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ORIGINAL ARTICLE
Year : 2017  |  Volume : 20  |  Issue : 2  |  Page : 55-58

Comparative ultrasound evaluation of thyroid nodule incidence among diabetics and healthy adults without overt thyroid disease


Department of Radiology, University of Benin Teaching Hospital, Benin City, Edo, Nigeria

Date of Web Publication18-Sep-2017

Correspondence Address:
Ademola A Adeyekun
Department of Radiology, University of Benin Teaching Hospital, PMB 1111, Benin City, Edo
Nigeria
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DOI: 10.4103/1118-8561.215032

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  Abstract 

Background: Diabetes mellitus is associated with increased incidence of thyroid abnormalities, including thyroid nodules and gland enlargement, compared to healthy individuals. Some of these nodules can be malignant. Ultrasound is a valuable tool in assessing the thyroid gland, for such parenchymal abnormalities. We assessed by means of ultrasound, the incidence of thyroid nodules and other parenchymal changes in diabetic patients, and compare same with apparently healthy controls. Materials and Methods: One hundred and twenty adult diabetic patients and an equal number of apparently healthy adults were sonographically examined. In each subject, both lobes of the gland were scanned with a 5-12 MHz linear array transducer of a Sonoace ultrasound scanner. The thyroid was examined for nodules and other parenchymal abnormalities. Results: Thyroid nodules were noted in both diabetic and control groups. Both male and female diabetic patients had significantly greater number of thyroid nodules compared to controls; 18 male diabetics or 34.6% against 2 male controls or 4.5%; P = 0.001 and 22 female diabetics or 32% against 13 females controls or 17%; P = 0.033. Gender did not influence the detection of thyroid nodules among diabetics. Conclusion: Diabetic patients have higher frequency of thyroid nodules compared to apparently healthy individuals. It is recommended that the nodules be subjected to further imaging studies/biopsy for possibility of malignancies.

Keywords: Diabetes, nodules, thyroid gland, ultrasound


How to cite this article:
Adeyekun AA, Nduka CC, Ighodaro EO. Comparative ultrasound evaluation of thyroid nodule incidence among diabetics and healthy adults without overt thyroid disease. Sahel Med J 2017;20:55-8

How to cite this URL:
Adeyekun AA, Nduka CC, Ighodaro EO. Comparative ultrasound evaluation of thyroid nodule incidence among diabetics and healthy adults without overt thyroid disease. Sahel Med J [serial online] 2017 [cited 2017 Oct 23];20:55-8. Available from: http://www.smjonline.org/text.asp?2017/20/2/55/215032


  Introduction Top


Thyroid diseases are common in the general population. These disorders include goiter, thyroiditis, and benign and malignant neoplasia. Diabetes is a disease condition characterized by absolute or relative deficiency of insulin or its action, resulting in hyperglycemia and abnormalities of carbohydrate, protein, and lipid metabolism.[1] Diabetes mellitus and thyroid disease have been shown to mutually influence each other. Increased levels of circulating insulin have a proliferative effect on thyroid tissue that may lead to formation of nodules. Hyperthyroidism worsens glycogenic control and probably increases insulin resistance.[1],[2]

Thyroid nodules also occur in the general healthy population and have been found in some autopsy series in as much as 50%.[3],[4] Most of these nodules are benign, and the incidence of malignancy is quite low, about 3.7%.[5],[6],[7] The superior resolution of ultrasound as an imaging method has resulted in incidental discovery of large number of thyroid nodules that hitherto had been obscured,[7] and with Doppler studies, better evaluation of the malignant potential of such nodules.[8]

Studies have shown that ultrasound evaluation of the thyroid gland is accurate, noninvasive, comfortable, rapid, inexpensive, and without radiation exposure to patient.[9] The cross-sectional imaging modalities, computerized tomography (CT) and magnetic resonance imaging (MRI), are expensive and not necessarily more efficient in detecting small thyroid lesions as compared to ultrasonography.[10]

Reports on sonographic assessment of incidental thyroid nodules in diabetic patients and apparently healthy individuals are scanty in the African medical literature. The aim of the study was to sonographically assess for thyroid nodules among patients with diabetes mellitus. It is hoped that this study will contribute to data on this topic, especially among Nigerians.


