Early efficacy of radiofrequency ablation for multifocal T1N0M0 papillary thyroid carcinoma: a multicenter study

OBJECTIVES

This study aimed to assess the efficacy and safety of radiofrequency ablation (RFA) for multifocal papillary thyroid carcinoma (M-PTC) and compare these outcomes with those for unifocal papillary thyroid carcinoma (U-PTC).

METHODS

This retrospective multicenter study included 465 patients (367 women and 98 men) who underwent RFA for either U-PTC (411 patients) or M-PTC (54 patients) between May 2015 and October 2022. Patients were followed up at 1, 3, 6, and 12 months post-RFA, then every 6 months in the second year, and annually thereafter. After 1:1 propensity score matching (PSM), local tumor progression rate (LTP), tumor volume, volume reduction rate (VRR), tumor complete response rate (CDR), and complications were evaluated and compared between the M-PTC and U-PTC groups during the follow-up period.

RESULTS

The median follow-up time was 23 months. The median follow-up time for the U-PTC and M-PTC groups was 23 months and 23.5 months, respectively. The overall local tumor progression rate was 0.9% (4/465), and the overall complication rate was 0.6% (3/465). After PSM, no significant differences were observed between the U-PTC and M-PTC groups regarding tumor volume (p = 0.377), VRR (p = 0.151), CDR (50% vs. 44.2%, p = 0.556), or LTP (1.9% vs. 0%, p = 0.556). Additionally, the complication rates were not significantly different between the groups (1.03% vs. 2.5%, p = 0.343).

CONCLUSION

After adequate preoperative evaluation, RFA is an effective and safe treatment for appropriately selected patients with M-PTC, with a prognosis similar to that of U-PTC.

Impact of Hashimoto's thyroiditis on radiofrequency ablation for papillary thyroid micro-carcinoma: a cohort study of 391 patients

PURPOSE

To assess the impact of Hashimoto's thyroiditis (HT) on radiofrequency ablation (RFA) outcomes for papillary thyroid microcarcinoma (PTMC).

METHODS

A retrospective study of 391 PTMC patients treated with RFA from March 2017 to August 2020, divided by HT accompanied or not. Ablation area size, volume reduction ratio (VRR), lesion disappearance, complications, and recurrences were analyzed.

RESULTS

391 patients (mean age, 41.3 ± 11.2 [SD]; 317 women, 110 with HT) were evaluated. The follow-up time was 2 years. HT+ PTMC patients (Group A) exhibited larger ablation diameters at 1st and 3rd month post-RFA. In comparison, PTMC patients (Group B) had larger diameters at 1st and 3rd months but smaller at 6th months, returning to baseline around 6th month in Group B and 9th month in Group A. VRRs in Group B were greater than Group A at 3rd, 6th, 9th, 12th and 15th month, all p < 0.05). The Kaplan-Meier curves revealed a slower lesion disappearance rate in A (12th) compared to B group (9th). Complication and recurrence rates were similar for both groups (4.4% and 0.8% overall, Group B vs Group A: 4.3% vs 4.6%, p = 0.905; 0.4% vs 1.8%, p = 0.192).

CONCLUSION

HT delays the resorption of PTMC lesions following RFA, but it does not impact the procedure's effectiveness or safety. Regardless of HT status, RFA remains a viable alternative to surgery for PTMC.

Associations between preoperative thyroid parameters, aggressive clinicopathological features and risk of recurrence in differentiated thyroid cancer

OBJECTIVE

The study aimed (1) to investigate the association between aggressive clinicopathological characteristics and the American Thyroid Association (ATA) recurrence risk classification in differentiated thyroid cancer (DTC) patients, and (2) to investigate the prognostic value of preoperative thyroid parameters.

METHODS

A total of 3833 patients histologically confirmed DTC were recruited. Preoperative clinical and postoperative pathologic data were retrospectively collected. Participants were stratified into low recurrence risk and intermediate-to-high recurrence risk groups based on the ATA risk stratification system.

RESULTS

The study cohort had a mean age of 48.87 ± 8.08 years, and 1,465 (76.82%) were female. Male (OR = 1.37, p = .024), aged 52 years and older (OR = 2.01, p < .001), larger tumor size (OR = 3.71, p = 0.011), nerve invasion (OR = 6.69, p = .004), margin involvement (OR = 5.46, p < .001), multifocality (OR = 3.71, p < .001), and bilaterality (OR = 3.95, p < .001) were identified as risk factors for a higher ATA recurrence risk classification, in addition to established factors such as lymph node metastasis and angioinvasion, after adjusting for potential confounding variables. Higher preoperative levels of free triiodothyronine (FT3), FT3 to free thyroxine (FT3/FT4), and lower thyroid feedback quantile-based index (TFQI) levels were associated with a higher ATA recurrence risk classification. The comprehensive predictive model incorporating these variables demonstrated excellent discrimination (AUC = 0.836). Furthermore, higher FT3/FT4 levels and lower TFQI levels were associated with higher risk of lymph node metastases and angioinvasion.

CONCLUSIONS

Factors such as male sex, older age, multifocality, bilaterality, margin involvement, nerve invasion, larger tumor size, and preoperative thyroid parameters serve as complementary predictors for higher ATA recurrence risk in DTC, in addition to conventional risk factors. These insights contribute to a more nuanced understanding and optimization of current risk stratification methodologies.

Frequency of ischemic cardiac events in patients receiving long-term multikinase inhibitor: A report of three cases

Objective

To investigate the incidence and characteristics of ischemic cardiac events, specifically major adverse cardiac events (MACE), in patients undergoing long-term treatment with multikinase inhibitors (MKIs) such as lenvatinib and sorafenib.

Methods

A single-center retrospective analysis was conducted on 41 patients treated with lenvatinib or sorafenib for more than one year at our institution from 2015 to 2022. Patient records were reviewed to collect data on demographics, cancer type, cardiovascular risk factors, MKI treatment duration, and MACE incidence. MACE events, defined as acute heart failure, fatal arrhythmia, acute myocardial infarction, and coronary revascularization, were analyzed to determine potential correlations with MKI therapy.

Results

Among the 41 patients, three (7.3%) developed MACE, presenting as acute heart failure, fatal arrhythmia, and acute myocardial infarction, all associated with significant coronary artery stenosis. Notably, none of these patients had a prior history of cardiovascular disease. Despite variations in clinical presentation, all cases suggested a link between long-term MKI administration and accelerated coronary atherosclerosis. Factors involved in atherosclerosis were significantly older and tended to be more hypertensive in the non-MACE group.

Conclusions

Long-term MKI therapy may increase the risk of severe ischemic cardiac events, likely due to accelerated atherosclerosis. Clinicians and oncology nurses should monitor patients closely for early signs of angina, especially in an outpatient setting, to prevent acute cardiac events. Further large-scale studies are warranted to establish a clearer causal relationship between MKI therapy and cardiovascular risks.

Thyroid nodule rupture after thermal ablation for benign thyroid nodules: incidence, risk factors, and clinical management

BACKGROUND

Thyroid nodule rupture (TNR) is a rare and severe complication after thermal ablation (TA), mostly from benign thyroid nodules (BTN).

OBJECTIVE

To summarize the incidence of TNR after TA and analyze the causes and prevention strategies.

MATERIALS AND METHODS

This retrospective study enrolled 3971 patients who underwent TA for BTN from January 2014 to March 2024. The incidence, causes, and risk factors of TNR were analyzed. Propensity score matching (PSM) controlled for confounding factors. Multivariate regression identified risk factors for TNR. ROC curves determined the optimal cutoff value for the maximum diameter (MD) for TNR.

RESULTS

TNR occurred in 8 cases [0.2% (8/3971)]. The mean time from TA to TNR was 29.6 ± 13.0 days (range, 20-60 days). After PSM, MD was larger in the TNR group than in the non-TNR group [mean 4.1 ± 1.6 cm vs. mean 1.8 ± 1.2 cm; p < 0.001]. The optimal cutoff value of MD for TNR was 2.75 cm. After PSM, the incidence of pressure on the ablation zone was significantly higher in the TNR group than in the non-TNR group [100% (8/8) vs. 0 (0/32); p < 0.001], which has been suspected as a case of TNR. Antibiotic drugs, aspiration, or incision drainage could successfully manage all TNR cases.

CONCLUSION

TNR could be encountered in case of pressure on the BTN after TA. Protecting the ablation site from pressure might be crucial in preventing TNR, especially within two months. TNR is more likely to occur if the MD of BTN exceeds 2.75 cm under pressure. Observation, antibiotics, and aspiration could successfully manage all TNR cases.

The clinical value of Delphian and pre-tracheal lymph nodes in predicting lateral lymph nodes metastasis of papillary thyroid carcinoma

BACKGROUND

Occult lymph node metastasis of papillary thyroid carcinoma is common. However, whether undergoing prophylactic lateral lymph node dissections is still controversial. This cross-sectional study with large cohort of patients aims to investigate the clinical value of Delphian and pre-tracheal lymph node in predicting lateral lymph node metastasis of papillary thyroid carcinoma.

MATERIALS AND METHODS

A retrospective analysis was conducted on 865 papillary thyroid carcinoma patients with Delphian and pre-tracheal lymph node data who underwent thyroidectomy plus central and lateral lymph node dissection. Data on clinicopathological characteristics were collected. Subsequently, a predictive model was established based on the results of the univariate and multivariate analyses.

