Association Between Eight Autoimmune Diseases and Thyroid Cancer: A Nationwide Cohort Study

Research progress on estrogen and estrogen receptors in the occurrence and progression of autoimmune thyroid diseases

Autoimmune thyroid disease (AITD) is a category of disease related to sex differences, with a significantly higher incidence in women than in men. In addition to X chromosome inactivation abnormalities, Estrogen and estrogen receptors may lead to the sex differences in AITD. Estrogen, estrogen receptors and estrogen receptor-mediated signaling pathways can affect the number and function of immune cells and the function of the thyroid to promote the development of AITD. This article describes the role of estrogen in regulating the composition ratio and the function of immune cells and the role of estrogen in promoting thyroid cell proliferation and thyroxine-binding protein and thyroid antibody production; the role of estrogen in stimulating the hypothalamus-pituitary-thyroid gland axis; and the role of estrogen and the estrogen receptor in the progression of AITD. These roles offer a new perspective for understanding the pathological mechanism of AITD and provide new targets for future therapeutic strategies.

Increased risk of malignancy and osteoporosis in primary Sjögren's syndrome with thyroid diseases: potential implication from T cells

OBJECTIVES

To evaluate the impact of thyroid diseases (TDs) on the comorbidities incidence and immune system of patients with primary SS (pSS).

METHODS

A total of 329 patients diagnosed with pSS who were admitted between January 2018 and September 2023 were evaluated. The patients were divided into two groups: those with and without TD. Clinical data at the onset of SS were recorded. Kaplan-Meier method and Cox proportional hazards model were utilized for survival analysis. Flow cytometry and immunofluorescence measurements were used to analyse the lymphocyte subtypes.

RESULTS

Of the 329 patients, 109 had TD. The most common types of TD were thyroid nodules (40.4%) and autoimmune thyroid diseases (AITDs) (28.4%). Patients with TD exhibited a significantly elevated incidence risk of malignancy (14.7% vs. 6.4%, P = 0.01) and osteoporosis (OP) (23.9% vs. 14.1%, P = 0.03). TD comorbidity was an independent risk factor of malignancy (HR 4.7, 95% CI 1.1-19.3, P = 0.03) and OP (HR 3.7, 95% CI 1.3-10.2, P = 0.01). Patients with SS and TD exhibited a higher ratio of programmed death-1 (PD1) + subsets of total CD3+ T cells, Th and Tc cells (all P = 0.03), as well as a lower ratio of unswitched memory B cells (P = 0.01) in peripheral blood. The ratio of PD1+ subsets of Th cells in salivary glands also exhibited a significantly increase in these patients compared with those without TD (P = 0.03) and the controls (P < 0.01).

CONCLUSION

The incidence risk of malignancy and OP was significantly elevated in pSS patients with TD. The significant elevated proportions of PD1+ T cells may influence the occurrence of this process.

Identification and validation of the common pathogenesis and hub biomarkers in Papillary thyroid carcinoma complicated by rheumatoid arthritis

BACKGROUND

Papillary thyroid carcinoma coexisting with rheumatoid arthritis is frequently observed in clinical patients, yet its pathogenesis has not been fully elucidated. This investigation sought to further explore the molecular underpinnings of these two diseases.

METHODS

Gene expression profiles for thyroid papillary carcinoma and rheumatoid arthritis patients were obtained from the Comprehensive Gene Expression Database (GEO). Following the discovery of shared differentially expressed genes (DEGs) between these two conditions, three separate analyses were conducted. These included functional annotation, the establishment of a protein‒protein interaction (PPI) network and module, and the identification of hub genes via coexpression analysis. The final step involved the validation of target genes via clinical specimens.

RESULTS

This study analyzed datasets from four GEO databases and identified 64 common DEGs. Functional enrichment analysis revealed that these genes are predominantly associated with pathways related to immunity and signal transduction. Protein‒protein interaction (PPI) network analysis revealed complex interactions among these differentially expressed genes and highlighted several genes that may play pivotal roles in shared pathological mechanisms, namely, CCR5, CD4, IL6, CXCL13, FOXM1, CXCL9, and CXCL10.

CONCLUSION

Our study highlights the shared pathogenesis between papillary thyroid cancer and rheumatoid arthritis. Shared pathways and crucial genes could offer novel perspectives for subsequent investigations into the mechanisms of these diseases.

