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Liu S, Wu S, Ma C, Wang S, Chen S, Wang H, Feng F. Long-Term Outcome of Low- and High-Dose Radioiodine for Thyroid Remnant Ablation. Clin Endocrinol (Oxf) 2024. [PMID: 39233456 DOI: 10.1111/cen.15134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 08/13/2024] [Accepted: 08/22/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVE We conducted a prospective randomized clinical trial to compare the efficacy of low- and high-dose radioiodine for remnant ablation in patients with low-risk differentiated thyroid cancer (DTC) in China. The first-stage results showed equivalence was observed between the two groups. Here, we report recurrence and survival at 3-5 and 6-10 years and biochemical parameters. DESIGN, PATIENTS AND METHODS Between January 2013 and December 2014, adult patients with DTC were enroled. Patients had undergone total or near-total thyroidectomy, with or without cervical lymph node dissection, with tumour stages T1-T3 with or without lymph node metastasis, but without distant metastasis. Patients were randomly assigned to the low-dose (1850 MBq) or high-dose (3700 MBq) radioiodine group. They were then followed up for 3-5 and 6-10 years. Data on biochemical abnormalities, recurrence and survival were analysed using Kolmogorov-Smirnov and χ2 tests. RESULTS The data of 228 patients (mean age = 42 years; 70.6% women) were analysed, with 117 patients in the low-dose group and 111 in the high-dose group. There were no significant differences in biochemical abnormalities, recurrence, or survival rates at the 6-10-year follow-up (all p > .05). Nine patients experienced recurrence in the low-dose group (8.7%), while eight patients experienced recurrence in the high-dose group (8.2%). The survival rates were 100% and 98.2% in the low- and high-dose groups, respectively. CONCLUSIONS The long-term effectiveness and safety of low-dose (1850 MBq) radioiodine are the same as those of high-dose (3700 MBq) radioiodine for thyroid remnant ablation in Chinese patients with low-risk DTC.
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Affiliation(s)
- Shiqi Liu
- Department of Nuclear Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuqi Wu
- Department of Nuclear Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Ma
- Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shaoyan Wang
- Department of Nuclear Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Suyun Chen
- Department of Nuclear Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Wang
- Department of Nuclear Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Feng
- Department of Nuclear Medicine, Shanghai Fourth Peoples' Hospital Affiliated to Tongji University, Shanghai, China
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Iizuka Y, Katagiri T, Ogura K, Inoue M, Nakashima R, Nakamura K, Mizowaki T. Recurrence-free survival and prognosis after adjuvant therapy with radioactive iodine-131 in patients with differentiated thyroid carcinoma. Sci Rep 2023; 13:10795. [PMID: 37402838 DOI: 10.1038/s41598-023-37899-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023] Open
Abstract
This study aimed to assess recurrence-free survival (RFS) rates and recurrence-related factors of patients who received adjuvant therapy (AT) with radioactive iodine (RAI) for differentiated thyroid cancer (DTC) following thyroidectomy. We evaluated 284 patients who underwent AT between January 2011 and July 2020 at our hospital. Recurrence was defined as visible recurrent lesions on image analysis or need for repeat surgery with pathologically confirmed recurrent lesions. RFS rate and prognostic factors were statistically evaluated. The median observation period was 30.2 months (range, 5.7-294 months). Overall, 192 patients were female and 92 were male, and the median age was 54 years (range, 9-85 years). Initial assessment revealed 39 recurrence cases. The 3-year RFS rate was 85.8% (95% confidence interval: 81.1-90.9%). Univariate analysis revealed that histology (except for papillary carcinoma), Tg level > 4 ng/dL before AT, and AT result significantly exacerbated the RFS rate. In multivariate analysis, histology and AT result were also important contributors to the worsening RFS rate. Results of AT can be determined relatively early and are important in predicting future recurrence in patients with DTC. Increasing the success rate of AT may lead to an improved prognosis.
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Affiliation(s)
- Yusuke Iizuka
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan.
- Department of Radiation Oncology, Shizuoka City Shizuoka Hospital, 10-93, Ote-machi, Aoi-ku, Shizuoka-shi, Shizuoka, 420-8630, Japan.
| | - Tomohiro Katagiri
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Kengo Ogura
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Minoru Inoue
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Ryota Nakashima
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Kiyonao Nakamura
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
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Pearce EN, Korevaar TIM, Leung AM. Levothyroxine for the Treatment of Subclinical Hypothyroidism in Thyroperoxidase Antibody Negative Pregnant Women: The Jury Is Still Out. Thyroid 2022; 32:349-350. [PMID: 35107366 DOI: 10.1089/thy.2022.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Tim I M Korevaar
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
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4
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Chen X, Wu C, Wang Z, Wu C, Guo Y, Zhu X, Hu YP, Shi Z, Song Q, Cui X, Su J, Zang J. Iodine nutrition status and thyroid autoimmunity during pregnancy: a cross-sectional study of 4635 pregnant women. Nutr J 2022; 21:7. [PMID: 35093086 PMCID: PMC8801104 DOI: 10.1186/s12937-022-00760-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/05/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Pregnant women in Shanghai have long been at risk for mild iodine deficiency. Because thyroid autoimmunity in pregnant women can lead to premature birth and miscarriage as well as neurodevelopmental deficits in the fetus, the aim of this study was to explore the association of iodine nutrition status with thyroid antibodies during pregnancy. METHODS A pregnancy-birth cohort was conducted including 4635 pregnant women in Shanghai, China. The eligible participants underwent a face-to-face interview and completed questionnaire surveys to collect baseline information and diet intake. Spot urine samples were collected to test urine iodine. Thyroid antibodies including thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb) and thyrotrophic antibodies (TRAb) were tested. Single-factor analysis and logistic regression were used to evaluate the association between iodine status and thyroid autoimmunity during pregnancy. RESULTS The median urinary iodine excretion level in the sample was 138.14 μg/L (interquartile range [IQR] 80.90-219.00 μg/L). Among all the subjects, 25.9% consumed non-iodized salt, 54.5% had iodine deficiency, and 31.0% had thyroid autoimmunity. The proportion of patients with iodine deficiency was significantly higher among those who consumed non-iodized salt (36.9% vs. 33.1%; p = 0.04). After adjusting for age, educational status, former smoker status, former drinker status, first pregnancy, and previous thyroid disease, non-iodized salt (odds ratio [OR] = 1.394 [confidence interval, CI, 1.165-1.562]; p = 0.003), iodine-rich food (OR = 0.681 [CI 0.585-0.793]; p = 0.003), iodized nutritional supplements (OR = 0.427 [CI 0.347-0.526]; p = 0.003), were found to be individually associated with thyroid autoimmunity in all participants. The results of the multivariable restricted cubic spline regression analysis showed a non-linear relationship between the continuous change in iodine intake and thyroid autoimmunity (p = 0.019). Participants with iodine deficiency (urinary iodine concentration, UIC,< 100 μg/L) had an increased risk of testing positive for thyroid antibodies (TPOAb/TgAb/TRAb[+]; OR = 1.324 [CI 1.125-1.559]; p < 0.001). Moreover, this associated existed even after removing participants with previous thyroid disease. CONCLUSION Inadequate iodine nutrition in pregnant women is an independent risk factor for thyroid autoimmunity in Shanghai. It's important to maintain the adequate iodine status in pregnant women.
