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Ghirri A, Campopiano MC, Prete A, Matrone A, Gambale C, Piaggi P, Rago T, Scutari M, Elisei R, Molinaro E. Effect of Pregnancy and Menopause on Micropapillary Thyroid Carcinomas During Active Surveillance. J Endocr Soc 2023; 7:bvad109. [PMID: 37873501 PMCID: PMC10590641 DOI: 10.1210/jendso/bvad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Indexed: 10/25/2023] Open
Abstract
Background The effect of estrogen and beta-human chorionic gonadotropin on micropapillary thyroid carcinoma (mPTC) is not defined. Pregnancy and menopause could represent critical moments during active surveillance (AS) for women with mPTC. Objective To evaluate the effect of either pregnancy or menopause on growth of mPTCs on AS. Patients and Methods Women with mPTC on AS who became pregnant or underwent menopause during AS were evaluated in this retrospective observational study. The primary outcome was disease progression according to the AS protocol. The secondary outcome was the shrinkage of mPTCs. We compared the menopause group of patients with 2 unmatched control groups: (1) the pre-menopause group of patients on AS who had not experienced menopause yet and (2) the post-menopause group of patients who started AS while already in menopause. Results Five patients who became pregnant and 9 who underwent menopause during AS were enrolled. No patient from either group had a disease progression, and all pregnant patients showed stable disease after pregnancy. Four patients of the menopause group (44%) experienced mPTC shrinkage. The percentage of patients with mPTC shrinkage was significantly higher in the menopause group than in the 2 control groups. Conclusions mPTC AS appears to be safe and feasible in patients who become pregnant or undergo menopause during surveillance. Our data suggest a possible association between menopause and mPTC shrinkage during AS.
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Affiliation(s)
- Arianna Ghirri
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa 56124, Italy
| | - Maria Cristina Campopiano
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa 56124, Italy
| | - Alessandro Prete
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa 56124, Italy
| | - Antonio Matrone
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa 56124, Italy
| | - Carla Gambale
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa 56124, Italy
| | - Paolo Piaggi
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa 56124, Italy
| | - Teresa Rago
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa 56124, Italy
| | - Maria Scutari
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa 56124, Italy
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa 56124, Italy
| | - Eleonora Molinaro
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa 56124, Italy
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Gobbo A, Gagliardi I, Gobbo A, Rossi R, Franceschetti P, Lupo S, Rossi M, Bondanelli M, Ambrosio MR, Zatelli MC. Glucose Metabolism Derangements and Thyroid Nodules: Does Sex Matter? J Pers Med 2022; 12:jpm12060903. [PMID: 35743689 PMCID: PMC9225610 DOI: 10.3390/jpm12060903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/17/2022] [Accepted: 05/28/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: Glucose metabolism derangements (GMD) and thyroid nodules (TNs) are the most frequent endocrine disorders, and their relationship is still controversial; little evidence is reported regarding sex differences. We aim to evaluate the association between GMDs and TNs according to sex and the sex differences in glucose metabolism and insulin sensitivity (IS). (2) Methods: We evaluated 342 patients (268 females and 74 males) at high GMD risk undergoing an oral glucose tolerance test and a thyroid ultrasound. (3) Results: The TN prevalence was 61% (n = 210), with no significant differences according to sex and GMD classes. The TN presence is significantly associated with age and impaired fasting glucose (IFG) in females. Males and females with normal fasting glucose (NFG) had a significantly lower OR of having TNs than females with IFG. IFG females had a significantly higher predicted probability of having TNs than NFG males and females but not IFG males. Impaired glucose tolerance/Type 2 diabetes mellitus (IGT/T2DM) is significantly associated with age and male sex, while IFG is associated with age. Females had significantly lower HOMA-index values than males. (4) Conclusions: No significant association between IGT/T2DM and TNs according to sex was found. IFG seems to play a role in TN development independently of sex. Further studies are needed to explore the relationship between TNs and GMD to identify subgroups with a higher TN risk.
