Associations of psychological status and ultrasonic characteristics of thyroid nodules in adults during the COVID-19 pandemic

Abstract

BackgroundThe morbidity of thyroid cancer has been increasing in the last decades all over the world. In addition to the more sensitive thyroid nodule screening technology, several social and environmental factors might represent credible candidates for this increase. They include psychological stress, lifestyle-associated risk factors, nutritional deficiencies, and environmental pollutants. Foremost, psychological stress had gained high interest as a possible promoter and a modifiable risk factor for thyroid nodules in recent years. The present study was to investigate the clinical characteristics and psychological status of the population during the peak of coronavirus disease 2019 (COVID-19) and assessed the association of psychosocial determinants and the ultrasonic characteristics of thyroid nodules.MethodsIn this cross-sectional study, 490 adult subjects who had received at least two doses of COVID-19 vaccine and were not infected with COVID-19, and did not know whether they had thyroid nodules, received thyroid color ultrasound examination and psychological questionnaire survey. Depression, anxiety, and stress were assessed using Depression Anxiety Stress Scales-21 (DASS-21). Sleep quality was rated using the Pittsburgh sleep quality index (PQSI). The characteristics of 243 subjects with thyroid nodules were described and recorded in detail by thyroid color ultrasound, and the correlations between anxiety, depression, sleep quality, clinical indicators, and thyroid nodule ultrasound characteristics were analyzed. Associations between psychological status (mutually adjusted predictors) and ultrasonic characteristics of thyroid nodules (outcome) were modeled using binary logistic regression controlling for sex, age, BMI, TSH, FT3, and FT4.ResultsDepression was positively correlated with thyroid hypoechoic nodule (OR = 3.720, 95%CI 1.615–8.570), microcalcification of thyroid nodule (OR = 3.638, 95%CI 1.476–8.966), the aspect ratio of thyroid nodule>1 (OR = 3.860, 95%CI 1.052–14.161), the unclear boundary of thyroid nodule (OR = 4.254, 95%CI 1.359–13.312), and the irregular edge of thyroid nodule (OR = 4.134, 95%CI 1.810–9.439). Anxiety was positively correlated with microcalcification of thyroid nodules (OR = 4.319, 95%CI 1.487–11.409). Stress was positively correlated with thyroid hypoechoic nodules (OR = 4.319, 95%CI 1.487–11.409), microcalcification of thyroid nodules (OR = 2.724, 95%CI 1.038–7.151), and the irregular edge of thyroid nodules (OR = 2.478, 95%CI 1.077–5.705).ConclusionThis study demonstrates that depression, anxiety, and stress were associated with the morbidity of thyroid nodules and thyroid ultrasound characteristics. During COVID-19, people’s negative emotions increased significantly compared to before. Negative emotions might be harmful to thyroid health. Therefore, during periods of high stress, strategies to prevent psychological problems should be implemented to improve thyroid health.

Prevalence of thyroid nodule and relationship with physiological and psychosocial factors among adults in Zhejiang Province, China: a baseline survey of a cohort study

“…Compared with the results of univariate chi-square analysis, the associations of multiple different factors with thyroid nodules changed before or after adjustment for sociodemographic factors in multivariate regression analysis. Among the factors of smoking status, low mood, neck radiation, PSQI score and night shift status, some or all no longer entered the regression formulas of model, which was different from the findings of other relevant reports [ 11 , 18 , 49 ]. In addition to the differences in research methods and subjects, we must acknowledge the possible limitations of this study.…”

“…With the advancement of psychosomatic medicine, the hypothalamus–pituitary–thyroid axis has garnered increasing attention. Studies have demonstrated that a fast-paced lifestyle, high-intensity work, and poor-quality sleep can exacerbate mental stress and emotional burden, leading to disruptions in the neuroendocrine system and resulting in psychosomatic disorders, including thyroid nodules [ 11 , 14 , 15 , 34 ]. Life satisfaction refers to an individual’s overall evaluation of their physical and mental well-being.…”

“…TNs represent a pathological change resulting from local abnormal growth of thyroid cells and are a common and frequently occurring disease of the endocrine system. Therefore, from the perspective of psychosomatic medicine, persistent negative emotions are likely related to thyroid nodules [ 11 , 12 ]. In addition, studies have shown that negative emotions can damage immune function [ 13 ], and a disorder of immune function leads to autoantibodies constantly attacking thyroid cells, leading to not only thyroid dysfunction but also abnormal proliferation, division and replication of thyroid cells, the formation of thyroid nodules, and even thyroid cancer [ 14 ].…”

“…Therefore, recently, a large number of studies have been conducted to explore the pathogenesis and prognosis of thyroid diseases from a psychological perspective [ 15 ]. The associations between anxiety, depression, stress, poor sleep quality and thyroid nodules have gradually attracted the attention of scholars worldwide [ 11 , 16 ]. Compared with those of psychological factors, the associations of age, gender, BMI, smoking status, drinking status, and radiation exposure with the risk of thyroid diseases have been reported, but the effects of drinking status and radiation exposure are still controversial [ 11 , 17 ].…”

“…The associations between anxiety, depression, stress, poor sleep quality and thyroid nodules have gradually attracted the attention of scholars worldwide [ 11 , 16 ]. Compared with those of psychological factors, the associations of age, gender, BMI, smoking status, drinking status, and radiation exposure with the risk of thyroid diseases have been reported, but the effects of drinking status and radiation exposure are still controversial [ 11 , 17 ]. Moreover, compared with heated discussions and in-depth studies on the evaluation and diagnosis of thyroid nodules [ 18 ], epidemiological investigations of the associated risk factors are insufficient.…”