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Affiliation(s)
- Xiao Chen
- Shanghai Putuo District Center for Disease Control and Prevention, Shanghai, 200033 China
| | - Chunfeng Wu
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336 China
| | - Zhengyuan Wang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336 China
| | - Chunxiang Wu
- Shanghai Putuo District Center for Disease Control and Prevention, Shanghai, 200033 China
| | - Yan Guo
- Shanghai Putuo District Center for Disease Control and Prevention, Shanghai, 200033 China
| | - Xiaoxia Zhu
- Shanghai Putuo District Center for Disease Control and Prevention, Shanghai, 200033 China
| | - Yan Ping Hu
- Shanghai Putuo District Center for Disease Control and Prevention, Shanghai, 200033 China
| | - Zehuan Shi
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336 China
| | - Qi Song
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336 China
| | - Xueying Cui
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336 China
| | - Jin Su
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336 China
| | - Jiajie Zang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336 China
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5
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Comparison between planar and single-photon computed tomography images for radiation intensity quantification in iodine-131 scintigraphy. Sci Rep 2021; 11:21858. [PMID: 34750482 PMCID: PMC8576011 DOI: 10.1038/s41598-021-01432-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022] Open
Abstract
This study aimed to evaluate the feasibility of quantifying iodine-131 (131I) accumulation in scintigraphy images and compare planar and single-photon emission computed tomography (SPECT) images to estimate 131I radioactivity in patients receiving radioactive iodine therapy for thyroid cancer. We evaluated 72 sets of planar and SPECT images acquired between February 2017 and December 2018. Simultaneously, we placed a reference 131I capsule next to the patient during image acquisition. We evaluated the correlation between the intensity of the capsule in the images and the capsule dose and estimated the radiation dose at the thyroid bed. The mean capsule dose was 2.14 MBq (range, 0.63–4.31 MBq). The correlation coefficients (p-value) between capsule dose and maximum and mean intensities in both planar and SPECT images were 0.93 (p < 0.01), 0.96 (p < 0.01), 0.60 (p < 0.01), and 0.47 (p < 0.01), respectively. The mean intensities of planar images show the highest correlation coefficients. Based on a regression equation, the average radiation dose in the thyroid bed was 5.9 MBq. In conclusion, planar images reflected the radiation dose more accurately than SPECT images. The regression equation allows to determine the dose in other regions, such as the thyroid bed or sites of distant metastasis.
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Zhang J, Li L, Liu D, Zhu T, Gao Q, Chen H, Ma L, Li J, Wang Z. Development and validation of the information needs questionnaire for differentiated thyroid cancer patient with radioactive iodine therapy (INQ-DTC). Nurs Open 2021; 9:1794-1804. [PMID: 34003590 PMCID: PMC8994968 DOI: 10.1002/nop2.925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/29/2021] [Accepted: 04/20/2021] [Indexed: 12/24/2022] Open
Abstract
AIMS This study aimed to develop and validate the psychometric properties of Information Needs Questionnaire for Differentiated Thyroid Cancer (INQ-DTC) in DTC patients with radioactive iodine (RAI) therapy. DESIGN Mixed methods. METHODS Using qualitative methods, we developed the initial questionnaire from a personal perspective of information needs of 15 patients with DTC. We used a formal Delphi consensus process to help assess the initial questionnaire and provide recommendations for its application. Totally, 230 DTC patients with RAI therapy were selected for the process of validation. RESULTS The final version of INQ-DTC contains 33 items. The total Cronbach's alpha coefficient was 0.945, the total split-half reliability was 0.822, and the test-retest value was 0.984 for the overall score. Exploratory factor analysis extracted 5 factors, which could explain 61.86% of the total variance. The Scale-level content validity index (S-CVI) was 0.928, and 0.929 for the item-level content validity index (I-CVI).
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Affiliation(s)
- Jing Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Limei Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongling Liu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Tingting Zhu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Qiaoqiao Gao
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Hui Chen
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Ling Ma
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Jiayin Li
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Zichen Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
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Bora Makal G, Aslan A. The Diagnostic Value of the American College of Radiology Thyroid Imaging Reporting and Data System Classification and Shear-Wave Elastography for the Differentiation of Thyroid Nodules. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1227-1234. [PMID: 33589354 DOI: 10.1016/j.ultrasmedbio.2021.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
This study aimed to determine the diagnostic accuracy of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) classification and shear-wave elastography (SWE) for the diagnosis of benign and malignant thyroid nodules. This retrospective study enrolled 141 patients (18-84 y of age) undergoing thyroidectomy between January 2015 and August 2020. All statistical analysis was based on pathologic results of patients. The cut-off value was found as category 4 for ACR TI-RADS classification and 5 m/s for shear-wave velocity (Vs) by the receiver operator characteristic curve analysis (area under the curve [AUC] = 0.684, p = 0.020 and AUC = 0.715, p = 0.005, respectively). SWE has higher diagnostic accuracy than the ACR TI-RADS classification system and can improve thyroid nodule discrimination in all sizes of the nodules. Also, the diagnostic performance decreases when the nodule diameter increases.
