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Exp Clin Endocrinol Diabetes 2013; 121(07): 402-406
DOI: 10.1055/s-0033-1341474
Article
© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Hyperthyroidism and Thyroid Cancer Risk: A Population-based Cohort Study

N.-C. Yeh
1   Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
,
C.-W. Chou
1   Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
,
S.-F. Weng
2   Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
3   Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science
,
C.-Y. Yang
1   Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
,
F.-C. Yen
1   Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
,
S.-Y. Lee
1   Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
,
J.-J. Wang
2   Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
,
K.-J. Tien
1   Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
4   The Center of General Education, Chia Nan University of Pharmacy and Science
› Author Affiliations
Further Information

Publication History

received 26 December 2012
first decision 26 December 2012

accepted 08 March 2013

Publication Date:
24 April 2013 (online)

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Abstract

Aim:

Thyroid hormones regulate the rate of metabolism and affect the differentiation and growth of many tissues in the body. We investigated the association between hyperthyroidism and cancer risk in Taiwan

Patients and methods:

A random sample of 1 000 000 individuals from Taiwan’s National Health Insurance database was enrolled. We found 17 033 patients to have newly diagnosed hyperthyroidism between 2000 and 2005. These patients were recruited along with a match cohort of 34 066 patients without hyperthyroidism. Starting from index date, we followed up all patients for 4 years to identify those who developed cancer.

Results:

During the 4-year follow-up study, cancer was diagnosed in 1.23% of patients with hyperthyroidism and 1.02% of the member of the comparison cohort. Regression analysis showed that patients with hyperthyroidism were at greater risk of cancer incidence, especially thyroid cancer, compared the comparison cohort (HR: 1.213; 95% CI: 1.022–1.440; p<0.05 and HR: 7.355; 95% CI: 3.885–13.92; p<0.05, respectively). After adjusting for age, gender, diabetes mellitus, hypertension, hyperlipidemia, gout, geographic region, and income, patients with hyperthyroidism remained at increased risk of cancer incidence and thyroid cancer (Adjusted HR: 1.206; 95% CI: 1.015–1.433 and 6.803; 95% CI: 3.584–12.91, respectively) (both p<0.05). The longer the duration of hyperthyroidism, the greater the risk of thyroid cancer.

Conclusions:

This 4-year follow up study suggests that patients with hyperthyroidism are at increased risk of cancer, especially thyroid cancer.