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Affiliation(s)
- Alberto Gobbo
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, 44100 Ferrrara, Italy; (A.G.); (I.G.); (M.B.); (M.R.A.)
| | - Irene Gagliardi
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, 44100 Ferrrara, Italy; (A.G.); (I.G.); (M.B.); (M.R.A.)
| | - Andrea Gobbo
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy;
- Department of Urology, IRCCS Humanitas Research Hospital, 20090 Milan, Italy
| | - Roberta Rossi
- Endocrine Unit, Department of Oncology & Specialty Medicines, Azienda Ospedaliero Universitaria, 44100 Ferrara, Italy; (R.R.); (P.F.); (S.L.); (M.R.)
| | - Paola Franceschetti
- Endocrine Unit, Department of Oncology & Specialty Medicines, Azienda Ospedaliero Universitaria, 44100 Ferrara, Italy; (R.R.); (P.F.); (S.L.); (M.R.)
| | - Sabrina Lupo
- Endocrine Unit, Department of Oncology & Specialty Medicines, Azienda Ospedaliero Universitaria, 44100 Ferrara, Italy; (R.R.); (P.F.); (S.L.); (M.R.)
| | - Martina Rossi
- Endocrine Unit, Department of Oncology & Specialty Medicines, Azienda Ospedaliero Universitaria, 44100 Ferrara, Italy; (R.R.); (P.F.); (S.L.); (M.R.)
| | - Marta Bondanelli
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, 44100 Ferrrara, Italy; (A.G.); (I.G.); (M.B.); (M.R.A.)
- Endocrine Unit, Department of Oncology & Specialty Medicines, Azienda Ospedaliero Universitaria, 44100 Ferrara, Italy; (R.R.); (P.F.); (S.L.); (M.R.)
| | - Maria Rosaria Ambrosio
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, 44100 Ferrrara, Italy; (A.G.); (I.G.); (M.B.); (M.R.A.)
- Endocrine Unit, Department of Oncology & Specialty Medicines, Azienda Ospedaliero Universitaria, 44100 Ferrara, Italy; (R.R.); (P.F.); (S.L.); (M.R.)
| | - Maria Chiara Zatelli
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, 44100 Ferrrara, Italy; (A.G.); (I.G.); (M.B.); (M.R.A.)
- Endocrine Unit, Department of Oncology & Specialty Medicines, Azienda Ospedaliero Universitaria, 44100 Ferrara, Italy; (R.R.); (P.F.); (S.L.); (M.R.)
- Correspondence:
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Uterine fibroids increase the risk of thyroid goiter and thyroid nodules. Sci Rep 2022; 12:6620. [PMID: 35459918 PMCID: PMC9033769 DOI: 10.1038/s41598-022-10625-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/11/2022] [Indexed: 12/26/2022] Open
Abstract
Uterine fibroid and benign thyroid disease are both common diseases in women. This study aimed to evaluate whether these diseases are related. We established the uterine fibroid group according to diagnosis and surgery codes using the Korea National Health Insurance data from 2009 to 2020. All women from 20 to 50 years old who underwent uterine myomectomy from 2009 to 2020 were identified. We selected the control group by performing a 1:1 propensity score matching on age at 5-year intervals, socioeconomic status (SES), region, Charlson comorbidity index (CCI), menopause, and year among women who visited a medical institution for a health check-up. Thyroid disease cases were selected using the thyroid disease diagnosis code and thyroid-associated laboratory tests. A total of 181,419 patients were included in the uterine fibroid and control groups. The median age of each group was 40 (range, 35 ~ 44) and 40 (range, 35 ~ 45) years old, respectively. Benign thyroid disease affected 1162 (0.6%) in the uterine fibroid group and 1137 (0.6%) in the control group. Among the benign thyroid diseases, hypothyroidism was the most common in both groups, followed by a nontoxic single thyroid nodule. The uterine fibroid group had a higher risk of thyroid goiter (hazard ratio (HR) 1.169, 95% confidence interval (CI) 1.022–1.338), nontoxic single thyroid nodule (HR 1.268, 95% CI 1.182–1.361), and total thyroid disease (HR 1.078, 95% CI 1.036–1.121) in stratified Cox regression analysis adjusted for age, SES, region, CCI, parity, menopause, hypertension, diabetes, dyslipidemia, systemic lupus erythematosus, irritable bowel syndrome, Crohn’s disease, and endometriosis than the control group. The results suggest that women with uterine fibroids have an increased risk of thyroid goiters and thyroid nodules. Although the mechanism is not well known, estrogen and iodide might be a link between uterine fibroids and thyroid goiters and nodules. Future studies that prospectively follow women with uterine fibroids across a lifetime are needed.