RESULTS

The rates of Delphian and pre-tracheal lymph node metastasis and lateral lymph node metastasis were 54.7% and 39.1%, respectively. Having ≥ 3 or 1-2 Delphian and pre-tracheal lymph node metastasis dramatically increased the risk of lateral lymph node metastasis (OR = 8.5, 95% CI 5.3-13.4 and OR = 3.9, 95% CI 2.7-5.7, respectively). The upper tumour had a 3.7 times higher risk of lateral lymph node metastasis than other locations. Patients ≤ 42 years or tumour size >8 mm had a higher risk of lateral lymph node metastasis.

CONCLUSIONS

Delphian and pre-tracheal lymph node metastasis was associated positively with the risk of lateral lymph node metastasis. For patients without clinical lateral lymph node metastasis, the Delphian and pre-tracheal lymph node could be considered to harvest as the first step in a thyroidectomy to facilitate further conduct of the operation.

Comparison of US-guided thermal ablation and surgery for papillary thyroid cancer: a systematic review and meta-analysis

OBJECTIVE

We conducted the systematic review and meta-analysis to comprehensively compare ablation and surgery in terms of effectiveness, safety and multiple factors affecting life quality of patients with papillary thyroid cancer (PTC).

METHODS

PubMed, Embase, Scopus, Web of Science and EBSCO were searched for relevant studies published between January 1980 and September 2023. Two reviewers independently extracted data according to the PRISMA recommendations and assessed the quality of each study with the Cochrane Risk of Bias Tool. Pooled analyses were performed using random or fixed-effects models, as appropriate.

RESULTS

A total of 4829 patients with PTC from 19 eligible studies were included. Through the meta-analysis, similar tumor progression (OR: 1.07; 95% CI 0.78, 1.48; p = 0.66) and recurrence-free survival (OR: 0.86; 95% CI, 0.55, 1.34; p = 0.50) were found between the patients undergoing ablation and those undergoing surgery. More strikingly, the lower risk of major complications (OR: 0.31; 95% CI 0.24, 0.41; p < 0.001), the shorter hospital stay (MD = 3.67 d; 95% CI, -4.89, -2.44; p < 0.001), the abbreviated procedure time (MD: -66.33 min, 95% CI, -77.08, -55.59; p < 0.001), the less intraoperative blood loss (MD: -27.43 ml, 95% CI, -34.60, -20.27; p < 0.001) and the lower treatment cost (MD: -860.42 USD, 95% CI, -1008.03, -712.81; p < 0.001) were noticed in ablation techniques compared to surgical operation. Thermal ablation has shown multiple advantages by virtue of its percutaneous puncture compared with surgical resection.

CONCLUSION

As an effective, safe, minimally invasive and economical modality, thermal ablation might be a promising alternative to existing PTC management options.

ITGA3-MET interaction promotes papillary thyroid cancer progression via ERK and PI3K/AKT pathways

BACKGROUND

Studies have examined the role of integrin α3 (ITGA3) in papillary thyroid carcinoma (PTC). However, the functional and molecular mechanism by which ITGA3 is involved in the progression of PTC remains poorly understood.

METHODS

To investigate the role of ITGA3 in PTC, raw PTC transcriptome data underwent comprehensive bioinformatics analyses, including differential expression, co-expression network, and enrichment analyses. ITGA3 expression was validated via immunohistochemistry and western blotting in PTC tissues. Cell functional assays and xenograft models assessed PTC cell behaviour. The potential mechanisms of ITGA3 were elucidated using bioinformatics analyses, western blotting, co-immunoprecipitation, and immunofluorescence. Finally, integration of ITGA3 expression with clinical parameters enabled nomogram construction for precise prediction of cervical lymph node metastasis (CLNM) in PTC.

RESULTS

ITGA3 was upregulated in PTC and associated strongly with CLNM (79.5% vs. 53.84%, p = 0.016). ITGA3 expression enhanced PTC proliferation and migration in vitro and in vivo via cooperating with the MET protein tyrosine kinase, followed by phosphorylation of MET at Tyr1234/1235, and activation of ERK and PI3K/AKT signaling pathways. Furthermore, upregulation ITGA3 reduced phosphorylation at FAK-Tyr397 and Src-Tyr416 in PTC cells. Finally, a nomogram combining ITGA3 expression and clinical parameters for predicting CLNM was constructed and validated, achieving a ROC curve AUC of 0.719, suggesting potential application for PTC diagnosis.

CONCLUSIONS

ITGA3 promotes PTC cell proliferation and migration by cooperating with MET to activate MET-ERK and MET-PI3K-AKT signalling. ITGA3-MET cooperation may serve as a potential therapeutic target.

TSH inhibits osteoclast differentiation through AMPK signaling pathway

PURPOSE

It is believed that osteoporosis (OP) is associated with hyperthyroidism as a result of the elevation in thyroxine levels. However, patients with subclinical hyperthyroidism, which is characterized by decreased levels of thyroid-stimulating hormone (TSH) alone, are at equal risk of osteoporosis. Research has shown that TSH receptor (TSHR) is expressed on osteoclasts, but whether TSH directly regulates osteoclasts and the underlying mechanisms remain unclear.

METHODS

In this study, we used osteoclast precursor cell conditional TSHR-knockout (TSHR CKO) mouse to study the effects of TSHR knockout on bone metabolism in mice and the changes in osteoclast differentiation in vitro. Transcriptomics was used to identify differentially expressed genes and signaling pathways.

RESULTS

In vitro, experiments confirmed that TSH inhibited osteoclast differentiation in mouse RAW264.7 monocyte/macrophage cell line and targeted the key signaling pathway AMPK by RNA-seq sequencing. We found TSHR CKO mice exhibited decreased femoral biomechanics and damaged bone microstructure. The serum levels of bone resorption marker were increased, accompanied by an increase in the number of osteoclasts.

CONCLUSION

TSH inhibits osteoclast differentiation by activating the AMPK signaling pathway, and exerts an osteoprotective effect. This study will provide guidance for the diagnosis and treatment of osteoporosis. TSH structural analogs or AMPK activators are expected to provide new ideas for the development of drugs to prevent and treat osteoporosis.

Anaplastic thyroid cancer: Genetic roles, targeted therapy, and immunotherapy

Anaplastic thyroid cancer (ATC) stands as the most formidable form of thyroid malignancy, presenting a persistent challenge in clinical management. Recent years have witnessed a gradual unveiling of the intricate genetic underpinnings governing ATC through next-generation sequencing. The emergence of this genetic landscape has paved the way for the exploration of targeted therapies and immunotherapies in clinical trials. Despite these strides, the precise mechanisms governing ATC pathogenesis and the identification of efficacious treatments demand further investigation. Our comprehensive review stems from an extensive literature search focusing on the genetic implications, notably the pivotal MAPK and PI3K-AKT-mTOR signaling pathways, along with targeted therapies and immunotherapies in ATC. Moreover, we screen and summarize the advances and challenges in the current diagnostic approaches for ATC, including the invasive tissue sampling represented by fine needle aspiration and core needle biopsy, immunohistochemistry, and 18F-fluorodeoxyglucose positron emission tomography/computed tomography. We also investigate enormous studies on the prognosis of ATC and outline independent prognostic factors for future clinical assessment and therapy for ATC. By synthesizing this literature, we aim to encapsulate the evolving landscape of ATC oncology, potentially shedding light on novel pathogenic mechanisms and avenues for therapeutic exploration.

Environmental mineral density and thyroid malignancy: A multicenter cross-sectional study

BACKGROUND

Several trace minerals have been shown to be associated with thyroid cancer. Democratic Republic of Congo (DRC) is deemed the most mineral-rich country globally. Data on the characteristics of thyroid nodules in various mineral-rich regions of the DRC is scarce.

AIM

To analyze the differential spectrum of thyroid nodules based on locoregional variance in mineral density.

METHODS

We conducted a cross-sectional study on 529 patients with thyroid nodules residing in Katanga, South Kivu and Kinshasa between 2005 and 2019. Of these three provinces, Katanga and South Kivu have the highest mineral density with the DRC.

RESULTS

Mean patient age was 44.2 years ± 14.6 years with a female predominance, with a female to male ratio of 5.4. The 66.5% of patients had a family history of thyroid disease. Total 74 patients had simple nodules, and the remaining 455 patients had multiple nodules. The 87.7% of patients were euthyroid. The nodules exhibited varying characteristics namely hypoechogenicity (84.5%), solid echostructure (72.2%), macronodular appearance (59.8%), calcifications (14.4%) and associated lymphadenopathy (15.5%). The 22.3% of the nodules were malignant. Factors independently associated with malignancy were older age (≥ 60 years) [adjusted odds ratio (aOR) = 2.81], Katanga province (aOR = 8.19), solid echostructure (aOR = 7.69), hypoechogenicity (aOR = 14.19), macronodular appearance (aOR = 9.13), calcifications (aOR = 2.6) and presence of lymphadenopathy (aOR = 6.94).

CONCLUSION

Thyroid nodules emanating from the mineral-laden province of Katanga were more likely to be malignant. Early and accurate risk-stratification of patients with thyroid nodules residing in high-risk areas could be instrumental in optimizing survival in these patients.

