The epidemiological landscape of thyroid cancer worldwide: GLOBOCAN estimates for incidence and mortality rates in 2020

Telitacicept for systemic lupus erythematosus with post‑surgical papillary thyroid carcinoma: A case report

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a complex etiology primarily linked to abnormalities in B lymphocytes within the human body, resulting in the production of numerous pathogenic autoantibodies. Telitacicept is a relatively novel humanized, recombinant transmembrane activator, calcium modulator and cyclophilin ligand interactor fused with the Fc portion (TACI-Fc). It works by competitively inhibiting the TACI site, neutralizing the activity of B-cell lymphocyte stimulator and A proliferation-inducing ligand. This, in turn, inhibits the development and survival of plasma cells and mature B cells. A 28-year-old female was admitted to the Department of Rheumatology and Immunology (People's Hospital of Longhua; Shenzhen, China) in June 2021 due to systemic edema for more than a month and hair loss lasting for a week. After comprehensive examination, the patient was diagnosed with SLE with hematological system involvement, serositis, lupus nephritis and secondary antiphospholipid syndrome. After receiving medications including glucocorticoids, mycophenolate mofetil and cyclosporine, the patient's white blood cells, platelets, hemoglobin, urinary protein and multiple serositis returned to normal. However, the levels of complement 3 (C3) and C4 did not significantly improve. Subsequently, the patient underwent thyroid ultrasound examination, which suggested thyroid nodules. After thyroid puncture biopsy, the patient was diagnosed with papillary thyroid carcinoma (PTC). After surgical resection, the patient was confirmed to have PTC by pathological biopsy, with no lymph node metastasis. At two months after surgery, the patient was treated with telitacicept, and the complement levels not only returned to normal but also remained stable for a long time. The present case was the first to report the use of telitacicept for the successful treatment of a patient with SLE with post-surgical PTC, providing a potential therapeutic option for SLE with a prior history of carcinoma. The role of telitacept in this field requires further research and attention.

A versatile nanoplatform carrying cascade Pt nanozymes remodeling tumor microenvironment for amplified sonodynamic/chemo therapy of thyroid cancer

Thyroid cancer is increasing globally, with anaplastic thyroid carcinoma (ATC) being the most aggressive type and having a poor prognosis. Current clinical treatments for thyroid cancer present numerous challenges, including invasiveness and the necessity of lifelong medication. Furthermore, a significant portion of patients with ATC experience cancer recurrence and metastasis. To overcome this dilemma, we developed a pH-responsive biomimetic nanocarrier (CLP@HP-A) through the incorporation of Chlorin e6 (Ce6) and Lenvatinib (Len) within hollow polydopamine nanoparticles (HP) that were further modified with platinum nanoparticles (Pt), enabling synergistic chemotherapy and sonodynamic therapy. The CLP@HP-A nanocarriers exhibited specific binding with galectin-3 receptors, facilitating their internalization through receptor-mediated endocytosis for targeted drug delivery. Upon exposure to ultrasound (US) irradiation, Ce6 rapidly generated reactive oxygen species (ROS) to induce significant oxidative stress and trigger apoptosis in tumor cells. Additionally, Pt not only alleviated tumor hypoxia by catalyzing the conversion of H2O2 to oxygen (O2) but also augmented intracellular ROS levels through the production of hydroxyl radicals (•OH), thereby enhancing the efficacy of sonodynamic therapy. Moreover, Len demonstrated a potent cytotoxic effect on thyroid cancer cells through the induction of apoptosis. Transcriptomics analysis findings additionally corroborated that CLP@HP-A effectively triggered cancer cell apoptosis, thereby serving as a crucial mechanism for its cytotoxic effects. In conclusion, the integration of sonodynamic/chemo combination therapy with targeted drug delivery systems offers a novel approach to the management of malignant tumors.

Association between metabolic dysfunction-associated steatotic liver disease and risk of thyroid cancer: a systematic review and meta-analysis

Several studies have reported associations between metabolic dysfunction-associated steatotic liver disease (MASLD) and the risk of various cancers. However, studies focusing specifically on the association between MASLD and thyroid cancer are relatively limited, and the conclusions drawn, thus, far remain inconclusive. In response, we conducted a meta-analysis of relevant cohort studies to clarify the association between MASLD and the risk of thyroid cancer. We systematically searched the Web of Science, Embase, Cochrane Library, and PubMed databases for articles published before 24 September 2024. We utilized the R software (version 4.4.1) for the comprehensive execution of all statistical analyses. Our meta-analysis included eight cohort studies (six retrospective and two prospective), comprising 18 925 396 participants. The pooled results of the eight cohort studies indicate that MASLD is linked to an increased risk of thyroid cancer (HR = 1.46; 95% CI: 1.14-1.86; I ² = 69%; P  < 0.01). A random-effects model was employed due to moderate heterogeneity ( I ² > 50%). Subgroup analyses revealed that the association between MASLD and thyroid cancer risk was stronger in the Chinese population (HR = 2.24; 95% CI: 1.32-3.81; I ² = 51%) and among overweight individuals (HR = 1.29; 95% CI: 1.02-1.63; I ² = 90%). No significant differences were identified between male and female subgroups. This meta-analysis demonstrates that MASLD increases the risk of developing thyroid cancer.

PET/CT imaging of differentiated and medullary thyroid carcinoma using the novel SSTR-targeting peptide [18F]SiTATE - first clinical experiences

PURPOSE

The novel 18F-labeled somatostatin receptor (SSTR)-directed radiotracer [18F]SiTATE demonstrated promising results for the imaging of various SSTR-expressing tumor types. Although thyroid carcinomas (TC) express SSTR, data on [18F]SiTATE PET/CT imaging in TC are lacking. This study explores the use of [18F]SiTATE PET/CT in a patient cohort with histologically proven TC.

METHODS

As part of a prospective observational study at a single tertiary cancer center, 21 patients with TC (10 medullary (MTC) and 11 differentiated (DTC)) who underwent at least one [18F]SiTATE PET/CT were included (37 scans in total). Mean SUVmax and SUVmean of tumoral lesions, mean total-tumor-volume (TTV), and whole-body (WB)-SUVmax and WB-SUVmean on PET with their standard deviations (SDs) were determined. PET parameters were correlated to clinical parameters including tumor marker levels (thyroglobulin for DTC, calcitonin for MTC).

RESULTS

89 lesions were included in the analysis. Metastases were localized in the bone, lymph nodes, lung, soft tissue, and thyroid bed. Osseous (31 lesions; SUVmax 8.6 ± 8.0; SUVmean 5.8 ± 5.4) and nodal (37 lesions; SUVmax 8.7 ± 7.8; SUVmean 5.7 ± 5.4) metastases showed the highest uptake. The MTC disease burden on PET significantly correlated with the calcitonin tumor marker level (e.g., TTV: r = 0.771, r2 = 0.594, p = 0.002). For DTC, no such correlation was present.

CONCLUSION

Our data demonstrate high feasibility of [18F]SiTATE PET/CT in a small cohort of patients with MTC and DTC. The use of [18F]SiTATE may overcome logistical disadvantages of 68Ga-based tracers and facilitate SSTR-targeted PET/CT imaging of thyroid carcinoma.

Managing Thyroid Nodules in Brain-Dead Donors: Our Experience and a Review of the Literature

BACKGROUND

Thyroid nodules are common findings during the diagnostic work-up in potential organ donors. A fast yet thorough assessment to rule out cancer is mandatory but their management remains heterogeneous among hospitals and the evidence in this field is scarce. We present our institutional experience and review the most recent literature on this topic.

METHODS

Retrospective case series and systematic review of the literature.

RESULTS

In the years 2000-2023, 47 total thyroidectomies were performed on potential brain-dead donors. Intraoperative frozen section (FS) revealed 6 cases (13.9%) of papillary carcinoma that led to organ discarding in 3 cases (6.9%). The mean operative time of the procedures was 42.75 min and no procurement-delaying complications were registered.

CONCLUSION

Total thyroidectomy with an intraoperative FS is a sound method for assessing suspicious nodules before organ harvesting. Future randomized studies comparing its performance against fine needle aspiration biopsy are needed to define the most cost-effective and time-saving strategy.

Transcriptome profiling and metabolic pathway analysis towards reliable biomarker discovery in early-stage lung cancer

Earlier diagnosis of lung cancer is crucial for reducing mortality and morbidity in high-risk patients. Liquid biopsy is a critical technique for detecting the cancer earlier and tracking the treatment outcomes. However, noninvasive biomarkers are desperately needed due to the lack of therapeutic sensitivity and early-stage diagnosis. Therefore, we have utilized transcriptomic profiling of early-stage lung cancer patients to discover promising biomarkers and their associated metabolic functions. Initially, PCA highlights the diversity level of gene expression in three stages of lung cancer samples. We have identified two major clusters consisting of highly variant genes among the three stages. Further, a total of 7742, 6611, and 643 genes were identified as DGE for stages I-III respectively. Topological analysis of the protein-protein interaction network resulted in seven candidate biomarkers such as JUN, LYN, PTK2, UBC, HSP90AA1, TP53, and UBB cumulatively for the three stages of lung cancers. Gene enrichment and KEGG pathway analyses aid in the comprehension of pathway mechanisms and regulation of identified hub genes in lung cancer. Importantly, the medial survival rates up to ~ 70 months were identified for hub genes during the Kaplan-Meier survival analysis. Moreover, the hub genes displayed the significance of risk factors during gene expression analysis using TIMER2.0 analysis. Therefore, we have reason that these biomarkers may serve as a prospective targeting candidate with higher treatment efficacy in early-stage lung cancer patients.

Haizao-Gancao herb pair ameliorates propylthiouracil-induced goiter by regulating the Beclin1-mediated autophagy

ETHNOPHARMACOLOGICAL RELEVANCE

Haizao, Sargassum, is widely used to treat goiter. Gancao, Glycyrrhizae radix et rhizome, is renowned for reducing toxicity or increasing effects in traditional Chinese medicine. As a classic herb pair, Haizao-Gancao (HG) is a commonly used and effective combined therapy for goiter. The underlying biological mechanisms of HG on goiter is still unclear.

AIM OF THE STUDY

To explore the effect of HG on goiter, employing molecular docking combined with experimental validation to elucidate the molecular mechanism.

