Correlation between Insulin Resistance and Thyroid Nodule in Type 2 Diabetes Mellitus

Yunzhao Tang, Tiantian Yan, Gang Wang, Yijun Chen, Yanjuan Zhu, Zhenhuan Jiang, Min Yang, Chenguang Li, Zhu Li, Ping Yu, Shanshan Wang, Nannan Zhu, Qiuyue Ren, Changlin Ni, Yunzhao Tang, Tiantian Yan, Gang Wang, Yijun Chen, Yanjuan Zhu, Zhenhuan Jiang, Min Yang, Chenguang Li, Zhu Li, Ping Yu, Shanshan Wang, Nannan Zhu, Qiuyue Ren, Changlin Ni

Abstract

Objective: The present study explored the association between insulin resistance (IR) and the clinical characteristics of thyroid nodules in patients with type 2 diabetes mellitus (T2DM).

Methods: All the patients were newly diagnosed with T2DM. 201 patients with thyroid nodule disease and 308 patients without the nodular thyroid disease. The participants were evaluated by relevant examination. Correlation analyses and regression analyses were performed to examine the relationships between the two groups.

Results: HOMA-IR values, serum FT4 (free thyroxine) levels, and age were higher in the thyroid nodule group than in the control group. The proportion of women in the thyroid nodule group is greater than the proportion of women in the control group. Logistic regression analysis showed that age, sex, FT4, and HOMA-IR were positive factors for thyroid nodule. The volume and size of the thyroid nodule were positively correlated with HOMA-IR, irrespective of gender. The thyroid nodule volume and size and the TSH (thyroid stimulating hormone) were greater in females than in males, whereas FT3 (free triiodothyronine) was lower in females.

Conclusion: IR might be a risk factor for thyroid nodule. Whether alleviating the IR might slow the growth, or diminish the volume and size of the thyroid nodules, is yet to be elucidated.

Figures

Figure 1
Figure 1
(a) The correlation between the thyroid nodule volume and HOMA-IR. A significant positive correlation between HOMA-IR and thyroid nodule volume in patients (r value: 0.808, P < 0.001). (b) The correlation between thyroid nodule size and HOMA-IR. A significant positive correlation between HOMA-IR and thyroid nodule size in patients (r value: 0.037, P < 0.001). (c) The correlation between thyroid nodule size and age. A significant positive correlation between age and thyroid nodule size in patients (r value: 0.167, P = 0.018).
Figure 2
Figure 2
(a) The correlation between thyroid nodule volume and HOMA-IR in patients with type 2 diabetes mellitus with thyroid nodules. A positive significant correlation between HOMA-IR and thyroid nodule volume in female and male patients (r value: 0.842, P < 0.001 versus r value: 0.840, P < 0.001). (b) The correlation between thyroid size volume and HOMA-IR in the patients with type 2 diabetes mellitus with thyroid nodules. A positive significant correlation between HOMA-IR and thyroid nodule volume in female and male patients (r value: 0.780, P < 0.001 versus r value: 0.715, P < 0.001).

