Thyroid nodule risk factors
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Prevalence of thyroid incidentalomas estimated from autopsy studies ranges from 30% to 60%. Studies comparing clinical palpation with thyroid imaging show a prevalence of 13% to 50%. Prospective studies of randomly selected patients have reported a prevalence of 19% to 67%. The risk for malignancy in asymptomatic nodules found in nonirradiated glands is 0.45% to 13% (mean +/- SD, 3.9% +/- 4.1%).
Risk Factors
Other factors associated with an increased risk of thyroid nodules and goiter include:
- Hard nodule
- Nodule that is stuck to nearby structures
- Family history of thyroid cancer
- Younger than 20 or older than 70
- History of radiation exposure to the head or neck
- Male gender
- Smoking 11863477
- Alcohol consumption 18031329
- Insulin-like growth factor 1 (IGF-1) levels
thyroid nodules in men and decreased serum TSH levels in women 17666480
- Uterine fibroids 17988198
Factors associated with a possible decreased risk include:
- Oral contraceptive use 12100072
- Use of statins (associated with a reduced risk of nodules on ultrasound)
- reduced prevalence, number and volume of thyroid nodules 17666091
- A history of papillary thyroid cancer in at least one first-degree family member is associated with an increased risk of a nodule being malignant
- 10030330
- 1415299
- Papillary thyroid carcinoma
- Hepatitis C-related chronic hepatitis (odds ratio [OR] 12.2 in one report) 17542674
- Increased parity and late age at first pregnancy 10965973 Several risk factors for the development of thyroid cancer have been identified, including age, sex, and history of thyroid irradiation. Thyroid nodularity increases with age . The presence of a thyroid nodule in a child is twice more likely to be a cancer than if it was in an adult.13263417 2773619 Among patients with thyroid nodules, the rate of cancer is twice as high in men than women (8 versus 4 percent), and it is higher in adults over age 60 and under age 30 years than in those aged 30 to 60 years . 1415299 A history of radiation treatment to the head and neck region to treat acne, inflammation of the tonsils or adenoids, or thymic enlargement is associated with an increased incidence of thyroid nodularity and cancer . 3965855
- In two large series, 20 to 27 percent of patients had thyroid nodularity, and 30 to 33 percent of the nodules were cancers; however, some were microcarcinomas . 1256510 687105
There is no evidence that radiation-associated thyroid cancers are more aggressive than other thyroid cancers.
12733137
- Hematopoietic stem cell transplantation increases the relative risk (RR) for thyroid cancer to 3.26; if transplantation occurred prior to age 10, the RR was 24.6.
17557958