High rate of cancer in Hashimoto's thyroiditis

 Hashimoto's thyroiditis is usually treated conservatively by monitoring and administration of thyroxine  when hypothyroidism occurs. Surgery may be performed when nodules develop or when the inflammation causes pressure symptoms, but this is uncommon as it has been considered that thyroidectomy in the presence of Hashimoto's thyroiditis  is more dangerous with a higher complication rate due to the inflammation and scarring. In a recent paper from  Dr Quan Duh's unit in San Francisco (see link to abstract), a series of 474 patients undergoing surgery for Hashimoto's thyroiditis were studied. Most of these patients required surgery for what were thought to be benign nodules or for pressure symptoms with only 133 having a pre-operative diagnosis of cancer. Despite the technical difficulties of surgery, there was a very low complication rate with bleeding in only 0.8% (4 patients) and  temporary damage to the recurrent laryngeal nerve in only 0.4% (2 patients). No permanent complications occurred in the series. Surprisingly the final pathology reported thyroid cancer in the more than half of the patients (53%). The authors conclude that cancer is common in patients who have a thyroidectomy for Hashimoto's thyroiditis even when not suspected pre-operatively. Concerns about surgery being more complicated and therefore avoided are not supported by the published outcomes when performed in a high volume centre.