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Tian C, Bu Y, Ji C, Shi M, Zhang L, Kong D, Dong X, Liu Y. Iodine Nutrition and the Prevalence Status of Thyroid Nodules in the Population: a Cross-sectional Survey in Heilongjiang Province, China. Biol Trace Elem Res 2021; 199:3181-3189. [PMID: 33123864 DOI: 10.1007/s12011-020-02442-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
The aim of this study was to determine the iodine nutritional status and the epidemiological characteristics of thyroid nodules (TNs) in the adult population of Heilongjiang Province. From December 2017 to December 2018, a total of 3661 adults aged 20-70 years were selected through probability proportional to size (PPS) sampling for a cross-sectional survey. During the field epidemiological investigation, each participant received a questionnaire survey and thyroid ultrasonography examination. The iodine concentrations in casual urine specimens and household edible salt were measured. The household coverage of iodized salt was 86.56%. The median urinary iodine concentration (MUIC) in the adult population in Heilongjiang Province was 161.57 μg/L (25th-75th percentile: 100.35-245.15 μg/L). The prevalence of TNs was 36.88%, and the prevalence in females was significantly higher than that in males (41.25% vs 32.50%, χ2 = 11.841, P < 0.01). The prevalence of TNs increased with age (χ2trend = 49.80, P < 0.001). The prevalence of multiple TNs increased with age (χ2trend = 48.709, P < 0.001). There was no significant difference in the MUIC between healthy control group and those with TNs (Z = - 1.386, P = 0.166). The female, age (40-49 age group, 50-59 age group, 60-70 age group), BMI (obesity, overweight), history of hypertension, history of diabetes, and smoking history were all independent risk factors that affected the occurrence of TNs. The iodine nutritional status of the adult population in Heilongjiang Province was adequate. The prevalence of TNs was higher in middle-aged and elderly women, so these individuals should be the focus of the prevention and treatment of thyroid nodule disease.
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Affiliation(s)
- Chunyuan Tian
- Key Laboratory of Etiology and Epidemiology, National Health and Family Planning Commission, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150081, Heilongjiang, China
| | - Ye Bu
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang, China
| | - Chunlei Ji
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang, China
| | - Mengqi Shi
- Key Laboratory of Etiology and Epidemiology, National Health and Family Planning Commission, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150081, Heilongjiang, China
| | - Liwei Zhang
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang, China
| | - Dejiao Kong
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang, China
| | - Xiaoqiu Dong
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang, China.
| | - Ying Liu
- Key Laboratory of Etiology and Epidemiology, National Health and Family Planning Commission, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150081, Heilongjiang, China.
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Li S, Li W, Sheng B, Zhu X. Relationship between thyroid disorders and uterine fibroids among reproductive-age women. Endocr J 2021; 68:211-219. [PMID: 33028746 DOI: 10.1507/endocrj.ej20-0340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Uterine fibroids and thyroid nodules, both of which are crucially affected by estrogen, are common diseases among reproductive-age women. However, little attention has been paid to the association between the two diseases. This retrospective case-control study aimed to assess the relationships among thyroid nodules, thyroid function and uterine fibroids in China. We reviewed the electronic records of 853 reproductive-age women who attended health check-ups at the Second Affiliated Hospital of Wenzhou Medical University from July 1st, 2017, to June 30th, 2018. All subjects received transvaginal pelvic ultrasound, thyroid ultrasound, thyroid function, and other laboratory tests. We found that the prevalence of thyroid nodules in subjects with uterine fibroids was remarkably higher than that in subjects without fibroids. The proportion of thyroid nodules ≥1 cm in subjects with uterine fibroids was significantly higher than that in subjects without fibroids. Women with thyroid nodules had a higher proportion of multiple uterine fibroids than women without thyroid nodules. Among the parameters of thyroid function, the only statistically significant parameter was total triiodothyronine, i.e., women with uterine fibroids had lower total triiodothyronine levels than unaffected controls; however, the total triiodothyronine levels were within the normal ranges. Moreover, no significant difference was noted in thyroid hormone status between subjects with and without uterine fibroids. Our findings suggest that thyroid nodules are positively correlated with uterine fibroids among reproductive-age women in China. Further studies are needed to confirm this association and fully understand the common pathogenetic mechanism underlying the association between uterine fibroids and thyroid nodules.