MATERIALS AND METHODS

The rat goiter model was created by gavageing propylthiouracil (PTU) intragastrically for a duration of 14 days. The rats had been separated into six groups: control, model, euthyrox, HG high-dose (HG-H), medium-dose (HG-M) and low-dose (HG-L) group. Based on general observations (such as the rats' living status, body weight, and rectal temperature), the relative weight of the thyroid, thyroid function, hematoxylin-eosin (HE) staining, and transmission electron microscopy (TEM) to view the pathological variations of the thyroid glands, the effect of HG was evaluated. Discovered the chemical composition of HG by UPLC-MS/MS and the possible targets were predicted adopting several databases. Next, we explored their pharmacological mechanisms using molecular docking and validated key targets using western blotting (WB) and co-immunoprecipitation (Co-IP).

RESULTS

HG significantly increased the levels of triiodothyronine(T3), free triiodothyronine (FT3), free thyroxine (FT4), gained body weight and reduced tumescent thyroid glands in PTU-induced rats. The model group pathological changes such as uneven size, irregular shape and disordered arrangement of follicular epithelial cells occurred. However, HG groups thyroid follicles and epithelial cells appeared apparently normal. A variety of characteristic changes of autophagic vesicles appeared in the HG groups as opposed to the model group. In conclusion, the HG-L showed the best therapeutic effect. By UPLC-MS/MS, the major chemical components of HG were identified. The result revealed that HG contained flavonoids, alkaloids, organic acids, phenolic acidsand and terpenoids, etc. The molecular docking results of formononetin and naringenin and Beclin1 protein showed a high interaction of -5.38 kcal/mol and -5.25 kcal/mol. This implies that formononetin and naringenin may have a therapeutic effect in goiter rats by controlling the Beclin1-mediated autophagy. Western Blot (WB) and co-immunoprecipitation (Co-IP) results showed that HG can disrupt Beclin1/class III phosphatidylinositol 3-kinase(PI3KC3) binding and promote Beclin1/B-cell leukemia/lymphoma-2(Bcl-2) complex formation. Taken together, results demonstrate that autophagy inhibition via reducing Beclin1/PI3KC3 formation and increasing Beclin1/Bcl-2 binding activity.

CONCLUSIONS

HG ameliorates propylthiouracil-induced goiter by regulating the Beclin1-mediated autophagy, thus promoting the autophagy of thyroid cells.

Thyroid cancer quality of care indicators: A scoping review

BACKGROUND

Thyroid cancer, the most common endocrine malignancy, has highly variable practice patterns. This scoping review aimed to identify quantitative and qualitative quality of care indicators (QIs) essential for providing optimal care in thyroid cancer management.

METHODS

A comprehensive search across MEDLINE, EMBASE, PubMed, and Web of Science identified QIs defining structures, processes, and outcomes in five care phases: pre-diagnosis, diagnosis, treatment, post-treatment surveillance, and end-of-life care.

RESULTS

Of the 3,143 articles screened, 36 were included, yielding 135 unique QIs. Key diagnostic QIs were the use of a standardized ultrasound reporting system (n ​= ​4), diagnostic fine needle aspiration biopsy (FNAB) (n ​= ​3), and FNA cytology reporting with the Bethesda System (n ​= ​3). Common treatment QIs included thyroidectomy by high-volume surgeons (≥10-32 cases/year) (n ​= ​7), preoperative voice assessment for high-risk patients (n ​= ​4), and recurrent laryngeal nerve monitoring (n ​= ​3). Serum thyroglobulin (Tg) monitoring was the primary post-treatment QI for recurrence (n ​= ​2).

CONCLUSIONS

Developing an evidence-based QI list can identify care gaps, direct targeted interventions, promote care standardization, and improve outcomes for thyroid cancer patients.

Second Primary Differentiated Thyroid Carcinoma in Adult Cancer Survivors: A SEER Database Analysis

CONTEXT

Adult cancer survivors are at a heightened risk for secondary primary differentiated thyroid carcinoma (2-DTC). The characteristics and outcomes of 2-DTC remain poorly understood.

OBJECTIVE

We aimed to explore the characteristics and outcomes of 2-DTC.

METHODS

We retrospectively analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2017). 2-DTC was divided into 25 subgroups based on prior primary malignancies (PPMs). Baseline characteristics were compared using the chi-square test. Multivariable logistic analysis was used to identified if PPMs were associated with aggressive DTC characteristics. DTC-specific and cancer-specific mortality were analyzed using a univariable and multivariable competing risk regression model.

RESULTS

There were 138 555 1-DTC and 9253 2-DTC patients identified. 2-DTC patients were predominantly older, male, and White compared to first primary DTC (1-DTC) (all P < .05). In multivariable logistic regression analysis, only 4 types of PPMs were associated with higher rates of DTC aggressive characteristics, while 19 types exhibited lower rates (all P < .05). In multivariable competing risk analysis, 2-DTC showed no mortality risk in stages I (SHR: 1.16; 95% CI, 0.65-2.07) and II (SHR: 0.67; 95% CI, 0.45-1.01), but a protective role in stages III (SHR: 0.47; 95% CI, 0.27-0.83) and IV (SHR: 0.72; 95% CI, 0.52-0.99). Most PPMs that developed into 2-DTC had a lower risk of DTC-specific death than 1-DTC, but many PPMs had a higher risk of cancer-specific death.

CONCLUSION

Given the characteristics and outcomes of 2-DTC, aggressive treatment for 2-DTC, particularly for PPM with a high mortality risk, may not be advisable.

Insights in biomarkers complexity and routine clinical practice for the diagnosis of thyroid nodules and cancer

Background

The differential diagnosis between benign and malignant thyroid nodules continues to be a major challenge in clinical practice. The rising incidence of thyroid neoplasm and the low incidence of aggressive thyroid carcinoma, urges the exploration of strategies to improve the diagnostic accuracy in a pre-surgical phase, particularly for indeterminate nodules, and to prevent unnecessary surgeries. Only in 2022, the 5th WHO Classification of Endocrine and Neuroendocrine Tumors, and in 2023, the 3rd Bethesda System for Reporting Thyroid Cytopathology and the European Thyroid Association included biomarkers in their guidelines. In this review, we discuss the integration of biomarkers within the routine clinical practice for diagnosis of thyroid nodules and cancer.

Methodology

The literature search for this review was performed through Pub Med, Science Direct, and Google Scholar. We selected 156 publications with significant contributions to this topic, with the majority (86, or 55.1%) published between January 2019 and March 2024, including some publications from our group during those periods. The inclusion criteria were based on articles published in recognized scientific journals with high contributions to the proposed topic. We excluded articles not emphasizing molecular biomarkers in refine the pre-surgical diagnosis of thyroid nodules.

Results

We explored genetic biomarkers, considering the division of thyroid neoplasm into BRAF-like tumor and RAS-like tumor. The specificity of BRAF mutation in the diagnosis of papillary thyroid carcinoma (PTC) is nearly 100% but its sensitivity is below 35%. RAS mutations are found in a broad spectrum of thyroid neoplasm, from benign to malignant follicular-patterned tumors, but do not increase the ability to distinguish benign from malignant lesions. The overexpression of miRNAs is correlated with tumor aggressiveness, high tumor node metastasis (TMN) stage, and recurrence, representing a real signature of thyroid cancer, particularly PTC. In addition, associations between the expression levels of selected miRNAs and the presence of specific genetic mutations have been related with aggressiveness and worse prognosis.

Conclusions

The knowledge of genetic and molecular biomarkers has achieved a high level of complexity, and the difficulties related to its applicability determine that their implementation in clinical practice is not yet a reality. More studies with larger series are needed to optimize their use in routine practice. Additionally, the improvement of new techniques, such as liquid biopsy and/or artificial intelligence, may be the future for a better understanding of molecular biomarkers in thyroid nodular disease.

NOS3 Gene Polymorphisms (rs2070744 and rs1799983) and Differentiated Thyroid Cancer: Investigating Associations with Clinical Outcomes

Differentiated thyroid cancer (DTC) is the most common endocrine malignancy, with genetic factors playing an important role in its development and progression. This study investigated the association between nitric oxide synthase 3 (NOS3) gene polymorphisms (-786T>C or rs2070744 and Glu298Asp or c.894T>G or rs1799983) and the clinical characteristics and outcomes of DTC, aiming to evaluate their potential as biomarkers for prognosis. A case-control study was conducted, enrolling 172 individuals from the Endocrinology Clinics of Târgu Mureș and Iași, Romania, between 2021 and 2023. This study included 88 patients with DTC and 84 healthy controls, matched for age and sex. DNA was extracted from blood samples, and the NOS3 polymorphisms were genotyped using TaqMan assays. Statistical analysis included chi-square tests with a significance level set at p < 0.05. The distribution of the rs2070744 and rs1799983 polymorphisms showed no significant differences between the patients with DTC and healthy controls (p = 0.387 and p = 0.329, respectively). Furthermore, no significant associations were found between these polymorphisms and key clinical outcomes such as biochemical control, structural control, or loco-regional metastases. Our findings indicate that NOS3 rs2070744 and rs1799983 gene polymorphisms do not significantly influence the clinical outcomes of DTC, suggesting their limited utility as biomarkers for DTC prognosis.

Relationship of modifiable risk factors with the incidence of thyroid cancer: a worldwide study

BACKGROUND

Thyroid cancer is one of the most common cancers of the endocrine system. The incidence of this cancer has increased in many countries. Many cases of thyroid cancer do not have any symptoms. This cancer has different risk factors. Some of them are unchangeable and some can be changed and modified. So, it is necessary to identify these risk factors. Therefore, this global study was conducted for the first time to investigate the correlation between the age-standardized incidence rate of thyroid cancer (ASIR) and some modifiable risk factors worldwide.

METHODS

The data of this global ecological research has been collected on the official website of health data ( https://www.healthdata.org/ ) for 204 countries and territories from 1990 to 2019. Pearson correlation coefficient was used to evaluate the correlation. Finally, statistical modeling was done using Generalized Additive Model (GAM). Statistical analyzes were performed using R version 4.2.2 software.

RESULTS

ASIR of thyroid cancer has a positive and significant correlation with tobacco, Secondhand smoke (SHS), mean BMI, and low physical activity. Multiple GAM showed that gender, alcohol consumption, smoking, SHS, mean BMI, and low physical activity have a statistically significant relationship with the ASIR of thyroid cancer (All Relative Risk > 1).

