Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi

1304-6187

Sağlık Bakanlığı Ankara Eğitim ve Araştırma Hastanesi

Health Care Administration

Sağlık Kurumları Yönetimi

Tiroid Nodullerinde Ultrasonografik ve Sitolojik bulgular ile Vitamin D Arasındaki İlişkinin Değerlendirilmesi

The Relationship Between Vitamin D and Ultrasonographic and Cytological Findings of Thyroid Nodules

https://orcid.org/0000-0002-9700-7019

Atalay

Eray

KAFKAS ÜNİVERSİTESİ, TIP FAKÜLTESİ

https://orcid.org/0000-0001-5989-2099

Tur

Bilge Kağan

AKSARAY ORTAKÖY DEVLET HASTANESİ

https://orcid.org/0000-0002-6410-1981

Kutas Kurt

Gülizar

KAFKAS ÜNİVERSİTESİ, TIP FAKÜLTESİ

https://orcid.org/0000-0003-2647-694X

Gürsoy

Gül

ANKARA EĞİTİM VE ARAŞTIRMA HASTANESİ

12 21 2019

52 3 206 213 03 30 2019 07 27 2019

2003

Medical Journal of Ankara Training and Research Hospital

Amaç: Vitamin D ile bazı kanserler arasında bir ilişki olduğubildirilmiş, ancak vitamin D ile tiroid kanserleri arasındaki ilişki tam olarakdeğerlendirilmemiştir. Bu çalışmanın amacı, D vitamini düzeyleri ile tiroidnodüllerinin ultrasonografik, sitolojik ve postoperatif patolojik verileriarasındaki ilişkiyi değerlendirmektir.Yöntem: Çalışmamıza tiroid nodül varlığı nedeniyle tiroid ince iğneaspirasyon biyopsisi (TİİAB) sonrası tiroidektomi operasyonu uygulanan 225hasta dahil edildi. Çalışmaya dahil edilen hastaların preoperatifultrasonografik bulguları, TİİAB ve tiroidektomi operasyonu sonrası elde edilensitopatolojik sonuçları ile serum vitamin D düzeyleri kaydedildi. Vitamin Ddüzeyleri ile tiroid nodüllerinin ultrasonografik ve sitolojik bulgularıarasındaki ilişki analiz edildi. Sonuçlar: Vitamin D ile tiroid nodüllerinin ultrasonografiközellikleri, TİİAB ve cerrahi sonrası histopatolojik sonuçları arasındaistatistiksel anlamlı ilişki saptanmadı.Tartışma: Sonuçlarımız D vitamini ile tiroid nodüllerinin ultrasonografiközellikleri, TİİAB ve cerrahi sonuçları arasında ilişki olmadığınıgöstermiştir. Bununla birlikte, sonuçlarımızı geriye dönük olarakincelediğimizde, operasyon sonrası malign saptanan çok az sayıda vakanınpreoperatif TİİAB değerlendirmesinde benign saptandığını gözlemledik. Buolgular vitamin D düzeyleri düşük ve nodül boyutu 2.5 cm'nin üzerinde olanolgulardı. Vitamin D eksikliğinin eşlik ettiği büyük tiroid nodülleri ilemalignite arasındaki ilişkiyi değerlendirmek için daha kapsamlı çalışmalaraihtiyaç olduğunu düşünüyoruz.

Objective: There are reported associations between Vitamin D and somecancers, but the relationship between vitamin D and thyroid cancers has notbeen fully evaluated. The aim of this study was to evaluate the relationshipbetween vitamin D levels and ultrasonographical, cytological and postoperativepathological data of the thyroid nodules.Methods: The study included 225 patients who underwent thyroidectomyafter thyroid fine needle aspiration biopsy (FNAB) due to the presence ofthyroid nodules.The preoperative ultrasonographical findings, thecytopathological results obtained after FNAB and thyroidectomy operation andserum vitamin D levels were recorded. The relationship between vitamin D levelsand ultrasonographical and cytological findings of thyroid nodules wasanalyzed.Results: There was no statistically significant relationship betweenvitamin D and ultrasonographical and histopathological results of thyroidnodules.Conclusions: Our results showed that there were no relationshipbetween Vitamin D and ultrasonographical characteristics, biopsy and surgeryresults of thyroid nodules. However, when we retrospectively examined ourresults, we observed that very few cases with malignancy were found to bebenign in the preoperative FNAB evaluation. These patients had low vitamin Dlevels and a nodule size of more than 2.5 cm. We think that more extensivestudies are needed to assess the association between malignancy and largethyroid nodules associated with vitamin D deficiencies.

