Correlation analysis of metabolic syndrome and its components with thyroid nodules

Establishment and validation of a multivariate logistic model for risk factors of thyroid nodules using lasso regression screening

Objective

This study aims to analyze the association between the occurrence of thyroid nodules and various factors and to establish a risk factor model for thyroid nodules.

Methods

The study population was divided into two groups: a group with thyroid nodules and a group without thyroid nodules. Regression with the least absolute shrinkage and selection operator (Lasso) was applied to the complete dataset for variable selection. Binary logistic regression was used to analyze the relationship between various influencing factors and the prevalence of thyroid nodules.

Results

Based on the screening results of Lasso regression and the subsequent establishment of the Binary Logistic Regression Model on the training dataset, it was found that advanced age (OR=1.046, 95% CI: 1.033-1.060), females (OR = 1.709, 95% CI: 1.342-2.181), overweight individuals (OR = 1.546, 95% CI: 1.165-2.058), individuals with impaired fasting glucose (OR = 1.590, 95% CI: 1.193-2.122), and those with dyslipidemia (OR = 1.588, 95% CI: 1.197-2.112) were potential risk factors for thyroid nodule disease (p<0.05). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve for the Binary Logistic Regression Model is 0.68 (95% CI: 0.64-0.72).

Conclusions

advanced age, females, overweight individuals, those with impaired fasting glucose, and individuals with dyslipidemia are potential risk factors for thyroid nodule disease.

Influence of metabolic syndrome and lifestyle factors on thyroid nodules in Chinese adult men: a cross-sectional study

Introduction

Given the high prevalence of thyroid nodules and the potential for malignancy, it is imperative to understand the various factors that contribute to their development. This study aimed to explore the relationship between metabolic syndrome, lifestyle, and thyroid nodules in adult men in southern China.

Methods

This study enrolled a total of 183,990 subjects at a medical examination center in a general hospital in southern China between January 1, 2015, and December 31, 2020. Multivariate logistic regression analysis was utilized to evaluate the relationship between metabolic syndrome, lifestyle factors, and thyroid nodules. Furthermore, structural equation modeling elucidated the intricate relationships among these variables.

Results

The prevalence of thyroid nodules among Chinese adult males was 14.9%. Several factors were identified as risk factors for thyroid nodules, including advanced age, irregular meal time, smoking or quitting smoking, quitting drinking, heavy manual labor, hypertension, diabetes, dyslipidemia and centripetal obesity, and those belonging to ethnic minorities and drinking alcohol were found to be protective factors against thyroid nodules. Structural equation modeling highlighted metabolic syndrome's mediating role amidst lifestyle influences on thyroid nodules.

Conclusion

The prevalence of thyroid nodules in Chinese adult males is relatively moderate to low. The factors identified in this study can help clinicians identify high-risk patients and develop targeted screening strategies for the timely detection of thyroid nodules. However, further mechanistic research and longitudinal studies are necessary to explore the underlying causes and establish causal relationships.

Borderline personality disorder and thyroid diseases: a Mendelian randomization study

Background

Previous studies have shown that there is a correlation between diseases of the thyroid gland and mental illnesses; however, any causal relationship between them remains unclear. This study aimed to evaluate the causal relationship between borderline personality disorder and four thyroid diseases.

Methods

The causal relationship was inferred using double-sample Mendelian randomization analysis of appropriate instrumental variables from genome-wide association studies. We calculated the estimated value of the effect using various statistical methods.

Results

Borderline personality disorder was a risk factor for non-toxic single thyroid nodules with each increase in standard deviation increasing the risk of a non-toxic single thyroid nodule by 1.13 times (odds ratio = 1.131; 95% confidence interval, 1.006-1.270; P=0.039). There was no evidence of a correlation between borderline personality disorder and hyperthyroidism/thyrotoxicosis, hypothyroidism, and autoimmune thyroiditis.

