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Thyroid Risk Factors For Breast Cancer

J Clin Endocrinol Metab. 1996 Mar;81(3):990-4.

Relationship between breast cancer and thyroid disease: relevance of autoimmune thyroid disorders in breast malignancy.
Giani C, Fierabracci P, Bonacci R, Gigliotti A, Campani D, De Negri F, Cecchetti D, Martino E, Pinchera A.
SourceInstitute of Endocrinology, University of Pisa, Italy.


The relationship between thyroid dysfunction and breast cancer (BC) is debated. To clarify this controversial issue, a prospective study on thyroid function in BC was performed.

The prevalence of thyroid disease was examined in 102 consecutive BC patients with ductal infiltrating carcinoma after surgery and before starting any chemohormonal or x-ray therapy and in 100 age-matched control healthy women living in the same borderline iodine-sufficient geographic area. All subjects were submitted to clinical ultrasound thyroid evaluation and serum free T4, free T3, TSH, thyroperoxidase antibody, and thyroglobulin antibody determination. Fine needle aspiration was performed in all thyroid nodules. Estrogen and progesterone receptors (ER and PR, respectively) were assayed in 92 and 55 BC specimens, respectively.

The overall prevalence of thyroid disease was 47 in 102 (46%) in BC patients and 14 in 100 (14%) in controls (P < 0.0001). The prevalence of nontoxic goiter was 27.4% in BC patients and 11% in controls (P = 0.003). Hashimoto's thyroiditis was found in 13.7% of BC patients and in only 2% of the controls (P < 0.005).

Other thyroid disorders found in the BC group included 2 cases of Graves' disease, 2 of thyroid carcinoma, and 1 of subacute thyroiditis, whereas in the control group only 1 case of Graves' disease and none of the other disorders were found. Mean free T3, free T4, and TSH concentrations showed no difference between BC patients and controls.

The prevalence of thyroperoxidase antibody was higher in BC patients than in controls (23.5% vs. 8%; P < 0.005), whereas the prevalence of thyroglobulin antibody was not different. In BC patients the presence of thyroid antibodies was more frequently associated with clinically detectable autoimmune thyroiditis (14 of 26, 51.8%; P = 0.03) and was more common in the younger group. The positivity of ER was found in 51 of 92 (55.43%) and that of PR was found in 26 of 55 (47.27%) BC specimens. No relationship was found among ER, PR status, and the presence of serum thyroid antibodies.

In conclusion, 1) the present study provides evidence that the overall prevalence of thyroid disorders is increased in patients with breast cancer, and 2) thyroid autoimmune disorders, especially Hashimoto's thyroiditis, account to a large extent for the increased prevalence of thyroid disease in patients with breast cancer. This feature is independent from the ER and PR status of the primary tumor.

The present findings call attention to the usefulness of screening for thyroid disease in any patient with breast cancer.

Clinical Studies

Thyroid autoimmunity in patients with malignant and benign breast diseases before surgery
E Giustarini,A Pinchera,P Fierabracci,M Roncella1,L Fustaino1,C Mammoli1 and C Giani

Exderp from website of:
Europen journal of endoctronology

Various authors have focused attention on the relationship between BC and thyroid disorders. In particular, a strong relationship between breast malignancy and thyroid autoimmune disorders has been found by Giani et al. and confirmed by Smyth et al. All these studies have been carried out in BC patients after mastectomy and before beginning any chemo-hormonal adjuvant therapy.

Probably the onset and course of Hashimoto’s thyroiditis are generally insidious and the patient does not become symptomatic until the development of hypothyroidism or goitre. This makes it difficult to evaluate the role of stress in the onset and/or course of these diseases.

In our study we confirmed the high prevalence of autoimmune thyroid diseases in BC.

In general, signs of thyroid autoimmunity, including diffuse hypoechogenicity of the thyroid gland associated or not with the presence of circulant antithyroid antibodies, were detected in the majority of BC patients at significantly higher levels than those detected in BBD patients.

The results of this study confirm a strong relationship between thyroid autoimmunity and BC. For the first time we have demonstrated that this relationship is also present before surgery and any anti-tumoural treatment. In addition, we have demonstrated a high incidence of thyroid autoimmune disorders in BBD, but at less significant values with respect to breast malignancies.

In conclusion, we confirm that all patients with breast pathology should be evaluated for thyroid autoimmune disorders, possibly to detect BC patients with hypothyroidism who need substitutive treatment before surgical treatment.

PMID:8772562[PubMed - indexed for MEDLINE]