CONCLUSION

This study showed that the risk of thyroid cancer is higher in women than men. Smoking, alcohol, obesity, and low physical activity may be risk factors for ASIR of thyroid cancer. Also, this study, for the first time globally, hypothesized an association between exposure to secondhand smoke and ASIR of thyroid cancer. To prevent and accurately control thyroid cancer, there is a need to increase awareness about the modifiable risk factors of this cancer.

Narrative overview of possible preventive measures for differentiated thyroid carcinomas

There is compelling evidence that although the increased availability of sensitive imaging is the main cause of the increasing incidence of differentiated thyroid cancer, particularly the papillary type, there are other factors involved. Despite the acknowledged role of genetic and certain lifestyle factors, comprehensive studies delineating the interactions between multiple risk factors and the mechanistic pathways involved are scarce. A greater understanding of both modifiable and non-modifiable risk factors for thyroid cancer is critical to prevent and manage the disease and could provide a scientific basis for future research into more appropriate lifestyles and living environments for people at high risk. We reviewed the main endogenous factors that, although considered non-modifiable, can help identify at-risk individuals. In addition, we offer a narrative review of other putative causes and make recommendations for measures to prevent the emergence of new cases of differentiated thyroid cancer.

Long noncoding RNA FAM111A-DT promotes aggressiveness of papillary thyroid cancer via activating NF-κB signaling

PURPOSE

Long noncoding RNAs (lncRNAs) play crucial regulatory roles in the tumorigenesis and progression of various cancers. However, the functional roles of lncRNAs in papillary thyroid cancer (PTC) remain unclear. In this study, we investigated the functional role of the lncRNA FAM111A-DT in PTC progression and the underlying mechanisms.

METHODS

Different expression levels of lncRNAs in PTC were compared via analysis of the Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA) databases. Bioinformatics analyses and qRT‒PCR were used to investigate the expression of FAM111A-DT in PTC. Cell proliferation was measured via CCK8, EdU, colony formation, and flow cytometry assays. Cell migration and invasion were examined by wound healing and Transwell assays. Apoptosis was detected via flow cytometry. RNA sequencing, qRT‒PCR, Western blot, immunofluorescence and dual-luciferase reporter assays were performed to assess the underlying mechanisms involved.

RESULTS

FAM111A-DT was highly expressed in PTC and associated with poor prognosis, thyroid dedifferentiation, various clinical features and the BRAFV600E mutation in PTC patients. Overexpression of FAM111A-DT enhanced the proliferation, migration and invasion of PTC cells while reducing their degree of apoptosis. The NF-κB signaling pathway was activated in FAM111A-DT-overexpressing PTC cells. The NF-κB inhibitor PDTC attenuated the promotive effects of FAM111A-DT on aggressive phenotypes and NF-κB pathway activity in PTC cells.

CONCLUSION

FAM111A-DT is upregulated in PTC, and its expression is associated with poor clinical outcomes. FAM111A-DT plays an oncogenic role by, at least partially, activating the NF-κB signaling pathway.

Assessment of thermal ablation for treating Bethesda IV thyroid nodules: a systematic review and meta-analysis

BACKGROUND

This study aimed to evaluate the efficacy and safety of thermal ablation in the treatment of patients with Bethesda IV thyroid nodules (follicular neoplasms) by analyzing large-scale data on various outcomes.

MATERIALS AND METHODS

Literature searches were conducted in PUBMED, EMBASE, Web of Science, and the Cochrane Library for studies on the use of thermal ablation in patients with Bethesda IV thyroid nodules published from March 1, 2014, to March 1, 2024. Data on volume change at 12 months; the volume reduction rate (VRR) at 1, 3, 6, and 12 months; the complete disappearance rate (CDR); and the complication rate were evaluated. All the data were analyzed with STATA 15.

RESULTS

Five eligible studies were included. The findings indicate that thermal ablation is both effective and safe. The mean change in tumor volume at 12 months postthermal ablation was characterized by a standardized mean difference (SMD) of -1.13 (95% CI: -1.36 - -0.90, p = 0.000). Specifically, the mean changes in tumor volume at 12 months after radiofrequency ablation (RFA) and microwave ablation (MWA) were - 1.19 (95% CI: -1.75 - -0.64) and - 1.26 (95% CI: -1.71 - -0.81), respectively. The VRRs at 1, 3, 6, and 12 months postthermal ablation were 43% (95% CI: 33 - 53%), 47% (95% CI: 20 - 74%), 69% (95% CI: 62 - 76%), and 85% (95% CI: 79 - 90%), respectively. The VRRs at 12 months after RFA and MWA were 84% (95% CI: 76 - 91%) and 85% (95% CI: 75 - 95%), respectively. The VRR at 12 months, stratified by initial nodule size, was 84% (95% CI: 77 - 91%) and 86% (95% CI: 78 - 94%). The CDR at the final follow-up was 88% (95% CI: 80 - 95%). The complication rate was 4.0% (95% CI: 0.0 - 8.0%), with pain and hoarseness being the most frequently reported complications; no life-threatening complications were documented.

CONCLUSIONS

Thermal ablation is a reliable treatment for Bethesda IV thyroid nodules, and RFA and MWA are advantageous treatment strategies. However, more prospective, multicenter, and large-sample studies are needed in the future.

Exploring the Link Between Exogenous Thyroid Hormones and Dementia Symptoms: A Real-World Disproportionality Analysis of FDA Adverse Event Reporting System

BACKGROUND

A growing body of evidence indicates a strong association between exogenous thyroid hormone (ETH) and brain health. Establishing the potential relationship between ETH therapy and dementia symptoms is crucial for patients with thyroid disorders.

OBJECTIVE

In this study, we investigate the potential association between ETH therapy and dementia symptoms by exploring the Food and Drug Administration Adverse Event Reporting System (FAERS) database.

METHODS

Disproportionality analysis (DPA) was conducted using postmarketing data from the FAERS repository (Q1 2004 to Q4 2023). Cases of dementia symptoms associated with ETH therapy were identified and analyzed through DPA using reporting odds ratios and information component methods. Dose and time-to-onset analyses were performed to assess the association between ETH therapy and dementia symptoms.

RESULTS

A total of 9889 cases of ETH-associated symptoms were identified in the FAERS database. Dementia accounted for a consistent proportion of adverse drug reactions each year (3.4%-6.3%). The DPA indicated an association between ETH therapy and dementia symptoms, which remained significant even across sex, age, and indications. The median time-to-onset of dementia symptoms was 7.5 days, and the median treatment time was 40.5 days. No significant dose-response relationship was observed.

CONCLUSION AND RELEVANCE

This study provides evidence for a link between ETH therapy and dementia. Clinicians are therefore advised to exercise vigilance, conduct comprehensive monitoring, and consider individualized dosing to mitigate potential reactions to ETH drug administration.

Selective anti-CXCR2 receptor blockade by AZD5069 inhibits CXCL8-mediated pro-tumorigenic activity in human thyroid cancer cells in vitro

BACKGROUND

Thyroid cancer is the most common endocrine malignancy. Current therapies are successful, however some patients progress to therapeutically refractive disease. The immunotherapeutic potential of the CXCL8-chemokine/CXCR2-chemokine-receptor system is currently being explored in numerous human cancers. This study aimed to evaluate if the targeting of CXCR2 by its selective antagonist, AZD5069, could modulate CXCL8-mediated pro-tumorigenic effects in thyroid-cancer (TC) cells in vitro.

METHODS

Normal human primary thyroid cells (NHT) and TC cell lines TPC-1 (RET/PTC), BCPAP, 8505C and 8305C (BRAFV600e) were treated with AZD5069 (100 pM-10 µM) over a time-course. Viability and proliferation were assessed by WST-1 and crystal violet assays. CXCL8 and CXCR2 mRNA were evaluated by RT-PCR. CXCL8-protein concentrations were measured in cell culture supernatants by ELISA. CXCR2 on cell surface was evaluated by flow-cytometry. Cell-migration was assessed by trans-well-migration chamber-system.

RESULTS

AZD5069 exerted negligible effects on cell proliferation or viability. AZD5069 significantly reduced CXCR2, (but not CXCL8) mRNAs in all cell types. CXCR2 was reduced on the membrane of some TC cell lines. A significant reduction of the CXCL8 secretion was found in TPC-1 cells (basal-secretion) and NHT (TNFα-induced secretion). AZD5069 significantly reduced basal and CXCL8-induced migration in NHT and different TC cells.

CONCLUSIONS

Our findings confirm the involvement of the CXCL8/CXCR2-axis in promoting pro-tumorigenic effects in TC cells, further demonstrating its immunotherapeutic significance in human cancer.

Glucagon-Like Peptide 1 Receptor Agonists and Risk of Thyroid Cancer: An International Multisite Cohort Study

Introduction: Concerns have been raised that glucagon-like peptide 1 receptor agonists (GLP1-RAs) may increase the risk of thyroid cancer, but evidence remains conflicting. We therefore investigated if GLP1-RA use, compared with use of dipeptidyl peptidase-4 inhibitors (DPP-4is), was associated with thyroid cancer risk in patients with type 2 diabetes. Methods: This multisite cohort study with subsequent meta-analysis included six population-based databases from Canada (Ontario), Denmark, Norway, South Korea, Sweden, and Taiwan. Study populations comprised patients with type 2 diabetes between 2007 and 2023. Cox regression models estimated hazard ratios (HR) and 95% confidence intervals (CIs) for thyroid cancer among GLP1-RA users compared with DPP-4is. Models were weighted using standardized mortality ratio weights generated from time-specific propensity scores. Site-specific HRs were pooled using a fixed-effects model. Results: We identified 98,147 users of GLP1-RA and 2,488,303 users of DPP-4i, with the median follow-up among users of GLP1-RA ranging from 1.8 to 3.0 years. Overall, use of GLP1-RA relative to use of DPP-4i was not associated with an increased risk of thyroid cancer (pooled weighted HR 0.81, CI 0.59-1.12). Similarly, we observed no increased risk in thyroid cancer with increasing cumulative dose of GLP1-RA among GLP1-RA ever-users. Subgroup analysis of types of thyroid cancer was not possible. Results remained consistent across a range of supplementary analyses. Discussion: In this large multisite study, utilizing data from six population-based databases, we found no evidence that GLP1-RA use is associated with an increased risk of thyroid cancer with follow-up ranging from 1.8 to 3.0 years, providing some reassurance to patients and clinicians about the short-term safety of these drugs. Nevertheless, evidence was insufficient to rule out excess risk with long-term use, due to the short follow-up.

