Öz
Amaç: Bu çalışmada, Azerbaycan'ın endemik ve endemik olmayan bölgelerinde nodüler guatrı olan hastalarda tiroid kanseri prevalansını ve kontrolsüz iyot profilaksisinin tiroid kanseri gelişimi üzerindeki etkisini incelemek amaçlanmıştır.
Gereç ve yöntemler:
Çalışmaya 2015-2022 yılları arasında nodüler guatr nedeniyle opere edilen 352 hasta dahil edildi. Hastalar endemik (n=126) ve endemik olmayan (n=226) bölgelere göre iki gruba ve iki alt gruba ayrıldı. Tiroitde olan nodül sayısına göre: soliter nodüler guatr (169) ve multinodüler guattr (183). Endemik bölgede 20 hastada (%15,9) tiroid kanseri saptandı (p=0259). Soliter nodüler guatr (SNG) hastalarının 11'inde (%8,7), multinodüler guatr (MNG) hastalarının 9'unda (%7,1) malignite saptandı (p=0,259): Bunların 19'unda (%15,1) papiller kanserin klasik varyantı ve 1'inde (%0,8) %) papiller kanserin foliküler varyantına saptandı. Endemik olmayan bölgelerde 47 olguda (%20,8) kanser saptandı (p=0,259): MNG hastalarının 23'ünde (%10,2), SNG hastalarının -24'ünde (%10,6) malignite saptandı. Endemik olmayan bölgelerde 2 hastada (%0,7) folliküler kanser, 36 hastada (%15,9) klasik tip papiller kanser, 7 hastada (%3,1) mikrokarsinom ve 2 hastada (%0,9) medüller kanser saptandı (p=0,220).
Bulgular: İyot profilaksisi nedeniyle endemik bölgelerde genel olarak guatr görülme sıklığında azalma olmasına rağmen, MNG görülme sıklığında artış (%56,4) kaydedildi. Endemik nodüler guatr hastalarının %15,9'unda ve endemik olmayan nodüler guatr hastalarının %20,8'inde tiroid malignitesi saptanmıştır. Bölge çalışmamızda papiller karsinomdaki anlamlı yüzde artışı literatür ile uyumlu olmuştur.
Sonuç: Endemik bölgelerde elde ettiğimiz verilere göre kontrolsüz iyot profilaksisi kullanılması nedeniyle foliküler karsinom prevalansında azalma gözlemlenirken ,papilyar karsinom sıklığında artış olmuştur. Epidemiyolojik takip koşullarında iyotlu sofra tuzunun bölgelerin endemik özelliklerine göre kontrol altında tutulması papiller kanser riskinin azalmasına yol açabilir.
Anahtar Kelimeler
iyot eksikliği endemik guatr multinodüler guatr soliter nodüler guatr papiller karsinom foliküler karsinom medüller karsinom
Kaynakça
- 1. Jiang H. The prevalence of thyroid nodules and an analysis of related lifestyle factors in beijing communities. International Journal of Environmental Research and Public Health. 2016;13(4).
- 2. Chen Z., Xu W., Huang Y., et al. Associations of noniodized salt and thyroid nodule among the Chinese population: a large cross-sectional study. The American Journal of Clinical Nutrition. 2013;98 (3):684–692. 3. Yod çatışmazlıq pozuntuları və duzun universal yodlaşdırılması Azərbaycan Respublikası Səhiyyə Nazirliyi. Unicef 54 s. 1996. Bakı
- 4. Ward JM, Ohshima M. The role of iodine in carcinogenesis. Adv Exp Med Biol. 1986; 206:529–42.
- 5. Lou X, Wang X, Wang Z, Mao G, et al. Effect of Iodine Status on the Risk of Thyroid Nodules: A Cross Sectional Study in Zhejiang, China Int J Endocrinol. 2020; Aug 18:2020:3760375.
- 6. Erbil Y, Barbaros U, Salmaslioglu A, Mete O, et al. Effect of thyroid gland volume in preoperative detection of suspected malignant thyroid nodules in a multinodular goiter. Arch Surg. 2008; 143(6):558-63.