Enhancing the Detection of Malignancy in Thyroid Nodules by Assessing Longitudinal Diameter-to-Anteroposterior Diameter Ratio

ABSTRACT

The aim of investigate the ability of 3-dimensional diameter measurements of the nodule to predict malignant nodules. Adult patients with thyroid nodules who underwent thyroid surgery or fine-needle aspiration biopsy between December 2017 and December 2022 were included in this retrospective study. Thyroid ultrasound images and final pathology results were collected. Nodule size was remeasured using recorded ultrasound images in 3 dimensions (longitudinal, anteroposterior, and transverse). The ratios of the longitudinal diameter to the transverse diameter (L/T), the longitudinal diameter to the anteroposterior diameter (L/AP), and the anteroposterior diameter to the transverse diameter (AP/T) were calculated. The recent American College of Radiology TI-RADS system was used for the ultrasonographic scoring of the nodules. Patients were grouped as benign or malignant based on their final pathology results. In total, 398 (70.69%) patients had benign nodules and 165 (29.31%) patients had malignant nodules. The malignant group was significantly older than the benign nodule group (P = 0.011), while sex distributions were similar (P = 0.101). Malignant nodules could be predicted with the following cutoff values: L/T ≤ 0.97 (P < 0.001), L/AP ≤1.6 (P < 0.001), and AP/T > 1.0 (P < 0.001) or >0.94 (P < 0.001). Multivariable logistic regression indicated that low (≤1.6) L/AP ratio and high scores for echogenicity, shape, margin, and echogenic foci were independently associated with malignancy. Combining the L/AP ratio with the AP/T ratio could improve the discrimination of malignant thyroid nodules from benign nodules. Incorporating the L/AP ratio into new risk classification systems warrants careful consideration.

Prevalence of macro-vascular complications among type 2 diabetic adults aged 50 and over: results from Ardakan cohort study on aging (ACSA)

Objective

Type 2 diabetes mellitus (T2DM) is a common condition that can lead to adverse macrovascular complications. This study aims to determine the prevalence of macrovascular complications in adults aged ≥ 50 with T2DM in Ardakan city, using data from the Ardakan Cohort Study on Aging (ACSA).

Methods

A cross-sectional investigation involved 5933 participants from the ACSA; of those assessed, 2340 had T2DM. Macrovascular complications, specifically coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral artery disease(PAD) were identified through medical records and physician assessment. Logistic regression was used to identify risk factors for these complications.

Results

The prevalence of CAD and CVD were 16.9% (95% CI:16.0-19.0) and 4% (95% CI:3.3-5.0), respectively. risk factors for CAD included age over 60 (OR = 1.47, 95% CI: 1.08-2.01, p = 0.01), male gender (OR = 1.87, 95% CI: 1.33-2.62, p < 0.001), former smoking (OR = 1.96, 95% CI: 1.30-2.95, p = 0.001), hypertension (OR = 3.16, 95% CI: 2.23-4.46, p < 0.001), and over ten years of diabetes duration(OR = 2.04, 95% CI: 1.39-2.99, p < 0.001) and For CVD, significant risk factors included male gender (OR = 2.61, 95% CI: 1.52-4.51, p = 0.001) and hypertension (OR = 2.36, 95% CI: 1.27-4.39, p = 0.006).

Conclusion

This study highlights the high prevalence of macrovascular complications in adults over 50 with T2DM in Ardakan. It emphasizes the importance of managing key risk factors such as hypertension and quitting smoking, especially in older adults and males.

Low-Dose Versus High-Dose Lenvatinib in Radioiodine Refractory Differentiated Thyroid Cancer-A Real-World Safety and Efficacy Analysis

OBJECTIVE

Lenvatinib, a tyrosine kinase inhibitor, is approved for the treatment of radioiodine refractory differentiated thyroid cancer (RR-DTC) at a dose of 24 mg/day. Given its significant toxicity profile, the present study aimed to compare the safety and efficacy of initial low-dose lenvatinib to that of higher starting doses in patients with RR-DTC.

METHODS

This retrospective study included patients with RR-DTC who were classified as: Group-A: patients receiving 10mg/day, and Group-B: patients receiving ≥ 14mg/day of lenvatinib as starting dose. Safety, radiological response (as per RECIST 1.1) and progression-free survival (PFS) outcomes were analysed and compared.

RESULTS

A total of 105 patients with RR-DTC were included in this study (Group-A: 60, Group-B: 45). The study found that Group-B experienced significantly higher rates of drug interruptions (68.9% vs 48.3%, p = 0.035) and dose reductions (60% vs 11.7%; p < 0.001) compared to Group-A. Adverse events such as hand-foot skin reaction (77.8% vs 58.3%), diarrhea (28.9% vs 11.7%), hepatotoxicity (33.3-40% vs 11.7-18.3%), and electrolyte imbalance (15.6% vs 3.3%) were also more frequent in Group-B (p-values < 0.05). However, both groups showed similar objective response rates (47.1% vs 46.3%; p = 0.936) and comparable PFS outcomes (restricted mean survival time at 24 months: 22.8 vs 21.4 months, p = 0.128).

CONCLUSIONS

The study suggests that starting with lower doses of lenvatinib, followed by dose escalation if tolerated, may offer a safer approach with significantly lower rates of drug interruptions and dose reductions, with comparable efficacy in RR-DTC patients. Further validation by larger prospective trials is warranted.

High-Dose Radioiodine Therapy Did Not Result in Better Thyroglobulin Decline in Patients with Extra-Thyroid Tumor Extension of Papillary Thyroid Cancer

Objective

In this study, the response to treatment in patients with extra-thyroid extension (ETE) of papillary thyroid cancer (PTC) was compared between different radioiodine treatment doses.

Methods and Materials

In this retrospective cross-sectional study, patients with pathology-proven ETE who were hospitalized for radioiodine therapy from December 2015 to May 2018 at a referral university hospital were identified. Demographic data, radioiodine doses, and off-levothyroxine thyroglobulin and antithyroglobulin levels, before and after treatment, were collected. Alterations in thyroglobulin levels before and after treatment were compared between patients receiving different doses of radioiodine.

Results

Sixty patients were analyzed (mean age: 44.1 ± 14.4 years; 61.7% females). On average, the thyroglobulin levels were 59.1 ± 92.0 and 45.7 ± 81.5 ng/mL at baseline and after treatment, respectively. The thyroglobulin levels decreased from 6.2 ± 6.3 to 1.7 ± 0.2 ng/mL ( p  = 0.510), 55.8 ± 101.3 to 11.5 ± 17.2 ng/mL ( p  = 0.07), and 62.8 ± 91 to 60.9 ± 93.1 ng/mL ( p  = 0.83) in the 100- to 149-, 150- to 199-, and 200- to 250-mCi iodine therapy groups, respectively. Treatment with doses of less than 200 mCi were significantly more effective in reducing posttreatment thyroglobulin levels compared with higher doses ( p  = 0.05). In the subgroup analysis, nonmetastatic cases treated with less than 200 mCi iodine had significantly greater thyroglobulin reduction compared with metastatic patients treated with ≥200 mCi iodine ( p  = 0.05). Macroscopic (vs. microscopic) invasion into adjacent tissues had no impact on thyroglobulin decrease.

Conclusion

The administration of higher radioiodine doses for the treatment of PTC patients with ETE does not yield additional therapeutic benefits in terms of posttreatment thyroglobulin reduction.

Telomere length and telomerase activity in men and non-pregnant women with and without metabolic syndrome: a systematic review and bootstrapped meta-analysis

Purpose

We performed a systematic review and meta-analysis to examine the associations between telomere length and telomerase activity in subjects with and without metabolic syndrome (MetS).

Methods

The meta-analysis protocol was registered in the PROSPERO database. The PubMed, Embase, Cochrane Library, and LILACS databases were searched for studies reporting telomere length or telomerase activity in adult men and non-pregnant women with and without MetS. The risk of bias was assessed with the Newcastle-Ottawa Scale. Random effects and inverse variance methods were used to meta-analyze associations. We conducted a bootstrapped analysis to test the accuracy of clinical results.

Results

Five studies reported telomere length and two studies telomerase activity. There was no significant difference in telomere length (standardized mean difference [SMD]: 0.10, 95% confidence interval [CI]: -0.07, 0.28, I 2: 54%), between subjects of similar age (mean difference: 2.68, 95%CI: -0.04, 5.40 years) with and without the MetS. Subjects with MetS displayed significantly higher body mass index, triglycerides, and blood pressure, and lower HDL-cholesterol values than subjects without the syndrome. A bootstrapping mediation analysis of telomere length confirmed the clinical results. There was no significant difference in telomerase activity (SMD: 1.19, 95% CI -0.17, 2.55, I 2: 93%) between subjects with and without the MetS.

Conclusion

There were no significant differences of telomere length and telomerase activity in patients with MetS and subjects of similar age without the syndrome.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01513-4.

