背景：基于人群的研究检查了甲状腺功能亢进症与癌症风险之间的关联，但得出了不一致的结果。目前尚不清楚接受抗甲状腺药物（ATD）作为初始治疗的格雷夫斯病（GD）患者患不同癌症的风险是否会增加。我们的目的是确定与对照组相比，GD 患者的癌症风险是否增加。方法：这项全国性回顾性队列研究利用了韩国国家健康信息数据库的数据。我们纳入了 29,502 名年龄 >20 岁的 GD 患者，他们接受 ATD 作为初始治疗，以及 57,173 名年龄和性别匹配的对照者。主要结果是各种癌症的发病率。使用 Cox 比例风险模型估计癌症风险的风险比 (HR) 和置信区间 (CI)。我们还根据 GD 诊断后的随访期分析 HR，说明监测效果。结果：胆道癌和胰腺癌（HR：1.41，CI：1.24-1.60）、甲状腺癌（HR：15.51，CI：12.29-19.57）、前列腺癌（HR：1.48，CI：1.28-1.71）、即使排除第一年的随访，GD 组的卵巢癌（HR：1.31，CI：1.13-1.52）仍高于对照组。经过 5 年多的随访后，这些癌症的风险持续增加。与超过2年的随访期相比，GD患者在初始随访期（1至<2年）期间患甲状腺癌的风险较高（HR：19.35，CI：7.66-48.87）。排除随后接受放射性碘治疗的 GD 患者后，癌症风险估计值仍然显着。结论：在这项大规模人群研究中，GD 与胆道癌、胰腺癌、前列腺癌、卵巢癌和甲状腺癌的风险增加相关。甲状腺癌的风险增加，特别是在最初的随访期间，可能是一种监测效应。

Background: Population-based studies that examine the associations between hyperthyroidism and cancer risk have yielded inconsistent results. It remains unclear whether the risks of different cancers increase in patients with Graves' disease (GD) who received antithyroid drugs (ATDs) as initial treatment. We aimed to determine whether cancer risk increases in patients with GD, compared with controls. Methods: This nationwide retrospective cohort study utilized data from the National Health Information Database of South Korea. We included 29,502 patients aged >20 years with GD, who received ATDs as initial treatment, and 57,173 age- and sex-matched controls. The primary outcome was the incidence of various types of cancers. Hazard ratios (HRs) with confidence intervals (CIs) for cancer risk were estimated using Cox proportional hazards models. We also analyzed HR by follow-up period since the diagnosis of GD, accounting for surveillance effect. Results: The risk of biliary tract and pancreatic cancers (HR: 1.41, CI: 1.24-1.60), thyroid cancer (HR: 15.51, CI: 12.29-19.57), prostate cancer (HR: 1.48, CI: 1.28-1.71), and ovarian cancer (HR: 1.31, CI: 1.13-1.52) was elevated in the GD group than in the control group even after the first year of follow-up was excluded. The increased risk of these cancers persisted after a follow-up period of more than 5 years. The risk of thyroid cancer in patients with GD was higher during the initial follow-up period (1 to <2 years) (HR: 19.35, CI: 7.66-48.87) compared with that in the follow-up period exceeding 2 years. The cancer risk estimates remained significant after excluding patients with GD who underwent subsequent radioactive iodine therapy. Conclusion: In this large-scale population-based study, GD was associated with increased risks of biliary tract and pancreatic, prostate, ovarian, and thyroid cancers. The increased risk of thyroid cancer, particularly during the initial follow-up period, may be a surveillance effect.