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Peștean C, Pavel A, Piciu D. Clinical and Paraclinical Considerations Regarding ki67's Role in the Management of Differentiated Thyroid Carcinoma-A Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:769. [PMID: 38792952 PMCID: PMC11123096 DOI: 10.3390/medicina60050769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: The ki67 nuclear protein is a tool for diagnosis and prognosis in oncology that is used to evaluate cell proliferation. Differentiated thyroid carcinoma is usually a slow-growing neoplasm, the most common type being the papillary form. Some clinical and pathological aspects may predict aggressive behaviour. There are reported cases of recurrence without clinico-pathological findings of aggressiveness. To obtain better predictions of the disease outcome in thyroid carcinoma, many immunohistochemical markers have been studied. The aim of this narrative literature review is to identify the benefits that ki67 may add to the management of patients with differentiated thyroid carcinoma, according to the latest evidence. Materials and Methods: We performed a search on the PubMed and Google Scholar databases using controlled vocabulary and keywords to find the most suitable published articles. A total number of sixty-eight items were identified, and five other articles were selected from other sources. After refining the selection, the inclusion criteria and exclusion criteria were applied, and a total number of twenty-nine articles were included in this literature review. Results and Discussion: The studies consist of retrospective studies (89.66%), case reports (6.9%) and literature reviews (3.45%), evaluating the role, implications and other parameters of ki67 as a diagnostic and/or prognostic tool. The statistical correlations between ki67 and other features were systematized as qualitative results of this review in order to improve the treatment strategies presented in the included articles. Conclusions: The included studies present converging data regarding most of the aspects concerning ki67. The ki67 proliferation index is a diagnostic/prognostic tool of interest in differentiated thyroid carcinoma and a good predictor of disease-free survival, disease recurrence and metastatic development. Prospective studies on large cohorts may add value for ki67 as a specific tool in the management strategy of differentiated thyroid carcinoma.
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Affiliation(s)
- Claudiu Peștean
- Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Prof. Dr. Ion Chiricuță Institute of Oncology, Department of Nuclear Medicine, 400015 Cluj-Napoca, Romania
- Affidea CT Clinic, 400015 Cluj-Napoca, Romania
| | - Alexandru Pavel
- Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Affidea CT Clinic, 400015 Cluj-Napoca, Romania
- Emergency Clinical County Hospital, 400347 Cluj-Napoca, Romania
| | - Doina Piciu
- Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Affidea CT Clinic, 400015 Cluj-Napoca, Romania
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Yan DE, Hu L, Shen YF, Lai XY, Zhang MY, Zhou M, Chen C, Liu MM, Wu LT, Liu LQ, Fan QW, Min WL, Wan SC, Zou F, Li J, Cai X, Lei SH, Xiong Y, Yang Y, Yu R, Gao WW, Zhang Y, Chen T. Iodine status and its association with prevalence of thyroid diseases in adults from Jiangxi Province, China. Endocrine 2023; 82:335-342. [PMID: 37308773 DOI: 10.1007/s12020-023-03413-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Iodine is an essential element for the biosynthesis of thyroid-stimulating hormone (TSH). Both excessive and deficient iodine are major risk factors for thyroid diseases, including thyroid dysfunction, thyroid nodules, and thyroid autoimmunity (TAI). This study aimed to elucidate the relationship between iodine status and the prevalence of thyroid diseases through a national cross-sectional epidemiological survey in Jiangxi province (China). METHODS This population-based, cross-sectional study enrolled 2636 Chinese local inhabitants who aged over 18 years old from April to August in 2015. Physical examination was performed and biochemical indices, urinary iodine concentration (UIC), and TSH level were measured. The Chi-square test, nonparametric test, and 4 multivariate logistic regression models adjusted for risk factors were applied to analysis. Spearman correlation coefficients were calculated to investigate the relationship between iodine intake level and the prevalence of thyroid diseases. RESULTS The median UIC was 176.4 μg/L, and a significant difference was found in median UIC between men (182.45 μg/L) and women (169.25 μg/L) (P = 0.03). Among these study subjects, 14.4%, 44.5%, 26.1%, and 15.0% had deficient, adequate, more than adequate, and excessive iodine concentrations, respectively. The prevalence rates of hyperthyroidism, subclinical hyperthyroidism, hypothyroidism, subclinical hypothyroidism, thyroid nodules, and TAI were 0.91%, 0.57%, 0.34% and 7.89%, 9.45%, and 12.7%, respectively. Significant differences were found in iodine status, waist circumstance, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), TSH, thyroid nodules, and TAI between men and