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Affiliation(s)
- Gül Bora Makal
- Yuksek Ihtisas University, Faculty of Medicine, Department of General Surgery, Ankara, Turkey.
| | - Aydın Aslan
- Yuksek Ihtisas University, Faculty of Medicine, Department of Radiology, Ankara, Turkey
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Sawka AM, Alexander EK, Bianco AC, Chou R, Haugen BR, Kopp PA, Pearce EN, Ross DS, Smallridge RC, Jonklaas J. Challenges in Developing Recommendations Based on Low-Quality Evidence in Thyroid Guidelines. Thyroid 2021; 31:3-7. [PMID: 32900277 DOI: 10.1089/thy.2020.0448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Anna M Sawka
- Division of Endocrinology, University Health Network, University of Toronto, Toronto, Canada
| | - Erik K Alexander
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Antonio C Bianco
- Section of Endocrinology and Metabolism, University of Chicago, Chicago, Illinois, USA
| | - Roger Chou
- Department of Medicine, and Oregon Health and Science University, Portland, Oregon, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Bryan R Haugen
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Peter A Kopp
- Division of Endocrinology, University of Lausanne, Lausanne, Switzerland
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University, Chicago, Illinois, USA
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Douglas S Ross
- Division of Endocrinology, Harvard University and Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jacqueline Jonklaas
- Division of Endocrinology, Georgetown University Medical Center, Washington, District of Columbia, USA
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Li J, Wu X, Mao N, Zheng G, Zhang H, Mou Y, Jia C, Mi J, Song X. Computed Tomography-Based Radiomics Model to Predict Central Cervical Lymph Node Metastases in Papillary Thyroid Carcinoma: A Multicenter Study. Front Endocrinol (Lausanne) 2021; 12:741698. [PMID: 34745008 PMCID: PMC8567994 DOI: 10.3389/fendo.2021.741698] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/04/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES This study aimed to develop a computed tomography (CT)-based radiomics model to predict central lymph node metastases (CLNM) preoperatively in patients with papillary thyroid carcinoma (PTC). METHODS In this retrospective study, 678 patients with PTC were enrolled from Yantai Yuhuangding Hot3spital (n=605) and the Affiliated Hospital of Binzhou Medical University (n=73) within August 2010 to December 2020. The patients were randomly divided into a training set (n=423), an internal test set (n=182), and an external test set (n=73). Radiomics features of each patient were extracted from preoperative plain scan and contrast-enhanced CT images (arterial and venous phases). One-way analysis of variance (ANOVA) and least absolute shrinkage and selection operator algorithm were used for feature selection. The K-nearest neighbor, logistics regression, decision tree, linear-support vector machine (linear-SVM), Gaussian-SVM, and polynomial-SVM algorithms were used to establish radiomics models for CLNM prediction. The clinical risk factors were selected by ANOVA and multivariate logistic regression. Incorporated with clinical risk factors, a combined radiomics model was established for the preoperative prediction of CLNM in patients with PTCs. The performance of the combined radiomics model was evaluated using the receiver operating characteristic (ROC) and calibration curves in the training and test sets. The clinical usefulness was evaluated through decision curve analysis (DCA). RESULTS A total of 4227 radiomic features were extracted from the CT images of each patient, and 14 non-zero coefficient features associated with CLNM were selected. Four clinical variables (sex, age, tumor diameter, and CT-reported lymph node status) were significantly associated with CLNM. Linear-SVM led to the best prediction model, which incorporated radiomic features and clinical risk factors. Areas under the ROC curves of 0.747 (95% confidence interval [CI] 0.706-0.782), 0.710 (95% CI 0.634-0.786), and 0.764 (95% CI 0.654-0.875) were obtained in the training, internal, and external test sets, respectively. The linear-SVM algorithm also showed better sensitivity (0.702 [95% CI 0.600-0.790] vs. 0.477 [95% CI 0.409-0.545]) and accuracy (0.670 [95% CI 0.600-0.738] vs. 0.642 [95% CI 0.569-0.712]) than an experienced radiologist in the internal test set in the combined radiomics model. The calibration plot reflected a favorable agreement between the actual and estimated probabilities of CLNM. The DCA indicated the clinical usefulness of the combined radiomics model. CONCLUSION The combined radiomics model is a non-invasive preoperative tool that incorporates radiomic features and clinical risk factors to predict CLNM in patients with PTC.
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Affiliation(s)
- Jingjing Li
- Second Clinical Medicine College, Binzhou Medical University, Yantai, China
- Department of Otorhinolaryngology-Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Xinxin Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, China
- Big Data and Artificial Intelligence Laboratory, Yantai Yuhuangding Hospital, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
| | - Guibin Zheng
- Department of Thyroid Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Haicheng Zhang
- Big Data and Artificial Intelligence Laboratory, Yantai Yuhuangding Hospital, Yantai, China
| | - Yakui Mou
- Department of Otorhinolaryngology-Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
| | - Chuanliang Jia
- Department of Otorhinolaryngology-Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Big Data and Artificial Intelligence Laboratory, Yantai Yuhuangding Hospital, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
| | - Jia Mi
- Precision Medicine Research Center, Binzhou Medical University, Yantai, China
- *Correspondence: Xicheng Song, ; Jia Mi,
| | - Xicheng Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Big Data and Artificial Intelligence Laboratory, Yantai Yuhuangding Hospital, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
- *Correspondence: Xicheng Song, ; Jia Mi,
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Ahtiainen V, Vaalavirta L, Tenhunen M, Joensuu H, Mäenpää H. Randomised comparison of 1.1 GBq and 3.7 GBq radioiodine to ablate the thyroid in the treatment of low-risk thyroid cancer: a 13-year follow-up. Acta Oncol 2020; 59:1064-1071. [PMID: 32603613 DOI: 10.1080/0284186x.2020.1785003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: The optimal activity of radioiodine (I-131) administered for ablation therapy in papillary and follicular thyroid cancer after thyroidectomy remains unknown in a long-term (> 10 year) follow-up. Some, shorter follow-up studies suggest that activities 1.1 GBq and 3.7 GBq are equally effective. We evaluated the long-term outcomes after radioiodine treatment to extend current knowledge about the optimal ablative dose of I-131.Methods: One hundred and sixty consecutive adult patients (129 females, 31 males; mean age 46 ± 14 y, range 18-89 y) diagnosed with histologically confirmed differentiated thyroid cancer, were randomised in a prospective, phase III, open-label, single-centre study, to receive either 1.1 GBq or 3.7 GBq of I-131 after thyroidectomy. At randomisation, patients were stratified according to the histologically verified cervical lymph node status and were prepared for ablation using thyroid hormone withdrawal. No uptake in the whole-body scan with I-131 and serum thyroglobulin concentration less than 1 ng/mL at 4-8 months after treatment was considered successful ablation.Results: Median follow-up time was 13.0 years (mean 11.0 ± 4.8 y; range 0.3-17.1 y). Altogether 81 patients received 1.1 GBq with successful ablation in 45 (56%) patients. In the original study, thirty-six patients (44%) needed one or more extra administrations to replete the ablation. Of these, 4 (8.9%) and 5 (14%) patients relapsed during the follow-up, respectively. Of the 79 patients treated with 3.7 GBq 45 (57%) had successful ablation after one administration of radioiodine and 34 (43%) needed several treatments. Of these, 2 (4.4%) and 9 (26.5%) patients relapsed, respectively. The groups did not differ in the proportion of patients relapsing (p = .591).Conclusion: During follow-up of median 13 years, 3.7 GBq is not superior to 1.1 GBq in the radioiodine treatment after thyroidectomy in papillary and follicular thyroid cancer.
