Increased Risk of Type 2 Diabetes in Patients With Thyroid Cancer After Thyroidectomy: A Nationwide Cohort Study

• Published in: The journal of clinical endocrinology and metabolism Vol. 107; no. 3; pp. e1047 - e1056
• Main Authors: Roh, Eun, Noh, Eunjin, Hwang, Soon Young, Kim, Jung A, Song, Eyun, Park, Minjeong, Choi, Kyung Mook, Baik, Sei Hyun, Cho, Geum Joon, Yoo, Hye Jin
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.03.2022
• Subjects: Adult; Cancer; Cancer patients; Care and treatment; Case-Control Studies; Cohort analysis; Development and progression; Dextrose; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - epidemiology; Disease susceptibility; Dosage; Dose-Response Relationship, Drug; Drug dosages; Female; Follow-Up Studies; Glucose; Homeostasis; Hormone Replacement Therapy - adverse effects; Hormone Replacement Therapy - methods; Humans; Male; Middle Aged; National health insurance; Oncology, Experimental; Population studies; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Republic of Korea - epidemiology; Retrospective Studies; Risk Assessment - statistics & numerical data; Risk factors; Thyroid cancer; Thyroid gland; Thyroid Gland - pathology; Thyroid Gland - surgery; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery; Thyroid-stimulating hormone; Thyroidectomy; Thyroidectomy - adverse effects; Thyrotropin - metabolism; Thyroxine; Thyroxine - administration & dosage; Thyroxine - adverse effects; Type 2 diabetes; Republic of Korea; South Korea; thyroid function; thyroidectomy; thyroid cancer; type 2 diabetes
• ISSN: 0021-972X; 1945-7197; 1945-7197
• DOI: 10.1210/clinem/dgab776

Abstract Context Abnormal thyroid function after thyroidectomy and subsequent thyroid-stimulating hormone suppression can have detrimental effects on glucose homeostasis in patients with thyroid cancer. Objective To investigate whether thyroidectomy increases the risk of type 2 diabetes in patients with thyroid cancer and to explore the association between levothyroxine dosage and type 2 diabetes risk. Methods A retrospective population-based cohort study using the Korean National Health Insurance database. We included 36 377 thyroid cancer patients without known diabetes who underwent thyroidectomy between 2004 and 2013. Matched subjects with nonthyroid cancer were selected using 1:1 propensity score matching. The main outcome measure was newly developed type 2 diabetes mellitus. Results Patients with thyroid cancer who underwent thyroidectomy had a higher risk of developing type 2 diabetes mellitus than the matched controls (hazard ratio [HR] 1.43, 95% CI 1.39-1.47). Among patients with thyroid cancer, when the second quartile group (in terms of the mean levothyroxine dosage; 101-127 μg/day) was considered the reference group, the risk of type 2 diabetes mellitus increased in the first quartile (<101 μg/day; HR 1.45, 95% CI 1.36-1.54) and fourth quartile groups (≥150 μg/day; HR 1.37, 95% CI 1.29-1.45); meanwhile, the risk decreased in the third quartile group (128-149 μg/day; HR 0.91, 95% CI 0.85-0.97). Conclusion Patients with thyroid cancer who underwent thyroidectomy were more likely to develop type 2 diabetes mellitus than the matched controls. There was a U-shaped dose-dependent relationship between the levothyroxine dosage and type 2 diabetes mellitus risk.