The prevalence of thyroid nodules and its relationship with metabolic parameters in a Chinese community-based population aged over 40 years

Association of gender and metabolic factors with thyroid nodules in T2DM: a retrospective study

Aims

Sex differences in the incidence of thyroid nodules (TNs) are broadly recognized, but further analysis is lacking. Thus, the aim of this study was to evaluate the association between TNs and anthropometric parameters in type 2 diabetic males and females.

Materials and Methods

This cross-sectional study included 747 patients with type 2 diabetes mellitus (T2DM). All patients underwent clinical examination, thyroid ultrasound, laboratory tests, anthropometrics and body composition. Multivariable logistic regression assessed factors associated with TNs, and a simple nomogram was finally developed.

Results

In total, the incidence of TNs was 36.95% (276/747) and was significantly higher in females (52.75%) than in males (27.85%). Age was positively correlated with TNs risk in patients with T2DM (males: OR = 4.141, 95% CI [1.999-8.577], females: OR = 4.630, 95% CI [1.845-11.618]). Obesity (OR = 2.655, 95% CI [1.257-5.607]) and hyperuricemia (OR = 1.997, 95% CI [1.030-3.873]) were only associated with the risk of TNs independent of other risk factors in type 2 diabetic females, as well as other obesity factors such as weight, BMI, waist-hip ratio, percent body fat, visceral curve area, and upper arm circumference, but not in type 2 diabetic males. However, the diameter of the largest thyroid nodule was only related to age (R = 0.226, p < 0.01). Finally, the nomogram for evaluating TNs in female T2DM patients was established, and the C-index of the nomogram was 0.704 (95% CI [0.89-0.94]).

Conclusion

TNs occur with a significantly higher frequency in type 2 diabetic females than in males, especially those with hyperuricemia and obesity. Modifiable metabolic factors, such as obesity and hyperuricemia, are a major focus for improving TNs risk in women.

A Comprehensive Mendelian Randomization Study Investigating Multiple Exposures and Outcomes: Focusing on Nontoxic Goitre and Type 2 Diabetes Mellitus

OBJECTIVE

Previous research suggests a correlation between nontoxic goitre and type 2 diabetes mellitus (T2DM). However, the causality was vulnerable to confounding variables. Therefore, there is an urgent need for a more rigorous research approach to examine the causal connection between nontoxic goitre and T2DM.

DESIGN

Multiple exposures and outcomes two-sample Mendelian randomization (MR) study was carried out in two stages: nontoxic goitre traits (including nontoxic diffuse goitre, NDG; nontoxic multinodular goitre, NMG; and other/unspecified nontoxic goitre, OUNG) were investigated as exposure while T2DM was investigated as an outcome in the first step, whereas the second step was reversed. The GWAS summary data for nontoxic goitre traits and T2DM were collected from the Finngen database. The summary data for fasting glucose, fasting insulin, and HbA1c were obtained from the open GWAS database established by the MRC Integrated Epidemiology Unit (IEU). The inverse-variance weighted (IVW) approach was used to obtain MR estimates, and various sensitivity analysis was also performed.

RESULTS

NDG had a potential protective causal relationship with T2DM (OR = 0.978; 95% CI: 0.957-0.998; p = 0.034) and fasting glucose (OR = 0.995; 95% CI: 0.990-0.999; p = 0.011), while NMG had a potential protective causal relationship with T2DM (OR = 0.941; 95% CI: 0.902-0.982; p = 0.008) and HbA1c (OR = 0.992; 95% CI: 0.986-0.998; p = 0.015). OUNG was found to decrease the odds of T2DM by 4.4% (OR = 0.966; 95% CI: 0.938-0.995, p = 0.023). T2DM had a potential causal relationship with NDG (OR = 1.239; 95% CI: 1.020-1.504; p = 0.031), and a potential protective effect against NMG (OR = 0.669; 95% CI: 0.566-0.792; p < 0.001) and OUNG (OR = 0.694; 95% CI: 0.545-0.883; p = 0.004). There was no evidence of a positive association between glycemic traits and nontoxic goitre traits (p > 0.05).

CONCLUSIONS

Our findings indicate a potential causal relationship between nontoxic goitre traits and T2DM. Specifically, our study addresses that NMG and T2DM may have a significant causal effect on each other in both directions.

Association of Body Mass Index trajectory with thyroid nodules during young adulthood in China

This longitudinal study sought to identify distinct body mass index (BMI) trajectories and investigate the impact of these level-independent BMI trajectories on the prevalence of thyroid nodules (TN).This study encompassed a cohort of 1967 participants from a hospital in China. Utilizing latent class growth mixture modeling (LCGMM), four BMI trajectory groups were identified based on the BMI of individuals without TN from 2017 to 2019. The occurrence of TN in participants was monitored from 2020 to 2021. BMI trajectory classes and age were considered potential risk factors for TN development. After adjusting for covariates, the odds ratios (ORs) of model-estimated BMI levels were confirmed in the 27-50-year age group, ranging from 1.077 (1.000-1.158) to 1.189 (1.072-1.319). Significant associations between model-estimated BMI slope and TN were observed in the 21-47-year-old age group, with ORs varying between 1.270 (1.014, 1.591) and 2.490 (1.004, 6.174). The level-independent BMI trajectories throughout life significantly influenced the risk of TN prevalence. Moreover, controlling BMI growth rate in early adulthood (27-47 years old) emerged as a critical age window for reducing TN prevalence, underscoring its importance in TN prevention strategies.

Association between obesity and thyroid nodules in children and adults living in iodine-sufficient areas: analysis of cross-sectional data from Tianjin, China

OBJECTIVE

The main purpose of this study was to analyse the association between obesity and thyroid nodules in children and adults living in iodine-sufficient areas in China.

DESIGN

Analysis of data from two cross-sectional surveys.

SETTING AND PARTICIPANTS

921 children from 2016 to 2021 and 1505 adults from 2018 to 2021 living in iodine-sufficient areas from Tianjin, China were recruited.

OUTCOME MEASURES

Anthropometric measures including height and weight were taken, and body mass index (BMI) and body surface area (BSA) were calculated. Thyroid ultrasonography was performed to assess thyroid nodules. A multifactor logistic regression model and a restricted cubic spline model were used to analyse the association between BMI/BSA and thyroid nodules in children and adults.

RESULTS

Thyroid nodules were detected in 21.72% of children and 40.00% of adults. Compared with children in the low BMI and low BSA groups, children in higher BMI (OR=1.53, 95% CI 1.09 to 2.15) and higher BSA (OR=1.40, 95% CI 1.01 to 1.94) groups had significantly higher risks for thyroid nodules. High BMI and high BSA were also significantly associated with multiple thyroid nodules in children, with ORs and 95% CIs of 1.51 (1.04 to 2.19) and 1.45 (1.01 to 2.08), respectively. The restricted cubic spline model indicated that the risk of thyroid nodules and multiple thyroid nodules in children increased with the increase of BMI-z-score and BSA. In adults, a high BSA (OR=1.34, 95% CI 1.01 to 1.77) was significantly associated with multiple thyroid nodules, but this association was not valid in the restricted cubic spline model.

CONCLUSION

Childhood obesity is associated with the risk of thyroid nodules; however, there is no clear association between adult obesity and thyroid nodules.

Associations of Combined Exposure to Metabolic and Inflammatory Indicators with Thyroid Nodules in Adults: A Nested Case-Control Study

Objective

To explore associations of combined exposure to metabolic/inflammatory indicators with thyroid nodules.

Methods

We reviewed personal data for health screenings from 2020 to 2021. A propensity score matching method was used to match 931 adults recently diagnosed with thyroid nodules in a 1 : 4 ratio based on age and gender. Conditional logistic regression and Bayesian kernel machine regression (BKMR) were used to explore the associations of single metabolic/inflammatory indicators and the mixture with thyroid nodules, respectively.

Results

In the adjusted models, five indicators (ORQ4 vs. Q1: 1.30, 95% CI: 1.07-1.58 for fasting blood glucose; ORQ4 vs. Q1: 1.30, 95% CI: 1.08-1.57 for systolic blood pressure; ORQ4 vs. Q1: 1.26, 95% CI: 1.04-1.53 for diastolic blood pressure; ORQ4 vs. Q1: 1.23, 95% CI: 1.02-1.48 for white blood cell; ORQ4 vs. Q1: 1.28, 95% CI: 1.07-1.55 for neutrophil) were positively associated with the risk of thyroid nodules, while high-density lipoproteins (ORQ3 vs. Q1: 0.75, 95% CI: 0.61-0.91) were negatively associated with the risk of thyroid nodules. Univariate exposure-response functions from BKMR models showed similar results. Moreover, the metabolic and inflammatory mixture exhibited a significant positive association with thyroid nodules in a dose-response pattern, with systolic blood pressure being the greatest contributor within the mixture (conditional posterior inclusion probability of 0.82). No interaction effects were found among the five indicators. These associations were more prominent in males, participants with higher age (≥40 years old), and individuals with abnormal body mass index status.

Conclusions

Levels of the metabolic and inflammatory mixture have a linear dose-response relationship with the risk of developing thyroid nodules, with systolic blood pressure levels being the most important contributor.

Prevalence of Thyroid Nodules and Associated Clinical Characteristics: Findings from a Large Sample of People Undergoing Health Checkups at a University Hospital in Vietnam

Background

Thyroid nodule is a common disorder normally detected by ultrasound. However, little is known about the population prevalence of thyroid nodules in a Vietnamese population. This study aimed to estimate the prevalence of thyroid nodules, its characteristics, and associated factors in a large number of people undergoing annual health checkups.