Federated learning via multi-attention guided UNet for thyroid nodule segmentation of ultrasound images

Accurate segmentation of thyroid nodules is essential for early screening and diagnosis, but it can be challenging due to the nodules' varying sizes and positions. To address this issue, we propose a multi-attention guided UNet (MAUNet) for thyroid nodule segmentation. We use a multi-scale cross attention (MSCA) module for initial image feature extraction. By integrating interactions between features at different scales, the impact of thyroid nodule shape and size on the segmentation results has been reduced. Additionally, we incorporate a dual attention (DA) module into the skip-connection step of the UNet network, which promotes information exchange and fusion between the encoder and decoder. To test the model's robustness and effectiveness, we conduct the extensive experiments on multi-center ultrasound images provided by 17 local hospitals. The model is trained using the federal learning mechanism to ensure privacy protection. The experimental results show that the Dice scores of the model on the data sets from the three centers are 0.908, 0.912 and 0.887, respectively. Compared to existing methods, our method demonstrates higher generalization ability on multi-center datasets and achieves better segmentation results.

Oncogenic mutations in the TP53 and PI-3 kinase/AKT pathway are independent predictors of survival for advanced thyroid cancer: Analysis from the Molecular Screening and Therapeutics (MoST) program

BACKGROUND

Thyroid cancers with mutations in the phosphatidylinositol-3 kinase/AKT pathway have a poorer prognosis. However, knowledge about the relationship between histology, mutation profile, and outcomes is still developing. This study assessed the prognostic value of genomic profiles for patients with advanced thyroid cancer who experienced progression on conventional treatment.

METHODS

Patients recruited to a national clinical oncology program for treatment-refractory locally advanced, recurrent or metastatic cancers were analyzed. Patients' archival tumor samples underwent comprehensive genomic profiling. Specific oncogenic mutations and the presence of cancer related pathways were correlated with overall survival.

RESULTS

From 2018 to 2021, 4,955 patients were recruited, with 44 (0.9%) having a diagnosis of thyroid cancer with 4 medullary and the remaining follicular derived: 17 differentiated, 13 poorly differentiated, and 10 anaplastic thyroid cancers. Of the 40 follicular-derived thyroid cancer samples, 17 (42.5%) carried TP53 mutations, followed by 11 with BRAF V600E (27.5%), 9 with NRAS (22.5%), 9 with mutations in the phosphatidylinositol-3 kinase/AKT pathway (22.5%), and 7 with TERT promoter mutations (17.5%). Both TP53 and phosphatidylinositol-3 kinase/AKT pathway alterations were associated with reduced overall survival (hazard ratio, 5.19; 95% confidence interval, 1.59-16.70, P = .02 and hazard ratio, 10.12; 95% confidence interval, 1.61-63.76, P = .01). Cox regression showed histologic type anaplastic thyroid cancer (hazard ratio, 12.93, P = .004), poorly differentiated thyroid cancer (hazard ratio, 5.19, P = .039), and TP53 and/or phosphatidylinositol-3 kinase/AKT pathway mutations (hazard ratio, 4.73, P = .017) were independently associated with overall survival.

CONCLUSION

TP53 and/or phosphatidylinositol-3 kinase/AKT pathway mutations correlated with overall survival independently of histotype in patients with advanced thyroid cancer. Comprehensive genomic profiling has potential to inform prognosis, as well as identifying treatment targets for patients with advanced thyroid cancer.

Preoperative ultrasonography parathyroid gland mapping can improve identification of normal parathyroid gland during thyroidectomy: A propensity score-matched case-control study

BACKGROUND

Accurate intraoperative identification of normal parathyroid glands (PTGs) is vital to avoid hypocalcemia post total thyroidectomy. Although ultrasonography (US) has been shown to identify normal PTGs, the significance of preoperative US PTG mapping in this context is not well studied. This study evaluated the impact of preoperative US PTG mapping on intraoperative identification of normal PTGs during total thyroidectomy.

METHODS

The study involved 161 consecutive patients who underwent total thyroidectomy between January 2020 and June 2022. These included patients without preoperative US PTG mapping (group 1, n = 91) and those with the mapping (group 2, n = 70). Propensity score matching yielded 61 matched patients from each group. We developed a preoperative US PTG mapping technique combining US identification of normal PTGs with their localization on thyroid CT images. The intraoperative detectability of normal PTGs during thyroid surgery and detectability of normal PTGs by the preoperative US mapping were assessed by the number of PTGs identified per patient and by location.

RESULTS

In the matched cohort, group 2 demonstrated a higher median number of identified PTGs (3 vs. 2, p = 0.011), a greater proportion of patients with three or more identified PTGs (65.5% vs. 44.3%, p = 0.018), and a higher ratio of identified to expected PTGs (70.5% vs. 60.2%, p = 0.011) than group 1. In group 2, the median number of normal PTGs identified preoperatively was 3, with at least one identified in 95.7% of patients, two or more in 84.3%, three or more in 52.9%, and four or five in 24.3%.

CONCLUSIONS

Preoperative US PTG mapping identified two or more normal PTGs in the majority of adult patients undergoing total thyroidectomy. Those with preoperative mapping showed a higher number of intraoperatively identified normal PTGs, including inferior PTGs, compared to those without. This technique appears to enhance the intraoperative identification of normal PTGs, thereby potentially improving surgical outcomes in total thyroidectomy.

Factors Associated With Psychological Distress Among Thyroid Cancer Patients

OBJECTIVE

To assess the prevalence of psychological distress (PD) among thyroid cancer patients (TCPs) and identify clinical, demographic, and socioeconomic factors associated with PD.

STUDY DESIGN

Retrospective population-based cohort study.

SETTING

2016 to 2018 National Health Interview Survey.

METHODS

Adults with cancer were included. The primary outcome measure was moderate-to-severe psychological distress (MSPD), defined as a respondent score ≥5 on the validated K6 Psychological Distress Scale. χ2 tests were used to assess differences in MSPD by cancer type. Weighted multivariable logistic regression was used to elucidate factors associated with MSPD among TCPs.

RESULTS

The majority of TCPs (n = 684,674) were white (75.4%), female (78.5%), and on average 55.65 years old (SD = 13.2). 28.4% reported MSPD. On weighted analysis, TCPs were more likely to have MSPD than prostate (14.9%, P < .001), bladder (16.4%, P = .011), and nonmelanoma skin cancer (16.3%, P < .001) patients but less likely than pancreatic cancer (30.0%, P = .030) patients. TCPs who were older when surveyed (odds ratio [OR], 0.93; 95% confidence interval [CI, 0.88-0.98), previously drank alcohol (OR, 0.23; 95% CI, 0.06-0.91), and saw a general physician (GP) in the past year (OR, 0.14; 95% CI, 0.03-0.56) were less likely to have MSPD. Female sex (OR, 8.12; 95% CI, 1.61-40.89), increased number of medical comorbidities (OR, 1.46; 95% CI, 1.00-2.14), and functional limitations (OR, 4.55; 95% CI, 1.33-15.74) were associated with increased likelihood of MSPD.

CONCLUSION

Nearly 30% of TCPs have MSPD, especially younger patients who do not regularly see GPs. Future work to identify the most at-risk patients is needed to improve prevention and develop meaningful psychosocial interventions.

Serum metabolome associated with novel and legacy per- and polyfluoroalkyl substances exposure and thyroid cancer risk: A multi-module integrated analysis based on machine learning

BACKGROUND

Exposure to per- and polyfluoroalkyl substances (PFAS) may linked to thyroid cancer (TC) risk, but inconsistent findings and a lack of studies on mixed exposures exist, especially regarding novel PFAS compounds. Additionally, little is known about the potential mechanisms underlying the association.

OBJECTIVES

Explore the effects of PFAS exposure on the serum metabolome and its correlation with TC.

METHODS

A 1:1 age- and sex-matched case-control study was administered with 746 TC cases and healthy controls. Liquid chromatography-high resolution mass spectrometry determined serum 11 PFAS and untargeted metabolome profile. ENET and LightGBM models were used to explore the exposure patterns and perform variable selection. The mixed exposure effects were assessed using Weighted quantile sum regression and Bayesian kernel machine regression. Metabolome-wide association analyses were performed to assess metabolic dysregulation associated with PFAS, and a structural synthesis analysis was used to detect latent groups of individuals with TC based on PFAS levels and metabolite patterns.

RESULTS

Ten of the 11 PFAS were detected in > 80 % of the population. PFHxA and PFDoA exposure associated with increased TC risk, while PFHxS and PFOA associated with decreased TC risk in single compound models (all P < 0.05). Machine learning algorithms identified PFHxA, PFDoA, PFHxS, PFOA, and PFHpA as the key PFAS influencing the development of TC, and mixed exposures have an overall positive effect on TC risk, with PFHxA making the primary contribution. A novel integrative analysis identified a cluster of TC patients characterized by increased PFHxA, PFDoA, PFHpA and decreased PFOA, PFHxS levels, and altered metabolite patterns highlighted by the upregulation of free fatty acids.

CONCLUSIONS

PFAS exposure is linked to a higher risk of TC, possibly through changes in fatty acid metabolism. Larger, prospective studies are needed to confirm these findings, and the role of short-chain PFAS requires more attention.

The association between the thickness of the hypoechoic halo of thyroid nodules and thyroid cancer: A retrospective study

RATIONALE AND OBJECTIVES

The association between hypoechoic halos and thyroid cancer in patients with thyroid nodules remains a contentious issue. The objective of this study was to examine the potential correlation between the thickness of hypoechoic halos and the presence of thyroid cancer in individuals with thyroid nodules.

METHODS

The study retrospectively analyzed a cohort of 320 patients with thyroid nodules presenting hypoechoic halos from January 2019 to December 2022. Logistic regression models, both univariate and multivariate, were applied to investigate the association between hypoechoic halo thickness and thyroid cancer, with adjustments for potential confounding variables. Interaction and stratified analyses were conducted to assess the influence of demographic and tumor-specific characteristics, such as age, sex, halo thickness, tumor size, and tumor location, on the relationship between halo thickness and thyroid cancer risk.

