Vıtamın D and Thyroıd Nodules in an Eastern Regıon of Turkey

Research Article

J Dis Markers. 2019; 4(1): 1037.

Vıtamın D and Thyroıd Nodules in an Eastern Regıon of Turkey

Atalay E1, Kurt GK1, Gursoy G2, Sısman P3*, Erdogdu HI1, Tur K1 and Ustun H4

¹Department of Internal Medicine, Kafkas University, Kars, Turkey

²Department of Internal Medicine, Ankara Training and Research Hospital, Ankara, Turkey

³Endocrinology and Metabolism Clinic, Medicana Hospital, Bursa, Turkey

4Department of Pathology, Kafkas University, Kars, Turkey

*Corresponding author: Dr Pinar Sisman, Endocrinology and Metabolism Clinic, Medicana Hospital, Bursa, Turkey

Received: December 04, 2018; Accepted: January 22, 2019; Published: January 29, 2019


Objective: There are reported associations between Vitamin D and some cancers, but the relationship in thyroid cancer has not been fully evaluated. The aim of this study is evaluate the relationship between Vitamin D levels and ultrasonographical data and cytological features of the nodules obtained by biopsy and after surgery in an eastern region of Turkey.

Methods: The records of 225 patients who underwent fine needle aspiration biopsy were included in the research. Thyroid hormone, and Vitamin D levels, ultrasonograpical parameters and biopsy and surgery results of the individuals were recorded. We seeked a relationship between Vitamin D levels and also results of the nodules obtained with ultrasonography, biopsy and surgery.

Results: There were no relationship between Vitamin D and ultrasonographical characteristics, fine needle aspiration biopsy and also histopathological surgery results.

Conclusions: Our results showed that there were no relationship between Vitamin D and ultrasonographical characteristics, biopsy and surgery results. However although size of our group was small, we found that if the patient had a large nodule and deficient Vitamin D levels, their cytological results might be malign. So we reached a conclusion that in such patients although biopsy reveals a benign result, the procedure must be repeated.

Keywords: Thyroid nodules; Vit D



This retrospective study was approved by our university board. Informed consent was not required. A total of 225 patients with thyroid nodules aged from 17-83 years [189 female (84%), 36 male (16%)] who admitted to outpatient Clinics of Endocrinolojy and Metabolism and also Internal Medicine of Kafkas University from October 2012 to October 2014 and had thyroid USG and FNAB were included in this study. Subjects without complete informations or taking medications that affected their thyroid function, such as oral contraceptives, oestrogen, glucocorticoids and iodine and women having doubt of pregnancy were excluded.

Laboratory measurements

Free triiodothyronin (fT3), free thyroxin (fT4), thyroid stimulating hormone (TSH), Vitamin D3(25(OH)D, thyroid autoantibodies; thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) levels of the patients were noted. FT3,fT4, TSH concentrations were determined by Access immunoassay method using Beckman Coulter DX1600 device. TPOAb and TgAb were examined by chemoluminessant immunoassy method using Cobas 4001 device.

Euthyroidism was defined as the absence of hypo and hyperthyroidism. Hypothyroidism was defined as the presence of TSH levels ≥ 5.0uIU/ml and fT4 levels ≤ 0.8ng/dl, hyperthyroidism was defined as the presence of TSH levels ≤ 035uIU/ml and fT4 levels ≥ 1,9ng/dl. Reference ranges of the parameters were as follows TSH: 0.34-5.6 μIU/ml, fT3: 2.5-3.9 pg/ml, fT4: 0.6-1.1 ng/ml, TPOAb: >34IU/ml positive, TgAb: >IU/ml115 positive, Vit D ‹20IU/ml: deficient, 20-30 IU/ml : insufficient, 30-100 IU/ml: normal.

The presence of thyroid nodule(s) and size of the thyroid gland were determined by thyroid ultrasonography. As every patient with a thyroid nodule is a candidate for FNAB, in our Clinic of Endocrinology and Metabolism section one doctor performed FNABs with the guide of USG. If surgical decision was taken, it was performed in our Clinic of General Surgery.