Bisphenol A exposure enhances proliferation and tumorigenesis of papillary thyroid carcinoma through ROS generation and activation of NOX4 signaling pathways

As a prevalent industrial material and component of consumer products, bisphenol A (BPA) is linked to hormone homeostasis disruption and potential carcinogenicity. However, the precise mechanisms through which BPA contributes to thyroid carcinogenesis, especially in papillary thyroid carcinoma (PTC), are not fully understood. This study investigates how BPA boosts the proliferation and tumorigenic characteristics of thyroid cells. BPA exposure significantly increased cell proliferation in a duration-dependent manner at a concentration of 0.5 μM, which is slightly higher than human exposure levels. Therefore, this study utilized BPA treatment concentrations of 0.1 µM and 0.5 µM. BPA augmented the invasiveness of PTC cells with a dependency on both dosage and temporal factors. RNA-seq and gene expression analysis from normal human thyroid follicular epithelial cells suggested that BPA upregulated genes related to oxidative stress and thyroid cancer. Concurrently, our study revealed significant upregulation of NOX4 in thyroid tumors compared to normal thyroid tissues, with higher expression levels observed in advanced carcinomas by analyses of the TCGA database. BPA induces the upregulation of NOX4 in human thyroid cells, thereby triggering the activation of MAPK and PI3K/AKT pathways. In xenograft models, BPA treatment resulted in increased tumor size and Ki-67 proliferation index, accompanied by upregulated NOX4 expression. Additionally, BPA exposure led to higher levels of free triiodothyronine (FT3), indicating thyroid hormone disruption. Mechanistically, BPA activates the MAPK and PI3K/AKT pathways via NOX4, leading to increased ROS production and cell proliferation. This was further demonstrated through the use of ROS scavenger treatment and si-NOX4, which showed that BPA stimulates ROS generation by activating NOX4/MAPK and NOX4/PI3K/AKT pathways in thyroid cells. This finding enhances our understanding of the pathogenesis of PTC related to BPA exposure and highlights the necessity for rigorous health risk assessments regarding BPA exposure.

Thyroid disease as a comorbidity in inflammatory rheumatic diseases

Thyroid disease is a common comorbidity in inflammatory rheumatic diseases (IRDs). It complicates disease management and treatment of IRDs. The interplay between thyroid disfunction and IRDs is confounded by shared autoimmune mechanisms and systemic inflammation. Available evidence suggests that rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc) are associated with an elevated risk of hypothyroidism, hyperthyroidism, and autoimmune thyroid disease (AITD). This review explores mechanisms of thyroid disease in IRDs, overviews implications for disease management, and highlights approaches to optimal patient outcomes. Recent studies point to the need for routine thyroid screening in high-risk IRD populations and justify therapies with anti-TNF-α and anti-IL-17 agents, targeting both thyroid disease and IRDs. This integrated management strategy is crucial for optimizing therapeutic approaches in overlapping autoimmune conditions.

Risk of Extrahepatic Malignancies in Patients With Autoimmune Hepatitis: A Nationwide Cohort Study

INTRODUCTION

Nationwide, population-based data on the risk of extrahepatic malignancy in patients with autoimmune hepatitis (AIH) in Asian countries are scarce. This study aimed to examine the risk of developing extrahepatic malignancies in a nationwide cohort of patients with AIH.

METHODS

Using claims data from the Korean National Health Insurance Service database, patients diagnosed with AIH between 2007 and 2019 (n = 7,382) were matched in a 1:8 ratio with an age- and sex-matched control population (n = 58,320). We compared the incidence rates and hazard ratios (HRs) of overall and specific extrahepatic malignancies between the 2 groups, while also examining the impact of immunosuppressant use.

RESULTS

During a median follow-up period of 5.2 years, a total of 3,713 extrahepatic malignancies developed. The incidence rate of extrahepatic malignancy in patients with AIH (990.8 cases per 100,000 person-years) was comparable with that in the matched controls (937.6 cases per 100,000 person-years), with an HR of 0.93 (95% confidence interval (CI), 0.81-1.07; P = 0.30). However, a significantly higher risk of hematologic malignancies, particularly lymphoma or myeloma (HR, 2.66; 95% CI, 1.70-4.17; P < 0.001), was observed. The use of glucocorticoids (HR, 0.74; 95% CI, 0.31-1.75; P = 0.50) or azathioprine (HR, 2.12; 95% CI, 0.90-5.02; P = 0.09) had no impact on the risk of lymphoma or myeloma in patients with AIH.

