Brief Article
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World J Gastroenterol. Feb 21, 2013; 19(7): 1079-1084
Published online Feb 21, 2013. doi: 10.3748/wjg.v19.i7.1079
Papillary thyroid cancer and inflammatory bowel disease: Is there a relationship?
Irene S Sonu, Wojciech Blonski, Ming Valerie Lin, James Lewis, Faten Aberra, Gary R Lichtenstein
Irene S Sonu, Division of Internal Medicine, Stanford University Hospital and Clinics, Stanford, CA 94305, United States
Wojciech Blonski, Division of Internal Medicine, UHS Wilson Medical Center, Johnson City, NY 13790, United States
Ming Valerie Lin, Division of Digestive Diseases, University of Cincinnati, Cincinnati, OH 45229, United States
James Lewis, Faten Aberra, Gary R Lichtenstein, Division of Gastroenterology, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA 19103, United States
Author contributions: Sonu IS was responsible for the study concept and design, acquisition of data, analysis and interpretation of data and drafting of the manuscript; Blonski W was responsible for the study concept and design, drafting of the manuscript, and critical revision of the manuscript for important intellectual content; Lin MV was responsible for the study concept and design and critical revision of the manuscript for important intellectual content; Lewis J and Aberra F were responsible for study concept and design, statistical analysis, and critical revision of the manuscript for important intellectual content; Lichtenstein GR was responsible for the study concept and design, critical revision of the manuscript for important intellectual content, study supervision, and guarantor of the manuscript.
Correspondence to: Gary R Lichtenstein, MD, Professor of Medicine, Division of Gastroenterology, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, 9th Floor Penn Tower, One Convention Avenue, Philadelphia, PA 19103, United States. grl@uphs.upenn.edu
Telephone: +1-215-3498222 Fax: +1-215-3495915
Received: July 1, 2012
Revised: September 28, 2012
Accepted: October 22, 2012
Published online: February 21, 2013
Abstract

AIM: To formally study age of diagnosis of papillary thyroid cancer (PTC) in inflammatory bowel disease (IBD) patients and evaluate the prevalence of PTC in IBD patients compared to a control population.

METHODS: We were interested in testing the hypothesis that patients with IBD are more likely to be diagnosed with PTC than a control population. A retrospective cohort analysis was performed using the University of Pennsylvania Health System’s electronic database. Outpatients from 1998-2009 were included in the search, and patients in the cohort were selected based on ICD-9 codes. Inclusion criteria included the diagnosis of Crohn’s disease (CD) or ulcerative colitis (UC) and the concurrent diagnosis of thyroid cancer in comparison to a control population. Using these methods 912 patients with CD and 1774 with UC were compared to 1638 diverticulitis and 19 447 asthma controls. Statistics were performed using corrected chi-square analysis. The primary outcome for this study was the diagnosis of PTC. Approval to conduct this study was obtained by the Institutional Review Board at the University of Pennsylvania.

RESULTS: The mean age was 47.5 years (range: 18-102 years) and 66% patients were female. An analysis of variance model was used to compare the age of PTC diagnosis between the CD, UC, asthma and diverticulitis groups, and a statistically significant difference in age at PTC diagnosis was noted across all groups (F = 6.35, df = 3, P = 0.0006). The age of PTC diagnosis in CD patients was statistically significantly lower than UC, asthma, and diverticulitis patients (average PTC diagnosis age for CD 25, UC 49, asthma 45, diverticulitis 63). After covarying for sex and age in 2009, the difference in age at PTC diagnosis remained statistically significant (F = 4.13, df = 3, P = 0.0089). A total of 86 patients were diagnosed with PTC. Nine patients (0.5%) with UC were diagnosed with PTC. Patients with UC were not shown to be more likely to develop PTC [odds ratio (OR): 1.544, 95%CI 0.767-3.108] compared to asthma controls. Four patients (0.4%) with CD were diagnosed with PTC. Patients with CD were not shown to be more likely to develop PTC (OR: 1.334, 95%CI 0.485-3.672) compared to a control population with asthma. Nine patients (0.5%) with a history of diverticulitis were diagnosed with PTC. Patients with diverticulitis were not shown to be more likely to develop PTC (OR: 1.673, 95%CI 0.831-3.368) compared to asthma controls. Patients with CD or UC were not less likely to develop PTC compared to those with diverticulitis (CD OR: 0.80, 95%CI 0.25-2.60; UC OR: 0.92, 95%CI 0.37-2.33). None of the patients used immunosuppressant medications prior to the diagnosis of PTC (azathioprine, 6-mercaptopurine, and methotrexate).

CONCLUSION: There is a significant difference in age of diagnosis of PTC in patients with CD compared to patients with UC and the control populations studied.

Keywords: Papillary thyroid cancer, Inflammatory bowel disease, Crohn disease, Ulcerative colitis