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Affiliation(s)
- Veera Ahtiainen
- Department of Radiation Oncology, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Department of Radionuclear Treatments, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Doctoral School in Health Sciences, University of Helsinki, Helsinki, Finland
| | - Leila Vaalavirta
- Department of Radiation Oncology, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Department of Radionuclear Treatments, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
| | - Mikko Tenhunen
- Department of Radiation Oncology, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Department of Radionuclear Treatments, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
| | - Heikki Joensuu
- Department of Radiation Oncology, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Department of Radionuclear Treatments, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
| | - Hanna Mäenpää
- Department of Radiation Oncology, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Department of Radionuclear Treatments, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
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11
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Luo J, Chen J, Sun Y, Xu F, Wu L, Huang P. A retrospective study of reducing unnecessary thyroid biopsy for American College of Radiology Thyroid Imaging Reporting and Data Systems 4 assessment through applying shear wave elastography. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:349-355. [PMID: 32725061 PMCID: PMC10522092 DOI: 10.20945/2359-3997000000267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 01/11/2020] [Indexed: 11/23/2022]
Abstract
Objective The purpose of the study is to quantitatively assess shear-wave elastography (SWE) value in American College of Radiology Thyroid Imaging Reporting and Data Systems (ACR TI-RADS) 4. Materials and methods One hundred and fifty-two ACR TI-RADS 4 thyroid nodules undergoing SWE were included in the study. The mean (EMean), minimum (EMin) and maximum (EMax) of SWE elasticity were measured. Results The areas under the receiver operating characteristic (ROC) curves for SWE EMean, EMin and EMax in detecting benign and malignant nodules were 0.95, 0.83 and 0.84, respectively. Cut-off value of EMean ≤ 23.30 kPa is able to downgrade the lesion category to ACR TI-RADS 3 and cut-off value of EMean ≥ 52.14 kPa is able to upgrade the lesion category to ACR TI-RADS 5. Conclusions The EMean of SWE will probably identify nodules that have a high potential for benignity in ACR TI-RADS 4. It may help identify and select benign nodules while reducing unnecessary biopsy of benign thyroid nodules.
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Affiliation(s)
- Jieli Luo
- Second Affiliated HospitalZhejiang UniversitySchool of MedicineChina Department of Ultrasound, the Second Affiliated Hospital of Zhejiang University School of Medicine , Hangzhou, China
| | - Jianshe Chen
- Second Affiliated HospitalZhejiang UniversitySchool of MedicineChina Department of Ultrasound, the Second Affiliated Hospital of Zhejiang University School of Medicine , Hangzhou, China
| | - Yang Sun
- Second Affiliated HospitalZhejiang UniversitySchool of MedicineChina Department of Ultrasound, the Second Affiliated Hospital of Zhejiang University School of Medicine , Hangzhou, China
| | - Fangting Xu
- Second Affiliated HospitalZhejiang UniversitySchool of MedicineChina Department of Ultrasound, the Second Affiliated Hospital of Zhejiang University School of Medicine , Hangzhou, China
| | - Lilu Wu
- Second Affiliated HospitalZhejiang UniversitySchool of MedicineChina Department of Ultrasound, the Second Affiliated Hospital of Zhejiang University School of Medicine , Hangzhou, China
| | - Pintong Huang
- Second Affiliated HospitalZhejiang UniversitySchool of MedicineChina Department of Ultrasound, the Second Affiliated Hospital of Zhejiang University School of Medicine , Hangzhou, China
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Pereira M, Williams VL, Hallanger Johnson J, Valderrabano P. Thyroid Cancer Incidence Trends in the United States: Association with Changes in Professional Guideline Recommendations. Thyroid 2020; 30:1132-1140. [PMID: 32098591 DOI: 10.1089/thy.2019.0415] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Overdiagnosis is the leading factor contributing to the rapid increase in thyroid cancer incidence of the last decades. During this period, however, thyroid cancer incidence has not been increasing at a constant pace. We hypothesized that changes in the slope of the incidence trends curve, called joinpoints, could be associated with changes in clinical practice guideline recommendations. Methods: Data were obtained from the initial nine registries of the Surveillance, Epidemiology, and End Results (SEER) Program. Thyroid cancer incidence was analyzed from 1975 to 2016. Joinpoints in thyroid cancer incidence trends and clinical variables were correlated with significant changes in clinical practice recommendations. Results: Incidence rate trends of medullary and anaplastic thyroid cancer were constant during the study period. Among papillary thyroid cancers (PTCs), three main joinpoints were identified, mainly driven by changes in incidence trends of smaller cancers. First, acceleration followed by two deceleration periods in thyroid cancer incidence coincident in time with the release of American Thyroid Association guidelines in 1996, 2009, and 2015. In 1996, the use of thyroid ultrasound and fine needle aspiration biopsy for the evaluation of thyroid nodules was described; and in 2009 and 2015, higher size thresholds for the biopsy of thyroid nodules were set. For the follicular variant of PTC, a joinpoint was observed around 1988, when the histological diagnosis of this entity was revised in the World Health Organization classification; and another one in 2015 coinciding with the proposal to remove the term carcinoma from noninvasive follicular-pattern tumors with papillary-like nuclear features which contributed to drive down the overall thyroid cancer incidence. Follicular thyroid cancer incidence was affected as well by changes in the guidelines, but to a lesser extent, and it was fairly stable during the study period. Conclusions: This study suggests that thyroid cancer incidence trends have been shaped, in large part, but not completely, by changes in professional guideline recommendations.