women (P < 0.05). Compared with those with adequate UIC, subjects with excessive UIC had higher prevalence rates of thyroid dysfunction (odds ratio (OR) = 1.74, 95% confidence interval (CI): 1.40-2.54) and thyroid nodules (OR = 3.33, 95%CI 1.32-8.42). In addition, subjects with deficient and excessive UIC were at the higher risk of TAI compared with those with adequate UIC (OR = 1.68, 95%CI: 1.19-2.60; OR = 1.52, 95%CI: 1.04-2.96, respectively). UIC was positively correlated with the prevalence rates of thyroid nodules (r = -0.44, P < 0.01) and TAI (r = -0.055, P < 0.01). On the contrary, UIC was negatively correlated with the risk of thyroid dysfunction (r = -0.24, P > 0.05). CONCLUSION Adult inhabitants from Jiangxi province in the TIDE study were in the adequate iodine status. Excessive iodine status was noted as a risk factor for thyroid dysfunction and thyroid nodules. In addition, both iodine deficiency and excessive iodine were risk factors for TAI.
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Affiliation(s)
- Di-En Yan
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Department of Endocrinology, Ji'an Central Hospital, Ji'an, 343000, Jiangxi, China
| | - Lei Hu
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Yun-Feng Shen
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China.
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China.
| | - Xiao-Yang Lai
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China.
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China.
| | - Mei-Ying Zhang
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Min Zhou
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Chao Chen
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Mei-Mei Liu
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Li-Ting Wu
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Li-Qun Liu
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Qi-Wei Fan
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Wen-Lan Min
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Si-Cong Wan
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Fang Zou
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Jing Li
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Xia Cai
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Shui-Hong Lei
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Yan Xiong
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Ya Yang
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Rong Yu
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Wei-Wei Gao
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Ying Zhang
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Ting Chen
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, 330006, Jiangxi, China
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Li S, Guo W, Meng Q, Zhu M, Wei H, Ji F, Tan L, Zhang W. The association between thyroid-stimulating hormone and thyroid nodules, goiter and thyroid antibody positivity. Front Endocrinol (Lausanne) 2023; 14:1204552. [PMID: 37850098 PMCID: PMC10577406 DOI: 10.3389/fendo.2023.1204552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/14/2023] [Indexed: 10/19/2023] Open
Abstract
Background The relationship between normal thyroid-stimulating hormone (TSH) levels and thyroid disease in adults remains controversial. This study aimed to investigate the correlation between serum TSH levels, particularly those falling within the normal range, and thyroid diseases in Chinese adults, including thyroid nodules (TN), goiter (GR), and thyroid antibody positivity. Materials and methods This research was a cross-sectional study conducted in an adult population in Tianjin, China. Thyroid volume (Tvol) and TN were assessed using thyroid ultrasonography. Fasting venous blood and spot urine samples were collected to evaluate thyroid function and iodine status. Results A total of 2460 subjects participated in the survey. The prevalence of thyroid dysfunction was 9.76%, and abnormal TSH levels were found to potentially increase the risk of GR and thyroid antibody positivity in adults. A total of 2220 subjects with TSH within the normal reference range were included in the further study. In these patients, Tvol decreased as TSH levels increased, in both men and women (P < 0.0001). Low TSH levels (0.27-1.41 IU/mL) were identified as a risk factor for TN (odds ratio [OR], 1.46; 95% CI: 1.14-1.87) and GR (OR 5.90, 95% CI 2.27-15.3). Upon stratification by sex and age, the risk of TN was found to be higher in women and elderly individuals (≥60 years old), while the risk of GR was found to be higher in men and younger individuals (<60 years old). High TSH levels (2.55-4.2 IU/mL) were identified as a risk factor for thyroid antibody positivity (OR, 1.53; 95% CI: 1.11-2.10). Men and younger individuals with high TSH levels exhibited a higher risk of thyroid antibody positivity. Conclusion In adults with normal TSH levels, low TSH levels were associated with an increased risk of TN and GR, whereas high TSH levels were associated with thyroid antibody positivity. The research also suggests that adults whose TSH levels at upper or lower limits of the normal range should be reviewed regularly.
