Cancer Causes & Control

, Volume 22, Issue 5, pp 743–751 | Cite as

Metabolic factors and risk of thyroid cancer in the Metabolic syndrome and Cancer project (Me-Can)

  • Martin AlmquistEmail author
  • Dorthe Johansen
  • Tone Björge
  • Hanno Ulmer
  • Björn Lindkvist
  • Tanja Stocks
  • Göran Hallmans
  • Anders Engeland
  • Kilian Rapp
  • Håkan Jonsson
  • Randi Selmer
  • Guenter Diem
  • Christel Häggström
  • Steinar Tretli
  • Pär Stattin
  • Jonas Manjer
Original paper



To investigate metabolic factors and their possible impact on risk of thyroid cancer.


A prospective cohort study was conducted based on seven population-based cohorts in Norway, Austria, and Sweden, in the Metabolic syndrome and Cancer project (Me-Can). Altogether 578,700 men and women with a mean age of 44.0 years at baseline were followed for on average 12.0 years. Relative risk of incident thyroid cancer was assessed by levels of BMI, blood pressure, and blood levels of glucose, cholesterol, triglycerides, and by a combined metabolic syndrome (MetS) score. Risk estimates were investigated for quintiles, and a z score distribution of exposures was analyzed using Cox proportional hazards regression.


During follow-up, 255 women and 133 men were diagnosed with thyroid cancer. In women, there was an inverse association between glucose and thyroid cancer risk, with adjusted RR: 95% CI was 0.61 (0.41–0.90), p trend = 0.02 in the fifth versus the first quintile, and a positive association between BMI and thyroid cancer risk with a significant trend over quintiles. There was no association between the other metabolic factors, single or combined (Met-S), and thyroid cancer.


In women, BMI was positively, while blood glucose levels were inversely, associated with thyroid cancer.


Thyroid cancer Epidemiology Metabolic syndrome Cohort study 



Financial support was provided by the World Cancer Research Fund (Grant 2007/09), The Swedish Research Council, The Ernhold Lundström Foundation, The Einar and Inga Nilsson Foundation, The Malmö University Hospital Cancer Research Fund, The Malmö University Hospital Funds and Donations, The Crafoord Foundation and the Mossfelt Foundation. The authors thank, in Norway, the screening team at the former National Health Screening Service of Norway, now the Norwegian Institute of Public Health, the services of CONOR, and the contributing research centres delivering data to CONOR; in the Vorarlberg Health Monitoring and Prevention Programme, Elmar Stimpfl, the database manager, Karin Parschalk at the cancer registry, and Elmar Bechter and Hans-Peter Bischof, medical doctors at the Health Department of the Vorarlberg State Government; in the Västerbotten Intervention Project, Åsa Ågren, the project database manager at the Medical Biobank, Umeå University, Sweden; and in the Malmö Preventive Project, Anders Dahlin, the database manager, and finally, all the study participants.

Conflict of interest

The authors state no conflict of interest.


