Thyroid nodule risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Risk Factors

Common risk factors associated with thyroid nodules

  • Older age
  • Iodine deficiency
    • Previous history of iodine deficiency hypothyroidism
    • Living in iodine deficient areas
  • Family history of autoimmune diseases
  • Multiparity
  • Smoking

Common risk factors associated with thyroid cancers

  • Hard nodule
  • Nodule that stuck to nearby structures
  • Family history of thyroid cancer
  • Younger than 20 or older than 70 years[1]
    • As thyroid nodularity increases with age, presence of thyroid nodule in a children is twice more likely to be a cancer than in adults[2][3]
  • History of radiation exposure to the head or neck
  • Either externally from therapeutic X-radiation or internally through treatment with radioactive iodine (131I) and possibly radioactive fallout (131I)
    • As an example, ground nuclear bomb testing in Nevada in the 1950s led to a meaningful increase in thyroid cancer incidence
  • History of radiation treatment to the head and neck region, for example for treatment purposes is associated with an increased incidence of thyroid nodularity and cancer:[4]
    • To treat acne
    • To treat inflammation of the tonsils or adenoids
    • To treat thymic enlargement
  • Male gender
    • The risk of benign thyroid nodule development in women is more but the rate of cancer is twice as high in men than women (8 versus 4 percent)
  • Smoking 11863477
  • Alcohol consumption 18031329
  • Insulin-like growth factor 1 (IGF-1) levels
  • Increased parity and late age at first pregnancy 10965973
  • Hepatitis C-related chronic hepatitis (odds ratio 12.2 in one report) 17542674
  • Decreased serum TSH levels in women 17666480
  • Uterine fibroids[5]

Factors associated with a possible decreased risk include:

  • Oral contraceptive use[6]
  • 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 [7][1]
  • 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[8]

References

  1. 1.0 1.1 Belfiore A, La Rosa GL, La Porta GA, Giuffrida D, Milazzo G, Lupo L, Regalbuto C, Vigneri R (1992). "Cancer risk in patients with cold thyroid nodules: relevance of iodine intake, sex, age, and multinodularity". Am. J. Med. 93 (4): 363–9. PMID 1415299.
  2. MORTENSEN JD, WOOLNER LB, BENNETT WA (1955). "Gross and microscopic findings in clinically normal thyroid glands". J. Clin. Endocrinol. Metab. 15 (10): 1270–80. doi:10.1210/jcem-15-10-1270. PMID 13263417.
  3. Belfiore A, Giuffrida D, La Rosa GL, Ippolito O, Russo G, Fiumara A, Vigneri R, Filetti S (1989). "High frequency of cancer in cold thyroid nodules occurring at young age". Acta Endocrinol. 121 (2): 197–202. PMID 2773619.
  4. Spinos N, Terzis G, Crysanthopoulou A, Adonakis G, Markou KB, Vervita V, Koukouras D, Tsapanos V, Decavalas G, Kourounis G, Georgopoulos NA (2007). "Increased frequency of thyroid nodules and breast fibroadenomas in women with uterine fibroids". Thyroid. 17 (12): 1257–9. doi:10.1089/thy.2006.0330. PMID 17988198.
  5. Knudsen N, Bülow I, Laurberg P, Perrild H, Ovesen L, Jørgensen T (2002). "Low goitre prevalence among users of oral contraceptives in a population sample of 3712 women". Clin. Endocrinol. (Oxf). 57 (1): 71–6. PMID 12100072.
  6. Lupoli G, Vitale G, Caraglia M, Fittipaldi MR, Abbruzzese A, Tagliaferri P, Bianco AR (1999). "Familial papillary thyroid microcarcinoma: a new clinical entity". Lancet. 353 (9153): 637–9. doi:10.1016/S0140-6736(98)08004-0. PMID 10030330.
  7. Cohen A, Rovelli A, Merlo DF, van Lint MT, Lanino E, Bresters D, Ceppi M, Bocchini V, Tichelli A, Socié G (2007). "Risk for secondary thyroid carcinoma after hematopoietic stem-cell transplantation: an EBMT Late Effects Working Party Study". J. Clin. Oncol. 25 (17): 2449–54. doi:10.1200/JCO.2006.08.9276. PMID 17557958.

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