Vitamin D Thyroid Nodules Ultrasonography Cytology

Vitamin D Tiroid Nodulü Ultrasonografi Sitoloji

1. Hagedus L. Clinical practice: The thyroid nodule. N Eng J Med 2004: 35: 1764-1771.

2. Maddox P, Wheeler M. Approach to thyroid nodules. in OH, C; QY, D; Kebehew, E, editors. Textbook of Endocrine Surgery. 2 Philadelphia, PA: Elsevier Saunders; 2005. p.85.3. Rice C. Incidence of nodules in the thyroid. Archives of Surgery 1932; 24:505-507.

4. Brander A, Viikinkoski P, Nickels J, Kivisaari L. Thyroid gland: US screening in a random adult population. Radiology 1991; 181: 683-687.

5. Erdogan MF, Atlı T, Ekinci C. Spectrum and prevalence of thyroid disorders in the elderly living in an iodine deficient community. Turkish Journal of Geriatrics 2002; 58:49-53.

6. Erdoğan MF, Gursoy A, G Erdoğan. Natural course of benign thyroid nodules in a moderately iodine-deficient area. Clin Endocrinol 2006; 65: 767-771.

7. Choi YJ, Jung I, Min SJ, Kim HJ, Kim JH, Kim S, et al. Thyroid nodule with benign cytology:Is clinical follow up enough? PloS One 2013; 8: 63834-63837.

8. Rossi ED, Straccia P, Martini M, Revelli L, Lombardi CP, Pontecorvi A, et al. The role of fine needle aspiration cytology inpopulation. Cancer Cytopatol 2014;122:359-367.

9. Lin JD, Chao TC, Huang BY, Chen ST, Chang HY, Hsueh C. Thyroid cancer in the thyroid nodules evaluated by ultrasonography and fine needle aspiration cytology. Thyroid 2005;15: 708-717.

10. Lew JI, Solorzano CC. Use of ultrasound in the managenment of thyroid cancer. Oncologist 2010; 15:253-258.

11. Kwak JY, Kim EK, Kim MJ, Son EJ. Significance of sonographic characterization for managing subcentimeter thyroid nodules. Acta Radiol 2009;50: 917-923.

12. Moon WJ, Jung SL, Lee JH. Benign and malignant thyroid nodules: US differentiation- multicenter retrospective study. Radiology 2008; 247: 762-770.

13. Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly:consequences for bone loss and fractures and therapeutic implications. Endocr Rev 2001;22: 477-501.

14. Bhandari SK, Pashayan S, Liu IL, Rasgon SA, Kujubu DA, Tom TY, et al. 25-hydroxyvitamin D levels and hypertension rates. J Clin Hypertens (Greenwich) 2011;13:170-177.

15. Burgaz A, Orsini N, Larsson SC, Wolk A. Blood 25 -hydroxyvitamin D concentration and hypertension: a meta-analysis. J Hypertens 2011;29:636-645.

16. Zippitis CS, Akobeng AK. Vitamin D supplementation in early childhood and risk of type 1 diabetes: a sysytemetic review and meta-analysis. Arch Dis Child 2008;93:512-517.

17. Thorand B, Zierer A, Huth C, Linseisen J, Meisinger C, Roden M, et al. Effect of serum 25-hydroxyvitamin D on risk for type 2 diabetes may be partially mediated by subclinical inflammation: results from the MONICA/KORA Augsburg study. Diabetes Care 2011; 34:2320-2322.

18. Wang TJ, Pencia MJ, Booth SL, Jacques PF, Ingelsson E, Lanier K, et al. Framingham Heart Study. Vitamin D deficiency and risk of cardiovascular disease. Circulation 2008;117:503-511.

19. Autier P, Gandini S. Vitamin D supplemention and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med 2007;167:1730-1737.

20. Kermani IA, Kojidi HT, Gharamaleki JV, Sanaat Z, Ziaei JE, Esfahani A, et al. Association of serum level of 25 hydroxy- vitamin D with prognostic factors for breast cancer. Asian Pac J Cancer Prev 2011;12:1381-1384.

21. Zhang X, Giovannucci E. Calcium, vitamin D and colorectal cancer chemoprevention. Best Pract Res Clin Gastroenterol 2011;25:485-494.

