Association between obesity and thyroid cancer in women: a comparative study of malignant and benign nodules

Main Article Content

Morgana Pinheiro Sousa
Thaynan dos Santos Dias
Luis Felipe Nunes de Oliveira
Ana Victória Varela da Silva
André Pires Cortez
Bruna Aparecida Melo Batista
Maria Dinara de Araújo Nogueira
Walter Breno de Sousa Freire
Carla Soraya Costa Maia

Abstract

Introduction: Obesity is a disease that induces various changes in the body, including oxidative stress, which can contribute to the development of cancer cells in the thyroid. Objective: Evaluate whether the presence of obesity and antioxidant defense is associated with the diagnosis of malignant thyroid nodules in adult women. Methods: The cross-sectional study consisted of 109 females diagnosed with nodular thyroid disease who underwent thyroidectomy surgery, with benignity or malignancy classification previously defined by Fine Needle Aspiration Biopsy (FNAB) and the Bethesda system. The participants had anthropometric and clinical markers assessed before the surgical process. The prevalence ratio of malignant nodules with obesity and antioxidant markers was determined using Poisson regression analysis. Results: After biopsy analysis, 70 women were diagnosed with a benign nodule and 39 with a malignant nodule. A significant association was found between body mass index and nodule type (p<0.015). All but one participant had glutathione peroxidase and superoxide dismutase enzyme activity above the reference values. The prevalence of malignant nodules was significantly higher in women diagnosed with obesity (PR=1.94; 95% CI: 1.01 - 3.17; p=0.046) compared to those without obesity. Antioxidant markers showed no association with nodule malignancy. Conclusion: The prevalence of malignant thyroid nodules in adult women is higher in those who are obese, and the presence of thyroid nodules, regardless of their type, can influence the increase in antioxidant enzyme activity.

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Sousa, M. P., Dias, T. dos S., Oliveira, L. F. N. de, Silva, A. V. V. da, Cortez, A. P., Batista, B. A. M., … Maia, C. S. C. (2026). Association between obesity and thyroid cancer in women: a comparative study of malignant and benign nodules. ABCS Health Sciences. https://doi.org/10.7322/abcshs.2024187.2928
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References

1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49. https://doi.org/10.3322/caac.21660

2. Brazil. Ministério da Saúde. Instituto Nacional de Câncer (INCA). Câncer de tireoide. Available from: https://www.gov.br/inca/pt-br/assuntos/cancer/tipos/tireoide

3. Zaid AM, Eid E, Gouda SI, Aboelnaga MM, Abdelsalam RA, Elbeltagy AMG, et al. Evaluation of Risk Factors for Malignancy in Patients With Thyroid Nodules. J Endocrinol Metab. 2022;12(2):66-72. https://doi.org/10.14740/jem770

4. MU C, Ming X, Tian Y, Liu Y, Yao M, Ni Y, et al. Mapping global epidemiology of thyroid nodules among the general population: a systematic review and meta-analysis. Front Oncol. 2022;12:1029926. https://doi.org/10.3389/fonc.2022.1029926

5. Li Y, Jin C, Li J, Tong M, Wang M, Huang J, et al. Prevalence of Thyroid Nodules in China: a health examination cohort-based study. Front Endocrinol (Lausanne). 2021;12:676144. https://doi.org/10.3389/fendo.2021.676144

6. Chen Y, Zhu C, Chen Y, Wang N, Li Q, Han B, et al. The Association of Thyroid Nodules with Metabolic Status: A Cross-Sectional SPECT-China Study. Int J Endocrinol. 2018;2018:6853617. https://doi.org/10.1155/2018/6853617

7. Kościuszko M, Buczyńska A, Krętowski AJ, Popławska-Kita A. Could Oxidative Stress Play a Role in the Development and Clinical Management of Differentiated Thyroid Cancer?. Cancers (Basel). 2023;15(12):3182. https://doi.org/10.3390/cancers15123182

8. Franchini F, Palatucci G, Colao A, Ungaro P, Macchia PE, Nettore IC. Obesity and Thyroid Cancer Risk: An Update. Int J Environ Res Public Health. 2022;19(3):1116. https://doi.org/10.3390/ijerph19031116

