2016年4月1日，欧洲内分泌学会（ESE）官方期刊《欧洲内分泌学杂志》（EJE）发表了丹麦奥胡斯大学附属医院、荷兰莱顿大学医学中心的全国队列研究，发现甲状腺功能亢进症女性患者罹患乳腺癌风险增加，而甲状腺功能减退症却与乳腺癌风险降低相关。
该研究纳入1978～2013年期间于丹麦首次经医院诊断为甲状腺功能减退症或甲状腺功能亢进症的患者，调查了甲状腺疾病与乳腺癌之间的关系。研究期间，通过与普通人群的预期风险进行比较，计算甲状腺功能减退症和甲状腺功能亢进症患者的超额乳腺癌风险。同时，为了避免诊断检查偏倚，排除甲状腺疾病确诊后前12个月内被诊断为乳腺癌的患者。
结果发现，1978～2013年期间，丹麦分别有61873例和80343例女性患者被诊断为甲状腺功能减退症和甲状腺功能亢进症。与普通人体相比，甲状腺功能亢进症与乳腺癌风险轻度增加相关（标准发病率比值[SIR]：1.11；95% CI：1.07～1.16），且这种相关性在长达5年随访期间持续存在（SIR：1.13；95% CI：1.08～1.19）。相比之下，甲状腺功能减退症却与乳腺癌风险降低相关（SIR：0.94；95% CI：0.88～1.00）。
因此，甲状腺功能亢进症女性患者罹患乳腺癌风险增加，而甲状腺功能减退症女性患者罹患乳腺癌风险却轻度下降，提示甲状腺功能水平与乳腺癌风险之间存在相关性。
Eur J Endocrinol. 2016 Apr;174(4):409-14.
Hypothyroidism and hyperthyroidism and breast cancer risk: a nationwide cohort study.
Sogaard M, Farkas DK, Ehrenstein V, Jorgensen JO, Dekkers OM, Sorensen HT.
Aarhus University Hospital, Olof Palmes Allé, Aarhus N, Denmark.
Leiden University Medical Center, Leiden, The Netherlands.
OBJECTIVE: The association between thyroid disease and breast cancer risk remains unclear. We, therefore examined the association between hypothyroidism, hyperthyroidism and breast cancer risk.
DESIGN: This was a population-based cohort study.
METHODS: Using nationwide registries, we identified all women in Denmark with a first-time hospital diagnosis of hypothyroidism or hyperthyroidism, 1978-2013. We estimated the excess risk of breast cancer among patients with hypothyroidism or hyperthyroidism compared with the expected risk in the general population, using standardized incidence ratios (SIRs) as a measure of risk ratio. Breast cancer diagnoses in the first 12 months following diagnosis of thyroid disease were excluded from the calculations to avoid diagnostic work-up bias.
RESULTS: We included 61,873 women diagnosed with hypothyroidism and 80,343 women diagnosed with hyperthyroidism. Median follow-up time was 4.9 years (interquartile range (IQR): 1.8-9.5 years) for hypothyroidism and 7.4 years (IQR: 3.1-13.5 years) for hyperthyroidism. Hyperthyroidism was associated with a slightly increased breast cancer risk compared with the general population (SIR: 1.11, 95% CI: 1.07-1.16), which persisted beyond 5 years of follow-up (SIR: 1.13, 95% CI: 1.08-1.19). In comparison, hypothyroidism was associated with a slightly lower risk of breast cancer (SIR: 0.94, 95% CI: 0.88-1.00). Stratification by cancer stage at diagnosis, estrogen receptor status, age, comorbidity, history of alcohol-related disease and clinical diagnoses of obesity produced little change in cancer risk.
CONCLUSIONS: We found an increased risk of breast cancer in women with hyperthyroidism and a slightly decreased risk in women with hypothyroidism indicating an association between thyroid function level and breast cancer risk.
PMID: 26863886
DOI: 10.1530/EJE-15-0989
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