THE SIMULTANEOUS OCCURRENCE OF TUMORS IN THE THYROID, UTERUS AND BREAST

THE SIMULTANEOUS OCCURRENCE OF TUMORS IN THE THYROID, UTERUS AND BREAST

MAX BALLIN, M.D. AND R. C. MOEHLIG, M.D.

DETROIT

article source: Journal of the American Medical Association, 1922


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Every surgeon who operates upon goiters must have noticed the frequent occurrence of tumors in the thyroid, uterus and breast. Apparently there has been very little written on the subject, however, for we could find only two references in the literature. Falta's 1 "Ductless Glandular Diseases" contains this note:

"There seems to exist a certain relationship between goiter and myomata of the uterus. At least it has been observed that in strumous women who also suffer from myomata the struma also decreases in size with the retrogression of the myoma at the menopause."

Falta's note is quoted from an article by Ullman 2  of Vienna. This article reads:

 thyroid gland

It has been known for a long time that a relationship exists between the uterus and the normal thyroid gland. The nature of this relationship is, of course, enshrouded in darkness; we only know that in a not infrequent number of women a transitory enlargement of the thyroid gland takes place at the time of menstruation. After the cessation of menstruation, the thyroid returns to normal. ... In many women during pregnancy an enlargement of the thyroid takes place, which still exists after childbirth. ... A third fact which concerns the question of the relationship between uterus and thyroid is that as to whether strumas develop more frequently in females then in males. ... I wish to emphasize that in women affected with myomas I was able to show a distinct enlargement of the thyroid gland, an enlargement that could be spoken of partly as struma parenchymatosa, partly as the result of degeneration, as colloid struma. ... I was then able to determine that these strumas following complete myomectomy became decidedly smaller; in many cases they disappeared entirely.

1. Falta, Wilhelm: Ductless Glandular Diseases, Philadelphia, P. Blakiston's Son & Co., 1916, p. 156.

2. Ullman. Emmerich: Ueher Uterusmyom and Kropf, Wicn. ktin. Wchnschr. 23: 58S, 1910.

In looking over our own records, we find that of the last 100 female patients who consulted us for goiter, eighteen had fibroids;  four of them also had breast tumors; and of the last 100 patients who consulted us for fibroids, thirty-five had goiter; six had breast tumors. Thus, of the total 200 patients, fifty-three, or 26.5 per cent., had tumors of both thyroid and uterus. Ten of these 200 patients required operations on both the thyroid and the uterus. This large number of multiple lesions is obviously much more than a coincidence; yet, as noted above, very little mention of it has been made.

The matter therefore seemed important enough to call attention to again. Three points suggest themselves:

(a) It is possible, as suggested by Ullman, that certain goiters might be reduced in size or even cured by removal of a fibroid.

(b) Thyroid extract and iodin might be beneficial in preventing the development of fibroids as well as of goiters.

(c) These relationships might have some bearing on the etiology of these tumor groups.

fibrocystic breast tissue

In the eighteen goiters found in the examination of 100 fibroids, fourteen were adenomas of the thyroid, three were colloid goiters, and one was an exophthalmic goiter. Of the four breast tumors which accompanied goiters, an adenofibroma with cyst-areas accompanied an adenomatous goiter; an adenoma of the left breast accompanied an adenomatous goiter; an intracanalicular adenofibroma in the right breast, and a similar tumor with hyaline changes in the left breast accompanied a colloid adenomatous goiter. Another goiter which is not tabulated showed virginal hypertrophy of the right breast. Of the six breast tumors which accompanied fibroids, three were interstitial mastitis; one was a fibro-adenoma; one was a carcinoma of the left breast and fibro-adenoma of the right breast, and one was a cystadenoma.

uterine fibroids

Of the fifty-three patients with the combination of goiter and fibroid, the youngest was 25 years old, this patient being the only one below 30. Fully two thirds were over 35. We may say, therefore, that the incidence mounts with age, the simultaneous occurrence of goiter and fibroid being most prevalent in the latter half of the third decade and during the fourth decade. Of the 100 goiter patients, twenty-one were under the age of 25. There were no fibroids among these patients, so that the percentage of eighteen fibroids is borne by seventy-nine patients more than 25 years of age. In other words, the fibroid-goiter combination shows its entire incidence after 25 years of age, and increases rapidly after 35 years.

The simultaneous occurrence of goiters, fibroids and breast tumors is more frequent than is usually supposed. The thyroid, breast and uterus have different anatomic structures and are different in their embryologic origins, but we note that the function of the thyroid is closely related to, and influences the function of the sexual organs. The interrelationship of uterus and breast is obvious. Since these organs are related to each other only by function, it must be that physiologic interdependence is a factor in the tumor formation.

normal breast tissue

When sexual function ceases or begins to wane, usually the time arises for the growth of all these

tumors. The symptoms of fibroids usually become more alarming toward the end of the reproductive period. The adenomatous goiter, in the great majority of cases, does not give much discomfort until the menopause. Then pressure and toxic symptoms arise. Small tumors in the breast have often existed from the age of 20 to the age of 40 without giving any symptoms, or without having been noticed at all; still, their long-standing existence usually is clear when their presence becomes obvious through growth or discomfort. Because of the aforementioned functional (physiologic) relationship which exists between thyroid, uterus and breast, we may be able to understand why growth or irritation in one of these organs may induce growth or irritation in another. For instance, when a small fibroid which has existed innocently for many years suddenly begins to grow, it may induce growth or irritation in the thyroid or breast (and vice versa).


CONCLUSIONS:


1. In a series of 200 cases (100 fibroids and 100 goiters), fifty-three patients, or 26.5 per cent., had both goiter and fibroid. Five per cent, had breast tumors.

2. The age of incidence of these combinations was greatest after 35.

3. Since these three organs are not related anatomically or embryologically, the simultaneous occurrence of tumors in the thyroid, uterus and breast may be explained by their physiologic interrelationship.

4. The prophylactic treatment now advocated, of giving iodids for goiter, may likewise prove beneficial in the prevention of fibroid.

5. Perhaps certain goiters can be reduced in size or even cured by the removal of a fibroid (as suggested by Ullman).

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