THE SIMULTANEOUS OCCURRENCE OF TUMORS IN THE THYROID, UTERUS AND BREAST
MAX BALLIN, M.D. AND R. C. MOEHLIG, M.D.
article source: Journal of the American Medical Association, 1922
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:
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|
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|
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).
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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