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Luigi Cantalamessa, MD, PhD; Marina Baldini, MD; Alessandra Orsatti, MSc; Laura Meroni, MD; Vincenzina Amodei, MD; Daniela Castagnone, MD

Arch Intern Med. 1999;159:1705-1708.

Background  The risk of thyroid carcinoma in patients with Graves disease has been particularly emphasized when nodules coexist with thyroid hyperplasia; a surgical approach has been suggested.

Objectives  To detect thyroid nodules early in patients with Graves disease and to evaluate the risk of carcinoma.

Methods  The study group included 315 consecutive outpatients with Graves hyperthyroidism not previously treated with surgery or radioiodine therapy. Thyroid ultrasonography was performed at the time of enrollment and repeated annually in all patients; fine-needle aspiration (FNA) was carried out in those patients with nodules and repeated after 2 years or at shorter intervals.

Results  One hundred six of 315 patients with Graves disease had thyroid nodules 8 mm in diameter or larger detected by ultrasonography. In 49 patients, nodules were present at the time of the first examination; in 57 patients, nodules developed during follow-up. Fine-needle aspiration cytology results revealed features of carcinoma in only 1 patient; this was confirmed by histologic examination of excised thyroid tissue. The nodules with normal cytologic features at the time of the first examination did not show any clinical and/or cytologic evolution toward malignancy during follow-up.

Conclusions  Ultrasonographic evidence of nodules was frequently found among our patients with Graves disease, but malignant FNA cytologic findings of the examined nodules were rare at the time of diagnosis and throughout the course of the disease. When FNA cytologic evaluation does not indicate malignancy, the presence of thyroid nodules in patients with Graves disease does not indicate an aggressive therapeutic approach.

From the Departments of Internal Medicine (Drs Cantalamessa, Baldini, Meroni, and Amodei and Ms Orsatti) and Radiology (Dr Castagnone), University of Milan, IRCCS Ospedale Maggiore, Milan, Italy.

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