Methods

A retrospective, cross-sectional descriptive study was conducted, based on electronic medical records of people undergoing health checkups at the Health Checkup Department, University Medical Center at Ho Chi Minh City. All of the participants underwent thyroid ultrasonography, anthropometric measurements, and serum examinations.

Results

A total of 16,784 participants (mean age: 40.4 ± 12.7 years, 45.1% female) were included in this study. The overall prevalence of thyroid nodules was 48.4%. The mean diameter of nodules was 7.2 ± 5.8 mm. The prevalence of nodules with malignant characteristics was 36.9%. Women had a significantly higher prevalence of thyroid nodules than men (55.2% vs 42.9%, p<0.001). Advanced age, hypertension, and hyperglycemia were significantly associated with thyroid nodules in both genders. In men, significant factors also included increased body mass index. In women, these included increased total cholesterol and LDLc, hypertriglyceridemia, and hyperuricemia.

Conclusion

This study showed a high prevalence of TNs in Vietnamese people undergoing general health checkups. Importantly, the proportion of TNs with malignant risk was quite high. Therefore, screening for TNs should be added to annual health checkups to improve early detection of TNs, targeting those who have a high-risk profile based on factors identified in this study.

Thyroid gland cancer and insulin resistance: a modern view of the problem

Background. The impact of insulin resistance on the probability of increase in thyroid cancer risk has been drawing a lot of attention of researchers lately. This problem is far from being completely solved. Studying this interrelationship may influence the effectiveness of the treatment of the mentioned widespread pathology. Purpose – to review present literature sources on research of interrelationship between insulin resistance and thyroid cancer, and also possible mechanisms of this relationship. Materials and methods. Literature search was performed manually by the keywords (thyroid cancer, insulin resistance, IGF-1, IGF-2, abdominal obesity, increase in body mass index, metformin), and also literature sources from evidential data bases PubMed, Web of Science were reviewed. Metaanalyses, systematic reviews and cohort studies were also taken into account. 148 literature sources were studied in total. The sources, which had been published within the last 10 years, were preferably selected. Results. Insulin resistance is viewed as an important independent factor of development of numerous malignancies. The carcinogenic activity of insulin resistance is caused by the resistance itself, as well as by the metabolic disorders related to it. It has been established that excessive weight and obesity are to a great extent attributed to more aggressive clinical pathological signs of thyroid cancer. Recent research showed a larger volume of thyroid and higher risk of knot forming in patients with insulin resistance. Thus, thyroid cancer is one of the main factors of thyroid transformation. Therapeutic methods of eliminating metabolic syndrome and associated hormonal diseases for prevention and therapy of oncologic diseases are drawing ever-greater scientific interest. The anti-tumor features of metformin and its capability of retarding carcinogenesis are shown in the studies. Conclusions. The given literature analysis has proved that the problem of treating malignant thyroid tumors and their metastasis is caused not only by morphological, cellular and molecular-biological features of the tumor itself, but also by insufficient knowledge about the interrelationship between insulin resistance, abdominal obesity, increase in body mass index, high-calorie diet and reduction of consumption of polyunsaturated fats, harmful impact of environment with molecular changes, specific for thyroid cancer. It is confirmed by a significant increase in thyroid cancer rate, especially papillary histotype, alongside with an increase in obesity rate. The studying of possibilities of decreasing incidence and mortality rates of oncologic pathology when using medications, which stabilize insulin and contribute to a decrease in degree of hyperinsulinemia, one of which is metformin, generates profound interest

Associations between Lake Urmia disaster and the prevalence of thyroid nodules and metabolic syndrome: The AZAR cohort survey

Background: In this study, we investigated the associations Lake Urmia's drought to the prevalence of thyroid nodules (TNs) and metabolic syndrome (MetS) among local inhabitants of the lake. Methods: In this cross-sectional study which was started in 2014, we collected data on 992 adults who participated in the Azar cohort study, in Shabestar county, Iran. The sociodemographic status, smoking, and medical history of the subjects living in the areas adjacent to (n = 163) and far from (n = 829) Lake Urmia were collected through questionnaires. After obtaining written consent, anthropometric factors and blood pressure (BP) were measured. The lipid profile and fasting blood glucose (FBG) of the respondents were measured using colorimetric methods, and all underwent thyroid examination and sonography. Furthermore, the size and characteristics of nodules were determined with a fine-needle aspiration biopsy (FNAB) method. Results: We did not find any significant difference in the prevalence of TNs between the two groups (P=0.44), whereas the prevalence of MetS were significantly higher among the subjects from the regions that were far from the Lake (P=0.04). After adjustment for confounding factors (age and gender) in both groups, low risk of TNs (OR=1.20, 95% CI:0.89-1.62) and high risk of TNs (OR=1.19, 95% CI:0.65-2.19) were not significantly associated to MetS (P>0.05). Conclusion: In this study, Lake Urmia's drought was identified to be with no contribution to the prevalence of TNs and MetS. Therefore, long term perspective studies are suggested to reach precise results.

The prevalence of thyroid nodules and its factors among Chinese adult women: A cross-sectional study

OBJECTIVE

To determine the prevalence of thyroid nodules in Chinese adult women. To analyze the relationships between lifestyle, metabolic syndrome and thyroid nodules.

METHODS

We conducted a retrospective cross-sectional study in the tertiary hospital from 2017 to 2019. Included participants underwent thyroid color Doppler ultrasonography, lipids examination, and dietary evaluation.

RESULTS

Totally 2,784 participants were included, and 933 participants were found to have thyroid nodule(s) by B-ultrasound. The prevalence of thyroid nodules was 33.3%. Women in 50-59 years (OR: 1.746, 95% CI [1.356-2.249]), older than 60 (2.147 [1.540-2.993]) and occupations with mainly manual work (1.780 [1.367-2.317]) were risk factors for thyroid nodules, while moderate dietary diversity (0.624 [0.476-0.817]) and normal triglycerides level (0.739 [0.604-0.905]) were protective factors.

CONCLUSION

Women over 50 and those whose jobs are mainly manual should enhance screening, follow-up and health management of thyroid nodules. Higher dietary diversity is protective measures against thyroid nodules for adult women and should consider dietary balance and the food varieties, not just increased quantities.

The Detection of Thyroid Nodules in Prediabetes Population and Analysis of Related Factors

Purpose

To explore the detection of thyroid nodules (TN) and related influencing factors in the population of prediabetes (PreDM) in northwest China’s Gansu Province.

Materials and Methods

A multi-stage stratified cluster random sampling method was used to select adult Han residents in Gansu Province for investigation, and recorded the clinical data of the subjects. The χ² test was used to analyze the difference in TN detection rate of the PreDM population. Logistic regression analyzed the risk factors of TN in the PreDM population.

Results

This study included 2659 people with normal glucose tolerance (NGT) and PreDM, of which 440 people were detected with TN. Among the PreDM population, the TN detection rate was higher than in the NGT population (24.48% vs 15.00%; P<0.05). The detection rate of TN in the impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and IFG+IGT group was also significantly higher than that in the NGT population (X²=4.117, X²=13.187, X²=13.016, all P<0.05), and of which, the IFG+IGT group was the highest (32.20%). The general trend of TN in the IFG, IGT and PreDM population all increased with age. General data showed that BMI, waist-to-height ratio, waist circumference, TG, TC, LDL-C, FPG, 2h PG, HbA1c and TSH indicators in the TN group were higher than those in the Non-TN group (P<0.05). The logistic regression suggested that the risk factors for TN in the PreDM population were female, age increase, high SP, high TSH, high FPG, high LDL-C, hypertension and family history of diabetes (all P<0.05).

Conclusion

The detection rate of TN in the PreDM population is high, especially in the IFG+IGT population. Middle-aged and elderly people with hypertension and abnormal glucose and lipid metabolism should be treated reasonably and regularly, and their TN should be screened and followed up.

The association between BMI, smoking, drinking and thyroid disease: a cross-sectional study in Wuhan, China

BACKGROUND

There is no clear conclusion on the relationship between thyroid disease and obesity and lifestyle factors such as smoking and drinking. In this study, we analysed the association of body mass index (BMI), smoking and drinking with subclinical hypothyroidism (SHO) and thyroid nodules (TNs) with the results of a cross-sectional survey of urban residents in central China and discussed the potential mechanism linking these predictive factors and the two diseases.

METHODS

This study included 1279 participants who were recruited from a Chinese community in 2011 and 2012. A questionnaire, laboratory examination and ultrasound diagnosis were conducted on these participants. Binary logistic regression analysis was used to analyse these factors.

RESULTS

Overweight (BMI ≥ 25 kg/m²) was closely related to SHO and TNs in univariate and multivariate logistic regression analyses. Smoking had a protective effect on SHO and TNs, while drinking had a protective effect on TNs in univariate logistic regression and multivariate logistic regression with some covariates, but there was no significant difference between smoking and drinking and the two kinds of thyroid diseases in multivariate logistic regression analysis with all the covariates. In subgroup analysis, BMI ≥ 25 kg/m2 was significantly associated with SHO in people with positive thyroid antibodies (odds ratio (OR) = 2.221, 95 % confidence interval (CI): 1.168-4.184, P = 0.015) and smokers (OR = 2.179, 95 % CI: 1.041-4.561, P = 0.039). BMI ≥ 25 kg/m2 was significantly associated with TNs in people over 60 years old (OR = 2.069, 95 % CI: 1.149-3.724, P = 0.015) and drinkers (OR = 3.065, 95 % CI: 1.413-6.648, P = 0.005). Drinking alcohol had a protective effect on TNs in smokers (OR = 0.456, 95 % CI: 0.240-0.865, P = 0.016) and people with BMI ≥ 25 kg/m² (OR = 0.467, 95 % CI: 0.236-0.925, P = 0.029). No significant association was found between smoking and the two thyroid diseases in different subgroups.

