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Chauhan A, Patel SS. Thyroid Hormone and Diabetes Mellitus Interplay: Making Management of Comorbid Disorders Complicated. Horm Metab Res 2024. [PMID: 39159661 DOI: 10.1055/a-2374-8756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
Insulin and thyroid hormones play important roles in our body. Insulin helps regulate the glucose level while the thyroid hormones affect various cells and tissues, metabolizing protein, lipids, and glucose. Hyperthyroidism and thyrotoxicosis are potential hazards for type 2 diabetes mellitus. There is a high prevalence of hypothyroidism being more common compared to hyperthyroidism coexisting with diabetes mellitus. Thyroid hormones affect glucose metabolism through its action on peripheral tissues (gastrointestinal tract, liver, skeletal muscles, adipose tissue, and pancreas). High-level thyroid hormone causes hyperglycemia, upregulation of glucose transport, and reduction in glycogen storage. The reverse is observed during low levels of thyroid hormone along with insulin clearance. The net result of thyroid disorder is insulin resistance. Type 2 diabetes mellitus can downsize the regulation of thyroid stimulating hormones and impair the conversion of thyroxine to triiodothyronine in peripheral tissues. Furthermore, poorly managed type 2 diabetes mellitus may result in insulin resistance and hyperinsulinemia, contributing to the proliferation of thyroid tissue and an increase in nodule formation and goiter size. Although metformin proves advantageous for both type 2 diabetes mellitus and thyroid disorder patients, other antidiabetics like sulfonylureas, pioglitazone, and thiazolidinediones may have adverse effects on thyroid disorders. Moreover, antithyroid drugs such as methimazole can weaken glycemic control in individuals with diabetes. Thus, an interplay between both endocrinopathies is observed and individualized care and management of the disorder needs to be facilitated.
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Affiliation(s)
- Ayush Chauhan
- Department of Pharmacology, Institute of Pharmacy, Nirma University, Ahmedabad, India
| | - Snehal S Patel
- Department of Pharmacology, Institute of Pharmacy, Nirma University, Ahmedabad, India
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2
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Brenta G, Di Fermo F. Thyroid cancer and insulin resistance. Rev Endocr Metab Disord 2024; 25:19-34. [PMID: 37957487 DOI: 10.1007/s11154-023-09849-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
Thyroid cancer has shown a parallel increase with diabetes in the last few years. This narrative review aims to explain the association between these two entities, focusing on insulin resistance as the mediator and exploring the effects of antidiabetic agents on thyroid cancer incidence and progression.We searched Pubmed for English-written articles on insulin resistance, diabetes, antidiabetic treatments, and thyroid cancer reported from January 2019 to April 2023. Exclusion criteria were preclinical and clinical studies involving a population with thyroid dysfunction, benign nodular goiter, or those that only analyzed thyroid cancer's association with obesity.The results of the narrative literature review revealed 96 articles. Additionally, four studies from a manual search were retrieved. After the exclusion criteria were applied, we included 20 studies. Out of 8 studies on insulin-resistant or Metabolic Syndrome patients, all suggest a positive association with thyroid cancer. At the same time, for diabetes, four out of five publications support a link with thyroid cancer. The seven remaining studies on antidiabetics suggest that metformin might benefit thyroid cancer. In contrast, the evidence for an association between Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and increased thyroid cancer findings is limited.In conclusion, the association between thyroid cancer and diabetes may be explained by insulin resistance, as shown in observational studies. However, the causal role is yet to be defined. Although the wide use of different antidiabetic agents has been related to thyroid cancer prevalence and progression, future research with drugs such as metformin or GLP-1 RA is still needed.
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Affiliation(s)
- Gabriela Brenta
- Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein, Buenos Aires, Argentina.
| | - Fernando Di Fermo
- Endocrinology Department, Hospital Virgen del Carmen, Zárate, Buenos Aires, Argentina
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Grigoriadis G, Koufakis T, Kotsa K. Epidemiological, Pathophysiological, and Clinical Considerations on the Interplay between Thyroid Disorders and Type 2 Diabetes Mellitus. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2013. [PMID: 38004062 PMCID: PMC10673571 DOI: 10.3390/medicina59112013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
Thyroid disorders (TD) and diabetes mellitus (DM) are the two endocrinopathies with the highest prevalence in the general population that frequently coexist. Thyroid dysfunction is more common in people with type 2 diabetes mellitus (T2DM) compared to normoglycemic individuals. Untreated TD can impair glycemic control, increasing the risk of diabetes complications. Hyperinsulinemia can affect the morphology of the thyroid gland by promoting the proliferation of thyroid tissue and increasing the size of thyroid nodules. Metformin can confer benefits in both endocrinopathies, while other antidiabetics, such as sulfonylureas, can negatively affect thyroid function. Animal and human observational data suggest an increased risk of medullary thyroid carcinoma after treatment with glucagon-like peptide-1 receptor agonists. However, randomized trials have so far been reassuring. Furthermore, some observational studies suggest an association between thyroid cancer and T2DM, especially in women. This narrative review aims to shed light on the epidemiological, pathophysiological, and clinical aspects of the interplay between TD and T2DM. Taking into account the important clinical implications of the coexistence of T2DM and TD, proper screening and management strategies are needed for both endocrinopathies to ensure optimal patient care.
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Affiliation(s)
- Gregory Grigoriadis
- Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Theocharis Koufakis
- Second Propaedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Kalliopi Kotsa
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece;
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Amirabadizadeh A, Amouzegar A, Mehran L, Azizi F. The effect of metformin therapy on serum thyrotropin and free thyroxine concentrations in patients with type 2 diabetes: a meta-analysis. Sci Rep 2023; 13:18757. [PMID: 37907510 PMCID: PMC10618453 DOI: 10.1038/s41598-023-43266-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/21/2023] [Indexed: 11/02/2023] Open
Abstract
Type 2 diabetes and thyroid function disorders are two common chronic endocrine disorders with the high prevalence in various populations. Metformin is well established as the first-line drug therapy for managing diabetes mellitus. In this meta-analysis, we aimed to determine the effect of metformin on serum TSH and FT4 concentrations in patients with type 2 diabetes. We searched PubMed, Scopus, web of science, Cochrane library, and google scholar to collect information on the effect of metformin on serum TSH and FT4 levels. Demographic and clinical information and serum TSH and FT4 concentrations before and after metformin treatment were extracted. Studies on patients over 18 years of age were included. A total of 11 studies including 1147 patients were selected for the final analysis. In hypothyroid patients, the TSH level decreased significantly after treatment with metformin (Hedges's g:1.55, 95%CI 0.93-2.16, p-value < 0.001); FT4 level increased slightly after taking metformin, but the increase was not significant (Heddges's g: - 0.30, 95%CI - 0.90,0.31, p-value = 0.34). In euthyroid subjects, the slight decrease found in TSH and FT4 concentrations was not statistically significant. Metformin reduces TSH levels in hypothyroid patients; however, it has no effect on TSH levels in euthyroid patients. Metformin does not affect serum FT4 levels in euthyroid and hypothyroid patients.
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Affiliation(s)
- Alireza Amirabadizadeh
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, I.R. of Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, I.R. of Iran
| | - Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, I.R. of Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, I.R. of Iran.
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Liang Y, Li X, Wang F, Yan Z, Sang Y, Yuan Y, Qin Y, Zhang X, Ju M. Detection of Thyroid Nodule Prevalence and Associated Risk Factors in Southwest China: A Study of 45,023 Individuals Undergoing Physical Examinations. Diabetes Metab Syndr Obes 2023; 16:1697-1707. [PMID: 37312898 PMCID: PMC10259576 DOI: 10.2147/dmso.s412567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/03/2023] [Indexed: 06/15/2023] Open
Abstract
Background Thyroid nodules (TNs) are among the most common thyroid lesions, and rates of these nodules have risen over the past three decades. As the majority of TN patients remain asymptomatic when these nodules are in the early stages of development, malignant nodules may continue to develop into thyroid cancer when not detected. As such, early screening and diagnosis-based strategies represent the most promising means of preventing or treating TNs and associated cancers. The present study was thus developed to explore TN prevalence among individuals in Luzhou, China. Methods Here, thyroid ultrasonography and metabolic-related indicators from 45,023 adults undergoing routine physical examinations in the Health Management Center of a large Grade A hospital in Luzhou over the last three years were retrospectively reviewed in an effort to identify factors associated with TN risk and the detection of these nodules through univariate and multivariate logistic regression analyses. Results In total, 13,437 TNs were detected in these 45,023 healthy adults for an overall 29.8% detection rate. This TN detection rate rose with age, and multivariate logistic regression analyses revealed that independent risk factors associated with TNs included greater age (≥31 years old), female (OR = 2.283, 95% CI: 2.177-2.393), central obesity (OR = 1.115, 95% CI: 1.051-1.183), impaired fasting glucose (OR = 1.203, 95% CI: 1.063-1.360), overweight status (OR = 1.085, 95% CI: 1.026-1.147), and obesity (OR = 1.156, 95% CI: 1.054-1.268), while low BMI was a protective factor associated with lower rates of TN incidence (OR = 0.789, 95% CI: 0.706-0.882). When results were stratified by gender, impaired fasting glucose was not an independent predictor of TN risk among males, while high LDL levels were an independent predictor of TNs among females, and other risk factors were not significantly changed. Conclusion TN detection rates were high among adults in Southwestern China. Female, elderly individuals, individuals exhibiting central obesity, and those with high levels of fasting plasma glucose are more likely to develop TN.
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Affiliation(s)
- Yi Liang
- Health Management Center, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China
- Nursing College, Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China
| | - Xiaohong Li
- Health Management Center, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China
| | - Fang Wang
- Nursing College, Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China
| | - Zongting Yan
- Nursing College, Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China
| | - Yuhuan Sang
- Nursing College, Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China
| | - Yuan Yuan
- Nursing College, Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China
| | - Yun Qin
- Health Management Center, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China
| | - Xuefei Zhang
- Health Management Center, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China
| | - Mei Ju
- Nursing College, Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China
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Sulu C, Bektas AB, Guzel SS, Tay K, Sahin S, Durcan E, Ozkaya HM, Kadioglu P. Effect of metformin on thyroid cancer risk in patients with acromegaly: A preliminary observational study. Growth Horm IGF Res 2022; 66:101484. [PMID: 35870256 DOI: 10.1016/j.ghir.2022.101484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/01/2022] [Accepted: 06/26/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE To evaluate the role of metformin on thyroid cancer risk in patients with acromegaly. METHODS Medical charts of 534 patients with acromegaly that were followed-up between 1983 and 2019 were reviewed. Patients with follow-up duration at least 6 months were included. Cohort entry was defined as first visit date. The date of each case's thyroid cancer diagnosis was defined as index date. Patients were followed until the index date, death, or last visit date, whichever came first. Nested case-control study design was selected to evaluate the association between metformin and the thyroid cancer risk in patients with acromegaly. RESULTS 291 patients with acromegaly were included into final analysis. The mean age at acromegaly diagnosis was 42.3 ± 1.3 years. The median follow-up duration was 76 [34-132] months. Among 291 patients, 13 patients (4.5%) had thyroid cancer. Thirty-one percent (n = 92) of the patients used metformin for 6 months or longer. One standard deviation (SD) increase in average growth hormone increased the odds of having thyroid cancer by 1.164 folds (p = 0.017). One SD increase of the average insulin-like growth factor 1 to upper limit of normal ratio increased the odds of having thyroid cancer by 1.201 folds (p = 0.004). If a patient used metformin for at least 6 months, the odds to have thyroid cancer was decreased, multiplied by 0.62 with a 95% confidence interval of [0.47, 0.83] (p = 0.0013). The risk of thyroid cancer decreased with increasing duration of metformin use. CONCLUSION Metformin may decrease the thyroid cancer risk in patients with acromegaly.
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Affiliation(s)
- Cem Sulu
- Division of Endocrinology, Metabolism, and Diabetes-Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey
| | - Ayyuce Begum Bektas
- Graduate School of Sciences and Engineering, Koç University, Istanbul 34450, Turkey
| | - Suleyman Sami Guzel
- Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey
| | - Kubilay Tay
- Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey
| | - Serdar Sahin
- Division of Endocrinology, Metabolism, and Diabetes-Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey
| | - Emre Durcan
- Division of Endocrinology, Metabolism, and Diabetes-Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey
| | - Hande Mefkure Ozkaya
- Division of Endocrinology, Metabolism, and Diabetes-Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey
| | - Pinar Kadioglu
- Division of Endocrinology, Metabolism, and Diabetes-Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey.
