Association of Menopausal Status with Thyroid Nodule Prevalence and Size in Women with Hypothyroidism

Objective: To examine the association between menopausal status and thyroid nodule prevalence and size in women with hypothyroidism.

Methods: In this retrospective comparative study, we reviewed 149 women with hypothyroidism seen in outpatient clinics at a tertiary care hospital. Hypothyroidism was defined as a documented clinical diagnosis supported by elevated thyroid-stimulating hormone (TSH) with low or normal thyroxine (T4). Women were classified as being in the reproductive period or postmenopausal; postmenopause was defined as amenorrhoea for at least 12 months or documented postmenopausal status in the medical record. Group comparisons used the chi-square test, independent-samples t-test, or Mann-Whitney U test, as appropriate. Crude ORs with 95% CIs were calculated for key dichotomous nodule outcomes.

Results: Of the 149 women, 89 (59.7%) were of reproductive age, and 60 (40.3%) were postmenopausal. Thyroid nodules were present in 61 (40.9%) patients. Postmenopausal women had a higher prevalence of nodules than reproductive-age women (56.7% vs 30.3%; crude OR, 3.00; 95% CI, 1.52–5.94; P=0.002). Nodules >1 cm were also more frequent after menopause (25.0% vs. 9.0%; crude OR, 3.38; 95% CI, 1.33–8.57; P=0.029). TSH, T4, anti-thyroid peroxidase (anti-TPO) levels, anti-TPO positivity, and levothyroxine use did not differ significantly between the groups.

Conclusion: Among women with hypothyroidism, postmenopausal status was associated with a greater thyroid nodule burden and a higher frequency of nodules >1 cm. Because age and menopausal status were closely linked, the findings should be interpreted as unadjusted associations rather than independent effects of menopause.