Guadalupe Vargas-Ortega , Carlos Alfonso Romero-Gameros , Mario Enrique Rendón-Macias , Lourdes Balcázar-Hernández , Ernesto Sosa-Eroza , Moises Mercado , Ana L. Espinosa de los Monteros-Sánchez , Barbara Pérez-Aguilar , Carlos Paredes-Manjarrez , Fernando Bernardo Reyes-Olhagaray , Diana Laura Serrano-Ramírez , Erick Vladimir Martínez-De la Cruz , Baldomero González-Virla
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The aim of this study was to evaluate, in a retrospective case-cohort study of patients with acromegaly, the associated risk factors for thyroid nodules disease in this population.</p></div><div><h3>Methods</h3><p>This was a case-cohort study matched by age, gender, and growth hormone at diagnosis. Cases consisted of acromegalic patients that developed thyroid nodules during the follow up, and controls consisted in acromegalic patients without thyroid nodules. A Cox proportional hazard estimation was carried out for measure the associated risk factors for thyroid nodules disease in acromegalic patients. A nodular thyroid disease-free survival analysis was estimated using the Kaplan-Meier analysis.</p></div><div><h3>Results</h3><p>We recruited 49 cases and 56 controls. In a multivariate Cox proportional hazard analysis age and IGF-1 ≥ 2.2 x ULN were significantly related with the presence of thyroid nodules [HR of 2.21 (95% CI; 1.15–4.25, <em>p</em> = 0.01)]. 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引用次数: 5
摘要
甲状腺肿在肢端肥大症患者中很常见;它的发展与疾病的持续时间有关。甲状腺细胞表达IGF-1受体，TSH/IGF-1相互作用已被证明在甲状腺细胞生长中具有协同作用。肢端肥大症患者IGF-1水平与甲状腺体积之间存在相关性。本研究的目的是通过对肢端肥大症患者的回顾性病例队列研究来评估该人群中甲状腺结节疾病的相关危险因素。方法采用病例队列研究，根据年龄、性别和诊断时的生长激素进行匹配。病例包括在随访中出现甲状腺结节的肢端肥大症患者，对照组包括没有甲状腺结节的肢端肥大症患者。对肢端肥大症患者甲状腺结节病的相关危险因素进行Cox比例风险估计。使用Kaplan-Meier分析估计甲状腺结节无病生存分析。结果纳入病例49例，对照组56例。在多变量Cox比例风险分析中，年龄和IGF-1 ≥ 2.2 x ULN与甲状腺结节的存在显著相关[HR为2.21 (95% CI;1.15 - -4.25, p = 0.01)]。Kaplan-Meier生存分析显示，IGF-1 X ULN ≥ 2.2患者的无结节生存率低于IGF-1 X ULN < 2.2患者。结论IGF-1 X ULN ≥ 2.2的肢端肥大症患者发生甲状腺结节病的可能性更大，提示暴露于IGF-1轴高活动的时间与甲状腺结节的发生可能存在直接影响。
Risk factors associated with thyroid nodular disease in acromegalic patients: A case-cohort study in a tertiary center
Introduction
Goiter is very common in patients with acromegaly; its development is correlated to the duration of the disease. Thyroid cells express the IGF-1 receptor and the TSH/IGF-1 interaction has been demonstrated to have a synergistic effect in thyroid cell growth. There is a correlation between IGF-1 levels and the thyroid volume of patients with acromegaly. The aim of this study was to evaluate, in a retrospective case-cohort study of patients with acromegaly, the associated risk factors for thyroid nodules disease in this population.
Methods
This was a case-cohort study matched by age, gender, and growth hormone at diagnosis. Cases consisted of acromegalic patients that developed thyroid nodules during the follow up, and controls consisted in acromegalic patients without thyroid nodules. A Cox proportional hazard estimation was carried out for measure the associated risk factors for thyroid nodules disease in acromegalic patients. A nodular thyroid disease-free survival analysis was estimated using the Kaplan-Meier analysis.
Results
We recruited 49 cases and 56 controls. In a multivariate Cox proportional hazard analysis age and IGF-1 ≥ 2.2 x ULN were significantly related with the presence of thyroid nodules [HR of 2.21 (95% CI; 1.15–4.25, p = 0.01)]. Nodularity-free survival rates in patients who had an IGF-1 X ULN ≥ 2.2 was found to be lower in comparison to those who had IGF-1 X ULN < 2.2, according to a Kaplan-Meier survival analysis.
Conclusions
Our findings support that exist more probability to develop thyroid nodular disease in patients with acromegaly that present IGF-1 X ULN ≥ 2.2, suggesting a possible direct effect between the time of exposure to the IGF-1 axis hyperactivity and the genesis of thyroid nodules.
期刊介绍：
Growth Hormone & IGF Research is a forum for research on the regulation of growth and metabolism in humans, animals, tissues and cells. It publishes articles on all aspects of growth-promoting and growth-inhibiting hormones and factors, with particular emphasis on insulin-like growth factors (IGFs) and growth hormone. This reflects the increasing importance of growth hormone and IGFs in clinical medicine and in the treatment of diseases.
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