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Affiliation(s)
- Malesa Pereira
- Department of Diagnostic Imaging and Interventional Radiology; H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Vonetta L Williams
- Collaborative Data Services Core; H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Julie Hallanger Johnson
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Pablo Valderrabano
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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Iizuka Y, Katagiri T, Ogura K, Inoue M, Nakamura K, Mizowaki T. Comparison of thyroid hormone withdrawal and recombinant human thyroid-stimulating hormone administration for adjuvant therapy in patients with intermediate- to high-risk differentiated thyroid cancer. Ann Nucl Med 2020; 34:736-741. [PMID: 32643022 DOI: 10.1007/s12149-020-01497-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/30/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the clinical outcome in patients who received adjuvant therapy with radioactive iodine (RAI) using different preparation methods, namely, thyroid hormone withdrawal (THW) and recombinant human thyroid-stimulating hormone (rhTSH), after undergoing thyroidectomy for intermediate- to high-risk differentiated thyroid carcinoma (DTC) according to the American Thyroid Association criteria. METHODS Between May 2012 and October 2018, 136 patients who underwent adjuvant therapy with high-dose (3700 MBq) RAI for DTC without any metastatic lesions or macroscopic residual lesions after surgical resection were retrospectively selected. Patients were excluded if distant metastasis was confirmed during adjuvant therapy or if the outcome could not be confirmed; thus, 112 patients were finally evaluated. Patients underwent either a 3-week I restriction with thyroxine withdrawal or a 2-week I restriction with rhTSH administration. The serum thyroglobulin (Tg) concentration was measured, and 131I scintigraphy (370 MBq) was performed 6-12 months after adjuvant therapy. The definition of the initial achievement of adjuvant therapy was the disappearance of the uptake of 131I at the thyroid bed and serum Tg concentration < 2.0 ng/mL. The results of the adjuvant therapy between the groups were compared using the Fisher's exact test, and the TSH levels and estimated glomerular filtration rate (eGFR) were compared using the Welch's t test. RESULTS The THW and rhTSH groups included 47 and 65 patients, respectively, and the intermediate- and high-risk groups included 63 and 49 patients, respectively. No patient was assigned to the low-risk group. In the THW and rhTSH groups, the initial RAI adjuvant therapy goal was achieved in 30/47 (63.8%) and 46/65 patients (70.8%), respectively (p = 0.54); mean ± standard deviation of the TSH levels was 123.8 ± 46.4 µIU/mL and 274.5 ± 97.7 µIU/mL, respectively (p < 0.01), and eGFR (treatment/pre-treatment) was 0.81 and 0.99, respectively (p < 0.01). In the intermediate- and high-risk groups, the initial RAI adjuvant therapy goal was achieved in 43/63 patients (68.3%) and 33/49 (67.3%), respectively (p = 1.0). CONCLUSION No significant differences were observed between the preparation methods in the initial achievement of RAI adjuvant therapy. However, patients in the rhTSH group demonstrated higher TSH levels and retained eGFR.
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Affiliation(s)
- Yusuke Iizuka
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, Japan.
| | - Tomohiro Katagiri
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, Japan
| | - Kengo Ogura
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, Japan
| | - Minoru Inoue
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, Japan
| | - Kiyonao Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, Japan
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Castillo-Gonzalez DA, Dorsey-Trevino EG, Gonzalez-Gonzalez JG, Garcia-Leal M, Bautista-Orduño KG, Raygoza K, Gionfriddo MR, Ospina NMS, Rodriguez-Gutierrez R. A deeper analysis in thyroid research: A meta-epidemiological study of the American Thyroid Association clinical guidelines. PLoS One 2020; 15:e0234297. [PMID: 32520949 PMCID: PMC7286515 DOI: 10.1371/journal.pone.0234297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/24/2020] [Indexed: 01/02/2023] Open
Abstract
Background The American Thyroid Association (ATA) uses the GRADE or the American College of Physicians (ACP) system to develop recommendations. Recommendations based on low-quality evidence should spur for the conduction of clinical studies, if feasible. The extent to which recommendations by the ATA based on low-quality of evidence are being actively researched remains unknown. Methods Clinical guidelines produced by the ATA using the GRADE or the ACP system to classify evidence were deemed eligible. Reviewers, in duplicate and independently, extracted therapeutic recommendations based on low-quality evidence, whereas recommendations with higher quality of evidence, aimed at diagnosis, or best practice statements were excluded. Eligible recommendations based on low-quality evidence were deconstructed to their components using the PICO format. We then searched on clinicaltrials.gov to identify ongoing research. Trials were deemed eligible if they addressed the PICO question with at least one of the intended outcomes. Results A total of 543 recommendations were retrieved, of which 305 (56%) were based on low-quality of evidence and only 90 were deemed eligible. Of these, we found that 33 (37%) recommendations were actively being researched in 53 clinical trials. Most of the trials were randomized and funded by non-profit organizations. Many clinical trials studied thyroid nodules and differentiated thyroid cancer (26/53; 49%), whereas few studied were aimed at anaplastic thyroid cancer (2/53; 4%). Conclusion One out of three of gaps in evidence, identified as low quality during the development of ATA guidelines, are currently actively researched. This finding calls for the need to develop a better research infrastructure and funding to support thyroid research.
