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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 4  |  Issue : 1  |  Page : 45-47

Evaluation of thyroid profile in patients with endometrial cancer


1 Department of Gynecological Oncology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India
2 Department of Community Medicine, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India
3 Department of Pathology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India
4 Department of Biochemistry, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India

Date of Web Publication10-Dec-2020

Correspondence Address:
Sangeeta Pankaj
Additional Professor, Gynecological Oncology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Background : Thyroid function has been suggested to interfere with tumour biology and affect the prognosis of various cancers. The present study was performed to evaluate pre-therapeutic serum thyroid-stimulating hormone (TSH) levels in all endometrial cancer (EC) and to study the relation between thyroid hormone and endometrial cancer.
Material And Methods : This retrospective study was done in 46 diagnosed patients of endometrial cancer and a control group of 50 patients with no cancer. The pretheraputic levels of thyroid stimulating hormones were recorded and analysed.
Results : In our study we found significant number of endometrial cancer patient had deranged thyroid profile as compare to control group with p value 0.0057. Most of endometrial cancer patients were menopausal (86.96%) and mean BMI was 28.78 (in control BMI was 21.01).
Conclusion : The results showed that TSH may increase the incidence of uterine cancer especially after menopause as it increases the BMI and estrogen and decreases adiponectin leading to hormonal imbalance. Hence TSH is a possible risk factor for uterine cancer especially after menopause. Thus women should pay attention to their thyroid function during menopausal age to reduce the risk of uterine cancer.

Keywords: Body mass index, endometrial cancer, menopause, thyroid profile, thyroid-stimulating hormone


How to cite this article:
Kumari J, Pankaj S, Kumari A, Kumari A, Nazaneen S, Sinha S, Choudhary V, Kumari R. Evaluation of thyroid profile in patients with endometrial cancer. J Indira Gandhi Inst Med Sci 2018;4:45-7

How to cite this URL:
Kumari J, Pankaj S, Kumari A, Kumari A, Nazaneen S, Sinha S, Choudhary V, Kumari R. Evaluation of thyroid profile in patients with endometrial cancer. J Indira Gandhi Inst Med Sci [serial online] 2018 [cited 2022 Jan 20];4:45-7. Available from: http://www.jigims.co.in/text.asp?2018/4/1/45/302984




  Introduction : Top


Endometrial cancer is the most common gynaecologic malignancy in developed countries. It is estimated that 61,380 new uterine cancer cases will occur in 2017, with 10,920 death resulting from the disease (US).[1]

In India endometrial cancer is the 9th most common cancer among women and 3rd most common gynaecological cancer with 12325 new cases and age-standardised incidence rate of 2.3 and mortality rate of 0.9 according to GLOBOCON 2012. Overall morbidity and mortality of endometrial cancer is low because most patients present at early stage because of early symptoms of abnormal bleeding.[2]

The thyroid gland’s integrity is of decisive importance for the metabolic activity and function of nearly every organ in the body. Experimental and clinical studies suggest a possible interaction between thyroid function and tumour biology and prognosis in different cancers.[3]

Thyroid hormones are important regulators of growth, differentiation, and metabolism of all tissues including the ovaries and endometrium.[4],[5] Thyroid disorders can present as hyperthyroidism or more commonly as hypothyroidism and this disorder is commonly seen in middle aged and elderly women[6]. Menstrual irregularities, anovulation, and infertility are common symptoms in thyroid disorders and is attributed to both direct and indirect effects of the thyroid hormones on the endometrium. Known comorbidities of Endometrial cancer are increased body mass index and age and these are positively associated with elevated serum thyroid-stimulating hormone (TSH) levels.[7] Moreover, higher serum TSH levels have been documented in patients of endometrial cancer when compared with healthy women.[7]

The present study aims to evaluate the association between pre-therapeutic serum TSH levels and endometrial cancer and compare it to a healthy control group.


  Material and Methods : Top


This retrospective study was carried in the gynaecological oncology department of Indira Gandhi Institute of Medical Science from 2008 to 2017 after taking clearance from the institutional ethical committee. In our institute 849 patients were operated for gynaecological cancer (ovarian cancer, endometrial cancer, cervical cancer and vulval cancer) in last 10 years of these 46 patients were operated for endometrial cancer. The pretherapeutic serum thyroid stimulating hormone (TSH) levels of all these 46 patients were recorded. (An age standerdazied control group of 50 healthy females was selected and their thyroid profiles was also evaluated and compared to the study group). Each patient was evaluated by first general clinical examination which include mainly mearurement of blood pressure and BMI (weight (kg)/height(m)2), pelvic examination and secondly serum TSH. The statistical methods used to analysis the data include number, percentage, mean while T-test and Anova analysis was used to compare control and test groups.

