Low Urinary Iodine is a Protective Factor of Central Lymph Node Metastasis in Papillary Thyroid Cancer: A Cross-sectional Study

Abstract Background: An abrupt increase of thyroid cancer has been witnessed paralleling the supplemented iodine intake in formerly iodine-deficient countries. And increased iodine intake has been linked to the rising incidence rate of papillary thyroid cancer (PTC). However, the correlation between iodine and clinicopathological features of PTC has not been well-characterized. This study aimed to investigate the associations between iodine intake and the clinicopathological features of PTC patients.Methods: 359 PTC patients who have received surgical treatment in Peking Union Medical College Hospital from May 2015 to November 2020 were retrospectively reviewed. The associations between urinary iodine (UI), urinary iodine/creatinine ratio (UI/U-Cr) and the clinicopathological features of PTC were analyzed. Univariate and multivariate analysis were performed to investigate the relationship between UI level and central lymph node metastasis (CLNM).Results: There were no significant differences of UI in different groups according to the variables studied, except that patients with CLNM had higher UI level than CLNM(-) patients. No associations were found between UI/U-Cr and clinicopathological features except variant subtypes (classic/follicular). After dividing patients into high-iodine group and low-iodine group, more patients were found to have CLNM in high-iodine group (p=0.017). In addition, younger age, larger tumor size and classic variant positively correlated with CLNM (p<0.05). Univariate analysis showed that insufficient iodine intake (≤ 99 μg/L) were associated with decreased CLNM risk in PTC. And after defining insufficient iodine intake as ≤ 109 μg/L and above requirements as ≥ 190 μg/L, multivariate analysis showed that lower iodine was associated with CLNM in total population of PTC (OR: 0.53, 95 % CI: 0.31 - 0.91) and in PTC < 1cm (papillary thyroid microcarcinoma, PTMC) (OR: 0.43, 95 % CI: 0.21 - 0.87).Conclusions: Low iodine was a protective factor for CLNM in papillary thyroid cancer, particularly in those < 1 cm. These results indicated that iodine may not only be an initiator of tumorigenesis, but also a promoter of the development of PTC.