A class-imbalanced hybrid learning strategy based on Raman spectroscopy of serum samples for the diagnosis of hepatitis B, hepatitis A, and thyroid dysfunction

Computer-aided vibrational spectroscopy detection technology has achieved promising results in the field of early disease diagnosis. Yet limited by factors such as the number of actual samples and the cost of spectral acquisition in clinical medicine, the data available for model training are insufficient, and the amount of data varies greatly between different diseases, which constrain the performance optimization and enhancement of the diagnostic model. In this study, vibrational spectroscopy data of three common diseases are selected as research objects, and experimental research is conducted around the class imbalance situation that exists in medical data. When dealing with the challenge of class imbalance in medical vibrational spectroscopy research, it no longer relies on some kind of independent and single method, but considers the combined effect of multiple strategies. SVM, K-Nearest Neighbor (KNN), and Decision Tree (DT) are used as baseline comparison models on Raman spectroscopy medical datasets with different imbalance rates. The performance of the three strategies, Ensemble Learning, Feature Extraction, and Resampling, is verified on the class imbalance dataset by G-mean and AUC metrics, respectively. The results show that all the above three methods mitigate the negative impact caused by unbalanced learning. Based on this, we propose a hybrid ensemble classifier (HEC) that integrates resampling, feature extraction, and ensemble learning to verify the effectiveness of the hybrid learning strategy in solving the class imbalance problem. The G-mean and AUC values of the HEC method are 82.7 % and 83.12 % for the HBV dataset, is 2.02 % and 1.98 % higher than the optimal strategy; 83.62 % and 83.76 % for the HCV dataset, is 9.79 % and 8.47 % higher than the optimal strategy; while for the thyroid dysfunction dataset are 77.56 % and 77.85 %, is 6.92 % and 6.36 % higher than that of the optimal strategy, respectively. The experimental results show that the G-mean and AUC metrics of the HEC method are higher than those of the baseline classifier as well as the optimal combination using separate strategies. It can be seen that the HEC method can effectively counteract the unfavorable effects of imbalance learning and is expected to be applied to a wider range of imbalance scenarios.

Defining Gestational Thyroid Dysfunction Through Modified Nonpregnancy Reference Intervals: An Individual Participant Meta-analysis

BACKGROUND

Establishing local trimester-specific reference intervals for gestational TSH and free T4 (FT4) is often not feasible, necessitating alternative strategies. We aimed to systematically quantify the diagnostic performance of standardized modifications of center-specific nonpregnancy reference intervals as compared to trimester-specific reference intervals.

METHODS

We included prospective cohorts participating in the Consortium on Thyroid and Pregnancy. After relevant exclusions, reference intervals were calculated per cohort in thyroperoxidase antibody-negative women. Modifications to the nonpregnancy reference intervals included an absolute modification (per .1 mU/L TSH or 1 pmol/L free T4), relative modification (in steps of 5%) and fixed limits (upper TSH limit between 3.0 and 4.5 mU/L and lower FT4 limit 5-15 pmol/L). We compared (sub)clinical hypothyroidism prevalence, sensitivity, and positive predictive value (PPV) of these methodologies with population-based trimester-specific reference intervals.

RESULTS

The final study population comprised 52 496 participants in 18 cohorts. Optimal modifications of standard reference intervals to diagnose gestational overt hypothyroidism were -5% for the upper limit of TSH and +5% for the lower limit of FT4 (sensitivity, .70, CI, 0.47-0.86; PPV, 0.64, CI, 0.54-0.74). For subclinical hypothyroidism, these were -20% for the upper limit of TSH and -15% for the lower limit of FT4 (sensitivity, 0.91; CI, 0.67-0.98; PPV, 0.71, CI, 0.58-0.80). Absolute and fixed modifications yielded similar results. CIs were wide, limiting generalizability.

CONCLUSION

We could not identify modifications of nonpregnancy TSH and FT4 reference intervals that would enable centers to adequately approximate trimester-specific reference intervals. Future efforts should be turned toward studying the meaningfulness of trimester-specific reference intervals and risk-based decision limits.

