Thyroid Nodules and Insulin Resistance in Type 2 Diabetes Patients
Authors: Hamdy El-Dawansy Esraa ElSayed , Mohammed Hussein Magda Shokry , Ali Hendawy Laila Mahmoud , Adly Nahla Nader 
Published: November 2024

Abstract

Background
Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. DM can result from deterioration in function and//or a loss of mass in pancreatic tissue. The disease burden of DM is expected to increase in the next few years and decades. The Atlas of the International DM Federation estimated that 537 million adults (20–79 years) were living with DM in 2022, and this number could increase to 643 million by 2030 and 781 million by 2045

Aim of the Work
To find out the association between Insulin resistance and thyroid nodules in T2DM.

Patients and Methods
This study was a Case-control study that was conducted to find association between insulin resistance and thyroid nodules in T2DM cases. The present study was carried out on 80 patients attending Ain Shams University internal medicine department and endocrinology outpatient clinic during the period from August 2021 to May 2023.

Results
Therefore, the aim of the current work is to find out the assosciation between insulin resistance and thyroid nodules in T2DM. Our study showed that fasting insulin and HOMI-IR were significantly higher in diabetic patients with nodules than in diabetic patients without nodules (P = 0.029 & P = 0.001 respectively). Our study also showed that fasting insulin and HOMI-IR were predictive risk factors for thyroid nodules. Moreover, our results revealed that fasting insulin & IR were positively correlated with thyroid nodule volume and size. Our study showed that there was a significant increase in the mean of FT4 levels in diabetic patients with thyroid nodules (when compared to diabetic patients without thyroid nodules (P = 0.043). Yet, no significant correlation was found between Thyroid nodule volume, Thyroid nodule size, and IR with FT4. The binary logistic regression analysis showed that FT4 was a risk factors for thyroid nodule in the T2DM patients. Furthermore, the results showed that there was a significant increase in the mean of TPO levels in diabetic patients with thyroid nodules when compared to diabetic patients without thyroid nodules (P = 0.038). The binary logistic regression analysis showed that TPO was risk factor for thyroid nodule in the T2DM patients. There was a significant increase in the mean value of fasting blood glucose level in diabetic groups with thyroid nodules when compared to those without thyroid nodules (P &lt; 0.001). Pearson's correlation test also showed significant positive correlation between thyroid nodule size and fasting blood glucose (r = 0.400, P = 0.010) as well as fasting blood insulin (r = 0.440, P = 0.005). The binary logistic regression analysis showed that FBG, PPGL were risk factors for thyroid nodule in the T2DM patients.

Conclusion
Our research demonstrates that IR is strong risk factors for thyroid nodule occurrence but its prevalence in diabetic cases is not evaluated in our study. So, it is of great clinical significance to perform thyroid Ultrasonography on patients with T2DM. The independent correlates of TNs were multifactorial, and there existed differences in different physiological states