Conclusion

This study showed that there is a positive causal correlation between borderline personality disorder and non-toxic single thyroid nodules but not with other thyroid diseases. This means that thyroid status should be monitored in patients with borderline personality disorder. However, the possibility of a causal relationship between other mental illnesses and thyroid diseases requires further research.

Relationship between complications of type 2 diabetes and thyroid nodules

OBJECTIVE

Recent evidence suggests that diabetes is a risk factor for thyroid nodules. However, the relationship between complications of type 2 diabetes and the risk of thyroid nodules remains unclear. This present study aims to investigate the association between thyroid nodules and complications of type 2 diabetes.

METHODS

This retrospective study collected 4696 adult inpatients with type 2 diabetes between January 2021 and December 2021. The complications examined in this paper included diabetic nephropathy, peripheral neuropathy, eye disorder, and peripheral vascular disease.

RESULTS

A total of 4696 patients with type 2 diabetes participated in the study, of whom 19.6% had thyroid nodules. Among all the complications, eye disorder had the highest incidence of thyroid nodules (incidence rate, 29.4%; 95% CI, 26.23%-32.51%). The prevalence of thyroid nodules was lower among patients without complications (incidence rate, 14.1%; 95% CI, 12.48% -15.67%) compared to patients who had complications (incidence rate, 23.1%; 95% CI, 21.59%-24.68%) (p < 0.001). Logistic regression revealed that peripheral neuropathy (adjusted OR, 1.6; 95% CI, 1.4-1.9), eye disorder (adjusted OR, 1.8; 95% CI, 1.5-2.2), and peripheral vascular disease (adjusted OR, 1.8; 95% CI, 1.6-2.1) were all significantly associated with an increased risk of thyroid nodules. However, no significant correlation was found between diabetic nephropathy and the risk of thyroid nodules.

CONCLUSION

One of the key findings of this study is that type 2 diabetes without complications is negatively correlated with the risk of thyroid nodules, while several complications are associated with a significantly increased risk of thyroid nodules.

Thyroid Nodules and Obesity

A widely discussed topic in the pathophysiology of thyroid nodules is the role of obesity, a state that leads to increased systemic inflammatory markers. Leptin plays a vital role in forming thyroid nodules and cancer through several mechanisms. Together with chronic inflammation, there is an augmentation in the secretion of tumor necrosis factor (TNF) and the cytokine interleukin 6 (IL-6), which contributed to cancer development, progression and metastasis. In addition, leptin exerts a modulatory action in the growth, proliferation and invasion of thyroid carcinoma cell lines via activating various signal pathways, such as Janus kinase/signal transducer and activator of transcription, mitogen-activated protein kinase (MAPK) and/or phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt). Through several proposed mechanisms, aberrant endogenous estrogen levels have been suggested to play a vital role in the development of both benign and malignant nodules. Metabolic syndrome triggers the development of thyroid nodules by stimulating thyroid proliferation and angiogenesis due to hyperinsulinemia, hyperglycemia and dyslipidemia. Insulin resistance influences the distribution and structure of the thyroid blood vessels. Insulin growth factor 1 (IGF-1) and insulin affect the regulation of the expression of thyroid genes and the proliferation and differentiation of thyroid cells. TSH can promote the differentiation of pre-adipocytes to mature adipocytes but also, in the presence of insulin, TSH possesses mitogenic properties. This review aims to summarize the underlying mechanisms explaining the role of obesity in the pathophysiology of thyroid nodules and discuss potential clinical implications.

Prevalence and Associated Predictors of Hypertension in Adult Patients with Thyroid Nodules at the Royal Commission Hospital, Kingdom of Saudi Arabia

Background

Hypertension and thyroid nodules (TNs) are common medical problems that are increasing in prevalence globally. Hence, we conducted this study to assess the prevalence and associated predictors of hypertension in adult patients with TNs at the Royal Commission Hospital, Kingdom of Saudi Arabia (KSA).