Biomarkers in the early stage of PD-1 inhibitor treatment have shown superior predictive capabilities for immune-related thyroid dysfunction

Objective

Hematological indicators in the early stage of PD-1 inhibitor treatment may show superior predictive ability of the occurrence of immune related adverse event (irAE) compared to the pre-treatment indicators, as the immune response is modulated during the PD-1 inhibitor treatment. The objective of this study was to investigate the predictive capabilities of biomarkers in the early treatment stage for immune related thyroid dysfunction (irTD), and explore the potential predictive cytokines.

Methods

Medical records and blood test results of cancer patients treated with PD-1 inhibitor at a certain medical institution were collected. Logistic regression analysis was utilized to identify the predictive factors of irTD, ROC curves were plotted and the area under the curves (AUC) was calculated. Serum samples were collected before and during early treatment phase, cytokine detection was performed to explore potential predictive cytokines.

Results

A total of 264 patients were enrolled, 58 developed irTD (21.97%), including 31 patients with thyrotoxicosis and 27 with hypothyroidism. There were no significant differences in demographic characteristics, tumor types and PD-1 inhibitors between patients with and without irTD. Multivariate logistic analysis showed that anti-thyroglobulin antibody (TgAb) (OR=2.831, 95%CI: 1.077-7.443, P=0.035) and anti-thyroperoxidase antibody (TPOAb) (OR=9.565, 95%CI: 3.399-26.921, P=0.000) in the early treatment phase were independent predictive factors for irTD, the AUC of early-stage biomarkers was larger than that of pre-treatment (0.655 vs 0.571); low level of TSH at the early stage (OR=0.162, 95%CI: 0.077-0.341, P=0.000) was significantly correlated with thyrotoxicosis; female (OR=3.889, 95%CI: 1.457-10.380, P=0.007) and positive TPOAb (OR=8.678, 95%CI: 2.656-28.357, P=0.000) at the early stage were significantly correlated with hypothyroidism. The AUCs of early-stage biomarkers were larger than that of pre-treatment both in thyrotoxicosis (0.812 vs 0.637) and hypothyroidism patients (0.728 vs 0.710). The increase of IL-16 (adjusted P=0.004), IL-12p70 (adjusted P=0.014), IL-17 (adjusted P=0.014), CCL-15 (adjusted P=0.014) and IL-1a (adjusted P=0.021) in the early treatment phase were positively correlated with irTD.

Conclusions

Biomarkers at the early stage of PD-1 inhibitor treatment could predict irTD, and demonstrated stronger predictive ability compared to pre-treatment biomarkers. IL-16, IL-12p70, IL-17, CCL-15 and IL-1a could serve as potential predictive biomarkers for irTD.

Clinical value of complete blood count ratio in benign and malignant thyroid diseases

OBJECTIVE

To investigate the clinical value of blood routine derivative biomarkers and thyroid function biomarkers in differentiating different thyroid diseases.

METHODS

The differences of blood routine derived indexes neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), platelet-large cell rate (P-LCR) and thyroid function indexes between benign and malignant thyroid diseases were compared, and the differences of each index between different benign thyroid diseases were further compared. Univariate regression analysis model was used to analyze the clinical value of various indexes. Receiver operating characteristic curve (ROC) was used to calculate the area under the curve (AUC).

RESULTS

There were statistically significant differences in PLR, NLR and P-LCR between patients with benign and malignant thyroid diseases (P < 0.05 for each). The results of univariate logistic regression analysis showed that P < 0.05 for all indicators except LMR, when PLR and NLR value increased by 1, the risk of thyroid malignancy decreased by 1 % and 21 %, when P-LCR value increased by 1, the risk of thyroid malignancy increased by 4 %.

CONCLUSIONS

PLR, NLR and P-LCR are helpful to distinguish different benign thyroid diseases and to diagnose benign and malignant thyroid diseases.