CONCLUSIONS

Obesity is a risk factor for both TNs and SHO, especially in elderly individuals and people with positive thyroid autoantibodies. Obesity and metabolic syndrome may be more associated with TNs than SHO. Smoking may have a protective effect on thyroid disease, while drinking may have a protective effect only on TNs.

Prevalence and associated metabolic factors for thyroid nodules: a cross-sectional study in Southwest of China with more than 120 thousand populations

OBJECTIVE

To explore the prevalence and its associated metabolic factors of thyroid nodules (TNs) among subjects who participated in the physical examinations in Chongqing, China.

METHODS

The participants from the Health Management Center of JinShan Hospital of Chongqing Medical University, between September 2015 and May 2020, were included in this study. All of the participants underwent thyroid ultrasonography, anthropometric measurements, and serum examinations. Differences in the TNs prevalence were compared with the chi-square test or Wilcoxon rang-sum test. Multivariable logistic regression analyses were used to estimate the metabolic factors associated with TNs and multiple thyroid nodules (MTNs).

RESULTS

Of the included 121,702 participants, 41,547 had TNs, and 20,899 had MTNs, with the prevalence of 34.1 and 17.0 %, respectively. Women had a significantly higher prevalence of TNs than men (40.6 % vs. 29.8 %; χ² = 1517.33, P < 0.001), and TNs prevalence was gradually increased with age (P for trend < 0.001). Female gender, advanced age, and metabolic factors including central obesity, hypertension, diabetes and fatty liver were positively associated with TNs; BMI, hyperlipoidemia and hyperuricemia were not independent risk factors of TNs. While female gender, advanced age, central obesity, hypertension and diabetes were independent risk factors of MTNs.

CONCLUSIONS

The prevalence of thyroid nodules was relatively high. The associated factors identified in this study could help the clinicians to detect the high-risk patients and make targeted screening strategies for the preventing of the occurrence of TNs.

Ultrasound guided microwave ablation of thyroid nodular goiter and cystadenoma: A single center, large cohort study

Thyroid nodules are one of the most common entities that affect the thyroid gland. Traditionally, their treatment was surgery. Currently, ablation combination with percutaneous procedure became a good option.To analyze safety, efficacy, and describe our experience in microwave-ablation using ultrasound-guidance for benign thyroid nodules.A total of 304 patients with 1180 thyroid nodules (thyroid cystadenoma and nodular goiter) were studied retrospectively. Two hundred sixty-seven patients who underwent microwave-ablation successfully in our hospital were enrolled in this study. The baseline, follow-up nodule volume, thyroid function tests, thyroid antibodies, and posttherapy complications were analyzed. The informed written consent was obtained from patients or guardians. The study was approved by the ethics committee of our hospital.The average age was 50.1 ± 11.7 (21-83 years), 214 were women (80.1%) and 53 (19.9%) were men. The average number of nodules per patient was 4.02 ± 1.8 (1-8), 9.86%, 6.13%, and 84% located in the right thyroid lobe, left lobe, and bilateral, respectively. The average size of the nodules was 5.28 cm2 ± 3.63 (0.09-23.45 cm2). The average ablation time was 11 minutes ± 5.36 (3-20 minutes). The hospitalization period was 24 hours ± 10.16 (7-48 hours). Eighteen complications were reported. Postablation volume reduction rate was 54.74% and 93.3% at 3 and 12 months follow-up respectively (P < .05). The thyroid function tests, pre and postablation showed no significant changes (P > .05).Ultrasound-guided microwave-ablation of thyroid nodules is safe and effective. More clinical trials are needed to define the true use of microwave-ablation.

Can "VAI" Better Indicate Metabolic Syndrome Compared with Other Metabolic Syndrome-Related Parameters in Patients with Thyroid Nodules? A Study from Turkey

Background: To investigate the relationship between visceral adiposity index (VAI) and other metabolic syndrome (MetS)-related parameters, and thyroid nodules. Methods: This single-center, prospective, case-control study included 67 patients with thyroid nodules and 48 healthy volunteers with similar age, sex, and body mass index (BMI). Biochemical parameters were obtained from medical charts. Anthropometric measurements and total body composition analysis were performed to calculate VAI and other MetS parameters. The parenchymal structure was evaluated according to VESINC (Volume, Echogenicity, Sonographic texture, Infiltration of pseudonodular Nodules, Cysts) system on thyroid ultrasound and nodule characteristics were also detected. MetS was defined according to International Diabetes Federation criteria. Results: We examined a total of 67 patients with thyroid nodule and 48 healthy volunteers. Sixty-one (91%) were female in the patient group; and 43 (90%) were female in the control group. The mean age was 48.5 ± 11.6 years in the patient group; 47.2 ± 9.5 years in the control. The median VAI was significantly higher in the patient group than the control group [4.1 interquartile range (IQR: 2.6-5.9) vs. 3 (IQR: 2-4.3), P = 0.024]. There was a positive correlation between VAI and BMI, waist/hip ratio (WHpR), waist/height ratio (WHtR), and homeostasis of model assessment of insulin resistance (HOMA-IR). On the other hand, there was no significant correlation between VAI and thyroid function tests and autoantibodies and thyroid volume. Conclusions: In conclusion, we demonstrated that MetS was more common in patients with thyroid nodules. Although VAI and HOMA-IR levels were significantly different between the two groups, we found no significant difference in terms of waist circumference, WHpR, and WHtR. This might suggest that VAI compared with these parameters, better predicts the risk of MetS in patients with thyroid nodules.

Microwave Ablation of Visible Benign Thyroid Nodules with Different Internal Characteristics: A Comparative Study with Follow-up Results

PURPOSE

To investigate the effects of microwave ablation (MWA) on visible benign thyroid nodules (BTN) with different internal characteristics.

MATERIALS & METHODS

A total of 51 cases with 53 visible BTN were treated by ultrasound-guided percutaneous MWA. The 53 nodules were classified into three categories according to the internal characteristics, which were simple solid, mainly solid and mainly cystic nodules. Ultrasound examinations were performed to evaluate the volume shrinkage rations during follow-up. The thyroid functions and the cervical cosmetic scores were evaluated. The complications were observed during and after ablation.

RESULTS

A total of 53 symptomatic BTN were treated by MWA completely. The average volume of the nodules was 11.68 ± 10.16 ml, the volume reduction rates (VRR) at 1st, 3rd, 6th, 12th, and 18th months after ablation were 0.29 ± 0.27, 0.46 ± 0.25, 0.67 ± 0.19, 0.83 ± 0.10, and 0.92 ± 0.10, respectively. The VRR was significantly different among the three categories of lesions (p < 0.05). The symptoms of all patients were improved. Thyroid function indicators were fluctuated in normal range. There were no serious complications during and after the procedure.

CONCLUSION

MWA of visible BTN is safe and effective, and the short-time ablation effect is significantly different due to the internal characteristics of the nodule.

Relation of prediabetes and type 2 diabetes mellitus to thyroid cancer

Objective

Patients with type 2 diabetes (T2DM) generally experience a higher incidence of cancer. However, the association between T2DM and thyroid cancer is inconclusive.

Methods

Case-control prospective study, where 722 patients were screened for T2DM and prediabetes (PDM) and underwent thyroid ultrasound and biochemical tests. The patients were assigned to groups of PDM (n = 55), T2DM (n = 79) or a non-diabetes group (NDM) (n = 588). Fine-needle aspiration biopsy was carried out in 263 patients. Histological examinations were done for 109 patients after surgery, with findings of 52 benign (BS) and 57 malignant tumors (MS).

Results

Thirty-three percent of patients with T2DM and especially PDM were newly diagnosed by our screening: 6.5% with T2DM and 72% with PDM, respectively. The percentage of thyroid cancers did not significantly differ between the groups (χ2 test = 0.461; P = 0.794). Relevant positive thyroid predictors for T2DM (t-statistic = 25.87; P < 0.01) and PDM (21.69; P < 0.01) contrary to NDM (-26.9; P < 0.01) were thyroid volume (4.79; P < 0.01), thyroid nodule volume (3.25; P < 0.01) and multinodular thyroid gland (4.83; P < 0.01), while negative relevant predictors included the occurrence of autoimmune thyroid disease (AITD) (-2.01; P < 0.05).

Conclusion

In general, we did not observe an increased risk for thyroid cancer in the diabetic and prediabetic groups in comparison to controls, in spite of well-established increased risk for other malignancies. Structural and benign changes such as larger and multinodular thyroid glands, in comparison to autoimmune thyroid disease, are present more often in diabetics.

Thyroid tumor surveillance using ultrasound in childhood cancer survivors

BACKGROUND

The optimal method for thyroid cancer screening in childhood cancer survivors (CCSs) who received radiation involving the thyroid gland is still debated. We describe a case series of ultrasound surveillance for thyroid tumor in CCSs in our institute.

METHODS

We conducted thyroid tumor surveillance for CCSs with a history of radiation therapy involving the thyroid. The basic screening method was palpation. Thyroid ultrasound was also performed for patients who agreed after its benefits and risks were explained to them. We surveyed CCSs who visited the long-term follow-up outpatient clinic in our institution between October 2014 and September 2018.

RESULTS

Of 82 CCSs who visited our institution during the study period, 44 were eligible for inclusion. None had a mass identified by palpation. Thyroid ultrasound was performed in 39 CCSs, and we identified thyroid nodules in 27. Four patients had a nodule with malignant echo features. Two of these cases received biopsies, and one patient was ultimately diagnosed with an early stage thyroid carcinoma.

