Skip to main content
SpringerLink
Log in

Case–Control Study of Papillary Thyroid Carcinoma on Urinary and Dietary Iodine Status in South Korea

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The association between iodine levels and the risk of papillary thyroid cancer (PTC) has been suggested, but not definitively established. This study is to compare the iodine status of a group of patients with PTC (with and without BRAF V600E) with that of a healthy population cohort.

Methods

A cohort of patients scheduled for thyroidectomy was enrolled, along with a community-based health-screening cohort with no known history of thyroid disease. Median urinary iodine (UI) levels, creatinine-adjusted median UI levels, and food frequency questionnaire (FFQ) scores (mean ± SD) were compared. In a subgroup analysis, these values were compared between BRAF V600E-positive and BRAF V600E-negative patients in the PTC group.

Results

The PTC group consisted of 210 patients, and the control group consisted of 90 healthy individuals. Among the 191 PTC patients whose BRAF V600E mutational status was reported, 169 (88.5%) were revealed positive for the mutation. The median UI levels were significantly higher in the PTC group (786.0 μg/l) than the control group (112.0 μg/l; p < 0.001), as was the case with creatinine-adjusted median UI levels (884.6 μg/g creatinine versus 182.0 μg/g creatinine; p < 0.001) and FFQ scores (66.2 ± 17.5, range 13–114 versus 54.6 ± 21.5, range 16–134; p < 0.001). No significant differences were seen in the subgroup analysis between BRAF V600E-positive and BRAF V600E-negative patients.

Conclusions

Our results indicate that iodine status differs significantly between patients with PTC and healthy controls, suggesting that iodine may be involved in the occurrence of PTC, although the association between iodine levels and BRAF mutational status did not reach statistical significance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Pellegriti G, Frasca F, Regalbuto C et al (2013) Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol 2013:965212

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ahn HS, Kim HJ, Welch HG (2014) Korea’s thyroid-cancer “epidemic”—screening and overdiagnosis. N Engl J Med 371:1765–1767

    Article  PubMed  Google Scholar 

  3. Choi YM, Kim TY, Jang EK et al (2014) Standardized thyroid cancer mortality in Korea between 1985 and 2010. Endocrinol Metab (Seoul) 29:530–535

    Article  Google Scholar 

  4. Williams D (2008) Radiation carcinogenesis: lessons from Chernobyl. Oncogene 27(Suppl 2):S9–18

    Article  CAS  PubMed  Google Scholar 

  5. Pearce MS, Salotti JA, Little MP et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mazonakis M, Tzedakis A, Damilakis J et al (2007) Thyroid dose from common head and neck CT examinations in children: is there an excess risk for thyroid cancer induction? Eur Radiol 17:1352–1357

    Article  PubMed  Google Scholar 

  7. Ron E, Lubin JH, Shore RE et al (1995) Thyroid cancer after exposure to external radiation: a pooled analysis of seven studies. Radiat Res 141:259–277

    Article  CAS  PubMed  Google Scholar 

  8. Richardson DB (2009) Exposure to ionizing radiation in adulthood and thyroid cancer incidence. Epidemiology 20:181–187

    Article  PubMed  Google Scholar 

  9. Pellegriti G, De Vathaire F, Scollo C et al (2009) Papillary thyroid cancer incidence in the volcanic area of Sicily. J Natl Cancer Inst 101:1575–1583

    Article  CAS  PubMed  Google Scholar 

  10. Feldt-Rasmussen U (2001) Iodine and cancer. Thyroid 11:483–486

    Article  CAS  PubMed  Google Scholar 

  11. Dijkstra B, Prichard RS, Lee A et al (2007) Changing patterns of thyroid carcinoma. Ir J Med Sci 176:87–90

    Article  CAS  PubMed  Google Scholar 

  12. Harach HR, Escalante DA, Onativia A et al (1985) Thyroid carcinoma and thyroiditis in an endemic goitre region before and after iodine prophylaxis. Acta Endocrinol (Copenh) 108:55–60

    CAS  Google Scholar 

  13. Hwang Y, Lee KE, Park YJ et al (2016) Annual average changes in adult obesity as a risk factor for papillary thyroid cancer: a large-scale case–control study. Medicine (Baltimore) 95:e2893

    Article  Google Scholar 

  14. WHO/UNICEF/ICCIDD (2007) Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers. World Health Organization: http://whqlibdoc.who.int/publications/2007/9789241595827_eng.pdf. Accessed 9789241595820 August 9789241592013)