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Effects of Slow-Acting Metformin Treatment on the Hormonal and Morphological Thyroid Profile in Patients with Insulin Resistance. Pharmaceutics 2022; 14:pharmaceutics14101987. [PMID: 36297423 PMCID: PMC9607242 DOI: 10.3390/pharmaceutics14101987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/30/2022] [Accepted: 09/15/2022] [Indexed: 12/05/2022] Open
Abstract
Metformin appears to reduce TSH levels in untreated hypothyroid patients. In contrast, in euthyroid patients with type 2 diabetes mellitus (T2DM), metformin is initially devoid of effects on TSH. However, it is followed by a significant reduction in TSH level after twelve months of treatment. Additionally, some evidence suggests that metformin may also improve thyroid morphological abnormalities. This study aimed to evaluate the effects of metformin not only on TSH and thyroid hormone values, but also on thyroid volume and nodules. A total of 50 patients (mean age: 36.9 ± 12.8 years) with insulin resistance (homeostatic model assessment (HOMA) index ≥2.5) and with thyroid uninodular disease were recruited for this study. They were prescribed slow-acting metformin at a daily dose of 500 mg for six months. Treatment with metformin in euthyroid patients with uninodular thyroid disease and insulin resistance reduces TSH levels, increases FT4 and FT3 values, and decreases thyroid and nodule volumes. These data suggest that metformin may be an effective drug not only for the treatment of T2DM and metabolic syndrome, but also for thyroid disease.
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Eom YS, Wilson JR, Bernet VJ. Links between Thyroid Disorders and Glucose Homeostasis. Diabetes Metab J 2022; 46:239-256. [PMID: 35385635 PMCID: PMC8987680 DOI: 10.4093/dmj.2022.0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/21/2022] [Indexed: 12/13/2022] Open
Abstract
Thyroid disorders and diabetes mellitus often coexist and are closely related. Several studies have shown a higher prevalence of thyroid disorders in patients with diabetes mellitus and vice versa. Thyroid hormone affects glucose homeostasis by impacting pancreatic β-cell development and glucose metabolism through several organs such as the liver, gastrointestinal tract, pancreas, adipose tissue, skeletal muscles, and the central nervous system. The present review discusses the effect of thyroid hormone on glucose homeostasis. We also review the relationship between thyroid disease and diabetes mellitus: type 1, type 2, and gestational diabetes, as well as guidelines for screening thyroid function with each disorder. Finally, we provide an overview of the effects of antidiabetic drugs on thyroid hormone and thyroid disorders.
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Affiliation(s)
- Young Sil Eom
- Division of Endocrinology, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jessica R. Wilson
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Jacksonville, FL, USA
| | - Victor J. Bernet
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Jacksonville, FL, USA
- Corresponding author: Victor J. Bernet https://orcid.org/0000-0002-2477-5631 Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA E-mail:
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Kushchayeva Y, Kushchayev S, Jensen K, Brown RJ. Impaired Glucose Metabolism, Anti-Diabetes Medications, and Risk of Thyroid Cancer. Cancers (Basel) 2022; 14:cancers14030555. [PMID: 35158824 PMCID: PMC8833385 DOI: 10.3390/cancers14030555] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/15/2022] [Accepted: 01/18/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary An epidemiologic link exists between obesity, insulin resistance, diabetes, and some cancers, such as breast cancer and colon cancer. The prevalence of obesity and diabetes is increasing, and additional epidemiologic data suggest that there may be a link between obesity and risk of thyroid abnormalities. Factors that may link obesity and diabetes with thyroid proliferative disorders include elevated circulating levels of insulin, increased body fat, high blood sugars, and exogenous insulin use. However, mechanisms underlying associations of obesity, diabetes, and thyroid proliferative disorders are not yet fully understood. The present manuscript reviews and summarizes current evidence of mechanisms and epidemiologic associations of obesity, insulin resistance, and use of anti-diabetes medications with benign and malignant proliferative disorders of the thyroid. Abstract The prevalence of obesity is progressively increasing along with the potential high risk for insulin resistance and development of type 2 diabetes mellitus. Obesity is associated with increased risk of many malignancies, and hyperinsulinemia has been proposed to be a link between obesity and cancer development. The incidence of thyroid cancer is also increasing, making this cancer the most common endocrine malignancy. There is some evidence of associations between obesity, insulin resistance and/or diabetes with thyroid proliferative disorders, including thyroid cancer. However, the etiology of such an association has not been fully elucidated. The goal of the present work is to review the current knowledge on crosstalk between thyroid and glucose metabolic pathways and the effects of obesity, insulin resistance, diabetes, and anti-hyperglycemic medications on the risk of thyroid cancer development.
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Affiliation(s)
- Yevgeniya Kushchayeva
- Diabetes and Endocrinology Center, University of South Florida, Tampa, FL 33612, USA
- Correspondence:
| | - Sergiy Kushchayev
- Department of Radiology, Moffitt Cancer Center, Tampa, FL 33612, USA;
| | - Kirk Jensen
- F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA;
| | - Rebecca J. Brown
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA;
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Or Koca A, Öztürk D, Koca HS, Dağdeviren M, Keskin M, Buluş H. The Effect of Sleeve Gastrectomy on the Function and Volume of the Thyroid Gland. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2019.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Arzu Or Koca
- Department of Endocrinology and Metabolism, Keçiören Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Doğan Öztürk
- Department of General Surgery, Keçiören Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Hüseyin Samet Koca
- Department of Otorhinolaryngology, Yüksek İhtisas University, Ankara, Turkey
| | - Murat Dağdeviren
- Department of Endocrinology and Metabolism, Keçiören Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Müge Keskin
- Department of Endocrinology and Metabolism, Ankara City Hospital, Ankara, Turkey
| | - Hakan Buluş
- Department of General Surgery, Keçiören Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Zhao J, Zhang Q, Yang Y, Yao J, Liao L, Dong J. High prevalence of thyroid carcinoma in patients with insulin resistance: a meta-analysis of case-control studies. Aging (Albany NY) 2021; 13:22232-22241. [PMID: 34550096 PMCID: PMC8507263 DOI: 10.18632/aging.203529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/03/2021] [Indexed: 12/26/2022]
Abstract
The association between insulin resistance and thyroid carcinoma is controversial. We conducted this meta-analysis of association between insulin resistance and thyroid carcinoma. There were 14 studies included in this meta-analysis. Random-effect model was used to merge the weighted mean difference value of fasting serum insulin level and the pooled effect shows that the level of fasting serum insulin is higher in patients with thyroid carcinoma than those of controls (1.88, 95% CI 0.87 to 2.90, P=0.0003). Random-effect model was used to estimate the pooled weighted mean difference and it shows that thyroid carcinoma patients have a higher level of homeostasis model assessment of insulin resistance (HOMA-IR) than patients without thyroid carcinoma (0.54, 95% CI 0.29 to 0.78, P<0.0001). Fixed-effect model with the odds ratio of insulin resistance shows that insulin resistance could increase the risk of thyroid carcinoma 216% compared with participants without insulin resistance (3.16, 95% CI 2.09 to 4.77, P<0.0001). In conclusion, insulin resistance might be a risk factor for thyroid carcinoma.
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Affiliation(s)
- Junyu Zhao
- Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan 250014, China.,Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250014, China
| | - Qianping Zhang
- Division of Endocrinology, Dezhou Municipal Hospital, Dezhou 253000, China
| | - Yupeng Yang
- Division of Breast and Thyroid Surgery, Jinan Zhangqiu District Hospital of Traditional Chinese Medicine, Jinan 250200, China
| | - Jinming Yao
- Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan 250014, China.,Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250014, China
| | - Lin Liao
- Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan 250014, China.,Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250014, China
| | - Jianjun Dong
- Division of Endocrinology, Department of Internal Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
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12
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Durcan E, Sahin S, Dedeoglu SE, Ozkaya HM, Gonen MS. Can "VAI" Better Indicate Metabolic Syndrome Compared with Other Metabolic Syndrome-Related Parameters in Patients with Thyroid Nodules? A Study from Turkey. Metab Syndr Relat Disord 2021; 19:358-366. [PMID: 33794138 DOI: 10.1089/met.2020.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Emre Durcan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdar Sahin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Selin Ece Dedeoglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hande Mefkure Ozkaya
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mustafa Sait Gonen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Wang J, Gao J, Fan Q, Li H, Di Y. The Effect of Metformin on Thyroid-Associated Serum Hormone Levels and Physiological Indexes: A Meta-Analysis. Curr Pharm Des 2020; 25:3257-3265. [PMID: 31533598 DOI: 10.2174/1381612825666190918162649] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many diseases can be treated with metformin. People with serum thyrotropin (TSH) levels higher than 10 mIU/L are at a risk of cardiovascular events. Some studies have suggested that metformin can lower serum TSH levels to a subnormal level in patients with hyperthyrotropinaemia or hypothyroidism. OBJECTIVE The objective of this analysis is to evaluate the effect of metformin treatment on serum TSH, free triiodothyronine (FT3), and free thyroxine (FT4) levels and other associated physiological indices. METHODS A comprehensive search using the PubMed, EMBASE, Web of Science and Cochrane Central databases was undertaken for controlled trials on the effect of metformin on serum TSH, FT3, and FT4 levels and associated physiological indices. The primary outcome measures were serum TSH, FT3 and FT4 levels, thyroid size, thyroid nodule size, blood pressure, heart rate, body weight, and body mass index (BMI). The final search was conducted in April 2019. RESULTS Six RCTs were included. A total of 494 patients met the inclusion criteria. Metformin treatment did not significantly lower the serum TSH levels at 3 or 6 months but did at 12 months. Moreover, forest plots also suggested that metformin can significantly lower the serum TSH levels in patients with normal thyroid function but cannot statistically change the serum TSH levels in patients with abnormal thyroid function. In addition, metformin treatment clearly lowered the serum FT3 levels and had no significant effect on serum FT4 levels. Lastly, metformin cannot significantly change the systolic blood pressure (SBP) or BMI but can clearly increase the diastolic blood pressure (DBP). CONCLUSION Metformin treatment can significantly lower the serum TSH levels, and this effect was much clearer after a 12-month treatment duration and in people with normal thyroid function. However, metformin cannot significantly change the serum FT4 levels or lower serum FT3 levels in people with non-thyroid cancer diseases. In addition, metformin can significantly increase DBP, but it has no clear effect on SBP or BMI.
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Affiliation(s)
- Junjie Wang
- Changzhi Medical College, No. 161, Jiefangdong Street, Shanxi Province, Changzhi 046000, China
| | - Jinghan Gao
- Central Hospital Affiliated to Shenyang Medical College, No.5, Nanqixi Road, Liaoning Province, Shenyang 110000, China
| | - Qin Fan
- Shanxi Dayi Hospital, No.99, Longcheng Street, Shanxi Province, Taiyuan 030000, China
| | - Hongzhuo Li
- Heping Hospital Affiliated to Changzhi Medical College, No.110, Yanannan Road, Shanxi Province, Changzhi 046000, China
| | - Yunhua Di
- Central Hospital Affliated to Shenyang Medical College, No.5, Nanqixi Road, Liaoning Province, Shenyang 110000, China
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Mayers RA, Soria Montoya A, Piscoya Rivera A, Silva Caso WG. Association between metabolic syndrome and euthyroid nodular goiter: a case-control study. Colomb Med (Cali) 2019; 50:239-251. [PMID: 32476690 PMCID: PMC7232946 DOI: 10.25100/cm.v50i4.2833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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. Objective: 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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Affiliation(s)
- Raisa A Mayers
- Universidad Peruana de Ciencias Aplicadas, Faculty of Health Sciences, Lima, Peru.,Beaumont Hospital, Dearborn, USA
| | - Andrea Soria Montoya
- Universidad Peruana de Ciencias Aplicadas, Faculty of Health Sciences, Lima, Peru.,SANNA Clínica El Golf, Lima, Peru
| | - Alejandro Piscoya Rivera
- Universidad Peruana de Ciencias Aplicadas, Faculty of Health Sciences, Lima, Peru.,Hospital Guillermo Kaelin de la Fuente, EsSalud - Gastroenterology service, Lima, Peru
| | - Wilmer Gianfranco Silva Caso
- Universidad Peruana de Ciencias Aplicadas, Faculty of Health Sciences, Lima, Peru.,Universidad Peruana de Ciencias Aplicadas, Faculty of Health Sciences, Research and Innovation Centre, Lima, Peru.,Ministerio de Salud del Perú, Centro de Salud Las Palmas, Tingo Maria, Huánuco, Peru
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15
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Thakur S, Daley B, Klubo-Gwiezdzinska J. The role of an anti-diabetic drug metformin in the treatment of endocrine tumors. J Mol Endocrinol 2019; 63:R17-R35. [PMID: 31307011 PMCID: PMC6938582 DOI: 10.1530/jme-19-0083] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/15/2019] [Indexed: 12/15/2022]
Abstract
Incidence of endocrine cancers is rising every year. Over the last decade, evidence has accumulated that demonstrates the anti-cancer effects of an anti-diabetic drug, metformin, in endocrine malignancies. We performed a literature review utilizing the PubMed, Medline and clinicaltrials.gov databases using the keyword 'metformin' plus the following terms: 'thyroid cancer', 'thyroid nodules', 'parathyroid', 'hyperparathyroidism', 'adrenal adenoma', 'Cushing syndrome', 'hyperaldosteronism', 'adrenocortical cancer', 'neuroendocrine tumor (NET)', 'pancreatic NET (pNET)', 'carcinoid', 'pituitary adenoma', 'pituitary neuroendocrine tumor (PitNET)', 'prolactinoma', 'pheochromocytoma/paraganglioma'. We found 37 studies describing the preclinical and clinical role of metformin in endocrine tumors. The available epidemiological data show an association between exposure of metformin and lower incidence of thyroid cancer and pNETs in diabetic patients. Metformin treatment has been associated with better response to cancer therapy in thyroid cancer and pNETs. Preclinical evidence suggests that the primary direct mechanisms of metformin action include inhibition of mitochondrial oxidative phosphorylation via inhibition of both mitochondrial complex I and mitochondrial glycerophosphate dehydrogenase, leading to metabolic stress. Decreased ATP production leads to an activation of a cellular energy sensor, AMPK, and subsequent downregulation of mTOR signaling pathway, which is associated with decreased cellular proliferation. We also describe several AMPK-independent mechanisms of metformin action, as well as the indirect mechanisms targeting insulin resistance. Overall, repositioning of metformin has emerged as a promising strategy for adjuvant therapy of endocrine tumors. The mechanisms of synergy between metformin and other anti-cancer agents need to be elucidated further to guide well-designed prospective trials on combination therapies in endocrine malignancies.
