Thursday, 28 November 2013

Thyroid disease: Thyroid adenoma – The Risk factors

Thyroid is one of the largest endocrine glands found in the neck, below the Adam’s Apple with the function of regulating the body use of energy, make of proteins by producing its hormones as a result of the stimulation of thyroid-stimulating hormone (TSH) produced by the anterior pituitary.
Thyroid disease is defined as a condition of malfunction of thyroid.
Thyroid adenoma is a benign tumor started in the layer of cell lined the inner surface of the thyroid gland. The disease are relatively common among adults living in the United States. According to the study by the Mayo Clinic and Mayo Foundation, there is a report of 4 patients described in whom a follicular carcinoma developed following thyroidectomy for a benign follicular neoplasm. Most thyroid nodules are Thyroid adenoma.
B.2. Risk factors
1. According to the study by the University of Campinas
a. Graves’ disease: the prevalence of thyroid nodules and thyroid carcinoma were 27.78% and 5.05%, respectively.
b. Older age (OR = 1.054; 95% CI = 1.029-1.080) and larger thyroid volumes (OR = 1.013; 95% CI = 1.003-1.022) increased the chance of nodules.
c. Younger age (OR = 1.073; 95% CI = 1.020-1.128) and larger thyroid volume (OR = 1.018; 95% CI = 1.005-1.030) predicted thyroid carcinoma.
d. Hashimoto’s thyroiditis: the prevalence of thyroid nodules and carcinomas were 50.7% and 7.8%, respectively. Nodules were predicted by thyroid volume (OR = 1.030; 95% CI = 1.001-1.062)(8).
2. Emotional stress and childbirth
98 patients with Graves’ disease have been compared to 95 patients with Hashimoto’s thyroiditis and to 97 patients with benign thyroid nodules (control group) in order to evaluate the triggering role of major stressors and pregnancy in the occurrence of autoimmune thyroid diseases. showed that Graves’ disease occurred after a pregnancy in 25% of the women in child bearing age versus 10% of the cases of Hashimoto’s (p 40 years and to explore the association between TN and its metabolic risk factors, found that the prevalence of TN was 46.6 % (39.7 %, men; 50.3 %, women) and it increased significantly with increasing age (P < 0.001). It was significantly higher in the group with hypertension than in that with normotension (P < 0.001) and was 43.0 % in the normal blood glucose group, 49.4 % in the prediabetes group, and 50.9 % in the diabetes group (P < 0.001). Logistic regression analysis indicated that hypertension [odds ratio (OR) = 1.121 (1.025-1.225)] as well as prediabetes and diabetes [OR = 1.130 (1.036-1.233)] were all independent risk factors for TN after adjustment for sex, age, body mass index, blood lipid levels, smoking status, and alcohol consumption(10).
4. Insulin resistance (IR)
According to the study by the Baskent University Faculty of Medicine, patients with impaired glucose metabolism have significantly increased thyroid volume and nodule prevalence(11). Other study indicated that MetS have significantly increased thyroid volume and nodule prevalence. Multivariate regression analysis model demonstrated that the presence of IR contributed substantially to this increased risk(12).
5. BRAF mutations and family history of thyroid disease
According to the study by the King Abdulaziz University, BRAF exon 15 was sequenced in 381 cases of thyroid lesions including Hashimoto´s thyroiditis, nodular goiters, hyperplastic nodules, follicular adenomas (FA), papillary TC (PTC), follicular variant PTC (FVPTC), microcarcinomas of PTC (micro PTC; tumor size ≤ 1 cm), follicular TC (FTC), and non-well differentiated TC (non-WDTC). Patients with PTC harboring no BRAF mutation (BRAFwt) were on average younger than those with a BRAF mutation (BRAFmut) in the PTC (36.6 years vs. 43.8 years). Older age (≥ 45 years) in patients with PTC was significantly associated with tumor size ≥ 4 cm (P = 0.018), vessel invasion (P = 0.004), and distant metastasis (P = 0.001). Lymph node (LN) involvement in PTC significantly correlated with tumor size (P = 0.044), and vessel invasion (P = 0.013). Of notice, taken the whole TC group, family history of thyroid disease positively correlated with capsular invasion (P = 0.025)(13).

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