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Affiliation(s)
- Shaohan Li
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wenxing Guo
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Qi Meng
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Mei Zhu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongyan Wei
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Fengying Ji
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
- Qingdao Institute of Preventive Medicine, Qingdao, China
| | - Long Tan
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wanqi Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
- Tianjin Key Laboratory of Hormones and Development (Ministry of Health), Tianjin, China
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Kermoison G, Draganescu C. Role of Dietary and Environmental Factors on Thyroid Cancer in Romania: A Brief Review. Diagnostics (Basel) 2022; 12:diagnostics12081959. [PMID: 36010309 PMCID: PMC9406885 DOI: 10.3390/diagnostics12081959] [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: 06/06/2022] [Revised: 07/26/2022] [Accepted: 08/05/2022] [Indexed: 11/25/2022] Open
Abstract
Thyroid cancer is the most common endocrine tumor, accounting for about 1% of all human malignancies. There are environmental factors that can potentiate the onset of thyroid cancer, in particular pollutants, lifestyle or radiation exposure. Another major cause responsible for the appearance of thyroid cancer is the habitat in endemic areas where there is a deficit of iodine in the soil, drinking water and food. We operated using the PubMed database in order to find the articles of interest. After a wary review of the literature, we designated the relevant articles necessary for our study including various factors such as alimentation, effects of the Chernobyl fallout radiation and the iodine and vitamin D deficiency in Romania. The aim of this article is to make a correlation between the different environmental and dietary factors in Romania, and the increased incidence of thyroid cancer.
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Affiliation(s)
- Gilles Kermoison
- Doctoral School of Iuliu Hațieganu, University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Nuclear Medicine Department, “Prof. Dr. Ion Chiricuta” Institute of Oncology, 400015 Cluj-Napoca, Romania
- Nuclear Medicine Department, University Institut of Martinique, 97200 Fort-de-France, France
- Correspondence: ; Tel.: +40-756-328-839
| | - Ciprian Draganescu
- Nuclear Medicine Department, University Institut of Martinique, 97200 Fort-de-France, France
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Stefan AI, Piciu A, Cosnarovici MM, Dragomir M, Netea-Maier R, Piciu D. Thyroid Microcarcinoma in Pediatric Population in Romania. CHILDREN-BASEL 2021; 8:children8050422. [PMID: 34065257 PMCID: PMC8161046 DOI: 10.3390/children8050422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/16/2021] [Accepted: 05/18/2021] [Indexed: 12/24/2022]
Abstract
Thyroid microcarcinoma in pediatric population in Romania Non-medullary thyroid cancer (TC) is the most common endocrine malignancy, with an increasing incidence in the recent years, due to the increase of the thyroid microcarcinoma. Thyroid microcarcinoma (mTC) is defined, according to WHO criteria, as ≤1 cm dimension thyroid carcinoma, being a rare disease in children population. In adults, the current guidelines recommend a limited surgical approach. In children, however, there are no specific guidelines for mTC. Due to the scarcity of these tumors, mTC in children have largely been understudied, to our knowledge with only one previous publication reporting on the outcomes of a large historic series of patients with mTC from the USA. In Romania, the incidence of TC is rising, one of the reason may be the effect of Chernobyl nuclear accident in the past and the iodine deficiency. The purpose of this study was to describe the characteristics and outcome of children diagnosed with mTC in Romania diagnosed from 1 January 2000 to 31 December 2018. During the study period we identified 77 cases of differentiated TC (papillary and follicular) and of these 20 cases (19.4%) were mTC. The mTC represented roughly one fifth of our nationwide pediatric population diagnosed in the last 20 years, the majority of cases being recorded in adolescents aged between 15–18 years. Although patients with apparently more unfavorable local phenotype were identified, this was not reflected in the outcome of the patients in terms of remission of the disease and survival. Our study illustrates the heterogeneity of the real-life practice with respect to the pediatric mTC, and underscores the need for carefully designed multicenter international studies, including larger cohorts of patients in order to provide the data required for establishing evidence based uniform protocols. The European Reference Networks (ERN), such as the ERN for Rare Endocrine Diseases (Endo-ERN) provides an ideal platform to initiate such collaborative studies.