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Affiliation(s)
- Dalia A. Castillo-Gonzalez
- Endocrinology Division, Department of Internal Medicine, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, México
- Plataforma INVEST Medicina UANL–KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Edgar G. Dorsey-Trevino
- Endocrinology Division, Department of Internal Medicine, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, México
- Plataforma INVEST Medicina UANL–KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Jose G. Gonzalez-Gonzalez
- Endocrinology Division, Department of Internal Medicine, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, México
- Plataforma INVEST Medicina UANL–KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey, México
- Research Unit, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Mariana Garcia-Leal
- Endocrinology Division, Department of Internal Medicine, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Karen G. Bautista-Orduño
- Endocrinology Division, Department of Internal Medicine, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, México
- Plataforma INVEST Medicina UANL–KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Karina Raygoza
- Plataforma INVEST Medicina UANL–KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Michael R. Gionfriddo
- Center for Pharmacy Innovation and Outcomes, Geisinger Health System, Forty Fort, PA, United States of America
| | - Naykky M. Singh Ospina
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, United States of America
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Rene Rodriguez-Gutierrez
- Endocrinology Division, Department of Internal Medicine, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, México
- Plataforma INVEST Medicina UANL–KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey, México
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, United States of America
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, United States of America
- * E-mail:
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15
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Li GY, Tan HL, Chen P, Hu HY, Liu M, Ou-Yang DJ, Khushbu RA, Pun D, Li JD, Zhang ZP, Yang Q, Huang P, Chang S. Predictive Factors for Level V Lymph Node Metastases in Papillary Thyroid Carcinoma with BRAFV600E Mutation and Clinicopathological Features. Cancer Manag Res 2020; 12:3371-3378. [PMID: 32494201 PMCID: PMC7231772 DOI: 10.2147/cmar.s247914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/25/2020] [Indexed: 12/27/2022] Open
Abstract
Background Therapeutic lateral neck dissection (LND) is recommended in papillary thyroid carcinoma (PTC) patients with clinically lateral lymph node metastasis (LLNM), whether underwent level V LND remains controversial for lacking of sensitive predicting system. BRAFV600E mutation is associated with aggressive tumor behavior, recurrence, and disease-specific mortality of PTC. However, the relationship between BRAFV600E mutation and level V LNM is unclear. Methods Univariate and multivariate analyses were retrospectively conducted on the potential predictive factors of 252 PTC patients who underwent initial treatment of neck lymph node dissection from September 2015 to October 2018 in our institute. BRAFV600E mutation and the clinicopathological characteristics of the two groups were compared. Results LLNM was presented in 208 (82.5%) patients and level II-V LNM was present in 42.8%, 71.2%, 85.1%, 17.8% patients, respectively. BRAFV600E mutation was observed in 188 (74.6%) patients and was significantly associated with patients' age, lymphocytic thyroiditis, capsule invasion, bilateral central lymph node metastasis (CLNM) and level V LNM in PTC. Univariate analysis revealed that lymphocytic thyroiditis, tumor size, number of CLNM, Level II LNM, Level III LNM, simultaneous Level II+III, simultaneous Level III+IV and simultaneous Level II+III+IV were significantly correlated with Level V LNM. In addition, multivariate analysis revealed that tumor size ≥2.5 cm, number of CLNM≥3, level II metastases and BRAFV600E mutation were independent Level V LNM predictors (odds ratio 3.910, 3.660, 8.410, 0.439; 95% CI 1.737-10.135, 1.054-12.713, 1.233-57.355, 0.280-0.827, respectively). Conclusion In summary, we presented several independent predictive factors for level V LNM in PTC patients. We constructed a risk prediction model consisting of tumor size ≥2.5 cm, number of CLNM≥3 and level II metastases and BRAFV600E mutation that may guide surgeons to evaluate the nodal status in PTC and perform tailored therapeutic LND.
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Affiliation(s)
- Gui-You Li
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Hai-Long Tan
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Pei Chen
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Hui-Yu Hu
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Mian Liu
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Deng-Jie Ou-Yang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Rooh-Afza Khushbu
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Deepak Pun
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Jin-Dong Li
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Zhi-Peng Zhang
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Qiong Yang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Peng Huang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Shi Chang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
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16
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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg 2020; 271:e21-e93. [PMID: 32079830 DOI: 10.1097/sla.0000000000003580] [Citation(s) in RCA: 238] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. BACKGROUND Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. METHODS The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
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17
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American thyroid association guidelines are inconsistent with Grading of Recommendations Assessment, Development, and Evaluations-A meta-epidemiologic study. J Clin Epidemiol 2020; 123:180-188.e2. [PMID: 32145366 DOI: 10.1016/j.jclinepi.2020.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/31/2020] [Accepted: 02/09/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The Grading of Recommendations Assessment, Development, and Evaluations (GRADE) working group has recognized some scenarios in which strong recommendations may be supported by low-quality evidence, the so-called paradigmatic situations. The adherence to these paradigmatic situations by the American Thyroid Association (ATA) guidelines, however, remains unknown. STUDY DESIGN AND SETTING Clinical guidelines from the ATA were retrieved and deemed eligible if created using GRADE or the American College of Physicians (ACP) system. Reviewers, independently and in duplicate, assessed all strong recommendations based on low-quality evidence and judged their alignment with GRADE paradigmatic situations. The study was conducted at KER Unit Mexico. RESULTS A total of five clinical guidelines, one using the GRADE and four using the ACP system, were eligible for analysis. We assessed a total of 518 recommendations, of which 355 (69%) were labeled as "strong" and 163 (31%) as "weak". A total of 151 strong recommendations were based on low-quality evidence, of which 36 (24%) were congruent with one of the five GRADE paradigmatic situations, whereas 115 (76%) were not consistent with any paradigmatic situations and should have been categorized as weak (23% [26/115]) or best-practice recommendations (77% [89/115]). CONCLUSION ATA clinical guidelines are discordant with GRADE guidance. Future guidelines should carefully evaluate the quality of evidence and recognize its limitations when developing recommendations.
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18
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Sawka AM, Gagliardi AR, Haymart MR, Sturgeon C, Bernet V, Hoff K, Angelos P, Brito JP, Haugen BR, Kim B, Kopp PA, Mandel SJ, Ross DS, Samuels M, Sarne D, Sinclair C, Jonklaas J. A Survey of American Thyroid Association Members Regarding the 2015 Adult Thyroid Nodule and Differentiated Thyroid Cancer Clinical Practice Guidelines. Thyroid 2020; 30:25-33. [PMID: 31830853 DOI: 10.1089/thy.2019.0486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: The 2015 American Thyroid Association (ATA) clinical practice guidelines (CPGs) on management of thyroid nodules (TNs) and differentiated thyroid cancer (DTC) in adults were developed to inform clinicians, patients, researchers, and health policy makers about the best available evidence, and its limitations, relating to management of these conditions. Methods: We conducted a cross-sectional electronic survey of ATA members' perspectives of these CPGs, using a standardized survey (Clinician Guidelines Determinant Questionnaire) developed by the Guidelines International Network. A survey link was electronically mailed to members in February of 2019, with reminders sent to nonrespondents 2 and 5 weeks later. Data were descriptively summarized, after excluding missing responses. Results: The overall response rate was 19.8% (348/1761). The effective response rate was 20.2% (348/1720), after excluding a recently deceased member and individuals who had either invalid e-mail addresses or whose e-mails were returned. Of the respondents, 37.9% (132/348) were female, 60.4% (209/346) were endocrinologists, 27.5% (95/346) were surgeons, and 3.5% (12/346) were nuclear medicine specialists. The majority of respondents (71.9%; 250/348) were at a mid- or advanced-career level, and more than half were in academia (57.5%; 195/339). The majority (69.8%; 243/348) practiced in North America. The vast majority of respondents indicated that the CPGs explained the underlying evidence (92.3%; 298/323) and 92.9% (300/323) agreed or strongly agreed with the content. Most respondents stated that they regularly used the CPGs in their practice (83.0%; 268/323). Most respondents (83.0%; 268/323) also agreed or strongly agreed that the recommendations were easy to incorporate in their practice. The most popular CPG format was an electronic desktop file (78.8%; 252/320). Shorter more frequent CPGs were favored by 55.0% (176/320) of respondents, and longer traditional CPGs were favored by 39.7% (127/320). Conclusions: The clinical content and evidence explanations in the adult TN and DTC CPGs are widely accepted and applied among ATA survey respondents. Future ATA CPG updates need to be optimized to best meet users' preferences regarding format, frequency, and length.
