Association between metabolic syndrome and euthyroid nodular goiter: a case-control study
Abstract
Background: Metabolic syndrome is a cluster of metabolic abnormalities and abdominal obesity; its pathophysiologic basis, insulin resistance, has been shown to act as agent in thyroid cell proliferation. Few studies analyze the relationship between metabolic syndrome and thyroid nodular disease, with a substantial knowledge gap.
Objetive: Determine the association between metabolic syndrome and nodular thyroid disease in a region with adequate iodine intake.
Methods: Case-control study. A total of 182 patients referred to radiology to undergo thyroid ultrasonography due to suspicion of thyroid disease. Cases had at least one thyroid nodule greater than 3 mm (n= 91). Controls did not have evidence of thyroid nodules (n= 91).
Results: Bivariate analysis showed a significant association between metabolic syndrome and the presence of thyroid nodule (OR 2.56, 95% CI: 1.41-4.66, p <0.05). Low levels of HDL (OR 2.81, 95% CI: 1.54-5.12, p <0.05) and impaired fasting glucose (OR 2.05, 95%CI 1.10 to 3.78, p <0.05) were significantly associated with the presence of thyroid nodule, independent of the presence of metabolic syndrome. Multivariate analysis maintained the association between metabolic syndrome and thyroid nodule with an OR of 2.96 (95%CI 1.47 to 5.95, p <0.05); similarly, the associations of low levels of HDL (OR 2.77, 95%CI 1.44 to 5.3, p <0.05) and impaired fasting glucose (OR 2.23, 95%CI 1.14 to 4.34, p<0.05) with thyroid nodule remained significant.
Conclusion: The thyroid nodular disease is associated with increased risk of metabolic syndrome, specifically decreased HDL and impaired fasting glucose levels were the factors that increased association was found.
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Keywords
- Thyroid Nodule
- Metabolic Syndrome
- Insulin Resistance
- Case-control study.
- Iodine
- Obesity
- Cholesterol
- Insulin
- human Insulin-Like Growth Factor II
- IGF2 protein
- human Insulin-Like Growth Factor I
- IGF1 protein
References
International Diabetes Federation. The International Diabetes Federation consensus worldwide definition of the metabolic syndrome. Lisbon: IDF; 2006.
Ayturk S, Gursoy A, Kut A, Anil C, Nar A, Tutuncu NB. Metabolic syndrome and its components are associated with increased thyroid volume and nodule prevalence in a mild-to-moderate iodine-deficient area. Eur J Endocrinol. 2009;161(4):599-605. https://doi.org/10.1530/EJE-09-0410
Alberti K, Eckel R, Grundy S, Zimmet P, Cleeman J. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640-5. https://doi.org/10.1161/CIRCULATIONAHA.109.192644
Grundy S, Brewer H, Cleeman J, Smith S, Lenfant C. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition. Circulation. 2004;109(3):433-8. https://doi.org/10.1161/01.ATV.0000111245.75752.C6
Grundy S. Metabolic syndrome pandemic. Arterioscler Thromb Vasc Biol. 2008; 28(4):629-36. https://doi.org/10.1161/ATVBAHA.107.151092
Zimmet P, Magliano D, Matsuzawa Y, Alberti G, Shaw J. The metabolic syndrome: A global public health problem and a new definition. J Atheroscler Thromb. 2005;12(6):295-300. https://doi.org/10.5551/jat.12.295
Bernabe-Ortiz A, Pastorius-Benziger C, Gilman R, Smeeth L. Sex differences in risk factors for cardiovascular disease: The PERU MIGRANT Study. PLoS One. 2012;7(4):e35127. https://doi.org/10.5551/jat.12.295
Haas JT, Biddinger SB. Dissecting the role of insulin resistance in the metabolic syndrome. Curr Opin Lipidol. 2009;20(3):206-10. https://doi.org/10.1097/MOL.0b013e32832b2024
Rezzonico J, Rezzonico M, Pusiol E, Pitoia F, Niepomniszcze H. Introducing the thyroid gland as another victim of the insulin resistance syndrome. Thyroid. 2008;18(4):461-4. https://doi.org/10.1089/thy.2007.0223
Frittitta L, Sciacca L, Catalfamo R, Ippolito A, Gangemi P, Pezzino V, et al. Functional insulin receptors are overexpressed in thyroid tumors: is this an early event in thyroid tumorigenesis? Cancer. 1999;85(2):492-8. https://doi.org/10.1002/(SICI)1097-0142(19990115)85:2<492::AID-CNCR30>3.0.CO;2-I
Yasar HY, Ertugrul O, Ertugrul B, Ertugrul D, Sahin M. Insulin resistance in nodular thyroid disease. Endocr Res. 2011;36(4):167-74. https://doi.org/10.3109/07435800.2011.593011
Hegedüs L. The thyroid nodule. N Engl J Med. 2004; 351(17):1764-71. https://doi.org/10.1056/NEJMcp031436
EsSalud. Sistema Estadístico de Salud (SES). Lima: EsSalud; 2015.
