The impact of hashimoto thyroiditis on thyroid nodule cytology and risk of thyroid cancer

Nathalie Silva De Morais*, Jessica Stuart, Haixia Guan, Zhihong Wang, Edmund S. Cibas, Mary C. Frates, Carol B. Benson, Nancy L. Cho, Mathew A. Nehs, Caroline A. Alexander, Ellen Marqusee, Mathew I. Kim, Jochen H. Lorch, Justine A. Barletta, Trevor E. Angell, Erik K. Alexander

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Context: The impact of Hashimoto thyroiditis (HT) on the risk of thyroid cancer and its accurate detection remains unclear. The presence of a chronic lymphocytic infiltration imparts a logical mechanism potentially altering neoplastic transformation, while also influencing the accuracy of diagnostic evaluation. Methods: We performed a prospective, cohort analysis of 9851 consecutive patients with 21,397 nodules≥1 cmwho underwent nodule evaluation between 1995 and 2017. The definition of HT included (i) elevated thyroid peroxidase antibody (TPOAb) level and/or (ii) findings of diffuse heterogeneity on ultrasound, and/or (iii) the finding of diffuse lymphocytic thyroiditis on histopathology. The impact of HT on the distribution of cytology and, ultimately, on malignancy risk was determined. Results: A total of 2651 patients (27%) were diagnosed with HT, and 3895 HT nodules and 10,168 non- HT nodules were biopsied. The prevalence of indeterminate and malignant cytology was higher in the HT vs non-HT group (indeterminate: 26.3% vs 21.8%, respectively, P,0.001; malignant: 10.0% vs 6.4%, respectively, P,0.001). Ultimately, the risk of any nodule proving malignant was significantly elevated in the setting of HT (relative risk, 1.6; 95% CI, 1.44 to 1.79; P , 0.001), and was maintained when patients with solitary or multiple nodules were analyzed separately (HT vs non-HT: 24.5% vs 16.3% solitary; 22.1% vs 15.4% multinodular; P , 0.01). Conclusion: HT increases the risk of thyroid malignancy in any patient presenting for nodule evaluation. Diffuse sonographic heterogeneity and/or TPOAb positivity should be used for risk assessment at time of evaluation.

Original languageEnglish (US)
Pages (from-to)791-800
Number of pages10
JournalJournal of the Endocrine Society
Issue number4
StatePublished - Apr 2019
Externally publishedYes


  • FNA
  • Hashimoto disease
  • thyroid cancer
  • thyroid nodule

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism


Dive into the research topics of 'The impact of hashimoto thyroiditis on thyroid nodule cytology and risk of thyroid cancer'. Together they form a unique fingerprint.

Cite this