References

    1. Eckel R. H., Grundy S. M., Zimmet P. Z. The metabolic syndrome. Lancet. 2005;365:1415–1428. doi: 10.1016/S0140-6736(05)66378-7.
    1. Reaven G. The metabolic syndrome or the insulin resistance syndrome? Different names, different concepts, and different goals. Endocrinology and Metabolism Clinics of North America. 2004;33(2):283–303. doi: 10.1016/j.ecl.2004.03.002.
    1. Roith D. L., Zick Y. Recent advances in our understanding of insulin action and insulin resistance. Diabetes Care. 2001;24:588–597. doi: 10.2337/diacare.24.3.588.
    1. Heidari Z., Mashhadi M. A., Nosratzehi S. Insulin resistance in patients with benign thyroid nodules. Archives of Iranian Medicine. 2015;18(9):572–576.
    1. Ayturk S., Gursoy A., Kut A., Anil C., Nar A., Tutuncu N. B. Metabolic syndrome and its components are associated with increased thyroid volume and nodule prevalence in a mild-to-moderate iodine-deficient area. European Journal of Endocrinology. 2009;161(4):599–605. doi: 10.1530/EJE-09-0410.
    1. Rezzonico J., Rezzonico M., Pusiol E., Pitoia F., Niepomniszcze H. Introducing the thyroid gland as another victim of the insulin resistance syndrome. Thyroid. 2008;18:461–464. doi: 10.1089/thy.2007.0223.
    1. Anil C., Akkurt A., Ayturk S., Kut A., Gursoy A. Impaired glucose metabolism is a risk factor for increased thyroid volume and nodule prevalence in a mild-to-moderate iodine deficient area. Metabolism. 2013;62:970–975. doi: 10.1016/j.metabol.2013.01.009.
    1. Gharib H., Papini E. Thyroid nodules: clinical importance, assessment, and treatment. Endocrinology and Metabolism Clinics of North America. 2007;36:707–735. doi: 10.1016/j.ecl.2007.04.009.
    1. Hegedüs L. The Thyroid Nodule. New England Journal of Medicine. 2004;351(17):1764–1771. doi: 10.1056/NEJMcp031436.
    1. Society, C. D. China guideline for type 2 diabetes (2013) Chinese Journal of Diabetes Mellitus. 2014;7:447–498.
    1. Knudsen N., Bulow I., Laurberg P., Ovesen L., Perrild H., Jørgensen T. Parity is associated with increased thyroid volumes solely among smokers in an area with moderate to mild iodine deficiency. European Journal of Endocrinology. 2002;146:39–43. doi: 10.1530/eje.0.1460039.
    1. Rossi R., Zatelli M. C., Franceschetti P., et al. Inhibitory effect of dihydrotestosterone on human thyroid cell growth. The Journal of Endocrinology. 1996;151(2):185–194. doi: 10.1677/joe.0.1510185.
    1. Bonora E., Targher G., Alberiche M., et al. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care. 2002;23(1):57–63. doi: 10.2337/diacare.23.1.57.
    1. Yasar H. Y., Ertuğrul Ö., Ertuğrul B., Ertuğrul D., Şahin M. Insulin resistance in nodular thyroid disease. Endocrine Research. 2011;36(4):167–174. doi: 10.3109/07435800.2011.593011.
    1. 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. Medical Principle and Practice. 2016;25(3):233–236. doi: 10.1159/000442821.
    1. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2008;1(Supplement 1):S55–S60. doi: 10.2337/dc08-S055.
    1. Mitchell I., Livingston E. H., Chang A. Y., et al. Trends in thyroid cancer demographics and surgical therapy in the United States. Surgery. 2007;142(6):823–828. doi: 10.1016/j.surg.2007.09.011.
    1. American Diabetes Association. Consensus development conference on insulin resistance. Diabetes Care. 1998;21:310–314. doi: 10.2337/diacare.21.2.310.
    1. Junik R., Kozinski M., Debska-Kozinska K. Thyroid ultrasound in diabetic patients without overt thyroid disease. Acta Radiologica. 2006;47(7):687–691. doi: 10.1080/02841850600806308.
    1. Knudsen N., Laurberg P., Perrild H., Bülow I., Ovesen L., Jørgensen T. Risk factors for goiter and thyroid nodules. Thyroid. 2002;12(10):879–888. doi: 10.1089/105072502761016502.
    1. Orosco R. K., Hussain T., Brumund K. T., Oh D. K., Chang D. C., Bouvet M. Analysis of age and disease status as predictors of thyroid cancer-specific mortality using the surveillance, epidemiology, and end results database. Thyroid. 2015;25:125–132. doi: 10.1089/thy.2014.0116.
    1. Vella V., Sciacca L., Pandini G., et al. The IGF system in thyroid cancer: new concepts. Molecular Pathology. 2001;54:121–124. doi: 10.1136/mp.54.3.121.
    1. van der Laan B. F., Freeman J. L., Asa S. L. Expression of growth factors and growth factor receptors in normal and tumorous human thyroid tissues. Thyroid. 1995;5(1):67–73. doi: 10.1089/thy.1995.5.67.