Rivera-Moscoso R, Hernández-Jiménez S, Ochoa-Sosa A, Rodríguez-Carramza S, Torres-Ambriz P. Diagnóstico y tratamiento del nódulo tiroideo: posición de la Sociedad Mexicana de Nutrición y Endocrinología. Rev Endocrinol Nutrición. 2010;18(1):34-50.
Moifo B, Oben TE, Tambe J, Blanc F, Gonsu FJ. Reliability of thyroid imaging reporting and data system (TIRADS) classification in differentiating benign from malignant thyroid nodules. OJRad. 2013;3:103-7. https://doi.org/10.4236/ojrad.2013.33016
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-20. https://doi.org/10.1001/jama.2013.284427
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159-219. https://doi.org/10.1001/jama.2013.284427
World Health Organization. Waist circumference and waist-hip ratio: report of a WHO expert consultation. Geneva: WHO; 2011.
Lohman T, Roche A, Martorell R. Anthropometric standardization reference manual. Champagne, Illinois, Human Kinetic Books, 1988.
Bastemir M, Akin F, Alkis E, Kaptanoglu B. Obesity is associated with increased serum TSH level, independent of thyroid function. Swiss Med Wkly. 2007;137(29-30):431-4. doi: 2007/29/smw-11774
Yin J, Wang C, Shao Q, Qu D, Song Z, Shan P, et al. Relationship between the Prevalence of thyroid nodules and metabolic syndrome in the iodine-adequate area of Hangzhou, China: a cross-sectional and cohort study. Int J Endocrinol. 2014;2014:675796. https://doi.org/10.1155/2014/675796
Blanc E, Ponce C, Brodschi D, Nepote A, Barreto A, Schnitman M, et al. Association between worse metabolic control and increased thyroid volume and nodular disease in elderly adults with metabolic syndrome. Metab Syndr Relat Disord. 2015;13(5):221-6. https://doi.org/10.1089/met.2014.0158
Rezzónico JN, Rezzónico M, Pusiol E, Niepomniszcze H. Increased prevalence of insulin resistance in patients with differentiated thyroid carcinoma. Metab Syndr Relat Disord. 2009;7(4):375-80. https://doi.org/10.1089/met.2008.0062
Pajuelo J, Sánchez J. El síndrome metabólico en adultos, en el Perú. An Fac Med (Lima). 2007; 68(1):38-46. https://doi.org/10.15381/anales.v68i1.1237
Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, et al. The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol. 2010;56(14):1113-32. https://doi.org/10.1016/j.jacc.2010.05.034
Robins SJ, Rubins HB, Faas FH, Schaefer EJ, Elam MB, Anderson JW, et al. Insulin resistance and cardiovascular events with low HDL cholesterol: the Veterans Affairs HDL Intervention Trial (VA-HIT). Diabetes Care. 2003;26(5):1513-7. https://doi.org/10.2337/diacare.26.5.1513
Laws A, Reaven GM. Evidence for an independent relationship between insulin resistance and fasting plasma HDL-cholesterol, triglyceride and insulin concentrations. J Intern Med. 1992;231(1):25-30. https://doi.org/10.1111/j.1365-2796.1992.tb00494.x
Golay A, Zech L, Shi MZ, Jeng CY, Chiou YA, Reaven GM, et al. Role of insulin in regulation of high density lipoprotein metabolism. J Lipid Res. 1987;28(1):10-8.
Stalder M, Suenram P, Suenram A. Relationship Between plasma insulin levels and high-density lipoprotein colesterol levels in healthy men. Diabetologia. 1981;21(6):544-8. doi: 10.1007/bf00281546
Aydogan Y, Altay M, Ünsal O, Kaplanoglu V, Çagir Y, Yildiz C, et al. An assessment of the relationship between thyroid nodule characteristics, insulin resistance and arterial stiffness in euthyroid nodular goiter. Endocrine. 2018;62(2):440-447. https://doi.org/10.1007/s12020-018-1701-6
Kir S, Aydin Y, Coskun H. Relationship between metabolic syndrome and nodular thyroid diseases. Scand J Clin Lab Invest. 2018;78(1-2):6-10. https://doi.org/10.1080/00365513.2017.1402363
Dauksiene D, Petkeviciene J, Klumbiene J, Verkauskiene R, Vainikonyte-Kristapone J, Seibokaite A, et al. Factors associated with the prevalence of thyroid nodules and goiter in middle-aged euthyroid subjects. Int J Endocrinol. 2017; 2017:8401518. https://doi.org/10.1155/2017/8401518
Rezzónico J, Rezzónico M, Pusiol E, Pitoia F, Niepomniszcze H. Metformin treatment for small benign thyroid nodules in patients with insulin resistance. Metab Syndr Relat Disord. 2011;9(1):69-75. https://doi.org/10.1089/met.2010.0026

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