CONCLUSIONS

Childhood cancer survivors irradiated in the thyroid had a higher prevalence of thyroid nodules than the general population. Ultrasound screening contributed to early detection of impalpable thyroid cancer and enabled us to perform minimal surgery. Thus, ultrasound appears to be a useful option for secondary thyroid cancer screening. The thyroid tumor surveillance modality should be considered according to the individual case, and the patient must receive a clear explanation of the benefits and risks. These results could help doctors consider how to screen for secondary thyroid cancer.

Monocyte-to-high-density lipoprotein cholesterol ratio is associated with the presence and size of thyroid nodule irrespective of the gender

Background

Systemic inflammation may be involved in the formation and progression of thyroid nodule (TN). The aim of this large-scale study was to investigate the association of several simple inflammatory markers with the presence and size of TN.

Methods

A total of 133,698 adults were included for the current analysis. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and monocyte-to-high-density lipoprotein cholesterol ratio (MHR) were calculated. The logistic regression was used to explore the association of the four markers with the presence and size of TN.

Results

The prevalence of TN was 55.1% among females and 44% among males; 13% of women and 8% of men had non-micronodule. In women, MHR and PLR were significantly associated with the presence of TN and non-micronodule; in men, MHR and NLR were significantly associated with the presence of TN and non-micronodule.

Conclusions

As a low-cost, simple, and reproducible inflammatory marker, MHR is strongly associated with the presence and size of TN irrespective of the gender.

[Detection rate of thyroid nodules in routine health check-up and its influencing factors: a 10-year survey of 309 576 cases]

OBJECTIVE

To analyze the detection rate of thyroid nodules and its influencing factors among individuals undergoing routine health check-up in Guangdong Province.

METHODS

We analyzed the results of thyroid ultrasonography of 309 576 individuals receiving routine health check-up in a general hospital in Guangdong Province over the past 10 years. The data were compared between the individuals with and without thyroid nodules using two independent samples t test, MannWhitney U test and Chi-square test. Binary logistic regression was used to analyze the relationship between different factors and thyroid nodules, and the odds ratio (OR) and 95% confidence interval (95% CI) were calculated.

RESULTS

Based on the structured and standardized data, the total detection rate of thyroid nodules was 9.68% among the individuals, 7.71% in male and 13.51% in female subjects, showing a significant gender difference (χ2=2677.08, P < 0.001). In the overall population, the detection rates of thyroid nodules gradually increased with age, but in each age group, the detection rate remained significantly higher in female subjects than in male subjects (P < 0.001). The subjects with thyroid nodules showed a significant higher percentage of male gender, an older age, a greater BMI, and significantly higher SBP, DBP, FBG, TC, LDL-C, HDL-C, TG as well as higher detection rates of fatty liver, hyperlipidemia, hyperglycemia, and metabolic syndrome than those without thyroid nodules (all P < 0.001). Binary logistic regression analysis showed that thyroid nodules were significantly associated with gender (OR=0.455, 95%CI: 0.443-0.468), age (45-59 years: OR=1.660, 95%CI: 1.613-1.710; ≥ 60 years: OR=3.329, 95%CI: 3.202- 3.462), BMI (underweight: OR=0.808, 95%CI: 0.755-0.864; overweight: OR=1.074, 95%CI: 1.038-1.112; obesity: OR=1.281, 95%CI: 1.221-1.343), hyperlipidemia (OR=1.053, 95%CI:1.022-1.085), high blood glucose (OR=1.177, 95%CI: 1.105-1.252), and metabolic syndrome (OR=1.111, 95%CI: 1.071-1.152).

CONCLUSIONS

The detection rate of thyroid nodule is much higher in female than in male individuals in Guangdong Province and is significantly associated with gender, age, BMI and metabolic related diseases. Male gender and underweight might be protective factors for thyroid nodules, while an advanced age, overweight/obesity, hyperlipidemia, high blood glucose and metabolic syndrome are associated with an increased risk of thyroid nodules. Thyroid ultrasound examination is recommended in routine health check-up for early detection and treatment of thyroid diseases.

Concentration of Metals and Trace Elements in the Normal Human and Rat Thyroid: Comparison with Muscle and Adipose Tissue and Volcanic Versus Control Areas

Background: The concentration of trace elements and metals in the thyroid is the result of exposure, uptake, retention, and clearance. The specificity and selectivity of thyroid capacity to concentrate these elements relative to other tissues are not known. To obtain this information, we measured the tissue concentration of 26 elements in the thyroid, muscle, and fat of euthyroid human subjects and also in normal rats. Methods: At programmed surgery, small (<1 g) tissue fragments were collected in 77 euthyroid subjects. Macroscopically normal thyroid tissue, sternothyroid muscle, and neck subcutaneous fat samples were excised, and thyroid tissue was confirmed to be morphologically normal through microscopy. Tissue specimens (thyroid, hindlimb muscle, and abdominal fat) were also obtained from normal rats. Measurements of trace elements were performed on tissues using inductively coupled plasma mass spectrometry (DRC-ICP-MS). Results: Only 19 of the 26 investigated elements were measurable as 7 elements were below the limit of detection. The ranking concentration in human thyroid tissue, not considering iodide, indicated that Zn, Br, Cu, Cr, Se, and Mn represented over 95% of the measured elements. A similar ranking was observed in the rat thyroid. A comparison with other tissues indicated that in addition to I, also Br, Mn, Se, and Sn were significantly more concentrated in the thyroid, and this was also the case for the recognized carcinogens As, Cd, and Hg. As and Hg, but not Cd (which was not detectable in any of the rat tissues), were also more concentrated in the rat thyroid. Since human thyroid specimens were also obtained from residents of a volcanic area, where environmental pollution may cause human biocontamination, we compared the trace element concentration in specimens from the volcanic area with controls. Many trace elements were slightly, but not significantly, increased in the volcanic area specimens. Conclusions: In the normal human thyroid, many trace elements, including Br, Mn, Se, and Sn, and the recognized carcinogens, As, Cd, and Hg, are significantly more concentrated than in muscle and fat of the same individual. Similar data were observed in rats. The reason for the differential element accumulation in the thyroid is unclear; a better understanding may be useful to further clarify thyroid biology.

The Prevalence of Single and Multiple Thyroid Nodules and Its Association with Metabolic Diseases in Chinese: A Cross-Sectional Study

PURPOSE

The present study aims to investigate the prevalence of single and multiple thyroid nodules and its association with metabolic diseases in subjects who participated in the heath examination in China.

METHODS

This is a cross-sectional study. The participants who attend the physical examination at the Health Management Center of Southwest Hospital, Army Military Medical University, between January 2014 and December 2018, were included. Thyroid nodules were diagnosed by thyroid ultrasound. Multivariable logistic regression was used to investigate the association between metabolic diseases and nodular thyroid disease.

RESULTS

A total of 9,146 subjects were included in this study; of them, 2,961 were diagnosed with thyroid nodules, with a prevalence of 32.4%. The prevalence in women was significantly higher than that in men (45.2% vs 26.0%; χ ²  = 339.56, P < 0.001), and the prevalence was gradually increased with age (Z = 20.05, P < 0.001), and the prevalence was gradually increased with age (.

CONCLUSIONS

The prevalence of thyroid nodules was relatively high. Age, female gender, and diabetes are positively associated with nodular thyroid disease. High LDL cholesterolemia is more likely to be associated with multiple thyroid sarcoidosis.

Large-Scale Comparative Analysis Reveals A Simple Model To Predict The Prevalence Of Thyroid Nodules

Background

The frequency of thyroid nodules (TNs) has increased rapidly in recent decades. We established a simple, effective model to predict TN occurrence by a large-scale comparative analysis of the Chinese population.

Subjects and methods

A total of 13,307 subjects were included to screen risk factors between the case group (TN+) and the control group (TN-) by univariate and multivariate analyses. A simple prediction model formed by a subset of five factors was established. The optimal index points for predicting the prevalence of TNs, the model discriminatory power and the association of the model with the size of TNs were assessed.

Results

Age at diagnosis ≥45 years, female sex, body mass index (BMI) ≥24 kg/m², hypertension, antithyroglobulin antibody (TGAB) ≥16.5 IU/mL were independently related to an increased risk of TNs. The cutoff value of 4 points was found to be the best prediction for the prevalence of TNs in the current study, and the model had better discriminatory power than other single independent predictors. In addition, a positive correlation was also found between the index points and the diameter of TNs.

Conclusion

Based on our prediction model, thyroid high-resolution ultrasound and associated laboratory tests may be necessary for patients with index points ≥4 due to a higher prevalence of thyroid nodules.

Association of adiposity with thyroid nodules: a cross-sectional study of a healthy population in Beijing, China

BACKGROUND

The relationship between thyroid nodules (TNs) and adiposity is controversial. This paper describes a cross-sectional investigation performed to determine the existence of any such relationship. To assess adiposity, body mass index (BMI) and visceral fat area (VFA) were utilized.

METHODS

Between January 1, 2017 and March 3, 2019. Three thousand five hundred thirty four healthy people were examined using thyroid ultrasonography, visceral fat and anthropometric measurements, laboratory tests and questionnaire interview. Binary logistic regression analyses were used.