- 7. Ahmet Diriko, Sevgi Faki, Hüsniye Başer, Didem Özdemir, et al. Thyroid malignancy risk in different clinical thyroid diseases. Turk J Med Sci 2017; 13;47(5):1509-1519.
- 8. Hummatov A., Abbasov A., Shirinova X., Mammadova E., Ismayilov A.,et l. Complications of thyroid surgery. Azerbaijan Medical Journal, 2022; (4), 55–59.
- 9. Smith JJ, Chen X, Schneider DF, Broome JT, Sippel RS, Chen H, Solórzano CC. Cancer after thyroidectomy: a multi-institutional experience with 1,523 patients. J Am Coll Surg. 2013;216(4):571-7; discussion 577-9.
- 10. Koutras DA, Matovinovic J, Vought R. The Ecology of Iodine. In: Stanbury JB, Hetzel BS, (eds) Endemic Goiter, Endemic Createnism. John Villey, New York, 1980; 185-95.
- 11. Chen AY, Jemal A, Ward EM. Increasing incidence of differentiated thyroid cancer in the United States, 1988 2005. Cancer. 2009 ;15;115(16):3801-7.
- 12. Lombardi CP, Bellantone R, De Crea C, Paladino NC, Fadda G, Salvatori M, Raffaelli M. Papillary thyroid microcarcinoma: extrathyroidal extension, lymph node metastases, and risk factors for recurrence in a high prevalence of goiter area. World J Surg. 2010;34(6):1214-21.
- 13. Ali Sürmelioğlu, Metin Tilki, Onur Birsen, Pelin Bağcı Iyot Eksikliğine Bağlı Endemik Bir Bölgede Yapılan Guatr Ameliyatlarında Tiroid Karsinomu Sıklığı ve Hücre Tipleri. Haydarpasa Numune Med J. 2017;57(3):161 6.
- 14. Abul Hossain, Zakaria Sarkar, Utpal Kumar Dutta, Abdul Karim, Zahedul Alam. Frequency of Malignancy in Solitary Thyroid Nodule and Multi-nodular Goitre. Bangladesh J Otorhinolaryngol 2014; 20(2): 55-65.
- 15. Huszno B, Szybiński Z, Przybylik-Mazurek E, et al. Influence of iodine deficiency and iodine prophylaxis on thyroid cancer histotypes and incidence in endemic goiter area. Journal of Endocrinological Investigation. 2003 ;26 (2 Suppl):71-76.
- 16. Lasithiotakis K., Grisbolaki E., Koutsomanolis D, Venianaki M., Petrakis I. et all. Indications for surgery and significance of unrecognized cancer in endemic multinodular goiter. World J Surg 2012;36(6):1286-2.
- 17. Ahn HS, Kim HJ, Welch HG. Korea's thyroid-cancer "epidemic"--screening and overdiagnosis. N Engl J Med. 2014; 6:371(19):1765-7.
- 18. Rubén HH, Dardo AE, Saravia ED. Thyroid cancer and thyroiditis in Salta, Argentina: a 40-yr study in relation to iodine prophylaxis. Endocr Pathol. 2002;13(3):175-1.
- 19. Zimmermann MB, Boelaert K. Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol. 2015; ;3(4):286-95.
- 20. JR, Dwyer T, McArdle K, Tucker P, Shugg D. The changing incidence and spectrum of thyroid carcinoma in Tasmania (1978-1998) during a transition from iodine sufficiency to iodine deficiency. J Clin Endocrinol Metab. 2000;85(4):1513-7.
- 21. Проблемы питания и эндемический зоб II (изучение особенностей фактического питания здоровых и болъных школъников). Керимова М.Г., Ахмедов И.Р., Наджафова А.Г., Ганиева Г.С. Sağlamlıq 2001; №2; S.26-28, Bakı, Azərbaycan.
