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Han, Kim, Kim, Song, Hong, Bae, Kim, Shong, and Kim: Association between Serum Gamma-Glutamyl Transferase and Thyroid Cancer in an Ultrasonographically Screened Population
Original Article

Clin Exp Thyroidol 2015;8(1):75-80.

Published online: 4 May 2015

DOI: https://doi.org/10.11106/cet.2015.8.1.75

Association between Serum Gamma-Glutamyl Transferase and Thyroid Cancer in an Ultrasonographically Screened Population

Ji Min Han1, Tae Yong Kim2, Won Gu Kim2, Dong Eun Song3, Suck Joon Hong4, Sung Jin Bae5, Hong-Kyu Kim5, Young Kee Shong2, Won Bae Kim2

Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Departments of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Health Screening & Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence: Won Bae Kim, MD, PhD, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea Tel: 82-2-3010-3913, Fax: 82-2-3010-6962, E-mail: kimwb@amc.seoul.kr

Received 7 October 2014       Accepted 3 March 2015

Copyright © 2015, the Korean Thyroid Association.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background and Objectives

We reported recently a positive correlation between obesity and thyroid cancer in women. Serum gamma-glutamyl transferase (GGT) is regarded as a marker of exposure to environmental pollutants, cancer-causing xenobiotic. This study was conducted to evaluate the mechanism behind the association of obesity with thyroid cancer. We hypothesized serum GGT may be a surrogate for persistent organic pollutants to explain the connection between obesity and thyroid cancer.

Materials and Methods

We obtained data from 15,131 subjects who underwent a routine health checkup including thyroid ultrasonography from 2007 to 2008 at the Health Screening and Promotion Center of Asan Medical Center. Suspicious nodules were examined by ultrasonography-guided aspiration. Those with a history of hepatobiliary disease and abnormal result of liver function test were excluded. Serum GGT cut-off points were the 25th, 50th, and 75th sex-specific percentiles.

Results

A total of 15,131 subjects (7662 men and 7469 women) were screened by thyroid ultrasonography. Thyroid cancers were diagnosed in 260 patients. After adjustment of age, smoking status, alcohol intake, body mass index, compared with the lowest serum GGT quartile, odds ratios (95% confidence intervals) of risk of thyroid cancer were 0.54 (0.28-0.99) for 2nd quartile, 0.92 (0.56-1.50) for 3rd quartile, and 0.61 (0.34-1.09) for 4th quartile in men. In women, the adjusted odds ratios were 1.06 (0.66-1.72), 1.18 (0.77-1.85), and 0.63 (0.38-1.06) for the 2nd, 3rd, and 4th quartile, respectively.

Conclusion

Elevated GGT is not associated with a higher prevalence of thyroid cancer in either gender when evaluated in a routine health checkup setting.

Keywords: Gamma-glutamyl transferase, Persistent organic pollutant, Thyroid cancer, Obesity

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Fig. 1.
The prevalence of thyroid cancer according to GGT quartiles. These prevalence estimates are not adjusted for other factors. Quartiles for GGT: 4.0-16.9, 17.0-24.9, 25.0-39.9, and 40.0-614.0 U/L in men; 4.0-9.9, 10.0-11.9, 12.0-16.9,and 17.0-309.0 U/L in women. GGT: gamma-glutamyl transferase.
jkta-8-75f1.tif
Table 1.
Comparison of the clinical characteristics of subjects without thyroid cancer and those with thyroid cancer
  Male
   Female
  