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Affiliation(s)
- Shilpa Thakur
- Metabolic Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Brianna Daley
- Metabolic Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Joanna Klubo-Gwiezdzinska
- Metabolic Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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16
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Chai W, Ye F, Zeng L, Li Y, Yang L. HMGB1-mediated autophagy regulates sodium/iodide symporter protein degradation in thyroid cancer cells. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2019; 38:325. [PMID: 31331356 PMCID: PMC6647330 DOI: 10.1186/s13046-019-1328-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/15/2019] [Indexed: 11/11/2022]
Abstract
Background Sodium/iodide symporter (NIS)-mediated iodide uptake plays an important physiological role in regulating thyroid gland function, as well as in diagnosing and treating Graves’ disease and thyroid cancer. High-mobility group box 1 (HMGB1), a highly conserved nuclear protein, is a positive regulator of autophagy conferring resistance to chemotherapy, radiotherapy and immunotherapy in cancer cells. Here the authors intended to identify the role of HMGB1 in Hank’s balanced salt solution (HBSS)-induced autophagy, explore NIS protein degradation through a autophagy-lysosome pathway in thyroid cancer cells and elucidate the possible molecular mechanisms. Methods Immunohistochemical staining and reverse transcription-polymerase chain reaction (RT-PCR) were performed for detecting the expression of HMGB1 in different tissues. HMGB1 was knocked down by lentiviral transfection in FTC-133/TPC-1 cells. Autophagic markers LC3-II, p62, Beclin1 and autophagosomal formation were employed for evaluating HMGB1-mediated autophagy in HBSS-treated cells by Western blot, immunofluorescence and electron microscopy. Western blot, quantitative RT-PCR and gamma counter analysis were performed for detecting NIS expression and iodide uptake in HMGB1-knockdown cells after different treatments. The reactive oxygen species (ROS) level, ROS-mediated LC3-II expression and HMGB1 cytosolic translocation were detected by fluorospectrophotometer, flow cytometry, Western blot and immunofluorescence. HMGB1-mediated AMPK, mTOR and p70S6K phosphorylation (p-AMPK, p-mTOR & p-p70S6K) were detected by Western blot. Furthermore, a nude murine model with transplanted tumor was employed for examining the effect of HMGB1-mediated autophagy on imaging and biodistribution of 99mTcO4−. NIS, Beclin1, p-AMPK and p-mTOR were detected by immunohistochemical staining and Western blot in transplanted tumor samples. Results HMGB1 was a critical regulator of autophagy-mediated NIS degradation in HBSS-treated FTC-133/TPC-1 cells. And HMGB1 up-regulation was rather prevalent in thyroid cancer tissues and closely correlated with worse overall lymph node metastasis and clinical stage. HMGB1-knockdown dramatically suppressed autophagy, NIS degradation and boosted iodide uptake in HBSS-treated cells. Moreover, HBSS enhanced ROS-sustained autophagy and promoted the cytosolic translocation of HMGB1. A knockdown of HMGB1 suppressed LC3-II conversion and NIS degradation via an AMPK/mTOR-dependent signal pathway through a regulation of ROS generation, rather than ATP. Furthermore, these data were further supported by our in vivo experiment of xenografts formed by HMGB1 knockdown cells reverting the uptake of 99mTcO4− as compared with control shRNA-transfected cells in hunger group. Conclusions Acting as a critical regulator of autophagy-mediated NIS degradation via ROS/AMPK/mTOR pathway, HMGB1is a potential intervention target of radioiodine therapy in thyroid cancer. Electronic supplementary material The online version of this article (10.1186/s13046-019-1328-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wenwen Chai
- Department of Nuclear Medicine, Hunan Cancer Hospital, Changsha, Hunan, 410008, People's Republic of China
| | - Fanghua Ye
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Li Zeng
- Department of Nuclear Medicine, Hunan Cancer Hospital, Changsha, Hunan, 410008, People's Republic of China
| | - Yanling Li
- Department of Nuclear Medicine, Hunan Cancer Hospital, Changsha, Hunan, 410008, People's Republic of China
| | - Liangchun Yang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China.
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Biondi B, Kahaly GJ, Robertson RP. Thyroid Dysfunction and Diabetes Mellitus: Two Closely Associated Disorders. Endocr Rev 2019; 40:789-824. [PMID: 30649221 PMCID: PMC6507635 DOI: 10.1210/er.2018-00163] [Citation(s) in RCA: 232] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022]
Abstract
Thyroid dysfunction and diabetes mellitus are closely linked. Several studies have documented the increased prevalence of thyroid disorders in patients with diabetes mellitus and vice versa. This review critically discusses the different underlying mechanisms linking type 1 and 2 diabetes and thyroid dysfunction to demonstrate that the association of these two common disorders is unlikely a simple coincidence. We assess the current state of knowledge on the central and peripheral control of thyroid hormone on food intake and glucose and lipid metabolism in target tissues (such as liver, white and brown adipose tissue, pancreatic β cells, and skeletal muscle) to explain the mechanism linking overt and subclinical hypothyroidism to type 2 diabetes and metabolic syndrome. We also elucidate the common susceptibility genes and the pathogenetic mechanisms contributing to the autoimmune mechanism involved in the onset of type 1 diabetes mellitus and autoimmune thyroid disorders. An untreated thyroid dysfunction can impair the metabolic control of diabetic patients, and this association can have important repercussions on the outcome of both of these disorders. Therefore, we offer recommendations for the diagnosis, management, and screening of thyroid disorders in patients with diabetes mellitus, including the treatment of diabetic patients planning a pregnancy. We also discuss the major causes of failure to achieve an optimal management of thyroid dysfunction in diabetic patients and provide recommendations for assessing and treating these disorders during therapy with antidiabetic drugs. An algorithm for a correct approach of these disorders when linked is also provided.
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Affiliation(s)
- Bernadette Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - George J Kahaly
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - R Paul Robertson
- Department of Medicine, Division of Endocrinology and Metabolism, University of Washington School of Medicine, Seattle, Washington.,Department of Pharmacology, University of Washington, Seattle, Washington
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He X, Wu D, Hu C, Xu T, Liu Y, Liu C, Xu B, Tang W. Role of Metformin in the Treatment of Patients with Thyroid Nodules and Insulin Resistance: A Systematic Review and Meta-Analysis. Thyroid 2019; 29:359-367. [PMID: 30595105 DOI: 10.1089/thy.2017.0707] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Metformin is the most-prescribed oral medication to lower blood glucose worldwide. Some data suggest that metformin may have a role in the treatment of patients with thyroid nodules, but contrasting results are reported in different settings. This study explores and critically reevaluates the knowledge on this topic. METHODS A literature search identified 250 records. Studies evaluating the size of thyroid nodules before and after metformin treatment were included. Assessed outcomes were the size of thyroid nodules, thyrotropin (TSH) level, thyroid gland volume, and insulin resistance index (HOMA-IR). After screening and full-text assessment, five studies were included in the systematic review. Random-effects meta-analyses of the standardized mean difference (SMD) were performed for the four outcomes of interest. Heterogeneity was estimated using I2, and the quality of evidence was assessed for each outcome using the Grading of Recommendations Assessment, Development, and Evaluation guidelines. RESULTS A total of 189 patients were included in the final analysis. After metformin treatment, a slight but significant reduction in thyroid nodule size was found in four studies, which included a total of 167 patients (SMD 0.46 [confidence interval (CI) 0.00-0.93]; p = 0.05). Similarly, in four studies reporting on a total of 146 patients, significant reductions in TSH level (SMD 0.30 [CI 0.07-0.53]; p = 0.01) and HOMA-IR level (SMD 0.90 [CI 0.12-1.67]; p = 0.02) were reported after treatment with metformin. In two studies, which included 114 patients, no change in thyroid gland volume was discovered after treatment with metformin (SMD 0.21 [CI -0.05 to 0.47]; p = 0.11). Quality of evidence was generally assessed as low or very low. CONCLUSIONS Metformin induces reductions in thyroid nodule size and TSH and HOMA-IR levels in patients with thyroid nodules and insulin resistance. In contrast, no change in thyroid gland volumes was found. Whether metformin treatment for thyroid nodules has clinical significance remains to be demonstrated.
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Affiliation(s)
- Xiaowei He
- 1 Department of Endocrinology and Metabolism, Diabetes Care & Research Center, Nanjing Medical University Affiliated Geriatric Hospital, Jiangsu Province Geriatric Hospital, Jiangsu Province Institute of Geriatrics, Nanjing, P.R. China
| | - Dan Wu
- 1 Department of Endocrinology and Metabolism, Diabetes Care & Research Center, Nanjing Medical University Affiliated Geriatric Hospital, Jiangsu Province Geriatric Hospital, Jiangsu Province Institute of Geriatrics, Nanjing, P.R. China
| | - Cuining Hu
- 1 Department of Endocrinology and Metabolism, Diabetes Care & Research Center, Nanjing Medical University Affiliated Geriatric Hospital, Jiangsu Province Geriatric Hospital, Jiangsu Province Institute of Geriatrics, Nanjing, P.R. China
| | - Ting Xu
- 1 Department of Endocrinology and Metabolism, Diabetes Care & Research Center, Nanjing Medical University Affiliated Geriatric Hospital, Jiangsu Province Geriatric Hospital, Jiangsu Province Institute of Geriatrics, Nanjing, P.R. China
| | - Yuanxin Liu
- 1 Department of Endocrinology and Metabolism, Diabetes Care & Research Center, Nanjing Medical University Affiliated Geriatric Hospital, Jiangsu Province Geriatric Hospital, Jiangsu Province Institute of Geriatrics, Nanjing, P.R. China
| | - Chao Liu
- 2 Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, P.R. China
- 3 Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, P.R. China
| | - Bo Xu
- 4 School of Public Health, Nanjing Medical University, Nanjing, P.R. China
| | - Wei Tang
- 1 Department of Endocrinology and Metabolism, Diabetes Care & Research Center, Nanjing Medical University Affiliated Geriatric Hospital, Jiangsu Province Geriatric Hospital, Jiangsu Province Institute of Geriatrics, Nanjing, P.R. China
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dos Santos PB, Gertrudes LN, Conceição FL, de Andrade BM, de Carvalho DP, Vaisman M, Teixeira PDFDS. Effects of Metformin on TSH Levels and Benign Nodular Goiter Volume in Patients Without Insulin Resistance or Iodine Insufficiency. Front Endocrinol (Lausanne) 2019; 10:465. [PMID: 31379740 PMCID: PMC6656339 DOI: 10.3389/fendo.2019.00465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/26/2019] [Indexed: 12/16/2022] Open
Abstract
Objectives: To evaluate the impact of metformin (MTF) use on TSH levels, thyroid volume and volume of benign thyroid nodules (TNs). Additionally, to study if iodine status influences the outcomes. Methods: A total of 23 euthyroid patients (42 TNs) with benign thyroid nodules, diagnosed by fine needle aspiration biopsy, were randomly assigned to MTF or placebo (P) use for 6 months. Serum TSH, homeostatic model assessment for insulin resistance (HOMA-IR), and urinary iodine concentrations (UIC) were assessed. Ultrasound was used to evaluate TNs and thyroid volumes (TV) and their variations throughout the study. Diabetic patients, those undergoing levothyroxine replacement, and/or using thyroid- or insulin level-influencing drugs were excluded. Results: The sample consisted predominantly of patients without IR. Both intervention groups were similar regarding several confounding variables and showed a comparable median UIC. Serum TSH decreased significantly after MTF (-0.21 vs. 0.09 mUI/L in the P group; p = 0.015). At 6 months, no significant variations were found between groups with respect to TN volumes, TV, HOMA-IR, or body mass index (BMI). However, a tendency toward enlargement of TV with placebo (16.0%; p = 0.09) and a protective effect of MTF on growing TN (OR: 0.25; CI 0.05-1.20) was detected after excluding patients with IR (a lower UIC subgroup). The reduction on TSH levels with MTF maintained in the population without iodine insufficiency (-0.24 vs. +0.07 in the P group; p = 0.046) and was accentuated in those with excessive or more than adequate UIC (-0.69; p = 0.043). A protective effect of MTF on growing TN was suggested (OR: 0.11; IC: 0.02-0.84) in those with higher UIC. Conclusions: This study demonstrated that MTF caused a reduction in TSH levels in benign nodular goiter. This effect was more accentuated in patients with higher levels of UIC and was accompanied by a suggested protective effect on TN enlargement.
