Visceral obesity and insulin resistance as risk factors for follicular thyroid adenoma

• Anzhelika S. Khalimova
• Ludmila V. Kvitkova
• Sergey F. Zinchuk
• Valentina G. Zinchuk
• Grigoriy V. Vavin

Abstract

Follicular thyroid adenomas (thyroid adenomas) occur in 2–4.3% of the population. To date, the causes and mechanisms of thyroid neoplasia have not been fully studied, which prevents effective primary and secondary prevention. There is a steady increase in obesity and associated diseases in the world. There is convincing evidence of the relationship of obesity with some types of cancer, including thyroid cancer. However, there is practically no data in the available literature on the role of visceral obesity and insulin resistance in the development of benign neoplasia – ​follicular thyroid adenomas. This was a prerequisite for conducting this study.

Purpose of the study was to evaluate the incidence of visceral obesity and insulin resistance in patients with follicular adenoma of the thyroid gland, taking into account their body weight.

Material and methods. the study included 107 women aged 20–60 years who underwent surgery for follicular thyroid adenomas, the diagnosis was confirmed histologically. The comparison group consisted of 46 women aged 20–60 years who do not have thyroid and severe somatic pathology. Anthropometric parameters were evaluated in patients [height, body weight, body mass index (BMI), waist circumference, waist and hip circumference ratio]; in venous blood plasma – ​levels of thyroid-stimulating hormone (TSH) and free thyroxine (free T4) by enzyme immunoassay (ELISA); fasting glucose level by the Trinder reaction with glucose oxidase at the endpoint using a set of reagents by the ELISA method, fasting insulin level using commercial test systems for ELISA, indicators were taken into account on an ABBOTT ARCHI TECT c800 device (USA) in the wavelength range of 450 nm (comparison length 590 nm); the HOmeostasis Model Assessment of Insulin Resistance (HOMA-IR) index was calculated by formula: [Fasting insulin (mcME/ml)×fasting glucose (mmol/L)]/22.5. All women underwent ultrasound of the thyroid gland. The reference values were taken as: BMI 18,5–25 kg/m², waist circumference ≤80 cm, waist and hip circumference ratio ≤0.85, TSH – ​0.4–4.0 µed/ml, free T4–9.0–22 pmol/l, fasting glucose level – ​3.5–6.1 mmol/l, insulin – ​0.7–9,0 mcME/ml, HOMA-IR <2,77, the volume of the thyroid gland is 9–18 cm³. The results were processed statistically using the Statistica 6.1 program. Differences were considered statistically significant at p<0.05. According to BMI, the patients were divided into comparable groups: normal, overweight and obese.

Results. It was found that more than half of the patients with follicular thyroid adenomas were overweight – ​30.8% and obese – ​38.4%. The predominant type of obesity is visceral: waist circumference >80 cm – ​in 73.8%, waist and hip circumference ratio >0.85 – ​in 61.6% of patients. It draws attention to the fact that even with normal body weight, in a significant part of patients with follicular thyroid adenomas, the deposition of adipose tissue is visceral in nature: the indicators of circumference ratio – ​in 35,5% and waist and hip circumference ratio – ​in 24.2% are increased. The revealed high frequency of hyperinsulinemia and an increased HOMA-IR index indicated the prevalence of insulin resistance among people with follicular thyroid adenomas. With normal body weight, their frequency was 27.3% and 30.3%, with overweight – ​48.5% and 51.5%, with obesity – ​70.7 and 75.6%. In the comparison group, the frequency of overweight (30.4%) and obesity (41.3%) did not differ from the main group (p=0.97, p=0.38, respectively). However, the visceral nature of fat deposition was much less common (increased level of waist circumference in 15.2%, waist and hip circumference ratio in 10.9%, p=0.001), and hyperinsulinemia and high values of the HOMA-IR index were registered only in 5.3% of obese women (p=0.000). Thus, the results obtained indicate the important role of visceral obesity and insulin resistance in the formation of follicular thyroid adenomas and the need for the treatment of obesity for the primary prevention of follicular thyroid adenomas.

Keywords:follicular adenoma; thyroid gland; insulin resistance; obesity

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