Unlocking the multifaceted roles of GLP-1: Physiological functions and therapeutic potential

Glucagon (GCG) like peptide 1 (GLP-1) has emerged as a powerful player in regulating metabolism and a promising therapeutic target for various chronic diseases. This review delves into the physiological roles of GLP-1, exploring its impact on glucose homeostasis, insulin secretion, and satiety. We examine the compelling evidence supporting GLP-1 receptor agonists (GLP-1RAs) in managing type 2 diabetes (T2D), obesity, and other diseases. The intricate molecular mechanisms underlying GLP-1RAs are explored, including their interactions with pathways like extracellular signal-regulated kinase 1/2 (ERK1/2), activated protein kinase (AMPK), cyclic adenine monophosphate (cAMP), mitogen-activated protein kinase (MAPK), and protein kinase C (PKC). Expanding our understanding, the review investigates the potential role of GLP-1 in cancers. Also, microribonucleic acid (RNA) (miRNAs), critical regulators of gene expression, are introduced as potential modulators of GLP-1 signaling. We delve into the link between miRNAs and T2D obesity and explore specific miRNA examples influencing GLP-1R function. Finally, the review explores the rationale for seeking alternatives to GLP-1RAs and highlights natural products with promising GLP-1 modulatory effects.

Chinese Association of Ultrasound in Medicine and Engineering, Superficial Organs and Peripheral Vessels Committee Expert Consensus on Selected Common Clinical Issues in Parathyroid Ultrasound (2024 Edition)

Parathyroid ultrasound is widely used in clinical practice and plays a crucial role in the diagnosis and treatment of parathyroid diseases. Nevertheless, ultrasound physicians frequently encounter a number of challenges and doubts in their professional practice. For this reason, Superficial Organs and Peripheral Vessels Committee of Chinese Association of Ultrasound in Medicine and Engineering has formulated the expert consensus on certain common clinical problems of parathyroid ultrasound based on the current research progress and clinical experience, in order to guide the clinical practice. This consensus describes in detail the diagnostic and interventional common problems of parathyroid ultrasound and provides in-depth discussion on related contents.

Prediction of BRAF and TERT status in PTCs by machine learning-based ultrasound radiomics methods: A multicenter study

Background

Preoperative identification of genetic mutations is conducive to individualized treatment and management of papillary thyroid carcinoma (PTC) patients. Purpose: To investigate the predictive value of the machine learning (ML)-based ultrasound (US) radiomics approaches for BRAF V600E and TERT promoter status (individually and coexistence) in PTC.

Methods

This multicenter study retrospectively collected data of 1076 PTC patients underwent genetic testing detection for BRAF V600E and TERT promoter between March 2016 and December 2021. Radiomics features were extracted from routine grayscale ultrasound images, and gene status-related features were selected. Then these features were included to nine different ML models to predicting different mutations, and optimal models plus statistically significant clinical information were also conducted. The models underwent training and testing, and comparisons were performed.

Results

The Decision Tree-based US radiomics approach had superior prediction performance for the BRAF V600E mutation compared to the other eight ML models, with an area under the curve (AUC) of 0.767 versus 0.547-0.675 (p < 0.05). The US radiomics methodology employing Logistic Regression exhibited the highest accuracy in predicting TERT promoter mutations (AUC, 0.802 vs. 0.525-0.701, p < 0.001) and coexisting BRAF V600E and TERT promoter mutations (0.805 vs. 0.678-0.743, p < 0.001) within the test set. The incorporation of clinical factors enhanced predictive performances to 0.810 for BRAF V600E mutant, 0.897 for TERT promoter mutations, and 0.900 for dual mutations in PTCs.

Conclusion

The machine learning-based US radiomics methods, integrated with clinical characteristics, demonstrated effectiveness in predicting the BRAF V600E and TERT promoter mutations in PTCs.

Monitoring the follow-up of autoimmune chronic atrophic gastritis using parietal cell antibodies and markers of gastric function

Increased interest in the pathogenesis and the evolution of autoimmune chronic atrophic gastritis (A-CAG) has led to the search for serological markers that can be used to detect changes in the gastric mucosa at an early stage and to monitor the course of the disease. Parietal cell autoantibodies have been proposed as suitable immunological markers of atrophic damage, as they can be detected in the serum when symptoms of gastritis are not yet present. However, the utility of measuring only the level of parietal cell autoantibodies in the follow-up of A-CAG does not appear to suffice. Recent evidence has suggested that, in monitoring A-CAG, parietal cell antibodies should be associated with an evaluation of gastric function through biochemical and hormonal tests, such as pepsinogens and gastrin 17. This integrated approach will allow for the more effective real-time monitoring of the state of the gastric mucosa. As A-CAG is a progressive disorder associated with an increased risk of gastric cancer and neuroendocrine tumors, the precise follow-up of patients with gastric atrophy needs to be better defined. Further longitudinal studies in large cohorts must be performed with long-term follow-up.

Prediction of lymph node metastasis in papillary thyroid carcinoma using non-contrast CT-based radiomics and deep learning with thyroid lobe segmentation: A dual-center study

Objectives

This study aimed to develop a predictive model for lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) patients by deep learning radiomic (DLRad) and clinical features.

Methods

This study included 271 thyroid lobes from 228 PTC patients who underwent preoperative neck non-contrast CT at Center 1 (May 2021-April 2024). LNM status was confirmed via postoperative pathology, with each thyroid lobe labeled accordingly. The cohort was divided into training (n = 189) and validation (n = 82) cohorts, with additional temporal (n = 59 lobes, Center 1, May-August 2024) and external (n = 66 lobes, Center 2) test cohorts. Thyroid lobes were manually segmented from the isthmus midline, ensuring interobserver consistency (ICC ≥ 0.8). Deep learning and radiomics features were selected using LASSO algorithms to compute DLRad scores. Logistic regression identified independent predictors, forming DLRad, clinical, and combined models. Model performance was evaluated using AUC, calibration, decision curves, and the DeLong test, compared against radiologists' assessments.

Results

Independent predictors of LNM included age, gender, multiple nodules, tumor size group, and DLRad. The combined model demonstrated superior diagnostic performance with AUCs of 0.830 (training), 0.799 (validation), 0.819 (temporal test), and 0.756 (external test), outperforming the DLRad model (AUCs: 0.786, 0.730, 0.753, 0.642), clinical model (AUCs: 0.723, 0.745, 0.671, 0.660), and radiologist evaluations (AUCs: 0.529, 0.606, 0.620, 0.503). It also achieved the lowest Brier scores (0.167, 0.184, 0.175, 0.201) and the highest net benefit in decision-curve analysis at threshold probabilities > 20 %.

Conclusions

The combined model integrating DLRad and clinical features exhibits good performance in predicting LNM in PTC patients.

Durable Response to Redifferentiation in a Patient With Metastatic NCOA4::RET Fusion-driven Papillary Thyroid Cancer

Redifferentiation therapy (RDT) is a promising strategy for follicular cell-derived thyroid cancer (TC) in the era of personalized oncology. Limited data are available on long-term clinical outcomes of RDT in patients with fusion-driven TC. A 22-year-old female with recurrent radioactive iodine (RAI)-refractory metastatic progressive, NCOA4::RET fusion-driven papillary TC was treated with selective RET inhibitor, selpercatinib, for 3 months before a therapeutic dose of RAI 146 mCi (5402 MBq). The posttherapy scan showed enhancement of RAI avidity of previously mildly avid pulmonary metastases. After RDT, the thyroglobulin levels significantly declined, and pulmonary nodules completely resolved on chest computed tomography scan. At 24 months of follow-up, the patient did not have evidence of progression. Moreover, thyroglobulin levels continued to decline. RDT with selpercatinib enhanced RAI uptake in the lungs, with a persistent structural and biochemical response sustained 24 months after RAI therapy and discontinuation of selpercatinib. Clinical trials are warranted further to investigate RDT with selective inhibitors in oncogene fusion-driven TC.

Evaluation of predictive factors for lymph node metastasis in thyroid microcarcinoma: a two-year experience from two high-volume centers

Papillary thyroid carcinoma incidence has increased rapidly in recent decades with microcarcinoma (maximum diameter ≤ 10 mm) representing the majority of new diagnoses. Being its prognosis excellent and mortality steady after surgery, some authors suggested active surveillance for microcarcinoma. However, microcarcinomas with lymph node metastasis at diagnosis are not uncommon. We aimed to assess independent risk factors for lymph node metastasis in patients with microcarcinoma. From January 2022 to December 2023, 234 papillary thyroid carcinomas from Fondazione Policlinico Universitario Campus Bio-Medico of Rome and Sant'Eugenio Hospital in Rome were retrospectively analyzed. Age, sex, maximum diameter, lymph node metastasis, Hashimoto's Thyroiditis, multifocality, capsule invasion and histological subtype were considered. Papillary carcinomas were stratified according to size and lymph node metastasis. Microcarcinoma were 145 (62.5%) and lymph node metastasis occurred in 16.6% of them. Multivariate regression revealed that young age (OR 0.90; 95% CI 0.86-0.95; p < 0.001) and capsular invasion (OR "presence" = 3.36; 95% CI 1.16-9.76; p = 0.026) resulted as independent risk factors for lymph node metastasis in patients with microcarcinoma. Being younger than 40 years old emerged as a significant cutoff for risk stratification of lymph node metastasis. Lymph node metastasis rate in microcarcinoma is considerable. A more careful evaluation is required for young patients with peripheral microcarcinoma where a more aggressive surgical approach (e.g. prophylactic central lymph node dissection) may be theorized. New tools are essential for the pre-surgical detection of high risk papillary thyroid microcarcinoma.

