Prevalence and impact of non-alcoholic fatty liver disease in patients with papillary thyroid carcinoma

PURPOSE: Papillary thyroid carcinoma (PTC) is the most common thyroid cancer. Non-alcoholic Fatty Liver Disease (NAFLD) was possibly among the risk factors for thyroid carcinoma. It is uncertain whether NAFLD is associated with the aggressiveness of PTC. METHODS: We obtained data on patients with PTC who had undergone surgery at the First Affiliated Hospital of Wenzhou Medical University between January 2020 and February 2022. Pre-and post-operative data were obtained from electronic medical records and analyzed. Patients were split into two groups based on the NAFLD diagnostic criteria and compared using univariate and multivariate analysis through a logistic regression model. RESULTS: In all, 3468 patients with PTC were included in this study, of which 594 (17.1%) were diagnosed with NAFLD. NAFLD was found to be an independent risk factor for lymph node metastasis (OR = 1.285 95% CI: 1.052–1.570), incidence of BRAF (V600E) mutation (OR = 1.504, 95% CI: 1.148–1.972) and later tumor stage at diagnosis (OR = 2.310, 95% CI: 1.700–3.139) in PTC. The association mentioned above remained significant in subgroups of patients with Hashimoto’s thyroiditis (HT), hypertension, diabetes (DM), high triglyceride (TG) levels, low levels of high-density lipoprotein-cholesterol (HDL-C), and high body mass index (BMI). In subgroup of female rather than male, NAFLD was an independent risk factor for lymph node metastasis (OR = 1.638 95% CI: 1.264–2.123), incidence of BRAF (V600E) mutation (OR = 1.973, 95% CI: 1.368–2.846) as well as later tumor stage (OR = 2.825, 95% CI: 1.964–4.063) in PTC. However, NAFLD was not a risk factor for the larger tumor size (>1 cm), extra-thyroidal extension (ETE), or multifocality in PTC. CONCLUSION: Our cross-sectional study indicated that there is a strong association of NAFLD with higher incidence of lymph node metastasis, higher incidence of BRAF (V600E) mutation and later TNM stage than non-NAFLD in females with PTC.