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Liu J, Wang C, Tang X, Fu S, Jing G, Ma L, Sun W, Li Y, Wu D, Niu Y, Niu Q, Guo H, Song P. Correlation analysis of metabolic syndrome and its components with thyroid nodules. Diabetes Metab Syndr Obes 2019; 12:1617-1623. [PMID: 31564932 PMCID: PMC6724178 DOI: 10.2147/dmso.s219019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/12/2019] [Indexed: 12/22/2022] Open
Abstract
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.
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Affiliation(s)
- Jingfang Liu
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu730000, People’s Republic of China
- Correspondence: Jingfang Liu; Xulei Tang Department of Endocrinology, The First Hospital of Lanzhou University, 1 Donggang West Road, Lanzhou, Gansu730000, People’s Republic of ChinaTel +86 0 931 835 6470Email
| | - Chenge Wang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu730000, People’s Republic of China
| | - Xulei Tang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu730000, People’s Republic of China
| | - Songbo Fu
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu730000, People’s Republic of China
| | - Gaojing Jing
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu730000, People’s Republic of China
| | - Lihua Ma
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu730000, People’s Republic of China
| | - Weiming Sun
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu730000, People’s Republic of China
| | - Yujuan Li
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu730000, People’s Republic of China
| | - Dan Wu
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu730000, People’s Republic of China
| | - Ying Niu
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu730000, People’s Republic of China
| | - Qianglong Niu
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu730000, People’s Republic of China
| | - Huiping Guo
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu730000, People’s Republic of China
| | - Pei Song
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu730000, People’s Republic of China
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The Emerging Role of Insulin Receptor Isoforms in Thyroid Cancer: Clinical Implications and New Perspectives. Int J Mol Sci 2018; 19:ijms19123814. [PMID: 30513575 PMCID: PMC6321330 DOI: 10.3390/ijms19123814] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/26/2018] [Accepted: 11/28/2018] [Indexed: 12/28/2022] Open
Abstract
Thyroid cancer (TC) is the most common endocrine tumor. Although the majority of TCs show good prognoses, a minor proportion are aggressive and refractory to conventional therapies. So far, the molecular mechanisms underlying TC pathogenesis are incompletely understood. Evidence suggests that TC cells and their precursors are responsive to insulin and insulin-like growth factors (IGFs), and often overexpress receptors for insulin (IR) and IGF-1 (IGF-1R). IR exists in two isoforms, namely IR-A and IR-B. The first binds insulin and IGF-2, unlike IR-B, which only binds insulin. IR-A is preferentially expressed in prenatal life and contributes to development through IGF-2 action. Aggressive TC overexpresses IR-A, IGF-2, and IGF-1R. The over-activation of IR-A/IGF-2 loop in TC is associated with stem-like features and refractoriness to some targeted therapies. Importantly, both IR isoforms crosstalk with IGF-1R, giving rise to the formation of hybrids receptors (HR-A or HR-B). Other interactions have been demonstrated with other molecules such as the non-integrin collagen receptor, discoidin domain receptor 1 (DDR1), and the receptor for the hepatocyte growth factor (HGF), Met. These functional networks provide mechanisms for IR signaling diversification, which may also exert a role in TC stem cell biology, thereby contributing to TC initiation and progression. This review focuses on the molecular mechanisms by which deregulated IR isoforms and their crosstalk with other molecules and signaling pathways in TC cells and their precursors may contribute to thyroid carcinogenesis, progression, and resistance to conventional treatments. We also highlight how targeting these alterations starting from TC progenitors cells may represent new therapeutic strategies to improve the clinical management of advanced TCs.
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22
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Răcătăianu N, Bolboacă SD, Sitar-Tăut AV, Mârza S, Moga D, Valea A, Ghervan C. The effect of Metformin treatment in obese insulin-resistant patients with euthyroid goiter. Acta Clin Belg 2018; 73:317-323. [PMID: 29452573 DOI: 10.1080/17843286.2018.1439273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective The study's objective was to evaluate the thyroid parameters in obese insulin-resistant patients with euthyroid diffuse or nodular goiter, following Metformin treatment. Patients and methods The study was experimental, open, and prospective. Fifty-three patients aged 18-68 were enrolled for two years. Obese insulin-resistant patients (cut-off Homeostasis-Model-Assessment of Insulin Resistance-HOMA-IR ≥ 2.5) with euthyroid nodular/diffuse goiter were included. Subjects with diabetes, hypo-/hyper-thyroidism, autoimmune thyroiditis, psychiatric disorders, liver or heart failure were excluded. Patients were randomly assigned to one of the following treatment: Metformin 1000 mg/day + Levothyroxine 25 μg/day (M + LT4 group) and only Levothyroxine 25 μg/day (LT4 group). Thyroid and metabolic parameters' evolution was investigated over six months. Results The two groups were comparable at baseline (p ≥ 0.10). TSH, waist/hip ratio (WHR), visceral fat thickness (VFT), insulin, and HOMA-IR decreased significantly more in M + LT4 group compared to LT4 group. TSH decrease correlated with WHR reduction (p = 0.002) only in M + LT4 group. Moreover, the multivariate regression analysis revealed that insulin's and HOMA-IR levels' decrease was an independent factor associated with FT4's increase (p = 0.031, p = 0.033) just in M + LT4 group. No other independent association between the evolution (Δ) of TSH, thyroid volume (TTV), thyroid nodules-maximum diameter (TN-MD), and metabolic parameters was found. In addition, no significant threshold between groups was reached when ΔFT4, ΔTTV, ΔTN-MD were compared (p > 0.07), although their significant improvement was recorded between the baseline and the follow-up moment in each group (p < 0.003). Conclusion Metformin added to obese insulin-resistant patients treated with Levothyroxine for diffuse/nodular goiter determined a significant decrease in TSH and metabolic parameters, compared to those treated with Levothyroxine alone, but no significant difference regarding thyroid morphology after 6 months.
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Affiliation(s)
- Nicoleta Răcătăianu
- Department of Endocrinology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sorana Daniela Bolboacă
- Department of Medical Informatics and Biostatistics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adela-Viviana Sitar-Tăut
- Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Smaranda Mârza
- Pediatrics, Infectious Diseases Clinical Hospital-Integrated Ambulatory, Cluj-Napoca, Romania
| | - Daniela Moga
- Laboratory Department, Infectious Diseases Clinical Hospital-Integrated Ambulatory, Cluj-Napoca, Romania
| | - Ana Valea
- Department of Endocrinology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristina Ghervan
- Department of Endocrinology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Yin DT, He H, Yu K, Xie J, Lei M, Ma R, Li H, Wang Y, Liu Z. The association between thyroid cancer and insulin resistance, metabolic syndrome and its components: A systematic review and meta-analysis. Int J Surg 2018; 57:66-75. [PMID: 30081182 DOI: 10.1016/j.ijsu.2018.07.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/15/2018] [Accepted: 07/28/2018] [Indexed: 12/18/2022]
Abstract
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.
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Affiliation(s)
- De-Tao Yin
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, PR China; Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, 450052, PR China.
| | - Huanan He
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, PR China; Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, 450052, PR China; Department of General Surgery, the First People's Hospital of Pingdingshan, Pingdingshan, 467000, PR China
| | - Kun Yu
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, PR China; Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, 450052, PR China
| | - Jing Xie
- Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Mengyuan Lei
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, PR China; Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, 450052, PR China
| | - Runsheng Ma
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, PR China; Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, 450052, PR China
| | - Hongqiang Li
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, PR China; Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, 450052, PR China
| | - Yongfei Wang
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, PR China; Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, 450052, PR China
| | - Zhen Liu
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, PR China; Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, 450052, PR China
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Cho YY, Kang MJ, Kim SK, Jung JH, Hahm JR, Kim TH, Nam JY, Lee BW, Lee YH, Chung JH, Song SO, Kim SW. Protective Effect of Metformin Against Thyroid Cancer Development: A Population-Based Study in Korea. Thyroid 2018; 28:864-870. [PMID: 29808777 DOI: 10.1089/thy.2017.0550] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Metformin, the most widely used drug for type 2 diabetes, has recently attracted attention with regard to its antitumor activity. However, clinical studies have yielded conflicting results regarding the association between metformin and thyroid cancer development, despite its antitumor effect in preclinical studies. METHODS This is a retrospective cohort study using the Korean National Health Insurance claim database. Matched populations of 128,453 metformin users and 128,453 non-users were analyzed for thyroid cancer incidence. Metformin users were categorized into lowest, middle, and highest tertiles according to cumulative dose or duration of metformin therapy. RESULTS Thyroid cancer developed in 340 (0.26%) metformin users and 487 (0.38%) non-users during a mean follow-up of 7.2 years (hazard ratio = 0.69 [confidence interval 0.60-0.79]; p < 0.001). The incidence of thyroid cancer per 105 person-years was 51.6 in metformin non-users. For metformin users, the incidence was 84.5 for <529,000 mg, 20.6 for 529,000-1,007,799 mg, and 6.3 for >1,007,799 mg; 86.3 for <1085 days, 20.3 for 1085-2094 days, and 4.7 for >2094 days for duration of therapy. The hazard ratio for thyroid cancer decreased significantly in metformin users as a function of dose and duration of metformin therapy. CONCLUSIONS Metformin appears to be associated with a preventive effect on thyroid cancer development in a nationwide population-based study, but is not effective in the early phase of treatment. Considering the increasing prevalence of obesity and the role of insulin resistance in the development of cancer, metformin might be the preferred treatment for its dual anti-diabetic and antitumor effects.
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Affiliation(s)
- Yoon Young Cho
- 1 Division of Endocrinology and Metabolism, Department of Medicine, Gyeongsang National University School of Medicine , Jinju, Korea
- 2 Institute of Health Sciences, Gyeongsang National University School of Medicine , Jinju, Korea
| | - Min Jin Kang
- 3 Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital , Goyang, Korea
| | - Soo Kyoung Kim
- 1 Division of Endocrinology and Metabolism, Department of Medicine, Gyeongsang National University School of Medicine , Jinju, Korea
- 2 Institute of Health Sciences, Gyeongsang National University School of Medicine , Jinju, Korea
| | - Jung Hwa Jung
- 1 Division of Endocrinology and Metabolism, Department of Medicine, Gyeongsang National University School of Medicine , Jinju, Korea
- 2 Institute of Health Sciences, Gyeongsang National University School of Medicine , Jinju, Korea
| | - Jong Ryeal Hahm
- 1 Division of Endocrinology and Metabolism, Department of Medicine, Gyeongsang National University School of Medicine , Jinju, Korea
- 2 Institute of Health Sciences, Gyeongsang National University School of Medicine , Jinju, Korea
| | - Tae Hyuk Kim
- 4 Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Joo Young Nam
- 5 Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital , Goyang, Korea
| | - Byung-Wan Lee
- 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine , Seoul, Korea
| | - Yong-Ho Lee
- 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine , Seoul, Korea
| | - Jae Hoon Chung
- 4 Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Sun Ok Song
- 5 Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital , Goyang, Korea
| | - Sun Wook Kim
- 4 Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
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Heidari Z, Abdani M, Mansournia MA. Insulin Resistance Associated With Differentiated Thyroid Carcinoma: Penalized Conditional Logistic Regression Analysis of a Matched Case-Control Study Data. Int J Endocrinol Metab 2018; 16:e14545. [PMID: 29696038 PMCID: PMC5903382 DOI: 10.5812/ijem.14545] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/07/2017] [Accepted: 10/04/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In the recent years, thyroid cancer incidence has increased worldwide. It has been questioned whether factors, such as insulin resistance, are involved in this rise. The main aim of this study was to examine the association between insulin resistance and differentiated thyroid cancer. METHODS This case-control study was performed on 30 newly diagnosed patients with differentiated thyroid cancer and 30 healthy controls. Thirty euthyroid patients recently diagnosed with differentiated thyroid cancer, based on the fine needle aspiration cytology, were examined for insulin resistance before thyroidectomy in the euthyroid state. For each patient in the case group, one healthy euthyroid individual without thyroid nodule from general population was matched based on gender, age (± 1 year), and body mass index (BMI) (± 1). Thyroid function test, thyroid antibodies, serum glucose, serum insulin, and thyroid ultrasonography was performed for all participants. Insulin resistance was defined based on homeostasis model assessment of insulin resistance (HOMA-IR) to be more than 2.5. RESULTS In the patient group, 24 (80%) cases were female and 6 (20%) were male. Insulin resistance was more prevalent in the case group than the control group (43.3% versus 13.3%). Insulin sensitivity index was lower in the case group than in the control group (50 and 81, respectively). There was a significant positive association between serum HOMA-IR levels and differentiated thyroid cancer (OR: 2.43 for 1 unit increase in HOMA-IR, 95% CI: 1.35 - 5.51; P = 0.001). Insulin resistance was significantly associated with differentiated thyroid cancer (OR: 4, 95 % CI: 1.27 - 17.6; P = 0.016). CONCLUSIONS There was a significant association between insulin resistance and differentiated thyroid carcinoma. More research with a larger sample size and prospective design are needed to determine the role of this factor in the development of differentiated thyroid cancers.
