Lack of Association Between Helicobacter pylori Infection and the Risk of Thyroid Nodule Types: A Multicenter Case-Control Studyin China

Abstract

The prevalence of Helicobacter pylori infection is high worldwide, while numerous research has focused on unraveling the relationship between H. pylori infection and extragastric diseases. Although H. pylori infection has been associated with thyroid diseases, including thyroid nodule (TN), the relationship has mainly focused on potential physiological mechanisms and has not been validated by large population epidemiological investigations. Therefore, we thus designed a case-control study comprising participants who received regular health examination between 2017 and 2019. The cases and controls were diagnosed via ultrasound, while TN types were classified according to the guidelines of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). Moreover, H. pylori infection was determined by C14 urea breath test, while its relationship with TN type risk and severity was analyzed using binary and ordinal logistic regression analyses. A total of 43,411 participants, including 13,036 TN patients and 30,375 controls, were finally recruited in the study. The crude odds ratio (OR) was 1.07 in Model 1 (95% CI = 1.03–1.14) without adjustment compared to the H. pylori non-infection group. However, it was negative in Model 2 (OR = 1.02, 95% CI = 0.97–1.06) after being adjusted for gender, age, body mass index (BMI), and blood pressure and in Model 3 (OR = 1.01, 95% CI = 0.97–1.06) after being adjusted for total cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein on the basis of Model 2. Control variables, including gender, age, BMI, and diastolic pressure, were significantly correlated with the risk of TN types. Additionally, ordinal logistic regression results revealed that H. pylori infection was positively correlated with malignant differentiation of TN (Model 1: OR = 1.06, 95% CI = 1.02–1.11), while Model 2 and Model 3 showed negative results (Model 2: OR = 1.01, 95% CI = 0.96–1.06; Model 3: OR = 1.01, 95% CI = 0.96–1.05). In conclusion, H. pylori infection was not significantly associated with both TN type risk and severity of its malignant differentiation. These findings provide relevant insights for correcting possible misconceptions regarding TN type pathogenesis and will help guide optimization of therapeutic strategies for thyroid diseases.

Metabolic parameters differentially influence varying sonographic risk-stratified thyroid nodules: independent of H. pylori infection

“…And then, the correlation between H.pylori infection and benign or suspicious TN subtypes were further analyzed in the logistic regression analysis adjusted for potential risk factors. Although the proportion of H.pylori positive population in suspicious TN group was statistically lower than that in negative population, H.pylori infection is not an independent risk factors for either benign or suspicious TN occurrence, which was in accordance with a previous research (14). Possible explanations for this nding might lie in complicated diseases increasing with age and weakening the in uence of H.pylori infection on the occurrence of thyroid nodules.…”

“…For example, Shen et al found that H. pylori infection was positively correlated with the risk of TN (8). However, a multicenter case-control study showed that H. pylori infection was not signi cantly associated with both the risk of TN and severity of its malignant differentiation (14). In the present study, the correlation between H.pylori infection and TN subtypes prevalence was investigated in a health examination population.…”

Helicobacter pylori infection increases the risk of thyroid nodules in adults of Northwest China

“…Moreover, a casecontrol study including 370 cases indicated that H. pylori infection was significantly higher in patients with benign TNs than in the control group (Bakhshipour et al, 2022). However, there was also an opposite view that the association between H. pylori infection and TNs risk was a lack of sufficient evidence (Wang et al, 2021). The reasons for this discrepancy among different cohorts remained unclear.…”

“…Although molecular mimicry is the mainstream hypothesis, it cannot fully explain the mechanism of TNs development. The scholars (Zhang et al, 2019;Wang et al, 2021) have proposed a complementary mechanism for dysbiosis, pointing out the induction of thyroid cancer and TNs are both associated with imbalanced composition of gut microbiome, such as an increasing proportion of H. pylori.…”

“…Growing studies report that H. pylori infection is correlated with the development of multiple thyroid disorders, including TNs (Shen et al, 2013;Figura et al, 2019). However, the data focused on the relationship between H. pylori infection and TNs are still inadequate and inconsistent, which contributes to a controversial conclusion (Hu et al, 2020;Wang et al, 2021). Our study aimed to evaluate the association between H. pylori infection and the risk of TNs.…”