RESULTS

Of the 3534 healthy subjects, 58.69% (2074/3534) of the subjects had TNs. A total of 55.91% (1976/3534) had BMI ≥ 25 kg/m² and 39.67% (1402/3534) had VFA ≥ 100 cm². After adjustment to address confounders, BMI-based overweight and obesity levels only correlated with higher risk TNs when used as a continuous variable (OR = 1.031, 95% CI: 1.008-1.055, P = 0.008), while VFA was both a continuous variable (OR = 1.003, 95% CI: 1.000-1.005, P = 0.034) and a categorical variable (OR = 1.198, 95% CI: 1.014-1.417, P = 0.034) associated with significantly elevated risk of TNs. Analyzing the subgroups, BMI ≥ 25 kg/m² (OR = 1.500, 95% CI: 1.110-2.026, P = 0.008) was significantly correlated with TN risk in individuals with TG ≥ 1.7 mmol/L. VFA ≥ 100 cm² correlated with the TN risk irrespective of age (< 50 years: OR = 1.374, 95% CI: 1.109-1.703, P = 0.004; ≥ 50 years: OR = 1.367, 95% CI: 1.063-1.759, P = 0.015) and in the following subgroups: women (OR = 4.575, 95% CI: 2.558-8.181, P = 0.000), FBG ≥ 6.1 mmol/L (OR = 1.522, 95% CI: 1.048-2.209, P = 0.027), and TG ≥ 1.7 mmol/L (OR = 1.414, 95% CI: 1.088-1.838, P = 0.010).

CONCLUSIONS

Adiposity correlates with TNs. To assess TN risk in Chinese individuals, VFA is better than BMI.

Relationship between metabolic syndrome and thyroid nodules and thyroid volume in an adult population

PURPOSE

The effects of metabolic syndrome (MetS) on thyroid nodules (TN) and thyroid volume (TV), especially the related gender and age disparities, are controversial. In this study, we aimed to assess the relationships between MetS and TN and TV in an adult population.

METHODS

This cross-sectional study was performed in an adult population in Tianjin. A total of 2606 subjects were enrolled. TV and TN were measured by thyroid ultrasonography. Blood samples were collected to measure biochemical and metabolic parameters.

RESULTS

The prevalence of TN was significantly higher in the MetS (+) group than in the MetS (-) group (P < 0.0001). MetS was independently associated with increased TN risk (OR: 1.24, 95% CI: 1.01-1.51). When stratified by gender, MetS was associated with higher prevalence of TN in males (OR: 1.38, 95% CI: 1.05-1.81) compared with females (OR: 1.02, 95% CI: 0.75-1.39). However, the interaction effect of gender and MetS on TN was not statistically significant (P for interaction = 0.94). MetS was associated with the greater risks of TN in both the <60-year-old group (OR: 1.32, 95% CI: 1.05-1.68) and the ≥60-year-old group (OR: 1.84, 95% CI: 1.24-2.73), while the OR value was significantly higher in the elderly group (P for interaction = 0.03). Additionally, TV was significantly higher in subjects with TN (β = 1.94, P < 0.0001) and MetS (β = 0.94, P = 0.0037).

CONCLUSIONS

This study suggested positive relationships between MetS and an increased risk of TN and enlarged TV. Elderly people (≥60 years old) with MetS were associated with a higher risk of TN than younger people (<60 years old). The effect of MetS on TN was not significantly affected by gender.

Thyroid Nodules in Type 2 Diabetes Mellitus

The present analysis aims to investigate the prevalence of thyroid nodules in type 2 diabetes mellitus (T2DM) population. We searched PubMed, EMBASE, and Web of Science from inception to the March 1, 2018. The studies were selected to estimate the prevalence of thyroid nodules in T2DM subjects and to compare the prevalence of thyroid nodules in different glucose tolerance status. The random effects model was used, and the outcome was presented as a pooled prevalence proportion with 95% confidence interval (95% CI) or a summary odds ratio (OR) with 95% CI. In the end, 9 studies met the inclusion criteria and were included in the analysis. The pooled prevalence of thyroid nodules was 60% (95% CI: 0.52, 0.68) for T2DM 2 diabetes patients, 50% (95% CI: 0.48, 0.51) for pre-diabetes, and 43% (95% CI: 0.34, 0.52) for normal glucose tolerance population. Compared with patients without diabetes, diabetes subjects are more likely to develop thyroid nodules, adjusted OR for thyroid nodule was 1.78 (95% CI: 1.25, 2.55). Insulin resistance might be involved in thyroid nodule development.

Anthropometric Parameters and Thyroid Morphology in a Sample of Overweight and Obese Syrian Women

Objective: Obesity and thyroid nodules are very common. Many studies have reported that weight gain is a new risk factor for goiters and thyroid nodules. In this study, the authors aimed to evaluate thyroid morphology in obese women and tried to link thyroid morphology with anthropometric parameters. Design: A cross-sectional study was conducted between January 2017 and January 2018. Overweight and obese Syrian females, aged >35 years, without past or recent thyroid complaints, and living in the southern region of Syria were included in the study. Weight, height, and hip and waist circumference were measured to calculate anthropometric parameters. Thyroid volume and prevalence of thyroid nodules were compared among BMI groups as defined by World Health Organization classifications. Body Surface Area (BSA), waist circumference (WC), waist:hip ratio, and waist-to-height ratio (WtHR) were compared between nodule groups. Results: A total of 140 overweight and obese females, with a mean age of aged 53±7 years were studied. Mean thyroid volume was 12.4±7.4 mL, with the highest volume identified in the Obesity Class III group (14.9±10.9 mL). Significant positive correlations were found between thyroid volume and weight, BMI, WC, BSA, and WtHR (p<0.05). Thyroid nodule prevalence was 84.3%, and 22.0% of the nodules were fine needle aspiration indicated. Weight and BSA were positively correlated with thyroid nodules (p<0.05), while BMI was not. Conclusion: Thyroid volume was positively correlated with increased weight, BMI, WC, BSA, and WtHR in Syrian females. Positive correlations were found between weight, BSA, and thyroid nodules after age and thyroid stimulating hormone were excluded.

Association Between Thyroid Nodules and Volume and Metabolic Syndrome in an Iodine-Adequate Area: A Large Community-Based Population Study

Background: Given its high incidence, thyroid nodule (TN) warrants public attention. Thyroid volume (TV) has also been associated with multiple factors, such as iodine deficiency and supply and body mass index. It is well known that metabolic syndrome (MetS) comprises many metabolic disturbances, with insulin resistance being its major component. Materials and Methods: The aim of this study was to investigate the relationship between TN and TV and MetS and its components in an iodine-adequate area in Asia. All participants were asked to complete a questionnaire. After excluding 938 individuals based on the exclusion criteria, we reviewed data from 927 of 1865 participants. Adopting MetS diagnostic criteria, we found 437 subjects to be MetS positive [MetS(+)] and 490 subjects to be MetS negative [MetS(-)], respectively. Multivariate linear regression was used to assess the relationship between TNs and MetS. Moreover, univariate binary logistic regression analyses were used to calculate odds ratios (ORs), and 95% confidence intervals (CIs) were used to estimate the associations between different variables and TNs. Results: A total of 232 females and 205 males were MetS(+), as diagnosed using the International Diabetes Federation criteria. However, there were 330 females and 160 males in the group of MetS(-) individuals. The prevalence of TNs was 38.29% in the MetS(+) group and 17.79% in the MetS(-) group. After adjusting for systolic blood pressure, diastolic blood pressure, and gender, only high-density lipoprotein, waist circumference (WC), and age were related to TNs (OR = 0.45, 95% CI 0.27-0.75, P = 0.0023; OR = 1.04, 95% CI 1.02-1.06, P = 0.0036). The TV of all participants was 13.98 (11.24, 17.01) mL; 13.26 (10.62, 16.17) mL for females and 14.96 (11.83, 18.01) mL for males. It was found that only WC was related to TV, after controlling for sex and age (P = 0.02). Conclusions: The morbidity among TN patients in the MetS(+) group was higher than that among the MetS(-) group. High-density lipoprotein cholesterol emerged as a protective factor, and WC was a risk factor for TN. Moreover, TV was related to MetS, and WC was an independent risk factor for TV.

Correlation analysis of metabolic syndrome and its components with thyroid nodules

OBJECTIVE

This study aimed to analyze the relationship between the metabolic syndrome (MetS) and its components with the occurrence of thyroid nodules.

METHODS

A total of 2719 volunteers from some areas of Gansu Province, China, who participated in the national survey of thyroid diseases and iodine nutrition status (Tide) and diabetes prevalence, were selected. Their height, weight, waist circumference (WC), systolic blood pressure (SBP), and diastolic blood pressure were recorded. The fasting plasma glucose (FPG), 2-h plasma postprandial glucose (2hPG), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and glycosylated hemoglobin (HbA1C) levels were measured. The prevalence of MetS and thyroid nodules was evaluated, and the correlation between each component of MetS and thyroid nodules was studied.

RESULTS

The prevalence of MetS and thyroid nodules was 15.4% and 17.2%, respectively. WC, SBP, body mass index, FPG, 2hPG, TG, TC, and thyroid-stimulating hormone levels were significantly higher in the thyroid nodule group. The prevalence of thyroid nodules was significantly higher in the MetS group. A positive correlation was found between the degree of metabolic disorder and the occurrence of thyroid nodules. WC was found to be a risk factor for the occurrence of thyroid nodules. For WC≥90 cm, an increase in the independent variables led to a significant rise in the incidence of thyroid nodules.

CONCLUSION

The prevalence of thyroid nodules was higher in the MetS group. The WC of the MetS components might be an independent risk factor for the occurrence of thyroid nodules.

The association between thyroid cancer and insulin resistance, metabolic syndrome and its components: A systematic review and meta-analysis

BACKGROUND

Thyroid cancer is rapidly increasing in incidence worldwide in the past several decades, same as the incidence of metabolic syndrome. We performed a system review and meta-analysis of the association between metabolic syndrome, its components and insulin resistance and thyroid cancer incidence.