Methods

A retrospective study was conducted between 1 January 2015 and 31 December 2021. Patients with documented TNs based on the Thyroid Imaging Reporting and Data System (TI-RADS) were recruited to assess the prevalence and associated risk factors for hypertension.

Result

Three hundred ninety-one patients with TNs were recruited for this study. The median (interquartile range, IQR) age was 46.00 (20.0) years, and 332 (84.9%) of the patients were females. The median (IQR) body mass index (BMI) was 30.26 (7.71) kg/m². There was a high prevalence of hypertension (22.5%) in adult patients with TNs. In the univariate analysis, there were significant associations between diagnosed hypertension in patients with TNs and age, sex, diabetes mellitus (DM), bronchial asthma, triiodothyronine (FT3), total cholesterol and high-density lipoprotein (HDL). In the multivariate analysis, age (OR = 1.076 [95% CI 1.048 - 1.105]), sex (OR = 2.28 [95% CI 1.132 - 4.591]), DM (OR = 0.316 [95% CI 0.175 - 0.573]) and total cholesterol levels (OR = 0.820 [95% CI 0.694 - 0.969]) were significantly associated with hypertension.

Conclusion

There is a high prevalence of hypertension in patients with TNs. Age, female sex, DM and elevated total cholesterol are significant predictors of hypertension in adult patients with TNs.

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

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

Gender-Specific Associations Between Metabolic Disorders and Thyroid Nodules: A Cross-Sectional Population-Based Study from China

Background: Metabolic disorders (MDs) and the metabolic syndrome (MetS) may be associated with thyroid diseases. The aim of this study was to investigate the relationship between MDs and various types of thyroid nodules (TNs), according to gender. Methods: We analyzed cross-sectional data from the Thyroid Disorders, Iodine Status, and Diabetes Epidemiological (TIDE) survey in China. A total of 56,729 subjects ≥18 years of age were included. Thyroid gland morphology was assessed by thyroid standardized ultrasonography. A multivariate logistic regression model was used to explore the odds ratio (OR) and confidence intervals [CIs] for any associations between MDs and TNs. Subgroup analyses were conducted according to gender and TN type (solitary, S-TN; multiple, M-TNs). Results: The prevalence of TNs was increased in several MDs, and was higher in women than men regardless of whether they suffered from MDs (22.0%, CI [21.6-22.5%] vs. 15.7%, CI [15.3-16.7%], p < 0.001). TNs were associated with the presence of MDs (OR = 1.189, CI [1.107-1.278], p < 0.001), hypercholesterolemia (OR = 1.235, CI [1.177-1.296], p < 0.001), high low-density lipoprotein cholesterol (LDL-C; OR = 1.249, CI [1.186-1.316], p < 0.001), and hyperuricemia (OR = 1.206, CI [1.126-1.293], p < 0.001). MDs and MetS were, respectively, significantly associated with TNs, S-TNs, and M-TNs in men, while MDs were significantly associated with the three TN profiles in women. With respect to dyslipidemia, hypercholesterolemia and high LDL-C had the strongest association with TNs, whereas hypertriglyceridemia had no effect. Conclusions: TNs (especially M-TNs) may be associated with MDs and their various components, and there appear to be some gender-specific associations.

[Epidemiology of benign thyroid disorders in the adult population of the Republic of Belarus: analysis of nationwide statistics 2009 to 2019]

BACKGROUND

Nowadays, the Republic of Belarus belongs to the countries with sufficient iodine supply, which made it possible to reduce the incidence of non-toxic goiter and congenital hypothyroidism. However, even a slight change in iodine consumption influences the pattern of thyroid diseases. In addition to iodine deficiency, other environmental conditions, as well as genetic factors, play a significant role in the etiology of thyroid diseases.

AIM

To analyze the dynamics of the main epidemiological indicators of benign thyroid diseases from 2009 to 2019 in the adult population of the Republic of Belarus, using the data of official state statistics.