  1. 1.
    Davies L, Welch HG (2006) Increasing incidence of thyroid cancer in the United States, 1973–2002. Jama 295:2164–2167PubMedCrossRefGoogle Scholar
  2. 2.
    Iribarren C, Haselkorn T, Tekawa IS, Friedman GD (2001) Cohort study of thyroid cancer in a San Francisco Bay area population. Int J Cancer 93:745–750PubMedCrossRefGoogle Scholar
  3. 3.
    Dal Maso L, La Vecchia C, Franceschi S et al (2000) A pooled analysis of thyroid cancer studies. V. Anthropometric factors. Cancer Causes Control 11:137–144PubMedCrossRefGoogle Scholar
  4. 4.
    Reaven GM (1997) Banting lecture 1988. Role of insulin resistance in human disease. Nutrition 13:65 discussion 64, 66Google Scholar
  5. 5.
    Daskalopoulou SS, Athyros VG, Kolovou GD, Anagnostopoulou KK, Mikhailidis DP (2006) Definitions of metabolic syndrome: where are we now? Curr Vasc Pharmacol 4:185–197PubMedCrossRefGoogle Scholar
  6. 6.
    Hu G, Qiao Q, Tuomilehto J (2005) The metabolic syndrome and cardiovascular risk. Curr Diabetes Rev 1:137–143PubMedCrossRefGoogle Scholar
  7. 7.
    Ahmed RL, Schmitz KH, Anderson KE, Rosamond WD, Folsom AR (2006) The metabolic syndrome and risk of incident colorectal cancer. Cancer 107:28–36PubMedCrossRefGoogle Scholar
  8. 8.
    Lund Haheim L, Wisloff TF, Holme I, Nafstad P (2006) Metabolic syndrome predicts prostate cancer in a cohort of middle-aged Norwegian men followed for 27 years. Am J Epidemiol 164:769–774PubMedCrossRefGoogle Scholar
  9. 9.
    Tulinius H, Sigfusson N, Sigvaldason H, Bjarnadottir K, Tryggvadottir L (1997) Risk factors for malignant diseases: a cohort study on a population of 22, 946 Icelanders. Cancer Epidemiol Biomarkers Prev 6:863–873PubMedGoogle Scholar
  10. 10.
    Stocks T, Borena W, Strohmaier S et al (2010) Cohort profile: the metabolic syndrome and cancer project (Me-Can). Int J Epidemiol 39:660–667PubMedCrossRefGoogle Scholar
  11. 11.
    Rapp K, Schroeder J, Klenk J et al (2006) Fasting blood glucose and cancer risk in a cohort of more than 140,000 adults in Austria. Diabetologia 49:945–952PubMedCrossRefGoogle Scholar
  12. 12.
    Leren P, Askevold EM, Foss OP et al (1975) The Oslo study. Cardiovascular disease in middle-aged and young Oslo men. Acta Med Scand Suppl 588:1–38PubMedGoogle Scholar
  13. 13.
    Bjartveit K, Foss OP, Gjervig T (1983) The cardiovascular disease study in Norwegian counties. Results from first screening. Acta Med Scand Suppl 675:1–184PubMedGoogle Scholar
  14. 14.
    Naess O, Sogaard AJ, Arnesen E et al (2008) Cohort profile: cohort of Norway (CONOR). Int J Epidemiol 37:481–485PubMedCrossRefGoogle Scholar
  15. 15.
    Aires N, Selmer R, Thelle D (2003) The validity of self-reported leisure time physical activity, and its relationship to serum cholesterol, blood pressure and body mass index. A population based study of 332, 182 men and women aged 40–42 years. Eur J Epidemiol 18:479–485PubMedCrossRefGoogle Scholar
  16. 16.
    Lindahl B, Weinehall L, Asplund K, Hallmans G (1999) Screening for impaired glucose tolerance. Results from a population-based study in 21, 057 individuals. Diabetes Care 22:1988–1992PubMedCrossRefGoogle Scholar
  17. 17.
    Berglund G, Eriksson KF, Israelsson B et al (1996) Cardiovascular risk groups and mortality in an urban swedish male population: the Malmo preventive project. J Intern Med 239:489–497PubMedCrossRefGoogle Scholar
  18. 18.
    Bjartveit K, Foss OP, Gjervig T, Lund-Larsen PG (1979) The cardiovascular disease study in Norwegian counties. Background and organization. Acta Med Scand Suppl 634:1–70PubMedGoogle Scholar