Exploring the potential of myo-inositol in thyroid disease management: focus on thyroid cancer diagnosis and therapy

Thyroid cancer (TC) is a malignancy that is increasing in prevalence on a global scale, necessitating the development of innovative approaches for both diagnosis and treatment. Myo-inositol (MI) plays a crucial role in a wide range of physiological and pathological functions within human cells. To date, studies have investigated the function of MI in thyroid physiology as well as its potential therapeutic benefits for hypothyroidism and autoimmune thyroiditis. However, research in the field of TC is very restricted. Metabolomics studies have highlighted the promising diagnostic capabilities of MI, recognizing it as a metabolic biomarker for identifying thyroid tumors. Furthermore, MI can influence therapeutic characteristics by modulating key cellular pathways involved in TC. This review evaluates the potential application of MI as a naturally occurring compound in the management of thyroid diseases, including hypothyroidism, autoimmune thyroiditis, and especially TC. The limited number of studies conducted in the field of TC emphasizes the critical need for future research to comprehend the multifaceted role of MI in TC. A significant amount of research and clinical trials is necessary to understand the role of MI in the pathology of TC, its diagnostic and therapeutic potential, and to pave the way for personalized medicine strategies in managing this intricate disease.

Establishment of reference intervals of thyroid-related hormones for adults with normal liver function in Zhejiang Province by indirect method

Objective

Thyroid disorders are prevalently diagnosed yet face significant challenges in their accurate identification in China. Predominantly, the reference intervals (RIs) currently in use across Chinese medical facilities derive from company-provided data, lacking stringent scientific validation. This practice underscores the urgent necessity for establishing tailored RIs for thyroid-related hormones, specifically tailored to the coastal area populations. Such refined RIs are imperative for empowering clinicians with the precise tools needed for the accurate diagnosis of both overt and subclinical thyroid conditions.

Methods

This investigation analyzed the medical histories of 6021 euthyroid individuals mainly from East coastal area of China between June 2019 and December 2020. The cohort comprised residents of coastal areas, focusing on extracting insights into the regional specificity of thyroid hormone levels. A thorough examination protocol was implemented, encompassing inquiries into thyroid health history, ultrasound screenings, palpations during thyroid surgery, detections of thyroid antibodies, and reviews of medication histories. Adherence to the CLSI C28-A3 guidelines facilitated the derivation of RIs for thyroid-related hormones, subsequently juxtaposed against those provided by commercial entities.

Results

The study delineated the following gender- and age-specific RIs for Thyroid-Stimulating Hormone (TSH): for males under 50 years, 0.57-3.37; males over 50 years, 0.51-4.03; females under 50 years, 0.53-3.91; and females over 50 years, 0.63-4.31. Further analysis revealed the RIs for Free Thyroxine (FT4), Free Triiodothyronine (FT3), Total Thyroxine (TT4), and Total Triiodothyronine (TT3) amongst males and females, with notable distinctions observed between the two genders and across age brackets. These findings are in stark contrast to the standardized intervals provided by manufacturers, particularly highlighting differences in TT3 and FT3 levels between genders and a tendency for TSH levels to increase with age.

Conclusion

This research successfully establishes refined RIs for thyroid-related hormones within the Chinese coastal area populations, taking into account critical demographic factors such as gender and age. These tailored RIs are anticipated to significantly enhance the diagnostic accuracy for thyroid diseases, addressing the previously noted discrepancies with manufacturer-provided data and underscoring the importance of regionally and demographically adjusted reference intervals in clinical practice.

Thyroid dysfunction among patients assessed by thyroid function tests at a tertiary care hospital: a retrospective study

Introduction

previous studies in African populations have not extensively described the spectrum of thyroid dysfunction using the profile of thyroid hormones. Although iodine deficiency is a common thyroid disorder in Africa, it does not represent the entire spectrum of thyroid dysfunction seen in patients. This retrospective study aimed to describe the spectrum of thyroid dysfunction among patients seen at the Korle-Bu Teaching Hospital (KBTH), a tertiary care hospital in Accra, Ghana.

Methods

a retrospective analysis of medical records of all consultations on thyroid disorders seen at the Internal Medicine Department of KBTH between January 2019 and December 2021 was conducted. Information on patient demographics, and thyroid hormone profiles (triiodothyronine - FT3, thyroxine - FT4, and thyroid stimulating hormone - TSH) were extracted and subjected to descriptive statistics. The thyroid hormone profiles of the subjects were analyzed and classified into thyroid dysfunction categories using guidelines from the American Thyroid Association (ATA).