9. El Hassani RA, Buffet C, Leboulleux S, Dupuy C. Oxidative stress in thyroid carcinomas: biological and clinical significance. Endocr Relat Cancer. 2019;26(3):131-43. https://doi.org/10.1530/erc-18-0476

10. Mancini A, Segni CD, Raimondo S, Olivieri G, Silvestrini A, Meucci E, et al. Thyroid Hormones, Oxidative Stress, and Inflammation. Mediators Inflamm. 2016;2016:6757154. https://doi.org/10.1155/2016/6757154

11. Faam B, Ghadiri AA, Ghaffari MA, Totonchi M, Khorsandi L. Comparing Oxidative Stress Status Among Iranian Males and Females with Malignant and Non-malignant Thyroid Nodules. Int J Endocrinol Metab. 2021;19(1):e105669. https://doi.org/10.5812/ijem.105669

12. Rovcanin B, Stojsavljevic A, Kekic D, Gopcevic K, Manojlovic D, Jovanovic M, et al. Redox status and antioxidative cofactor metals influence clinical and pathological characteristics of papillary thyroid carcinoma and colloid goiter. Biol Trace Elem Res. 2020;197(2):349-59. https://doi.org/10.1007/s12011-019-01995-x

13. Demetriou E, Fokou M, Frangos S, Papageorgis P, Economides PA, Economides A. Thyroid Nodules and Obesity. Life (Basel). 2023;13(6):1292. https://doi.org/10.3390/life13061292

14. Bassan J. Educação e tecnologia. Rev Tec Cient CEFETs PR/MG/RJ. 2007;1(1):4-29.

15. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133. https://doi.org/10.1089/thy.2015.0020

16. Frisancho AR. Anthropometric Standards for the Assessment of Growth and Nutritional Status. Michigan: University of Michigan Press, 1990.

17. World Health Organization (WHO). WHO Consultation on Obesity: Geneva, Switzerland) Obesity: preventing and managing the global epidemic: report of a WHO consultation. Available from: https://iris.who.int/handle/10665/42330

18. Aksenov MY, Markesbery WR. Changes in thiol content and expression of glutathione redox system genes in the hippocampus and cerebellum in Alzheimer's disease. Neurosci Lett. 2001;302(2-3):141-5. https://doi.org/10.1016/s0304-3940(01)01636-6

19. Eissa MS, Abdellateif MS, Elesawy YF, Shaarawy S, Al-Jarhi UM. Obesity and Waist Circumference are Possible Risk Factors for Thyroid Cancer: Correlation with Different Ultrasonography Criteria. Cancer Manag Res. 2020;12:6077-89. https://doi.org/10.2147/CMAR.S256268

20. Xu N, Liu H, Wang Y, Xue Y. Relationship between insulin resistance and thyroid cancer in Chinese euthyroid subjects without conditions affecting insulin resistance. BMC Endocr Disord. 2022;22(1):58. https://doi.org/10.1186/s12902-022-00943-6

21. Arduc A, Dogan BA, Tuna MM, Tutuncu Y, Isik S, Berker D, et al. Higher body mass index and larger waist circumference may be predictors of thyroid carcinoma in patients with Hürthle-cell lesion/neoplasm fine-needle aspiration diagnosis. Clin Endocrinol. 2015;83(3):405-11. https://doi.org/10.1111/cen.12628

22. Kolb R, Sutterwala FS, Zhang W. Obesity and cancer: inflammation bridges the two. Curr Opin Pharmacol. 2016;29:77-89. https://doi.org/10.1016/j.coph.2016.07.005

23. Lega IC, Lipscombe LL. Review: Diabetes, obesity, and cancer-pathophysiology and clinical implications. Endocr Rev. 2020;41(1):bnz014. https://doi.org/10.1210/endrev/bnz014

24. Zhao J, Wen J, Wang S, Yao J, Liao L, Dong J. Association between adipokines and thyroid carcinoma: a meta-analysis of case-control studies. BMC Cancer. 2020;20(1):788. https://doi.org/10.1186/s12885-020-07299-x

25. Yin DT, He H, Yu K, Xie J, Lei M, Ma R, et al. The association between thyroid cancer and insulin resistance, metabolic syndrome, and its components: A systematic review and meta-analysis. Int J Surg. 2018;57:66-75. https://doi.org/10.1016/j.ijsu.2018.07.013