22. Murphy AB, Nyame Y, Martin IK, Catalona WJ, Hollowell CM, Nadler RB, et al. Vitamin D deficiency predicts prostate biopsy outcomes. Clin Cancer Res 2014; 20: 2289-2299.23. Michikawa T, Inoue M, Shimazu T, Sasazuki S, Iwasaki M, Sawada N, et al. Green tea and coffee consumption and its association with thyroid cancer risk: a population based cohort study in Japan. Cancer Causes Control 2011; 22: 985-993.

24. Jung SK, Kim K, Tae K, Kong G, Kim MK. The effect of raw vegetable and fruit intake on thyroid cancer risk among women : a case control study in South Korea. Br J Nutr 2013; 109: 118-128.

25. Clero E, Doyon F, Chungue V, Rachedi F, Boissin JL, Sebbag J, et al. Dietary patterns, goitrogenic food, and thyroid cancer: a case control study in French Polinesia. Nutr Cancer 2012; 64: 929-936.

26. lmez D, Bober E, Buyukgebiz A, Cimrin D. The frequency of vitamin D insufficiency in healthy female adolescents. Acta Paediatr 2006;95:1266-1269.

27. Çizmecioglu FM, Etiler N, Görmüş U, Hamzaoğlu O, Hatun Ş. Hypovitaminosis D in Obese and Overweight Schoolchildren. J Clin Res Ped Endo 2008;1:89-96.

28. Bindal ME, Taskapan H. Hypovitaminosis D and insulin resistance in peritoneal dialysis patients. Int Urol Neprol 2011; 43: 527-534.

29. Sümbül AT, Sezer A, Kavvasoglu G, Batmaci CY, Yengil E, Yağız AE, et al. Low serum levels of vitamin D in metastatic cancer patients: a case control study. Med Oncol 2104 ;31: 861-867.

30. Cimbek A, Gürsoy G, Kılıç Z, et al. Serum hydroxy vitamin D3 levels in type 2 diabetic patients. Med J Ank Hosp 2012; 45: 14-19.

31. Hekimsoy Z, Dinç G, Kafesçiler S, Onur E, Güvenç Y, Pala T, et al. Vitamin D status among adults in the Aegean region of Turkey. BMC Public Health 2010; 10: 782-788.

32. Balla B, Kosa JP, Tobias B, Halaszlaki C, Takacs I, Horvath H, et al. Marked increase in CYP24A1 gene expression in human papillary thyroid cancer. Thyroid 2011; 21: 459-460.

33. Khazdou K, Buchwald P, Westin G, Dralle H, Akerström G, Hellman P. 25 hydroxy vitamin D3 1alpha hydroxylase and Vitamin D receptor expression in papillary thyroid carcinoma. J Histochem Cytochem 2006, 54:355- 361.

34. Somjen D, Grafi-Cohen M, Posner GH, Sharon O, Kraiem Z, Stern N. Vitamin D less calcemic analog modulates the expression of estrojen receptors, Vitamin D receptor and 1- hdroxylase 25 hydroxy vitamin D in human thyroid cancer cell lines. J Steroid Biochem Mol Biol 2013; 136:80-82.

35. Clinckspor I, Verlinden L, Overbergh L, Korch C, Boullion R, Mathieu C, et al. 1-25 dihydroxy vitamin D3 and a superagonistic analog in combination with paclitaxel or suberoylanilide hydoxyamic acid have potent antiproliferative effects on anaplastic thyroid cancer. J Steroid Biochem Mol Biol 2011; 124: 1-9.

36. Sharma V, Fretwell D, Cress Z, Kerege A, Klopper JB. Thyroid cancer resistance to vitamin D receptor activation is associated with 24-hydroxylase levels but not the ff FokI polymorphism. Thyroid 2010; 200: 1103-1111.

37. Liu W, Asa SL, Fantus IG, Walfish PG, Ezzat S. Vitamin D arrests thyroid carcinoma cell growth and induces p27 dephosphorylation and accumulation through PTEN/Akt dependent and independent pathways. Ame J Pathol 2002; 160: 511-519.

38. Bennett RG, Wakeley SE, Hamel FG, High RR, Korch C, Goldner WS. Gene expression of Vitamin D metabolic enzymes at baseline and response to Vitamin D treatment in thyroid cancer cell lines. Oncology 2012; 83: 264-272.