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Affiliation(s)
- Andreea-Ioana Stefan
- Doctoral School “Iuliu Hațieganu”, University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.-I.S.); (M.M.C.); (D.P.)
| | - Andra Piciu
- Department of Medical Oncology “Iuliu Hațieganu”, University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-744-401-318
| | - Maria Margareta Cosnarovici
- Doctoral School “Iuliu Hațieganu”, University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.-I.S.); (M.M.C.); (D.P.)
| | - Monica Dragomir
- Institute of Oncology “Carol Davila”, University of Medicine and Pharmacy, 022328 Bucharest, Romania;
| | - Romana Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Doina Piciu
- Doctoral School “Iuliu Hațieganu”, University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.-I.S.); (M.M.C.); (D.P.)
- Department of Endocrine Tumors and Nuclear Medicine, “Prof. Dr. Ion Chiricuţă” Institute of Oncology, 400012 Cluj-Napoca, Romania
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Boyanov MA. Trends in the epidemiology of thyroid diseases in Bulgaria since the year 2000-a review of the literature. Hormones (Athens) 2020; 19:477-484. [PMID: 32328904 DOI: 10.1007/s42000-020-00203-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
This review attempts to summarize data on the prevalence of thyroid pathology in the Bulgarian population over a period of 20 years. Thyroid dysfunction was studied in two population-based studies (2006 and 2012). In the first, hypothyroidism was found in 6.3% and hyperthyroidism in 3.7% of the participants. The second study found overt and subclinical hypothyroidism in 3.2% and 4.5%, respectively, of females, and in 1.1% and 2% of males. TPOAb levels were elevated in 23% of females and in 9.6% of males. Nodules were found using ultrasound (US) in 23.4% of the participants in the 2006 study (in 30.1% of females and 15.0% of males), while the 2012 study showed 24.4% (32.1% of females and 15.7% of males). Recent data regarding prevalence of thyroid carcinoma in the Bulgarian population are lacking. Between 4 and 6% of thyroid biopsies produce results which have markers for malignancy. Four studies were carried out to address urinary iodine excretion levels in schoolchildren and three for those in pregnant women. Although median urinary iodine was in the iodine-sufficient range, a rising proportion of women had low urinary excretion. In the studies involving schoolchildren, excessive iodine excretion was also observed. The major strength of this review is the combination of data from different publications to give an overall baseline of thyroid epidemiology in Bulgaria. Further work is needed to map the recent trends regarding thyroid pathology in Bulgaria and the complete epidemiological dataset.
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Affiliation(s)
- Mihail A Boyanov
- Clinic of Endocrinology and Metabolism, University Hospital Alexandrovska, 1, G. Sofiyski Str., 1431, Sofia, Bulgaria.