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Affiliation(s)
- Anna M Sawka
- Division of Endocrinology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Megan R Haymart
- Division of Endocrinology, University of Michigan, Ann Arbor, Michigan
| | - Cord Sturgeon
- Division of Endocrine Surgery, Northwestern University, Chicago, Illinois
| | - Victor Bernet
- Division of Endocrinology, Mayo Clinic, Jacksonville, Florida
| | - Kelly Hoff
- American Thyroid Association, Falls Church, Virginia
| | - Peter Angelos
- Division of Endocrine Surgery, General Surgery, University of Chicago, Chicago, Illinois
| | - Juan P Brito
- Division of Endocrinology and Knowledge Evaluation and Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Bryan R Haugen
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian Kim
- Division of Endocrinology, Rush University, Chicago, Illinois
| | - Peter A Kopp
- Division of Endocrinology, University of Lausanne, Lausanne, Switzerland
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University, Chicago, Illinois
| | - Susan J Mandel
- Division of Endocrinology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Douglas S Ross
- Division of Endocrinology, Harvard Medical School, Boston, Massachusetts
| | - Mary Samuels
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health Sciences University, Portland, Oregon
| | - David Sarne
- Division of Endocrinology, University of Chicago, Chicago, Illinois
| | - Catherine Sinclair
- Department of Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jacqueline Jonklaas
- Division of Endocrinology, Georgetown University Medical Center, Washington, District of Columbia
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Affiliation(s)
- Jerome M Hershman
- Division of Endocrinology, Department of Medicine, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California
| | - Terry F Davies
- Thyroid Research Unit, Icahn School of Medicine at Mount Sinai, and the James J. Peters VA Medical Center, New York, New York
| | - Charles H Emerson
- Department of Medicine, University of Massachusetts School of Medicine, Worcester, Massachusetts
| | - Peter A Kopp
- Division of Endocrinology, Diabetes and Metabolism, University of Lausanne, Lausanne, Switzerland
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20
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Kaliszewski K, Diakowska D, Wojtczak B, Migoń J, Kasprzyk A, Rudnicki J. The occurrence of and predictive factors for multifocality and bilaterality in patients with papillary thyroid microcarcinoma. Medicine (Baltimore) 2019; 98:e15609. [PMID: 31083255 PMCID: PMC6531220 DOI: 10.1097/md.0000000000015609] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Thyroidectomy or hemithyroidectomy may be performed as treatment for papillary thyroid microcarcinoma (PTMC). However, in cases of bilateral PTMCs, only thyroidectomies should be recommended. Sometimes bilateral PTMC may be undetected in presurgical evaluations, so reoperation might be necessary after a partial thyroid resection. The aim of this study was to assess the occurrence of and predictive factors for the multifocality and bilaterality of PTMCs.We performed a retrospective review of 4716 consecutive patients with thyroid tumors. Of these patients, 434 (9.2%) had thyroid malignancies. All patients underwent thyroidectomies with central and/or lateral lymph node dissection between January 2008 and December 2017. PTMC was identified in 177 (3.75%) individuals.Solitary PTMC was observed in 114 (64.4%) patients, multifocal PTMC was seen in 48 (27.1%) patients, and bilateral PTMC was detected in 15 (8.5%) patients. The occurrence of solitary PTMC increased from 11.1% in 2008 to 61.9% in 2017. The occurrence of multifocal tumors significantly decreased from 77.8% in 2008 to 6.3% to 18.4% in 2013 to 2016 (P < .05). The occurrence of bilateral tumors, with respect to all PTMC cases, did not change during the 10-year period. We observed significantly higher rates of hypoechogenicity, more microcalcifications, more irregular margins, larger tumor sizes, and higher vascularity in the patients with multifocal and bilateral tumors than in the patients with solitary tumors (P < .0001 for all).The occurrence of bilateral PTMC is not very common. In patients with PTMC, thyroidectomy should be considered when microcalcifications, an irregular tumor shape, unclear margins, hypoechogenicity, high vascularity, and a large tumor size are observed. These clinicopathological features are prognostic factors for multifocal and bilateral PTMC.
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Affiliation(s)
| | - Dorota Diakowska
- Department of Nervous System Diseases, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Beata Wojtczak
- Department of General, Minimally Invasive and Endocrine Surgery
| | - Jakub Migoń
- Department of General, Minimally Invasive and Endocrine Surgery
| | - Agata Kasprzyk
- Department of General, Minimally Invasive and Endocrine Surgery
| | - Jerzy Rudnicki
- Department of General, Minimally Invasive and Endocrine Surgery
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Current Practice of Surgery for Benign Goitre-An Analysis of the Prospective DGAV StuDoQ|Thyroid Registry. J Clin Med 2019; 8:jcm8040477. [PMID: 30965665 PMCID: PMC6517925 DOI: 10.3390/jcm8040477] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/14/2022] Open
Abstract
Background: To evaluate the current indications, resection strategies and short-term outcomes of surgery for benign goitre in a country with endemic goitre. Methods: Data of patients who underwent surgery for benign goitre were retrieved from the prospective StuDoQ/Thyroid registry and retrospectively analysed regarding the patient’s demographics, indications for surgery, surgical procedures, histology, and perioperative outcomes. Results: In a 15-month period, 12,888 patients from 83 departments underwent thyroid resections for benign conditions. Main indications for surgery were exclusion of malignancy (68%), compression symptoms (20.7%) and hyperthyroidism (9.7%). Preoperative fine needle aspiration cytology was performed in only 12.2% of patients with the indication “exclusion of malignancy”. Thyroidectomy (49.8%) or hemithyroidectomy (36.9%) were performed in 86.7% of patients. Minimally invasive or alternative surgical techniques were applied in only 2.2%. Intraoperative neuromonitoring was used in 98.4% of procedures, in 97.5% of patients at least one parathyroid gland was visualized, and in 15.3% of patients parathyroid tissue was autografted, respectively. The rates of unilateral and bilateral transient recurrent nerve palsy were 3.6% and 0.07% of nerves at risk, the rate of transitory hypoparathyroidism was 15.3%. The rates of postoperative bleeding and wound infections requiring reoperation were 1.4% and 0.07%, respectively. Conclusions: The indication “exclusion of malignancy” is made too liberally, and there is a strong attitude to perform complete thyroid resections. Postoperative hypoparathyroidism is the major complication after surgery for benign thyroid disease, thus requiring more awareness.