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Affiliation(s)
- Zahra Heidari
- MD, Department of Endocrinology and Metabolism, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Mahdi Abdani
- MD, Department of Endocrinology and Metabolism, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Mohammad Ali Mansournia
- MD, MPH, PhD, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mohammad Ali Mansournia, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, PO Box: 14155-6446, Tehran, IR Iran. E-mail:
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Sui M, Yu Y, Zhang H, Di H, Liu C, Fan Y. Efficacy of Metformin for Benign Thyroid Nodules in Subjects With Insulin Resistance: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2018; 9:494. [PMID: 30233494 PMCID: PMC6127618 DOI: 10.3389/fendo.2018.00494] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/07/2018] [Indexed: 01/23/2023] Open
Abstract
Background: To evaluate the effect of metformin therapy on decreasing benign thyroid nodule volume in subjects with insulin resistance (IR). Method: Randomized controlled trials (RCTs) and self-controlled trials for the meta-analysis published, before January 31, 2018 were selected from the PubMed, Cochrane Library, Embase, Web of Science, Chinese Biomedical Literature Database, National Knowledge Infrastructure, WANFANG and VIP Database. Pooled standard mean difference with 95% confidence interval was estimated by fixed- or random-effects model depending on heterogeneity. The risk of bias using the Cochrane Collaboration's tool was used to assess the quality of the RCTs contained. The quality of self-controlled studies was evaluated using the Methodological index for non-randomized studies (MINORS) method. Results: 7 studies (3 RCTs and 4 prospective self-controlled studies) with 240 patients were considered to be appropriate for the meta-analysis. The results of the meta-analysis indicated that the volume of thyroid nodule decreased significantly after metformin therapy (SMD -0.62, 95% CI -0.98 ~ -0.27). 6 studies reported the changes of the level of TSH. TSH levels decreased significantly after metformin therapy (SMD -0.27, 95% CI -0.47 ~ -0.07). The pooled data indicated an increase in FT3 level, and an unchanged FT4 level after metformin therapy (FT3, SMD 0.25, 95% CI 0.05 ~ 0.45; FT4, SMD -0.07, 95% CI -0.27 ~ 0.13). HOMA-IR levels decreased significantly after metformin therapy based on the pooled results of 3 RCTs and 3 prospective self-controlled studies (SMD -1.08, 95% CI -1.69 ~ -0.47). Conclusion: The meta-analysis demonstrated that metformin was safe and useful in shrinking benign thyroid nodules volume, improving thyroid function and IR. A large number of high-quality prospective studies still need to be carried out.
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Affiliation(s)
- Miao Sui
- Endocrinology Laboratory, The Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
- Department of Endocrinology, Xuzhou Hospital of Traditional Chinese Medicine, Xuzhou, China
| | - Yuan Yu
- Department of Gastroenterology, Jiangning District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Huifeng Zhang
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Hongjie Di
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chao Liu
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- *Correspondence: Chao Liu
| | - Yaofu Fan
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Yaofu Fan
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Krysiak R, Szkróbka W, Okopień B. Effect of Metformin on Hypothalamic-Pituitary-Thyroid Axis Activity in Elderly Antipsychotic-Treated Women With Type 2 Diabetes and Subclinical Hypothyroidism: A Preliminary Study. J Clin Pharmacol 2017; 58:586-592. [PMID: 29251783 DOI: 10.1002/jcph.1048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/25/2017] [Indexed: 12/14/2022]
Abstract
Metformin was found to reduce elevated serum thyrotropin levels, and this effect was partially determined by endogenous dopaminergic tone. The aim of this study was to compare the effect of metformin treatment on hypothalamic-pituitary-thyroid axis activity in elderly women with subclinical hypothyroidism treated with antipsychotic agents and not receiving this drug. The study population consisted of 34 elderly women with subclinical hypothyroidism, 16 of whom received antipsychotic drugs. Because of coexistent type 2 diabetes, these women were treated with metformin (2.55-3 g daily). Glucose homeostasis markers as well as serum levels of thyrotropin, free thyroid hormones and prolactin were measured at the beginning of the study and 6 months later. Thirty women completed the study. With the exception of prolactin, baseline serum levels of the assessed hormones were comparable in both study groups. Although metformin reduced serum thyrotropin levels in both groups, this effect was more pronounced in the antipsychotic-treated than in the antipsychotic-naive patients. The effect on serum prolactin was observed only in antipsychotic-treated patients. The impact on serum thyrotropin levels correlated with improvement in insulin sensitivity and with a reduction in prolactin levels. Free thyroxine and free triiodothyronine remained at a similar level throughout the study. The obtained results indicate that metformin reduces serum thyrotropin levels in elderly women, and this effect is particularly pronounced in women with diminished dopaminergic transmission.
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Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
| | - Witold Szkróbka
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
| | - Bogusław Okopień
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
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28
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Barmpari ME, Kokkorou M, Micheli A, Alexiou I, Spanou E, Noutsou M, Thanopoulou A. Thyroid Dysfunction among Greek Patients with Type 1 and Type 2 Diabetes Mellitus as a Disregarded Comorbidity. J Diabetes Res 2017; 2017:6505814. [PMID: 29214182 PMCID: PMC5682912 DOI: 10.1155/2017/6505814] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/27/2017] [Accepted: 10/08/2017] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The aim of this study was to determine the prevalence of thyroid dysfunction in Greek patients with type 1 (T1DM) and type 2 (T2DM) diabetes mellitus as well as its possible relations to glycaemic control and to diabetic complications. METHODS A total of 1015 patients, consecutively followed in the Outpatient Diabetes Center, were studied. Anthropometric and biochemical measurements, occurrence of diabetes complications, and classical comorbidities were assessed. Average HbA1c of the previous year was calculated. Wellbeing was determined, using a 10-point optimal scale. All the above parameters were compared between subjects with or without thyroid disease. RESULTS All patients were euthyroid at the time of the study, either on thyroid medications or not. Hypothyroidism occurrence did not differ between T2DM and T1DM patients (37.1% versus 43.5%, p > 0.05). Nodular goiter was observed more frequently in T2DM patients (34.1% versus 18.8%, p < 0.05). T2DM patients with hypothyroidism compared to those without hypothyroidism had higher HbA1c (7.27% versus 6.98%, p < 0.01), TChol (184.97 mg/dl versus 168.17 mg/dl, p < 0.001), and higher HDL-Chol (51.28 mg/dl versus 46.77 mg/dl, p < 0.01). T2DM patients without hypothyroidism had a better wellness feeling (7.5 versus 5.3 points, p < 0.01). CONCLUSIONS Screening for thyroid disease among T2DM patients should be routinely considered, as it is found to be an additional commorbidity. If it remains undiagnosed, it could aggravate the clinical course of the disease.
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Affiliation(s)
- Maria E. Barmpari
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Maria Kokkorou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Anastasia Micheli
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Irene Alexiou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Elefteria Spanou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Marina Noutsou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Anastasia Thanopoulou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
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Panagiotou G, Komninou D, Anagnostis P, Linardos G, Karoglou E, Somali M, Duntas L, Kita M, Tziomalos K, Pazaitou-Panayiotou K. Association between lifestyle and anthropometric parameters and thyroid nodule features. Endocrine 2017; 56:560-567. [PMID: 28390011 DOI: 10.1007/s12020-017-1285-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Thyroid nodularity has been associated with obesity, but data regarding associations of body composition parameters with specific ultrasound features of thyroid nodules are lacking. The aim of the present study was to assess associations between thyroid nodule ultrasound characteristics, lifestyle, and anthropometric parameters. SUBJECTS AND METHODS This was a cross-sectional study in the general apparently healthy population of Northern Greece. Thyroid ultrasound data together with medical history, demographic, and anthropometric characteristics were individually recorded. Body composition was evaluated using bioelectrical impedance. RESULTS Three hundred and six subjects [215 females (70.3%), aged 20-83 years] were included. Ultrasound revealed one or more thyroid nodules in 168 subjects (54.9%). Subjects with thyroid nodules were more frequently females (p = 0.033), older (p < 0.001) and had higher fat mass (p = 0.011), total body fat percentage (p < 0.001) and waist circumference (p = 0.045) than subjects without nodules. In logistic regression analyses, age and female gender were the only independent predictors of presence of thyroid nodules, as well as specific sonographic features. Additionally, total body fat percentage was positively correlated with nodule size (rho = 0.210, p = 0.006) and was the only independent predictor of hypoechoic thyroid nodule(s) and peripheral vascularity, while lack of exercise was predictive of internal vascularity. CONCLUSIONS Body fat accumulation and lack of exercise, used as surrogate markers of sedentary lifestyle, influence thyroid nodule size and could predict some ultrasonographic characteristics, like hypoechoicity and internal vascularity. Therefore, routine thyroid examination of obese patients and promotion of active lifestyle may be warranted to prevent thyroid nodule formation and possibly progression to malignancy.
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Affiliation(s)
- Grigorios Panagiotou
- Department of Endocrinology-Endocrine Oncology, Theagenio Cancer Hospital, Thessaloniki, Greece
| | - Despina Komninou
- Department of Endocrinology-Endocrine Oncology, Theagenio Cancer Hospital, Thessaloniki, Greece
| | | | - George Linardos
- Department of Endocrinology-Endocrine Oncology, Theagenio Cancer Hospital, Thessaloniki, Greece
| | - Eleni Karoglou
- Department of Endocrinology-Endocrine Oncology, Theagenio Cancer Hospital, Thessaloniki, Greece
| | - Maria Somali
- Department of Endocrinology, Hippokration General Hospital, Thessaloniki, Greece
| | - Leonidas Duntas
- Department of Endocrinology-Endocrine Oncology, Theagenio Cancer Hospital, Thessaloniki, Greece
| | - Marina Kita
- Department of Endocrinology, Hippokration General Hospital, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- Department of Endocrinology-Endocrine Oncology, Theagenio Cancer Hospital, Thessaloniki, Greece
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Gender Disparity in the Relationship between Prevalence of Thyroid Nodules and Metabolic Syndrome Components: The SHDC-CDPC Community-Based Study. Mediators Inflamm 2017; 2017:8481049. [PMID: 28607535 PMCID: PMC5457761 DOI: 10.1155/2017/8481049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 02/20/2017] [Indexed: 12/31/2022] Open
Abstract
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.
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Meng X, Xu S, Chen G, Derwahl M, Liu C. Metformin and thyroid disease. J Endocrinol 2017; 233:R43-R51. [PMID: 28196954 DOI: 10.1530/joe-16-0450] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 01/04/2017] [Indexed: 12/26/2022]
Abstract
An intriguing area of research in thyroidology is the recently discovered association of insulin resistance with thyroid functional and morphological abnormalities. Individuals with hyperinsulinemia have larger thyroid gland and a higher prevalence of thyroid nodules and cancer. Accordingly, patients treated with metformin have a smaller thyroid volume and a lower risk of incident goiter, thyroid nodule and cancer. Multiple studies in vitro and in vivo have demonstrated that metformin can inhibit the growth of thyroid cells and different types of thyroid cancer cells by affecting the insulin/IGF1 and mTOR pathways. Besides, metformin treatment was associated with a decrease in the levels of serum thyroid-stimulating hormone (TSH) in diabetic patients possibly by enhancing the effects of thyroid hormones in the pituitary and activating the adenosine monophosphate-activated protein kinase (AMPK). Based on this evidence, metformin appears to be a promising therapeutic tool in patients with thyroid disease. More clinical studies are necessary to evaluate the clinical significance of metformin for the treatment of thyroid diseases.
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Affiliation(s)
| | - Shuhang Xu
- Affiliated Hospital of Integrated Traditional Chinese and Western MedicineNanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Guofang Chen
- Affiliated Hospital of Integrated Traditional Chinese and Western MedicineNanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Michael Derwahl
- Division of EndocrinologyDepartment of Medicine, St. Hedwig Hospital, Berlin, Germany
| | - Chao Liu
- Affiliated Hospital of Integrated Traditional Chinese and Western MedicineNanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
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Sahin M, Demircioglu D, Oguz A, Tuzun D, Sarica MA, Inanc E, Gul K. Does insulin resistance increase thyroid volume in patients with polycystic ovary syndrome? ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:145-151. [PMID: 27901182 PMCID: PMC10118860 DOI: 10.1590/2359-3997000000225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/29/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the effect of gonadotropin, sex hormone levels and insulin resistance (IR) on thyroid functions and thyroid volume (TV) in polycystic ovary syndrome (PCOS). SUBJECTS AND METHODS 69 new diagnosed PCOS patients (age 24.82 ± 6.17) and 56 healthy control female (age 26.69 ± 5.25) were involved to the study. Fasting plasma glucose, lipid profile, insulin, thyroid stimulating hormone (TSH), free thyroxine (fT4), estradiol (E2), luteinizing hormone (LH), follicle stimulating hormone levels and urine iodine were measured in all participants. Thyroid and pelvic ultrasound were performed in all participants. RESULTS Insulin, HOMA-IR, LH, E2 and TV were higher in PCOS group (p < 0.05). TV was significantly higher in PCOS patients with IR compared to non-IR PCOS patients (p < 0.001), while TSH, fT4, and urine iodine levels were similar between these groups (p > 0.05). There was a negative correlation between E2 and TSH (p < 0.05) and a positive correlation between TSH and TV (p < 0.05). There was a significant positive correlation between TV and LH, insulin, HOMA-IR (p < 0.05). CONCLUSION This study showed that TV was increased in patients with insulin resistance but differences in TSH and LH levels may affect TV changes as well.