- Department of Internal Medicine, Faculty of Medicine, Medical University Sofia, Sofia, Bulgaria.
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TI-RADS Diagnostic Performance: Which Algorithm is Superior and How Elastography and 4D Vascularity Improve the Malignancy Risk Assessment. Diagnostics (Basel) 2020; 10:diagnostics10040180. [PMID: 32225078 PMCID: PMC7235757 DOI: 10.3390/diagnostics10040180] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 12/14/2022] Open
Abstract
Given the increased prevalence of thyroid nodules in the general population (~50%), the real challenge resides in correctly recognizing the suspicious ones. This study proposes to compare four important Thyroid Imaging and Reporting Data Systems (TI-RADS) and evaluate the contribution of elastography and 4D Color Doppler assessment of vascularity in estimating the risk of malignancy. In the study, 133 nodules with histopathological examination were included. Of these, 35 (26.31%) proved to be malignant. All nodules were classified using the four selected systems and our proposed improved score. The American College of Radiology (ACR) and EU TI-RADS had good sensitivity (94.28%, 97.14%) and NPV (93.33%, 95.83%), but fairly poor specificity (31.81%, 23.46%) and PPV (35.48%, 31.19%), with an accuracy of 42.8% and 45.8%, respectively. Horvath TI-RADS had better accuracy of 66.9% and somewhat improved specificity (62.24%), but poorer sensitivity (80%). Russ’ French TI-RADS includes elastography in the risk assessment strategy. This classification proved superior in all aspects (Se: 91.42%, Sp:82.65%, NPV:96.42%, PPV:65.30%, and Acc of 84.96%). The mean strain ratio (SR) value for malignant lesions was 5.56, while the mean SR value for benign ones was significantly lower, 2.54 (p < 0.05). It also correlated well with the response variable: histopathological result (p < 0.001). Although, adding 4D vascularity to the French score generated a similar calculated accuracy and from a statistical point of view, the parameter itself proved beneficial for predicting the malignancy risk (p < 0.001) and may add important knowledge in uncertain situations. Advanced ultrasound techniques definitely improved the risk estimation and should be used more extensively.
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Lou X, Wang X, Wang Z, Mao G, Zhu W, Wang Y, Pan X, Chen Z, Mo Z. The Effect of Iodine Status on the Risk of Thyroid Nodules: A Cross-Sectional Study in Zhejiang, China. Int J Endocrinol 2020; 2020:3760375. [PMID: 32908502 PMCID: PMC7450337 DOI: 10.1155/2020/3760375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/09/2020] [Accepted: 08/05/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore whether iodine nutrition is associated with the risk of thyroid nodules among adult population in Zhejiang Province, China. METHODS A cross-sectional study was conducted in the general population aged 18 years or older. A total of 2,710 subjects received physical examination, questionnaires, and thyroid ultrasonography. Urinary iodine concentration (UIC) and thyroid hormone levels were measured and documented for each subject. 4 multiple logistic regression models adjusted for other risk factors were applied to analyze the association between iodine nutrition and thyroid nodules. RESULTS The prevalence of thyroid nodules was 15.5% among all adults. As indicated by all 4 models, subjects with UIC varying from 200 μg l-1 to 399 μg l-1 had lower risk of thyroid nodules compared with those with relatively low UIC (<100 μg l-1), with approximately 37-57 percent reduction in risk. Moreover, subjects with UIC between 100 and 199 μg l-1 had a decreased risk of thyroid nodules in model 1 and 2 (OR = 0.75, 95% CI, 0.58-0.97; OR = 0.75, 95% CI, 0.58-0.97, respectively). However, there was no significant difference of risk in thyroid nodules between subjects with high UIC (≥400 μg l-1) and low UIC (<100 μg l-1). Furthermore, intake of iodized salt was inversely associated with risk of thyroid nodules, with approximately 69-77 percent reduction in risk. CONCLUSION The relationship between UIC and the risk of thyroid nodules is U-shaped. Consumption of noniodized salt is an independent risk factor of thyroid nodules.