Non-cancer (n=7561) Cancer (n=101) p value Non-cancer (n=7310) Cancer (n=159) p value
Age (years) 52.6±9.0 50.9±7.8 0.038 50.8±9.4 51.1±8.6 0.672
Smoking 6130 (81%) 80 (79%) 0.276 634 (9%) 6 (4%) 0.330
GGT (U/L)⋆ 25 (17-40) 26 (20-36) 0.618 12 (10-17) 12 (10-15) 0.931
BMI (kg/m2)     0.070     0.090
<18.5 (Underweight) 84 (1%) 1 (1%)   302 (4%) 3 (2%)  
18.5-22.9 (Normal weight) 1934 (26%) 20 (20%)   3824 (52%) 64 (40%)  
23.0-24.9 (Overweight) 2315 (31%) 28 (28%)   1681 (23%) 48 (30%)  
25.0-29.9 (Obesity) 3046 (40%) 46 (45%)   1376 (19%) 35 (22%)  
≥30.0 (Severe obesity) 182 (2%) 6 (6%)   127 (2%) 9 (6%)  
Systolic BP (mmHg) 117.5±9.4 118.4±7.7 0.261 111.4±11.4 114.7±10.6 0.001
Glucose (mg/dL) 101 (94-110) 100 (95-108) 0.949 95.0 (89-102) 96.0 (90-105) 0.078
Insulin (mU/L) 6.3 (4.4-8.8) 6.5 (4.6-8.6) 0.967 5.7 (4.1-8.1) 6.5 (4.7-9.2) 0.083
Cholesterol (mg/dL) 191.2±33.1 189.8±29.9 0.631 193.0±35.3 192.4±37.3 0.842
HDL (mg/dL) 50 (43-59) 50 (42-61) 0.789 60 (51-71) 57 (50-65) 0.001
Alcohol consumption     0.067     0.272
1 time per week 3058 (40%) 39 (39%)   6378 (87%) 137 (86%)  
2-3 times per week 2660 (35%) 39 (39%)   734 (10%) 17 (10%)  
4-6 times per week 1221 (16%) 21 (20%)   137 (2%) 4 (3%)  
7 times per week 622 (8.2%) 2 (2%)   61 (1%) 1 (1%)  

BMI: body mass index, BP: blood pressure, GGT: gamma-glutamyl transferase, HDL: high density lipoprotein

Table 2.
Unadjusted and adjusted odds ratios for presence of thyroid cancer according to GGT quartiles
  Baseline serum GGT (U/L)
Q1 Q2
 Q3
 Q4
Odds ratio p value Odds ratio p value Odds ratio p value
Male              
Cases/controls 34/1993 14/1653   32/1994   21/1918  
Model 1 1 0.50 (0.26-0.91) 0.029 0.94 (0.58-1.53) 0.807 0.65 (0.37-1.10) 0.115
Model 2 1 0.52 (0.27-0.94) 0.037 0.93 (0.57-1.51) 0.763 0.60 (0.35-1.04) 0.071
Model 3 1 0.54 (0.28-0.99) 0.054 0.92 (0.56-1.50) 0.735 0.61 (0.34-1.09) 0.099
Model 4 1 0.52 (0.27-0.96) 0.043 0.95 (0.58-1.56) 0.847 0.65 (0.36-1.17) 0.156
Female              
Cases/controls 31/1426 38/1723   59/2188   31/1952  
Model 1 1 1.01 (0.63-1.64) 0.954 1.23 (0.81-1.93) 0.343 0.73 (0.44-1.21) 0.225
Model 2 1 1.02 (0.63-1.65) 0.942 1.23 (0.80-1.93) 0.349 0.73 (0.44-1.20) 0.209
Model 3 1 1.06 (0.66-1.72) 0.780 1.18 (0.77-1.85) 0.46 0.63 (0.38-1.06) 0.080
Model 4 1 1.07 (0.67-1.74) 0.769 1.14 (0.74-1.79) 0.568 0.59 (0.35-0.99) 0.046

Model 1: unadjusted

Model 2: adjusted for matching factors age

Model 3: adjusted for matching factors age, BMI, smoking, and alcohol consumption

Model 4: adjusted for matching factors age, BMI, smoking, alcohol consumption, systolic blood pressure, serum glucose, serum cholesterol, serum HDL, and serum insulin

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