Thyroid Nodules: Are There Gender Differences?

Introduction

It is well known that gender variations are important clinical factors that should be considered in the diagnosis, prognosis, and treatment of the majority of diseases ⁽¹⁾. No exemption applies to endocrine disorders. The term "gender" encompasses more than just "sex"; although "sex" refers to the biological distinctions between men and women brought about by hormones and genetics, "gender" refers to a variety of cultural, psychological, and environmental aspects. Research indicates that women have a greater incidence of metabolic and endocrine changes than men do, with varying clinical paths and consequences.

It should come as no surprise that endocrinologists play a significant role in gender medicine and may contribute significantly to the medical management of endocrine disorders using this relatively new approach ⁽²⁾. Thyroid disorders are the third most common endocrinopathy, following osteoporosis/osteopenia and diabetes, according to growing epidemio-logical statistics. An estimated 200 million individuals worldwide may be impacted by thyroid disorders of some type ⁽³⁾. Our objective is to provide an overview and quick analysis of the current knowledge about how gender affects the thyroid.

Patients & Methods

Study Design and Sample: This cross-sectional research was conducted between December 2020 and June 2023 on 100 patients, aged 18 to 79, who were selected from the endocrine outpatient clinic at Minia University Hospital.

Every patient in the study had a comprehensive history taken and a clinical physical examination. Thyroid function tests, antithyroid antibodies (such as thyroid peroxidase antibodies, or anti-TPO Antibodies), and thyroglobulin antibodies using ELISA kits are among the laboratory investigations that are undertaken.

A radiology professional performed an ultrasound (US) on each patient to assess the thyroid parenchyma. Each set of data was evaluated and scored using the malignancy risk grading method developed by the American College of Radiology (ACR-TIRADS) ⁽⁴⁾.

Ethical consideration:

Ethical permission was taken by the research ethical committee of the Faculty of Medicine in Minia University (ethical approval number 806-08-2021). Written consent was obtained from all participants after providing comprehensive information about the aim and the nature of the study. The issues of privacy and confidentiality of all study participants were considered

Statistical analysis

The statistical program for social science, SPSS version 20, was used to do statistical analysis and presentation utilizing the mean, standard deviation, student t test, Chi-square, and Mann-Whitney U test.

Our patients were 10(10%) males and 90 (90%) females; their mean age was (39.9 ± 12.1). As regards the site of the dominant nodule in the thyroid gland detected by ultrasonography, there were 31 patients with a left lobe nodule, 44 patients within the right lobe, 5 in the isthmus, 8 patients with multi-nodular goiter and 3 calcified nodules. These patients also classified according to the TIRADS system into 13 patients with TIRADS II, 45 patients with TIRADS III, 36 patients with TIRADS IV and 6 patients with TIRADSV.

All of the patients are in an euthyroid state, within the normal range of TSH (0.15 – 4.5) and free T4 (0.8 – 1.9), also normal thyroid antibodies, including thyroid peroxidase AB with a mean (22.3 ± 55.9) and antithyroglobulin (13.12 ± 27.9).

Discussion

Our patients were 10(10%) male and 90 (90%) female, the mean age of them was 39.9 ± 12.1. Kwong et al., examined the relationship between patient age and thyroid cancer risk, multinodularity, and nodule development. Of the 6391 individuals they examined, 943 (15%) were male and 5447 (85%) were female. The mean age of the patients was 47.4 ± 10.8, and the researchers concluded that as people age, the prevalence of thyroid nodular disease increases ⁽⁵⁾.

According to Rahbar et al., there may be a connection between females' greater incidence of thyroid nodules and cancer and estrogen and the state of estrogen hormone receptors in thyroid cells. Furthermore, it was discovered that the risk of thyroid cancer is tripled for reproductive women ⁽⁶⁾.

We classified the thyroid nodules accor-ding to their site into Lt lobe nodule (31%). Multinodular goiter with large nodule (8%), right lobe nodule (44%), Solitary isthmic nodule (5%); all of them within the euthyroid state, within the normal range of TSH (0.15–4.5) and free T4 (0.8–1.9), as well as normal thyroid antibodies, including TPO.AB with a mean range (22.4±55.8) and antithyroglobulin (13.1± 27.8). Thyroid nodule placement was assessed by Jasim et al., in 2020, who classified the nodules as upper, middle, lower, or isthmic. They discovered that the nodule is a distinct risk factor that predicts the probability of thyroid cancer. Lower lobe nodules have the lowest probability of cancer diagnosis, while isthmic nodules have the highest risk ⁽⁷⁾.