- 22. Pelizzo MR, Merante Boschin I, Toniato A, Sorgato N, Marzola MC, Rubello D. Surgical therapeutic planning options in nodular goiter. Minerva Endocrinol. 2010;35(3):173-85.
Öz
Aim: The purpose of this study is to look into the prevalence of thyroid cancer in Azerbaijan's endemic and non-endemic regions, as well as the effect of unmanaged iodine prophylaxis on the development of thyroid cancer.
Material and methods: The study includes 352 patients who were treated operatively for nodular goiter between 2015 and 2022. Patients were separated into two groups based on endemic (n=126) and non-endemic (n=226) regions, as well as two subgroups based on the number of nodules in the thyroid: single nodule (169) and multinodule (183). Thyroid cancer was discovered in 20 patients (15.9%) in the endemic zone (p=0259). Malignancy was found in 11 (8.7%) of single-nodular goiter (SNG) patients and 9 (7.1%) of multi-nodular goiter (MNG) patients (p=0,259): 19 (15.1%) had the classic variation of papillary cancer and 1 (0.8%) had the follicular variant of papillary cancer. Cancer was discovered in 47 cases (20.8%) (p=0.259) in non-endemic regions: malignancy was detected in 23 (10.2%) cases of MNG patients and in -24 (10.6%) of SNG patients. In non-endemic areas, 2 patients (0.7%) had follicular cancer, 36 (15.9%) had the classic type of papillary cancer, 7 (3.1%) had microcarcinoma, and 2 (0.9%) had medullary cancer (p=0,220).
Results: Although there was a decrease in the frequency of incidence of goiter disease in general in endemic regions due to the prohibition of iodized table salt, an increase in the frequency of occurrence of MNG (56.4%) was noted. Thyroid malignancy have been identified in 15.9% of endemic nodular goiter patients and 20.8% of non-endemic nodular goiter patients. The significant percentage increase in papillary carcinoma in our region study was consistent with the literature.
Conclusions: According to data collected in endemic areas, the use of unregulated iodine prophylaxis resulted in a decrease in the prevalence of follicular carcinoma while increasing the frequency of papillary carcinoma. The prevention of iodized table salt under the conditions of sanitary-epidemiological follow-up under the control according to the endemic characteristics of the regions can lead to a decrease in the risk of follicular cancer
Anahtar Kelimeler
iodine deficiency endemic goiter multinodular goiter singular nodular goiter papillary carcinoma follicular carcinoma medullary carcinoma
Kaynakça
- 1. Jiang H. The prevalence of thyroid nodules and an analysis of related lifestyle factors in beijing communities. International Journal of Environmental Research and Public Health. 2016;13(4).
- 2. Chen Z., Xu W., Huang Y., et al. Associations of noniodized salt and thyroid nodule among the Chinese population: a large cross-sectional study. The American Journal of Clinical Nutrition. 2013;98 (3):684–692. 3. Yod çatışmazlıq pozuntuları və duzun universal yodlaşdırılması Azərbaycan Respublikası Səhiyyə Nazirliyi. Unicef 54 s. 1996. Bakı
- 4. Ward JM, Ohshima M. The role of iodine in carcinogenesis. Adv Exp Med Biol. 1986; 206:529–42.
- 5. Lou X, Wang X, Wang Z, Mao G, et al. Effect of Iodine Status on the Risk of Thyroid Nodules: A Cross Sectional Study in Zhejiang, China Int J Endocrinol. 2020; Aug 18:2020:3760375.
- 6. Erbil Y, Barbaros U, Salmaslioglu A, Mete O, et al. Effect of thyroid gland volume in preoperative detection of suspected malignant thyroid nodules in a multinodular goiter. Arch Surg. 2008; 143(6):558-63.
- 7. Ahmet Diriko, Sevgi Faki, Hüsniye Başer, Didem Özdemir, et al. Thyroid malignancy risk in different clinical thyroid diseases. Turk J Med Sci 2017; 13;47(5):1509-1519.