Results

out of the 215 patients with thyroid disorders enrolled, 85.1% (n=183) were females and 14.9% (n=32), were males. The mean age of patients was 45±14 years, with most of the patients within the age range of 31-50 years (49.3%; n=106). The most reported thyroid function dysfunction was primary hyperthyroidism (57.7%), followed by primary hypothyroidism (22.3%), subclinical hyperthyroidism (9.3%), euthyroid sick syndrome (6.5%), and subclinical hypothyroidism (4.6%) respectively.

Conclusion

primary hyperthyroidism was the most commonly diagnosed thyroid dysfunction. Hyperthyroidism has been associated with cardiac morbidity and mortality. Timely interventions are required to reduce the morbidity risks and burden associated with the hyperthyroid state.

The correlation between the thyroid function and urinary iodine/creatinine ratio of pregnant women attending a tertiary hospital in Beijing, China, during different trimesters

OBJECTIVE

This study investigated the correlation between thyroid function and urinary iodine/creatinine ratio (UI/Cr) in pregnant women during different trimesters and explored potential influencing factors.

METHODS

In this cross-sectional study, serum levels of thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), and UI/Cr were measured in 450 pregnant women. Correlations were analyzed using Pearson's correlation coefficient and multiple linear regression. Subgroup analyses were performed based on age, body mass index (BMI), parity, gestational age, education, occupation, and family history of thyroid disorders.

RESULTS

UI/Cr was positively correlated with FT4 levels in the first and second trimesters, particularly in women with older age, higher BMI, multiparity, higher education, and employment. No significant correlations were found between UI/Cr and TSH or FT3 levels.

CONCLUSION

UI/Cr is positively correlated with FT4 levels in early pregnancy, especially in women with certain risk factors. Regular monitoring of iodine status and thyroid function is recommended for pregnant women to ensure optimal maternal and fetal health.

Testing for a causal role of thyroid hormone measurements within the normal range on human metabolism and diseases: a systematic Mendelian randomization

BACKGROUND

Variation in thyroid function parameters within the normal range has been observationally associated with adverse health outcomes. Whether those associations reflect causal effects is largely unknown.

METHODS

We systematically tested associations between genetic differences in thyrotropin (TSH) and free thyroxine (FT4) within the normal range and more than 1100 diseases and more than 6000 molecular traits (metabolites and proteins) in three large population-based cohorts. This was performed by combining individual and summary level genetic data and using polygenic scores and Mendelian randomization (MR) methods. We performed a phenome-wide MR study in the OpenGWAS database covering thousands of complex phenotypes and diseases.

FINDINGS

Genetically predicted TSH or FT4 levels within the normal range were predominately associated with thyroid-related outcomes, like goitre. The few extra-thyroidal outcomes that were found to be associated with genetic liability towards high but normal TSH levels included atrial fibrillation (odds ratio = 0.92, p-value = 2.13 × 10-3), thyroid cancer (odds ratio = 0.57, p-value = 2.97 × 10-4), and specific biomarkers, such as sex hormone binding globulin (β = -0.046, p-value = 1.33 × 10-6) and total cholesterol (β = 0.027, p-value = 5.80 × 10-3).

INTERPRETATION

In contrast to previous studies that have described the association with thyroid hormone levels and disease outcomes, our genetic approach finds little evidence of an association between genetic differences in thyroid function within the normal range and non-thyroidal phenotypes. The association described in previous studies may be explained by reverse causation and confounding.

FUNDING

This research was funded by the Swiss National Science Foundation (P1BEP3_200041). The Fenland study (DOI 10.22025/2017.10.101.00001) is funded by the Medical Research Council (MC_UU_12015/1, MC_PC_13046 and MC_UU_00006/1). The EPIC-Norfolk study (DOI 10.22025/2019.10.105.00004) has received funding from the Medical Research Council (MR/N003284/1, MC-UU_12015/1, MC_PC_13048 and MC_UU_00006/1).

