Gao Xingxing, Liu Mi, Wu Yijun
Department of Thyroid Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.
Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.
PeerJ. 2025 Aug 28;13:e19915. doi: 10.7717/peerj.19915. eCollection 2025.
The occurrence of thyroid carcinoma in patients with Graves' disease (GD) has been rising recently. However, the linkage between lipids and the incidence of thyroid carcinoma among GD patients is still not well-established.
The research aims to explore the relationship between serum lipid concentrations and the occurrence of thyroid cancer in patients diagnosed with GD.
We conducted a retrospective analysis of data from 512 patients with GD who underwent surgical procedures at our institution between 2015 and 2024. Our study focused on examining the correlations between various patient characteristics and the occurrence of thyroid cancer. Logistic regression models were developed to analyze the predictive factors. Ultimately, we constructed a predictive nomogram to estimate the potential of thyroid cancer in GD patients.
Among the 512 patients with GD, 299 patients were pathologically confirmed as differentiated thyroid carcinoma (DTC) (58.4%). Multivariate analysis revealed that high triglyceride (TAG > 1.185 mmol/L), low high-density lipoprotein (HDL < 1.325 mmol/L), and overweight (body mass index (BMI) ≥ 25) were risk factors for malignancy. In addition, ultrasound characteristics, including nodules in the thyroid, aspect ratio imbalance, hypoechogenicity, irregular borders, and microcalcifications, were risk factors for malignancy. The predictive nomogram demonstrated significant clinical utility, exhibiting an area under the curve (AUC) of 0.91 (95% CI [0.88-0.94]) and 0.91 (95% CI [0.87-0.96]) in the training set and validation set. Moreover, a high level of TAG was a risk factor for central lymph node metastasis and high AJCC staging in GD patients with thyroid carcinoma.
Our study presents initial findings suggesting that elevated TAG levels, reduced HDL cholesterol levels, and overweight status are individually linked to the incidence of thyroid carcinoma in patients with GD. These results indicate that preoperative serum lipid profiles and BMI can serve as valuable predictors for the occurrence of thyroid carcinoma in this patient population.
格雷夫斯病（GD）患者中甲状腺癌的发生率近来呈上升趋势。然而，GD患者中脂质与甲状腺癌发病率之间的联系仍未完全确立。
本研究旨在探究血清脂质浓度与诊断为GD的患者甲状腺癌发生之间的关系。
我们对2015年至2024年间在本机构接受手术的512例GD患者的数据进行了回顾性分析。我们的研究重点是检查各种患者特征与甲状腺癌发生之间的相关性。建立逻辑回归模型以分析预测因素。最终，我们构建了一个预测列线图来估计GD患者患甲状腺癌的可能性。
在512例GD患者中，299例经病理证实为分化型甲状腺癌（DTC）（58.4%）。多因素分析显示，高甘油三酯（TAG>1.185 mmol/L）、低高密度脂蛋白（HDL<1.325 mmol/L）和超重（体重指数（BMI）≥25）是恶性肿瘤的危险因素。此外，甲状腺结节、纵横比失衡、低回声、边界不规则和微钙化等超声特征是恶性肿瘤的危险因素。预测列线图显示出显著的临床实用性，在训练集和验证集中的曲线下面积（AUC）分别为0.91（95%CI[0.88 - 0.94]）和0.91（95%CI[0.87 - 0.96]）。此外，高水平的TAG是GD甲状腺癌患者中央淋巴结转移和高美国癌症联合委员会（AJCC）分期的危险因素。
我们的研究初步结果表明，TAG水平升高、HDL胆固醇水平降低和超重状态分别与GD患者甲状腺癌的发生率相关。这些结果表明，术前血清脂质谱和BMI可作为该患者群体甲状腺癌发生的有价值预测指标。