DISCUSSION

In this nationwide, population-based cohort, AIH was not associated with an increased risk of overall extrahepatic malignancy compared with age- and sex-matched controls. However, AIH itself increased the risk of lymphoma or myeloma, independent of immunosuppressant use.

FOXO3 as a potential diagnostic biomarker for autophagy in rheumatoid arthritis: A bioinformatics study

This study aimed to identify genes associated with autophagy and potential diagnostic biomarkers by comparing the gene expression profiles of synovial tissues in patients with rheumatoid arthritis (RA) and healthy individuals, aiming to offer new insights for clinical treatment strategies. We used publicly available datasets to analyze differentially expressed genes (DEGs) between the synovial tissue of RA patients and healthy individuals. Then, we intersected these DEGs with autophagy-related genes to identify autophagy genes in the synovial tissue of RA patients. We further analyzed the biological processes and functions of these genes. Furthermore, we used machine learning to identify characteristic autophagy genes in RA synovial tissue. Finally, we examined the differential expression of these characteristic genes in the blood of RA patients using an external dataset. Our study identified FOXO3 as a potential biomarker for diagnosing RA. FOXO3 gene expression was downregulated in both the synovial tissue and blood of RA patients, suggesting its involvement in multiple biological processes such as local inflammation, oxidative stress, metabolic processes, and immune responses. Our findings suggest that FOXO3 may be a novel biomarker for the clinical diagnosis of RA and may play a crucial role in the pathogenesis of RA. The study provides new insights into the molecular mechanisms of RA and potential new therapeutic targets.

Germline polymorphisms of the NOD2 pathway may predict the effectiveness of radioiodine in differentiated thyroid cancer treatment

PURPOSE

Differentiated thyroid cancer (DTC) presents a complex clinical challenge, especially in patients with distant metastases and resistance to standard treatments. This study aimed to investigate the influence of specific genes and their germline single nucleotide polymorphisms (SNPs) linked to both inflammatory processes and other neoplasms on the clinical and pathological characteristics of DTC, particularly their potential impact on radioiodine (RAI) treatment efficacy.

METHODS

This retrospective analysis involved a cohort of 646 patients diagnosed with DTC after thyroidectomy. Study covering 1998-2014, updated in 2023, included 567 women and 79 men (median age: 49; range: 7-83). SNP selection targeted functional significance, while mutational status was assessed by pyrosequencing for comprehensive characterization. Patient genetic profiles were assessed for associations with disease characteristics, RAI response, and cancer pathology.

RESULTS

Significant correlations emerged between certain SNPs and DTC features. Notably, the NOD2 c.802 T > C variant (rs2066842) was identified as a marker distinguishing between papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC). Moreover, the c.802 T allele was associated with an enhanced response to RAI treatment, indicating a more substantial decrease in posttreatment stimulated thyroglobulin (sTg) concentrations. The NFKB1A allele c.126A (rs696) exhibited connections with lower FTC stages and a reduced probability of multifocality.

CONCLUSION

This study explored the molecular mechanisms of particular SNPs, highlighting the role of NOD2 in innate immunity and the stress response, and its potential impact on RAI efficacy. This research underscores the clinical promise of SNP analysis and contributes to personalized treatment strategies for DTC, emphasizing the relevance of genetic factors in cancer progression and treatment outcomes.

Impact of extrathyroidal autoimmune diseases on clinical features and the efficacy of Iodine-131 therapy in patients with differentiated thyroid cancer

OBJECTIVE

The aim of this study is to assess the impact of extrathyroidal autoimmune diseases (ADs) on the clinical characteristics and efficacy of iodine-131 (131I) therapy in patients with differentiated thyroid cancer (DTC).

METHODS

Patients with DTC who were received 131I therapy simultaneously were classified into the combination group (n = 35) and noncombination group (n = 146) depending on the presence of ADs. The clinical characteristics, such as gender, age, tumor lesions, lymph node metastasis, distant metastasis, 131I therapy efficacy, and use of levothyroxine, were compared between the two groups. Statistical analysis was conducted using SPSS 26.0 and R 4.0.3.