    1. Blanc E., Ponce C., Brodschi D., et al. Association between worse metabolic control and increased thyroid volume and nodular disease in elderly adults with metabolic syndrome. Metabolic Syndrome and Related Disorders. 2015;13(5):221–226. doi: 10.1089/met.2014.0158.
    1. Pazaitou-Panayiotou K., Panagiotou G., Polyzos S. A., Mantzoros C. S. Serum adiponectin and insulin-like growth factor 1 in predominantly female patients with thyroid cancer: association with the histologic characteristics of the tumor. Endocrine Practice. 2015;22(1):68–75. doi: 10.4158/EP15814.OR.
    1. 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(3):894–901. doi: 10.1007/s12020-014-0416-6.
    1. Schmidt M. I., Duncan B. B., Vigo A., et al. Leptin and incident type 2 diabetes: risk or protection? Diabetologia. 2006;49:2086–2096. doi: 10.1007/s00125-006-0351-z.
    1. Rosenbaum M., Hirsch J., Murphy E., Leibel R. L. Effects of changes in body weight on carbohydrate metabolism, catecholamine excretion, and thyroid function. The American Journal of Clinical Nutrition. 2000;71(6):1421–1432.
    1. Tahirović H., Dućić V., Smajić A. Euthyroid sick syndrome in type I diabetes mellitus in children and adolescents. Acta Paediatrica Hungarica. 1991;31(1):67–73.
    1. Singh P., Khan S., Mittal R. K. Assessment of thyroid disfuntion in the type 2 of diabetis patient. International Journal of Diabetes in Developing Countries. 2014;34(4):p. 229. doi: 10.1007/s13410-014-0204-0.
    1. Neto A. M., Parisi M. C. R., Tambascia M. A., Pavin E. J., Alegre S. M., Zantut-Wittmann D. E. Relationship of thyroid hormone levels and cardiovascular events in patients with type 2 diabetes. Endocrine. 2014;45(1):84–91. doi: 10.1007/s12020-013-9938-6.
    1. Pickup J. C., Chusney G. D., Thomas S. M., Burt D. Plasma interleukin-6, tumour necrosis factor α and blood cytokine production in type 2 diabetes. Life Sciences. 2000;67(3):291–300. doi: 10.1016/s0024-3205(00)00622-6.
    1. van der Poll T., Romijn J. A., Wiersinga W. M., Sauerwein H. P. Tumor necrosis factor: a putative mediator of the sick euthyroid syndrome in man. The Journal of Clinical Endocrinology and Metabolism. 1990;71(6):1567–1572. doi: 10.1210/jcem-71-6-1567.
    1. Leiria L. B., Dora J. M., Wajner S. M., Estivalet A. A. F., Crispim D., Maia A. L. The rs225017 polymorphism in the 3′ UTR of the human DIO2 gene is associated with increased insulin resistance. PLoS One. 2014;9(8, article e103960) doi: 10.1371/journal.pone.0103960.
    1. Roef G., Lapauw B., Goemaere S., et al. Body composition and metabolic parameters are associated with variation in thyroid hormone levels among euthyroid young men. European Journal of Endocrinology. 2012;167(5):719–726. doi: 10.1530/EJE-12-0447.
    1. Moriggi G., Verga Falzacappa C. V., Mangialardo C., et al. Thyroid hormones (T3 and T4): dual effect on human cancer cell proliferation. Anticancer Research. 2011;31(1):89–96.
    1. Rosano G., Vitale C., Silvestri A., Fini M. The metabolic syndrome in women: implications for therapy. International Journal of Clinical Practice Supplement. 2004;3(139):20–25.
    1. Tu W., Zhang G., Yu S., Tang J., Yu J. Observations on factors that influence thyroid nodules in diabetic and non-diabetic patients in the Zhejiang province of China. International Journal of Clinical and Experimental Medicine. 2015;8(10):19332–19338.
    1. Han C., He X., Xia X., et al. Subclinical hypothyroidism and type 2 diabetes: a systematic review and meta-analysis. PLoS One. 2015;10(8, article e0135233) doi: 10.1371/journal.pone.0135233.
    1. Wang C. The relationship between type 2 diabetes mellitus and related thyroid diseases. Journal of Diabetes Research. 2013;2013:9. doi: 10.1155/2013/390534.390534
    1. Derosa G., Maffioli P., D'Angelo A., Fogari E., Bianchi L., Cicero A. F. Acarbose on insulin resistance after an oral fat load: a double-blind, placebo controlled study. Journal of Diabetes and its Complications. 2011;25(4):258–266. doi: 10.1016/j.jdiacomp.2011.01.003.
    1. Yan T., Tang Y., Wang G., et al. Relationship between insulin resistance and thyroid nodules in type 2 diabetes in iodine-sufficient areas. Diabetes/Metabolism Research and Reviews. 2016;32(Supplement 2):19–20.

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