- 8. Hummatov A., Abbasov A., Shirinova X., Mammadova E., Ismayilov A.,et l. Complications of thyroid surgery. Azerbaijan Medical Journal, 2022; (4), 55–59.
- 9. Smith JJ, Chen X, Schneider DF, Broome JT, Sippel RS, Chen H, Solórzano CC. Cancer after thyroidectomy: a multi-institutional experience with 1,523 patients. J Am Coll Surg. 2013;216(4):571-7; discussion 577-9.
- 10. Koutras DA, Matovinovic J, Vought R. The Ecology of Iodine. In: Stanbury JB, Hetzel BS, (eds) Endemic Goiter, Endemic Createnism. John Villey, New York, 1980; 185-95.
- 11. Chen AY, Jemal A, Ward EM. Increasing incidence of differentiated thyroid cancer in the United States, 1988 2005. Cancer. 2009 ;15;115(16):3801-7.
- 12. Lombardi CP, Bellantone R, De Crea C, Paladino NC, Fadda G, Salvatori M, Raffaelli M. Papillary thyroid microcarcinoma: extrathyroidal extension, lymph node metastases, and risk factors for recurrence in a high prevalence of goiter area. World J Surg. 2010;34(6):1214-21.
- 13. Ali Sürmelioğlu, Metin Tilki, Onur Birsen, Pelin Bağcı Iyot Eksikliğine Bağlı Endemik Bir Bölgede Yapılan Guatr Ameliyatlarında Tiroid Karsinomu Sıklığı ve Hücre Tipleri. Haydarpasa Numune Med J. 2017;57(3):161 6.
- 14. Abul Hossain, Zakaria Sarkar, Utpal Kumar Dutta, Abdul Karim, Zahedul Alam. Frequency of Malignancy in Solitary Thyroid Nodule and Multi-nodular Goitre. Bangladesh J Otorhinolaryngol 2014; 20(2): 55-65.
- 15. Huszno B, Szybiński Z, Przybylik-Mazurek E, et al. Influence of iodine deficiency and iodine prophylaxis on thyroid cancer histotypes and incidence in endemic goiter area. Journal of Endocrinological Investigation. 2003 ;26 (2 Suppl):71-76.
- 16. Lasithiotakis K., Grisbolaki E., Koutsomanolis D, Venianaki M., Petrakis I. et all. Indications for surgery and significance of unrecognized cancer in endemic multinodular goiter. World J Surg 2012;36(6):1286-2.
- 17. Ahn HS, Kim HJ, Welch HG. Korea's thyroid-cancer "epidemic"--screening and overdiagnosis. N Engl J Med. 2014; 6:371(19):1765-7.
- 18. Rubén HH, Dardo AE, Saravia ED. Thyroid cancer and thyroiditis in Salta, Argentina: a 40-yr study in relation to iodine prophylaxis. Endocr Pathol. 2002;13(3):175-1.
- 19. Zimmermann MB, Boelaert K. Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol. 2015; ;3(4):286-95.
- 20. JR, Dwyer T, McArdle K, Tucker P, Shugg D. The changing incidence and spectrum of thyroid carcinoma in Tasmania (1978-1998) during a transition from iodine sufficiency to iodine deficiency. J Clin Endocrinol Metab. 2000;85(4):1513-7.
- 21. Проблемы питания и эндемический зоб II (изучение особенностей фактического питания здоровых и болъных школъников). Керимова М.Г., Ахмедов И.Р., Наджафова А.Г., Ганиева Г.С. Sağlamlıq 2001; №2; S.26-28, Bakı, Azərbaycan.
- 22. Pelizzo MR, Merante Boschin I, Toniato A, Sorgato N, Marzola MC, Rubello D. Surgical therapeutic planning options in nodular goiter. Minerva Endocrinol. 2010;35(3):173-85.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Cerrahi (Diğer) |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 9 Eylül 2024 |
| Gönderilme Tarihi | 14 Kasım 2023 |
| Kabul Tarihi | 8 Nisan 2024 |
| Yayımlandığı Sayı | Yıl 2024 |