Additionally, insulin resistance and hyperinsulinemia enhance thyroid tissue development, which can cause nodular thyroid disease and a goiter. Furthermore, the literature suggests that subclinical hypothyroidism or hyperthyroidism raises blood pressure and cholesterol levels, impairs insulin secretion, and compromises both micro- and macrovascular function, increasing the risk of peripheral neuropathy, peripheral artery disease, and diabetic nephropathy. This evidence concerns the gene INS and goiter.