The role of preexisting diabetes mellitus on the risk for aggressive thyroid cancers

Rodis Paparodis; Dimitra Bantouna; Sarantis Livadas; Nicholas Angelopoulos; Ioannis Androulakis; George Simeakis; Dimitra Zianni; Ilias Perogamvros; Anastasios Boniakos; Andreas Rizoulis; Juan Carlos Jaume; Evaggelos Karvounis; Aikaterini Kapezanou; Dimitrios Askitis

doi:10.1530/endoabs.99.RC8.1

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Endocrine Abstracts (2024) 99 RC8.1 | DOI: 10.1530/endoabs.99.RC8.1

ECE2024 Rapid Communications Rapid Communications 8: Thyroid | Part II (5 abstracts)

The role of preexisting diabetes mellitus on the risk for aggressive thyroid cancers

Rodis Paparodis ^1,2,3 , Dimitra Bantouna ² , Sarantis Livadas ^4,5 , Nicholas Angelopoulos ^2,6 , Ioannis Androulakis ^2,7 , George Simeakis ^2,8 , Dimitra Zianni ^2,5 , Ilias Perogamvros ⁹ , Anastasios Boniakos ^2,5 , Andreas Rizoulis ^2,10 , Juan Carlos Jaume ¹ , Evaggelos Karvounis ^2,11 , Aikaterini Kapezanou ¹¹ & Dimitrios Askitis ^2,12

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Author affiliations

¹Loyola Medical Center:, Endcrinology, Diabetes and Metabolism, Maywood, United States; ²Hellenic Endocrine Network, Athens, Greece; ³Endocrinology, Diabetes and Metabolism Clinics, Private Practice, Patra; ⁴, Athens, Greece; ⁵Endocrinology, Diabetes and Metabolism Clinics, Private Practice, Athens, Greece; ⁶Endocrinology, Diabetes and Metabolism Clinics, Private Practice, Kavala, Greece; ⁷Endocrinology, Diabetes and Metabolism Clinics, Private Practice, Chania, Greece; ⁸401 General Military Hospital of Athens, Endocrine Dept - Thyroid Cancer Outpatient’s Clinic, Athens, Greece; ⁹University of Manchester, Manchester, United Kingdom, ¹⁰Endocrinology, Diabetes and Metabolism Clinics, Private Practice, Larisa, Greece, ¹¹Euroclinic Hospital, Center of Excellence in Endocrine Surgery, Athens, Greece, ¹²Endocrinology, Diabetes and Metabolism Clinics, Private Practice, Alexandroupolis, Greece

Introduction: Multiple cancers have been described more commonly in patients with diabetes, and some exhibit increased aggressiveness of the tumor as well. This association has been debated with regard to thyroid cancer. With this work, we aim to clarify whether type 2 diabetes (DM2) or autoimmunity-related diabetes (type 1 diabetes+LADA=DM1) could coexist with thyroid cancers more aggressive as compared to those found in unaffected (non-DM) individuals.

Methods: We collected data from patients who underwent thyroid surgery in 10 referral clinics in Greece over 2 years. Our retrospective collection included the type of diabetes, pre-existing to the thyroid surgery, its treatments and duration, the preoperative thyroid function tests and the surgical pathology report. We compared the presence of different forms of thyroid cancer histology and the features of tumor aggressiveness between patients with and without diabetes.

Results: Overall, n=808 subjects with thyroid cancer were included: n=571 were females (70.7%), age 47.3±14.3 years, BMI 27.0±5.0 Kg/m², mean TSH 1.99±2.21 mIU/l; n= 692 were non-DM, n=10 had DM1 and n=107 had DM2. Histology revealed n=5 poorly differentiated / anaplastic, n=13 medullary, n=12 Hürthle cell, n=17 follicular and n=773 papillary thyroid cancers (PTC); n=20 (2.5%) with aggressive histological subtypes of PTC, n=5 (0.6%) with distant metastases (MET), n=199 (24.6%) with extrathyroidal extension (ETE), n=419 (51.9%) with capsular invasion (CI), n=225 (27.8%) with lymph nodes involvement (LNi) and n=23 with cancer recurrence (CR) (2.8%). The incidence of aggressive histological types, CR, MET or number of I-131 treatments were not different between groups (p>0.05). ETE, CI and LNi were significantly more common in non-DM compared to both diabetes groups, while gross ETE was more common in DM2 over DM1 and non-DM (P<0.001).

Conclusions: Some protective effects are observed in patients with DM1 more than DM2 on certain features of cancer aggressiveness in patients with diabetes. In addition, ETE seems more common in patients with DM2 compared to those with DM1. Aggressive histological types of thyroid cancer and aggressive variants of PTC incidence do not seem affected by the presence of diabetes. Obviously, the relatively small sample size of the present study limits the ability to detect effects of smaller magnitude, but an interplay between tumor biology, glucose homeostasis, insulin secretion and resistance and autoimmunity could have a significant effect on thyroid cancer development and aggressiveness.