Toshiba brand Apliox6 model using 12 MHz ultrasound probe was utilized in this study. The patient was placed in the supine position without a pillow with his or her neck in extension. Structure and size of thyroid tissue and presence of nodule were examined. The paranchimal structure (solid, cystic or mixed), size, location, number, shape, boundaries, acoustic halo, echo intensity, echo uniformity of the nodules were recorded. Three dimentions of the nodule was measured and the largest diameter was determined. Echogenity of the nodule was named as iso, hypo and hyperechoic according to thyroid tissue. Calcifications were classified as rough and micro. In Doppler examination vascularisation was evaluated and classified as intranodular and peripheral.

Specific ultrasonography features of a nodule that raise suspicion for malignity was accepted as follows: solidity, tall configuration (the anterioposterior diameter of the nodule is greater than its transvers diameter), markedly hypoechoic, microcalcifications, intranodular vasculatity, irregular margin, no halo. One of these USG features was accepted as suspicious.


After the patient was placed in supine position, a pillow was put under the shoulders, their neck was brought to maximum extantion. The neck region was cleaered with iodine. No anesthetical agent was used. Aspiration was performed with an 10 cc enjector mounted 22G needle once or if it was necessary more. Biopsy material were evaluated in Clinic of Pathology. Preperations were examined with light microscopy after they were stained with May-Grunwald- Giemsa, Hemotoxylin and eosin and covered with coating material. The occurence of at least 6 follicule groups consisting at least 10 cells without artifacts were accepted as qualification criteria. The cytological diagnosis was given according to Bethesda system. The cytology results were stratified into following 6 cathegories: non-diagnostic, benign, atipia of undetermined significance, follicular neoplasm or suspicious for follicular neoplasm, suspicious for malignancy and malignant. In malign group suspicious for malignancy and malign cathegories were included. In benign group non-diagnostic, benign, atipia of undetermined significance and follicular neoplasm or suspicious for follicular neoplasm cathegories were included.

Statistical analysis

Calculations were performed using SPSS version PASW 18. Descriptive value on the numerical measurements obtained in this study were determined as mean, standard deviation, median, minimum, maximum, and the descriptive statitics of categorical variables were determined as number and percentage. The relationship between cathegorical variables have been studied with Pearson-Qui Square and Fisher Exact Qui Square, Fisher-Freeman Halton tests. Shapiro Wik test was used for determining whether the numerical values were normally dsitributed. We compared the groups (consisting of two cathegories) in terms of the mean of numerical variables by Student t test and in terms of the median of them by Mann Whitney U test. One way ANOVA and Kruskall Wallis tests were used to compare the mean of numerical variables of the groups (consisting of more than two cathegories). In order to compare the methods used in the study with biopsy which is regarded as a gold standard, sensitivity, selectivity, positive predictive value and negative predictive value rates were analysed. The relationship between numarical variables were investigated by Sperman and Pearson correlation analysis. Zero point zero five was taken for statistical significance level and a p value of ‹ 0.05 was considered as statistically significant.


A total of 225 thyroid nodules were noted for the study. Thirty six patients (16%) were male and 189 were female (84%). Female-male ratio of the nodules were 5.2. The avarage age of female was 48.9 ± 12.7 and male was 53.6 ± 11.1, total age was 49.6 ± 12.6. The mean age was significanly higher in men than women (p 0.039).

In terms of thyroid hormone status our patients were mostly euthyroid (79.0%). Hypothyroidy rate was 20.0% and hyperthyroidy 1.0%. The rate of the patients with POAb positivity was 22.9% and TgAb positivity 22.3%.

Vit D results of the patients were as follows:

• 172 (76.4%) deficient,

• 27 (12.0%) insufficient,

• 26 (11.6%) normal.

The avarage level of Vit D were 16.1 ± 7.6. In males the level was 16.2 ± 8.2 and in females 14.4 ± 4.9. There was no relationship between ages and Vit D levels of the patients.

When Vit D levels were deficient, insufficient and normal, there was no correlation between thyroid hormone levels. The size of thyroid nodules were between 5-61 mm ( 19.5 ± 10.3), in 14 cases the size of the nodules were > 4cm and in others the size were 0.5-1.5cm. As Vit D levels decreased, thyroid nodule sizes significantly increased (p:0.02, r:- 0.299).

In Table 1 USG characteristics of the nodules and Vit D levels were presented. When Vit D levels and characteristics of the nodules were evaluated, we did not find significant difference in Vit D levels (Deficient, insufficient and normal) of the patients and the number, the structure, echogenity, calcification, vascularity, boundaries and halo sign of the nodules.