  19. 19.
    Percy C, Van Holten V, Muir C (eds) (1990) International classification of diseases for oncology. World Health Organization, GenevaGoogle Scholar
  20. 20.
  21. 21.
    Fibrinogen Studies Collaboration (2009) Correcting for multivariate measurement error by regression calibration in meta-analyses of epidemiological studies. Stat Med 28:1067–1092CrossRefGoogle Scholar
  22. 22.
    Clarke R, Shipley M, Lewington S et al (1999) Underestimation of risk associations due to regression dilution in long-term follow-up of prospective studies. Am J Epidemiol 150:341–353PubMedGoogle Scholar
  23. 23.
    Wood AM, White I, Thompson SG, Lewington S, Danesh J (2006) Regression dilution methods for meta-analysis: assessing long-term variability in plasma fibrinogen among 27,247 adults in 15 prospective studies. Int J Epidemiol 35:1570–1578PubMedCrossRefGoogle Scholar
  24. 24.
    Jee SH, Ohrr H, Sull JW et al (2005) Fasting serum glucose level and cancer risk in Korean men and women. Jama 293:194–202PubMedCrossRefGoogle Scholar
  25. 25.
    Stattin P, Björ O, Ferrari P et al (2007) Prospective study of hyperglycemia and cancer risk. Diabetes Care 30:7CrossRefGoogle Scholar
  26. 26.
    Stocks T, Rapp K, Bjorge T et al (2009) Blood glucose and risk of incident and fatal cancer in the metabolic syndrome and cancer project (me-can): analysis of six prospective cohorts. PLoS Med 6:e1000201PubMedCrossRefGoogle Scholar
  27. 27.
    Zhan YS, Feng L, Tang SH et al (2010) Glucose metabolism disorders in cancer patients in a Chinese population. Med Oncol 27:177–184PubMedCrossRefGoogle Scholar
  28. 28.
    Zivaljevic V, Vlajinac H, Jankovic R et al (2004) Case-control study of anaplastic thyroid cancer. Tumori 90:9–12PubMedGoogle Scholar
  29. 29.
    Randi G, Ferraroni M, Talamini R et al (2008) Glycemic index, glycemic load and thyroid cancer risk. Ann Oncol 19:380–383PubMedCrossRefGoogle Scholar
  30. 30.
    Clavel-Chapelon F, Guillas G, Tondeur L, Kernaleguen C, Boutron-Ruault MC (2010) Risk of differentiated thyroid cancer in relation to adult weight, height, and body shape over life: the French E3 N cohort. Int J Cancer 126:2984–2990PubMedGoogle Scholar
  31. 31.
    Engeland A, Tretli S, Akslen LA, Bjorge T (2006) Body size and thyroid cancer in two million Norwegian men and women. Br J Cancer 95:366–370PubMedCrossRefGoogle Scholar
  32. 32.
    Barlow L, Westergren K, Holmberg L, Talback M (2009) The completeness of the Swedish cancer register: a sample survey for year 1998. Acta Oncol 48:27–33PubMedCrossRefGoogle Scholar
  33. 33.
    Larsen IK, Smastuen M, Johannesen TB et al (2009) Data quality at the cancer registry of Norway: an overview of comparability, completeness, validity and timeliness. Eur J Cancer 45:1218–1231PubMedCrossRefGoogle Scholar
  34. 34.
    Fiore E, Rago T, Provenzale MA et al (2009) Lower levels of TSH are associated with a lower risk of papillary thyroid cancer in patients with thyroid nodular disease: thyroid autonomy may play a protective role. Endocr Relat Cancer 16:1251–1260PubMedCrossRefGoogle Scholar
  35. 35.
    Ayturk S, Gursoy A, Kut A et al (2009) Metabolic syndrome and its components are associated with increased thyroid volume and nodule prevalence in a mild-to-moderate iodine-deficient area. Eur J Endocrinol 161:599–605PubMedCrossRefGoogle Scholar
  36. 36.
