Abstract
Recent studies suggested that a lower serum thyroid hormone level is associated with more vascular calcification. However, it has been rarely evaluated whether lower thyroid hormone levels affect the calcification of thyroid cancer and there is a relationship between calcification patterns of papillary thyroid carcinoma (PTC) and coronary artery calcification (CAC). The study was divided into two groups: First, we retrospectively reviewed 182 PTC patients and examined the correlation between PTC calcification patterns and CAC by coronary computed tomography (CT). Second, the correlation between the calcification pattern of PTC and thyroid hormone concentration was investigated (n = 354). The calcification pattern of PTC was evaluated by thyroid ultrasonography and classified into four groups: no-calcification, microcalcification, macrocalcification, and mixed-calcification. In PTC patients with microcalcification and mixed calcification, more CAC was observed and coronary calcium score (CCS) was higher. Lower free T4 and higher thyroid-stimulating hormone (TSH) levels were associated with microcalcification and mixed calcification, not with macrocalcification and no calcification. PTC with microcalcification and mixed calcification showed more aggressive phenotypes like lymph node metastasis and more advanced TNM (tumor, node, and metastasis) stage than those with no calcification and macrocalcification. Calcification patterns of PTC showed close association with thyroid hormone levels and CAC. Further research is needed to determine how these findings are related to cardiovascular risk and disease-specific mortality.
Highlights
Thyroid cancer is the most common endocrine tumor, and its incidence has increased over the past two decades
The calcium score (CCS) was higher in the microcalcification and mixed calcification groups than in the no calcification and macrocalcification groups (p = 0.000) (Table 1 and Figure 2)
CAC was observed in 57% and 64% of the microcalcification and mixed calcification groups of Papillary thyroid carcinoma (PTC) patients, respectively, compared to 17% in the no-calcification group and CCS was higher in these two groups
Summary
Thyroid cancer is the most common endocrine tumor, and its incidence has increased over the past two decades. Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer and frequently shows microcalcification on ultrasonography (US), which is the most remarkable finding indicating PTC. Coronary artery calcification (CAC) is associated with an increased risk of cardiovascular morbidity and mortality [7,8]. Breast artery calcification is associated with a higher CCS and increased CVD risk [10,11]. It has been unknown whether intratumoral calcification per se within thyroid cancer is associated with vascular calcification. We investigated CAC and CCS in patients with PTC, according to intratumoral calcification patterns. We examined how these findings are related to thyroid hormones
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