  Materials and Methods Top


The study setting was the Department of Radiology, University of Benin Teaching Hospital (UBTH), Benin City. It was a prospective ultrasound evaluation of the thyroid gland. The subjects were 120 adult diabetic patients without overt thyroid disease attending the medical outpatient of UBTH, and an equal number of apparently healthy adults screened for diabetics and thyroid disease at the Centre for Disease Control of the same hospital to serve as controls. Subjects with a history of head and neck trauma or radiation exposure were excluded from the study. Approval of the Ethics and Research Committee of the hospital was obtained. Informed consent was obtained from each study subject.

A SonoAce X4 ultrasound machine (Medison Inc., Korea. 2010) with a 5–12 MHz linear transducer was used. Each subject was examined in the supine position with the head in extension and a sand bag placed under the shoulder. Using the common carotid artery and internal jugular vein on each side as landmarks, transverse and longitudinal scans of the thyroid gland were done. The parenchymal echotexture of the gland was assessed by comparison to the surrounding muscles. Both thyroids were evaluated for the presence of nodules. A nodule was defined as a solitary lesion distorting the uniform shape or echo pattern of the thyroid gland and was at least 1 cm in diameter [11],[12] [Figure 1].
Figure 1: Ultrasound image of the thyroid gland showing a nodule (white arrow)

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Data were entered into a Microsoft Excel Spreadsheet and analyzed using Statistical Package for Social Sciences (SPSS) Version 17 (SPSS Inc., Chicago, IL, USA). Data comparison/statistical test of significance was performed with the Student's t-test and Pearson's correlation coefficient for continuous variables and Chi-square test for categorical data. At 95% confidence interval, two-tailed P ≤ 0.05 was considered statistically significant.


  Results Top


The study subjects consisted of 120 diabetic patients and an equal number of age- and sex-matched controls. The age range for diabetics was 20–76 years (mean: 54.5 ± 13.5 years), and sex distribution was 52 males (43%) and 68 females (57%). The age range for controls was 20–80 years (mean: 52.0 ± 12.3 years), made of 44 males (37%) and 76 females (63%) [Table 1].
Table 1: General data of the studied population showing the mean age, weight, height, BMI, BSA, and presence of nodules (including standard deviation) in diabetics and controls

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[Table 1] also represents the general data of study the population with the mean and standard deviation for age, weight, height, body mass index (BMI), body surface area (BSA) in diabetic patients and controls. The total number and percentage of the thyroid parenchymal nodules in both diabetic patients and controls are also shown.

Comparison of the data between diabetic patients and controls from unpaired t-test and Chi-square showed no statistically significant difference in the age (P = 0.140), height (P = 0.808), weight (P = 0.386), BMI (P = 0.236), and BSA (P = 0.654).

Diabetic subjects had a higher frequency of thyroid nodules compared to the controls (40 diabetics or 33.3% against 15 controls or 12.5%; P = 0.0001). Furthermore, both male and female diabetics had higher frequency of thyroid nodules as compared to their respective male and female controls; 18 male diabetics (34.6%) versus 2 male controls (4.5%), P = 0.0001; and 22 female diabetics (32%) against 13 female controls (17%), P = 0.033 [Table 2].
Table 2: Comparison of diabetics and Controls according to gender

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As depicted in [Table 3], there was no significant difference in the frequency of thyroid nodules between male and female diabetics; 18 male diabetics (34%) against 22 female diabetics (32%), P = 0.794.
Table 3: Comparison of Diabetics and controls

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[Table 4] shows the distribution of thyroid nodules among the different age groups among male and female diabetic patients and controls. In both male and female diabetic subjects, thyroid nodules were found only in the age group 40 years and above. The age group of 61–70 years had the highest frequency of thyroid nodules in male diabetic patients (n = 7 or 43%) while the age group of 51–60 years had the highest frequency in female diabetic subjects (n = 8 or 42%). Among male controls, thyroid nodules were found only in age groups of 61–70 years and 71–80 years; whereas among female controls, nodules were found in all age groups, with the highest frequency in the 51–60 years group (6 or 18.8%). No other thyroid parenchymal abnormality was found in both diabetics and controls.
Table 4: Distribution of thyroid nodules in different age groups according to gender

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  Discussion Top


Many thyroid nodules are incidental findings of other imaging studies, such as CT and MRI of the neck or carotid ultrasound imaging.[13] Sonographically, a thyroid nodule is a distinct lesion from the surrounding thyroid parenchyma,[14] and nodules are manifestations of a gamut of thyroid diseases rather than a single disease.[15]