Machine learning model for differentiating malignant from benign thyroid nodules based on the thyroid function data

OBJECTIVES

To develop and validate a machine learning (ML) model to differentiate malignant from benign thyroid nodules (TNs) based on the routine data and provide diagnostic assistance for medical professionals.

SETTING

A qualified panel of 1649 patients with TNs from one hospital were stratified by gender, age, free triiodothyronine (FT3), free thyroxine (FT4) and thyroid peroxidase antibody (TPOAB).

PARTICIPANTS

Thyroid function (TF) data of 1649 patients with TNs were collected in a single centre from January 2018 to June 2022, with a total of 273 males and 1376 females, respectively.

MEASURES

Seven popular ML models (Random Forest, Decision Tree, Logistic Regression (LR), K-Neighbours, Gaussian Naive Bayes, Multilayer Perception and Gradient Boosting) were developed to predict malignant and benign TNs, whose performance indicators included area under the curve (AUC), accuracy, recall, precision and F1 score.

RESULTS

A total of 1649 patients were enrolled in this study, with the median age of 45.15±13.41 years, and the male to female ratio was 1:5.055. In the multivariate LR analysis, statistically significant differences existed between the TNs group and thyroid cancer group in gender, age, free triiodothyronine (FT3), free thyroxine (FT4) and TPOAB. Among the seven tested ML models, the best performance was achieved in the Gradient Boosting model in terms of precision, AUC, accuracy, recall and F1 score, with the AUC of 0.82, accuracy of 79.4% and precision of 0.814 after experimental verification. FT4, TPOAB and FT3 were validated as the top three features in the Gradient Boosting model.

CONCLUSIONS

This study innovatively developed a predictive model for benign and malignant TNs based on the Gradient Boosting Decision Tree algorithm. For the first time, it validated the clinical predictive value of TF parameters (FT4, FT3) and TPOAB as key biomarkers.

Multifaceted investigations of PSMB8 provides insights into prognostic prediction and immunological target in thyroid carcinoma

The Proteasome 20S subunit beta 8 (PSMB8) is an integral element of the immunoproteasome complex, playing a pivotal role in antigen processing. Despite its significance, the contributory role of PSMB8 in oncogenesis, particularly in thyroid carcinoma (THCA), has not been well-characterized. To address this gap in knowledge, our study endeavored to delineate the potential associations between PSMB8 and THCA. Transcriptomic profiles and clinical data of patients with THCA were retrieved from The Cancer Genome Atlas (TCGA) database to facilitate comprehensive analysis. Complementary resources from additional online databases were utilized to augment the study. Logistic regression analysis was employed to elucidate the relationship between PSMB8 and various clinicopathological parameters. Uni/multivariate Cox regression analyses were conducted to ascertain the independent prognostic factors for THCA patient outcomes. Quantitative polymerase chain reaction (qPCR) and western blot assays were employed to verify the expression level of PSMB8 in vitro. Our study demonstrated that PSMB8 was significantly upregulated in THCA, with its overexpression correlating with lymph node metastasis, extrathyroidal extension, and favorable prognosis. Immunohistochemistry substantiated a higher PSMB8 protein presence in THCA tissue compared to the normal, supporting its potential role as a moderately accurate diagnostic biomarker. Logistic regression analysis identified PSMB8 as a significant indicator of the N1 stage, classical histological subtype, and extrathyroidal extension. Age, T stage, and PSMB8 were further determined as independent prognostic factors for THCA. Functional investigations linked PSMB8 to immune processes, evidenced by its association with increased immune cell infiltration and higher stromal/immune scores, as well as a positive co-expression with several immune checkpoints. A constructed predicted competing endogenous RNA (ceRNA) network implicated PSMB8 in complex post-transcriptional regulation. Finally, in vitro assays confirmed the upregulation of PSMB8, underscoring its relevance in THCA and as a target for future research. Our work has preliminarily appraised PSMB8 as a biomarker with certain prognostic and diagnostic significance, and as a potential target for immunotherapy in THCA.

Predicting 10-year risk of type 2 diabetes in Chinese people with overweight or obesity treated with Tirzepatide: Post hoc analysis of SURMOUNT-CN trial

AIM

To assess the association of tirzepatide use with a 10-year predicted risk of type 2 diabetes (T2D) among Chinese participants with obesity or overweight from the SURMOUNT-CN trial.

MATERIALS AND METHODS

In this post hoc analysis, the QDiabetes-2018 risk engine was used to calculate the 10-year predicted T2D risk at baseline, week 24 and week 52 among SURMOUNT-CN participants randomized to receive tirzepatide 10 mg, 15 mg or placebo. A mixed model for repeated measures was used to compare mean predicted risk changes from baseline to weeks 24 and 52 between tirzepatide and placebo. Subgroup analyses were conducted by baseline body weight mass index (BMI) status and baseline prediabetes status.

RESULTS

Demographic and baseline clinical characteristics were similar among tirzepatide10 mg (n = 59), 15 mg (n = 53) and placebo (n = 57). From baseline to week 52, the least square (LS) mean predicted T2D risk changed from 5.3% to 1.2% for tirzepatide 10 mg, from 4.9% to 1.0% for tirzepatide 15 mg and from 5.8% to 4.5% for placebo. The difference in LS mean risk change from baseline to week 52 was significant between both tirzepatide 10 mg (-3.2%, 95% confidence interval [CI]: -4.2%, -2.2%) and 15 mg (-3.4%, 95% CI: -4.4%, -2.4%) and placebo. Significantly greater predicted risk reductions for tirzepatide than placebo were observed in all subgroups.

CONCLUSION

Tirzepatide was associated with significantly reduced predicted 10-year risk of T2D among SURMOUNT-CN participants with obesity or overweight, irrespective of baseline BMI and prediabetes status.

Glucagon-like peptide 1 (GLP-1) receptor agonists' use during pregnancy: Safety data from regulatory clinical trials

AIMS

The prevalence of diabetes and obesity continues to rise in women of reproductive age, with significant implications for both mother and foetus. Glucagon-like peptide-1 receptor agonists are effective treatments of diabetes and obesity. However, no Glucagon-like peptide-1 receptor agonists are currently approved for use during pregnancy. We describe the outcomes of unplanned pregnancies during regulatory clinical trials of Glucagon-like peptide-1 receptor agonists submitted to the Food and Drug Administration and European Medicines Agency.

MATERIALS AND METHODS

A search was conducted of the regulatory documentation published by the European Medicines Agency and the Food and Drug Administration on unplanned pregnancies during regulatory clinical trials of Glucagon-like peptide-1 receptor agonists. Clinical and Medical Reviews published by the Center for Drug Evaluation and Research at the Food and Drug Administration for every Glucagon-like peptide-1 receptor agonist prior to market authorisation were assessed to gather information on unplanned pregnancies that occurred while females were partaking in the clinical development programmes of such drugs.

RESULTS

Evidence in women having planned pregnancies is lacking, and the only evidence thus far relies on pregnancies occurring inadvertently during Glucagon-like peptide-1 receptor agonist trials. The incidence of congenital abnormalities in humans appears relatively low following Glucagon-like peptide-1 receptor agonist use during pregnancy.

CONCLUSIONS

Key knowledge gaps must be addressed before the introduction of the Glucagon-like peptide-1 receptor agonist class of drugs for pregnant women. Currently, Glucagon-like peptide-1 receptor agonists should be stopped as soon as the patient becomes aware of a pregnancy. The establishment of patient registries designed to capture data relating to cases of Glucagon-like peptide-1 receptor agonist exposure during pregnancy is a high priority, and where data already exist, the findings need to be published.

Biochemical and structural response in patients with tall cell papillary thyroid cancer: a dual centre retrospective study : Early Recurrence in Tall Cell PTC

PURPOSE

Tall cell papillary thyroid cancer (tcPTC) is traditionally considered to be an aggressive subtype of differentiated thyroid cancer, although its independent prognostic value is unclear. To investigate the independent prognostic value of tall cell morphology a tcPTC cohort was compared with a classical PTC (cPTC) cohort.

METHODS

A retrospective longitudinal study was performed using a cohort of tcPTC patients treated at Royal North Shore Hospital and Westmead Hospital in Sydney, Australia, and a cohort of cPTC patients treated at Westmead Hospital. Clinicopathological tumour characteristics and treatment pathways were analysed. Thyroglobulin and thyroglobulin antibody levels and further neck surgeries in the two years post thyroidectomy were used as a surrogate marker for early disease recurrence.

RESULTS

Presentation and treatment were analysed for 51 tcPTC patients and a comparator group of 365 cPTC patients. On univariate analysis, tcPTC was found to present at an older age (53.6 years v 46.4 years, p < 0.01), with greater rates of positive surgical margins (31.37% v 16.44%, p < 0.05), and greater rates of microscopic (47.06% v 22.74%, p < 0.001) and gross extrathyroidal extension (15.69% v 6.30%, p < 0.05). Longitudinal analysis was conducted for 236 patients (n = 24 for tcPTC, n = 212 for cPTC). Multivariate analysis found no difference in the odds of developing early recurrence between the tcPTC cohort and the cPTC cohort (OR = 0.65, p > 0.1).

CONCLUSION

tcPTC is associated with more aggressive features compared with cPTC. Tall cell morphology was not found to be an independent predictor of early recurrence.