26. Metere A, Frezzotti F, Graves CE, Vergine M, De Luca M, Petraforte D, et al. A possible role for selenoprotein glutathione peroxidase (GPx1) and thioredoxin reductases (TrxR1) in thyroid cancer: our experience in thyroid surgery. Cancer Cell Int. 2018;18(1):7. https://doi.org/10.1186/s12935-018-0504-4

27. Liu J, Xu T, Ma L, Chang W. Signal Pathway of Estrogen and Estrogen Receptor in the Development of Thyroid Cancer. Front Oncol. 2021;11:593479. https://doi.org/10.3389/fonc.2021.593479

28. Gravena AAF, Lopes TR, Demitto MO, Borghesan DHP, Dell’Agnolo CM, Brischiliari SCR, et al. The Obesity and the Risk of Breast Cancer among Pre and Postmenopausal Women. Asian Pac J Cancer Prev. 2018;19(9):2429-36. https://doi.org/10.22034/APJCP.2018.19.9.2429

29. Brasil. Ministério da Saúde. Vigitel Brasil 2023: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2023. Brasília: Ministério da Saúde, 2023.

30. Brasil. Ministério da Saúde. Relatórios públicos do Sistema de Vigilância Alimentar e Nutricional. Available from: https://sisaps.saude.gov.br/sisvan/relatoriopublico/index

31. Nguyen DN, Kim JH, Kim MK. Association of Metabolic Health and Central Obesity with the Risk of Thyroid Cancer: Data from the Korean Genome and Epidemiology Study. Cancer Epidemiol Biomarkers Prev. 2022;31(3):543-53. https://doi.org/10.1158/1055-9965.EPI-21-0255

32. Macvanin MT, Gluvic Z, Zafirovic S, Gao X, Essack M, Isenovic ER. The protective role of nutritional antioxidants against oxidative stress in thyroid disorders. Front Endocrinol. 2022;13:1092837. https://doi.org/10.3389/fendo.2022.1092837

33. Dogan R, Dogan EE, Guler EM, Senturk E, Yenigun A, Celik I, et al. Oxidative stress values of tumor core, edge, and healthy thyroid tissue in thyroid masses. Eur Arch Otorhinolaryngol. 2021;278(8):2953-60. https://doi.org/10.1007/s00405-020-06422-9

34. Muzza M, Pogliaghi G, Colombo C, Carbone E, Cirello V, Palazzo S, et al. Oxidative Stress Correlates with More Aggressive Features in Thyroid Cancer. Cancers (Basel). 2022;14(23):5857. https://doi.org/10.3390/cancers14235857

35. Ramli NSF, Mat Junit S, Leong NK, Razali N, Jayapalan JJ, Abdul Aziz A. Analyses of antioxidant status and nucleotide alterations in genes encoding antioxidant enzymes in patients with benign and malignant thyroid disorders. Peer J. 2017;5:e3365. https://doi.org/10.7717/peerj.3365

36. Metere A, Graves CE, Chirico M, Caramujo MJ, Pisanu ME, Iorio E. Metabolomic Reprogramming Detected by 1H-NMR Spectroscopy in Human Thyroid Cancer Tissues. Biology (Basel). 2020;9(6):112. https://doi.org/10.3390/biology9060112

37. Kochman J, Jakubczyk K, Bargiel P, Janda-Milczarek K. The Influence of Oxidative Stress on Thyroid Diseases. Antioxidants (Basel). 2021;10(9):1442. https://doi.org/10.3390/antiox10091442

38. Szanto I, Pusztaszeri M, Mavromati M. H2O2 Metabolism in Normal Thyroid Cells and in Thyroid Tumorigenesis: Focus on NADPH Oxidases. Antioxidants (Basel). 2019;8(5):126. https://doi.org/10.3390/antiox8050126

39. Villanueva I, Alva-Sánchez C, Pacheco-Rosado J. The Role of Thyroid Hormones as Inductors of Oxidative Stress and Neurodegeneration. Oxid Med Cell Longev. 2013;2013:218145. https://doi.org/10.1155/2013/218145

40. Islam MN, Rauf A, Fahad FI, Emran TB, Mitra S, Olatunde A, et al. Superoxide dismutase: an updated review on its health benefits and industrial applications. Crit Rev Food Sci Nutr. 2022;62(26):7282-7300. https://doi.org/10.1080/10408398.2021.1913400