Graves' Disease (GD) is the leading cause of hyperthyroidism worldwide. Although pharmacological therapy is effective in controlling symptoms, total thyroidectomy remains a first-line option in severe and refractory cases. The association between GD and Papillary Thyroid Carcinoma (PTC) is debated, raising questions about preoperative patient management and the accuracy of predicting carcinoma before thyroidectomy. This study aims to investigate the incidence and risk factors associated with the development of PTC in patients with GD undergoing total thyroidectomy.

Retrospective longitudinal observational and analytical study, which included 66 patients with GD, undergoing total thyroidectomy at the Hospital de Braga, between 2010-2022. Sociodemographic characteristics, personal and family health history, clinical findings, and reason for thyroidectomy, as well as laboratory and imaging results were evaluated. A descriptive and comparative analysis was performed using SPSS®, with significance set at p ≤ 0.05.

Of the 66 patients studied, 52 (78.8%) were female and 14 (21.2%) were male. Thyroid cancer was confirmed in 17 (25.8%), of which 14 were papillary carcinomas (82.4%) and 3 were benign neoplasms (17.6%). It was concluded that the incidence of PTC in this study was 21.2%. The variables 'BMI' (p = 0.039), "smoking" (p=0.046) 'palpable nodules' (p = 0.025), 'lymphadenopathy' (p= 0.008), and 'suspicious nodules' (p = 0.006) showed significant differences between patients with and without PTC.

Specific risk factors were identified that can serve as potential predictors of carcinoma presence pre-surgery. Early detection of these factors is crucial in risk stratification and preoperative planning, enabling a tailored approach for each patient.