurgery.ucla.edu/patient_education_adm_chronic_thyroiditis.ht ml http://endocrinesurgery.ucla.edu/patient_education_adm_chronic_thyroiditis.ht ml  Ultrasonographic screening for detection of thyroid cancer in patients with Graves' disease.Clin Endocrinol (Oxf). 2004 Jun;60(6):719-25. Ultrasonographic screening for detection of thyroid cancer in patients with Graves' disease.  Thyroid nodule in Basedow-Graves disease and thyroid cancer: experience in 6 patients. Rev Med Chil. 1995 Nov;123(11):1402-8. Spanish.  Recent outcome of Graves' disease patients with papillary thyroid cancer.Eur J Endocrinol. 2007 Sep;157(3):325-9. Recent outcome of Graves' disease patients with papillary thyroid cancer.

21. Thank you !