    Roos A, Bakker SJ, Links TP, Gans RO, Wolffenbuttel BH (2007) Thyroid function is associated with components of the metabolic syndrome in euthyroid subjects. J Clin Endocrinol Metab 92:491–496PubMedCrossRefGoogle Scholar
  37. 37.
    Garduno-Garcia Jde J, Alvirde-Garcia U, Lopez-Carrasco G et al (2010) TSH and free thyroxine concentrations are associated with differing metabolic markers in euthyroid subjects. Eur J Endocrinol 163:273–278Google Scholar
  38. 38.
    Negri E, Dal Maso L, Ron E et al (1999) A pooled analysis of case-control studies of thyroid cancer. II. Menstrual and reproductive factors. Cancer Causes Control 10:143–155PubMedCrossRefGoogle Scholar
  39. 39.
    La Vecchia C, Ron E, Franceschi S et al (1999) A pooled analysis of case-control studies of thyroid cancer. III. Oral contraceptives, menopausal replacement therapy and other female hormones. Cancer Causes Control 10:157–166PubMedCrossRefGoogle Scholar
  40. 40.
    Saad F, Gooren L (2009) The role of testosterone in the metabolic syndrome: a review. J Steroid Biochem Mol Biol 114:40–43PubMedCrossRefGoogle Scholar
  41. 41.
    Ropero AB, Alonso-Magdalena P, Quesada I, Nadal A (2008) The role of estrogen receptors in the control of energy and glucose homeostasis. Steroids 73:874–879PubMedCrossRefGoogle Scholar
  42. 42.
    Salpeter SR, Walsh JM, Ormiston TM et al (2006) Meta-analysis: effect of hormone-replacement therapy on components of the metabolic syndrome in postmenopausal women. Diabetes Obes Metab 8:538–554PubMedCrossRefGoogle Scholar
  43. 43.
    Teede H, Deeks A, Moran L (2010) Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med 8:41Google Scholar
  44. 44.
    Sondheimer SJ (1991) Update on the metabolic effects of steroidal contraceptives. Endocrinol Metab Clin North Am 20:911–923PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Martin Almquist
    • 1
    Email author
  • Dorthe Johansen
    • 2
  • Tone Björge
    • 3
    • 14
  • Hanno Ulmer
    • 4
  • Björn Lindkvist
    • 5
  • Tanja Stocks
    • 6
    • 7
  • Göran Hallmans
    • 8
  • Anders Engeland
    • 3
    • 14
  • Kilian Rapp
    • 9
  • Håkan Jonsson
    • 10
  • Randi Selmer
    • 3
  • Guenter Diem
    • 11
  • Christel Häggström
    • 6
  • Steinar Tretli
    • 12
  • Pär Stattin
    • 6
  • Jonas Manjer
    • 2
    • 13
  1. 1.Department of SurgerySkåne University Hospital Lund and Lund UniversityLundSweden
  2. 2.Department of SurgerySkåne University Hospital Malmö and Lund UniversityMalmöSweden
  3. 3.Norwegian Institute of Public HealthOslo/BergenNorway
  4. 4.Department of Medical Statistics, Informatics and Health EconomicsInnsbruck Medical UniversityInnsbruckAustria
  5. 5.Department of Internal Medicine, Division of Gastroenterology and HepatologySahlgrenska University HospitalGöteborgSweden
  6. 6.Department of Surgical and Perioperative Sciences, Urology and AndrologyUmeå UniversityUmeåSweden
  7. 7.Institute of Health SciencesVU UniversityAmsterdamThe Netherlands
  8. 8.Department of Public Health and Clinical Medicine, Nutritional ResearchUmeå UniversityUmeåSweden
  9. 9.Institute of EpidemiologyUlm UniversityUlmGermany
  10. 10.Department of Radiation Science, OncologyUmeå UniversityUmeåSweden
  11. 11.Agency for Social- and Preventive MedicineBregenzAustria
  12. 12.Cancer Registry of NorwayInstitute of Population-based Cancer ResearchOsloNorway
  13. 13.The Malmö Diet and Cancer StudyLund UniversityMalmöSweden
  14. 14.Department of Public Health and Primary Health CareUniversity of BergenBergenNorway

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