Hypoparathyroidism After Total Thyroidectomy: A Population-Based Analysis of California Databases

INTRODUCTION

Postthyroidectomy hypoparathyroidism is common and usually managed as an outpatient. A better understanding of patients at risk for an emergency department (ED) visit can improve health-care utilization and patient care.

METHODS

The California Cancer Registry and Health Care Access and Information Databases were linked to identify patients who underwent a thyroidectomy for thyroid cancer 2005-2018 and had an ED visit for hypoparathyroidism within 2 y of surgery. Cumulative incidence and multivariable Cox proportional hazards models were used to identify factors associated with an ED visit.

RESULTS

Among 41,502 thyroidectomy patients, 588 (1.42%) presented to the ED for hypoparathyroidism, with a median time between thyroidectomy and first ED visit of 4 ds. Two-year cumulative incidence was highest for women (1.56%), Hispanic patients (2.04%), younger adults aged 18-40 y (1.97%), higher Charlson comorbidity index score (2.43%), lowest neighborhood socioeconomic status quintile (1.97%), patients with >4 lymph nodes removed (2.04%), and patients not seen at an American College of Surgeons Committee on Cancer site (1.60%). Multivariable analysis revealed several factors associated with an increased risk of hypoparathyroidism, including female gender (hazard ratio [HR] 1.67, 95% confidence interval [CI] = 1.32-2.10), Hispanic ethnicity (HR 1.41, 95% CI = 1.16-1.71), a higher Charlson comorbidity index score (≥2 = HR 1.91 [95% CI = 1.46-2.51]), and patients with >4 lymph nodesremoved (HR 1.70 [95% CI = 1.43-2.01]).

CONCLUSIONS

ED visits for postthyroidectomy hypoparathyroidism are uncommon, but usually occurs shortly after surgery. Most risk factors identified are not modifiable, but they help identify high-risk patients who could benefit from targeted postoperative care (programs) to reduce unplanned ED visits.

Multimodal ultrasound radiomics model combined with clinical model for differentiating follicular thyroid adenoma from carcinoma

OBJECTIVE

This study aimed to develop a nomogram integrating radiomics features derived from contrast-enhanced ultrasound (CEUS) and B-mode ultrasound (B-US) with clinical features to improve preoperative differentiation between follicular thyroid carcinoma (FTC) and follicular thyroid adenoma (FTA). Accurate preoperative diagnosis is critical for guiding appropriate treatment strategies and reducing unnecessary interventions.

METHODS

We retrospectively included 201 patients with histopathologically confirmed FTC (n = 133) or FTA (n = 68). Radiomics features were extracted from B-US and CEUS images, followed by feature selection and machine-learning model development. Five models were evaluated, and the one with the highest area under the curve (AUC) was used to construct a radiomics signature. A Clinical Risk model was developed using statistically significant clinical features, which outperformed the conventional Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) in both training and test groups. The radiomics signature and Clinical Risk model were integrated into a nomogram, whose diagnostic performance, calibration and clinical utility were assessed.

RESULTS

The Clinical Risk model achieved superior diagnostic performance compared to the C-TIRADS model, with AUCs of 0.802 vs. 0.719 in the training group and 0.745 vs. 0.703 in the test group. The nomogram further improved diagnostic efficacy, with AUCs of 0.867 (95% CI, 0.800-0.933) in the training group and 0.833 (95% CI, 0.729-0.937) in the test group. It also demonstrated excellent calibration. Decision curve analysis (DCA) also indicated that the nomogram showed good clinical utility.

CONCLUSION

By combining CEUS and B-US radiomics features with clinical data, we developed a robust nomogram for distinguishing FTC from FTA. The model demonstrated superior diagnostic performance compared to existing methods and holds promise for enhancing clinical decision-making in thyroid nodule management.

CLINICAL TRIAL NUMBER

Not applicable.

Preliminary results suggest the potential of evaluating combined bFGF and TNF-β concentrations for differentiating papillary thyroid cancer from benign nodular goiter

Papillary thyroid cancer (PTC) is the most common type of thyroid cancer, accounting for approximately 80% of cases. Considering the lack of available blood diagnostic tests for detecting thyroid cancer, as well as the issue of overdiagnosis and overtreatment, our study aimed to investigate whether the concentrations of 48 selected proteins, including chemokines, interleukins, cytokines, and growth factors, could serve as indicators to distinguish patients with PTC from individuals with nodular goiter. The study group included 32 PTC patients and 26 nodular goiter patients as a comparative group. Serum protein concentrations were evaluated in venous blood collected in tubes without anticoagulant, using the multiplexed immunoassay method. The concentrations of basic FGF (bFGF), IL-9, IL-18, TNF-α, and TNF-β were significantly higher (p < 0.05) in patients with PTC compared to those with nodular goiter. The highest area under the ROC curve (AUC), equal to 0.720 ± 0.066, along with a diagnostic specificity of 92% and a positive predictive value of 89% for differentiating PTC patients from nodular goiter patients, was found for TNF-β. The combined evaluation of TNF-β and bFGF concentrations proved most useful in differentiating papillary thyroid cancer from benign nodular goiter, revealing a diagnostic specificity of 96%. Further studies should be conducted with an appropriate sample size and across other histopathological types of thyroid cancer to confirm that the combined evaluation of bFGF and TNF-β concentrations is useful in differentiating PTC patients from individuals with benign nodular goiter.

Global status and trends in type 2 diabetes remission from 2002 to 2022: A bibliometric and visual analysis

Type 2 diabetes mellitus (T2DM) is estimated to impact 693 million individuals globally by 2045. Diabetes remission has the potential to slow disease progression, alleviate psychological burdens, minimize complications, and improve quality of life. We aimed to perform a bibliometric analysis of research on T2DM remission. We searched the Web of Science (WoS) database to identify relevant publications on T2DM remission during 2002 to 2022. Research trends and hotspots in T2DM remission were analyzed using Bibliometrix R and CiteSpace. The analysis considered various factors such as publication year, authors, journal, institution, country/region, themes, thematic evolution, keywords, and keyword bursts. The WoS search yielded 2254 articles. The annual scientific output has consistently increased. Lee was the most prolific author (48 papers). Obesity surgery was the leading journal (296 publications), while diabetes care had the highest h_index (43). The University of Copenhagen was the most active institution (116 papers). The most productive countries were the US (476), China (347), the UK (180), Italy (121), and Japan (90). The top 3 keywords were "bariatric surgery," "weight loss," and "remission." From 2013 to 2015, the usage of the term "medical therapy" significantly surged, lasting for 3 years. The term "GLP-I receptor agonists" also had a lasting burst. In the past 5 years, "weight loss" and "low-calorie diets" have emerged as prominent areas of research. This study analyzed the research trends and key factors in the field of type 2 diabetes mitigation through bibliometrics, providing important data support and a basis for decision-making for future research and public health policies.

Kinome profiling reveals pathogenic variant specific protein signalling networks in MEN2 children with Medullary Thyroid Cancer

Multiple Endocrine Neoplasia Type 2 (MEN2) is an autosomal dominant disease caused by pathogenic variants in the receptor tyrosine kinase RET, with strong genotype-phenotype correlations. The development and progression of these tumours are not always predictable even within families with the same RET pathogenic variant, demonstrating a need for better understanding of the underlying molecular mechanisms. Precision molecular medicine is not widely used and the standard of care remains prophylactic thyroidectomy. This absence of curative approaches is exacerbated by the lack of novel therapeutic markers/targets. In this study, we investigated the functional kinome of 24 familial MEN2 patients. We identified MEN2 subtype and RET pathogenic variant-specific alterations in signalling pathways including mTOR, PKA, NF-κB and focal adhesions, which were validated in patient thyroid tissue. Overall, our study of MEN2 functional kinomes uncovers novel specific drivers of MEN2 disease and its pathogenic variant subtypes, identifying new potential therapeutic targets for MEN2.

NCOA5 induces sorafenib resistance in hepatocellular carcinoma by inhibiting ferroptosis

NCOA5 has been identified as a crucial factor in the progression of hepatocellular carcinoma (HCC). This study investigates the expression of NCOA5 in HCC, revealing its significant overexpression in tumor tissues compared to healthy liver tissues, as evidenced by analysis of the TCGA dataset and RT-qPCR in patient samples. Higher NCOA5 levels correlate with poor overall survival, highlighting its role as a prognostic indicator. Furthermore, our findings suggest that elevated NCOA5 is associated with resistance to sorafenib, a common chemotherapeutic agent for HCC, as shown through analysis of publicly available datasets and the establishment of sorafenib-resistant HCC cell lines. Mechanistically, NCOA5 appears to inhibit ferroptosis in HCC cells by modulating glutathione peroxidase 4 (GPX4) levels. Knockdown of NCOA5 sensitizes resistant cell lines to sorafenib and induces ferroptosis by decreasing GPX4 expression. Additionally, NCOA5 regulation of GPX4 is mediated through the transcription factor MYC. In vivo studies further validate that targeting NCOA5 enhances the efficacy of sorafenib in resistant HCC models by promoting ferroptosis. Collectively, these findings underscore the potential of NCOA5 as a therapeutic target to overcome drug resistance in HCC, providing insights into its role in modulating treatment responses and patient prognosis.