RESULTS

After adjusting for multiple covariates, the odds ratios (ORs) (95% confidence intervals (CIs)) of thyroid cancer for participants with a halo thickness ≥1 mm were 3.99 (2.4-6.62), 3.73 (2.09-6.67), and 3.16 (1.61-6.19), compared to those with a thickness <1 mm. The association between thyroid cancer and the thickness of the halo remained stable across different subgroups (all P for interaction > 0.05). The area under the curve (AUC) for the hypoechoic halo in nodules for diagnosing thyroid cancer was 0.821 (95% CI: 0.774-0.868), with the highest sensitivity and specificity observed at a thickness cutoff value of 1.29 mm.

CONCLUSION

Our single-center study on adults reveals a positive correlation between halo thickness and thyroid cancer risk, indicating that halo thickness may potentially serve as a valuable predictor for thyroid cancer incidence.

The clinical significance and burden of thyroid nodules discovered incidentally

BACKGROUND

The majority of thyroid nodules are benign; however current guidelines suggest that thyroid incidentalomas should be appropriately evaluated to rule out malignancy.

AIMS

This study aims to determine the incidence of thyroid incidentalomas and the likelihood that they harbour sinister pathology in the largest Irish cohort studied to-date.

METHODS

A retrospective observational chart review was conducted using data from July 2018 to December 2018 using the Radiology Database in use at Cork University Hospital. The text of 1000 imaging reports (500 carotid Doppler and 500 computed tomography thorax) was manually screened for phrases such as "thyroid mass" or "thyroid nodule".

RESULTS

On 1000 scans, 14 (1.4%) thyroid incidentalomas were discovered. The occurrence of incidentalomas by imaging was 2/500 (0.4%) for ultrasound and 12/500 (2.4%) for computed tomography. Three of these nodules (21.4%) were further evaluated with a subsequent ultrasound and due to a size of more than 1 cm underwent fine needle aspiration. Using the Thy classification, all three were given a Thy 2 (non-neoplastic) grading.

CONCLUSION

This study found that there was no clinical benefit to reporting the presence of thyroid incidentalomas incidentally noted on radiology investigations. Although the overall percentage of thyroid incidentalomas is low, this number may be enough to cause unnecessary strain on the healthcare system and burden patients with invasive investigations in addition to causing unnecessary anxiety.

Impact of menopausal status on cognitive function in female papillary thyroid carcinoma patients: a longitudinal propensity score matched study

PURPOSE

Previous research has documented cognitive deficits in survivors of papillary thyroid carcinoma (PTC).Our longitudinal study with large sample size, aims to assess the impact of menopausal status on cognitive function, elucidate related factors of cognitive impairment, and chart the trajectory of cognitive changes over time in female PTC patients.

METHODS

In this longitudinal study, we administered the Montreal Cognitive Assessment (MoCA) to 322 female PTC patients over 40 years old, before surgery and at 3 and 6 months after surgery. Propensity score matching (PSM) was used to adjust for baseline disparities, leading to a final analysis of 228 patients (114 premenopausal and 114 postmenopausal). Cognitive scores were compared between groups using the Mann-Whitney U test, and univariate and multivariate logistic regression analyses were performed to identify independent predictors of cognitive impairment.

RESULTS

Postmenopausal women demonstrated a significantly higher susceptibility to impairment in delayed recall (p = 0.004) and global cognition (p = 0.006) when compared with premenopausal women. Multivariate analysis identified menopause (p < 0.001) and rural residence (p = 0.001) as independent risk factors for cognitive impairment. Furthermore, a gradual improvement in cognitive function over time was observed across both groups over the course of the study.

CONCLUSIONS

In female PTC patients, postmenopausal status and rural residence are significant risk factors for cognitive impairment. Postmenopausal women are more susceptible to cognitive deficits than premenopausal women in delayed recall and global cognition.Although cognitive function improves over time, it is crucial for physicians to closely monitor and support these patients to optimize their prognosis.

Decoding RAS mutations in thyroid cancer: A meta-analysis unveils specific links to distant metastasis and increased mortality

BACKGROUND/OBJECTIVES

RAS mutations are common in thyroid cancer, but their impact on clinical outcomes remains controversial. This study aimed to evaluate the prevalence of RAS mutations in thyroid cancer and their association with various clinical and pathological features.

METHODS

We conducted a systematic review and meta-analysis of studies reporting on RAS mutations in thyroid cancer. Both one-arm and pairwise meta-analyses were performed to compare outcomes between RAS-mutated (RAS+) and wild-type (RAS-) thyroid cancers.

RESULTS

Our analysis included 2552 thyroid cancer patients from 17 studies. The overall prevalence of RAS mutations was 35.4 % (95 % CI: 22.7 %-50.7 %). NRAS mutations were most common (69.47 %, 95 % CI: 66.15 %-72.66 %), followed by HRAS (25.83 %, 95 % CI: 22.77 %-29.14 %) and KRAS (6.92 %, 95 % CI: 5.27 %-9.04 %). No statistically significant differences were found between RAS+ and RAS- cases in rates of T1/2 tumors, lymph node metastasis, extrathyroidal extension, or recurrence. The risk of distant metastasis was significantly higher in RAS+ cases (15 %, 95 % CI: 6 %-34 %) compared to RAS- cases (4 %, 95 % CI: 1 %-12 %), with a relative risk of 3.23 (95 % CI: 1.49-7.02). Notably, RAS+ cases showed a significantly higher mortality rate (8 %, 95 % CI: 3 %-18 %) compared to RAS- cases (2 %, 95 % CI: 1 %-5 %), with a relative risk of 4.36 (95 % CI: 1.23-15.50, p = 0.03).

CONCLUSION

While RAS mutations are prevalent in thyroid cancer, they do not significantly impact most clinical and pathological features. However, the presence of RAS mutations is associated with a significantly higher risk of distant metastasis and mortality, suggesting their potential role as a prognostic marker in thyroid cancer. These findings underscore the importance of RAS mutation testing in risk stratification and treatment planning for thyroid cancer patients.

Elevated thyroid-stimulating hormone levels, independent of Hashimoto's thyroiditis, increase thyroid cancer risk: Insights from genetic and clinical evidence

PURPOSE

Hashimoto's thyroiditis (HT) is a prevalent autoimmune disorder and thyroid cancer (TC) is the most prevalent endocrine malignancy. Recent debates have focused on whether HT increases the risk of developing TC. This study combined Mendelian randomization (MR) and observational methods to investigate the potential causal relationship between HT and TC risk.

METHODS

First, we performed two-sample MR and multivariable MR (MVMR) analysis using the genome-wide association studies (GWAS) data from multiple databases, including European and East Asian populations, to estimate the effect of HT and thyroid-stimulating hormone (TSH) levels on TC risk. Second, we conducted an observational study using data from the National Health and Nutrition Examination Survey (NHANES) database and evaluated the association between HT, TSH, and TC prevalence through logistic regression model and restricted cubic spline model.

RESULTS

Our MR findings revealed no significant association between HT and TC risk in both populations. However, elevated TSH levels significantly increased TC and papillary thyroid carcinoma (PTC) risk, while lower TSH levels were associated with reduced TC risk. Further MVMR analysis and an observational study confirmed this. Additionally, our observational study also indicated no significant relationship between HT and TC prevalence and abnormal TSH levels correlated with higher TC risk.

CONCLUSION

HT was not a TC risk factor, but high TSH levels increased TC risk. Controlling TSH within normal ranges through thyroid hormone replacement was recommended to reduce TC risk in HT patients with elevated TSH levels, even those without symptoms.

Burden of thyroid cancer in China and worldwide from 1990 to 2021: observation, comparison, and forecast from the Global Burden of Disease Study 2021

Background

Thyroid cancer (TC) is a prevalent malignant tumor of the endocrine system in China. Current research primarily focuses on clinical diagnosis and treatment as well as underlying mechanisms, lacking epidemiological studies on the burden of the disease in China and worldwide.

Methods

The Global Burden of Disease Study 2021 was utilized to assess the incidence, prevalence, death, and disability-adjusted life years of TC in China and worldwide from 1990 to 2021 using the Joinpoint and R software.

Results

From 1990 to 2021, the incidence and prevalence rates of TC in China have been consistently rising, and their growth rates are far higher than the global average. In China, TC usually occurs in patients aged 50-59, and the crude death rate generally increases with age. The burden of death among females has gradually declined, while that among males has continued to increase and surpassed females at the beginning of the 21st century. The burden of TC is heavy among middle-aged and elderly populations and the younger populations is also rapidly rising. The increased number of TC is mainly attributed to epidemiological changes, while the increase of deaths in China is primarily due to aging and population. Additionally, we predict that the age-standardized incidence rate of TC in China will continue to grow slowly over the next decade, while the age-standardized death rate will gradually decline among females and stabilize among males.

Conclusion

It is imperative to avoid over-screening and over-treatments for TC. Meanwhile, we should also avoid missing aggressive types of TC that may have an impact on overall survival. Additionally, understanding the mechanisms of metastasis and improving clinical treatments should be prioritized for further investigation. TC remains a significant public health challenge in China, necessitating a careful balance of the cost-benefit ratio.

Therapeutic treatments targeting communication between angiogenic and immune microenvironments in thyroid cancers

Thyroid cancer treatment has recently been revolutionized by the introduction of specific targeted therapies (e.g. BRAFV600E or highly selective RET inhibitors), anti-angiogenic agents (e.g. tyrosine kinase inhibitors (TKIs)) and immune checkpoint inhibitors, which significantly ameliorate outcomes in selected groups of thyroid cancer patients. Targeted and anti-angiogenic treatments are characterized by transient and partial efficacy, due to primary or secondary tumor resistance mechanisms, and toxicity profile. Immune therapy-based approaches are producing preliminary results. Herein, we review and prospectively discuss immune microenvironment in non-medullary and medullary thyroid cancers and its interplays with angiogenic microenvironment (endothelial cells and pericytes). In addition, we discuss how these interactions might be targeted using combined therapies. Furthermore, we will review chimeric antigen receptor (CAR) T cells treatment that potentially may ensure a more durable and effective response in advanced thyroid cancers. In sum, angiogenic and immune microenvironments show functional connectivity in TCs. Therapies with anti-angiogenic and immune checkpoint inhibitors combined with specific targeted therapy inhibitors with a tolerable toxicity profile may overcome drug resistance and provide better clinical outcomes than single agents.

