Coexistent thyroid nodules in patients with graves' disease: What is the frequency and the risk of malignancy?

BACKGROUND: The purpose of this study was to determine the frequency of coexistent thyroid nodules and the rate of malignancy in patients with surgically treated Graves' disease (GD).

METHODS: A retrospective review of all patients with GD who underwent thyroidectomy from 1990 to 2017 was completed. Pathology reports were reviewed for coexistent nodules. Demographics, nodule size, and results of ultrasound, 123 I scintigraphy, fine needle aspiration biopsy and pathology were analyzed.

RESULTS: There were 233 patients with GD who underwent thyroidectomy, 103 (44%) had one or more thyroid nodules, which were incidentally discovered on pathologic exam in 54(52%) patients. 14 (6%) patients had cancer, 9 (4%) papillary microcarcinoma and 5 (2%) papillary cancer ≥ 1 cm that occurred within a nodule diagnosed preoperatively.

CONCLUSIONS: Most thyroid nodules in patients with GD were incidentally discovered on pathologic exam. A higher rate of malignancy was found in patients with GD and clinically identifiable nodular disease.