Sarcouncil Journal of Internal Medicine and Public Health

Abstract: Background: Papillary thyroid carcinoma (PTC) diagnosed in the context of Graves' disease has been described as having more aggressive histopathological features than PTC in euthyroid nodular goiter, although the tumor is usually smaller at diagnosis. Data across cohorts are still heterogeneous, and very little work has been done to quantify the independent contribution of Graves' disease to nodal metastasis formally. In this study, the clinical presentation, histopathological features, and predictors of lymph node metastasis of PTC were compared among the patients with Graves' disease and patients with euthyroid nodular goiter. Methods: A retrospective analysis of 87 cases from Iraq with different hospitals at 2025 to April 2026 of histologically confirmed PTC after thyroidectomy was performed after the patients were grouped into two categories: Graves' disease (n = 29) and euthyroid nodular goiter (n = 58). Independent-samples t-tests or Mann–Whitney U tests were used to compare demographic, biochemical, and sonographic parameters as continuous variables, and chi-square and Fisher's exact tests were used as categorical variables, as appropriate. To determine the independent predictors of cervical lymph node metastasis, multivariate binary logistic regression was performed, and Pearson correlation coefficients were computed for the important continuous variables. Results: Patients with Graves' disease were significantly younger (41.2 ± 11.4 vs. 48.6 ± 13.1 years, p = 0.012) and harbored smaller tumors (0.9 ± 0.5 vs. 1.6 ± 0.8 cm, p < 0.001) than the euthyroid goiter group. Graves' disease was an independent risk factor for lymph node metastasis on multivariate logistic regression analysis (adjusted OR 3.10, 95% CI 1.15–8.35, p = 0.025) along with extrathyroidal extension (p = 0.005) and multifocality (p = 0.028). The number of positive lymph nodes (r = −0.34, p = 0.001) and multifocality (r = −0.29, p = 0.007) were negatively correlated with preoperative TSH. Conclusion: The clinico-pathological pattern of PTC developing in Graves' disease is different from that in non-Graves' origin, with smaller tumour size, but higher frequency of multifocality, bilaterality and nodal metastasis. The findings should not imply that the status of Graves' disease itself is a reassuring factor and should not be considered as a sole criterion for surgical planning but should instead be viewed as an independent risk factor for a more comprehensive preoperative assessment and individual surgical planning.