Male Predominance of Gastric Cancer among Patients with Hypothyroidism from a Defined Geographic Area

Abstract

In the past, hypothyroidism has been associated with an increased susceptibility to gastric cancer (GC). Although several epidemiological studies have corroborated this association, a precise mechanistic explanation remains elusive. In this study, this hypothesis was tested by using a large database of subjects who underwent upper endoscopy for various reasons. This was a retrospective, case-control, single-center study. Subjects with GC (cases) were compared with subjects without (controls), according to hypothyroidism status. Overall, the prevalence of GC was 0.73% in the total cohort and was significantly higher in males compared to females (1.4% versus 0.4%, p < 0.0001). Multivariate logistic regression analysis confirmed an increased risk in males with hypothyroidism (OR 5.10; p < 0.0001) after adjusting for potential confounders, especially H. pylori infection. Interestingly, only hypothyroidism and not treatment with levothyroxine was a significant predictor of GC, ruling out a possible direct carcinogenic effect of the replacement therapy. The present study suggests a male-restricted association of gastric carcinogenesis with a hypothyroid state. If the results of this study are confirmed by longitudinal studies, an attractive perspective could open up for the better management of males with concomitant hypothyroidism and a higher risk of GC.

Spatial Association between Gastric Cancer Mortality and Goiter in Sardinia

“…Interestingly, in the present study the strong association of GC with goiter was significant only in males, in line with our recent clinical observation (Dore et al, 2020) reinforcing the hypothesis that the association is likely sex-dependent and involves different mechanisms in men and women. The fact that the hotspot of GC mortality mainly affects men is intriguing and deserves further studies.…”

“…It has previously been reported that shepherds are frequently positive for H. pylori infection (e.g., 98%), and the sheep's stomach may be a reservoir of the bacteria Dore et al, 2001). However, in the present study, the strength of association with GC was statistically higher for goiter, similarly to our previous observation (Dore et al, 2020).…”

“…The spatial analysis conducted in this study identified a GC mortality hotspot in the Ogliastra mountain ous area, largely overlapping with an area of endemic goiter (Tolu et al, 2019). The GWR analysis confirmed a strong association between goiter prevalence and mortality for GC, consistent with the notion that GC is more frequent in areas where hypothyroidism is common (Venturi et al, 1993;Costa and Mortara, 1960;Gołkowski et al, 2007;Dore et al, 2020). For example, in Italian mountainous areas (i.e.…”

“…Another possibility is that thyroid dysfunction could increase the risk of metabolic syndrome (Delitala et al, 2017;Delitala et al, 2019), which has been associated with GC (Li et al, 2018). Moreover, in a recent retrospective, case-control, single-center study, the prevalence of GC was significantly higher in males compared to females with hypothyroidism (1.4% versus 0.4%, p < 0.0001) (Dore et al, 2020). The increased risk in males with hypothyroidism (OR 5.10; p < 0.0001) remained after adjusting for potential confounders, especially for H. pylori infection.…”

A Case of Autoimmune Polyendocrine Syndrome Type 3B and Peripheral Neuropathy Due to Thiamine Deficiency

“…Here, the patient had a history of hypothyroidism related to anti-TG and anti-TPO antibodies and gastrectomy by gastric cancer. Classically, hypothyroidism has been reported to be associated with an increased susceptibility to gastric cancer [5]. Gastrectomy is a risk factor for thiamine deficiency, which could occur within four to six weeks postoperatively [6,7].…”