Abstract
Thyroid hormones have been shown to affect several important pathways in cancer development, including colorectal cancer (CRC). Clinical studies examining the association between thyroid disorders and colorectal cancer have conflicting results and have predominantly involved white populations. To determine if a diagnosis of hyperthyroidism or hypothyroidism is associated with the risk of developing colorectal cancer in an East Asian population. This nationwide population-based case-control study was conducted from April 27, 2018, to November 8, 2018, using the Taiwanese National Health Insurance Research Database. Participants were adults (n = 139 426) either with a new diagnosis (between 2008 and 2013) of primary colorectal cancer without a history of cancer, or without cancer. Cases and controls were matched 1:1 by age, sex, and index date. Diagnosis of hyperthyroidism or hypothyroidism prior to the diagnosis of colorectal cancer (or the same index date in controls) was then determined. Risk differences in developing colorectal cancer among patients with a medical history of hyperthyroidism or hypothyroidism. A total of 139 426 patients were included in the study, and 69 713 individuals made up each case and control group, which were both predominantly male (39 872 [57.2%]). The mean (SD) age for those with CRC was 65.8 (13.7) years and for those without CRC was 66.0 (13.6) years. Both hyperthyroidism (adjusted odds ratio [aOR], 0.77; 95% CI, 0.69-0.86; P < .001) and hypothyroidism (aOR, 0.78; 95% CI, 0.65-0.94; P = .008) were associated with a decreased risk of being diagnosed with colorectal cancer. An inverse association of rectal cancer was found among patients aged 50 years or older with a history of hypothyroidism despite treatment (aOR, 0.54; 95% CI, 0.39-0.74; P < .001). A history of hyperthyroidism in all age groups was associated with a lower risk of colon cancer (aOR, 0.74; 95% CI, 0.64-0.85; P < .001), with a stronger association seen among those younger than 50 years (aOR, 0.55; 95% CI, 0.36-0.85; P = .007). In this study, hypothyroidism appeared to be associated with a lower risk of rectal cancer, whereas hyperthyroidism appeared to be associated with a lower risk of colon cancer. Because of this, biochemical in vivo research and epidemiologic studies appear to be needed to further clarify the nature of these associations.
Highlights
Colorectal cancer (CRC) is an increasingly common disease with far-reaching consequences.[1]
An inverse association of rectal cancer was found among patients aged 50 years or older with a history of hypothyroidism despite treatment
A history of hyperthyroidism in all age groups was associated with a lower risk of colon cancer, with a stronger association seen among those younger than 50 years
Summary
Colorectal cancer (CRC) is an increasingly common disease with far-reaching consequences.[1]. Hormones have been identified as key factors associated with the development and evolution of many cancers and are being pursued as potential targets for therapy.[7,8,9,10,11] This association may be most obvious within the realm of sex hormones and gynecologic cancers, but the role of trophic hormones, including the family of thyroid hormones, has come under greater scrutiny Thyroid hormones, their nuclear and cellular surface receptors, and even antithyroid antibodies have been shown to be associated with several important pathways in cancer development.[5,6]
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