Understanding the effect of obesity on papillary thyroid cancer: is there a need for tailored diagnostic and therapeutic management?

ABSTRACT

Introduction

Several studies have focused on the relationship between obesity and differentiated thyroid carcinoma (DTC), particularly papillary histotype (PTC). However, the association of obesity with both incidence and aggressiveness of PTC is still incompletely understood.

Areas covered

We reviewed the mechanisms underlying the cross talk between obesity and thyroid carcinomas and described the most recent evidence evaluating the effect of obesity on the development of PTC, as well as the impact of excessive body weight on the clinicopathologic features and outcome of this type of cancer.

Expert opinion

Available evidence suggests that excessive body weight is linked with a higher risk of getting PTC, while its impact on the aggressiveness of the disease, if present, is still not clear. Therefore, while attention should be paid to discover thyroid cancer in patients with obesity earlier, once diagnosed it should be managed following a conventional workup as in normal weight patients, based on the clinical presentation of the disease and including active surveillance if appropriate, as recommended by referral guidelines.

KEYWORDS:

• Body mass index
• obesity
• differentiated thyroid cancer
• papillary thyroid cancer
• aggressive histology
• management of thyroid cancer in obesity

Article highlights

• Increased body mass index (BMI) is associated with raised incidence of differentiated thyroid cancer (DTC), particularly papillary (PTC)

• The link between obesity and PTC might be explained through several pathogenetic mechanisms

• The workup of patients with obesity and a suspicion of a thyroid nodule should include neck ultrasound due to the difficulties encountered in their neck palpation and the higher incidence of thyroid cancer in this population

• Obesity does not seem to play a clear role in worsening the aggressiveness of PTC

• No tailored management is currently suggested in case of diagnosis of thyroid cancer in subjects with obesity.

Declaration of interest

A Matrone and R Elisei are consultants for Lilly. R Elisei is also a consultant for EISAI, Ipsen, and Bayer.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.