降糖药物对甲状腺癌的影响
糖尿病患者的降糖方案对甲状腺癌的发生也具有一定的影响，但是目前的研究结果不完全一致。中国台湾学者Tseng C H报道磺脲类药物可以增加甲状腺癌的发生率。西格列汀的使用可以增加糖尿病患者甲状腺癌的风险。但是Luo J对147 934例绝经期后女性（Women's Health Initiative数据库）进行平均随访15.9年并未发现降糖药物可以使得甲状腺癌的风险增加[25]。另外一项研究提示二甲双胍、罗格列酮可以降低糖尿病患者甲状腺癌的风险。Jang E K的研究认为二甲双胍的使用可以延长伴有颈部淋巴结转移的分化型甲状腺癌患者的无疾病的存活时间。在糖尿病合并颈部淋巴结转移的分化型甲状腺癌患者中，二甲双胍使用组无疾病存活时间（Disease-Free Survival，DFS）更长（17.1年vs 8.6年，HR 0.16， P = 0.021），且经过多元回归校正年龄、BMI、糖尿病病程、同位素治疗后Tg水平等因素后，仍然具有显著统计学意义。也有研究得到不同的结果。Becker C通过基于英国的CPRD（Clinical Practice Research Datalink）数据库进行病例对照研究认为二甲双胍（或者其他降糖药物）的使用并不能降低糖尿病患者甲状腺癌的发生率。人胰岛素的使用不增加甲状腺癌的风险。Drab S R通过对MEDLINE数据库的回顾性分析得出目前的证据并不支持胰高血糖素样肽1受体激动剂增加甲状腺癌的风险。Paulus Y M发现在年龄小于44岁的甲状腺癌患者中，糖尿病的发生率明显增加。但是对于所有年龄患者而言，甲状腺癌患者与非甲癌患者相比糖尿病发生率无明显增加。
总之，甲状腺结节和肿瘤与糖尿病以及糖尿病前期有着复杂的关系。总体而言，糖尿病和糖尿病前期是甲状腺结节以及甲状腺肿瘤的危险因素。其中肥胖、胰岛素抵抗、TSH等因素可能是两者相关联的中间因素。不同研究结果呈现不完全一致的结果可能与研究方法以及入选的人群有关。关于两者的关系还需要进一步的研究来证实。
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