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Peer-reviewedCC BYArchives of endocrinology and metabolism

Association of thyroid peroxidase antibodies with thyroid nodules and differentiated thyroid cancer in Graves' disease: a retrospective cohort study.

  • Elif Güneş1
  • Mutlu Güneş2
  • Muhammet İlker Kaya3
  • Murat Yüksel3
  • Sümeyye Meinet3
  • Beyza Kibar4
  • Nizameddin Koca4
  • Gökhan Garip5
  • Behiye Oral6
6 affiliations
  1. 1Department of Endocrinology, Metabolism and Diabetes, Health Sciences University, Bursa State Hospital, Bursa, Turkey.
  2. 2Department of Endocrinology, Metabolism and Diabetes, Health Sciences University, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
  3. 3Department of Internal Medicine, Health Sciences University, Bursa State Hospital, Bursa, Turkey.
  4. 4Bursa State Hospital Health Sciences University Department of Internal Medicine Bursa Turkey Department of Internal Medicine, Health Sciences University, Bursa State Hospital, Bursa, Turkey.
  5. 5Bursa State Hospital Department of General Surgery Bursa Turkey Department of General Surgery, Bursa State Hospital, Bursa, Turkey.
  6. 6Bursa State Hospital Department of Radiology Bursa Turkey Department of Radiology, Bursa State Hospital, Bursa, Turkey.
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Abstract

Objective

In Graves' disease (GD), thyroid nodules are the principal determinant of differentiated thyroidcaneer(DTC); however, the predictors of nodules and DTC remain uncertain. The role of thyroid peroxidase antibodies (TPOAb) in this context is controversial. Hence, this study aimed to determine whether TPOAb status is associated with thyroid nodules and DTC in GD and to compare the prevalence of DTC across subtypes of hyperthyroid disease.Subjects and methods

We conducted a retrospective cohort study (September 2020-July 2023) including patients with GD (n = 577) and toxic nodular/multinodular goiter (TNG/ TMNG) (n = 216) who had available TPOAb measurements and thyroid ultrasonography. Within the GD cohort, multivariable logistic regression was used to assess associations of TPOAb titer with nodules and DTC.Results

TPOAb positivity was more frequent in GD than in TNG/TMNG (60.4% vs. 7.4%, p < 0.001). Among GD patients, thyroid nodules were detected in 25.8% and were less frequent in TPOAb-positive patients compared with TPOAb-negative patients (8.3% vs. 52.6%, p < 0.001). Within GD, DTC was rare among those without nodular disease (0.93%) but substantially higher in nodular GD (14.1%, p < 0.001), exceeding the prevalence observed in TNG/TMNG (p = 0.009). TPOAb status further stratified DTC risk in GD: DTC was present in 1.15% of TPOAb-positive compared to 9.21% of TPOAb-negative patients (p < 0.001), with 84% of GD-associated DTCs arising in the TPOAb-negative subgroup. Regression analyses showed that TPOAb titer was independently associated with lower frequencies of both DTC and nodules in GD, whereas thyrotropin receptor antibodies levels showed no independent association.Conclusion

In GD, our study showed that TPOAb positivity was strongly associated with lower prevalence of thyroid nodules and DTC, whereas TPOAb-negative patients constitute a clinically relevant, higher-risk subgroup.

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Cite

BibTeXRIS
BibTeX
@article{gunes2026association,
  title = {{Association of thyroid peroxidase antibodies with thyroid nodules and differentiated thyroid cancer in Graves' disease: a retrospective cohort study.}},
  author = {Elif Güneş and Mutlu Güneş and Muhammet İlker Kaya and Murat Yüksel and Sümeyye Meinet and Beyza Kibar and Nizameddin Koca and Gökhan Garip and Behiye Oral},
  journal = {Archives of endocrinology and metabolism},
  year = {2026},
  month = oct,
  doi = {10.20945/2359-4292-2026-0123},
  url = {https://europepmc.org/article/MED/42905598},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Association of thyroid peroxidase antibodies with thyroid nodules and differentiated thyroid cancer in Graves' disease: a retrospective cohort study.
AU  - Elif Güneş
AU  - Mutlu Güneş
AU  - Muhammet İlker Kaya
AU  - Murat Yüksel
AU  - Sümeyye Meinet
AU  - Beyza Kibar
AU  - Nizameddin Koca
AU  - Gökhan Garip
AU  - Behiye Oral
PY  - 2026
DA  - 2026/10/20
JO  - Archives of endocrinology and metabolism
DO  - 10.20945/2359-4292-2026-0123
UR  - https://europepmc.org/article/MED/42905598
AB  - Objective  In Graves' disease (GD), thyroid nodules are the principal determinant of differentiated thyroidcaneer(DTC); however, the predictors of nodules and DTC remain uncertain. The role of thyroid peroxidase antibodies (TPOAb) in this context is controversial. Hence, this study aimed to determine whether TPOAb status is associated with thyroid nodules and DTC in GD and to compare the prevalence of DTC across subtypes of hyperthyroid disease.Subjects and methods  We conducted a retrospective cohort study (September 2020-July 2023) including patients with GD (n = 577) and toxic nodular/multinodular goiter (TNG/ TMNG) (n = 216) who had available TPOAb measurements and thyroid ultrasonography. Within the GD cohort, multivariable logistic regression was used to assess associations of TPOAb titer with nodules and DTC.Results  TPOAb positivity was more frequent in GD than in TNG/TMNG (60.4% vs. 7.4%, p < 0.001). Among GD patients, thyroid nodules were detected in 25.8% and were less frequent in TPOAb-positive patients compared with TPOAb-negative patients (8.3% vs. 52.6%, p < 0.001). Within GD, DTC was rare among those without nodular disease (0.93%) but substantially higher in nodular GD (14.1%, p < 0.001), exceeding the prevalence observed in TNG/TMNG (p = 0.009). TPOAb status further stratified DTC risk in GD: DTC was present in 1.15% of TPOAb-positive compared to 9.21% of TPOAb-negative patients (p < 0.001), with 84% of GD-associated DTCs arising in the TPOAb-negative subgroup. Regression analyses showed that TPOAb titer was independently associated with lower frequencies of both DTC and nodules in GD, whereas thyrotropin receptor antibodies levels showed no independent association.Conclusion  In GD, our study showed that TPOAb positivity was strongly associated with lower prevalence of thyroid nodules and DTC, whereas TPOAb-negative patients constitute a clinically relevant, higher-risk subgroup.
SN  - 2359-3997
SN  - 2359-4292
ER  -