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Affiliation(s)
- Saisai Li
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University. Wenzhou 325027, Zhejiang, China
| | - Weibo Li
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University. Wenzhou 325027, Zhejiang, China
| | - Bo Sheng
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University. Wenzhou 325027, Zhejiang, China
| | - Xueqiong Zhu
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University. Wenzhou 325027, Zhejiang, China
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Liang Q, Yu S, Chen S, Yang Y, Li S, Hu C, Huang D, Kuang L, Li D. Association of Changes in Metabolic Syndrome Status With the Incidence of Thyroid Nodules: A Prospective Study in Chinese Adults. Front Endocrinol (Lausanne) 2020; 11:582. [PMID: 32973687 PMCID: PMC7472883 DOI: 10.3389/fendo.2020.00582] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/17/2020] [Indexed: 02/02/2023] Open
Abstract
Although several cross-sectional studies have shown an association of metabolic syndrome (MetS) with nodular thyroid disease, related prospective studies are scarce. This study investigated the association of MetS with thyroid nodule (TN) incidence in Chinese adults, and explored whether the development of or recovery from MetS is associated with changes in the risk of developing TNs. A total of 4,749 Chinese aged 18-65 years were involved in this 6-year prospective study. The association of MetS with TN prevalence was examined. TN-free individuals at baseline (n = 3,133) were further examined. TN incidence rates in groups with different MetS statuses (MetS-free, MetS-developed, MetS-recovery and MetS-chronic) were analyzed. Of all participants, 18.21 and 31.65% had MetS and TNs, respectively. MetS patients had a higher TN prevalence than the non-MetS group (31.08 vs. 19.81% in males, p < 0.01; 59.52 vs. 39.59% in females, p < 0.01). Sex, age and MetS were independent risk factors for TNs. At a median follow up of 5.94 years, the MetS-chronic group (4.37/100 person-years) had a higher risk of TNs (adjusted incidence rate ratio [IRR] = 1.288 [95% CI 1.014-1.636]) compared with the MetS-free group (2.72/100 person-years) in the whole cohort. In males, the MetS-chronic group (3.76/100 person-years) had a higher risk of TNs (adjusted IRR = 1.367 [95% CI 1.017-1.835]) compared with the MetS-free group (2.31/100 person-years). In females, the risk of TNs was significantly higher in the MetS-chronic (6.44/100 person-years) and MetS-developed (6.31/100 person-years) groups compared with the MetS-free group (3.23/100 person-years).
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Chen CY, Chen ST, Huang BY, Hwang JS, Lin JD, Liu FH. The effect of suppressive thyroxine therapy in nodular goiter in postmenopausal women and 2 year's bone mineral density change. Endocr J 2018; 65:1101-1109. [PMID: 30158361 DOI: 10.1507/endocrj.ej18-0125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The efficacy of thyroxine suppressive therapy in reducing nodular growth and its effect to bone mineral density (BMD) in postmenopausal women is still debated. This study aimed to evaluate the therapeutic effect of thyroxine and its influence on BMD. Postmenopausal women with nodular or multinodular goiter during 2013-2015 at Chang Gung Memorial Hospital were enrolled and retrospectively traced back to the first date of visit or treatment. Ninety-four eligible patients were enrolled, of whom 45 were thyroxine-treated (LT-4 group) and 49 were treatment-naïve (control group). Data, including volume of nodules, were analyzed retrospectively. BMD was measured in each LT-4 group patient since the year of enrollment. Nodular volumes were reduced in both LT-4 (from 4.89 ± 4.46 to 4.10 ± 4.57 mL, p = 0.033) and control group (3.48 ± 4.36 to 3.09 ± 2.88 mL, p = 0.239) at initial 2-year follow-up. Nodular volume in LT-4 group increased insignificantly (from 4.89 ± 4.46 to 4.91 ± 5.40 mL, p = 0.711) at the end of 7-year follow-up. The best cut-off predictive nodular volume that may have responded to thyroxine is 2.6 mL (AUC, 0.740; sensitivity, 0.750; specificity, 0.733) during first 2 year. Lumbar spine, total hip and femoral neck BMD were not significantly changed during 2 year's thyroxine suppression therapy. In conclusion, thyroxine suppressive therapy in postmenopausal women had significant reduction in nodule volume at initial 2 years of treatment, especially in volume larger than 2.6 mL. Prolonged thyroxine treatment did not benefit nodular size reduction and may affect BMD minimally in postmenopausal women.
