title: Subclinical hypothyroidism is associated with increased risk for cancer mortality in adult Taiwanese-a 10 years population-based cohort.
abstract: BACKGROUND
  The association between subclinical hypothyroidism (SCH) and cancer mortality is seldom discussed.
  
  
  METHODS
  A total of 115,746 participants without thyroid disease history, aged 20 and above, were recruited from four nationwide health screening centers in Taiwan from 1998 to 1999. SCH was defined as a serum thyroid-stimulating hormone (TSH) level of 5.0-19.96 mIU/L with normal total thyroxine concentrations. Euthyroidism was defined as a serum TSH level of 0.47-4.9 mIU/L. Cox proportional hazards regression analyses were used to estimate the relative risks (RRs) of death from cancer for adults with SCH during a 10-year follow-up period.
  
  
  RESULTS
  Among 115,746 adults, 1,841 had SCH (1.6%) and 113,905 (98.4%) had euthyroidism. There were 1,532 cancer deaths during the 1,034,082 person-years follow-up period. Adjusted for age, gender, body mass index, diabetes, hypertension, dyslipidemia, smoking, alcohol drinking, betel nut chewing, physical activity, income, and education level, the RRs (95% confidence interval) of cancer deaths among subjects with SCH versus euthyroid subjects were 1.51 (1.06 to 2.15). Cancer site analysis revealed a significant increased risk of bone, skin and breast cancer among SCH subjects (RR 2.79, (1.01, 7.70)). The risks of total cancer deaths were more prominent in the aged (RR 1.71, (1.02 to 2.87)), in females (RR 1.69 (1.08 to 2.65)), and in heavy smokers (RR 2.24, (1.19 to 4.21)).
  
  
  CONCLUSIONS
  Subjects with SCH had a significantly increased risk for cancer mortality among adult Taiwanese. This is the first report to demonstrate the association between SCH and cancer mortality.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Fen-Yu
authors.initials: FY
authors.lastname: Tseng
authors.affiliation: Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Graduate Institute of Clinical Medicine Science, China Medical University, Taichung, Taiwan.
authors.forename: Wen-Yuan
authors.initials: WY
authors.lastname: Lin
authors.affiliation: Medical Research, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Chia-Ing
authors.initials: CI
authors.lastname: Li
authors.affiliation: Medical Research, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan; Institute of Health Care Administration, College of Health Science, Asia University, Taichung, Taiwan.
authors.forename: Tsai-Chung
authors.initials: TC
authors.lastname: Li
authors.affiliation: Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Graduate Institute of Clinical Medicine Science, China Medical University, Taichung, Taiwan; Institute of Health Care Administration, College of Health Science, Asia University, Taichung, Taiwan.
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Family Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine Science, China Medical University, Taichung, Taiwan.
authors.forename: Kuo-Chin
authors.initials: KC
authors.lastname: Huang
mesh_terms: D000328:Adult; D058070:Asymptomatic Diseases / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000150:complications / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology / Q000401:mortality*; D016016:Proportional Hazards Models; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
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