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Affiliation(s)
- Xiaoming Lou
- Department of Environmental Health, Zhejiang Provincial Center for Disease Prevention and Control, 3399 Binsheng Road, Hangzhou 310051, Zhejiang, China
| | - Xiaofeng Wang
- Department of Environmental Health, Zhejiang Provincial Center for Disease Prevention and Control, 3399 Binsheng Road, Hangzhou 310051, Zhejiang, China
| | - Zhifang Wang
- Department of Environmental Health, Zhejiang Provincial Center for Disease Prevention and Control, 3399 Binsheng Road, Hangzhou 310051, Zhejiang, China
| | - Guangming Mao
- Department of Environmental Health, Zhejiang Provincial Center for Disease Prevention and Control, 3399 Binsheng Road, Hangzhou 310051, Zhejiang, China
| | - Wenming Zhu
- Department of Environmental Health, Zhejiang Provincial Center for Disease Prevention and Control, 3399 Binsheng Road, Hangzhou 310051, Zhejiang, China
| | - Yuanyang Wang
- Department of Environmental Health, Zhejiang Provincial Center for Disease Prevention and Control, 3399 Binsheng Road, Hangzhou 310051, Zhejiang, China
| | - Xuejiao Pan
- Department of Environmental Health, Zhejiang Provincial Center for Disease Prevention and Control, 3399 Binsheng Road, Hangzhou 310051, Zhejiang, China
| | - Zhijian Chen
- Department of Environmental Health, Zhejiang Provincial Center for Disease Prevention and Control, 3399 Binsheng Road, Hangzhou 310051, Zhejiang, China
| | - Zhe Mo
- Department of Environmental Health, Zhejiang Provincial Center for Disease Prevention and Control, 3399 Binsheng Road, Hangzhou 310051, Zhejiang, China
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Fan L, Tan L, Chen Y, Du C, Zhu M, Wang K, Wei H, Wang W, Gao M, Zhang Y, Cui T, Chen W, Shen J, Zhang W. Investigation on the factors that influence the prevalence of thyroid nodules in adults in Tianjin, China. J Trace Elem Med Biol 2018; 50:537-542. [PMID: 29544745 DOI: 10.1016/j.jtemb.2018.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/06/2018] [Accepted: 03/06/2018] [Indexed: 11/23/2022]
Abstract
Studies have shown that prevalence of thyroid nodules (TNs) has been increasing recently. However, the factors that may influence TN prevalence is not fully understood. In this study, we aimed to understand the prevalence of TNs and identify possible factors that are associated with the prevalence of TNs in Tianjin, China. Subjects aged 18 years or older were randomly collected and all subjects received thyroid ultrasonography, physical examination and questionnaires. Subjects (n = 2647) were divided into the case group in which the subjects had TNs and the control group in which the subjects did not have TNs. Potential influencing factors on TNs including sex, age, iodine status, thyroid volume, thyroid hormone (TSH), thyroid autoantibody TPOAb, TGAb and living habits were analyzed. Our results showed that the overall TN prevalence was 26.7%. The prevalence of TNs in women was higher than that in men (P < 0.05). TN prevalence increased with age (P < 0.001), and a U-shaped curve relationship between urine iodine concentrations (UICs) and prevalence of TNs was observed. The positive rate of TPOAb and goiter rate in case group was higher than that in control group (P < 0.05). The thyroid volume in case group was larger than that in control group (P < 0.001). Other factors that may influence TNs included high blood pressure, iodized salt, menopause, seafood intake, and education levels. None of UIC, TSH, TPOAb and TGAb were associated with TN prevalence in regression models. In conclusion, our results showed that TNs prevalence in Tianjin was high. TNs prevalence was higher in women than in men, and it increases with age. The older, female, high education level physical labor and goiter are independent risk factors for TNs.