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Affiliation(s)
- Chiung-Ya Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kweishan, Taoyuan, Taiwan
| | - Szu-Tah Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kweishan, Taoyuan, Taiwan
| | - Bie-Yu Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kweishan, Taoyuan, Taiwan
| | - Jawl-Shan Hwang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kweishan, Taoyuan, Taiwan
| | - Jen-Der Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kweishan, Taoyuan, Taiwan
| | - Feng-Hsuan Liu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kweishan, Taoyuan, Taiwan
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Feng S, Zhang Z, Xu S, Mao X, Feng Y, Zhu Y, Liu C. The Prevalence of Thyroid Nodules and Their Association with Metabolic Syndrome Risk Factors in a Moderate Iodine Intake Area. Metab Syndr Relat Disord 2016; 15:93-97. [PMID: 27929732 DOI: 10.1089/met.2016.0077] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND To investigate the prevalence of thyroid nodules (TNs) and to evaluate the association between TNs and metabolic syndrome (MetS) in the moderate iodine intake area of Jiangsu, China. SUBJECTS AND METHODS A cross-sectional study was carried out in a Chinese community-based epidemiological investigation from January to December 2014. A questionnaire was completed by 6494 subjects (2427 men and 4067 women). Thyroid ultrasound was performed by using a 7.5-MHz linear probe. MetS was defined according to the 2006 International Diabetes Federation criteria. RESULTS The prevalence of TNs in the study population was 17.7% (12.9% for men and 20.6% for women) and significantly higher in subjects with MetS [MetS(+)] than in those without MetS [MetS(-)] (25.8% vs. 15.5%, χ2 = 78.471, P < 0.001). Binary logistic regression indicated that (in addition to female sex and increased age) increased fasting plasma glucose (FPG), waist circumference (WC), hypertension, and smoking were positively associated with the prevalence of TNs. CONCLUSIONS Our findings indicated a positive association between MetS and formation of TNs. Increased WC and FPG, as well as hypertension, might increase the prevalence of TNs.
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Affiliation(s)
- Shangyong Feng
- 1 Nanjing University of Chinese Medicine , Nanjing, China
| | - Zhenwen Zhang
- 2 Department of Endocrinology, Affiliated Hospital of Yangzhou University , Yangzhou, China
| | - Shuhang Xu
- 3 Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine , Nanjing, China
| | - Xiaodong Mao
- 3 Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine , Nanjing, China
| | - Yu Feng
- 4 Department of Endocrinology, The Second Affiliated Hospital of Soochow University , Suzhou, China
| | - Yan Zhu
- 2 Department of Endocrinology, Affiliated Hospital of Yangzhou University , Yangzhou, China
| | - Chao Liu
- 3 Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine , Nanjing, China
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Wang K, Yang Y, Wu Y, Chen J, Zhang D, Liu C. The association of menstrual and reproductive factors with thyroid nodules in Chinese women older than 40 years of age. Endocrine 2015; 48:603-14. [PMID: 25012252 DOI: 10.1007/s12020-014-0342-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
Abstract
The purpose of the study was to explore the association of menstrual and reproductive factors with thyroid nodules in Chinese women older than 40 years of age. A questionnaire was completed by 6,571 women aged 40 years or older in a community-based epidemiological investigation of thyroid nodules conducted from June to November 2011 in Nanjing City. Thyroid nodules were measured by ultrasound. The Thyroid Imaging Reporting and Data System score was used to differentiate between benign and possibly malignant nodules. Menopausal age (>55 vs. <50 years: RR = 1.17, 95 % CI 1.00-1.34) and number of reproductive years (>40 vs. <35 years: RR = 1.12, 95 % CI 1.01-1.24) increased the risk of thyroid nodules, but were not associated with suspected malignant nodules. Women who experienced more pregnancies (≥5 vs. ≤1: RR = 2.09, 95 % CI 1.79-2.40) and abortions (≥3 vs. 0: RR = 1.61, 95 % CI 1.41-1.81) were prone to development of thyroid nodules, and more likely to form suspected malignant nodules (pregnancies, RR = 3.59, 95 % CI 1.60-7.20; abortions, RR = 2.36, 95 % CI 1.31-4.06). Furthermore, higher risks of thyroid nodules (RR = 1.36, 95 % CI 1.14-1.59) and suspected malignant nodules (RR = 2.80, 95 % CI 1.08-6.53) were observed in women who had undergone artificial compared with natural abortion. Periods of elevated estrogen and progesterone levels in women, such as pregnancy, were the key occasions for occurrence of both benign and suspiciously malignant thyroid nodules, while longer lifetime length of exposure to female sex hormones might promote the growth of thyroid nodules.
