Changes in parameters of carbohydrate metabolism over the course of antitumor treatment with metformin in patients with papillary thyroid cancer
Authors: Pidchenko N.S. , Vasylyev L.Ya. , Astapieva O.M. 
Published: January 2024

Background. Recently, the incidence of thyroid cancer, namely, its most common histological subtype, papillary thyroid cancer (PTC), has increased. One of the signs of malignant cells of the thyroid is an accelerated metabolism and an increased glucose absorption, which is a source of energy for malignant cells and their growth. Metformin is an insulin sensitizer, and this is the reason why it is used as a potential anticancer drug. The purpose of the work is to analyze changes in parameters of carbohydrate metabolism in patients with PTC over the course of the combined antitumor treatment with metformin depending on the initial level of insulin resistance. Materials and methods. We studied treatment data of 77 patients with PTC who were prescribed 2 courses of radioactive iodine therapy. The patients were divided according to morphological signs: encapsulated cancer (group 1); non-encapsulated cancer (group 2); metastatic lesion (group 3). Also, the analysis of the following factors was performed: sex, age, extent of surgery, stage according to TNM classification, tumor size, presence of metastases, their number and size, level of invasion of cancer (capsule). We measured anthropometric parameters of patients and calculated BMI. The degree of insulin resistance was assessed according to the HOMA-IR index. Results. During the second course of radioactive iodine therapy, insulin level in PTC patients without insulin resistance (IR) increased by 1,23 times in group 1, by 1,44 times in group 2, and by 1,48 times in group 3. We observed an increase in C-peptide values by 1,1 times (5–10%) among the groups. Before the second course of radioactive iodine therapy, the HOMA-IR index increased by 1,33 times in group 1, by 1,46 times in group 2, and by 1,45 times in group 3. During the first and second courses, its value was higher in groups with more aggressive cancer (groups 2 and 3). In group of PTC patients with IR who received metformin, we observed a decrease in insulin level by 1,4 times in group 1 and by 1,5–1,7 times in groups 2 and 3. A similar change can be noted when analyzing C-peptide level. The level of glycated hemoglobin increased by 1,2 times before the second course of radioactive iodine therapy only in groups 2 and 3. However, metformin intake reduced it below the baseline level in all groups of patients. Conclusions. An increase in levels of insulin, C-peptide, and HOMA-IR index was observed in PTC patients without IR after antitumor treatment, especially during the second course of radioactive iodine therapy. A significant increase in the HOMA-IR index by 1,3–1,5 times (t < 1,96) was observed in all PTC patients without IR over the course of antitumor treatment between the first and second courses of radioactive iodine therapy, which is indicative of an increase in insulin resistance, therefore it requires corrective therapy. It is especially observed in groups of patients with more aggressive forms of tumor. Adding metformin led to normalization of the value of this parameter by decreasing it by 1,5 times in all PTC patients with IR regardless of the tumor stage. Inclusion of metformin in the antitumor treatment regimen also contributed to normalization of carbohydrate metabolism. papillary thyroid cancer, HOMA-IR, BMI, carbohydrate metabolism, antitumor treatment, metformin. Для цитування: Підченко Н.С., Васильєв Л.Я., Астап’єва О.М. Показники вуглеводного обміну у динаміці протипухлинного лікування з використанням метформіну у хворих на папілярний рак щитоподібної залози. Український радіологічний та онкологічний журнал. 2023. Т. 31. № 4. С. 285–302. DOI: https://doi.org/10.46879/ukroj.4.2023.285-302 глікованого гемоглобіну збільшуються у 1,2 рази перед 2-м курсом РЙТ тільки у 2-й та 3-й групах, однак, прийом метформіну зменшує їх нижче за вихідний рівень у всіх групах пацієнтів. Висновки. У хворих на ПРЩЗ без ІР на тлі проведеного протипухлинного лікування спостерігалось збільшення рівнів інсуліну, С-пептиду та індексу HOMA-IR, особливо на етапі другого курсу радіойодотерапії. Достовірне збільшення індексу HOMA-IR для всіх хворих на папілярний рак ЩЗ без інсулінорезистентності у 1,3–1,5 рази (t < 1,96) спостерігається в динаміці протипухлинного лікування між першим та другим курсами радіойодотерапії, що свідчить про наростання ІР та потребує корегуючої терапії. Особливо це спостерігається в групах хворих з більш агресивними формами пухлини. У всіх хворих на ПРЩЗ з ІР додавання метформіну сприяло нормалізації рівня цього показника, знижуючи його в 1,5 рази незалежно від ступеня пухлинної агресії. Додавання до схеми протипухлинного лікування метформіну впливало на нормалізацію вуглеводного обміну.