Key words

hyperthyroidism - thyroid cancer - asians - national health insurance
 

  • References

  • 1 Lim DY, Cho HJ, Kim J et al. Luteolin decreases IGF-II production and downregulates insulin-like growth factor-I receptor signaling in HT-29 human colon cancer cells. BMC Gastroenterology 2012; 12: 9 DOI: 10.1186/1471-230x-12-9.
    CrossrefPubMedGoogle Scholar
  • 2 Makoto Nakao SH. Interaction between IGF-1 polymorphisms and overweight for the risk of pancreatic cancer in Japanese. Int J Mol Epidemiol Genet 2011; 2: 354-366
    PubMedGoogle Scholar
  • 3 Prestwich RJ, Errington F, Hatfield P et al. The immune system–is it relevant to cancer development, progression and treatment?. Clin Oncol (R Coll Radiol) 2008; 20: 101-112 DOI: S0936-6555(07)00866-7. [pii]10.1016/j.clon.2007.10.011
    CrossrefPubMedGoogle Scholar
  • 4 Means I. The Thyroid and its Diseases. Philadelphia: Lippincott; 1937
    Google Scholar
  • 5 Oertli D, Harder F, Oberholzer M et al. Hyperthyroidism and thyroid carcinoma – coincidence or association?. Schweiz Med Wochenschr 1998; 128: 1910-1914
    PubMedGoogle Scholar
  • 6 Gabriele R, Letizia C, Borghese M et al. Thyroid cancer in patients with hyperthyroidism. Hormone research 2003; 60: 79-83 DOI: 10.1159/000071875.
    CrossrefPubMedGoogle Scholar
  • 7 Calo PG, Tatti A, Farris S et al. Differentiated thyroid carcinoma and hyperthyroidism: a frequent association?. Chir Ital 2005; 57: 193-197
    PubMedGoogle Scholar
  • 8 Beahrs OH, Pemberton JdeJ, Black BM. Nodular goiter and malignant lesions of the thyroid gland. J Clin Endocrinol Metab 1951; 11: 1157-1165
    CrossrefPubMedGoogle Scholar
  • 9 Sokal JE. Incidence of malignancy in toxic and nontoxic nodular goiter. J Am Med Assoc 1954; 154: 1321-1325
    CrossrefPubMedGoogle Scholar
  • 10 Shapiro SJFN, Perzik SL, Catz B. Incidence of thyroid carcinoma in Graves’disease. Cancer 1970; 26: 1261-1270
    CrossrefPubMedGoogle Scholar
  • 11 Chou FF, Sheen-Chen SM, Chen YS et al. Hyperthyroidism and concurrent thyroid cancer. International surgery 1993; 78: 343-346
    PubMedGoogle Scholar
  • 12 Chao TC, Lin JD, Jeng LB et al. Thyroid cancer with concurrent hyperthyroidism. Arch Surg 1999; 134: 130-134
    CrossrefPubMedGoogle Scholar
  • 13 Zanella E, Rulli F, Sianesi M et al. Hyperthyroidism with concurrent thyroid cancer. Annali italiani di chirurgia 2001; 72: 293-297
    PubMedGoogle Scholar
  • 14 Lin CH, Chiang FY, Wang LF. Prevalence of thyroid cancer in hyperthyroidism treated by surgery. The Kaohsiung journal of medical sciences 2003; 19: 379-384 DOI: 10.1016/S1607-551X(09)70480-2.
    CrossrefPubMedGoogle Scholar
  • 15 Shu X, Ji J, Li X et al. Cancer risk in patients hospitalised for Graves’ disease: a population-based cohort study in Sweden. British journal of cancer 2010; 102: 1397-1399 DOI: 10.1038/sj.bjc.6605624.
    CrossrefPubMedGoogle Scholar
  • 16 Franklyn JA, Maisonneuve P, Sheppard M et al. Cancer incidence and mortality after radioiodine treatment for hyperthyroidism: a population-based cohort study. Lancet 1999; 353: 2111-2115 DOI: S0140-6736(98)12295-X. [pii]10.1016/S0140-6736(98)12295-X
    CrossrefPubMedGoogle Scholar
  • 17 Ribatti D, Conconi MT, Nussdorfer GG. Nonclassic endogenous novel [corrected] regulators of angiogenesis. Pharmacol Rev 2007; 59: 185-205 DOI: 59/2/185. [pii]10.1124/pr.59.2.3
    CrossrefPubMedGoogle Scholar
  • 18 Tomanek RJ, Doty MK, Sandra A. Early coronary angiogenesis in response to thyroxine: growth characteristics and upregulation of basic fibroblast growth factor. Circ Res 1998; 82: 587-593
    CrossrefPubMedGoogle Scholar
  • 19 Hall LC, Salazar EP, Kane SR et al. Effects of thyroid hormones on human breast cancer cell proliferation. The Journal of steroid biochemistry and molecular biology 2008; 109: 57-66 DOI: 10.1016/j.jsbmb.2007.12.008.
    CrossrefPubMedGoogle Scholar
  • 20 Conde SJ, Luvizotto RA, Sibio MT et al. Tamoxifen inhibits transforming growth factor-alpha gene expression in human breast carcinoma samples treated with triiodothyronine. Journal of endocrinological investigation 2008; 31: 1047-1051
    PubMedGoogle Scholar
  • 21 Yen CC, Huang YH, Liao CY et al. Mediation of the inhibitory effect of thyroid hormone on proliferation of hepatoma cells by transforming growth factor-beta. Journal of molecular endocrinology 2006; 36: 9-21 DOI: 10.1677/jme.1.01911.
    CrossrefPubMedGoogle Scholar
  • 22 Tsui KH, Hsieh WC, Lin MH et al. Triiodothyronine modulates cell proliferation of human prostatic carcinoma cells by downregulation of the B-cell translocation gene 2. The Prostate 2008; 68: 610-619 DOI: 10.1002/pros.20725.
    CrossrefPubMedGoogle Scholar
  • 23 Turkyilmaz A, Eroglu A, Aydin Y et al. A new risk factor in oesophageal cancer aetiology: hyperthyroidism. Acta chirurgica Belgica 2010; 110: 533-536
    PubMedGoogle Scholar
  • 24 Iishi H, Tatsuta M, Baba M et al. Enhancement by thyroxine of gastric carcinogenesis induced by N-methyl-N’-nitro-N-nitrosoguanidine in Wistar rats. British journal of cancer 1993; 68: 515-518
    CrossrefPubMedGoogle Scholar
  • 25 Lin HY, Tang HY, Shih A et al. Thyroid hormone is a MAPK-dependent growth factor for thyroid cancer cells and is anti-apoptotic. Steroids 2007; 72: 180-187 DOI: 10.1016/j.steroids.2006.11.014.
    CrossrefPubMedGoogle Scholar
  • 26 Valenti TM, Macchia E, Pisa R et al. Toxic adenoma and papillary thyroid carcinoma in a patient with Graves’ disease. Journal of endocrinological investigation 1999; 22: 701-704
    PubMedGoogle Scholar
  • 27 Pellegriti G, Belfiore A, Giuffrida D et al. Outcome of differentiated thyroid cancer in Graves’ patients. The Journal of clinical endocrinology and metabolism 1998; 83: 2805-2809
    CrossrefPubMedGoogle Scholar
  • 28 Hales IB, McElduff A, Crummer P et al. Does Graves’ disease or thyrotoxicosis affect the prognosis of thyroid cancer. The Journal of clinical endocrinology and metabolism 1992; 75: 886-889
    CrossrefPubMedGoogle Scholar
  • 29 Belfiore A, Garofalo MR, Giuffrida D et al. Increased aggressiveness of thyroid cancer in patients with Graves’ disease. The Journal of clinical endocrinology and metabolism 1990; 70: 830-835
    CrossrefPubMedGoogle Scholar
  • 30 Yano Y, Shibuya H, Kitagawa W et al. Recent outcome of Graves' disease patients with papillary thyroid cancer. European journal of endocrinology/European Federation of Endocrine Societies 2007; 157: 325-329 DOI: 10.1530/EJE-07-0136.
    CrossrefPubMedGoogle Scholar
  • 31 Lee MY, Lin KD, Hsiao PJ et al. The association of diabetes mellitus with liver, colon, lung, and prostate cancer is independent of hypertension, hyperlipidemia, and gout in Taiwanese patients. Metabolism 2012; 61: 242-249 DOI: S0026-0495(11)00200-9. [pii]10.1016/j.metabol.2011.06.020
    CrossrefPubMedGoogle Scholar