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Affiliation(s)
- Kun Wang
- Department of Endocrinology, The First Clinical College, Nanjing University of Chinese Medicine, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, 138 Xianlin Dadao Road, Nanjing, 210023, China
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Lim DJ, Kim JY, Baek KH, Kim MK, Park WC, Lee JM, Kang MI, Cha BY. Natural course of cytologically benign thyroid nodules: observation of ultrasonographic changes. Endocrinol Metab (Seoul) 2013; 28:110-8. [PMID: 24396664 PMCID: PMC3811716 DOI: 10.3803/enm.2013.28.2.110] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 05/07/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The natural course of cytologically benign thyroid nodules remains unclear. The aim of this study was to evaluate whether ultrasonographic (US) changes are associated with changes in nodule volume during follow-up. METHODS We retrospectively reviewed over 4 years of clinical records of patients with benign thyroid nodules as confirmed by fine needle aspiration (FNA). In total, 186 patients with 202 benign thyroid nodules were included for study. We assessed for changes in nodule volume and examined the cystic portion of the nodule as well as four US features (echogenicity, margin, calcification pattern, and shape). RESULTS During follow-up (mean, 21.7±10.7 months) and using 50% as a cutoff value, nodule volumes increased in 11.8%, exhibited no change in 79.9%, and decreased in 8.3% of patients. Proportion of nodules demonstrating at least one US change was 20.8% (42/202). The most common US changes (in descending order of frequency) were cystic change, margin change, and calcification pattern change. Nodule shape and echogenicity rarely changed. Increased nodule volume was not significantly associated with any US features or with the number of FNAs but was associated with younger age at time of diagnosis. CONCLUSION Although a portion of thyroid nodules confirmed as benign showed US changes or volume changes during the follow-up period, these findings may only represent the natural course of benign nodules. Frequent follow-up with US might be needed for only a small number of cases with suspicious US findings.
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Affiliation(s)
- Dong Jun Lim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jee Young Kim
- Department of Radiology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ki Hyun Baek
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Mee Kyoung Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Woo Chan Park
- Department of Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jong Min Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Moo Il Kang
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Bong Yun Cha
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Sapio MR, Guerra A, Marotta V, Campanile E, Formisano R, Deandrea M, Motta M, Limone PP, Fenzi G, Rossi G, Vitale M. High growth rate of benign thyroid nodules bearing RET/PTC rearrangements. J Clin Endocrinol Metab 2011; 96:E916-9. [PMID: 21411555 DOI: 10.1210/jc.2010-1599] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Benign thyroid nodules display a broad range of behaviors from a stationary size to a progressive growth. The RET/PTC oncogene has been documented in a fraction of benign thyroid nodules, besides papillary thyroid carcinomas, and it might therefore influence their growth. OBJECTIVE The aim of the present work was to evaluate whether RET/PTC in benign thyroid nodules associates with a different nodular growth rate. STUDY DESIGN In this prospective multicentric study, 125 subjects with benign nodules were included. RET rearrangements were analyzed in cytology samples; clinical and ultrasonographic nodule characteristics were assessed at the start and at the end of the study. RESULTS RET/PTC was present in 19 nodules. The difference between the mean baseline nodular volume of the RET/PTC- and RET/PTC+ nodules was not significant. After 36 months of follow-up, the RET/PTC+ group (n = 16) reached a volume higher than the RET/PTC- group (n = 90) (5.04 ± 2.67 vs. 3.04 ± 2.26 ml; P = 0.0028). We calculated the monthly change of nodule volumes as a percentage of baseline. After a mean follow-up of 36.6 months, the monthly volume increase of nodules bearing a RET rearrangement was 4.3-fold that of nodules with wild-type RET (1.83 ± 1.2 vs. 0.43 ± 1.0% of baseline volume; P < 0.0001). CONCLUSIONS Benign thyroid nodules bearing RET rearrangements grow more rapidly than those with wild-type RET. Searching for RET rearrangements in benign thyroid nodules might be useful to the clinician in choosing the more appropriate and timely therapeutic option.