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Iizuka Y, Katagiri T, Ogura K, Mizowaki T. Comparison between the different doses of radioactive iodine ablation prescribed in patients with intermediate-to-high-risk differentiated thyroid cancer. Ann Nucl Med 2019; 33:495-501. [PMID: 30955202 DOI: 10.1007/s12149-019-01357-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/02/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to compare the clinical outcomes of patients who received radioactive iodine (RAI) ablation after undergoing thyroidectomy for intermediate-to-high-risk differentiated thyroid carcinoma (DTC) according to the American Thyroid Association (ATA) criteria. METHODS We retrospectively examined patients who underwent RAI ablation for DTC after surgical resection without macroscopic residual lesions or metastatic lesions between December 2011 and August 2016. Among 147 patients who underwent RAI ablation, those whose initial pathological stages or RAI ablation results were unknown and whose distant metastases were confirmed during RAI ablation were excluded. Low-dose therapy was defined as administration of 1110 MBq of 131iodine (131I), while high-dose therapy referred to administration of 2960-3700 MBq of 131I. We defined initial success of RAI ablation as a serum thyroglobulin concentration of < 2.0 ng/mL without thyroid-stimulating hormone stimulation and disappearance of 131I uptake in the thyroid bed on 131I scintigraphy 6-12 months after RAI ablation. RAI ablation success rates were compared between the low-dose and high-dose groups using Fisher's exact test, and inverse probability of treatment weighting (IPTW) analysis was performed for adjusting potential biases. RESULTS Among the 119 patients examined in this study (39 men and 80 women), 79 were classified as having intermediate risk, while 40 were classified as having high risk based on the ATA guideline. Initial RAI ablation success was achieved in 50/68 (73.5%) patients from the low-dose group and in 36/51 patients (70.6%) from the high-dose group (p = 0.84). Moreover, IPTW analysis showed no significant difference between the low-dose and high-dose groups. However, the success rate tended to be superior in high-risk patients who received high-dose therapy (86.2%) than in those who received low-dose therapy (72.7%) (p = 0.37). CONCLUSION There was no significant difference in the RAI ablation success rate between the low-dose and high-dose groups involving patients with intermediate-to-high-risk DTC. However, high-dose RAI ablation may be recommended in high-risk patients.
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Affiliation(s)
- Yusuke Iizuka
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Tomohiro Katagiri
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kengo Ogura
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Jonklaas J, Tefera E, Shara N. Short-Term Time Trends in Prescribing Therapy for Hypothyroidism: Results of a Survey of American Thyroid Association Members. Front Endocrinol (Lausanne) 2019; 10:31. [PMID: 30761091 PMCID: PMC6363658 DOI: 10.3389/fendo.2019.00031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 01/16/2019] [Indexed: 12/27/2022] Open
Abstract
Objective: Hypothyroid patients frequently request specific therapies from their physicians. Combination therapy is vigorously discussed at professional meetings. We wished to determine if physician prescribing patterns for hypothyroidism changed during 2017 after specific educational events. Methods: A survey addressing treatment of hypothyroidism was emailed to American Thyroid Association (ATA) members on three occasions in 2017. The Spring emails were sent prior to a satellite symposium addressing hypothyroidism, and prior to the annual Endocrine Society and ATA meetings; the December emails were sent after these events. Physicians were presented with thirteen theoretical patients and chose from 6 therapeutic options, including levothyroxine, synthetic combination therapy, thyroid extract, and liothyronine monotherapy. The patient scenarios successively incorporated factors potentially providing reasons for considering combination therapy. Multivariate repeated measures logistic regression analyses first examined effects of physician characteristics on prescribing the various therapies. Then, analyses also incorporated timing, by comparing prescribing patterns in February, March, and December. Results: In analyses of prescribing levothyroxine monotherapy vs. any T3 therapy, there was a trend of borderline significance (p = 0.053) for T3 therapy to be prescribed more in December compared with February-March combined. When multivariate analyses were performed controlling for time and physician characteristics, choice of therapy was only significantly affected by country of practice (OR 1.7, CI 1.3-2.2). Physician choice of therapies was also examined for the options of continuing (1) levothyroxine, vs. (2) increasing levothyroxine, (3) adding liothyronine either with or without levothyroxine reduction, or (4) replacing levothyroxine with desiccated thyroid extract or liothyronine. When multivariate analyses incorporating time and physician characteristics were performed, respondents in December (OR 1.5, CI 1.0-2.3) and those practicing in North America (OR 1.8, CI 1.2-2.6) were more likely to prescribe liothyronine. Conclusions: This survey shows that although current North American guidelines do not recommend combination therapy, such therapy is being prescribed more over time and is also more commonly prescribed in North America. It is possible our guidelines are failing to incorporate evidence that physicians are considering when prescribing combination therapy. Such evidence could include data about patient preferences, and this needs to be a focus of future studies.
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Affiliation(s)
- Jacqueline Jonklaas
- Division of Endocrinology, Georgetown University, Washington, DC, United States
- *Correspondence: Jacqueline Jonklaas
| | - Eshetu Tefera
- Department of Biostatistics and Biomedical Informatics, Medstar Health Research Institute, Hyattsville, MD, United States
| | - Nawar Shara
- Division of Endocrinology, Georgetown University, Washington, DC, United States
- Department of Biostatistics and Biomedical Informatics, Medstar Health Research Institute, Hyattsville, MD, United States
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