Prevalence and risk of thyroid disease among adult primary aldosteronism patients: a systematic review, meta-analysis, and trial sequential analysis

TL;DR

This study finds that people with primary aldosteronism are more likely to have thyroid nodules, suggesting the need for thyroid screening in these patients.

Contribution

The first meta-analysis to explore the link between primary aldosteronism and thyroid disease, identifying thyroid nodules as the main driver.

Findings

PA patients had a 33% higher overall prevalence of thyroid diseases compared to controls.

Thyroid nodules were significantly more common in PA patients (85% higher prevalence).

No significant associations were found between PA and other thyroid conditions like cancer or thyroiditis.

Abstract

Primary aldosteronism (PA), the most prevalent curable secondary hypertension, and thyroid diseases (the second most common endocrine disorder) are increasingly linked, yet their mechanistic connections remain unclear.

Four databases (PubMed, Embase, Web of Science, Cochrane Library) were searched for case-control studies. Random-effects meta-analysis and subgroup analyses for thyroid disease subtypes were performed. Sensitivity/trial sequential analyses and Begg’s test evaluated robustness/publication bias.

Our meta-analysis included five case-control studies, encompassing 1,368 patients with primary aldosteronism (PA) and 6,774 controls. While the overall prevalence of thyroid diseases was higher in PA patients (OR: 1.33, 95% CI: 1.03-1.71, p=0.03), subgroup analysis revealed that this association was primarily driven by a significantly increased prevalence of thyroid nodules (OR: 1.85, 95% CI: 1.23-2.80, p=0.003). No statistically significant associations were found between PA and other specific thyroid conditions, including hyperthyroidism, hypothyroidism, thyroiditis, or thyroid cancer (all p > 0.05).

This first meta-analysis demonstrates a significant PA-thyroid disease association. The elevated overall risk of thyroid disease in PA patients appears to be largely attributable to the high burden of thyroid nodules. These findings suggest that patients with PA may benefit from targeted screening for thyroid nodules.

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