Thyroid. 2021 Dec 31; doi: 10.1089/thy.2021.0361. Epub 2021 Dec 31.
Sex Differences in Differentiated Thyroid Cancer.
Thyroid : official journal of the American Thyroid Association
Leila Shobab, Kenneth D Burman, Leonard Wartofsky
Affiliations
Affiliations
- MedStar Washington Hospital Center, 8405, Endocrinology, 110 Irving St. NW, Room 2A72, Washington, District of Columbia, United States, 20010-2975; [email protected].
- Washington Hospital Center, Endocrine, 110 Irving St. NW, Washington, District of Columbia, United States, 20010; [email protected].
- Washington Hospital Center, Medicine, 110 Irving Street, NW, Washington, District of Columbia, United States, 20010; [email protected].
PMID: 34969307
DOI: 10.1089/thy.2021.0361
Abstract
Sex dimorphism strongly impacts tumor biology with most cancers having a male predominance. Uniquely, thyroid cancer is the only non-reproductive cancer with striking female predominance with 3-4-fold higher incidence among females, although males generally have more aggressive disease. The molecular basis for this observation is not known and current approaches in treatment and surveillance are not sex specific. Although thyroid cancer has overall good prognosis, 6-20% of patients develop regional or distant metastasis, one third of whom are not responsive to conventional treatment approaches and suffer a 10-year survival rate of only 10%. More efficacious treatment strategies are needed for these aggressive thyroid cancers as tyrosine kinase inhibitors and immunotherapy have major toxicities without demonstrable overall survival benefit. Emerging evidence indicates a role of sex-hormones, genetics and the immune system in modulation of both risk for thyroid cancer and its progression in a sex-specific manner. Greater understanding of the molecular mechanisms underlying sex-differences in thyroid cancer pathogenesis could provide insights to the development of sex-specific, targeted, effective strategies for prevention, diagnosis, and management. This review summarizes emerging evidence for the importance of sex in the pathogenesis, progression, and response to treatment in differentiated thyroid cancer with emphasis on the role of sex-hormones, genetics and the immune system.
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