Pre-diagnostic vitamin D deficiency and subsequent thyroid cancer risk: a propensity-matched cohort study
Abstract
Background Vitamin D deficiency (VDD) has been implicated as a potential risk factor for thyroid cancer; however, existing evidence is derived primarily from case-control or cross-sectional studies. This study aimed to examine the association between pre-diagnostic VDD and the risk of incident thyroid cancer over a 10-year follow-up period. Methods This retrospective propensity score–matched cohort study used the TriNetX Global Collaborative Network. Adults aged ≥ 18 y with serum 25-hydroxyvitamin D [25(OH)D] measurements between 2010 and 2023 were classified as having VDD (<20 ng/mL) or vitamin D sufficiency (≥30 ng/mL). One-to-one propensity score matching was performed on demographics, comorbidities, thyroid-related disorders, laboratory values, and vitamin D supplementation. The primary outcome was incident thyroid cancer ascertained ≥ 180 day after the index date (landmark approach) over 10 y of follow-up. Positive (osteoporotic fracture) and negative (appendicitis, goiter) control outcomes and thyroid procedure utilization were evaluated to assess detection bias. Results After matching, 571,669 pairs were analyzed over a median follow-up of 6.8 y. VDD was associated with an increased risk of incident thyroid cancer (HR: 1.41; 95% CI: 1.32, 1.50), and this risk was attenuated among patients with vitamin D insufficiency (25[OH]D 20–30 ng/mL; HR: 1.27; 95% CI: 1.20, 1.34), demonstrating a dose-dependent relationship. Thyroid biopsy and ultrasonography utilization were…
How strong is the evidence?
Evidence Hub reads this as a case-control, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause.
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