Metformin Decreases Thyroid Volume and Nodule Size in Subjects with Insulin Resistance: A Preliminary Study

Anıl, Cüneyd; Kut, Altuğ; Atesagaoglu, Berna; Nar, Aslı; Tütüncü, Neslihan Başçıl; Gürsoy, Alptekin

doi:10.1159/000442821

Cited by 44 publications

(41 citation statements)

References 18 publications

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“…Recently, a preliminary study also found that metformin therapy significantly decreased thyroid volume and nodule size in subjects with IR (Anil et al 2016). Therefore, in patients with IR and nodular goiter, metformin may be a useful drug both to decrease IR and the size of solid nodules.…”

Section: :1mentioning

confidence: 96%

Metformin and thyroid disease

Meng

Chen

et al. 2017

Journal of Endocrinology

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An intriguing area of research in thyroidology is the recently discovered association of insulin resistance with thyroid functional and morphological abnormalities. Individuals with hyperinsulinemia have larger thyroid gland and a higher prevalence of thyroid nodules and cancer. Accordingly, patients treated with metformin have a smaller thyroid volume and a lower risk of incident goiter, thyroid nodule and cancer. Multiple studies in vitro and in vivo have demonstrated that metformin can inhibit the growth of thyroid cells and different types of thyroid cancer cells by affecting the insulin/IGF1 and mTOR pathways. Besides, metformin treatment was associated with a decrease in the levels of serum thyroid-stimulating hormone (TSH) in diabetic patients possibly by enhancing the effects of thyroid hormones in the pituitary and activating the adenosine monophosphate-activated protein kinase (AMPK). Based on this evidence, metformin appears to be a promising therapeutic tool in patients with thyroid disease. More clinical studies are necessary to evaluate the clinical significance of metformin for the treatment of thyroid diseases.

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Section: :1mentioning

confidence: 96%

Metformin and thyroid disease

Meng

Chen

et al. 2017

Journal of Endocrinology

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“…Experimental studies have shown that metformin via activation of AMP-kinase and mTOR (mammalian target of rapamycin) exhibits inhibitory effects on the growth of thyroid cells and antagonises the pro-growth effect of insulin [47]. In the population of patients with insulin resistance, metformin therapy resulted in a reduction in volume of thyroid and nodules [48]. In addition, Ittermann et al showed that type 2 diabetes patients treated with metformin have a lower thyroid volume compared to those treated with other hypoglycaemic agents [49].…”

Section: Goitre and Thyroid Cancermentioning

confidence: 99%

“…Badania eksperymentalne wykazały, że metformina poprzez aktywację AMP-kinazy i szlaku mTOR (mammalian target of rapamycin) wykazuje właściwości hamujące na wzrost komórek tarczycy i antagonizuje pro-wzrostowy efekt insuliny [47]. W populacji osób z insulinoopornością terapia metforminą PRACE POGLĄDOWE powodowała zmniejszenie wola i objętości guzków tarczycy [48]. Ponadto, Ittermann i wsp.…”