The present study found thyroid nodules to be more common in diabetic patients as compared to controls (P = 0.0001) and all the nodules were found in type 2 diabetics. Comparison between male and female diabetics and the age- and sex-matched controls also showed higher frequency of thyroid nodules for diabetics of both sexes, for males and females with P = 0.0001 and P = 0.033, respectively. This is similar to the findings of Junik et al.,[11] who observed significantly higher frequency of thyroid nodules in type 2 diabetics compared to controls. They also found that the frequency of thyroid nodules in type 1 diabetics was not significantly different from that of controls. The explanation for these findings may be due to hyperinsulinism, which occurs more with type 2 diabetics, and its proliferative effect on thyroid tissue leading to increase in gland size and formation of nodules. This work found no significant difference in the frequency of thyroid nodules between male and female diabetics (P = 0.794). A probable explanation for this is an apparent lack of differential influence by the sex hormones on the existing hyperinsulinism in diabetic patients.


  Conclusion Top


The study has established baseline data on the prevalence of asymptomatic thyroid nodules among diabetics and apparently healthy individual. However, we recommend further imaging/histological studies with large sample sizes. This may assist in analyzing the relationship between sonographic features of thyroid nodules and possible malignancy. Thus, the accuracy of morphologic features for the identification of benign thyroid nodules may be established.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Wu P. Thyroid disease and diabetes. Clin Diabetes 2000;18:38-9.  Back to cited text no. 1
    
2.
Mirella H, Mira SZ, Sami TA. Thyroid disorders and diabetes mellitus. J Thyroid Res 2011;2011:55-61.  Back to cited text no. 2
    
3.
Ezzat S, Sarti DA, Cain DR, Braunstein GD. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Intern Med 1994;154:1838-40.  Back to cited text no. 3
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4.
Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology 2005;237:794-800.  Back to cited text no. 4
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Brander AE, Viikinkoski VP, Nickels JI, Kivisaari LM. Importance of thyroid abnormalities detected at US screening: A 5-year follow-up. Radiology 2000;215:801-6.  Back to cited text no. 5
    
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Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A, et al. Cancer statistics, 2005. CA Cancer J Clin 2005;55:10-30.  Back to cited text no. 6
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7.
Harnsberger H. Diagnostic Imaging: Head and Neck. Salt Lake City, UT: Amirsys; 2004. p. 24-40.  Back to cited text no. 7
    
8.
Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in non-palpable thyroid nodules: Predictive value of ultrasound and color flow-Doppler sonography in predicting malignancy in “cold” thyroid nodules. Eur J Endocrinol 1998;138:41-6.  Back to cited text no. 8
    
9.
Hegedüs L. Thyroid ultrasound. Endocrinol Metab Clin North Am 2001;30:339-60, viii-ix.  Back to cited text no. 9
    
10.
Jennal LJ. Diabetes control in thyroid disease. J Diabetes Spectr 2006;19:148-53.  Back to cited text no. 10
    
11.
Junik R, Kozinski M, Debska-Kozinska K. Thyroid ultrasound in diabetic patients without overt thyroid disease. Acta Radiol 2006;47:687-91.  Back to cited text no. 11
    
12.
Hansen D, Bennedbaek FN, Hansen LK, Hoier-Madsen M, Jacobsen BB, Hegedüs L. Thyroid function, morphology and autoimmunity in young patients with insulin-dependent diabetes mellitus. Eur J Endocrinol 1999;140:512-8.  Back to cited text no. 12
    
13.
Bonavita JA, Mayo J, Babb J, Bennett G, Oweity T, Macari M, et al. Pattern recognition of benign nodules at ultrasound of the thyroid: Which nodules can be left alone? AJR Am J Roentgenol 2009;193:207-13.  Back to cited text no. 13
    
14.
Vandermeer FQ, Wong-You-Cheong J. Thyroid nodules: When to biopsy. Appl Radiol 2007;36:8-19.  Back to cited text no. 14
    
15.
Pacini F, Burroni L, Ciuoli C, Di Cairano G, Guarino E. Management of thyroid nodules: A clinicopathological, evidence-based approach. Eur J Nucl Med Mol Imaging 2004;31:1443-9.  Back to cited text no. 15
    


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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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