[Arrhythmias in thyroid dysfunction]

Thyroid dysfunction is associated with characteristic changes in heart rate and arrhythmias. Thyroid hormones act through genomic and non-genomic effects on myocytes and influence contractility, relaxation and action potential duration through a variety of mechanisms. Atrial fibrillation is the most common arrhythmia associated with thyroid dysfunction, it occurs in both euthyroidism and hyperthyroidism in clear association with T4 levels. Mechanistically, in the hyperthyroid state, increased automaticity and triggered activity, together with a shortened refractory period and slowing of the conduction speed, lead to the initiation and maintenance of multiple intraatrial reentry circuits. Influences from the autonomic nervous system and hemodynamics controlled by thyroid hormones act as modulators for arrhythmias, which are promoted by a corresponding substrate (significant impact of comorbidities). Concerning therapy, in addition to treating hyperthyroidism, the initial therapeutic focus is on adequate rate control and anticoagulation in patients with a high risk of thromboembolism. Ablation of atrial fibrillation can be considered later on, although there is an increased likelihood of recurrence compared to patients without hyperthyroidism.Prolongation of the QT interval and increase in QT dispersion are involved in the formation of ventricular arrhythmias. Epidemiological data suggest an association of elevated T4 levels with ventricular arrhythmias and sudden cardiac death. However, this seems to be mainly relevant for patients with underlying cardiac disease (e.g. ICD users).

Recent advances in liquid chromatography-tandem mass spectrometry for the detection of thyroid hormones and thyroglobulin in clinical samples: A review

Thyroid hormones (THs), including triiodothyronine (T3), thyroxine (T4), and their metabolites, are essential for regulating development, growth, and energy metabolism. Thyroglobulin (Tg) produced by thyroid follicular cells acts as an essential substrate for TH synthesis. The combination of THs with Tg is a widely used serological laboratory test for thyroid function assessment. Early detection and timely intervention are significant for preventing and managing thyroid disease. In recent years, liquid chromatography-tandem mass spectrometry (LC-MS/MS) has emerged as a powerful tool for the precise detection of small molecular analytes and steroid hormones in clinical practice as a result of its high sensitivity and specificity. While LC-MS/MS has been increasingly used for detecting THs and Tg recently, its application in clinical practice is still in its early stages. Recent advances in the assessment of thyroid metabolism using LC-MS/MS in clinical samples published during 2004-2023 were reviewed, with a special focus on the use of this technique for quantifying molecules involved in thyroid diseases.

Thyroid Disorders

This article includes a review of information primary care physicians need to know direct their evaluation and treatment of thyroid disorders that include sick euthyroid, hyperthyroidism, hypothyroidism, and subclinical thyroid disorders.

Mass spectrometry in measurement of thyroid biomarkers

In 2022, the number of patients with thyroid disease in China exceeded 200 million (10 million with hyperthyroidism, 90 million with hypothyroidism, and 100 million with other thyroid disease such as goiter, thyroid nodules, and thyroid cancer). Well-established markers include FT3, FT4, TT3, TT4, and TSH tested by a number of immunoassay methods. This approach is based on the primary binding of antigen with antibody and a subsequent secondary chemical reaction that provides an indirect measure. The use of traceable standards for quantitation remains an important factor to ensure inter-assay reliability and precision. Recently, mass spectrometry (MS) has received considerable attention as an analytic tool due to high resolution and quantitative accuracy. In addition, MS allows for sensitive determination of low-abundance markers making it ideal for development of traceable standards. Furthermore, this technology will allow for the development of highly accurate thyroid biomarker assays to facilitate diagnosis, enable early treatment and improve outcomes. Herein, we provide a systematic review and summary of MS in enhancing the analysis of thyroid biomarkers.