METHODS

We searched several computer-assisted databases PUBMED, EMBASE and ISI Web of Science to identify studies published before 31st January 2018. Every study must report either risk estimates of thyroid cancer incidence with 95% confidence interval (CI) or related data can speculate. Two investigators independently identified eligible studies and extracted data. Evaluating the summaries of relative risk estimates use both fixed and random effects methods.

RESULTS

We found 42 articles met the inclusion criteria of this review. There is an increased risk for thyroid cancer for patients with insulin resistance (relative risk [RR] = 1.59, 95%confidence interval [CI] = 1.12-2.27, P = 0.01), dysglycemia (RR = 1.40, 95%CI = 1.15-1.70,P < 0.001), high BMI (RR = 1.35,95%CI = 1.23-1.48,P < 0.001) and hypertension(RR = 1.34,95%CI = 1.22-1.47, p < 0.001). However, patients with dyslipidemia, both total cholesterol (RR = 1.09, 95%CI = 0.98-1.21, P = 0.13) and triglyceride (RR = 1.01, 95%CI = 0.91-1.12, P = 0.82) was not associated with thyroid cancer.

CONCLUSIONS

Our meta-analysis showed Insulin Resistance, dysglycemia, high BMI and hypertension significantly increased the thyroid cancer risk. These results may help identify people with high risk of thyroid cancer and change to healthy life style.

Prevalence of thyroid nodules and their associated clinical parameters: a large-scale, multicenter-based health checkup study

Background/Aims

We evaluated the prevalence and characteristics of thyroid nodules detected by thyroid ultrasound (US) at health checkups and the associated clinical parameters.

METHODS

A total of 72,319 subjects who underwent thyroid US at three health checkup centers in Korea from January 2004 to December 2010 were included in this study. The correlations between the presence of thyroid nodules and other clinical parameters were analyzed.

RESULTS

The prevalence of thyroid nodules and cysts was 34.2% (n = 24,757). Thyroid nodules were more prevalent in women and older age groups. Among the subjects with thyroid nodules with size information (n = 24,686), 18,833 (76.3%) had nodules measuring ≤ 1.0 cm. Women and older age groups showed higher proportion of larger nodules. Percentage of women, age, body mass index (BMI), waist circumference, body fat composition, blood pressure, and the level of fasting glucose, total cholesterol, and low density lipoprotein cholesterol were higher in the subjects with thyroid nodules compared to those without nodules. The prevalence of metabolic syndrome and overt/subclinical thyrotoxic state was higher in the subjects with thyroid nodules. In the multivariable logistic regression analysis, women, age, BMI, metabolic syndrome, and thyrotoxicosis were independently associated with the presence of thyroid nodules.

Conclusions

The high prevalence of thyroid nodules in people who underwent thyroid US at a health checkup suggests that increased detection of thyroid nodules resulted in an increased prevalence in the general population. However, metabolic disturbances may also have contributed to the increase in thyroid nodule prevalence in Korea.

Prevalence and Annual Incidence of Thyroid Disease in Korea from 2006 to 2015: A Nationwide Population-Based Cohort Study

BACKGROUND

The incidence of thyroid nodules has increased worldwide in recent years. Thyroid dysfunction is a potential risk factor for hypercholesterolemia, cardiovascular disease, osteoporosis, arrhythmia, and neuropsychiatric disease. This study investigated the prevalence and annual incidence of thyroid nodules, hypothyroidism, and hyperthyroidism in Koreans.

METHODS

In this nationwide population-based cohort study, 51,834,660 subjects were included using the National Health Information database from 2006 to 2015, after the exclusion of subjects with thyroid cancer.

RESULTS

The prevalence in Korea in 2015 of thyroid nodules, hypothyroidism in patients taking thyroid hormone, and hyperthyroidism in patients undergoing treatment was 15.82/1,000 population, 15.94/1,000 population, and 2.76/1,000 population, respectively. All these diseases were more prevalent among women than among men. The number of incident cases of these three thyroid diseases steadily increased from 2006 to 2012, and then decreased through 2015. The incidence of thyroid nodules, hypothyroidism treated with thyroid hormone, and treated hyperthyroidism was 6.79/1,000 population, 1.76/1,000 population, and 0.55/1,000 population, respectively, in Korea in 2015. The use of methimazole continuously increased, from 33% of total antithyroid drug prescriptions in 2006 to 74.4% in 2015, and it became the most frequently prescribed antithyroid drug in Korea. In contrast, the use of propylthiouracil continuously decreased.

CONCLUSION

This was the first nationwide study of the prevalence and annual incidence of thyroid nodules, hypothyroidism, and hyperthyroidism to take into account recent changes and to include the current status of patients receiving treatment.

Association of obesity and diabetes with thyroid nodules

AIM

There are conflicting data concerning the possibility that obesity and diabetes raise the risk of thyroid nodules. The incidence of thyroid nodules is increasing, as is that of obesity and diabetes; therefore, understanding whether these metabolic and nutritional disorders influence nodular thyroid disease is important for organizing prevention strategies. This study investigated the association between thyroid nodules, obesity, diabetes, and dietary habits.

MATERIALS AND METHODS

A cohort of randomly selected adults (455 males, 746 females; age: 18-90 years) living in Palermo (Italy), a mild iodine deficiency area, was cross-sectionally investigated. Participants underwent high-resolution ultrasonographic evaluation of the thyroid, and answered a food frequency questionnaire. Laboratory blood measurements were obtained in 587 participants.

RESULTS AND DISCUSSION

Thyroid nodules were detected in 475 (39.5%) participants. The number of thyroid nodules was correlated with age (r = 0.19; P < 0.001), gender (r = 0.08; P = 0.005), and body mass index (r = 0.07; P = 0.02). No significant correlation was observed between the number of nodules and glycated hemoglobin, serum insulin concentrations, and homeostasis model assessment of insulin resistance. Age-adjusted and gender-adjusted prevalence of both overweight/obesity and type 2 diabetes of each group of participants divided according to the number of nodules significantly increased with the number of nodules (P < 0.05 in both cases). The group of participants with nodules exhibited a significantly lower age-adjusted and gender-adjusted habitual intake of milk (P = 0.02). Multivariate regression analysis showed that age, gender, body mass index, diabetes, and habitual consumption of milk were independently correlated with presence of thyroid nodules.

CONCLUSION

This study seems to indicate that an association exists between obesity, diabetes, and thyroid nodules.

The prevalence of thyroid nodules in northwest China and its correlation with metabolic parameters and uric acid

This study aimed to estimate the prevalence of thyroid nodules (TN) and investigate its correlation with metabolic parameters, especially uric acid (UA) in northwest Chinese population. We conducted a large cross-sectional survey with 67,781 residents (33,020 men, 34,761 women), aged from 18 to 86 years in Shanxi, China, from January 2012 to December 2014. A thyroid ultrasound examination was performed with number and size of nodules being recorded. Metabolic parameters including body mass index (BMI), blood pressure (BP), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), fasting glucose (FG), and uric acid (UA) were also examined. Our study revealed that approximately 30.7% of men and 39.9% of women in Northwest China had TN, about half of which were multi-nodularity and a quarter of their TN larger than 1 cm. The prevalence of TN increased with aging and increasing BMI, and metabolic disorders, which also related to the increased incident of multi-nodularity and larger TN. Serum UA appeared to be a protective factor for TN in men older than 30 years, but a risk factor in both men younger than 30 years and women older than 30 years. This phenomenon needs to be further investigated.

Thyroid nodules in centenarians: prevalence and relationship to lifestyle characteristics and dietary habits

BACKGROUND

Thyroid nodules (TNs) are common thyroid lesions in older population. Few studies have focused on the prevalence of TNs and their relationship to lifestyle characteristics and dietary habits in centenarians. The current study aimed at determining the prevalence of TNs in Chinese centenarians by using high-resolution ultrasound (US) equipment and at investigating its relationship to lifestyle characteristics and dietary habits.

PARTICIPANTS AND METHODS

The current study was part of the China Hainan Centenarian Cohort Study that was conducted in Hainan, an iodine-sufficient region in People's Republic of China. A total of 874 permanent residents aged ≥100 years (mean age =102.8±2.8 years) without any missing data were included in the analysis.

RESULTS

Among the participants, 649 of them were detected at least one TN under the US examinations. The overall prevalence rate of TNs was 74.3%. The prevalence of TNs was higher in participants who were women, had hypertension, had diabetes, and were underweight compared with their counterparts. Multivariate logistic regression analyses showed that being female, hypertensive, and diabetic; betel quid consumption; and red meat consumption were independent risk factors, while being underweight and nut consumption were independent protective factors for TNs.

CONCLUSION

Our findings indicate that the presence of TNs was highly prevalent in Chinese centenarians, particularly in women. In addition to gender, having hypertension, having diabetes, and being underweight, the presence of TNs was independently associated with betel quid, red meat, and nut consumption. Further prospective studies are warranted to verify these associations in populations from different age strata, races, cultures, and iodine supplementation.

Association of thyroid nodules with adiposity: a community-based cross-sectional study in China

BACKGROUND

The association between thyroid nodules and adiposity remains controversial. We performed a cross-sectional, community-based study to examine whether thyroid nodules are associated with overweight and obesity, as defined with body mass index (BMI) and waist circumference.

METHODS

The study included 1482 subjects (≥20 years of age; residing in Nanjing, China) receiving questionnaire interview, anthropometric measurements, laboratory tests and thyroid ultrasonography in 2009-2010. Overweight and obesity were defined as BMI ≥24 and ≥28 kg/m², respectively. Central obesity was defined as waist circumference at ≥90 cm in men and ≥80 cm in women. A sensitivity analysis was conducted using the American Diabetes Association (ADA) criteria for overweight and obesity (BMI ≥ 23 and ≥25 kg/m²).