Association Between Environmental Air Pollution and Thyroid Cancer and Nodules: A Systematic Review

Background: The global incidence of thyroid cancer has increased over the past several decades. While this increase is partially due to increased detection, environmental pollutants have also emerged as a possible contributing factor. Our goal was to perform a systematic review to assess the relationship between environmental air pollution and thyroid cancer. Methods: Systematic literature search was performed using PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus databases for original articles published prior to March 2024, investigating outdoor air pollution and thyroid cancer/nodules (PROSPERO CRD42024517624). Inclusion criteria included quantitative reporting of pollutant levels and effect size. Specific pollutants included ozone (O3), particulate matter less than 2.5 (PM2.5) or 10 microns in diameter (PM10), sulfur dioxide (SO2), nitric oxides (NOx), carbon monoxide (CO), and polyaromatic hydrocarbons (PAHs). Study design, sample size, pollution assessment method, covariates, and strength/direction of associations between pollutants and thyroid cancer/nodule detection were extracted, and descriptive synthesis was utilized to summarize pertinent findings. Risk of bias was assessed using the National Heart, Lung, and Blood Institute quality assessment tool. Results: Of 1294 identified studies, 11 met inclusion criteria. Over 6 million patients from diverse regions were represented across studies. Pollutants studied included O3 in 5 studies; PM2.5, PM10, SO2, and NOx in 3 studies; unspecified PM and CO in 2 studies; and PAHs in 1 study. Primary outcome was thyroid cancer diagnosis among 9 studies and thyroid nodule detection in 2. All studies examining NOx and O3 reported increased risks ranging from 1.03 to 1.5-fold and 1.1 to 1.3-fold, respectively. Both studies assessing PM2.5 reported 1.18 to 1.23-fold increased odds of thyroid cancer diagnosis, and the magnitude of association increased with increasing duration or concentration of PM2.5 Inconsistent results were observed for levels of CO, PM10, and SO2. Conclusion: While an emerging body of literature suggests a potential association between air pollution and thyroid cancer, the quality of evidence is limited by study design constraints, variability in exposure assessment, and inconsistent adjustment for potential confounding factors. The heterogeneity in study designs and methodologies present challenges in interpreting results, underscoring the need for standardized approaches in future research.

miR-144-3p Targets GABRB2 to Suppress Thyroid Cancer Progression In Vitro

Thyroid cancer, as one of the most common cancers in many countries, has attracted increasing attention, but its pathogenesis is still unclear. This research explored the effects of miR-144-3p and GABRB2 on thyroid cancer cells and the underlying mechanism. Gene expression data was obtained from the GEO database to analyze differential expression of mRNAs and miRNAs in patients with thyroid cancer. CCK-8, transwell, scratch, and flow cytometry assays were performed to detect cell proliferation, invasion, migration, and apoptosis, respectively. Dual-luciferase reporters were used to detect the binding of miR-144-3p to GABRB2. GABRB2 was highly expressed and miR-144-3p was underexpressed in thyroid cancer. In thyroid cancer cells, inhibiting GABRB2 or upregulating miR-144-3p reduced proliferation, invasion, and migration and increased apoptotic rates; GABRB2 overexpression or miR-144-3p inhibition brought about the opposite results. miR-144-3p targeted GABRB2 and negatively regulated its expression. PI3K/AKT activation was reduced in thyroid cancer cells overexpressing miR-144-3p. GABRB2 overexpression partially mitigated the tumor-suppressive effect of miR-144-3p overexpression. In conclusion, miR-144-3p targets GABRB2 to inhibit PI3K/AKT activation, thereby inhibiting the progression of thyroid cancer in vitro.

Determination of effective half-life of 131I in thyroid cancer patients using remote dose-rate meter

BACKGROUND

Continuously monitored external dose-rate signals from remote dose-rate meters (DRMs) were analyzed to determine the effective half-life (Teff) of 131I in differentiated thyroid cancer (DTC) patients. The aim is to gain novel understanding of the excretion of radioactive iodine (RAI) in DTC patients and to demonstrate that a remote DRM system can be reliably used for real-time monitoring of external dose-rates of DTC patients.

METHODS

110 DTC patients who received postoperative RAI therapy between September 2018 and February 2023 in Turku University Hospital were studied retrospectively. The external dose-rates of the patients were continuously monitored during their hospitalization with a remote DRM fixed in the ceiling of the isolation room. Generalized linear mixed model (GLMM) was used to analyse the association between logarithmical Teff and patient characteristics.

RESULTS

The median Teff for all patients was 12.60 h (Q1: 10.35; Q3: 14.75 h). Longer Teffs were associated with higher BMI (p = 0.004), lower GFR (p < 0.001), and diabetes (p = 0.007). Our study also revealed that neither age nor subsequent RAI therapies have a significant impact on the whole body Teff (p = 0.522 and p = 0.414, respectively).

CONCLUSION

Patients with higher BMI, decreased GFR, or diabetes have a longer whole-body Teff of 131I. Ceiling-mounted remote DMRs can reliably be used to determine patient's Teff. Since Teff values vary among patients, ceiling-mounted meters can be used to optimize the length of radiation isolation period at the hospital while improving patient comfort and staff efficiency.

Analysis of risk factors for negative emotions in patients with thyroid nodules: A cross-sectional study

Investigations have indicated that there is a correlation between thyroid nodules and patients'negative emotions. Nevertheless, the risk factors contributing to the development of negative emotions in thyroid nodule patients remain unidentified. This cross-sectional study recruited 150 patients diagnosed with thyroid nodules through ultrasound examination from January 2022 to January 2023 at Jinan Central Hospital, the Second Affiliated Hospital of Shandong First Medical University, and Qingyun County Maternal and Child Health Hospital as the case group, which were categorized based on their levels of anxiety and depression. Simultaneously, 150 individuals with normal thyroid ultrasound findings were selected as the control group. The researchers chose a self-administered general information questionnaire and 6 psychological scales as the assessment tools for the patients. SPSS 26.0 was used to analyze the risk factors for negative emotions in patients with thyroid nodules. The scores of the self-rating anxiety scale were higher in the case group than in the control group (40.90 ± 9.490 vs 38.37 ± 6.836, P = .028), as were the scores of the self-rating depression scale (44.35 ± 9.180 vs 41.48 ± 8.297, P = .004). There is a positive correlation between thyroid nodules and degrees of anxiety and depression (R = 0.176, P = .002; R = 0.206, P = .000). The results of the binary logistic regression analysis revealed that both fatigue state (P = .013) and negative life events (P = .001) exerted independent effects on anxiety, whereas negative life events (P = .002) had independent effects on depression. This study enhances the understanding of the relationship between thyroid nodules and anxiety and depression. It reveals that thyroid nodules are associated with negative emotions and that negative life events have a significant influence on anxiety and depression in these individuals, which may contribute to the development of strategies for preventing and treating thyroid nodules in clinical practice.

PKCα Activation via the Thyroid Hormone Membrane Receptor Is Key to Thyroid Cancer Growth

Thyroid carcinoma (TC) is the most common endocrine neoplasia, with its incidence increasing in the last 40 years worldwide. The determination of genetic and/or protein markers for thyroid carcinoma could increase diagnostic precision. Accumulated evidence shows that Protein kinase C alpha (PKCα) contributes to tumorigenesis and therapy resistance in cancer. However, the role of PKCα in TC remains poorly studied. Our group and others have demonstrated that PKCs can mediate the proliferative effects of thyroid hormones (THs) through their membrane receptor, the integrin αvβ3, in several cancer types. We found that PKCα is overexpressed in TC cell lines, and it also appeared as the predominant expressed isoform in public databases of TC patients. PKCα-depleted cells significantly reduced THs-induced proliferation, mediated by the integrin αvβ3 receptor, through AKT and Erk activation. In databases of TC patients, higher PKCα expression was associated with lower overall survival. Further analyses showed a positive correlation between PKCα and genes from the MAPK and PI3K-Akt pathways. Finally, immunohistochemical analysis showed abnormal upregulation of PKCα in human thyroid tumors. Our findings establish a potential role for PKCα in the control of hormone-induced proliferation that can be explored as a therapeutic and/or diagnostic target for TC.

Predicting lymph node metastasis in papillary thyroid carcinoma with Hashimoto's thyroiditis using regression and network analysis

The comprehensive study of the relationship between lymph node metastasis (LNM) and its associated factors in patients with concurrent papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis (HT) remains insufficient. Building upon the initial investigation of factors associated with LNM in patients with concurrent PTC and HT, we further analyzed the complex relationships between different severity indicators of LNM and these associated factors. This study included patients confirmed PTC with HT who underwent total thyroidectomy at Xiangya Hospital, from January 2020 to December 2021. A total of 271 patients from 2020 were used as the training set, and 300 patients from 2021 as the validation set. Univariate analysis and regression modeling were used to identify key factors associated with LNM. Model reliability was assessed using the area under the receiver operating characteristic curve (AUC). Network analysis was employed to explore associations between LNM severity and its related factors. The regression model indicated that age, calcification, free triiodothyronine (FT3), and tumor maximum diameter (TMD) are independent factors for LNM. The severity model showed free thyroxine (FT4) and hemoglobin (Hb) are independent protective factors for the region and quantity of LNM, respectively, while TMD is an independent risk factor for both. Network analysis revealed TMD has a closer relationship with LNM severity compared to other associated factors. This study innovatively combined regression models and network analysis to investigate factors related to LNM in patients with PTC and HT, providing a theoretical basis for predicting preoperative LNM in future clinical practice.

How Many Lymph Nodes are Enough in Thyroidectomy? A Cohort Study Based on Real-World Data

BACKGROUND

Thyroidectomy with only limited examination of lymph nodes is considered to pose potential risk for harboring occult nodal disease in patients with papillary thyroid cancer (PTC). However, the optimal number of examined lymph nodes (ELNs) in patients with PTC with clinically lateral lymph node metastasis (cN1b) remains unclear.

PATIENTS AND METHODS

Patients with cN1b PTC who underwent therapeutic neck dissection were retrospectively enrolled. A β-binomial distribution was utilized to calculate the likelihood of occult nodal disease as a function of total number of ELNs, and recurrence-free survival analysis was performed using the Kaplan-Meier method.

