Basedow's disease associated with benign and malignant nodular disease of the thyroid: diagnosis and treatment

Nowadays the prevalence of thyroid nodules in Graves' disease (GD) is estimated as ranging from 15 to 33% and several studies support a high risk of thyroid cancer in this condition. The present study presents a retrospective analysis of 41 cases of GD submitted to total thyroidectomy from 1995 to 2003, aimed at discovering the most useful elements for an optimal diagnostic and therapeutic strategy. We identified 23 patients with coexisting nodular goitre (nodular variants of GD) and among these we carried out a comparative study of 12 cases with only benign nodules and 7 with thyroid carcinoma detected prior to the operation. Four cases were not considered because of incidental microcarcinomas. We found no significant differences in the number, average size and radionuclide imaging of nodules in the two groups. In contrast, analysis of ultrasonographic findings showed that hypoechogenicity correlated closely with malignancy, particularly if associated with ill-defined margins, microcalcifications and intranodular vascular patterns, whereas hyperechogenicity was a typical appearance of benign lesions. Our study suggests that routine thyroid US scans should be considered for complete evaluation of GD, since this pathology frequently implies the development of thyroid nodules which are not always detectable at clinical or radionuclide examination. Surgery is mandatory when nodules with suspicious ultrasonographic features are found and if malignancy cannot be excluded at fine needle aspiration cytology