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Adv Biomed Res 2023,  12:208

Evaluation of Insulin Resistance (HOMA-IR) for Patients with and without Thyroid Nodules: A Patient-Based Study

1 Department of Internal Medicine, School of Medicine, Ahvaz Jondi Shapour University of Medical Sciences, Ahvaz, Iran
2 Department of Radiology, School of Medicine, Ahvaz Jondi Shapour University of Medical Sciences, Ahvaz, Iran
3 Department of Anatomical, School of Medicine, Arak University of Medical Sciences, Arak, Iran

Date of Submission19-Mar-2021
Date of Acceptance13-Jun-2021
Date of Web Publication31-Aug-2023

Correspondence Address:
Maryam Amir Ahmadi
Department of Internal Medicine, School of Medicine, Ahvaz Jondi Shapour University of Medical Sciences, Ahvaz
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/abr.abr_63_21

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Background: The aim of this study was to assess the prevalence of insulin resistance (HOMA-IR) between patients with and without thyroid nodules.
Materials and Methods: This case–control study was performed on 86 patients with normal Thyroid-stimulating hormone (TSH) level (0.5–4.5 mIU/L) with thyroid nodules, who referred to Imam Khomeini and Golestan Hospitals (Ahvaz, Iran). Furthermore, 43 nonnodule patients with normal TSH level and normal thyroid ultrasonography were recruited from the general population as control group. The insulin resistance was evaluated for them made and the HOMA-IR ≥2.5 was defined as insulin resistance.
Results: The mean of HOMA-IR value was significantly higher in thyroid nodule patients compared to controls (3.02 ± 1.92 vs. 1.10 ± 1.55; P < 0.001). Insulin resistance was seen in 49 thyroid nodule patients (57.0%), and 4 patients (9.3%) in the control group (P < 0.0001). Waist circumference, body mass index, fasting blood sugar, triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and insulin levels were significantly higher in the thyroid nodule group.
Conclusions: Our study shows there is an association between insulin resistance and thyroid nodules. The patients with thyroid nodules have higher HOMA-IR value.

Keywords: Insulin resistance, metabolic syndrome, thyroid nodules

How to cite this article:
Moradi L, Ahmadi MA, Moaatamedfar A, Rashidi H, Zaman F, Taheri H. Evaluation of Insulin Resistance (HOMA-IR) for Patients with and without Thyroid Nodules: A Patient-Based Study. Adv Biomed Res 2023;12:208

How to cite this URL:
Moradi L, Ahmadi MA, Moaatamedfar A, Rashidi H, Zaman F, Taheri H. Evaluation of Insulin Resistance (HOMA-IR) for Patients with and without Thyroid Nodules: A Patient-Based Study. Adv Biomed Res [serial online] 2023 [cited 2023 Sep 28];12:208. Available from:

  Introduction Top

Insulin resistance (HOMA-IR) is one of the pervasive abnormalities in different societies.[1] It is considered that insulin resistance may lead to cellular proliferation and also some metabolic abnormalities.[1] A large number of studies have focused about the impact of insulin resistance syndromes on human body, but there are a limited data about its implications on prevalence of thyroids nodules in different populations. Rezzónico et al. have reported that, patients with insulin resistance syndrome possibly will have larger thyroid sizes.[2] Furthermore, a vast amount of blood insulin may pose to a significant increase for proliferation of thyroid nodules.[1] In other study, Rezzonico et al. have showed that, there is a considerable insulin resistance in their studied thyroid cancer patients.[3] Furthermore, Heidari et al. have reported that a direct correlation between thyroid malignancies and insulin resistance was seen.[4] Therefore, it seems that, insulin have an important role in human body growth and may cause to a large proliferation for the thyroid cells. According to results of some studies, the insulin resistance may pose a considerable increase in alpha-tumor necrosis factor, Interleukin-1, and also thyroid cancer prevalence.[5],[6],[7] In other study, Shin et al. have evaluated the relationship among metabolic syndrome such as insulin resistance and thyroid nodules for some of the healthy Korean population and have found that females may suffer from insulin resistance and thyroid nodules more than males.[8]

To the best of our knowledge, it is considered that data about insulin resistance and thyroid nodule for the Iranian population is scarce. Therefore, the purpose of this study was to compare the prevalence of HOMA-IR in patients with and without thyroids nodules.

