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Review
. 2012:2012:578285.
doi: 10.1155/2012/578285. Epub 2012 Jun 12.

Diabetes and thyroid cancer risk: literature review

Shyang-Rong Shih  1 , Wei-Yih Chiu, Tien-Chun Chang, Chin-Hsiao Tseng
Affiliations
Review

Diabetes and thyroid cancer risk: literature review

Shyang-Rong Shih et al. Exp Diabetes Res. 2012.

Abstract

Diabetic patients have a higher risk of various types of cancer. However, whether diabetes may increase the risk of thyroid cancer has not been extensively studied. This paper reviews and summarizes the current literature studying the relationship between diabetes mellitus and thyroid cancer, and the possible mechanisms linking such an association. Epidemiologic studies showed significant or nonsignificant increases in thyroid cancer risk in diabetic women and nonsignificant increase or no change in thyroid cancer risk in diabetic men. A recent pooled analysis, including 5 prospective studies from the USA, showed that the summary hazard ratio (95% confidence interval) for women was 1.19 (0.84-1.69) and was 0.96 (0.65-1.42) for men. Therefore, the results are controversial and the association between diabetes and thyroid cancer is probably weak. Further studies are necessary to confirm their relationship. Proposed mechanisms for such a possible link between diabetes and thyroid cancer include elevated levels of thyroid-stimulating hormone, insulin, glucose and triglycerides, insulin resistance, obesity, vitamin D deficiency, and antidiabetic medications such as insulin or sulfonylureas.

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Figures

Figure 1
Figure 1
Pathophysiology proposed to link diabetes and thyroid cancer together. Diabetes mellitus may affect mitogenic pathway of the follicular cells through several mechanisms. Increased insulin amount stimulates follicular cells because of its structural similarity to insulin-like growth factor. Increased TSH stimulated AC/cAMP/PKA pathway. Increased body mass index will increase adipokines and subsequently stimulate mitogenic pathways. Antidiabetic medicines of sulfonylurea and insulin contribute to the elevated insulin level. Hyperglycemia and hypertriglycemia increase oxidative stress and stimulate mitogenic pathway. Vitamin D deficiency decreases deiodinase 2, T3 and GLUT4 transcription, which subsequently increase TSH and insulin levels and activate mitogenic pathways.
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