  15. Guan H, Ji M, Bao R et al (2009) Association of high iodine intake with the T1799A BRAF mutation in papillary thyroid cancer. J Clin Endocrinol Metab 94:1612–1617

    Article  CAS  PubMed  Google Scholar 

  16. Wang F, Wang Y, Wang L et al (2014) Strong association of high urinary iodine with thyroid nodule and papillary thyroid cancer. Tumour Biol 35:11375–11379

    Article  CAS  PubMed  Google Scholar 

  17. Choi J, Kim HS, Hong DJ et al (2012) Urinary iodine and sodium status of urban Korean subjects: a pilot study. Clin Biochem 45:596–598

    Article  CAS  PubMed  Google Scholar 

  18. Hong AR, Lim JA, Kim TH et al (2014) The frequency and clinical implications of the BRAF(V600E) mutation in papillary thyroid cancer patients in Korea over the past two decades. Endocrinol Metab (Seoul) 29:505–513

    Article  Google Scholar 

  19. Viertler C, Groelz D, Gundisch S et al (2012) A new technology for stabilization of biomolecules in tissues for combined histological and molecular analyses. J Mol Diagn JMD 14:458–466

    Article  CAS  PubMed  Google Scholar 

  20. WHO (2013) Urinary iodine concentrations for determining iodine status in populations. World Health Organizations, Geneva

    Google Scholar 

  21. Zimmermann MB, Andersson M (2012) Assessment of iodine nutrition in populations: past, present, and future. Nutr Rev 70:553–570

    Article  PubMed  Google Scholar 

  22. Kim HK, Lee SY, Lee JI et al (2010) Usefulness of iodine/creatinine ratio from spot-urine samples to evaluate the effectiveness of low-iodine diet preparation for radioiodine therapy. Clin Endocrinol 73:114–118

    CAS  Google Scholar 

  23. Lee KE, Park YJ, Cho B et al (2015) Protocol of a thyroid cancer longitudinal study (T-CALOS): a prospective, clinical and epidemiological study in Korea. BMJ Open 5:e007234

    Article  PubMed  PubMed Central  Google Scholar 

  24. Moon SJ, Kim JY, Chung YJ et al (1998) The iodine content in common Korean foods. Korean Nutr Soc 31:7

    Google Scholar 

  25. Mood AM (1954) On the asymptotic efficiency of certain nonparametric two-sample tests. Ann Math Stat 25:8

    Article  Google Scholar 

  26. Laurberg P, Bulow Pedersen I, Knudsen N et al (2001) Environmental iodine intake affects the type of nonmalignant thyroid disease. Thyroid 11:457–469

    Article  CAS  PubMed  Google Scholar 

  27. Todd CH, Allain T, Gomo ZA et al (1995) Increase in thyrotoxicosis associated with iodine supplements in Zimbabwe. Lancet 346:1563–1564

    Article  CAS  PubMed  Google Scholar 

  28. Stanbury JB, Ermans AE, Bourdoux P et al (1998) Iodine-induced hyperthyroidism: occurrence and epidemiology. Thyroid 8:83–100

    Article  CAS  PubMed  Google Scholar 

  29. Michikawa T, Inoue M, Shimazu T et al (2012) Seaweed consumption and the risk of thyroid cancer in women: the Japan Public Health Center-based prospective study. Eur J Cancer Prev 21:254–260

    Article  CAS  PubMed  Google Scholar 

  30. Pagano L, Caputo M, Sama MT et al (2012) Clinical-pathological changes in differentiated thyroid cancer (DTC) over time (1997–2010): data from the University Hospital “Maggiore della Carita” in Novara. Endocrine 42:382–390

    Article  CAS  PubMed  Google Scholar 

  31. Kim JY, Kim KR (2000) Dietary iodine intake and urinary iodine excretion in patients with thyroid diseases. Yonsei Med J 41:22–28

    Article  CAS  PubMed  Google Scholar 

  32. Kim H, Lee H, Park K et al (1985) A study on the urinary iodide excretion in normal subjects and patients with thyroid disease. Korean J Intern Med 29:625–631

    Google Scholar 

  33. Kim JY, Moon SJ, Kim KR et al (1998) Dietary iodine intake and urinary iodine excretion in normal Korean adults. Yonsei Med J 39:355–362