  Materials and Methods Top

This case-control study was approved by the ethical committee of Ahvaz Jondi Shapour University of Medical Sciences, Ahvaz, Iran (IR. AJUMS. REC.1399.417). This work was a multi-center study performing on 129 patients who were referred to Imam Khomeini and Golestan Hospitals (Ahvaz, Iran) from October 2019 to February 2021. The all mentioned studied patients completed their consent form and also announced their agreement to participate in this work.

Patient selection

The studied participants were chosen based on the following criteria:

For case group, having normal functional thyroid tests (thyroid-stimulating hormone [TSH]: 0.5–4.5 mIU/L), an agreement to participate in this study, nodal size ≥5 mm for case group and benign thyroid nodules was necessary to include in this study. In addition, for the control group, having normal palpable thyroid, normal thyroid ultrasonic findings, and having negative diabetic laboratory findings was necessary.

Patients who had a positive diabetic laboratory results, abnormal TSH levels, thyroid nodule <5 mm, thyroid cancer, and also who underwent radiotherapy were excluded from this study.

In this work, 86 patients who had case group criteria were selected for this group and others were included for the control group. [Table 1] illustrates the demographic characteristics of the studied patients. The thyroid, body mass index (BMI), anthropomorphic factors of the patients such as Waist circumference, and also laboratory results were evaluated.
Table 1: Demographic characteristic of the studied patients

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Thyroid ultrasonography

The thyroid ultrasonography was performed using a 7.5 MHz linear transducer ultrasonography (Alpinion, Seoul, South Korea) system for the all studied patients [Figure 1].
Figure 1: The Ultrasonic images for thyroid nodule (left) and nonnodule patients (right)

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In this work, for the case group, the size, location, and the number of nodules were evaluated. In addition, if the mentioned patients had more than one nodule, the larger nodule was selected.

Insulin resistance

The insulin resistance (HOMA–IR) was calculated according to the following (equation 2):

HOMA-IR = fasting glucose serum (mMol/L) × fast insulin serum (μu/Ml)/22.5 (2)

The HOMA-IR ≥ 2.5 indicates the insulin resistance.

Statistical analysis

Mean values and standard deviations (SD) values for the patients were assessed. The SPSS (version 22, Chicago, IL, USA) software was used for the statistical significance and analysis of the differences among them. In addition, Mann–Whitney and Chi-square as nonparametric tests were employed to evaluate the findings of this work. In addition, logistic regression was used in this study. Criterion level of 0.0001 was defined for the statistical analysis.

  Results Top

[Table 1] shows the demographic characteristics for the studied mentioned patients. Based on this table, the age range of the thyroid nodules patients was significantly higher than other participants (P < 0.0001). In addition, there was a significant difference for the TSH level among them (P < 0.0001). [Table 2] illustrates The HOMA-IR for the patients. It was found that there was a significant relationship among insulin resistance and prevalence of thyroid nodule (P < 0.0001) [Table 2]. The HOMA-IR ≥2.5 was found in 49 (57%) and 4 (9.3%) patients for the case and control groups, respectively (P < 0.0001). [Table 3], illustrates the diabetes percentage of the studied patients. [Table 4] and [Table 5] show the HOMA-IR and BMI for the nonnodules and also nodular patients in two genders.
Table 2: The insulin resistance index (homeostasis model assessment-insulin resistance) for the patients

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Table 3: The diabetes percentage of the studied genders for nonnodules and nodular patients.

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Table 4: The homeostasis model assessment-insulin resistance in two genders for nonnodules and nodular patients

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Table 5: The body mass index in two genders for nonnodules and nodular patients

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The mean (±SD) number of nodular patients was 1.85 ± 0.98 (1–5 thyroid nodules). As shown in [Figure 1], many of the participants had 1 or 2 nodules (49.1%), and the mean (±SD) nodular size was 28.8 ± 12.46 mm. In this study, there were not any significant relationships between insulin resistance and the number thyroid nodule (P > 0.05).