RESULTS

There was a statistically significant difference in age between the combination and noncombination groups (t = -2.872, p < .01), and the optimal cutoff value was 50.5 years. Propensity score matching was completed effectively on a total of 121 patients, using age as the matching factor, comprising 32 cases in the combination group and 80 cases in the noncombination group. The baseline demographic features of the two groups were equivalent after matching (p > .05), and there was no significant difference in the therapeutic efficacy of 131I between the two groups (p > .05). In the subgroup analysis involving patients aged great than 50.5 years, the levothyroxine/weight (µg/kg) was increased in the combination group, and the difference was statistically significant (p < .05).

CONCLUSION

While extrathyroidal ADs may enhance the detection of DTC among elderly women, they have no impact on the clinical characteristics of thyroid cancer or the efficacy of 131I therapy. ADs may necessitate higher per-unit dosages of levothyroxine in patients with DTC, regardless of the clinical status. Consequently, it is not essential for nuclear medicine physicians to consider the presence of ADs when designing treatment plans for patients with DTC.

Causal effects of autoimmune diseases on thyroid cancer: a two-sample Mendelian randomization study

Background

Although numerous studies had revealed associations between autoimmune diseases (AIDs) and thyroid cancer (TC), the potential causal associations between the two remain poorly defined.

Methods

Using five approaches, two-sample Mendelian randomization (MR) analyses were carried out to determine the causal effects of 12 major AIDs on risk of TC. The sensitivity analyses were conducted to verify the reliability of the analysis. The reverse MR analysis was performed to evaluate the possibility of reverse causation.

Results

The results showed a significant causal association of systemic lupus erythematosus (SLE) and primary biliary cirrhosis (PBC) on the risk of TC. Genetically predicted PBC elevated the risk of TC (OR = 1.46, 95% CI = 1.06-2.02, p = 0.021). The risk of TC was also increased by genetically predicted SLE (OR = 6.52, 95% CI = 1.38-30.84, p = 0.018) with heterogeneity. After outlier-corrected analyses, the results still suggested that genetically predicted SLE increased the risk of TC (p = 0.019). No evidence of a causal relationship between the remaining 10 AIDs and TC was observed. No reverse causal effects of TC on AIDs were found in reverse MR analysis.

Conclusion

These findings support a significant causal association of SLE/PBC on the increased risk of TC, indicating that patients with SLE/PBC should be under a close monitoring of TC.

Elucidating the role of Pyroptosis in papillary thyroid cancer: prognostic, immunological, and therapeutic perspectives

BACKGROUND

Pyroptosis, an inflammatory form of programmed cell death, has been implicated in the pathogenesis and progression of several cancers. However, the significance of pyroptosis-related genes (PRGs) in papillary thyroid cancer (PTC) remains unclear.

METHODS

Transcriptome and clinical data of PTC patients were obtained from The Cancer Genome Atlas. The expression patterns of PRGs were identified by consensus clustering. A prognostic model for predicting the thyroid cancer-free interval (TCFi) employed five machine learning methods. Enrichment and immune-related analyses were performed to elucidate the role of pyroptosis. The responses to radioactive iodine (RAI), immune checkpoint inhibitors (ICIs), molecular targeted therapy (MTT), and chemotherapy (CTx) were predicted based on pyroptosis-derived features. Additionally, the expression of prognostic PRGs was validated via six external datasets, 16 cell lines, and 20 pairs of clinical samples.

RESULTS

PTC patients were classified into three PyroClusters, C1 exhibited BRFA-like tumors with the highest invasiveness and the worst prognosis, C2 presented RAS-like tumors, and C3 was characterized by gene fusion. Nine PRGs (CXCL8, GJA1, H2BC8, IFI27, PRDM1, PYCARD, SEZ6L2, SIGLEC15, TRAF6) were filtered out to construct a PyroScore prognostic model. A derived nomogram demonstrated superior predictive performance than four clinical staging systems. A strong correlation between pyroptosis and tumor immune microenvironment (TIME) remodeling was observed in mechanistic analyses. Patients with a high PyroScore exhibited "hot" tumor immunophenotypes and had a poorer prognosis but could benefit more from ICIs and CTx (such as paclitaxel). Patients with a low PyroScore were more sensitive to RAI and MTT (such as pazopanib and sorafenib).

CONCLUSIONS

PyroScore model can effectively predict TCFi in patients with PTC. Dysregulated expression of PRGs is associated with the TIME modeling. Pyroptosis features have potential significance for developing novel therapeutic strategies for PTC patients.