    Article  PubMed  Google Scholar 

  34. Murray CW, Egan SK, Kim H et al (2008) US Food and Drug Administration’s Total Diet Study: dietary intake of perchlorate and iodine. J Expo Sci Environ Epidemiol 18:571–580

    Article  CAS  PubMed  Google Scholar 

  35. Scientific Committee on Food (2002) Opinion of the scientific committee on food on the tolerable upper intake level of iodine, European Commission. Health & Consumer Protection Directorate-General, Brussels

    Google Scholar 

  36. Expert Group on Vitamins and Minerals (2003) Safe upper levels for vitamins and minerals. Food Standards Agency, London

    Google Scholar 

  37. Sehestedt T, Knudsen N, Perrild H et al (2006) Iodine intake and incidence of thyroid cancer in Denmark. Clin Endocrinol 65:229–233

    Article  CAS  Google Scholar 

  38. Xiang J, Wang X, Wang Z et al (2015) Effect of different iodine concentrations on well-differentiated thyroid cancer cell behavior and its inner mechanism. Cell Biochem Biophys 71:299–305

    Article  CAS  PubMed  Google Scholar 

  39. Durante C, Puxeddu E, Ferretti E et al (2007) BRAF mutations in papillary thyroid carcinomas inhibit genes involved in iodine metabolism. J Clin Endocrinol Metab 92:2840–2843

    Article  CAS  PubMed  Google Scholar 

  40. Fuziwara CS, Kimura ET (2014) High iodine blocks a Notch/miR-19 loop activated by the BRAF(V600E) oncoprotein and restores the response to TGFbeta in thyroid follicular cells. Thyroid 24:453–462

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Song YS, Lim JA, Park YJ (2015) Mutation profile of well-differentiated thyroid cancer in asians. Endocrinol Metab (Seoul) 30:252–262

    Article  CAS  Google Scholar 

  42. Andersen S, Karmisholt J, Pedersen KM et al (2008) Reliability of studies of iodine intake and recommendations for number of samples in groups and in individuals. Br J Nutr 99:813–818

    CAS  PubMed  Google Scholar 

  43. Lim CY, Kim JY, Yoon MJ et al (2015) Effect of a low iodine diet vs. restricted iodine diet on postsurgical preparation for radioiodine ablation therapy in thyroid carcinoma patients. Yonsei Med J 56:1021–1027

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Cho YA, Kim J (2015) Dietary factors affecting thyroid cancer risk: a meta-analysis. Nutr Cancer 67:811–817

    Article  CAS  PubMed  Google Scholar 

  45. Bosetti C, Kolonel L, Negri E et al (2001) A pooled analysis of case–control studies of thyroid cancer. VI. Fish and shellfish consumption. Cancer Causes Control CCC 12:375–382

    Article  CAS  PubMed  Google Scholar 

  46. Liu ZT, Lin AH (2014) Dietary factors and thyroid cancer risk: a meta-analysis of observational studies. Nutr Cancer 66:1165–1178

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea

    Joon-Hyop Lee & June Young Choi

  2. Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea

    Ra-Yeong Song, Jin Wook Yi, Hyeong Won Yu, Hyungju Kwon, Su-jin Kim & Kyu Eun Lee

  3. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea

    Su-jin Kim, Kyu Eun Lee, Young Joo Park & Sue K. Park

  4. Department of Surgery, Seoul National University Hospital Boramae Medical Center, Seoul, Republic of Korea

    Young Jun Chai

  5. Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea

    Jae Hoon Moon

  6. Department of Internal Medicine, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea

    Young Joo Park

  7. Department of Preventive Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea

    Sue K. Park

  8. Thyroid and Endocrine Surgery Section, Department of Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea

    Joon-Hyop Lee

Authors
  1. Joon-Hyop Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ra-Yeong Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jin Wook Yi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hyeong Won Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hyungju Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Su-jin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Young Jun Chai
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. June Young Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jae Hoon Moon
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kyu Eun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Young Joo Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Sue K. Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kyu Eun Lee.

Ethics declarations

Conflict of interest

None of the authors involved in this study have actual or potential competing conflict of interests to declare.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, JH., Song, RY., Yi, J.W. et al. Case–Control Study of Papillary Thyroid Carcinoma on Urinary and Dietary Iodine Status in South Korea. World J Surg 42, 1424–1431 (2018). https://doi.org/10.1007/s00268-017-4287-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-017-4287-x

Search

Navigation