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Affiliation(s)
- Maria Rosaria Sapio
- Department of Endocrinologia ed Oncologia Molecolare e Clinica, Università di Napoli Federico II, Via S. Pansini, 5, 80131 Naples, Italy
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Ito Y, Amino N, Hirokawa M, Kobayashi K, Miya A, Miyauchi A. A solid thyroid benign nodule that showed a significant decrease in size and ultrasonographic findings mimicking papillary carcinoma during 16-year follow-up. Endocr J 2011; 58:19-22. [PMID: 21099128 DOI: 10.1507/endocrj.k10e-309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Recent advances in ultrasonography and fine needle aspiration biopsy (FNAB) have facilitated accurate diagnosis of thyroid carcinomas that require treatment. However, we often encounter nodules evaluated as malignant on ultrasonography but diagnosed as benign on cytology, for which the optimal treatment strategy remains uncertain. A 28-year-old female had solitary and solid thyroid nodule measuring 6 cm in maximal diameter in February 1994. The lesion was cytologically diagnosed as benign. From September 1998, the nodule spontaneously decreased in size but ultrasonographic findings suspicious of malignancy such as peripheral and intra-tumoral calcification, low internal echo and irregular border gradually appeared. In July 2010, the volume of her nodule showed 97% decrease but was evaluated as papillary carcinoma on ultrasonography. FNAB was performed again and the nodule was diagnosed as benign. When we encounter a nodule showing ultrasonographic findings suggestive of malignancy with negative cytology, we should consider the possibility of a benign nodule degenerating over time.
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Affiliation(s)
- Yasuhiro Ito
- Department of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Japan.
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Yousef A, Clark J, Doi SAR. Thyroxine suppression therapy for benign, non-functioning solitary thyroid nodules: a quality-effects meta-analysis. Clin Med Res 2010; 8:150-8. [PMID: 20739581 PMCID: PMC3006560 DOI: 10.3121/cmr.2010.881] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Levothyroxine (LT4) suppressive therapy for solitary thyroid nodules is not popularly advocated presently because its clinical efficacy and safety are currently considered controversial. This meta-analysis aims to address efficacy issues by using rigorous methods to arrive at a pooled estimate. On the basis of the analysis, it is estimated that LT4 therapy is clearly associated with up to a two-fold increase in the chance of nodule reduction. This translates to a number needed to treat (NNT) of 6 or a 50% decrease in the risk of cancer given nodule reduction. Keeping this definition of efficacy in mind and a low incidence of adverse events with low level LT4 suppression, such an intervention might be appropriate in patients selected on the basis of a low risk for adverse effects.
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Affiliation(s)
- Altayyeb Yousef
- Department of Medicine, Mubarak Al-Kabeer Teaching Hospital, Kuwait
| | - Justin Clark
- Herston Health Sciences Library, University of Queensland, Brisbane, Australia
| | - Suhail A. R. Doi
- Clinical Epidemiology Unit, School of Population Health, University of Queensland, Brisbane, Australia
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Langer P. The impacts of organochlorines and other persistent pollutants on thyroid and metabolic health. Front Neuroendocrinol 2010; 31:497-518. [PMID: 20797403 DOI: 10.1016/j.yfrne.2010.08.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 08/12/2010] [Accepted: 08/19/2010] [Indexed: 12/24/2022]
Abstract
High prevalence of thyroid and metabolic disorders has been repeatedly observed in the population living in the area of eastern Slovakia highly polluted by a mixture of PCBs, DDE and HCB since about 50 years ago. Among thyroid disorders, increase of thyroid volume as measured by ultrasound volumetry may be suggested as one of notable findings which appeared possibly related to increased OCs levels and to autoimmunity signs (e.g. positive thyroperoxidase antibodies in blood and/or hypoechogenicity image obtained by ultrasound), while some participation of individual susceptibility and also of immunogenic effect of OCs and iodine in this iodine replete country cannot be excluded. Another notable finding has been the increase of blood FT4 and TT3 positively related to high PCBs level. Such increased FT4 level has been found associated with TSH level in hyperthyroid range in about 2% of examined population from polluted area. High prevalence of thyroid autoimmune disorders strongly supported the assumption on impaired immune system and thus also on presumably increased prevalence of other autoimmune disorders in highly exposed population. In addition, markedly increased prevalence of prediabetes and diabetes significantly related to major OCs (PCBs, DDE and HCB) levels and accompanied by increasing level of cholesterol and triglycerides has been observed. The observations also suggested a role of prenatal exposure to OCs in the development of several adverse health signs (e.g. increased prevalence of thyroid antibodies, impaired fasting glucose level, increased thyroid volume, decreased thymus volume, decreased neurobehavioral performance, increased hearing and dental disorders) in young generation born to highly exposed mothers in polluted area.
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Affiliation(s)
- Pavel Langer
- Slovak Academy of Sciences, Bratislava, Slovakia.
