Male Patients With Diabetes, Obesity Have Poorer Prognosis of Thyroid Cancer
Recently, there has been concern around glucagon-like peptide-1 receptor agonists and increase the risk of thyroid cancer, with liraglutide having a black box warning label for the disease.
Type 2 diabetes (T2D) and obesity are not risk factors for thyroid cancer, according to a study published in Physiological Research.1 However, investigators found that a subgroup of male patients have a poorer prognosis with the disease.
Diabetes and thyroid cancer have been linked, with some evidence demonstrating an increased risk. | Image Credit: Chinnapong | stock.adobe.com
Diabetes and thyroid cancer have been linked, with some evidence demonstrating an increased risk. In a review published in Diabetes, Metabolic Syndrome and Obesity, investigators evaluated diabetes as a risk factor for thyroid cancer. Some studies showed an increased risk for female patients, while others showed that men with diabetes had a greater risk than women. However, the reviewers also stated that “patients with type 2 diabetes have a low risk of developing thyroid cancer, and this risk increased after receiving hypoglycemic drugs.” Type 1 diabetes showed an elevated risk.2
Likewise, due to the increasing rates of obesity and thyroid cancer, investigators suggest that there could be a link between the 2 due to low-grade chronic inflammation, altered cytokine levels, insulin resistance, oxidative stress, and hormonal changes. Many studies have linked the association of the 2, with an approximate 5-point increase in BMI and 0.1-point increase in waist-to-hip ratio linked with an increased risk of thyroid cancer by 30% and 14%, respectively.3
Recently, glucagon-like peptide-1 (GLP-1) receptor agonists have also been said to increase the risk of thyroid cancer, with liraglutide (Victoza, Saxenda) having a black box warning label for the disease. In a study published in BJM, GLP-1 medications were not associated with a significantly increased risk of thyroid cancer, but the study results could not exclude small increased risks. Out of 145,410 patients who were treated with a GLP-1 receptor agonist in the study, only 76 developed thyroid cancer during the follow-up period.4
In the Physiological Research study, investigators used a cohort retrospective study to explore whether the presence of thyroid cancer is more common in diabetic and/or obese patients compared with benign results. There were 184 patients included in the study (145 women and 39 men) who were divided into cohorts for malignant tumors (72 patients), low-risk carcinoma (6 patients), and benign tumors (106 patients). Sixteen patients had prediabetes, and 30 patients had T2D. Thyroid cancer was detected in 20 patients with either prediabetes or T2D compared with 52 patients who had normal glucose tolerance.1
Investigators also found that hemoglobin A1c was higher in the benign cohort compared with those in the malignant cohort, but the results were not significant. Further, patients in the malignant and benign cohorts had a non-significantly higher body mass index compared with those in the low-risk carcinoma group. Men had higher insulin resistance, fasting glucose, and C-peptide levels compared with women, but hemoglobin A1c levels were comparable. The investigators reported that men were more likely to have goiter, distal metastases, minimally invasive disease, and advanced thyroid cancer, which was particularly true for men with prediabetes and T2D.1
The study authors concluded, “insulin resistance with hyperinsulinemia could be a more potent candidate for thyroid growth stimulation compared to stimulation by thyrotropin or autoimmune thyroid disease in these patients,” as there was not a link between diabetes and obesity with thyroid cancer in their dataset.1
READ MORE: Diabetes Resource Center
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