MATERIALS AND METHODS

The indicators of the incidence and prevalence of benign thyroid diseases were studied on the basis of state statistics for 2009-2019. To analyze the dynamics of the studied indicators, regression analysis was used with the construction of linear and polynomial models.

RESULTS

A decrease in the incidence and prevalence of diffuse euthyroid goiter and an increase in the incidence and prevalence of nodular euthyroid goiter, thyroiditis, acquired hypothyroidism, Graves' disease, as well as the incidence of nodular toxic goiter were revealed.

CONCLUSION

Obtained data indicate, that there is an increase in the prevalence of most of the studied thyroid diseases, despite the adequate iodine supply. The above justifies the need for further study of the causes of the identified trends, as well as the necessity of developing new methods of diagnosis and treatment of thyroid diseases.

Correlation Analysis of Breast and Thyroid Nodules: A Cross-Sectional Study

Objective

Based on physical examination, to explore the relationship between breast mass (BM) and thyroid nodule (TN) prevalence, and to further explore other related factors that affect the occurrence of BM and TN.

Methods

From January 1, 2018, to January 1, 2021, 12,538 female subjects received breast and thyroid ultrasound examinations at the same time in the health examination center of the Affiliated Hospital of North Sichuan Medical College. Univariate analysis and multivariate logistic analysis were used to screen the relevant factors affecting TN and BM, and propensity score matching was used to further verify the results of the relationship between breast and thyroid.

Results

A total of 4975 (39.7%) of the included subjects have BM and a total of 6315 (50.4%) have TN,2557 (20.4%) had both BM and TN. The logistic regression results show that patients with TN are more likely to suffer from BM [OR = 1.185, 95% CI (1.099-1.278), p<0.0001]. In addition, age, free T4, HDL, height, BMI, systolic blood pressure, diastolic blood pressure, and albumin are independent factors affecting the occurrence of BM; patients with BM are more likely to have TN [OR = 1.180, 95% CI (1.094-1.272), p<0.0001], and age, free T3, free T4, AST, ALT, albumin, height, and BMI are independent influencing factors on the occurrence of TN. The result of propensity score matching confirmed the relationship between BM and TN.

Conclusion

There is a bidirectional pathogenic relationship between BM and TN, women with BM are at increased risk of TN, and women with TN are more likely to have BM. Thyroid hormone is not only related to the occurrence of TN but also affects the occurrence of BM.

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

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

Presence of Metabolic Syndrome and Thyroid Nodules in Subjects with Colorectal Polyps

Background

Thyroid nodules (TNs) and metabolic syndrome (MS) have been individually associated with colorectal polyps. However, the potential joint relationship between them in relation to colorectal polyps has not been fully evaluated. This study aimed to validate the association of TNs/MS and colorectal polyps/adenomas and to determine the risk of colonic polyps in patients with TNs/MS.

Material/Methods

A retrospective study was conducted on patients undergoing routine health checks in the First Affiliated Hospital of Wenzhou Medical University from July 2014 to August 2017. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for colorectal polyps/adenomas after adjusting for confounding factors. Then patients were divided into 4 groups according to whether they had TNs or MS. Relative excess risks of interaction, attributable proportion, and synergy index were used to determine the additive interaction of TNs and MS on colorectal polyps/adenomas.

Results

A total of 4514 eligible patients were included in this study. TNs and MS were confirmed to be independent risk factors for colorectal polyps/adenomas. Compared with the group of TNs(−)/MS(−), the odds ratios of TNs(+)/MS(+) in colorectal polyps (odds ratio [OR]: 3.031, 95% confidence interval [CI]: 2.262–4.062, P<0.05) or adenomas (OR: 2.894, 95% CI: 2.099–3.990, P<0.05) were significantly increased, and there was an interactive additive effect between TNs and MS.

