Reviewer’s report
Title: 
Menstrual, reproductive and hormonal factors and thyroid cancer: a
hospital-based case-control study in China
Version: 
0 
Date: 
12 Oct 2020
Reviewer's report:
Major concerns
Wang M et al. performed a case-controlled study in a large cohort of women to
identify menstrual, reproductive and hormonal factors that could protect against
thyroid cancer. The authors reported that later age on first pregnancy and longer
duration of breast feeding were significant protective factors.
Authors stated that only women with an "incident thyroid cancer" diagnosis were
included in the case group. If the cancer was incidentally found, what was the
reason for hospital admission? The cause of hospital admission should be
evaluated, as this could influence the replies to the questionnaire and data
analysis. The control group should be free from any thyroid pathology, because a
thyroid nodule could harbour a thyroid cancer.
The thyroid cancer showed different histological characteristics and several
degrees of differentiation from normal tissue. There is a wide range of
therapeutic strategies and long-term survival, according to thyroid cancer type.
The case population probably included a large number of stage 1 papillary
thyroid cancers. Greater precision in the case description, or a separate analysis
according to stage and histology, must be done. 
The authors report conflicting literature data, but make no hypothesis to justify
the results. In the discussion, the authors should express opinion regarding the
data observed in case/control Chinese women.
Minor concerns
- The references to male subjects (background and results section) are irrelevant
to this study and should be deleted. 
- Background. More information on risk factors should be added. For example,
sleep and anxiety: Luo et al. (Am. J Epidemiol 177: 
42-49, 2013) reported an
association between sleep abnormalities and thyroid cancer, and Singer et al.
(Thyroid 22: 117-124, 2012) compared the quality of life of thyroid cancer
patients with that of the general population.
- P. 4 lines 20-22. Specify US findings. US nodules can now be better classified
bt means of the TIRADS ACR score. 
- The English language needs to be improved; there are several inelegant or
imprecise turns of phrase and some lexical errors (e.g. p. 6, line 6, "full time
pregnancy" should be "full-term pregnancy"). 
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Is the study design appropriate to answer the research question (including the use
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presented?
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