The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Prevalence of thyroid nodules and their associated clinical parameters: a large-scale, multicenter-based health checkup study

  • Moon, Jae Hoon (Department of Internal Medicine, Seoul National University Bundang Hospital) ;
  • Hyun, Min Kyung (Department of Preventive Medicine, Dongguk University College of Korean Medicine) ;
  • Lee, Ja Youn (National Evidence-based Healthcare Collaborating Agency) ;
  • Shim, Jung Im (National Evidence-based Healthcare Collaborating Agency) ;
  • Kim, Tae Hyuk (Department of Internal Medicine, Seoul National University Hospital) ;
  • Choi, Hoon Sung (Department of Internal Medicine, Kangwon National University Hospital) ;
  • Ahn, Hwa Young (Department of Internal Medicine, Chung-Ang University Hospital) ;
  • Kim, Kyung Won (Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center) ;
  • Park, Do Joon (Department of Internal Medicine, Seoul National University Hospital) ;
  • Park, Young Joo (National Evidence-based Healthcare Collaborating Agency) ;
  • Yi, Ka Hee (Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center)
  • Received : 2015.08.12
  • Accepted : 2016.06.13
  • Published : 2018.07.01
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Abstract

Background/Aims: We evaluated the prevalence and characteristics of thyroid nodules detected by thyroid ultrasound (US) at health checkups and the associated clinical parameters. Methods: A total of 72,319 subjects who underwent thyroid US at three health checkup centers in Korea from January 2004 to December 2010 were included in this study. The correlations between the presence of thyroid nodules and other clinical parameters were analyzed. Results: The prevalence of thyroid nodules and cysts was 34.2% (n = 24,757). Thyroid nodules were more prevalent in women and older age groups. Among the subjects with thyroid nodules with size information (n = 24,686), 18,833 (76.3%) had nodules measuring ${\leq}1.0cm$. Women and older age groups showed higher proportion of larger nodules. Percentage of women, age, body mass index (BMI), waist circumference, body fat composition, blood pressure, and the level of fasting glucose, total cholesterol, and low density lipoprotein cholesterol were higher in the subjects with thyroid nodules compared to those without nodules. The prevalence of metabolic syndrome and overt/subclinical thyrotoxic state was higher in the subjects with thyroid nodules. In the multivariable logistic regression analysis, women, age, BMI, metabolic syndrome, and thyrotoxicosis were independently associated with the presence of thyroid nodules. Conclusions: The high prevalence of thyroid nodules in people who underwent thyroid US at a health checkup suggests that increased detection of thyroid nodules resulted in an increased prevalence in the general population. However, metabolic disturbances may also have contributed to the increase in thyroid nodule prevalence in Korea.

Keywords

Acknowledgement

Supported by : National Evidence-based Healthcare Collaborating Agency(NECA), Korean Foundation for Cancer Research