2024 European Thyroid Association Guidelines on diagnosis and management of genetic disorders of thyroid hormone transport, metabolism and action

Impaired sensitivity to thyroid hormones encompasses disorders with defective transport of hormones into cells, reduced hormone metabolism, and resistance to hormone action. Mediated by heritable single-gene defects, these rare conditions exhibit different patterns of discordant thyroid function associated with multisystem phenotypes. In this context, challenges include ruling out other causes of biochemical discordance, making a diagnosis using clinical features together with the identification of pathogenic variants in causal genes, and managing these rare disorders with a limited evidence base. For each condition, the present guidelines aim to inform clinical practice by summarizing key clinical features and useful investigations, criteria for molecular genetic diagnosis, and pathways for management and therapy. Specific, key recommendations were developed by combining the best research evidence available with the knowledge and clinical experience of panel members, to achieve a consensus.

Disseminated Tuberculosis Presenting as Ciliary Body and Thyroid Mass Lesions: A Case Report

PURPOSE

To report a case of disseminated TB presenting as ciliary body and thyroid mass lesions.

CASE REPORT

A 17-year-old male patient presented with a thyroid mass and blurring of vision in the left eye. A diagnosis of ciliary body granuloma was made. Although the Mantoux was negative, the HRCT chest showed evidence of miliary TB, and the fine needle aspiration cytology from the thyroid mass revealed AFB. On initiation of Antitubercular therapy(ATT), a paradoxical worsening of ciliary body granuloma was noted which resolved on starting steroids.

CONCLUSION

Involvement of thyroid gland and ciliary body although rare in tuberculosis, may be the presenting feature of disseminated TB. Paradoxical reactions seen after initiation of ATT in these cases may respond well to oral steroids.

Routine screening serum tests to detect underlying thyroid and autoimmune diseases in patients with moyamoya disease

BACKGROUND

Recent studies have revealed that thyroid and autoimmune diseases may be associated with sporadic moyamoya disease. However, whether routine screening serum tests to detect these underlying diseases are useful or not remains unclear.

METHODS

We retrospectively evaluated 459 patients with moyamoya disease but without previous history of thyroid or autoimmune diseases who underwent the screening serum tests targeting thyroid and autoimmune diseases from 2016 to 2023 in our institute. The number of patients who were diagnosed as thyroid or autoimmune diseases after these tests were investigated.

RESULTS

Among the patients who were screened, 237 (42.6 %) patients had abnormal results for some factors, such as thyroid hormones or autoantibodies. After consultation with endocrinologists or rheumatologists, 27 (5.9 %) patients were newly diagnosed with thyroid diseases, including six (1.3 %) patients with Graves' disease, 19 (4.1 %) patients with Hashimoto thyroiditis and two (0.4 %) patients with other thyroid diseases; however, none of the patients were diagnosed with nonthyroidal autoimmune diseases, such as Sjogren's syndrome, antiphospholipid syndrome, or rheumatoid arthritis, listed as moyamoya-related diseases and targeted by our screening serum tests. Patients with newly diagnosed underlying diseases were more likely to be female compared to patients without new diagnosis (96.3 % vs. 72.2 %, p = 0.03).

CONCLUSION

Routine thyroid-related serum screening may be clinically meaningful in patients with moyamoya disease to detect occult thyroid diseases, especially in female patients. However, routine serum screening tests targeting other autoimmune diseases are not recommended unless the patients have equivalent symptoms.

Towards Personalized TSH Reference Ranges: A Genetic and Population-Based Approach in Three Independent Cohorts

Background: Serum thyroid-stimulating hormone (TSH) measurement is the diagnostic cornerstone for primary thyroid dysfunction. There is high inter-individual but limited intra-individual variation in TSH concentrations, largely due to genetic factors. The currently used wide population-based reference intervals may lead to inappropriate management decisions. Methods: A polygenic score (PGS) including 59 genetic variants was used to calculate genetically determined TSH reference ranges in a thyroid disease-free cohort (n = 6,834). Its effect on reclassification of diagnoses was investigated when compared to using population-based reference ranges. Next, results were validated in a second independent population-based thyroid disease-free cohort (n = 3,800). Potential clinical implications were assessed in a third independent population-based cohort including individuals without thyroid disease (n = 26,321) as well as individuals on levothyroxine (LT4) treatment (n = 1,132). Results: PGS was a much stronger predictor of individual TSH concentrations than FT4 (total variance in TSH concentrations explained 9.2-11.1% vs. 2.4-2.7%, respectively) or any other nongenetic factor (total variance in TSH concentrations explained 0.2-1.8%). Genetically determined TSH reference ranges differed significantly between PGS quartiles in all cohorts, while the differences in FT4 concentrations were absent or only minor. Up to 24.7-30.1% of individuals, previously classified as having subclinical hypo- and hyperthyroidism when using population-based TSH reference ranges, were reclassified as euthyroid when genetically determined TSH reference ranges were applied. Individuals in the higher PGS quartiles had a higher probability of being prescribed LT4 treatment compared to individuals from the lower PGS quartiles (3.3% in Q1 vs. 5.2% in Q4, Pfor trend =1.7 × 10-8). Conclusions: Individual genetic profiles have the potential to personalize TSH reference ranges, with large effects on reclassification of diagnosis and LT4 prescriptions. As the currently used PGS can only predict approximately 10% of inter-individual variation in TSH concentrations, it should be further improved when more genetic variants determining TSH concentrations are identified in future studies.