RESULTS

Thyroid nodules were identified in 12.6% of the subjects. A greater proportion of the subjects with thyroid nodules had a BMI at ≥24 kg/m² (51.9% vs. 40.5% in those without thyroid nodules, P = 0.003) and central obesity (43.3% vs. 24.2%, P < 0.001). After adjustment for other confounders, central obesity was still associated with significantly elevated risk of thyroid nodules (OR 1.62, 95%CI 1.14-2.28), whereas obesity/overweight based on BMI was not in both the main analysis and sensitivity analysis with the alternative criteria. In the subgroup analysis, BMI ≥24 kg/m² (OR 1.61, 95%CI 1.01-2.54), as well as BMI ≥25 kg/m² (OR 1.95, 95%CI 1.14-3.34), was significantly associated with higher risk of thyroid nodules among women. Using the ADA criteria, overweight and obesity were associated with thyroid nodules (OR 5.59, 95%CI 1.39-22.51 and 5.15, 95%CI 1.30-20.37) in thyroid-stimulating hormone (TSH) > 4.2 mIU/L subgroup. Central obesity correlated with higher risk of thyroid nodules regardless of age (< 50 years: OR 1.87, 95%CI 1.05-3.32: ≥50 years: OR 1.54, 95%CI 1.00-2.37) and in the following subgroups: men (OR 1.91, 95%CI 1.14-3.20), TSH > 4.2 mIU/L (OR 3.05, 95%CI 1.01-9.22), and urine iodine ≥200 µg/L (OR 1.79, 95%CI 1.14-2.81).

CONCLUSION

Waist circumference is superior to BMI for assessing risk of thyroid nodules in Chinese subjects.

Associations of adiposity measurements with thyroid nodules in Chinese children living in iodine-sufficient areas: an observational study

OBJECTIVES

Obesity has been found to be associated with an elevated risk of thyroid nodule(s), mainly in adults; however, evidence for this association in children was limited. The objective of this study was to investigate the association of adiposity and thyroid nodule(s) in children living in iodine-sufficiency areas.

SETTING AND PARTICIPANTS

We conducted a cross-sectional study of 1403 Chinese children living in the East Coast of China in 2014.

OUTCOME MEASURES

Anthropometric measures including height, weight and waist and hip circumferences were taken, and body mass index (BMI), body surface area (BSA) and waist-hip ratio (WHR) were then calculated. Thyroid ultrasonography was performed to assess thyroid volume and nodules.

RESULTS

Based on BMI, 255 (18.17%) children were overweight and 174 (12.40%) were obese. Thyroid nodule(s) was detected in 18.46% of all participants and showed little age and sex variations. As compared with normal-weight children, obese children experienced significantly higher risks for solitary (OR 2.07 (95% CI 1.16 to 3.71)) and multiple (OR 1.67 (95% CI 1.03 to 2.70)) thyroid nodules. Similar associations with thyroid nodule(s) were observed with adiposity measured by waist circumference and BSA, but not WHR. There were no notable differences in the associations between children consuming iodised and non-iodised salt.

CONCLUSIONS

These findings provide further evidence that childhood obesity is associated with the risk for thyroid nodule(s).

Gender Disparity in the Relationship between Prevalence of Thyroid Nodules and Metabolic Syndrome Components: The SHDC-CDPC Community-Based Study

The study is aimed to investigate the pathogenesis underlying the increased prevalence of thyroid nodule (TN) in different levels of metabolic syndrome (MetS) components and analyze the relationships between TN and MetS components. A total of 6,798 subjects, including 2201 patients with TN, were enrolled in this study. Anthropometric, biochemical, thyroid ultrasonographic, and other metabolic parameters were all measured. There was obviously sexual difference in the prevalence of TN (males 26.0%, females 38.5%, resp.). The prevalence of TN in hyperuricemia (45.7% versus 37.4%, P = 0.001), NAFLD (41.2% versus 36.4%, P < 0.05), and MetS (41.4% versus 35.4%, P < 0.001) groups was significantly increased only in females. Insulin resistance [OR = 1.31 (1.15, 1.49)], MetS [OR = 1.18 (1.03, 1.35)], and diabetes [OR = 1.25 (1.06, 1.48)] were all independent risk factors for TN in total subjects, whereas, after stratified analysis of gender, MetS [OR = 1.29, (1.09, 1.53)] and diabetes [OR = 1.47, (1.17, 1.84)] are still strongly and independently associated with the higher risks of TN in female subjects, but not in males. Our results suggest that the components of MetS might associate with the higher risks of TN in women than in men, but further cohort study of this gender disparity in the association between TN and MetS is required.

Ultrasound-Guided Percutaneous Microwave Ablation for Solid Benign Thyroid Nodules: Comparison of MWA versus Control Group

BACKGROUND

The aim of this research is to investigate the feasibility of percutaneous ultrasound-guided microwave ablation (MWA) for benign solid thyroid nodules.

METHODS

Ultrasound-guided percutaneous microwave ablation was performed for 90 benign solid thyroid nodules in 75 patients. The volume changes of the nodules were evaluated before and after microwave ablation, and the cosmetic grading and clinical symptoms were assessed as well.

RESULTS

The volume of all the 90 benign thyroid nodules obviously decreased after microwave ablation at 3-, 6-, 9-, and 12-month follow-ups (p < 0.01), while that of the control group increased at the follow-up of 12 months (p < 0.01). The volume reduction rate (VRR) at 3-, 6-, 9-, and 12-month follow-ups was 55.98%, 69.31%, 76.65%, and 84.67% in the MWA group, respectively. The cosmetic problems and clinical symptoms were also improved in the MWA group. All the patients are well tolerated to the procedure. Hoarseness occurred in 2 cases (2.7%) and Horner syndrome in 1 case (1.3%), and 1 patient (1.3%) developed slight burn on cervical skin.

CONCLUSIONS

Ultrasound-guided percutaneous microwave ablation is a practical method for treating benign solid thyroid nodules, and the complications were acceptable. The trial is registered with clinicaltrials.gov with the registration number NCT03057925.

Evolutionary features of thyroid cancer in patients with thyroidectomies from 2008 to 2013 in China

To evaluate the characteristics of thyroid carcinoma over time, we carried out a retrospective study to illustrate the evolutionary features of thyroid carcinoma. All records of thyroidectomies from the First Affiliated Hospital of Nanjing Medical University from 2008 to 2013 were obtained focusing on pathological diagnosis, size, local lymph node metastasis (LNM) of the tumors. The thyroid cancer detection rate increased from 24.6% to 41.5% significantly (P < 0.05). Papillary thyroid carcinoma (PTC) remained to be the most common type counting 86.4% of all thyroid carcinomas. In all 1,704 PTCs, microPTC (mPTC) with maximum diameter less than or equal to 10 mm has become the dominant form taking up 56.5% of all PTCs in 2013 while only 43.1% in 2008. The mean maximum tumor size has decreased from 17.8 mm to 12.2 mm significantly (P < 0.05). However, the average age, female dominance, and local LNM remained similarly in the past six years. Logistic regression test showed that the determinants for local LNM were age, gender and tumor size. mPTC has become the most common form of thyroid carcinoma detected during thyroidectomies in China while other features of thyroid carcinoma remained similarly in the recent years.

The Prevalence of Thyroid Nodules and an Analysis of Related Lifestyle Factors in Beijing Communities

Thyroid nodules (TNs) have annual increasing trends worldwide, and large-scale investigations on the prevalence of TNs in Beijing communities have not been conducted since the introduction of salt iodization in 1995. We performed a cross-sectional study to determine the prevalence of TNs, their epidemiological characteristics, and their correlation with lifestyle factors. A total of 6324 permanent residents aged 18 years or older (mean age, 52.15 ± 11.58 years) from seven representative communities in Beijing were included in the analyses. Once informed consent was obtained, the subjects were asked to complete questionnaires, a physical examination, and thyroid ultrasound. A total of 3100 cases had TNs. The overall prevalence rate was 49.0%, and the age-standardized prevalence was 40.1%, which increased significantly as age increased (p < 0.001). The prevalence was significantly higher in females compared to males (p < 0.001), and it was significantly higher among female current smokers and former smokers compared to non-smokers (p = 0.007). There was no correlation between alcohol consumption and TNs, and there were no significant differences in the prevalence among different groups of taste preference. The prevalence decreased with an increased frequency of seafood intake (p = 0.015) and with higher literacy levels (p < 0.001). The Cochran-Armitage trend test showed that the prevalence significantly increased with decreased physical labor and exercise intensity (p < 0.001, p = 0.009). Logistic regression analysis showed that age (Odds ratio (OR) = 1.039 (1.034-1.044), p < 0.001), the female sex (OR = 1.789 (1.527-2.097)), Body mass index (BMI) (OR = 1.019 (1.005-1.034)), and current smoking habits (OR = 1.246 (1.046-1.483)) were independent risk factors for TNs. Our findings indicate that there is a high prevalence of TNs in Beijing, with a higher prevalence in females than in males. Moreover, the prevalence increases as age increases. Smoking and BMI are independent risk factors for TNs. Therefore, intervention against smoking and weight loss might help reduce the risk of TN occurrence.