RESULTS

Together 982 patients met the inclusion criteria for this study, of which 853 patients had node-positive disease. The median ELN count was 23 (interquartile range 14-33). Increased ELN counts were associated with a decreased rate of occult nodal disease. The prevalence of nodal metastasis was 84%, while the corrected prevalence was 90%. The estimated probability of false-negative nodal disease was 67% for patients with PTC when only a single node was examined. Survival analysis revealed that populations with higher probability of occult nodal diseases experienced significantly higher recurrence rate. For patient with cN1b PTC, 20 ELNs were required to achieve 95% confidence of having no occult nodal disease. Minimum thresholds of 24, 14, 14, and 15 ELNs were selected for patients with pT1, pT2, pT3, and pT4 diseases, respectively.

CONCLUSIONS

Our findings robustly conclude that a minimum of 20 ELNs is essential to assess the quality of neck dissection and acquire accurate staging for patients with cN1b PTC.

Systemic Immune-Inflammation Index and Systemic Inflammation Response Index Predict the Response to Radioiodine Therapy for Differentiated Thyroid Cancer

Purpose

This research sought to evaluate the clinical value of systemic immune-inflammation index and systemic inflammation response index in predicting the response to radioactive iodine (RAI) therapy in individuals diagnosed with differentiated thyroid cancer.

Patients and Methods

This retrospective study included 406 patients with differentiated thyroid cancer who received initial RAI therapy and follow-up from December 2019 to December 2023. Patients were divided into two groups based on imaging and serum indicators to evaluate the response to radioactive iodine treatment: the ER group (excellent response) and the non-ER group (suboptimal response). Systemic immune-inflammation index and systemic inflammation response index were calculated based on peripheral blood cell counts before treatment. Multivariable logistic regression analysis was used to assess the independent associations of these indices with the therapeutic response to radioiodine treatment. Receiver operating characteristic (ROC) curves were graphed and the area under the curve (AUC) was calculated to evaluate their predictive ability.

Results

Compared to the ER group, patients in the non-ER group had significantly elevated systemic immune-inflammation index and systemic inflammation response index levels (p < 0.001). After adjusting for confounding factors, there was a significant association between these indices and the response to radioactive iodine treatment in patients with differentiated thyroid cancer. The optimal cutoff values for predicting the response to RAI treatment were 668.91 for systemic immune-inflammation index (AUC=0.692, sensitivity 58.2%, specificity 73.1%, 95% CI: 0.639-0.745, p < 0.001) and 0.47 for systemic inflammation response index (AUC=0.664, sensitivity 85.6%, specificity 42.7%, 95% CI: 0.612-0.717, p < 0.001).

Conclusion

Systemic immune-inflammation index and systemic inflammation response index could be valuable for predicting the response to RAI treatment in individuals diagnosed with differentiated thyroid cancer. Further research is needed to explore their practical utility, and these novel inflammation markers could serve as adjunct tools in clinical practice.

Association between vitamin C intake and thyroid function among U.S. adults: a population-based study

Background

Although some evidence suggests a role for vitamin C intake in thyroid diseases, the complex interplay between vitamin C intake and thyroid function remains incompletely understood. The objective of this study was to explore the relationship between vitamin C intake and serum thyroid function in the United States adults.

Methods

A total of 5,878 participants from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2012 were included in this study. Weighted multivariate linear regression models, subgroup analyses, and interaction terms were used to assess the association between vitamin C intake, evaluated as a continuous and categorical variable, and thyroid function. Additionally, restricted cubic spline (RCS) regression was employed to assess any nonlinear relationship that may exist between vitamin C intake and thyroid function.

Results

After adjusting for covariates, our research found a significant inverse correlation between vitamin C intake and total thyroxine (TT4) (β= -0.182, P= 0.006). Using subgroup analyses, the association was more pronounced among subjects with lower alcohol consumption(β= -0.151, P=0.013, P for interaction = 0.043). In RCS regression, the correlation between vitamin C and TT4 exhibited a distinct reversed L-shaped curve pattern in total participants (P for nonlinear = 0.005) and male adults (P for nonlinear = 0.014). Additionally, we found an inverted U-shaped curve pattern in the relationship between vitamin C intake and FT4 (P for nonlinear = 0.029), while an U-shaped curve relationship was observed between vitamin C consumption and the FT3/FT4 ratio (P for nonlinear = 0.026).

Conclusion

The findings of our study have illustrated a notable correlation between vitamin C intake and thyroid function. A high level of vitamin C intake is associated with a decreased in TT4 levels among American adults, and the association was more pronounced among subjects with lower alcohol consumption. Furthermore, our analysis revealed a nonlinear correlation between the intake of vitamin C and the levels of TT4, FT4, and FT3/FT4 ratio. Our findings support the rationale for making food-based dietary recommendations and maybe provide guidance for diet guidelines with thyroid dysfunction to a certain extent in the future.

Global burden of thyroid cancer in 2022: Incidence and mortality estimates from GLOBOCAN

BACKGROUND

Thyroid cancer (TC) is the most common malignancy of the endocrine system. This study aimed to assess the global distribution of TC incidence and mortality in 2022, as well as to predict the burden for the year 2050.

METHODS

Data from the GLOBOCAN 2022 database were used to analyze the age-standardized incidence and mortality rates of TC by sex, age group (<55 years and ≥55 years), country, world region, and level of Human Development Index (HDI) for 185 countries. The predicted incidence and mortality burden for 2050 was calculated based on demographic projections.

RESULTS

In 2022, an estimated 821,214 new TC cases and 47,507 TC-related deaths occurred worldwide. The age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) were higher in women (ASIR: 13.60 per 100,000; ASMR: 0.53 per 100,000) than in men (ASIR: 4.60 per 100,000; ASMR: 0.35 per 100,000). The ASIR in high HDI countries was approximately ten times higher than that in low HDI countries for both sexes, with relatively similar ASMR across regions. Among 185 countries, China had the largest number of TC cases (accounting for 56.77% of total cases) and TC-related deaths (accounting for 24.35% of global TC-related deaths), with the highest ASIR in men (13.30 per 100,000). Worldwide, approximately 64.63% of TC cases occurred in populations under 55 years old, while nearly 82.99% of TC-related deaths occurred in populations aged 55 years and above. If the rates stay the same as in 2022, it is projected that approximately 1,100,000 new TC cases and 91,000 TC-related deaths will occur in 2050, indicating a 34.15% and 89.58% increase, respectively.

CONCLUSIONS

TC is a highly frequent cancer worldwide with disparities across regions, genders, and age groups. Our results provide light on the worldwide TC disease burden and facilitate regionally customized prevention measures.

Dwindling dollars: The inflation-adjusted decline of Medicare reimbursement in endocrine surgery (2003-2023)

INTRODUCTION

Medicare determines reimbursement rates for medical services, often setting a benchmark that is followed by private insurers. Across various medical specialties, decreases in Medicare reimbursement have been observed. However, the extent of Medicare reimbursement for endocrine surgery remains unexplored. This study investigates the trajectory of reimbursement rates for endocrine surgical procedures.

METHODS

Data spanning 2003 to 2023 were gathered from the Physician Fee Schedule Look-Up Tool for 16 endocrine operations and procedures. Each operation's or procedure's relative value units and conversion factor, which accounts for geographic variation in relative value units, are determined annually by the Centers for Medicare and Medicaid Services. The total annual Medicare reimbursement for each operation or procedure was determined by multiplying procedure-specific relative value units with the conversion factor. Raw yearly percentage changes in reimbursement were computed and compared to changes in the general consumer price index. All data were then corrected for inflation. The compound annual growth rate for each procedure was calculated using inflation-adjusted data.

RESULTS

From 2003 to 2023, the mean unadjusted percentage change for all queried procedures was +14.14% (standard deviation 0.28). During this same time, the consumer price index increased by 69.15% (P < .001). After adjusting for inflation, the mean total adjusted percentage change for all queried procedures over the entire study period was -31% (standard deviation 0.17). The adjusted average yearly compound annual growth rate was -1.93% (standard deviation 0.92). Only 1 procedure showed an increase in reimbursement (image-guided fine-needle aspiration, +32%).

CONCLUSION

Inflation-adjusted Medicare reimbursement rates for endocrine surgical procedures have consistently declined. Stakeholders must address these trends to ensure access to quality surgical endocrine care in an evolving health care landscape.

Standardized Ultrasound Evaluation for Active Surveillance of Low-Risk Thyroid Microcarcinoma in Adults: 2024 Korean Society of Thyroid Radiology Consensus Statement

Active surveillance (AS) has been widely adopted as an alternative to immediate surgery owing to the indolent nature and favorable outcomes of papillary thyroid microcarcinoma (PTMC). AS is generally recommended for tumors measuring ≤1 cm without aggressive cytological subtypes, risk of gross extrathyroidal extension (ETE), lymph node metastasis (LNM), or distant metastasis. AS requires careful patient selection based on various patient and tumor characteristics, and ultrasound (US) findings. Moreover, during AS, regular US is performed to monitor any signs of tumor progression, including tumor growth, new US features of potential gross ETE, and LNM. Therefore, appropriate imaging-based assessment plays a crucial role in determining whether AS or surgery should be pursued. However, detailed recommendations concerning US evaluation are currently insufficient, necessitating the formulation of this guideline. The Korean Society of Thyroid Radiology has developed a consensus statement for low-risk PTMC, covering US assessment methods when considering AS as a management option and conducting follow-up imaging tests during AS. This guideline aims to provide optimal scientific evidence and expert opinion consensus regarding a standardized US-based assessment protocol for low-risk PTMC.