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Affiliation(s)
| | | | - Ayten Oguz
- Kahramanmaras Sutcu Imam University, Turkey
| | | | | | - Elif Inanc
- Kahramanmaras Sutcu Imam University, Turkey
| | - Kamile Gul
- Kahramanmaras Sutcu Imam University, Turkey
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Malaguarnera R, Vella V, Nicolosi ML, Belfiore A. Insulin Resistance: Any Role in the Changing Epidemiology of Thyroid Cancer? Front Endocrinol (Lausanne) 2017; 8:314. [PMID: 29184536 PMCID: PMC5694441 DOI: 10.3389/fendo.2017.00314] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/30/2017] [Indexed: 12/13/2022] Open
Abstract
In the past few decades, the incidence of thyroid cancer (TC), namely of its papillary hystotype (PTC), has shown a steady increase worldwide, which has been attributed at least in part to the increasing diagnosis of early stage tumors. However, some evidence suggests that environmental and lifestyle factors can also play a role. Among the potential risk factors involved in the changing epidemiology of TC, particular attention has been drawn to insulin-resistance and related metabolic disorders, such as obesity, type 2 diabetes, and metabolic syndrome, which have been also rapidly increasing worldwide due to widespread dietary and lifestyle changes. In accordance with this possibility, various epidemiological studies have indeed gathered substantial evidence that insulin resistance-related metabolic disorders might be associated with an increased TC risk either through hyperinsulinemia or by affecting other TC risk factors including iodine deficiency, elevated thyroid stimulating hormone, estrogen-dependent signaling, chronic autoimmune thyroiditis, and others. This review summarizes the current literature evaluating the relationship between metabolic disorders characterized by insulin resistance and the risk for TC as well as the possible underlying mechanisms. The potential implications of such association in TC prevention and therapy are discussed.
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Affiliation(s)
- Roberta Malaguarnera
- Endocrinology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Veronica Vella
- School of Human and Social Sciences, “Kore” University of Enna, Enna, Italy
- *Correspondence: Veronica Vella, ; Antonino Belfiore,
| | - Maria Luisa Nicolosi
- Endocrinology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Antonino Belfiore
- Endocrinology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- *Correspondence: Veronica Vella, ; Antonino Belfiore,
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Abstract
Myo-inositol and phosphatidylinositol(s) play a pivotal function in many metabolic pathways that, if impaired, impact unfavorably on human health. This review analyzes several experimental and clinical investigations regarding the involvement of this class of molecules in physiological and pathological situations, with a major focus on thyroid. Central issues are the relationship between phosphatidylinositol and thyrotropin (TSH) signaling on one hand, and phosphatydylinositol and autoimmunity on the other hand. Other issues are the consequences of malfunction of some receptors, such as those ones for TSH (TSHR), insulin (IR) and insulin-like growth factor-1 (IGF-1R), or the connection between serum TSH concentrations and insulin resistance. Also covered are insulin resistance, metabolic syndrome and their allied disorders (diabetes, polycystic ovary syndrome [PCOS]), autoimmunity and certain malignancies, with their reciprocal links. Myoinositol has promising therapeutic potential. Appreciation of the inositol pathways involved in certain disorders, as mentioned in this review, may stimulate researchers to envisage additional therapeutic applications.
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Affiliation(s)
- Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina School of Medicine, via Consolare Valeria, 1, 98125, Messina, Italy.
- Master Program of Childhood, Adolescence and Women's Endocrine Health, University of Messina School of Medicine, via Consolare Valeria, 1, 98125, Messina, Italy.
- Interdepartmental Program of Molecular & Clinical Endocrinology, and Women's Endocrine Health, University hospital, Padiglione H, 4 piano, Policlinico G. Martino, 98125, Messina, Italy.
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126, Pisa, Italy
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Sex-dependent effect of metformin on hypothalamic-pituitary-thyroid axis activity in patients with subclinical hypothyroidism. Pharmacol Rep 2016; 68:1115-1119. [PMID: 27588386 DOI: 10.1016/j.pharep.2016.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 06/27/2016] [Accepted: 07/14/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Metformin was found to reduce elevated serum thyrotropin levels. No previous study has compared the effect of this drug on serum levels of thyrotropin and thyroid hormones between men and women. METHODS The study included 23 women and 12 men with subclinical hypothyroidism, who because of coexisting diabetes or impaired fasting glucose were treated with metformin (1.7-3.0g daily). Fasting plasma glucose levels, the homeostatic model assessment 1 of insulin resistance ratio (HOMA1-IR), glycated hemoglobin, serum levels of thyrotropin, free and total thyroid hormones and prolactin, as well as thyroid peroxidase and thyroglobulin antibodies were assessed at baseline and after 4 months of metformin treatment. RESULTS Baseline serum levels of thyrotropin, free thyroxine and free triiodothyronine, as well as a percentage of patients with positive thyroid peroxidase and thyroglobulin antibodies were comparable in both sexes. Metformin treatment reduced plasma glucose and insulin resistance, irrespective of the gender. However, only in women, metformin decreased serum thyrotropin levels. Neither in men nor in women, metformin affected serum levels of thyroid hormone and prolactin, as well as in the subgroups of patients with thyroiditis thyroid antibody titers. CONCLUSIONS The obtained results suggest that sex may determine the effect of metformin on hypothalamic-pituitary-thyroid axis activity.
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Craps J, Joris V, De Jongh B, Sonveaux P, Horman S, Lengelé B, Bertrand L, Many MC, Colin IM, Gérard AC. Involvement of mTOR and Regulation by AMPK in Early Iodine Deficiency-Induced Thyroid Microvascular Activation. Endocrinology 2016; 157:2545-59. [PMID: 27035650 DOI: 10.1210/en.2015-1911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Iodine deficiency (ID) induces TSH-independent microvascular activation in the thyroid via the reactive oxygen species/nitric oxide-hypoxia-inducible factor-1α/vascular endothelial growth factor (VEGF) pathway. We hypothesized the additional involvement of mammalian target of rapamycin (mTOR) as a positive regulator of this pathway and AMP-activated protein kinase (AMPK) as a negative feedback regulator to explain the transient nature of ID-induced microvascular changes under nonmalignant conditions. mTOR and AMPK involvement was investigated using an in vitro model (human thyrocytes in primary cultures) and 2 murine models of goitrogenesis (normal NMRI and RET-PTC mice [a papillary thyroid cancer model]). In NMRI mice, ID had no effect on the phosphorylation of ribosomal S6 kinase (p70S6K), a downstream target of mTOR. However, rapamycin inhibited ID-induced thyroid blood flow and VEGF protein expression. In the RET-PTC model, ID strongly increased the phosphorylation of p70S6K, whereas rapamycin completely inhibited the ID-induced increase in p70S6K phosphorylation, thyroid blood flow, and VEGF-A expression. In vitro, although ID increased p70S6K phosphorylation, the ID-stimulated hypoxia-inducible factor/VEGF pathway was inhibited by rapamycin. Activation of AMPK by metformin inhibited ID effects both in vivo and in vitro. In AMPK-α1 knockout mice, the ID-induced increase in thyroid blood flow and VEGF-A protein expression persisted throughout the treatment, whereas both parameters returned to control values in wild-type mice after 4 days of ID. In conclusion, mTOR is required for early ID-induced thyroid microvascular activation. AMPK negatively regulates this pathway, which may account for the transient nature of ID-induced TSH-independent vascular effects under benign conditions.
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Affiliation(s)
- J Craps
- Pôle de Morphologie (J.C., B.D.J., B.L., M.-C.M., I.M.C., A.-C.G.), de Pharmacologie et Thérapeutique (V.J., P.S.), de Recherche Cardiovasculaire (S.H., L.B.), Institut de Recherche Expérimentale et Clinique, Laboratoire de Biologie Cellulaire, and Institut des Sciences de la Vie (A.-C.G.), Université Catholique de Louvain, Louvain-La-Neuve, Brussels 1200, Belgium
| | - V Joris
- Pôle de Morphologie (J.C., B.D.J., B.L., M.-C.M., I.M.C., A.-C.G.), de Pharmacologie et Thérapeutique (V.J., P.S.), de Recherche Cardiovasculaire (S.H., L.B.), Institut de Recherche Expérimentale et Clinique, Laboratoire de Biologie Cellulaire, and Institut des Sciences de la Vie (A.-C.G.), Université Catholique de Louvain, Louvain-La-Neuve, Brussels 1200, Belgium
| | - B De Jongh
- Pôle de Morphologie (J.C., B.D.J., B.L., M.-C.M., I.M.C., A.-C.G.), de Pharmacologie et Thérapeutique (V.J., P.S.), de Recherche Cardiovasculaire (S.H., L.B.), Institut de Recherche Expérimentale et Clinique, Laboratoire de Biologie Cellulaire, and Institut des Sciences de la Vie (A.-C.G.), Université Catholique de Louvain, Louvain-La-Neuve, Brussels 1200, Belgium
| | - P Sonveaux
- Pôle de Morphologie (J.C., B.D.J., B.L., M.-C.M., I.M.C., A.-C.G.), de Pharmacologie et Thérapeutique (V.J., P.S.), de Recherche Cardiovasculaire (S.H., L.B.), Institut de Recherche Expérimentale et Clinique, Laboratoire de Biologie Cellulaire, and Institut des Sciences de la Vie (A.-C.G.), Université Catholique de Louvain, Louvain-La-Neuve, Brussels 1200, Belgium
| | - S Horman
- Pôle de Morphologie (J.C., B.D.J., B.L., M.-C.M., I.M.C., A.-C.G.), de Pharmacologie et Thérapeutique (V.J., P.S.), de Recherche Cardiovasculaire (S.H., L.B.), Institut de Recherche Expérimentale et Clinique, Laboratoire de Biologie Cellulaire, and Institut des Sciences de la Vie (A.-C.G.), Université Catholique de Louvain, Louvain-La-Neuve, Brussels 1200, Belgium
| | - B Lengelé
- Pôle de Morphologie (J.C., B.D.J., B.L., M.-C.M., I.M.C., A.-C.G.), de Pharmacologie et Thérapeutique (V.J., P.S.), de Recherche Cardiovasculaire (S.H., L.B.), Institut de Recherche Expérimentale et Clinique, Laboratoire de Biologie Cellulaire, and Institut des Sciences de la Vie (A.-C.G.), Université Catholique de Louvain, Louvain-La-Neuve, Brussels 1200, Belgium
| | - L Bertrand
- Pôle de Morphologie (J.C., B.D.J., B.L., M.-C.M., I.M.C., A.-C.G.), de Pharmacologie et Thérapeutique (V.J., P.S.), de Recherche Cardiovasculaire (S.H., L.B.), Institut de Recherche Expérimentale et Clinique, Laboratoire de Biologie Cellulaire, and Institut des Sciences de la Vie (A.-C.G.), Université Catholique de Louvain, Louvain-La-Neuve, Brussels 1200, Belgium
| | - M-C Many
- Pôle de Morphologie (J.C., B.D.J., B.L., M.-C.M., I.M.C., A.-C.G.), de Pharmacologie et Thérapeutique (V.J., P.S.), de Recherche Cardiovasculaire (S.H., L.B.), Institut de Recherche Expérimentale et Clinique, Laboratoire de Biologie Cellulaire, and Institut des Sciences de la Vie (A.-C.G.), Université Catholique de Louvain, Louvain-La-Neuve, Brussels 1200, Belgium
| | - I M Colin
- Pôle de Morphologie (J.C., B.D.J., B.L., M.-C.M., I.M.C., A.-C.G.), de Pharmacologie et Thérapeutique (V.J., P.S.), de Recherche Cardiovasculaire (S.H., L.B.), Institut de Recherche Expérimentale et Clinique, Laboratoire de Biologie Cellulaire, and Institut des Sciences de la Vie (A.-C.G.), Université Catholique de Louvain, Louvain-La-Neuve, Brussels 1200, Belgium
| | - A-C Gérard
- Pôle de Morphologie (J.C., B.D.J., B.L., M.-C.M., I.M.C., A.-C.G.), de Pharmacologie et Thérapeutique (V.J., P.S.), de Recherche Cardiovasculaire (S.H., L.B.), Institut de Recherche Expérimentale et Clinique, Laboratoire de Biologie Cellulaire, and Institut des Sciences de la Vie (A.-C.G.), Université Catholique de Louvain, Louvain-La-Neuve, Brussels 1200, Belgium
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Krysiak R, Gilowska M, Szkróbka W, Okopień B. The effect of metformin on the hypothalamic-pituitary-thyroid axis in patients with type 2 diabetes and amiodarone-induced hypothyroidism. Pharmacol Rep 2016; 68:490-4. [DOI: 10.1016/j.pharep.2015.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 11/26/2015] [Accepted: 11/27/2015] [Indexed: 12/30/2022]
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38
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Anil C, Kut A, Atesagaoglu B, Nar A, Bascil Tutuncu N, Gursoy A. Metformin Decreases Thyroid Volume and Nodule Size in Subjects with Insulin Resistance: A Preliminary Study. Med Princ Pract 2016; 25:233-6. [PMID: 26618447 PMCID: PMC5588367 DOI: 10.1159/000442821] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 11/29/2015] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate the effects of metformin on thyroid volume and nodule size. SUBJECTS AND METHODS Prospective data were gathered on 100 newly diagnosed subjects with insulin resistance (68 female, 32 male) between August 2008 and May 2010. Each subject followed a standard diet and exercise program, and received 1,700 mg/day of metformin therapy for 6 months. The height, weight, waist circumference (WC) and thyroid hormone levels of each subject were measured. Additionally, the dimensions of the thyroid lobes and maximum diameter of each thyroid nodule were determined by ultrasonography. BMI and thyroid volumes were also calculated. Insulin resistance was estimated by homeostasis model assessment. All these parameters were measured at the beginning and at the end of the treatment period. RESULTS BMI and WC decreased significantly after metformin therapy (34.5 ± 5.1 vs. 32.7 ± 4.8, p < 0.0001, and 106.3 ± 11.8 vs. 101.8 ± 19.0 cm, p = 0.008, respectively). Insulin resistance also decreased after metformin therapy (4.5 ± 1.9 vs. 2.9 ± 1.7, p < 0.0001). The mean thyroid volume (22.5 ± 11.2 vs. 20.3 ± 10.4 ml, p < 0.0001) and mean thyroid nodule size (12.9 ± 7.6 vs. 11.7 ± 7.2 mm, p < 0.0001) also decreased after treatment. CONCLUSION In subjects with insulin resistance, metformin therapy significantly decreased thyroid volume and nodule size.
