Hyperthyroidism and the Risk of Non-Thyroid Cancer: A Danish Register-Based Long-Term Follow-Up Study

IF 3.5 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM European Thyroid Journal Pub Date : 2024-02-01 DOI:10.1530/etj-23-0181
Thea Riis, Steen Joop Bonnema, Thomas Heiberg Brix, Lars Folkestad
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Abstract

Objectives: Cancer is the second most common cause of death worldwide. It is currently debated whether thyroid dysfunction is a modifiable cancer risk factor. Our aim was to evaluate the risk of cancer in patients with hyperthyroidism.

Methods: This is a register-based nationwide cohort study of individuals with a diagnosis of hyperthyroidism. Each hyperthyroid case was matched with four reference individuals according to age and sex. Using Fine and Gray competing risk regression models, we studied the association of hyperthyroidism and subsequent all-cause cancer diagnoses, adjusted for preexisting morbidity. Sub-analyses were stratified for cause of hyperthyroidism (Graves’ disease and toxic nodular goiter, age when diagnosed with hyperthyroidism, sex, and cancer localization (lung-, prostate-, breast-, and colorectal).

Results: The cohort consisted of 95,469 patients with hyperthyroidism (followed for a median of 10.9 years (range: 5.2-17.2)), and 364,494 reference individuals (followed for a median of 11.2 years (range: 5.4-17.4)). Hyperthyroidism was associated with increased all-cause cancer risk (sub-distribution hazard ratio (SHR): 1.12; 95% confidence interval (CI): 1.10-1.14), as well as an increased risk of breast- (SHR: 1.07; 95% CI: 1.02-1.13), lung- (SHR: 1.20; 95% CI: 1.16-1.26), and prostate cancer (SHR: 1.10; 95% CI: 1.02-1.19), but not colorectal cancer (SHR: 1.04; 95% CI: 0.99-1.09). Sub-analyses stratified for age when diagnosed with hyperthyroidism and cause of hyperthyroidism yielded similar results.

Conclusion: In this register-based study, patients with hyperthyroidism had an increased risk of cancer, in particular lung, prostate, and breast cancer. Whether a causal link exists remains to be proven.

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甲状腺功能亢进症与非甲状腺癌风险:一项基于丹麦登记册的长期随访研究
目标:癌症是全球第二大常见死因。目前,甲状腺功能障碍是否是一种可改变的癌症风险因素还存在争议。我们的目的是评估甲状腺功能亢进症患者罹患癌症的风险:这是一项以登记为基础的全国性队列研究,研究对象是确诊为甲状腺功能亢进症的患者。根据年龄和性别,每个甲亢病例与四个参照个体进行配对。利用Fine和Gray竞争风险回归模型,我们研究了甲状腺机能亢进症与后续全因癌症诊断之间的关系,并对原有发病率进行了调整。根据甲亢病因(巴塞杜氏病和毒性结节性甲状腺肿)、确诊甲亢时的年龄、性别和癌症部位(肺癌、前列腺癌、乳腺癌和结直肠癌)进行了分层分析:队列由 95,469 名甲亢患者(随访时间中位数为 10.9 年(范围:5.2-17.2))和 364,494 名参照个体(随访时间中位数为 11.2 年(范围:5.4-17.4))组成。甲状腺功能亢进与全因癌症风险增加有关(亚分布危险比 (SHR):1.12;95% 置信区间 (CI):1.10-1.14),也与乳腺癌风险增加有关(SHR:1.07;95% CI:1.02-1.13)、肺癌(SHR:1.20;95% CI:1.16-1.26)和前列腺癌(SHR:1.10;95% CI:1.02-1.19)的风险增加,但结肠直肠癌(SHR:1.04;95% CI:0.99-1.09)的风险没有增加。根据甲状腺功能亢进症的诊断年龄和甲状腺功能亢进症的病因进行的分层分析得出了相似的结果:在这项基于登记的研究中,甲亢患者罹患癌症的风险增加,尤其是肺癌、前列腺癌和乳腺癌。是否存在因果关系仍有待证实。
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来源期刊
European Thyroid Journal
European Thyroid Journal Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
6.70
自引率
2.10%
发文量
156
期刊介绍: The ''European Thyroid Journal'' publishes papers reporting original research in basic, translational and clinical thyroidology. Original contributions cover all aspects of the field, from molecular and cellular biology to immunology and biochemistry, from physiology to pathology, and from pediatric to adult thyroid diseases with a special focus on thyroid cancer. Readers also benefit from reviews by noted experts, which highlight especially active areas of current research. The journal will further publish formal guidelines in the field, produced and endorsed by the European Thyroid Association.
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