TSH measurement

Pretreatment thyroid profile were recorded. According to recommendations of the National Academy of Clinical Biochemistry, a TSH serum level of 0.1 to 5 mU1-1 was considered as normal euthyroid reference range.[7] Considering their normal values; patients were categorized into three groups as follows:

1. Euthyroid 2. Hypothyroid 3. Hyperthyroid


  Results : Top


This showes the increasing trend of endometrial cancer in last 10 yrs. Thus the incidence of endometrial cancer is rising in our population as predicted and if not curbed might reach the western figures soon.

This figure shows that most of the endometrial cancer patients were >50years i.e perimenopausal and postmenopausal women. 40 out of 46 of endometrial cancer patients had complains of postmenopausal bleeding and the rest 6 had abnormal uterine bleeding and pus discharge per vagina. Patients in control group were of same age group.

[Table 1] showes that significant number of EC patient had deranged thyroid profile as compare to control group with p value 0.0057. Mean BMI of EC patients was 28.78 and of control group 21.01. We also found obese EC patient had deranged thyroid profile. An association between deranged thyroid profile and obesity in menopausal women was also found with a statistically significant p value of <0.01.
Table 1: Distribution in relation to thyroid profile.

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  Discussion : Top


The present study investigates the influence of deranged serum TSH in perimenopausal and menopausal women and its association with endometrial cancer. Our data demonstrates an independent association between elevated pre-therapeutic serum TSH levels and endometrial cancer with p value of 0.0057.

Various studies suggest that TSH might be associated with systemic processes that interact with carcinogenesis, for example, hormonal imbalance or inflammation.[7] Thyroid disorder is a common cause of abnormal uterine bleeding and has been shown to increase the risk of uterine cancer by altering the lipid profile.[9] Leptin regulates energy homeostasis and neuroendocrine processes and acts as a potential growth stimulator in normal and neoplastic cancer cells. TSH act on adipose tissue and releases leptin. Recent studies suggest a role of leptin in promoting endometrial cancer growth and invasion by regulating proangiogenic and proinflammatory factors. [4],[10],[11]

Circulating levels of adiponectin, a hormone with insulin-sensitizing properties, are decreased in conditions related to obesity which are recognized risk factors for endometrial cancer, because its play an important role not only in glucose and lipid metabolism but also in the development and progression of several obesity-related malignancies.[13] Thyroid hormones decreased production of adiponectin in obese patients thus making them more prone to endometrial cancer.[12] Most cases of uterine cancer occur between the ages of 60 and ≥70 years, but a few cases may occur before age 40 as showed in [Figure 2] and this corresponding with other study which found increased uterine cancer after menopause.[14],[15] High levels of thyroid hormones lead to obesity, low levels of adiponectin and high levels of leptin which is significantly associated with an increased risk for endometrial cancer in postmenopausal women.[16],[17] Therefore the primary prevention of cancer will probably depend on modification of the factors which affect the secretion and metabolism of the responsible hormones rather than on control of exposure to classical exogenous initiators.
Figure 1

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Figure 2: Distribution of patients according to their age.

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Figure 3: Distribution of EC patients according to histopathology.

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  Conclusion : Top


This study showed that deranged thyroid profile especially after menopause is a risk factor for uterine cancer. So, it is very essential to measure thyroid hormone during perimenopausal and menopausal women to facilitate early diagnosis and treatment of thyroid disorders and also to reduce the risk of uterine cancer.