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Affiliation(s)
- Lili Fan
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Long Tan
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Yanting Chen
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Cong Du
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Mei Zhu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No 154 Anshan Road, Heping District, Tianjin 300052, China
| | - Kunling Wang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No 154 Anshan Road, Heping District, Tianjin 300052, China
| | - Hongyan Wei
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No 154 Anshan Road, Heping District, Tianjin 300052, China
| | - Wei Wang
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Min Gao
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Yixin Zhang
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Tingkai Cui
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Wen Chen
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Jun Shen
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Wanqi Zhang
- School of Public Health, Tianjin Medical University, Tianjin 300070, China; Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No 154 Anshan Road, Heping District, Tianjin 300052, China.
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Negro R, Attanasio R, Papini E, Guglielmi R, Grimaldi F, Toscano V, Niculescu DA, Paun DL, Poiana C. A 2018 Italian and Romanian Survey on Subclinical Hypothyroidism in Pregnancy. Eur Thyroid J 2018; 7:294-301. [PMID: 30574459 PMCID: PMC6276751 DOI: 10.1159/000490944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/15/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Pregnancy induces changes in thyroid function, and thyroid dysfunction during gestation is associated with adverse outcomes. We examined the management of subclinical hypothyroidism and chronic autoimmune thyroiditis in pregnancy among Italian and Romanian endocrinologists. METHODS Members of the Associazione Medici Endocrinologi (AME) and Romanian Society of Endocrinology (RSE) were invited to participate in a web-based survey investigating the topic. RESULTS A total of 902 individuals participated in the survey, 759 of whom completed all sections. Among the respondents, 85.1% were aware of the 2017 American Thyroid Association guidelines about thyroid disease and pregnancy, and 82.9% declared that thyroid-stimulating hormone (TSH) screening at the beginning of pregnancy should be warranted. In a patient negative for peroxidase antibodies, 53.6% considered 2.5 mIU/L and 26.2% considered 4.0 mIU/L as the upper normal limit of TSH, and 50% would treat a patient with TSH 3.5 mIU/L with levothyroxine. About 20% did not suggest iodine supplementation. Isolated hypothyroxinemia detected in the first trimester would be treated by 40.8%. In patients undergoing ovarian stimulation, a TSH < 2.5 mIU/L would be targeted by 70%. CONCLUSIONS Respondents globally appeared well informed about the management of thyroid autoimmunity and subclinical hypothyroidism in pregnancy. A more aggressive attitude in implementing iodine supplementation would be desirable. Most endocrinologists were convinced about an evident association between mild thyroid impairment and adverse outcomes in pregnancy, thus using a TSH value of 2.5 mIU/L as the threshold for diagnosing hypothyroidism and starting levothyroxine in pregnant women.
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Affiliation(s)
- Roberto Negro
- Division of Endocrinology, “V. Fazzi” Hospital, Lecce, Italy
- *Roberto Negro, MD, Division of Endocrinology, “V. Fazzi” Hospital, Piazza Muratore, 1, IT–73100 Lecce (Italy), E-Mail
| | | | - Enrico Papini
- Department of Endocrinology, Regina Apostolorum Hospital, Albano Laziale, Italy
| | - Rinaldo Guglielmi
- Department of Endocrinology, Regina Apostolorum Hospital, Albano Laziale, Italy
| | - Franco Grimaldi
- Endocrinology and Metabolic Disease Unit, Azienda Ospedaliero-Universitaria “S. Maria della Misericordia”, Udine, Italy
| | - Vincenzo Toscano
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Roma, Italy
| | - Dan Alexandru Niculescu
- Department of Endocrinology, Carol Davila University of Medicine of Pharmacy, Bucharest, Romania
| | - Diana Loreta Paun
- Department of Endocrinology, Carol Davila University of Medicine of Pharmacy, Bucharest, Romania
| | - Catalina Poiana
- Department of Endocrinology, Carol Davila University of Medicine of Pharmacy, Bucharest, Romania
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