  Discussion Top

A huge number of factors may lead to thyroid nodules such as HOMA-IR, and it is taken into account as one of the most important factors for the metabolic syndrome.[9] Moreover, HOMA-IR may cause to the prevalence of thyroid nodule and thyroid cancer. Several studies have performed about the relationship between insulin resistance and the prevalence of thyroid nodule,[10],[11],[12],[13],[14],[15],[16],[17],[18],[19] however, data about its relationship for nodular and non-nodule Iranian population is scarce. Based on our findings, HOMA-IR for thyroid nodules patients were significantly higher than nonnodules (P < 0.0001). Heidari et al. have reported that, the FPG and fasting insulin levels for the benign thyroid nodule patients was significantly higher than nonnodules patients.[4] In another study, Yaser, et al. have focused on insulin resistance in patients with euthyroid nodular goiter. In this study, they concluded that HOMA-IR was significantly higher in euthyroid patients compared to others.[20] Rezzónico et al. have reported that, patients with skin tag (which is defined as a marker of insulin resistance) have higher prevalence of thyroid nodules and larger thyroid glands compared to others.[2] In another study, Rezzonico et al. have found that, patients with thyroid nodules have an increased prevalence of insulin resistance and hyperinsulinemia compared to other studied patients.[3] It seems that, TSH is the most important growth factor for thyroid gland. TSH have prominent role in the control of expression of growth factors and its related receptors,[21],[22],[23] and also IGF-1related signals.[24] In addition, this would seem that the insulin is a thyroid growth factor which may stimulate proliferation of thyroid cells.[25] Results of some studies have shown that, IGF-I dependent and TSH independent signals may lead to growth regulation of the human thyroid gland. It is mainly due to physiologic conditions and not related to an increased TSH secretion. Moreover, the IGF system consists of ligands network (IGF-1 and IGF-2) and also their related receptors (IGF-1receptor), which are largely homologous for insulin and its receptor as well.[26] Furthermore, insulin/IGF-1 signal pathways can modulate the thyroid gene regulate expression, and may lead to thyroid cells proliferation and differentiation.[27] It should be noted that IGF-1, IGF-2 receptors and also insulin receptor isoforms can be expressed at high levels in the process of thyroid follicular cells. Therefore, our findings are highly due to the activation of insulin pathway which is resulted from the activation of the IGF system.

Based on our findings, the relationship among HOMA-IR and prevalence of thyroid nodules is significant. In this study, it was found that the mean (±SD) of HOMA-IR (3.02 ± 1.91) for thyroid nodule patients was considerably higher than others (1.55 ± 1.1).

  Conclusions Top

In this study, the relationship of HOMA-IR for patients with and without thyroid nodules was investigated.

According to our findings, there is a significant relationship between HOMA-IR and thyroid nodules in our studied patients. Further research and studies are recommended to evaluate the relationship of HOMA-IR and prevalence of thyroid nodules in other populations.


The authors of this study would like to thank the Ahvaz Jondi Shapour University of Medical Silences, Ahvaz, Iran, for support of this work.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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Rezzónico J, Rezzónico M, Pusiol E, Pitoia F, Niepomniszcze H. High prevalence of thyroid nodules in patients with achrocordons (skin tags). Possible role of insulin-resistance. Medicina (B Aires) 2009;69:302-4.  Back to cited text no. 2
Rezzonico J, Rezzonico M, Pusiol E, Pitoia F, Niepomniszcze H. Introducing the thyroid gland as another victim of the insulin resistance syndrome. Thyroid 2008;18:461-4.  Back to cited text no. 3
Heidari Z, Abdani M, Mansournia MA. Insulin resistance associated with differentiated thyroid carcinoma: Penalized conditional logistic regression analysis of a matched case-control study data. Int J Endocrinol Metab 2018;16:e14545.  Back to cited text no. 4
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Blanc E, Ponce C, Brodschi D, Nepote A, Barreto A, Schnitman M, et al. Association between worse metabolic control and increased thyroid volume and nodular disease in elderly adults with metabolic syndrome. Metab Syndr Relat Disord 2015;13:221-6.  Back to cited text no. 16
Yin J, Wang C, Shao Q, Qu D, Song Z, Shan P, et al. Relationship between the prevalence of thyroid nodules and metabolic syndrome in the iodine-adequate area of Hangzhou, China: A Cross-Sectional and Cohort Study. Int J Endocrinol 2014;2014:675796.  Back to cited text no. 17
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  [Figure 1]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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