39. Clinckspor I, Hauben E, Verlinden L, Van Den Bruel A, Vanwalleghem L, Vander Poorten V, et al. Altered expression of key players in vitamin D metabolism and signalling in malignant and benign thyroid tumors. J Histochem Cytochem 2012; 60: 502-511.

40. Akslen LA, Sothern RB. Seasonal variations in the presentation and growth of thyroid cancer. Br J Cancer 1998; 77: 1174-1179.

41. Boscoe FB, Schymura MJ. Solar Ultraviolet-B exposure and cancer incidence and mortality in the United states 1993-2002. BMC Cancer 2006; 6:264-267.

42. Grant WB. An acologic study of cancer mortality rates in Spain with respect to indices of solar UVB irradiance and smoking. Int J Cancer 2007; 120: 1123- 1128.

43. Pena- Martinez M, Ramos- Lopez E, Stern J, Hinsch N, Hansmann ML, Selkinski I, et al. Vitamin D receptor polymorphisms in differentiated thyroid carcinoma. Thyroid 2009; 19: 623-628.

44. Pena- Martinez M, Ramos- Lopez E, Stern J, Kahles H, Hinsch N, Hansmann ML, et al. Impaired Vitamin D activation and association with CYP24A1 haplotypes in differentiated thyroid carcinoma. Thyroid 2012; 22:709- 712.

45. Şahin M, Ucan B, Giris Z, Topaloğlu O, Güngüneş A, Bozkurt NÇ, et al. Vitamin D3 levels and insulin resistance in papillary thyroid cancer patients. Med Oncol 2013; 30: 589-593.

46. Roskies M, Dolev Y, Caglar D, Hier MP, Mlynarek A, Majdan A, et al. Vitamin D deficiency as a potentially modifiable risk factor for thyroid cancer. J Otolaryngol Head Neck Surg 2012 ; 41: 160-163.

47. Stepien T, Krunski R, Sopinski J, Kuzdak K, Komorowski J, Lawnicka H, et al. Decreased 1-25 dihydroxyvitamin D3 concentration in peripheral blood serum of patients with thyroid cancer. Arch Med Res 2010; 41: 190- 194.

48. D’Avanzo B, Ron E, La Vecchia C, Francaschi S, negri E, Zleglar R. Selected micronutrient intake and thyroid carcinoma risk. Cancer 1997; 79: 2186-2192.49. Glattre E, Haldorsen T, Berg JP, Stensvold I, Solvoll K. Norwegian case- control study testing the hypothesis that seafood increases the risk of thyroid cancer. Cancer Causes Control 1993; 4: 11-16.

50. Laney N, Meza J, Lyden E, Erickson J, Treude K, Goldner W. The prevalence of vitamin D deficiency is similar between thyroid nodule and thyroid cancer patients. Int J Endocrinol 2010; 1: 1-7.

51. Jonklaas J, Danielsen M, Wang H. A pilot study of serum selenium, Vitamin D, and thyrotropin concentrations in patients with thyroid cancer. Thyroid 2013; 23: 1079- 1086.

52. Mack WJ, Preston-Martin S, Bernstein L, Qian D. Lifestyle and other risk factors for thyroid cancer in Los Angeles county females. Ann Epidemiol 2002; 12: 395-401.

53. Greenlee H, White E, Patterson RE, Kristal AR. Supplement use among cancer survivors in the viatamins and lifestyle study cohort. J Altern Complement Med 2004; 10: 660-66654. Ron E, Kleinerman RA, Boice JDJ, Livolsi VA, Flannery JT, Fraumeni JF. A population based case-control study of thyroid cancer. J Natl Cancer Inst 1987; 79: 1-12.55. Levin GP, Robinson-Cohen C, De Boer IH, Houston DK, Lohman K, Liu Y, et al. Genetic variations and associations of 25-hydroxyvitamin D concentrations with major clinical outcomes. JAMA 201; 308: 1898-1905.

56. Serrano JC, De Lorenzo D, Cassanye A, Martin-Gari M, Espinel A, Delgado MA, et al. Vit D receptor Bsnl polymorphism modulates soy intake and 25-hydroxyvitamin D supplementation benefits in cardiovascular disease risk factors profile. Genes Nutr 2013; 8: 561-569.

57. Van Der Meer IM, Middelkoop BJC, Boeke AJP, Lips P. Prevalence of vitamin D deficiency among Turkish, Moroccan, Indian and sub-Sahara African populations in Europe and their countries of origin: an overview. Osteoporosis Int 2011; 22: 1009-1021.