Section: Prace Poglądoweunclassified

Insulinooporność w chorobach endokrynnych — sposoby terapii

Rogowicz-Frontczak

Majchrzak²,

Zozulińska‐Ziółkiewicz

2017

Endokrynologia Polska

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Changes in sensitivity to insulin occur in the course of a number of endocrine disorders. Most of the hormones through their antagonistic action to insulin lead to increased hepatic glucose output and its decreased utilisation in peripheral tissues. Carbohydrate disorders observed in endocrine diseases result from the phenomenon of insulin resistance, and in some cases also a reduction in insulin secretion is present. Abnormalities of glucose metabolism are observed in acromegaly, but also in growth hormone deficiency, hypercortisolism in the course of Cushing's syndrome, hyper- or hypothyroidism, primary hyperparathyroidism, aldosteronism, pheochromocytoma, congenital hypertrophy of the adrenal glands, polycystic ovaries syndrome, hypogonadism, or other hormonally active neuroendocrine tumours. They are of a secondary nature in relation to impaired hormonal balance. Hyperglycaemia is therefore often reversible, and the most effective method of treatment of impaired insulin sensitivity is successful therapy of specific endocrinopathies. Insulin sensitisers, also with a good effect, are used. Most experiences to date can be attributed to metformin therapy. Attempts have been made at treatment with other agents that are also effective in reducing insulin resistance as incretins or glitazones. In the presented paper, the authors reviewed endocrine diseases in which there is a clinically significant change in insulin sensitivity. Moreover, methods of therapy of concomitant disturbed glucose metabolism were presented.

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“…Treatment with metformin has been shown to reduce insulin resistance and has been associated with a decrease in thyroid nodule size [3,4]. In a 6-months study of 66 women with insulin resistance and NTD, metformin therapy was associated with a 30% median reduction in nodule size while the combination of levothyroxine and metformin was associated with 55% reduction [10].…”

Section: Discussionmentioning

confidence: 99%

“…While there are no studies linking exogenous insulin treatment in T2DM and thyroid nodule growth, there is mounting evidence that insulin resistance and endogenous hyperinsulinaemia are associated with nodule development [2] and that reduction of insulin resistance has favourable effects on nodule size [3,4]. Hyperinsulinaemia may also be associated with an increased risk of differentiated thyroid carcinoma [5] and persistence of disease post-operatively [6].…”

Section: Introductionmentioning

confidence: 99%

Effects of Exogenous Insulin Therapy on Thyroid Nodule Size in Patients with Type 2 Diabetes Mellitus

El-Kaissi¹,

Buhary²,

Sherbeeni³

2017

Open J Thyroid Res

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Objectives: Recent evidence suggests that insulin resistance and endogenous hyperinsulinaemia are related to thyroid nodule growth and development, but the effect of exogenous insulin therapy on thyroid nodules is unknown. The objectives of this study are to investigate the effects of exogenous insulin on thyroid nodule size in diabetic patients.Methods: retrospective analysis of patients with nodular thyroid disease and type 2 diabetes mellitus receiving metformin alone or insulin-and-metformin. Thyroid ultrasonography was used to monitor changes in nodule size: ≥2 mm and ≥20% being statistically signifi cant.Results: 34 insulin-treated (73 nodules) and 53 metformin-only (135 nodules) patients were followed for 5.9-67.9 months (mean 24.5±1.8). Nodule size ranged from 0.17-5.25 cm (mean 1.29±0.08). There were no signifi cant differences in serum TSH, free-T4 or Vitamin D between the two groups, but haemoglobin A1C was higher in insulin-treated patients at baseline and during follow-up (8.75±0.12% vs. 6.48±0.08%; P-value <0.001). In insulin-treated patients, the number of nodules with no change, increase or decrease in size were 49/73 (67.12%), 13/73 (17.81%) and 11/73 (15.07%) at the end of follow-up. The respective number of nodules in the metformin-only group were 105/135 (77.78%), 20/135 (14.81%) and 10/135 (7.41%). Chi-square test for type of treatment and changes in nodule size was not signifi cant (P-value 0.15). Conclusions:Compared to metformin alone, treatment with a combination of exogenous insulin and metformin was not associated with thyroid nodule size or thyroid volumes. The effects of exogenous insulin alone, without metformin, on nodular thyroid disease warrant further evaluation.

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Metformin Decreases Thyroid Volume and Nodule Size in Subjects with Insulin Resistance: A Preliminary Study

Cited by 44 publications

References 18 publications

Metformin and thyroid disease

Metformin and thyroid disease

Insulinooporność w chorobach endokrynnych — sposoby terapii

Effects of Exogenous Insulin Therapy on Thyroid Nodule Size in Patients with Type 2 Diabetes Mellitus

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