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, I-12(3) 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. (C) 2018 Elsevier Inc. All rights reserved.