Abstract
Obesity and diabetes are the risk factors for cancer development including differentiated thyroid cancer (DTC). Contradictory accumulated data indicates the possible negative effects of obesity and hyperglyceamia as a factor for aggressiveness of DTC. The aim of the present study is to investigate the association of high body mass index (BMI) and presence of type 2 diabetes mellitus (T2DM) on the histological aggressiveness and clinical outcomes in DTC patients followed for over 4 years in a single center. Consequative 526 DTC patients who had undergone total thyroidectomy and/or radioactive iodine (RAI) ablation were reviewed retrospectively. Patients were divided into groups based on their BMI: normal weight, overweight, obese and also were evalauted in 3 groups presence of diabetes, prediabetes and nomoglyceamia. Histological aggressiveness of DTC at the time of diagnosis and clinical response at the time of last clinical visit were reassessed according to the criteria suggested by ATA 2015 guideline. No differences in histopathologic features, risk of recurrence, cumulative dose of RAI ablation and prevalence of 131I avid metastatic disease were demonstrated among the groups both classified according to BMI and hyperglycemia. Mean of 3.4 year follow-up also showed no differences in the clinial repsonse to therapy and percentage of nonthyroid primary cancer in DTC patients. In this retrospective study we demonstrated that obesity and T2DM have no additive effect on DTC aggressiveness and response to therapy. DTC patients with obesity and diabetes can be treated according to present guidelines without requirement for spesific attention.
Highlights
Thyroid cancer is one of the most common endocrine malignancies and its incidence rate has increased significantly in the last decades
We aimed to investigated the associations of body mass index (BMI), prediabetes and type 2 diabetes mellitus (T2DM) with pathological features and clinical outcomes of differentiated thyroid cancer (DTC) patients followed for over 4 years in a single center
Patients were categorized in three groups according to their BMI: normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2) and obese (BMI ≥ 30 kg/m2), and were classified in three groups according to their glycemic status considering diabetes history, fasting plasma glucose (FPG), Hba1c values as normoglycemia (FPG < 100 mg/dL and/or HbA1c < 5.7), prediabetes (FPG = 100-125 mg/dL and/or HbA1c = 5.7%-6.4%) and diabetes (FPG ≥ 126 and/or HbA1c ≥ 6.5) according to the ADA 2019 guideline
Summary
Thyroid cancer is one of the most common endocrine malignancies and its incidence rate has increased significantly in the last decades. Increased incidence of thyroid carcinoma is attributed to rising awareness and easier diagnosis, accumulating data have suggested that concomitant diseases such as diabetes and obesity may play a role [2,3,4,5]. The possible mechanisms with increased thyroid cancer risk in obesity and diabetes are still unclear. Obese and diabetic patients may have an increased risk of malignancy and differentiated thyroid cancer (DTC) aggressiveness as a result of clinically higher serum thyroid stimulating hormone (TSH) levels compared to the normal population [9,10,11]
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