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Affiliation(s)
- Cuneyd Anil
- Department of Endocrinology and Metabolism, Ankara, Turkey
- *Cuneyd Anil, Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, 5 Sokak No. 48, TR-06490 Bahcelievler, Ankara (Turkey), E-Mail
| | - Altug Kut
- Department of Family Medicine, Baskent University Faculty of Medicine, Ankara, Turkey
| | | | - Asli Nar
- Department of Endocrinology and Metabolism, Ankara, Turkey
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Bae MJ, Kim SS, Kim WJ, Yi YS, Jeon YK, Kim BH, Lee BJ, Lee JC, Kim IJ, Wang SG, Kim YK. High prevalence of papillary thyroid cancer in Korean women with insulin resistance. Head Neck 2015; 38:66-71. [PMID: 25196854 DOI: 10.1002/hed.23848] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2014] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine if hyperinsulinemia and/or insulin resistance are/is associated with the prevalence of papillary thyroid cancer (PTC) in Korean women. METHODS This study included 735 female patients with PTC and 537 female non-PTC control subjects. Multiple logistic regression analysis was performed to evaluate the associations between hyperinsulinemia/insulin resistance and the occurrence of PTC. RESULTS The prevalence of PTC was significantly correlated with increased insulin, glucose levels, and a high homeostasis model of assessment-insulin resistance (HOMA-IR). The multivariate adjusted odds ratios for the prevalence of PTC in the highest quartile groups for insulin, glucose, and HOMA-IR were 2.88, 9.32, and 4.07 (all p < .001), respectively, compared with the lowest quartile groups. Pathological analyses revealed that increased serum glucose, insulin levels, and a higher HOMA-IR were associated with the multifocality of PTC. CONCLUSION Hyperinsulinemia and/or insulin resistance may be associated with the development of PTC, but not disease severity in Korean women.
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Affiliation(s)
- Min Jung Bae
- Kim Yong Ki Internal Medicine Clinic, Busan, Korea
| | - Sang Soo Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Won Jin Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yang Seon Yi
- Department of Internal Medicine, Busan Veterans Hospital, Busan, Korea
| | - Yun Kyung Jeon
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Bo Hyun Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Byung Joo Lee
- Department of Otolaryngology, Pusan National University Hospital, Busan, Korea
| | - Jin Choon Lee
- Department of Otolaryngology, Pusan National University Hospital, Busan, Korea
| | - In Joo Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Soo Geun Wang
- Department of Otolaryngology, Pusan National University Hospital, Busan, Korea
| | - Yong Ki Kim
- Kim Yong Ki Internal Medicine Clinic, Busan, Korea
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40
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Duran C, Basaran M, Kutlu O, Kucukaydin Z, Bakdik S, Burnik FS, Aslan U, Erdem SS, Ecirli S. Frequency of nodular goiter and autoimmune thyroid disease in patients with polycystic ovary syndrome. Endocrine 2015; 49:464-9. [PMID: 25522724 DOI: 10.1007/s12020-014-0504-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 12/05/2014] [Indexed: 11/29/2022]
Abstract
Polycystic ovary syndrome (PCOS), and nodular and autoimmune thyroid diseases are frequently seen disorders. Previous studies reported conflicting results regarding possible association between PCOS and thyroid disorders. In this study, we investigated the frequency of autoimmune thyroid disease (AITD) and nodular goiter in patients with PCOS. Seventy-three PCOS patients and 60 age-matched controls were enrolled in the study. In PCOS group, body mass index values (27.45 ± 5.73 vs. 22.55 ± 3.78 kg/m(2), p < 0.001, respectively), systolic [110 mmHg (90-130) vs. 100 mmHg (90-140), p = 0.016, respectively] and diastolic (72.67 ± 6.52 vs. 66.42 ± 8.88 mmHg, p < 0.001, respectively) blood pressure, waist circumference (86.27 ± 14.41 vs. 78.78 ± 8.87 cm, p < 0.001, respectively), and homeostasis model assessment-insulin resistance (HOMA-IR) levels (2.96 ± 2.11 and 1.77 ± 0.83 p < 0.001, respectively) were higher than controls. However, thyroid nodule frequency was similar in both groups [22 (30.1 %) vs. 12 (20 %)], also thyroid gland volume was not significantly different [9.23 ml (3.08-32.40) vs. 8.52 ml (4.28-50.29)] among groups. The percentages of patients with thyroid parenchymal heterogeneity, positive anti-thyroid peroxidase, anti-thyroglobulin, and AITD were similar. Cases were reclassified according to the presence of thyroid nodule in which similar HOMA-IR levels were detected (median 2.39 and 1.89, p = 0.093, respectively) despite the fact that the group with nodules had higher mean age (26.5 (18-37) vs. 21 (18-34), p = 0.013, respectively). Similar ratios of thyroid nodule and AITD were found in patients with PCOS and controls.
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Affiliation(s)
- Cevdet Duran
- Division of Internal Medicine, Endocrinology and Metabolism, Konya Training and Research Hospital, 42100, Konya, Turkey,
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Blanc E, Ponce C, Brodschi D, Nepote A, Barreto A, Schnitman M, Fossati P, Salgado P, Cejas C, Faingold C, Musso C, Brenta G. Association Between Worse Metabolic Control and Increased Thyroid Volume and Nodular Disease in Elderly Adults with Metabolic Syndrome. Metab Syndr Relat Disord 2015; 13:221-6. [DOI: 10.1089/met.2014.0158] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Evelyn Blanc
- Department of Endocrinology and Metabolism, Cesar Milstein Hospital, Buenos Aires, Argentina
| | - Cecilia Ponce
- Department of Endocrinology and Metabolism, Cesar Milstein Hospital, Buenos Aires, Argentina
| | - Dafne Brodschi
- Department of Endocrinology and Metabolism, Cesar Milstein Hospital, Buenos Aires, Argentina
| | - Alejandra Nepote
- Department of Endocrinology and Metabolism, Cesar Milstein Hospital, Buenos Aires, Argentina
| | - Adriana Barreto
- Department of Endocrinology and Metabolism, Cesar Milstein Hospital, Buenos Aires, Argentina
| | - Marta Schnitman
- Department of Endocrinology and Metabolism, Cesar Milstein Hospital, Buenos Aires, Argentina
| | - Pia Fossati
- Clinical Laboratory, Cesar Milstein Hospital, Buenos Aires, Argentina
| | - Pablo Salgado
- Centro de investigación en salud poblacional CISAP, Hospital Durand, Buenos Aires, Argentina
| | - Claudia Cejas
- Department of Radiology, Cesar Milstein Hospital, Buenos Aires, Argentina
| | - Cristina Faingold
- Department of Endocrinology and Metabolism, Cesar Milstein Hospital, Buenos Aires, Argentina
| | - Carla Musso
- Department of Endocrinology and Metabolism, Cesar Milstein Hospital, Buenos Aires, Argentina
| | - Gabriela Brenta
- Department of Endocrinology and Metabolism, Cesar Milstein Hospital, Buenos Aires, Argentina
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Plews RL, Mohd Yusof A, Wang C, Saji M, Zhang X, Chen CS, Ringel MD, Phay JE. A novel dual AMPK activator/mTOR inhibitor inhibits thyroid cancer cell growth. J Clin Endocrinol Metab 2015; 100:E748-56. [PMID: 25710562 PMCID: PMC4422890 DOI: 10.1210/jc.2014-1777] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
CONTEXT Activated AMP protein kinase (AMPK) is a key regulator of intracellular energy homeostasis and may also function as a tumor suppressor by inhibiting cell growth through suppression of mammalian target of rapamycin (mTOR)/p70S6K signaling. AMPK activating agents, such as metformin and 5-aminoimidazole-4-carboxamide-ribonucleoside, have been demonstrated to inhibit thyroid cancer cell growth in in vitro and in vivo models. OSU-53, a recently developed AMPK activator, was previously shown to exhibit both in vitro and in vivo antitumor activity against aggressive breast cancer cell lines and their xenografts in nude mice. OBJECTIVE The objective of the study was to assess the in vitro effects of OSU-53 treatment in a panel of thyroid cancer cells. DESIGN Experiments were performed to determine the effects of OSU-53 on cell growth, oncogenic signaling, apoptosis, autophagy, and cell rescue after selective knockdown of AMPK. RESULTS OSU-53 inhibited in vitro cell growth of all seven thyroid cancer cells tested and induced activation of AMPK. Cell lines with activating mutations in RAS or BRAF, compared with cells with phosphatase and tensin homolog deleted from chromosome 10 null and RET/papillary thyroid carcinoma mutations, were more sensitive to drug treatment and demonstrated a more robust AMPK activation, inhibition of mTOR signaling, and autophagy stimulation. After selective knockdown of AMPK, cell rescue from OSU-53 treatment was not observed. We demonstrated an off-target effect of direct mTOR inhibition by OSU-53. Increased autophagy was observed in cells with activation RAS or BRAF mutations. CONCLUSIONS OSU-53, a novel dual-AMPK activator/mTOR inhibitor, effectively inhibits growth in a variety of thyroid cancer cell lines and is most potent in cells with activating mutations in RAS or BRAF.
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Affiliation(s)
- Robert L Plews
- Division of Surgical Oncology (R.L.P., J.E.P.), Department of Surgery, Division of Endocrinology, Diabetes, and Metabolism (A.M.Y., C.W., M.S., M.D.R.), Department of Medicine, The Ohio State University, Arthur G. James Comprehensive Cancer Center, and Richard G. Solove Research Institute, and Division of Medicinal Chemistry (C.-S.C.), College of Pharmacy, Columbus, Ohio 43210; and Center for Biostatistics (X.Z.), The Ohio State University, Columbus, Ohio 43221
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Pitoia F, Abelleira E, Bueno F, Urciuoli C, Schmidt A, Niepomniszcze H. Insulin resistance is another factor that increases the risk of recurrence in patients with thyroid cancer. Endocrine 2015; 48:894-901. [PMID: 25209891 DOI: 10.1007/s12020-014-0416-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 09/01/2014] [Indexed: 12/15/2022]
Abstract
The objective of this study was to evaluate the initial response to treatment and the long-term outcome of patients with papillary thyroid cancer (PTC), according to the modified 2014 risk of recurrence classification of the American Thyroid Association and the presence or absence of insulin resistance (IR). We retrospectively reviewed our database of 636 records and selected 171 patients in whom we had previously validated the ATA risk of recurrence (RR) classification. From these patients, 38 non-diabetic subjects were included for analysis according to the following criteria: age older than 18 years, classic papillary thyroid carcinoma, stable body mass index 5 years previous to PTC diagnosis and during the entire time of follow-up, low and intermediate RR, follow-up after initial treatment at least for 3 years, and absence of any drug treatment for the metabolic syndrome. The IR was evaluated through the homeostasis model assessment (HOMA) index. When equal or higher than 2.5, patients were considered as harboring IR. The initial response to treatment was classified as remission or persistent disease (biochemical and/or structural). The clinical status at final follow-up was defined as no evidence of disease, biochemical persistent disease, structural persistent disease, or recurrence (biochemical or structural disease identified after a period of no evidence of disease). RR was as follows: low: n=15, intermediate: n=23. The median follow-up of this patient cohort was 5.5 years (range 3-22 years). We found no statistically significant differences when the response to initial treatment was considered in low-risk patients with or without IR. However, remission was more frequently found in those patients without IR when the intermediate RR was considered (36 vs. 11%, p=0.01). When considering the status at final follow-up, we found more frequency of structural persistent disease in both, low and intermediate RR patients with IR (10 vs. 0%, p=0.02 and 45 vs.7%, p=0.01, respectively). In this series of patients with PTC, the state of IR was associated with increased frequency of structural persistent disease at final follow-up. The IR could have a deleterious effect on the outcome of patients with PTC.