 
  References Top

1.
Siengel RL, Miller KD , Jemal A. Cancer statistics, 2017. CA Cancer J Clin 2017 ; 67 :7- 30.  Back to cited text no. 1
    
2.
Lewis Braverman, David Cooper. The thyroid. In: Lewis Braverman, David Cooper, eds. Ingbar and Werner’s Fundamental and Clinical Text. 10th ed. Philadelphia: Lippincott Williams and Wilkins Company. 2012: 792.  Back to cited text no. 2
    
3.
Schmidinger M, Vogl UM, Bojic M, Lamm W, Heinzl H, Haitel A, Clodi M, Kramer G, Zielinski CC. Hypothyroidism in patients with renal cell carcinoma: blessing or curse. Cancer. 2011;117:534-544.  Back to cited text no. 3
    
4.
G. E. Krassas, K. Poppe, and D. Glinoer, “Thyroid function and human reproductive health,” Endocrine Reviews, vol. 31, no. 5, pp. 702-755, 2010.  Back to cited text no. 4
    
5.
A. Pascual and A. Aranda, “Thyroid hormone receptors, cell growth and differentiation,” Biochimica et Biophysica Acta (BBA), vol. 1830, no. 7, pp. 3908-3916, 2013.  Back to cited text no. 5
    
6.
M. McDermott, “Hyperthyroidism,” Annals of Internal Medicine, vol. 157, no. 1, pp. 1-10, 2012.  Back to cited text no. 6
    
7.
Kanat-Pektas M, Yenicesu O, Gungor T, Bilge U. Predictive power of sexual hormones and tumor markers in endometrial cancer. Arch Gynecol Obstet. 2010;281:709-715.  Back to cited text no. 7
    
8.
Kirkpatrick, L.A. and B.C. Feeney, 2012. A Simple Guide to IBM SPSS Statistics for Versions 18.0 and 19.0. 11th Edn., Wadsworth Cengage Learning, Belmont, ISBN-10: 1111352550, pp: 115.  Back to cited text no. 8
    
9.
Sweet, M.G., T.A.S. Dalton, P.M. Weiss and K.P. Madsen, 2012. Evaluation and management of abnormal uterine bleeding in premenopausal women. Am. Fam. Physician., 85: 35-43. PMID: 22230306.  Back to cited text no. 9
    
10.
Liu Y, Lv L, Xiao W, Gong C, Yin J, Wang D, Sheng H. Leptin activates STAT3 and ERK1/2 pathways and induces endometrial cancer cell proliferation. J Huazhong Univ Sci Technolog Med Sci. 2011;31:365- 370  Back to cited text no. 10
    
11.
Wright, J.D., M.N.I. Barrena, J. Sehouli, K. Fujiwara and T.J. Herzog, 2012. Contemporary management of endometrial cancer. Lancet, 379: 1352-1360. PMID: 22444602.  Back to cited text no. 11
    
12.
WHO, 2004. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet, 363: 157-163. PMID: 14726171.  Back to cited text no. 12
    
13.
Singh, A.K., R. Chattopadhyay, B. Chakravarty and K. Chaudhury, 2013. Altered circulating levels of matrix metalloproteinases 2 and 9 and their inhibitors and effect of progesterone supplementation in women with endometriosis undergoing in vitro fertilization. Fertility Sterility, 100: 127-134. DOI: 10.1016/j.fertnstert.2013.03.006  Back to cited text no. 13
    
14.
Park, C.K., S. Apte, G. Acs and E. Harris, 2008. Cancer of the Endometrium. In: Abeloff’s Clinical Oncology, Abeloff, M.D., J.O. Armitage, J.E. Niederhuber and M.B. Kastan et al., (Eds)., Philadelphia, pp:  Back to cited text no. 14
    
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Barlin, J.N., I. Puri and R.E. Bristow, 2010. Cytoreductive surgery for advanced or recurrent endometrial cancer: A meta-analysis. Gynecol. Oncol., 118: 14-18. DOI: 10.1016/j.ygyno.2010.04.005  Back to cited text no. 15
    
16.
Luhn, P., C.M. Dallal, J.M. Weiss, A. Black and W. Huang et al., 2013. Circulating adipokine levels and endometrial cancer risk in the prostate, lung, colorectal and ovarian cancer screening trial. Cancer Epidemiol. Biomarkers Prev., 22: 13041312. DOI: 10.1158/1055- 9965.EPI-13-0258.  Back to cited text no. 16
    
17.
Erdogan, S., S. Sezer, E. Baser, O. Gun-Eryilmaz and T. Gungor et al., 2013. Evaluating vaspin and adiponectin in postmenopausal women with endometrial cancer. Endocr. Relat. Cancer, 20: 669675. DOI: 10.1530/ERC-13-0280.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
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