Classic Variant Papillary Thyroid Carcinoma in Graves Disease and Multinodular Goiter Backgrounds: A Propensity Score-Matched Comparison

Dalcı K., AYDOĞAN B.

Çukurova Anestezi ve Cerrahi Bilimler Dergisi, cilt.9, sa.1, ss.209-213, 2026 (TRDizin)

Özet

Aim: There are conflicting data in the literature regarding the prognosis and aggressiveness of papillary thyroid carcinoma arising in the background of Graves disease. This study aimed to compare the histopathologic features of incidentally discovered classic variant papillary thyroid carcinomas in Graves disease and multinodular goiter backgrounds using propensity score matching. Methods: Patients who underwent total thyroidectomy for benign indications and were found to have classic var- iant papillary thyroid carcinoma on histopathologic examination at Çukurova University Balcalı Hospital between 2015 and 2025 were retrospectively evaluated. Graves disease diagnosis was established based on the criteria of at least 2 years of antithyroid drug use, TSH receptor antibody positivity, and presence of clinical/radiologic oph- thalmopathy. Groups were balanced by propensity score matching at a 1:3 ratio for age and sex. Histopathologic aggressiveness parameters were compared using non-parametric tests. Results: A total of 44 patients with incidentally discovered classic variant papillary thyroid carcinoma following thyroidectomy for benign indications were categorized into Graves disease (n=11) and multinodular goiter (n=33) groups.After matching, standardized mean difference of <0.10 was achieved for all covariates. Median tumor size was significantly smaller in the Graves disease group compared to the multinodular goiter group (6.0 mm vs 10.0 mm, p=0.007). While lymphatic invasion was not detected in any patient in the Graves disease group, it was observed at a rate of 33.3% in the multinodular goiter group (p=0.041). Extrathyroidal extension, perineural inva- sion, and vascular invasion rates were found to be lower in the Graves disease group. No recurrence was observed in any patient during a median 44-month follow-up. Conclusions: Classic variant papillary thyroid carcinomas arising in the background of Graves disease demon- strate smaller size and less invasive features compared to those arising in multinodular goiter background. These findings suggest that the autoimmune microenvironment in Graves disease may have a potential protective effect on tumor invasiveness.