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Affiliation(s)
- Fabián Pitoia
- División Endocrinología, Hospital de Clínicas, University of Buenos Aires, Córdoba 2351, 5th Floor, Buenos Aires, Argentina,
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Rotondi M, Coperchini F, Pignatti P, Magri F, Chiovato L. Metformin reverts the secretion of CXCL8 induced by TNF-α in primary cultures of human thyroid cells: an additional indirect anti-tumor effect of the drug. J Clin Endocrinol Metab 2015; 100:E427-32. [PMID: 25590211 DOI: 10.1210/jc.2014-3045] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Metformin displays both direct and indirect anti-tumor effects. CXCL8 is a crucial downstream mediator of Nuclear-Factor-κB signaling related to the growth and progression of thyroid cancers. Targeting CXCL8 results in prolonged survival and reduced metastatic spread in in-vivo animal models of thyroid tumors. OBJECTIVE This study aimed to evaluate whether metformin inhibits the secretion of CXCL8 induced by Tumor-Necrosis-Factor-α (TNF-α) in primary cultures of normal and tumor human thyroid cells as well as in thyroid cancer cell lines. METHODS Normal human thyrocytes, papillary thyroid cancer cells, and thyroid cancer cell lines (TPC-1 and BCPAP) were stimulated with TNF-α (10 ng/mL) alone or in combination with metformin (0.01, 0.1, 1, 2.5, 5, and 10mM). CXCL8 levels were measured in the cell supernatants after 24 hours. RESULTS Metformin significantly and dose-dependently inhibited the TNF-α-induced CXCL8 secretion in both normal thyrocytes (ANOVA: F = 42.04; P < .0001) and papillary thyroid cancer cells (ANOVA: F = 21.691; P < .0001) but not in TPC-1 and BCPAP cell lines. CONCLUSION Metformin inhibits the TNF-α-induced CXCL8 secretion in primary cultures of normal thyroid cells and differentiated thyroid cancer cells at least of the most frequent poorly aggressive phenotype. The recruitment of neutrophils within the thyroid gland is a crucial metastasis-promoting factor, and it depends on the amount of CXCL8 produced by both tumor cells and by the more abundant normal thyroid cells exposed to TNF-α. Thus, the here-reported inhibiting effect of metformin on TNF-α-induced CXCL8 secretion could be considered as a further indirect anticancer property of the drug.
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Affiliation(s)
- Mario Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors (M.R., F.C., F.M., L.C.), and Allergy and Immunology Unit (P.P.), Fondazione Salvatore Maugeri I.R.C.C.S., 27100 Pavia, Italy
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Kasznicki J, Sliwinska A, Drzewoski J. Metformin in cancer prevention and therapy. ANNALS OF TRANSLATIONAL MEDICINE 2014; 2:57. [PMID: 25333032 DOI: 10.3978/j.issn.2305-5839.2014.06.01] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 05/23/2014] [Indexed: 12/15/2022]
Abstract
The prevalence of diabetes is dramatically increasing worldwide. The results of numerous epidemiological studies indicate that diabetic population is not only at increased risk of cardiovascular complications, but also at substantially higher risk of many forms of malignancies. The use of metformin, the most commonly prescribed drug for type 2 diabetes, was repeatedly associated with the decreased risk of the occurrence of various types of cancers, especially of pancreas and colon and hepatocellular carcinoma. This observation was also confirmed by the results of numerous meta-analyses. There are however, several unanswered questions regarding the exact mechanism of the anticancer effect of metformin as well as its activity against various types of cancer both in diabetic and nondiabetic populations. In the present work we discuss the proposed mechanism(s) of anticancer effect of metformin and preclinical and clinical data suggesting its anticancer effect in different populations.
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Affiliation(s)
- Jacek Kasznicki
- Department of Internal Diseases, Diabetology and Clinical Pharmacology, Medical University of Lodz, ul. Pomorska 251, 92-213 Lodz, Poland
| | - Agnieszka Sliwinska
- Department of Internal Diseases, Diabetology and Clinical Pharmacology, Medical University of Lodz, ul. Pomorska 251, 92-213 Lodz, Poland
| | - Józef Drzewoski
- Department of Internal Diseases, Diabetology and Clinical Pharmacology, Medical University of Lodz, ul. Pomorska 251, 92-213 Lodz, Poland
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Tseng CH. Metformin reduces thyroid cancer risk in Taiwanese patients with type 2 diabetes. PLoS One 2014; 9:e109852. [PMID: 25303400 PMCID: PMC4193839 DOI: 10.1371/journal.pone.0109852] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 09/04/2014] [Indexed: 12/29/2022] Open
Abstract
Background Whether metformin may affect thyroid cancer risk has not been studied. This study investigated the association between metformin use and thyroid cancer risk in Taiwanese patients with type 2 diabetes mellitus. Methods The reimbursement databases of all diabetic patients from 1996 to 2009 were retrieved from the National Health Insurance. An entry date was set at 1 January 2006 and 1,414,723 patients with type 2 diabetes were followed for thyroid cancer incidence until the end of 2009. Incidences for ever-users, never-users and subgroups of metformin exposure using tertile cutoffs for cumulative duration of therapy and cumulative dose were calculated and adjusted hazard ratios were estimated by Cox regression. Additional sensitivity analyses were conducted. Results There were 795,321 ever-users and 619,402 never-users, with respective numbers of incident thyroid cancer of 683 (0.09%) and 1,614 (0.26%), and respective incidence of 24.09 and 87.33 per 100,000 person-years. The overall fully adjusted hazard ratio (95% confidence interval) was 0.683 (0.598–0.780), and all categories of the dose-response parameters showed significantly lower risk with P-trends <0.0001. The protective effect of metformin on thyroid cancer incidence was also supported by sensitivity analyses, disregarding age (<50 or ≥50 years) and sex; and was not affected by excluding users of insulin, sulfonylurea, and insulin and/or sulfonylurea respectively, by previous diagnosis of other cancers or by potential detection examinations that might lead to differential diagnosis of thyroid cancer. Conclusions This study provides evidence for the first time that metformin use in patients with type 2 diabetes may reduce the risk of thyroid cancer.
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Affiliation(s)
- Chin-Hsiao Tseng
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Division of Environmental Health and Occupational Medicine of the National Health Research Institutes, Taipei, Taiwan
- * E-mail:
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Abstract
Many studies have provided observational data on the association of obesity and thyroid cancers, but only few of them propose mechanisms that would permit a better understanding of the causal molecular mechanisms of this association. Considering that there is an increasing incidence of both obesity and thyroid cancers, we need to summarize and link recent studies in order to characterize and understand the contribution of obesity-related factors that might affect thyroid cancer development and progression. Adipose tissue is involved in many vital processes, including insulin sensitivity, angiogenesis, regulation of energy balance, activation of the complement system, and responses such as inflammation. Although these processes have their own molecular pathways, they involve the same molecules through which obesity and adipose tissue might exert their roles in carcinogenesis, not only affecting MAPK and PI3K or even insulin pathways, but also recruiting local inflammatory responses that could result in disease formation and progression. This review describes five important issues that might explain the link between excessive weight and thyroid cancer: thyroid hormones, insulin resistance, adipokines, inflammation, and sexual hormones.
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Affiliation(s)
- Marjory Alana Marcello
- Laboratory of Cancer Molecular Genetics (Gemoca)Faculty of Medical Sciences, University of Campinas (FCM- Unicamp), Rua Tessália Vieira de Camargo 126, Barão Geraldo, Campinas, São Paulo 13083-970, Brazil
| | - Lucas Leite Cunha
- Laboratory of Cancer Molecular Genetics (Gemoca)Faculty of Medical Sciences, University of Campinas (FCM- Unicamp), Rua Tessália Vieira de Camargo 126, Barão Geraldo, Campinas, São Paulo 13083-970, Brazil
| | - Fernando Assis Batista
- Laboratory of Cancer Molecular Genetics (Gemoca)Faculty of Medical Sciences, University of Campinas (FCM- Unicamp), Rua Tessália Vieira de Camargo 126, Barão Geraldo, Campinas, São Paulo 13083-970, Brazil
| | - Laura Sterian Ward
- Laboratory of Cancer Molecular Genetics (Gemoca)Faculty of Medical Sciences, University of Campinas (FCM- Unicamp), Rua Tessália Vieira de Camargo 126, Barão Geraldo, Campinas, São Paulo 13083-970, Brazil
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Krysiak R, Okopien B. The effect of metformin on the hypothalamic-pituitary-thyroid axis in women with polycystic ovary syndrome and subclinical hypothyroidism. J Clin Pharmacol 2014; 55:45-9. [PMID: 25079765 DOI: 10.1002/jcph.373] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 07/28/2014] [Indexed: 01/28/2023]
Abstract
The effect of metformin treatment on the hypothalamic-pituitary-thyroid axis is relatively weakly understood. This study included 24 prediabetic patients with polycystic ovary syndrome and untreated subclinical hypothyroidism, 12 of whom had already been treated with bromocriptine (5.0-7.5 mg daily). The included patients received metformin (2.55 g daily) for 6 months. Glucose homeostasis markers, serum prolactin, and thyroid function tests were determined before, after 3 months, and at the end of the treatment. Beyond improving glucose homeostasis, metformin administered for 6 months reduced serum levels of thyrotropin but did not affect serum levels of total and free thyroid hormones. Thyrotropin-lowering effect of this agent was stronger in patients not treated with bromocriptine than in patients receiving this drug, and weakly correlated with an improvement in insulin sensitivity. The obtained results indicate that metformin treatment may have an impact on thyrotrope function in hypothyroid patients, probably by enhancing the effect of thyroid hormone action in the pituitary.
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Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, PL 40-752, Katowice, Poland
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Abstract
Genetic and a large number of environmental non-iodine-related factors play a role in the cause of nodular goitre. Most evidence for the influence of genetic and environmental factors in the cause of goitre is from cross-sectional, population-based studies. Only a few studies have included prospective data on risk factors for nodular goitre, although few prospective data are available on the effect of iodine and tobacco smoking on goitre development. Goitre is not one single phenotype. Many epidemiological studies do not distinguish diffuse from nodular goitre, as the investigated parameter is often thyroid volume or frequency with increased thyroid volume. Moreover, information on the presence and effect of gene-environment, gene-gene, and environment-environment effect modifications is limited. Thus, firm conclusions about the relative contributions and causality of the investigated risk factors should be made with caution. Smoking seems to be an established risk factor for nodular goitre, possibly with effect modification from iodine intake, as the risk associated with smoking is smaller or absent in areas with sufficient iodine intake. The use of oral contraceptives might have protective effects against goitre, and childbirth is an increased risk factor for goitre in areas with non-optimal iodine intake. Insulin resistance is a recently investigated risk factor, and the risk of goitre may be reversible with metformin treatment. Iodine remains the major environmental risk factor for nodular goitre.
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Affiliation(s)
- Nils Knudsen
- Department of Endocrinology, Bispebjerg University Hospital, 2400 Copenhagen NV, Denmark.
| | - Thomas Heiberg Brix
- Department of Endocrinology and Metabolism, Odense University Hospital, 5000 Odense C, Denmark
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Kushchayeva Y, Jensen K, Burman KD, Vasko V. Repositioning therapy for thyroid cancer: new insights on established medications. Endocr Relat Cancer 2014; 21:R183-94. [PMID: 24446492 DOI: 10.1530/erc-13-0473] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Repositioning of established non-cancer pharmacotherapeutic agents with well-known activity and side-effect profiles is a promising avenue for the development of new treatment modalities for multiple cancer types. We have analyzed some of the medications with mechanism of action that may have relevance to thyroid cancer (TC). Experimental in vitro and in vivo evidences, as well as results of clinical studies, have indicated that molecular targets for medications currently available for the treatment of mood disorders, sexually transmitted diseases, metabolic disorders, and diabetes may be active and relevant in TC. For instance, the derivatives of cannabis and an anti-diabetic agent, metformin, both are able to inhibit ERK, which is commonly activated in TC cells. We present here several examples of well-known medications that have the potential to become new therapeutics for patients with TC. Repositioning of established medications for the treatment of TC could broaden the scope of current therapeutic strategies. These diverse treatment choices could allow physicians to provide an individualized approach to optimize treatment for patients with TC.
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Affiliation(s)
- Yevgeniya Kushchayeva
- Department of Pediatrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 20814-4712, USA Division of Endocrinology, Department of Medicine, Washington Hospital Center, 110 Irving Street Northwest, Washington, District of Columbia, USA
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