Energy and macronutrient intake and risk of differentiated thyroid carcinoma in the European Prospective Investigation into Cancer and Nutrition study

Incidence rates of differentiated thyroid carcinoma (TC) have increased in many countries. Adiposity and dietary risk factors may play a role, but little is known on the influence of energy intake and macronutrient composition. The aim of this study was to investigate the associations between TC and the intake of energy, macronutrients, glycemic index (GI) and glycemic load in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The study included 477,274 middle-age participants (70.2% women) from ten European countries. Dietary data were collected using country-specific validated dietary questionnaires. Total carbohydrates, proteins, fats, saturated, monounsaturated and polyunsaturated fats (PUFA), starch, sugar, and fiber were computed as g/1,000 kcal. Multivariable Cox regression was used to calculate multivariable adjusted hazard ratios (HR) and 95% confidence interval (CI) by intake quartile (Q). After a mean follow-up time of 11 years, differentiated TC was diagnosed in 556 participants (90% women). Overall, we found significant associations only with total energy (HRQ4 vs .Q1 , 1.29; 95% CI, 1.00-1.68) and PUFA intakes (HRQ4 vs .Q1 , 0.74; 95% CI, 0.57-0.95). However, the associations with starch and sugar intake and GI were significantly heterogeneous across body mass index (BMI) groups, i.e., positive associations with starch and GI were found in participants with a BMI ≥ 25 and with sugar intake in those with BMI < 25. Moreover, inverse associations with starch and GI were observed in subjects with BMI < 25. In conclusion, our results suggest that high total energy and low PUFA intakes may increase the risk of differentiated TC. Positive associations with starch intake and GI in participants with BMI ≥ 25 suggest that those persons may have a greater insulin response to high starch intake and GI than lean people.

An Epidemiological Study of Risk Factors of Thyroid Nodule and Goiter in Chinese Women

Thyroid nodule (TN) and goiter are two common disorders of the thyroid. Despite their benign nature, both conditions can be associated with multiple pathologic conditions including thyroid cancer. In this study, we conducted a large-scale epidemiological study in Chinese women to identify the risk factors implicated in the occurrence of TN and goiter. We analyzed demographic data, lifestyle, medical history, body height, weight, waist circumference, body mass index (BMI), blood pressure, serum glucose and lipids. In addition, thyroid ultrasonography was performed for all subjects. Our results showed that age, menopause, waist circumference, BMI, hypertension, dyslipidemia, and hyperglycemia were associated with both TN and goiter. Furthermore, we found that the prevalence of TN was significantly affected by the medical management of hypertension. Our study suggests that postmenopausal Chinese women with advanced age, obesity, diabetes, and hypertension have an increased awareness of thyroid examination in the annual physical check. Conversely, patients with TN and goiter of the same population may have a higher incidence of age- and obesity-related metabolic disorders.

Lipotoxicity, a potential risk factor for the increasing prevalence of subclinical hypothyroidism?

CONTEXT

Subclinical hypothyroidism (SCH) is an important public health problem worldwide for its increasing prevalence and potential deleterious effects, whereas its etiology has not been fully elucidated. Lipotoxicity exerts extensive and serious impact on human health, but so far, the potential effect of lipotoxicity on thyroid is unclear.

OBJECTIVE

The objective of the study was to assess the association between serum triglyceride levels and the risk for SCH.

DESIGN, PARTICIPANTS, AND METHODS

We conducted a population-based case-control study. A total of 24 100 subjects with similar and stable iodine nutrition status were recruited from China. Cases of 5033 SCH patients were identified and equal controls were matched by age, gender, and region. Conditional logistic regression was used to analyze the association between serum triglyceride levels and risk for SCH.

RESULTS

Hypertriglyceridemia was associated with an approximately 35% increased risk for SCH in both men (odds ratio 1.325; 95% confidence interval 1.002-1.753) and women (odds ratio 1.397; 95% confidence interval 1.217-1.604), even after adjustment for potential confounders. Notably, the risk for SCH increased progressively following the elevation of serum triglyceride levels. Compared with individuals with serum triglyceride levels less than 0.97 mmol/L, the risk for SCH increased approximately 1.9-fold in men and 1.4-fold in women, respectively, when triglyceride levels were greater than 1.99 mmol/L.

CONCLUSION

Our findings suggested that hypertriglyceridemia was positively associated with the risk for SCH.

The association of menstrual and reproductive factors with thyroid nodules in Chinese women older than 40 years of age

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.

Comparison of two different standards of care in detecting malignant thyroid nodules using thyroid fine-needle aspiration

The aim of the present study was to verify the optimal method to obtain enough fine-needle aspiration (FNA) materials for detecting thyroid malignancy. A prospective study was performed by comparing two different regional standards of care. In one group a traditional FNA method mainly used in Asian countries, including China, was performed in which a single pass of a 22-G needle was applied with or without aspiration. In the other group, the method mainly used in Western countries was performed in which three passes of a 25-G needle with non-aspiration were undertaken for thyroid nodules. The study included 718 thyroid nodules from 695 patients. These nodules were allocated for three different methods of performing thyroid FNA. There were 332 thyroid nodules subjected to the traditional Asian FNA method using a 22-G needle with aspiration for 142 nodules and non-aspiration for 190 nodules. FNA using the Western method was performed with three passes of non-aspiration using 25 G for 386 nodules. All the FNAs were performed with the guidance of ultrasound. The components of the nodules were documented. All the samples were reported using the Bethesda System for Reporting Thyroid Cytopathology. Among the 22 G group, the non-diagnostic rate in the aspiration group was as high as 76.76%, which was significantly higher than 44.21% in the non-aspiration group (P<0.01). For the non-aspiration group, the non-diagnostic rate in the 25 G group was 34.97%, which was significantly lower than 44.21% in the 22 G group. In general, the non-diagnostic rate for the 25-G needle was 34.97%, which was significantly lower than 58.13% in all the 22 G groups. For the solid and mixed nodules, the non-diagnostic rate was lower in the 25-G needle group compared to the 22 G groups with statistical significance. The non-aspiration method using a 25-G needle with multiple passes can result in a higher diagnostic rate for thyroid FNA.

Biochemical and ultrasonographic parameters influencing thyroid nodules elasticity

Elastography is a method of tissue stiffness assessment. It has already been demonstrated that thyroid cancers are less elastic than benign lesions. However, little is known about other factors, which might influence the stiffness of thyroid nodules and disrupt the prediction of malignancy using this technique. The aim of this study was to conduct the first systematic assessment of factors potentially affecting the elasticity of thyroid lesions. One hundred and twenty-two patients with thyroid nodular disease admitted for thyroidectomy underwent preoperative ultrasonography and sonoelastography. The definite diagnosis of thyroid lesions was based on histological examination. What was evaluated in the study was the influence of composition, size, localization, nodularity, and selected laboratory parameters on thyroid nodule elasticity. Firstly, association between the above-mentioned factors and elasticity was assessed in benign lesions. Secondly, all nodules (benign and malignant) were divided into subgroups according to the presence or absence of particular features, which turned out to be an important disturbing factor increasing the stiffness of the lesion in the first step of analysis. There were 22 malignant and 371 benign lesions. The analysis of benign lesions revealed that the presence calcifications (p < 0.0001) significantly increased nodule stiffness. Partially, cystic nodules were significantly less elastic than solid ones (p = 0.03). There was also positive correlation between nodule size and stiffness (p < 0.0001). Lesions localized in the isthmus were significantly less elastic than nodules in other localizations. (p = 0.0001). Solitary nodules were less elastic than lesions in multinodular goiter (p = 0.006). Correlation between Tg concentration and stiffness was significant (p < 0.0001, r = 0.24). The concentration of anti-thyroid autoantibodies was associated with stiffness at the border of significance. However, there was no significant difference between benign lesions in patients with diagnosed chronic autoimmune thyroiditis and patients without the disease. The analysis of the entire group of nodules revealed that shear wave elastography is a valuable modality of thyroid nodule assessment, with sensitivity of over 95 % and specificity of about 70 %. However, the stiffness value of the lesion might be increased in the case of nodules containing calcifications, cystic component, and those of size above 20 mm. Certain clinical conditions or attributes of the lesions influence the stiffness values of thyroid nodules. Identifying these variables is the basis for a credible interpretation of the results of a sonoelastographic examination and makes it possible to estimate the risk of thyroid nodule malignancy adequately.

Prevalence of goiter and thyroid nodules before and after implementation of the universal salt iodization program in mainland China from 1985 to 2014: a systematic review and meta-analysis

OBJECTIVES

We comprehensively estimated the prevalence of goiter and thyroid nodules (TNs) before and after the implementation of the Universal Salt Iodization (USI) program in mainland China and provided information for creating effective health policies.

METHODS

PubMed, Google Scholar, CNKI, Chinese Wanfang and Chongqing VIP databases were searched for relevant studies from Jan 1985 to Feb 2014. Data from eligible citations were extracted by two independent reviewers. All analyses were performed with Stata 11.0 and SPSS 17.0.

RESULTS

Eligible articles (N = 31; 4 in English and 27 in Chinese) included 52 studies (15 about goiter rates made before 1996 and 14 afterwards, and 23 about TNs). Our meta-analysis suggests a pooled prevalence for goiter before and after 1996 and for TNs of 22.8% (95% CI: 15.3%, 30.3%), 12.6% (95% CI: 9.4%, 15.8%) and 22.7% (95% CI: 18.3%, 27.0%), respectively. Egger's test of three independent categories revealed no evidence of publication bias (p = 0.101, 0.148 and 0.113, respectively).

CONCLUSIONS

The prevalence of goiter was reduced by almost half after 1996 in mainland China, so the USI program was considered beneficial. However, subgroup analysis suggests that both insufficient and excess iodine may be associated with goiter. The prevalence of goiter and TNs increased significantly after 2002, suggesting a risk of excessive iodine intake. Thus, salt iodization standardizations should be set according to local conditions.