الفهرس 
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Abstract
Background: The insulin/IGF-1 signalling pathway modulates the regulation of thyroid gene expression and it is an important factor in the proliferation and differentiation of thyroid cells. Numerous growth factors are identified in thyroid tissue: like epidermal growth factor (EGF), transforming growth factor-alpha (TGF-alpha), insulin-like growth factor-1 (IGF-1), IGF1-receptor (IGF-R) and IGF binding proteins (IGFBPs) Overexpression of these growth factors and/or their receptors may play a role in the growth of the thyroid nodules. in addition to TSH, insulin is also a thyroid growth factor that stimulates the growth of thyroid cells.
Aim of Work: The aim of this study was to investigate the possible association between IGF-1 and thyroid nodules by determining the effect of serum IGF-1 on thyroid nodules and its u/s findings and to investigate IGF-1 relation with insulin resistance (IR) and whether IR and obesity also plays a role in the thyroid nodular formation and its ultrasonography(u/s) findings
Subjects and methods: This study is a cross sectional study conducted on 80 medically free euthyroid subjects with thyroid nodules detected by clinical examination (palpation) and radiologically by neck u/s screening selected from outpatient endocrine clinic at Ain Shams University hospitals. For all participants, the following investigations were done: Glycaemic profile (fasting plasma glucose (mg/dl), 2hours post prandial plasma glucose (mg/dl, HbA1C(%)), Lipid profile (total cholesterol (mg/dl), LDL (mg/dl), HDL (mg/dl), triglycerides (mg/dl)),The thyroid function tests (free tetra iodothyronine (FT4), (free tri iodothyronine (FT3) and serum thyroid stimulating hormone (TSH), IGF-1 determined by enzyme linked immunosorbent assay (ELISA), Fasting serum insulin determined by ELISA, HOMA-IR was determined for all patients as a quantitative method for insulin resistance. Neck u/s was done for all patients with colour doppler and comment on TIRADS score of the nodule.
Results: The study conducted on 80 medically free euthyroid subjects with thyroid nodules and revealed that IGF-1 was high in patients with thyroid nodules. but there was no statistical association with nodular number, size or volume, p value (0.184,0.75,0.25), respectively. there was a statistically significant association between IGF-1 and TIRADS score of the nodule, p value= (0.039). There was an association between HOMA-IR, volume and size of the nodules, p value (0.023,0.013), respectively. but no statistical significance with number of the nodules, p value (0.279). by logistic regression analysis HOMA-IR can’t be used as a predictor of nodular size and volume p value (0.384). There was no statistical significance between presence of metabolic syndrome and number length volume or TIRADS score of the nodules, p value (> 0.05). Also, there was no association between serum IGF-1 and HOMA-IR, p value (0.077).
Conclusion: IGF complex is involved in thyroid development and seems to play an important role in thyroid nodules. There was an association between IGF-1 and thyroid nodules. IR also plays a role in the thyroid nodular formation and its ultrasonography(u/s) findings . Presence of Insulin resistance leads to higher nodular volume and size in non-diabetic euthyroid patients but HOMA-IR can’t be used as a predictor of nodular size or volume.