EMAS position statement: Thyroid disease and menopause

INTRODUCTION

Thyroid diseases are common in women in their late reproductive years; therefore, thyroid disease and menopause may co-exist. Both conditions may present with a wide range of symptoms, leading to diagnostic challenges and delayed diagnosis. Aim To construct the first European Menopause and Andropause Society (EMAS) statement on thyroid diseases and menopause.

MATERIALS AND METHODS

Literature review and consensus of expert opinion (EMAS executive board members/experts on menopause and thyroid disease).

SUMMARY RECOMMENDATIONS

This position paper highlights the diagnostic and therapeutic dilemmas in managing women with thyroid disease during the menopausal transition, aiming to increase healthcare professionals' awareness of thyroid disorders and menopause-related symptoms. Clinical decisions regarding the treatment of both conditions should be made with caution and attention to the specific characteristics of this age group while adopting a personalized patient approach. The latter must include the family history, involvement of the woman in the decision-making, and respect for her preferences, to achieve overall well-being.

CXCL9 mediating the effect of thyroid disorders on oral and oropharyngeal cancer risk: A mediation Mendelian randomization study

INTRODUCTION

The established association between thyroid disorders (TD) and its two main subtypes-hyperthyroidism and hypothyroidism-and the incidence of oral and oropharyngeal cancer (OCPC) has been substantiated. However, the direct causal relationship and potential intermediary mechanisms linking these conditions have not been clearly defined in prior studies.

MATERIAL & METHODS

This study employed univariate Mendelian randomization (MR) analysis to explore those relationship. Instrumental variables from genome-wide association study (GWAS) datasets for TD (n = 218,792), hyperthyroidism (n = 460,499), hypothyroidism (n = 213,990), and OCPC (n = 12,619), along with 41 intermediary inflammatory cytokines (n = 8293), were analyzed. Inverse variance weighting (IVW) method assessed the causal relationships, while summary MR analysis with pQTL datasets from decode and 91 inflammatory cytokines explored the cytokines' roles as biomarkers and therapeutic targets for OCPC. Multivariable MR (MVMR) analysis quantified the mediation effect of these cytokines in the TD-OCPC relationship.

RESULTS

UVMR analysis provided strong evidence for a causal relationship between TD (OR = 1.376, 95 % CI = 1.142-1.656, p = 0.001), hyperthyroidism (OR = 1.319, 95 % CI=1.129-1.541, p = 0.001), hypothyroidism (OR = 1.224, 95 % CI = 1.071-1.400, p = 0.003), and the risk of OCPC. CXCL9 was identified as a significant intermediary in mediating the risk of OCPC from TD and its two subtypes (OR = 1.218, 95 % CI = 1.016-1.461, P = 0.033), suggesting its potential as a predictive biomarker for OCPC. MVMR analysis further revealed that CXCL9 mediated 7.94 %, 14.4 %, and 18 % of the effects of TD, hyperthyroidism, and hypothyroidism on OCPC risk, respectively.

DISCUSSION

This study not only elucidated the potential causal relationships between TD including its two subtypes and OCPC risk, but also highlighted CXCL9 as a pivotal mediator in this association.