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Vitamin D3 Deficiency, Rather Than Vitamin D2, Is Associated with Thyroid Nodules with Malignant Ultrasound Characteristics in Male Petroleum Workers: A Retrospective Cohort Study

epidemiology
nutrition
public-health

Abstract

Background: Thyroid nodules (TNs) are common thyroid disorders. Vitamin D (VD) is linked to thyroid disease risk, but prior studies mainly focused on total serum VD and TN risk, ignoring the different impacts of VD3 and VD2 metabolites on TN development.

Methods: A retrospective cohort study was conducted from July 2021 to December 2021. The study was conducted at the Health Management Center, the Second Hospital of Dalian Medical University, Dalian, China. A total of 2,037 y oung-to- m middle- a ged euthyroid male petroleum workers (YMAEMPWs) aged 30–60 years without TAI were enrolled. Serum 25-hydroxy vitamin D [25(OH)VD], 25(OH)VD3, and 25(OH)VD2 levels were assayed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The participants were classified into different groups according to their ultrasound images of TNs based on the Chinese-Thyroid Imaging Reporting and Data System (C-TRIADS). C-TRIADS consists of 6 grades, and the upper three indicate TNs with potential malignancy.

Results: No C-TRIADS 5 or 6 nodules were found in these participants. The serum 25(OH)VD level in the C-TIRADS 4 TN group was significantly lower than that in the C-TIRADS 1, C-TIRADS 2, and C-TIRADS 3 groups. The overall prevalence of TNs was similar among the VD-deficient, insufficient, and sufficient groups. However, the prevalence of patients with C-TIRADS 4 TNs was markedly higher in the VD-deficient group (18.5%) than in the insufficient (5.5%, P. adj < 0.05) and sufficient groups (4.1%, P. adj < 0.05). Identical findings were observed among the groups with low, medium, and high serum 25(OH)VD3 levels, but not among those with different serum 25(OH)VD2 levels. Binary logistic regression analysis revealed that low VD 3 levels [ 25(OH)VD3 < 19.07 ng/mL ] were associated with a significantly increased risk of developing C-TIRADS 4 TNs, with an adjusted odds ratio (OR) of 4.50 [95% confidence interval (CI): 2.94 – 6.87 ; P < 0.001], compared to high VD 3 levels, after adjusting for confounding variables such as age, body mass index (BMI), thyroid function, and autoantibodies.

Conclusions: VD3 deficiency—but not VD2 deficiency—constituted an independent risk factor for TNs demonstrating suspicious malignant ultrasound characteristics in YMAEMPWs without TAI.

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