| Background:Diabetes and thyroid nodules are common diseases in the elderly.Many clinical studies have shown that the prevalence of thyroid nodules in patients with diabetes is significantly increased.But the mechanism is still unclear.Studies have shown that hyperglycemia may lead to tumorigenesis by changing the levels of DNA 5-methylcytosine(5mC)and 5-hydroxymethylcytosine(5hmC),but in thyroid nodules,the correlation between the two is still unclear.Objective:To investigate the prevalence of thyroid nodules in the elderly in Suqian City and Xuzhou City,Jiangsu Province,to explore the correlation between glucose metabolism,traditional Chinese medicine syndrome identification modes for patients with diabetes mellitus and thyroid nodules,and to analyze the relationship between blood glucose level,thyroid nodules as well as peripheral 5mC and 5hmC levels.Methods:A total of 2037 elderly people(51.3%males)were enrolled.All the participants underwent physical examination,biochemical test,and thyroid ultrasonography.Traditional Chinese medicine dialectical classification of diabetic patients with reference to the guiding principles of Clinical Research of New drugs of traditional Chinese Medicine published in 2002.Logistic regression analyzed the relationship between glucose metabolism and thyroid nodule occurrence,thyroid nodule number,thyroid nodule size,benign thyroid nodules and suspected malignant nodules,and the levels of 5mC and 5hmC in different blood glucose levels with or without detected thyroid nodules.Results:(1)The prevalence of thyroid nodules in the elderly in Suqian and Xuzhou areas was 35.1%,of which 42.4%were multiple nodules and 33.9%were nodules≥1cm.(2)There were significant differences in sex,age,height,body mass index,waist circumference,hip circumference,fasting blood glucose,glycosylated hemoglobin,fasting insulin,insulin resistance index and triglyceride levels between the two groups with and without thyroid nodules(all P<0.05).There were significant differences in sex,waist circumference,waist-to-hip ratio,fasting insulin and insulin resistance index between single thyroid nodule group and multiple thyroid nodule group(P<0.05).Meanwhile,significant differences were found in sex,weight,waist circumference,hip circumference,fasting blood glucose,glycosylated hemoglobin,fasting insulin and insulin resistance index between nodule<lcm group and nodule>lcm group.(3)Logistic regression model adjusted the baseline levels of age,sex,body mass index,total cholesterol,triglyceride,high density lipoprotein cholesterol,low density lipoprotein cholesterol,urine iodine concentration,thyroid peroxidase antibody and thyroglobulin antibody,fasting blood glucose(OR=1.188,95%CI:1.095-1.288),glycosylated hemoglobin(OR=1.223.95%CI:1.079-1.387)and insulin resistance index(OR=1.071,95%CI:1.003-1.142)were associated with the risk of thyroid nodule occurrence.Fasting blood glucose(OR=1.173,95%CI:1.048-1.313),glycosylated hemoglobin(OR=1.235,95%CI:1.0036-1.471)and insulin resistance index(OR=1.101,95%CI:1.001-1.21 1)were significantly correlated with larger thyroid nodules.(4)A total of 116 patients with emaciation-thirst disease were enrolled,including 55 males(47.41%)and 61 females(52.59%).The distribution pattern is deficiency of both qi and yin(49 cases)>damp-heat trapping spleen(23 cases)>yin deficiency heat superfluity(21 cases)>blood stasis(14 cases)>yin and yang deficiency(9 cases).The prevalence of thyroid nodules in patients with emaciation-thirst disease was 51.72%.Among the different syndrome types,the prevalence of thyroid nodules with deficiency of both qi and yin was the highest(36.67%),followed by yin deficiency heat superfluity(20.00%),and yin and yang deficiency was the least(11.67%).There was significant difference in total cholesterol among different syndrome types(P<0.05).(5)Compared with normal blood glucose group,the levels of global 5mC[0.56(0.20,0.77)vs.0.19(0.14,0.33),P=0.002]and 5hmC[0.13(0.04,0.38)vs.0.04(0.03,0.08),P=0.007]in blood genomic DNA of hyperglycemia group were significantly lower.Compared with the group without thyroid nodules,the levels of global 5mC[0.51(0.19,0.68)vs.0.24(0.15,0.36),P=0.046]and 5hmC[0.15(0.08,0.22)vs.0.04(0.03,0.08),P<0.001]in blood genomic DNA of the group with thyroid nodules were lower.Further analysis showed that the level of global 5mC[0.27(0.17,0.75)vs.0.20(0.14,0.27),P=0.049]and 5hmC[0.27(0.17,0.75)vs.0.03(0.03,0.05),P<0.001]in blood genomic DNA of hyperglycemia with thyroid nodules was significantly lower than that of normal blood glucose with thyroid nodules.Conclusion:Thyroid nodules is prevalent in the elderly.Hyperglycemia is significantly related to thyroid nodules and nodular size.The most common type in diabetic patients and diabetic patients with thyroid nodules is deficiency of both qi and yin.Hyperglycemia is markedly associated with the change of peripheral 5mC/5hmC levels of patients with thyroid nodules. |
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