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Figure 1: Pathophysiology proposed to link diabetes and thyroid cancer together. Diabetes mellitus may affect mitogenic pathway of the follicular cells through several mechanisms. Increased insulin amount stimulates follicular cells because of its structural similarity to insulin-like growth factor. Increased TSH stimulated AC/cAMP/PKA pathway. Increased body mass index will increase adipokines and subsequently stimulate mitogenic pathways. Antidiabetic medicines of sulfonylurea and insulin contribute to the elevated insulin level. Hyperglycemia and hypertriglycemia increase oxidative stress and stimulate mitogenic pathway. Vitamin D deficiency decreases deiodinase 2, T3 and GLUT4 transcription, which subsequently increase TSH and insulin levels and activate mitogenic pathways.