Conclusions

TNs and MS have an associative and superimposing effect on the increased occurrence of colorectal adenomas. Colonoscopy screening should be advocated for patients with both of these diseases.

Correlation Between Thyroid Nodules and Metabolic Syndrome: A Systematic Review and Meta-Analysis

OBJECTIVE

Thyroid nodules (TNs) are a common thyroid disorder that can be caused by many factors. Several studies have investigated the relationship between TNs and metabolic syndrome (MetS), but the role of sex and age remains controversial. The purpose of this paper was to analyze published data from all relevant studies to reliably estimate the relationship between TNs and MetS.

METHODS

Thirteen articles were included in this study; articles were identified by searching for publications until July 2021 in PubMed, EMBASE, the Cochrane Library and the Web of Science. The outcomes are presented as the summary odds ratio (OR) and 95% confidence interval (CI) and the pooled prevalence and 95% CI.

RESULTS

The TNs prevalence was significantly higher in MetS patients than in controls (OR 1.88, 95% CI 1.42-2.50, P < 0.0001) and was independent of sex (male: OR 1.53, 95% CI 1.20-1.94, P = 0.0006; female: OR 1.90, 95% CI 1.54-2.33, P < 0.00001; combined: OR 2.06, 95% CI 1.31-3.25, P = 0.002) and age (< 40 years old: OR 1.62, 95% CI 1.39-1.89, P < 0.0001; 40~50 years old: OR 2.14, 95% CI 1.49-3.08, P < 0.0001;50~60 years old: OR 1.50, 95% CI 1.08-2.07, P = 0. 01; 60 years old: OR 1.70, 95% CI 1.36-2.14, P < 0.00001); the pooled TNs prevalence in MetS patients was 45% (95% CI 36-54%). However, it has not yet been considered that MetS is related to TNs in people with iodine deficiency (OR 3.14, 95% CI 0.92-10.73, P = 0.07).

CONCLUSION

The meta-analysis results showed a strong correlation between TNs and MetS. Both male and female patients with MetS had an increased TNs prevalence. In addition, the prevalence was independent of age. However, MetS is not considered to be associated with TNs in iodine-deficient populations.

Association of Changes in Metabolic Syndrome Status With the Incidence of Thyroid Nodules: A Prospective Study in Chinese Adults

Although several cross-sectional studies have shown an association of metabolic syndrome (MetS) with nodular thyroid disease, related prospective studies are scarce. This study investigated the association of MetS with thyroid nodule (TN) incidence in Chinese adults, and explored whether the development of or recovery from MetS is associated with changes in the risk of developing TNs. A total of 4,749 Chinese aged 18-65 years were involved in this 6-year prospective study. The association of MetS with TN prevalence was examined. TN-free individuals at baseline (n = 3,133) were further examined. TN incidence rates in groups with different MetS statuses (MetS-free, MetS-developed, MetS-recovery and MetS-chronic) were analyzed. Of all participants, 18.21 and 31.65% had MetS and TNs, respectively. MetS patients had a higher TN prevalence than the non-MetS group (31.08 vs. 19.81% in males, p < 0.01; 59.52 vs. 39.59% in females, p < 0.01). Sex, age and MetS were independent risk factors for TNs. At a median follow up of 5.94 years, the MetS-chronic group (4.37/100 person-years) had a higher risk of TNs (adjusted incidence rate ratio [IRR] = 1.288 [95% CI 1.014-1.636]) compared with the MetS-free group (2.72/100 person-years) in the whole cohort. In males, the MetS-chronic group (3.76/100 person-years) had a higher risk of TNs (adjusted IRR = 1.367 [95% CI 1.017-1.835]) compared with the MetS-free group (2.31/100 person-years). In females, the risk of TNs was significantly higher in the MetS-chronic (6.44/100 person-years) and MetS-developed (6.31/100 person-years) groups compared with the MetS-free group (3.23/100 person-years).