References

  1. Mitchell J, Parangi S. The thyroid incidentaloma: an increasingly frequent consequence of radiologic imaging. Semin Ultrasound CT MR 2005;26:37-46. https://doi.org/10.1053/j.sult.2004.10.004
  2. Davies L, Ouellette M, Hunter M, Welch HG. The increasing incidence of small thyroid cancers: where are the cases coming from? Laryngoscope 2010;120:2446-2451. https://doi.org/10.1002/lary.21076
  3. Morris LG, Sikora AG, Tosteson TD, Davies L. The increasing incidence of thyroid cancer: the influence of access to care. Thyroid 2013;23:885-891. https://doi.org/10.1089/thy.2013.0045
  4. Korea Centers for Disease Control and Prevention. Korea Health Statistics 2013: Korea National Health and Nutrition Examination Survey (KNHANES VI-1). Cheongju: Ministry of Health and Welfare, 2014.
  5. Yim CH, Oh HJ, Chung HY, et al. Prevalence of thyroid nodules detected by ultrasonography in womens attending health check-ups. J Korean Soc Endocrinol 2002;17:183-188.
  6. Suk JH, Kim TY, Kim MK, et al. Prevalence of ultrasonographically- detected thyroid nodules in adults without previous history of thyroid disease. J Korean Endocr Soc 2006;21:389-393. https://doi.org/10.3803/jkes.2006.21.5.389
  7. Kim JH, Park SJ, Kim SE, et al. Prevalence of thyroid nodules detected by ultrasonography in adult men attending health check-ups. J Korean Endocr Soc 2007;22:112-117. https://doi.org/10.3803/jkes.2007.22.2.112
  8. Kim WJ, Kim JH, Park DW, et al. Prevalence of thyroid nodules detected by ultrasonography in adults for health check-ups and analysis of fine needle aspiration cytology. J Korean Endocr Soc 2008;23:413-419. https://doi.org/10.3803/jkes.2008.23.6.413
  9. Knudsen N, Laurberg P, Perrild H, Bulow I, Ovesen L, Jorgensen T. Risk factors for goiter and thyroid nodules. Thyroid 2002;12:879-888. https://doi.org/10.1089/105072502761016502
  10. 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. https://doi.org/10.1089/thy.2007.0223
  11. Ayturk S, Gursoy A, Kut A, Anil C, Nar A, Tutuncu NB. Metabolic syndrome and its components are associated with increased thyroid volume and nodule prevalence in a mild-to-moderate iodine-deficient area. Eur J Endocrinol 2009;161:599-605. https://doi.org/10.1530/EJE-09-0410
  12. Guo H, Sun M, He W, et al. The prevalence of thyroid nodules and its relationship with metabolic parameters in a Chinese community-based population aged over 40 years. Endocrine 2014;45:230-235. https://doi.org/10.1007/s12020-013-9968-0
  13. Kim JY, Jung EJ, Park ST, et al. Body size and thyroid nodules in healthy Korean population. J Korean Surg Soc 2012;82:13-17. https://doi.org/10.4174/jkss.2012.82.1.13
  14. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735-2752. https://doi.org/10.1161/CIRCULATIONAHA.105.169404
  15. Horvath E, Majlis S, Rossi R, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab 2009;94:1748-1751. https://doi.org/10.1210/jc.2008-1724
  16. Brito JP, Gionfriddo MR, Al Nofal A, et al. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis. J Clin Endocrinol Metab 2014;99:1253-1263. https://doi.org/10.1210/jc.2013-2928
  17. Brander A, Viikinkoski P, Nickels J, Kivisaari L. Thyroid gland: US screening in a random adult population. Radiology 1991;181:683-687. https://doi.org/10.1148/radiology.181.3.1947082
  18. Burguera B, Gharib H. Thyroid incidentalomas: prevalence, diagnosis, significance, and management. Endocrinol Metab Clin North Am 2000;29:187-203. https://doi.org/10.1016/S0889-8529(05)70123-7
  19. Volzke H, Ludemann J, Robinson DM, et al. The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area. Thyroid 2003;13:803-810. https://doi.org/10.1089/105072503768499680
  20. Brander AE, Viikinkoski VP, Nickels JI, Kivisaari LM. Importance of thyroid abnormalities detected at US screening: a 5-year follow-up. Radiology 2000;215:801-806. https://doi.org/10.1148/radiology.215.3.r00jn07801
  21. 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. https://doi.org/10.1016/j.metabol.2013.01.009
  22. Yin J, Wang C, Shao Q, et al. Relationship between the Prevalence of thyroid nodules and metabolic syndrome in the iodine-adequate area of Hangzhou, China: a cross-sectional and cohort study. Int J Endocrinol 2014;2014:675796.
  23. Zimmermann-Belsing T, Brabant G, Holst JJ, Feldt-Rasmussen U. Circulating leptin and thyroid dysfunction. Eur J Endocrinol 2003;149:257-271. https://doi.org/10.1530/eje.0.1490257
  24. Lewandowski K, Randeva HS, O'Callaghan CJ, et al. Effects of insulin and glucocorticoids on the leptin system are mediated through free leptin. Clin Endocrinol (Oxf ) 2001;54:533-539. https://doi.org/10.1046/j.1365-2265.2001.01243.x
  25. Schmidt MI, Duncan BB, Vigo A, et al. Leptin and incident type 2 diabetes: risk or protection? Diabetologia 2006;49:2086-2096. https://doi.org/10.1007/s00125-006-0351-z
  26. Jones JI, Clemmons DR. Insulin-like growth factors and their binding proteins: biological actions. Endocr Rev 1995;16:3-34.
  27. Kimura T, Van Keymeulen A, Golstein J, Fusco A, Dumont JE, Roger PP. Regulation of thyroid cell proliferation by TSH and other factors: a critical evaluation of in vitro models. Endocr Rev 2001;22:631-656. https://doi.org/10.1210/edrv.22.5.0444
  28. Hartog H, Wesseling J, Boezen HM, van der Graaf WT. The insulin-like growth factor 1 receptor in cancer: old focus, new future. Eur J Cancer 2007;43:1895-1904. https://doi.org/10.1016/j.ejca.2007.05.021
  29. Liu YJ, Qiang W, Shi J, Lv SQ, Ji MJ, Shi BY. Expression and significance of IGF-1 and IGF-1R in thyroid nodules. Endocrine 2013;44:158-164. https://doi.org/10.1007/s12020-012-9864-z
  30. Riedemann J, Macaulay VM. IGF1R signalling and its inhibition. Endocr Relat Cancer 2006;13 Suppl 1:S33-S43. https://doi.org/10.1677/erc.1.01280

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