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15
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Kim MH, Park YR, Lim DJ, Yoon KH, Kang MI, Cha BY, Lee KW, Son HY. The relationship between thyroid nodules and uterine fibroids. Endocr J 2010; 57:615-21. [PMID: 20467159 DOI: 10.1507/endocrj.k10e-024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Previous studies suggested that estrogen might have an important role in thyroid nodule formation. Besides, it was recently reported that women with uterine fibroids, which estrogen has effects on, had an increased incidence of thyroid nodules. Our study was to identify the relationship between uterine fibroids and thyroid nodules and to find the factors that may have influences on the occurrence of thyroid nodules. We reviewed the records of 1144 participants who attended health check-ups from 2005 to 2008. Evaluated clinical variables included the size and number of thyroid nodules, presence of uterine fibroids, menopausal status, BMI, smoking, alcohol, medication status, serum levels of cholesterol, LH, FSH, and estradiol. A total of 925 participants were included and 163 (17.6%) subjects had thyroid nodules and uterine fibroids simultaneously. A significant association between both diseases existed (P=0.010), and closer relationship was observed in premenopausal women (n=445, P=0.001). In univariate analysis of systemic E2 level and the incidence of thyroid nodule in premenopausal women, systemic E2 levels had inverse correlation with the incidence of thyroid nodules (P=0.024, OR=0.631, CI: 0.424-0.940). In multivariate logistic regression analysis, older age and the presence of uterine fibroids were the independent factors for the presence of thyroid nodules. Our study suggested that uterine fibroids in women were definitely associated with thyroid nodules and estrogen might have a pivotal role in occurrence of both uterine fibroids and thyroid nodules.
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Affiliation(s)
- Min-Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seocho-Gu, Seoul, Korea
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Gharib H, Papini E. Thyroid nodules: clinical importance, assessment, and treatment. Endocrinol Metab Clin North Am 2007; 36:707-35, vi. [PMID: 17673125 DOI: 10.1016/j.ecl.2007.04.009] [Citation(s) in RCA: 207] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In the general population, thyroid nodules are found in 5% by palpation and in 50% by ultrasonography (US). Initial evaluation of nodules should include serum thyroid-stimulating hormone measurement, fine-needle aspiration (FNA) biopsy, and US. Thyroid micronodules are being detected with increasing frequency and are currently evaluated by US-FNA. Routine measurement of serum calcitonin and thyroglobulin and FNA rebiopsy are not recommended. Cytologically benign thyroid nodules should be followed rather than treated. Novel treatment options including iodine 131, percutaneous ethanol injection, and percutaneous laser thermal ablation have specific indications, advantages, and adverse effects.
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Affiliation(s)
- Hossein Gharib
- Mayo Clinic College of Medicine, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, MN 55905, USA, and Department of Endocrine & Metabolic Diseases, Regina Apostolorum Hospital, Albano Laziale, Italy.
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Filetti S, Durante C, Torlontano M. Nonsurgical approaches to the management of thyroid nodules. ACTA ACUST UNITED AC 2006; 2:384-94. [PMID: 16932321 DOI: 10.1038/ncpendmet0215] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Accepted: 03/06/2006] [Indexed: 01/08/2023]
Abstract
Epidemiologic studies have documented substantial increases in the frequency of nodular thyroid disease. This trend is largely due to the increasing detection of nodules by the routine use of sonography in clinical practice. Only a small percentage of the nodules currently being detected will prove to be malignant. The probability of malignancy is similar in nonpalpable and palpable nodules. Fine-needle aspiration cytology has a central role in identifying malignant nodules, which are generally treated with surgery. Most thyroid nodules are cytologically benign and can be managed nonsurgically. Nodules that are completely asymptomatic require follow-up without treatment. Cosmetic problems and/or compression-related symptoms may be indications for surgery. When surgery is contraindicated or refused, several nonsurgical approaches are available. These include levothyroxine therapy, radioiodine treatment, percutaneous ethanol injections, and the new technique of laser photocoagulation. Levothyroxine therapy is the most widely used approach, but its clinical efficacy and safety are controversial. Levothyroxine might, nonetheless, be appropriate in selected cases characterized by low risk for adverse effects and nodule characteristics associated with response to this type of therapy. Radioiodine is the therapy of choice for toxic nodules or for symptomatic nodular goiters when surgery is not possible. Percutaneous ethanol injection should be used, in our opinion, as the first-line therapy only for recurrent symptomatic cystic nodules. Laser therapy should be reserved for selected patients treated in experienced centers only. With these options, clinicians can personalize the management of nodular thyroid disease according to a careful cost-benefit analysis.
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