Nationwide trends and the impact of an oncology hospital network on reducing the burden of thyroid cytology procedures

The diagnostic care pathway of thyroid nodules spans multiple institutions. Collaborative networks are important to deal with such pathways that result from centralization and differentiation of care. Despite the high prevalence of thyroid nodules and the increase in cancer diagnoses, most nodules are benign and attributable to overdiagnosis, leading to an increase in fine-needle aspirations (FNAs). This study assessed the effectiveness of a multi-hospital network that implemented a unified thyroid care pathway in reducing the number of FNAs without compromising malignancy detection. In this nationwide population-based cohort study, Bethesda scores were extracted from all thyroid FNA reports from 2010 to 2021 in the Netherlands using text mining. Trends in the number of FNAs and Bethesda scores were visualized for the network and the rest of the country. Joinpoint analyses with the Davies test determined the statistical significance of observed trend changes. Nationwide, FNAs increased by an average of 5.7% annually from 2010 to 2018. In the network, FNAs started to decrease in 2016-2017, coinciding with the care pathway implementation (p < 0.001). In contrast, in the rest of the Netherlands, a decline was observed in 2020, potentially attributable to the COVID-19 pandemic. In both cases, the reduction mainly involved Bethesda categories 1 and 2, without compromising malignancy detection. High-volume surgical centers seemed to initiate a decline more rapidly compared to non-high-volume surgical centers. This study indicates that a unified care pathway within a multi-hospital network can reduce the number of FNAs without compromising malignancy detection, which could alleviate the burden on both patients and the healthcare system.

Radioactive Iodine in Differentiated Thyroid Cancer: Effect on Detection of Distant Metastases Comparing 4 Guidelines

Context

Guidelines vary in their recommendations for postoperative radioactive iodine (RAI) in differentiated thyroid cancer (DTC). Omitting RAI reduces overtreatment but poses the possibility of missing distant metastases.

Objective

This study compares 4 guidelines on RAI indications and potentially missed metastases.

Methods

DTC patients were included retrospectively, including 48 patients with distant metastases after first RAI cycle, and 469 without distant metastases. The percentage of distant metastases missed was calculated if RAI had been omitted following the 2015 American Thyroid Association (ATA), 2019 European Society for Medical Oncology (ESMO), 2022 European Thyroid Association (ETA), and 2022 American Society of Nuclear Medicine and Molecular Imaging/European Association of Nuclear Medicine (SNMMI/EANM) guidelines.

Results

In patients without RAI indication, 1.3% to 1.6% of distant metastases may initially be missed with the ATA, ESMO, and ETA guidelines. All these cases had postoperative thyroglobulin (Tg) between 1 and 10 ng/mL or positive Tg antibodies (Tg-abs). In patients for whom RAI should be considered following the ATA, ESMO, and ETA guidelines, 2.6% to 4.0% of distant metastases may initially be missed, with all but 1 case having Tg greater than 10 ng/mL or positive Tg-abs. With the SNMMI/EANM guideline, no distant metastases would be missed, but it resulted in markedly higher RAI use in low-risk patients (82% vs 0%).

Conclusion

Omitting postoperative RAI in low- and intermediate-risk patients, as recommended by the 2015 ATA, 2019 ESMO, and 2022 ETA guidelines, may lead to a small number of initially undetected distant metastases. However, these metastases could potentially be detected later due to the presence of biochemical disease. In contrast, the broader RAI indications endorsed by SNMMI/EANM reduce the likelihood of missed metastases, but substantially increases RAI use, exposing patients to unnecessary treatment and side effects.

Papillary Thyroid Carcinoma With 5 Unique Point Mutations and Typical Behavior

The frequency and impact of multiple driver mutations have not been extensively explored in papillary thyroid carcinoma (PTC), in which driver mutations are most commonly solitary. We present a case of a 62-year-old female who was found to have a 2.6-cm classical, nonaggressive-appearing PTC. A next-generation sequencing panel assessed the tumor for mutations. Five unique single nucleotide sequence variants, none of which was seen in The Cancer Genome Atlas study on PTC, were found: BRAF D594N, NRAS Q61H, PIK3CA G1007R, PTEN R335*, and PTEN Y225*. We believe that 5 pathogenic variants are the highest reported number for a primary PTC resection specimen to date. The observed typical PTC behavior may be due to a weaker strength of the individual pathogenic variants to drive oncogenic processes. In this case, the high number of genetic alterations did not translate into aggressive histopathology or clinical course.

Prophylactic central neck dissection in clinically node-negative papillary thyroid carcinoma: 10-year impact on surgical and oncologic outcomes

BACKGROUND

The role of prophylactic central compartment lymph node dissection in clinically node-negative papillary thyroid carcinoma is debated. This study presents the findings from a 10-year follow-up of a single-institution randomized controlled trial assessing the role of prophylactic central compartment lymph node dissection in clinically node-negative papillary thyroid carcinoma.

METHODS

Between 2008 and 2010, a total of 196 patients with clinically node-negative papillary thyroid carcinoma were randomly assigned to 2 groups in a 1:1 ratio to undergo total thyroidectomy (group A) or total thyroidectomy with prophylactic central compartment lymph node dissection (group B). Patients received low-dose radioactive iodine treatment (30 mCi) postoperatively, with additional doses as needed. Monitoring included serum thyroglobulin, thyroglobulin antibodies, and neck ultrasound imaging.

RESULTS

At the end of the follow-up, 151 patients were analyzed, after 28 from group A and 17 from group B were excluded. The 2 groups were similar in age at diagnosis (P = .643), sex distribution (P = .735), body mass index (P = .134), ultrasound-estimated thyroid volume (P = .650), and histologic tumor features. After >10 years (12.9 ± 2 years), no significant differences were observed in surgical and oncologic outcomes. The mean thyroglobulin levels were 0.1 ± 0.1 ng/mL in group A and 0.3 ± 1.3 ng/mL in group B (P = .146). Both groups showed similar findings in the need for further surgery (P = .917), for additional radioactive iodine (P = .979), and mean radioactive iodine dosage (P = .822). No difference was documented in permanent recurrent laryngeal nerve palsy (P = .640), permanent hypocalcemia (P = .238), and serum calcium level (P = .181). The only observed distinction was more parathyroid removal in prophylactic central compartment lymph node dissection cases based on histologic examination (P = .005).

CONCLUSION

Prophylactic central compartment lymph node dissection does not significantly affect surgical and oncologic outcomes in patients with clinically node-negative small papillary thyroid carcinoma after long-term follow-up.

Recombinant TSH Performs as Well as Thyroid Hormone Withdrawal for Iodine-131 Therapy With Dosimetry for Thyroid Cancer

Introduction

Dosimetry helps calculate the optimal iodine-131 (I-131) dose for treating metastatic differentiated thyroid cancer (DTC). We aimed to evaluate if recombinant human TSH (rhTSH) and thyroid hormone withdrawal (THW) are equivalent methods of preparation for dosimetry-guided I-131 therapy in metastatic DTC.

Methods

We performed a retrospective cohort study of 51 adults with metastatic DTC who received I-131 with dosimetry from 2010 through 2022. Gamma camera and blood activity measurements were taken following the pretherapeutic I-131 dose. Statistical analysis compared rhTSH and THW groups; P < .05 was considered significant.

Results

Fifty-one adults undergoing 55 I-131 dosimetry-guided treatments were included: 22 by rhTSH and 33 by THW. The median age was lower (P = .0008), and the proportion of stage IV (P = .009) was higher in rhTSH compared to the THW group. The terminal effective half-life at 24 to 48 hours in the whole body was longer in rhTSH compared to THW group (21.9 vs 17.1 hours; P = .014), but this difference was less significant when limited to the n = 37 metastatic cases (P = .046) and not different for red marrow effective half-life. The calculated allowed I-131 dose was lower in rhTSH compared to THW group (187.5 mCi vs 259.9 mCi; P = .0000). Thyroglobulin was higher during treatment in the rhTSH group (P = .031), whereas its reduction at 3 months was not different after adjusting for age and stage.

Conclusion

rhTSH is noninferior to THW in preparation for I-131 dosimetry. Compared to THW, rhTSH results in lower calculated allowed I-131 dose after dosimetry, which could translate to fewer side effects or impact on quality of life.

Communication of Voice-Related Complications in Thyroidectomy: A Qualitative Analysis

OBJECTIVE

This study aims to characterize patient-surgeon discussions of voice-related complications during thyroidectomy for low-risk thyroid cancer.

STUDY DESIGN

A qualitative study.

SETTING

Three academic medical centers.

METHODS

Pre-operative clinic visits between 14 surgeons (6 otolaryngologists and 8 endocrine surgeons) and 49 patients with low-risk (cT1-2, N0) thyroid cancer were audio-recorded and transcribed. Qualitative analysis was used to evaluate surgeon counseling strategies and patient concerns related to voice.

RESULTS

Patients aged from 20 to 77 years old were predominantly female (77.6%) and white (89.9%). Surgeons presented risk with negative framing and numerical percentages (1%-4%) and/or qualified the risk as "low" or "small" for a lobectomy, but a "much bigger deal" for bilateral nerve injury in total thyroidectomy. At a minimum, surgeons referred to voice dysfunction as "voice change." Some further described "hoarseness" or the "inability to project voice." Other surgeons imitated what voice dysfunction would sound like. A few surgeons probed the importance of voice to a patient's life. One surgeon imparted that having a voice-related complication "can be really emotional." Patients responded with varying degrees of concern about voice changes after surgery, from feeling "super concerned … about losing [their] voice" to feeling "ok" with it "as long as [they're] around to deal with it."

