الفهرس 
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Abstract
The present study was carried out from December 2016 to April 2018. The subjects were collected from Minia oncology centre. The laboratory investigations of this study were carried out in the clinical pathology department of Minia University Hospital while the pathological examination of the specimens was carried by the pathology department of Minia oncology center.
The study included 70 consecutive patients with breast cancer at Minia oncology center and 50 apparently healthy females as a control.
The study aimed to:
1-To determine if there is a link between thyroid autoimmunity and breast cancer.
2-To determine the type of thyroid disorder if present between cases of breast cancer.
3-To compare the percentage of thyroid disorder if present between cases and control groups.
4-To determine the percentage of thyroid receptor alpha in the three groups of breast cancer patients.
5-To determine if there is a link between the presence of thyroid receptor alpha and thyroid autoimmunity.
Subjects and methods:
The study populations included four groups. group 1, included 30 patients with invasive duct carcinoma. group 2, included 25 patients with invasive lobular carcinoma. group 3, included 15 patients with carcinoma in situ (CIS) classified as low, moderate and high grade (three, five and seven cases, respectively). And finally group 4, included 50 apparently healthy females as a control.
Exclusion criteria:
Patients with proven breast metastasis, Patients less than 30 or more than 70 years old, patients with known thyroid disease and finally, Patients on adjuvant chemo or radiotherapy.
All patients were subjected to the followings:
History taking, Clinical examination (general examination, thyroid gland Examination, mammary gland examination). In addition, laboratory investigations include Complete blood count, Random blood sugar, Blood urea and serum creatinine. Liver functions tests including, AST, ALT, Serum albumin, total and direct bilirubin, Lipid profile including serum triglycerides, LDL and HDL. Hepatitis c antibody titer. Also, Thyroid function tests including free T3, free T4, and TSH assay. Antiperoxidase antibody and antithyroglobulin antibody titer. Assessment of thyroid receptor alpha antibody expression was done using Anti-THRA polyclonal antibody. Radiological investigations achieved to all subjects included: Thyroid ultrasonography, Breast ultrasonography, Breast mammography, Metastatic workup as plain x ray chest, spine and pelvis, abdominal us, CT chest, abdomen, MRI bone and spine were performed to exclude systemic metastasis. And finally, ECG was done for all participants.
Statistical analyses:
All of the analyses were performed with version 13 of Statistical Package of Social Science (SPSS).
Results:
In our study, we established that, the most dependent factors predicting breast cancer development are using hormonal contraception, locational status, parity and the age of menarche.
Regarding the thyroid functions, fT3, fT4, TSH, anti TPO and Anti-TG titers we found that, TSH level was higher in breast cancer cases compared to control, while the free T3 and free T4 levels were lower in breast cancer cases than control. As regard the TPO antibody titer, it was positive in 24.3% of breast cancer cases and 2% of the control. And the Anti-TG titer was positive in 18.6% of cases, and 2% of the control.
Also, we found that, Thyroid hormone receptor alpha expression was positive in ten patients of CIS (26.3%), sixteen patients of invasive duct carcinoma (42.1%) and twelve patients of invasive lobular carcinoma (31.6%).
Finally, we found that, TRA was positive in six cases with hypothyroidism (15.8%) and negative in the remaining one case (3.1%). TRA was positive in eleven patients with positive anti-TG autoantibody titer (28.9%), and negative in the remaining two cases (6.2%). TRA was positive in fifteen patients with positive anti-TPO autoantibody (39.5%), and negative in the remaining two cases (6.2%). There was a statistical significance as regard the relation between TRA expression and anti-TG autoantibody, (p value 0.028) also between TRA expression and anti-TPO autoantibody, (p value 0.002).
Conclusions:
The present study supports the association between thyroid autoimmunity and breast cancer.
The study detected that autoimmune hypothyroidism was present in seven of the breast cancers cases (10.0%) compared to zero in the control (0.0%).
The study noticed that, Thyroid hormone receptor alpha expression was higher in invasive breast cancers compared to the non-invasive types. It was positive in ten patients of CIS (26.3%), sixteen patients of invasive duct carcinoma (42.1%) and twelve patients of invasive lobular carcinoma (31.6%).
Our study showed that using hormonal contraception, lactation, No. of offspring and age of menarche are the most dependent factors predicting breast cancer.