Celescuekci Lina Guzikauskas, Pinto Mariana Pereira, Botelho Ilka Mara Borges, Pavin Elizabeth João, Zantut-Wittmann Denise Engelbrecht
Faculty of Medicine, Pontifical Catholic University of Campinas, Campinas, São Paulo, Brazil.
Division of Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil.
Ann Med. 2025 Dec;57(1):2530697. doi: 10.1080/07853890.2025.2530697. Epub 2025 Jul 15.
Factors related to cardiovascular risk and insulin sensitivity seem to be related to the increase in the number of thyroid cancer (TC) diagnosis, but there is a lack of studies to corroborate these hypotheses.
This observational and cross-sectional study evaluated ultrasonographic, clinical, cytological and anatomopathological characteristics of thyroid nodules (TN) related with factors indicative of cardiovascular risk (CVR), serum lipids, and glucose profiles through medical records, and interviews during routine medical consultation.
The study included 160 TN patients, 85.53% women, 41.3% with obesity, 24.18% with type 2 Diabetes Mellitus, 63.4% with arterial hypertension, 9.15% with previous CVR, 38.16% with dyslipidemia. 38.5% had Papillary TC, 8.5% Follicular TC. Regarding cytology categories (Bethesda,B), 34.64% BII, 8.5% BIII, 11.11% BIV, 26.8% BV, 8.5% BVI. Microcalcifications were associated with higher Framingham and ASCVD CVR Scores, fasting glucose and glycated hemoglobin. BII TN had lower fasting glucose; BIII greater glycated hemoglobin; and BIV higher both CVR scores. Framingham Score was lower in papillary TC, abdominal waist was lower in follicular TC. Higher FT4 increased 4.7 times the chance of malignant cytology. Higher HDL was an associated factor for malignant cytology (OR = 1.064) and higher FT4 for Differentiated TC (OR = 7.409).
TN with greater malignant potential on ultrasound and cytology were associated with greater CVR and altered glucose metabolism. Larger goiters and multiple nodules were related to factors indicative of insulin resistance. Malignant cytology was related to hormonal factors that induce greater cell replication, such as thyroxine and insulin resistance.
与心血管风险和胰岛素敏感性相关的因素似乎与甲状腺癌（TC）诊断数量的增加有关，但缺乏研究来证实这些假设。
这项观察性横断面研究通过病历以及常规医疗咨询期间的访谈，评估了与心血管风险（CVR）指标、血脂和血糖谱相关的甲状腺结节（TN）的超声、临床、细胞学和解剖病理学特征。
该研究纳入了160例TN患者，其中85.53%为女性，41.3%患有肥胖症，24.18%患有2型糖尿病，63.4%患有动脉高血压，9.15%有既往CVR，38.16%患有血脂异常。38.5%患有乳头状TC，8.5%患有滤泡状TC。关于细胞学分类（贝塞斯达分类，B），34.64%BII，8.5%BIII，11.11%BIV，26.8%BV，8.5%BVI。微钙化与较高的弗雷明汉和动脉粥样硬化性心血管疾病（ASCVD）CVR评分、空腹血糖和糖化血红蛋白相关。BII级TN的空腹血糖较低；BIII级糖化血红蛋白较高；BIV级CVR评分均较高。乳头状TC的弗雷明汉评分较低，滤泡状TC的腹围较低。较高的游离甲状腺素（FT4）使恶性细胞学的几率增加4.7倍。较高的高密度脂蛋白（HDL）是恶性细胞学的相关因素（比值比[OR]=1.064），较高的FT4是分化型TC的相关因素（OR=7.409）。
超声和细胞学上具有更大恶性潜能的TN与更大的CVR和糖代谢改变有关。更大的甲状腺肿和多发结节与胰岛素抵抗指标相关。恶性细胞学与诱导更多细胞复制的激素因素有关，如甲状腺素和胰岛素抵抗。