CONCLUSION

Significant variability exists in how surgeons describe and set expectations about voice-related complications. The degree to which patients value voice-related outcomes differed based on their occupation and hobbies, but this was tempered by their cancer diagnosis. Further research is needed to identify optimal disclosure of voice-related risks and expectations.

Cancer and Overgrowth Manifestations of PTEN Hamartoma Tumor Syndrome: Management Recommendations from the International PHTS Consensus Guidelines Working Group

PURPOSE

PTEN hamartoma tumor syndrome (PHTS) is an autosomal dominant cancer predisposition and overgrowth syndrome caused by pathogenic germline variants in the PTEN gene, with an increased risk of both benign and malignant tumors involving the breast, colon, endometrium, thyroid, skin, and kidney. The objective of these clinical guidelines was to use the latest knowledge to generate an international consensus resource for providers, researchers, and individuals with PHTS on the best practices in the surveillance and management of cancer and overgrowth in PHTS.

EXPERIMENTAL DESIGN

The International PHTS Cancer and Overgrowth Guidelines Working Group was established, comprising a core group of six international experts in the diagnosis and management of PHTS. The working group held joint meetings with individuals with PHTS and their advocates. Informed by the literature, the working group met regularly between 2022 and 2024 to produce guideline statements, refined through iterative feedback. A modified Delphi approach was used with an independent external panel of PHTS, genetics, and cancer experts to establish final consensus guidelines.

RESULTS

Clinical consensus recommendations for the surveillance and management of cancer and overgrowth in individuals with PHTS were formed. The guidelines encompass the recommended practices in cases of breast, colon, endometrial, thyroid, and kidney cancers, as well as overgrowths.

CONCLUSIONS

The clinical management of individuals with PHTS is complex and necessitates a multidisciplinary approach. We generated international consensus guidelines for the surveillance and management of cancer and overgrowth in PHTS, aiming at improving care for affected individuals and families.

MDM2 Knockdown Reduces the Oncogenic Activities and Enhances NIS Protein Abundance in Papillary Thyroid Cancer

BACKGROUND/AIM

Despite the excellent prognosis post thyroidectomy and radioiodine therapy, papillary thyroid cancer (PTC) patients still undergo dismal outcomes, especially when tumors undergo de-differentiation and thus progress to radioiodine refractory status. Our knowledge on the pathogenesis mechanisms of PTC and NIS protein (responsible for iodine uptake) activity is still behind satisfaction. To increase our knowledge on these issues, we conducted this study.

MATERIALS AND METHODS

We analyzed microarray data to identify the genes differentially expressed between normal and tumor thyroid tissues. Next, pathway enrichment analysis was conducted to derive candidate genes and pathways involved in PTC oncogenesis and NIS activity. The expression of candidate genes was confirmed by an independent TCGA dataset. Then, we used siRNA to knockdown the MDM2 gene to examine the potential pathogenesis mechanisms of MDM2 and MDM2-P53-NIS axis in cells. Also, we examined whether oncogenic activities, including cell proliferation, colony formation, cell migration and cell invasion, were altered with MDM2 knockdown. Moreover, NIS protein intensity in cell membrane was also investigated.

RESULTS

Through analyzing microarray data, pathway enrichment and correlation analyses, we focused on MDM2 since it could be involved in the MDM2-P53-NIS axis. Knockdown of MDM2 significantly reduced the mRNA levels and protein abundance of MDM2. In addition, P53 protein was also elevated with MDM2 knockdown. With MDM2 knockdown, cell proliferation and colony formation were repressed. And, both cell migration and invasion abilities were interfered. Moreover, MDM2 knockdown also enhanced the intensity of membrane NIS protein.

CONCLUSION

MDM2 knockdown not only reduced the oncogenic activities of thyroid cancer but also enhanced the intensity of NIS protein responsible for iodine intake in thyroid gland. Therefore, MDM2 could serve as a prognosis indicator in thyroid cancer.

Risk of Cancer Recurrence Exerts the Strongest Influence on Choice Between Active Surveillance and Thyroid Surgery as Initial Treatment for Low-Risk Thyroid Cancer: Results of a Discrete Choice Experiment

BACKGROUND

Treatment options for low-risk differentiated thyroid cancer (DTC) include active surveillance (AS), hemithyroidectomy (HT), or total thyroidectomy (TT). Improved understanding of patient values and preferences is required to inform shared decision-making. This study examined factors influencing patient treatment preferences and trade-offs for low-risk DTC.

METHODS

Adult participants with benign thyroid nodules or low-risk DTC completed an online discrete choice experiment (DCE). Utilizing the scenario of a 50-year-old person with a small solitary DTC, participants chose between three unlabeled treatment options (representing AS, HT, and TT). Risk profiles varied across 5 domains: voice change, thyroid hormone supplementation, hypocalcaemia, chance of future thyroid surgery, and 10-year risk of cancer recurrence. Participants self-reported demographics, disease factors, and answered a decisional regret scale. A conditional logit model was utilized.

RESULTS

The DCE was completed by 143 patients across three sites. The conditional logit model demonstrated that participants preferred AS (49%) over TT (29%) or HT (22%). All five domains influenced choices (all p < 0.001), but perceived risk of cancer recurrence exerted most influence. Cancer survivors chose AS less often than those with benign disease (46% vs. 57%), driven by perceived risks of further surgery and cancer recurrence. As the perceived risk of cancer recurrence increased, more participants preferred HT over AS.

CONCLUSION

This study demonstrates that when blinded to the actual treatment, patients prefer the trade-offs associated with AS rather than TT or HT. Perceived risk of cancer recurrence exerted the greatest influence. Accurate risk stratification for cancer recurrence is critical to shared decision-making.

Endocrinological toxicities related to immunotherapy combinations for advanced renal cell carcinoma: Practical expert-based management recommendations

Nowadays immune-based combinations are the standard first-line treatment for metastatic renal cell carcinoma and involve the use of either two immunotherapy agents or an immunotherapeutic drug associated with a tyrosine kinase inhibitor. Treatment-related toxicity is the primary cause of drug discontinuation or dose reduction. A thorough understanding of the prevention and management of adverse events of the immune-based combinations is critical to ensure the success of treatment. Endocrinological toxicities during treatment with immune-based combinations are frequent and often manageable. However, in some cases, diagnosis can be complex, and the treatment requires multidisciplinary discussion. In addition, it is often challenging to determine which agent in the combination is responsible for a specific toxicity. In this review, we analyze the evidence regarding treatment-related endocrinopathies in renal cell carcinoma first-line therapy. We also discuss monitoring strategies to diagnose endocrinological adverse events and provide some practical tools for their daily management.

Menin: from molecular insights to clinical impact

Menin, the protein product of the MEN1 gene, is essential for development and has been implicated in multiple different cancer types. These include leukemias and several different solid tumors, including neuroendocrine tumors. Menin interacts with many different protein partners and genomic loci in a context-dependent manner, implicating it in numerous cellular processes. The role of Menin varies across tumor types as well, acting as a tumor suppressor in some tissues and an oncogenic co-factor in others. Given the role of Menin in cancer, and particularly its oncogenic role in acute myeloid leukemia, the development of Menin inhibitors has been an expanding field over the past 10-15 years. Many inhibitors have been in clinical trials and one has recently received approval from the Food and Drug Administration (FDA). In this review, we explore the role of Menin in multiple cancer types, the development of Menin inhibitors and their clinical applications and what the focus of the field should be in the next 5-10 years to expand the use and efficacy of these drugs.

Nomogram for predicting difficult transoral and submental thyroidectomy: a retrospective model development and validation study with large-scale population

OBJECTIVE

No prior studies have described or stratified the difficulty of transoral and submental thyroidectomy (TOaST). We aimed to investigate preoperative factors as indicators of difficult TOaSTs and to develop a predictive model accordingly.

METHODS

This retrospective study included 255 eligible DTC patients who underwent total thyroidectomy and central neck dissection (CND) via transoral and submental endoscopic approach between February 2021 and April 2024. These patients were randomized into training and validation groups in a 7:3 ratio. Procedures were categorized into difficult and normal TOaST based on operation time, conversion to open and intraoperative injury. Univariate and multivariate logistic regression analyses were used to assess the association between surgical difficulty and factors regarding demographics, laboratory tests and ultrasound information. A nomogram was then developed and validated internally. Surgical and oncological profiles and follow-up data were also analyzed.

RESULTS

Five independent risk factors for difficult TOaST were identified in multivariate analysis: age (OR 0.84, p < 0.001), male sex (OR 4.75, p = 0.016), thyromental distance (TMD) < 7 cm (OR 7.59, p < 0.001), presence of diffuse changes on ultrasound (OR 14.5, p < 0.001), and elevated anti-thyroid peroxidase antibody (TPO-Ab) level (OR 5.22, p = 0.005). The nomogram performed well on both the training and the validation datasets, achieving an area under curve (AUC) of 0.908 and 0.888, respectively. Calibration curves for both datasets also fit well. There was no significant difference in complication rates between the difficult and normal TOaST groups.

CONCLUSION

The developed nomogram provides a reliable, straightforward prediction of difficult TOaST, thus supporting preoperative preparation and consultation, as well as optimizing training and promotion.