Assessment of the Diagnostic Performance of a Commercially Available Artificial Intelligence Algorithm for Risk Stratification of Thyroid Nodules on Ultrasound

Background: Thyroid nodules are challenging to accurately characterize on ultrasound (US), though the emergence of risk stratification systems and more recently artificial intelligence (AI) algorithms has improved nodule classification. The purpose of this study was to evaluate the performance of a recent Food and Drug Administration (FDA)-cleared AI tool for detection of malignancy in thyroid nodules on US. Methods: One year of consecutive thyroid US with ≥1 nodule from Duke University Hospital and its affiliate community hospital (649 nodules from 347 patients) were retrospectively evaluated. Included nodules had ground truth diagnoses by surgical pathology, fine needle aspiration (FNA), or three-year follow-up US showing stability. An FDA-cleared AI tool (Koios DS Thyroid) analyzed each nodule to generate (i) American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) descriptors, scores, and follow-up recommendations and (ii) an AI-adapter score to further adjust risk assessments and recommendations. Four groups were then compared: (i) Koios with AI-adapter, (ii) Koios without AI-adapter, (iii) clinical radiology report, and (iv) radiology report combined with AI-adapter. Performance of the final recommendations (FNA or no FNA) was determined based on ground truth, and comparison between the four groups was made using sensitivity, specificity, and receiver-operating-curve analysis. Results: Of 649 nodules, 32 were malignant and 617 were benign. Performance of Koios with AI-adapter enabled was similar to radiologists (area under the curve [AUC] 0.70 for both, [CI 0.60-0.81] and [0.60-0.79], respectively). Koios with AI-adapter had improved specificity compared to radiologists (0.63 [CI: 0.59-0.67] versus 0.43 [CI: 0.38-0.48]) but decreased sensitivity (0.69 [CI: 0.50-0.83) versus 0.81 [CI: 0.61, 0.92]). Highest performance was seen when the radiology interpretation was combined with the AI-adapter (AUC 0.76, [CI: 0.67-0.85]). Combined with the AI-adapter, radiologist specificity improved from 0.43 ([CI: 0.38-0.48]) to 0.53 ([CI: 0.49-0.58]) (McNemar's test p < 0.001), resulting in 17% fewer FNA recommendations, with unchanged sensitivity (0.81, p = 1). Conclusion: Koios DS demonstrated standalone performance similar to radiologists, though with lower sensitivity and higher specificity. Performance was best when radiologist interpretations were combined with the AI-adapter component, with improved specificity and reduced unnecessary FNA recommendations.

Evolving epidemiological patterns of thyroid cancer and estimates of overdiagnosis in 2013-17 in 63 countries worldwide: a population-based study

BACKGROUND

The incidence of thyroid cancer has been increasing in many countries, mainly due to overdiagnosis. Given these rapid changes, we aim to assess the specific features of the thyroid cancer diagnosis epidemic and provide estimates of overdiagnosis across countries spanning five continents and identify areas in which coping strategies are needed.

METHODS

Two types of data were retrieved from the International Agency for Research on Cancer (IARC) Global Cancer Observatory database. The long-term annual incidence of thyroid cancer by sex and 5-year age group for all ages from 1980 to 2017 was obtained from continuous population-based registries available in the Cancer Incidence in Five Continents (CI5) plus, with 97 registries from 43 countries selected. Sex-age-specific thyroid cancer cases, overall and by subtype, along with corresponding population counts were retrieved from all registries included in the latest volume of CI5 (CI5-XII), with 385 registries in 63 countries. Annual mortality data from 1980 to 2022 were obtained from WHO, with population counts supplemented by UN population estimates. We estimated age-standardised rates (ASRs) of thyroid cancer incidence and mortality for all ages by sex using direct age standardisation, with the world population as a reference. Long-term annual trends of ASRs were compared between incidence and mortality since 1980. Subtype distribution was calculated for thyroid cancer incidence during 2013-17. We estimated the numbers of thyroid cancer cases and overdiagnosed cases and extrapolated to the whole country using a previously developed and validated method.

FINDINGS

Thyroid cancer incidence rates rose during 1980-2017 for most countries, with the highest rates seen in South Korea, Cyprus, Ecuador, China, and Türkiye for females and males. An upward trend was seen until the early 2010s, followed by a downward trend in South Korea, the USA, Canada, and Israel and some Western European countries, such as France, Italy, Austria, and Ireland. The difference between the highest and lowest incidence rates ranged from less than 10·0 per 100 000 females in the early 1980s to 101·4 per 100 000 females in 2012. For males, the difference between the highest and lowest incidence rates ranged from 2·7 per 100 000 to 23·5 per 100 000 over the study period. Mortality rates were substantially lower, with a difference between the highest and lowest rates across countries of around 1·0-2·0 per 100 000 for both sexes throughout the study period. During 2013-17, papillary thyroid cancer contributed to the large variation in ASRs of thyroid cancer incidence. The mortality rates of thyroid cancer increased with age for all countries, whereas the observed age-specific incidence rates showed an inverted U-shape in most countries. The magnitude of overdiagnosis varied across countries, ranging from no overdiagnosis (in Uganda, Zimbabwe, and Trinidad and Tobago) to more than 85·0% of thyroid cancer cases being overdiagnosed in females (in Cyprus, China, South Korea, and Türkiye). Overall, 1 736 133 (75·6%) of 2 297 057 cases were attributable to overdiagnosis, including 1 368 181 females and 367 952 males.

INTERPRETATION

Although the incidence of thyroid cancer has reached a plateau or decrease in some high-income countries, the magnitude of overdiagnosis is still very large and the expansion of overdiagnosis of thyroid cancer to the transitioning countries has been rapid, which makes it a global public health challenge that needs to be addressed.

FUNDING

National Natural Science Foundation of China, Guangdong Basic and Applied Basic Research Foundation, Young Talents Program of Sun Yat-sen University Cancer Center, Italian Association for Cancer Research, and the Italian Ministry of Health (Ricerca Corrente).

Standardized Ultrasound Evaluation for Active Surveillance of Low-Risk Thyroid Microcarcinoma in Adults: 2024 Korean Society of Thyroid Radiology Consensus Statement

Active surveillance (AS) has been widely adopted as an alternative to immediate surgery owing to the indolent nature and favorable outcomes of papillary thyroid microcarcinoma (PTMC). AS is generally recommended for tumors measuring ≤1 cm without aggressive cytological subtypes, risk of gross extrathyroidal extension (ETE), lymph node metastasis (LNM), or distant metastasis. AS requires careful patient selection based on various patient and tumor characteristics, and ultrasound (US) findings. Moreover, during AS, regular US is performed to monitor any signs of tumor progression, including tumor growth, new US features of potential gross ETE, and LNM. Therefore, appropriate imaging-based assessment plays a crucial role in determining whether AS or surgery should be pursued. However, detailed recommendations concerning US evaluation are currently insufficient, necessitating the formulation of this guideline. The Korean Society of Thyroid Radiology has developed a consensus statement for low-risk PTMC, covering US assessment methods when considering AS as a management option and conducting follow-up imaging tests during AS. This guideline aims to provide optimal scientific evidence and expert opinion consensus regarding a standardized US-based assessment protocol for low-risk PTMC.

The role of intraoperative central lymph node biopsy in the treatment of clinically low-risk PTMC

PURPOSE

To evaluate the role of intraoperative frozen biopsy of central lymph nodes in central neck dissection and thyroidectomy in patients of unilateral, clinically negative nodes (cN0) papillary thyroid microcarcinoma (PTMC) without extra-glandular invasion.

METHODS

The clinical data of 465 patients were collected retrospectively. Part of prelaryngeal, pretracheal and ipsilateral paratracheal lymph nodes were taken for frozen pathological examination during the operation. Then the thyroid lobe on the tumor side and isthmus were excised, and central neck dissection of the affected side was performed in all patients. The number of metastases in entire central lymph nodes of the affected side can be obtained by postoperative paraffin pathology. If the number of positive lymph nodes during surgery is ≥3, contralateral gland resection was performed.

RESULTS

In this group of 465 patients, there were 186 cases with central lymph node metastasis. The Kappa coefficient of consistency between frozen pathology and paraffin pathology in central lymph nodes was 0.605. The ROC curve for the number of intraoperative frozen metastases-postoperative pathological metastases over 5 showed that the AUC of the curve was 0.793, while the maximum Youden index was 0.5259, whose corresponding number of positive lymph nodes was 3.

CONCLUSION

Intraoperative central lymph nodes biopsy can be used as an important indicator for the status of central lymph node metastasis in unilateral cN0 PTMC patients without extra-glandular invasion and a determinant for central lymph node dissection. While the number of positive lymph nodes intraoperatively is ≥3, total thyroidectomy should be considered.

Development and validation of an interpretable machine learning model for predicting the risk of distant metastasis in papillary thyroid cancer: a multicenter study

Background

The survival rate of patients with distant metastasis (DM) of papillary thyroid carcinoma (PTC) is significantly reduced. It is of great significance to find an effective method for early prediction of the risk of DM for formulating individualized diagnosis and treatment plans and improving prognosis. Previous studies have significant limitations, and it is still necessary to develop new models for predicting the risk of DM of PTC. We aimed to develop and validate interpretable machine learning (ML) models for early prediction of DM in patients with PTC using a multicenter cohort.

Methods

We collected data on patients with PTC who were admitted between June 2013 and May 2023. Data from 1430 patients at Yunnan Cancer Hospital (YCH) served as the training and internal validation set, while data from 434 patients at the First Affiliated Hospital of Kunming Medical University (KMU 1st AH) was used as the external test set. Nine ML methods such as random forest (RF) were used to construct the model. Model prediction performance was compared using evaluation indicators such as the area under the receiver operating characteristic curve (AUC). The SHapley Additive exPlanation (SHAP) method was used to rank the feature importance and explain the final model.

Findings

Among the nine ML models, the RF model performed the best. The RF model accurately predicted the risk of DM in patients with PTC in both the internal validation of the training set [AUC: 0.913, 95% confidence interval (CI) (0.9075-0.9185)] and the external test set [AUC: 0.8996, 95% CI (0.8483-0.9509)]. The calibration curve showed high agreement between the predicted and observed risks. In the sensitivity analysis focusing on DM sites of PTC, the RF model exhibited outstanding performance in predicting "lung-only metastasis" showing high AUC, specificity, sensitivity, F1 score, and a low Brier score. SHAP analysis identified variables that contributed to the model predictions. An online calculator based on the RF model was developed and made available for clinicians at https://predictingdistantmetastasis.shinyapps.io/shiny1/. 11 variables were included in the final RF model: age of the patient with PTC, whether the tumor size is > 2 cm, whether the tumor size is ≤ 1 cm, lymphocyte (LYM) count, monocyte (MONO) count, monocyte/lymphocyte ratio (MLR), thyroglobulin (TG) level, thyroid peroxidase antibody (TPOAb) level, whether the T stage is T1/2, whether the T stage is T3/4, and whether the N stage is N0.

Interpretation

On the basis of large-sample and multicenter data, we developed and validated an explainable ML model for predicting the risk of DM in patients with PTC. The model helps clinicians to identify high-risk patients early and provides a basis for individualized patient treatment plans.

Funding

This work was supported by the National Natural Science Foundation of China (No. 81960426, 82360345 and 82001986), the Outstanding Youth Science Foundation of Yunnan Basic Research Project (No. 202401AY070001-316), Yunnan Province Applied and Basic Research Foundation (No. 202401AT070008), and Ten Thousand Talent Plans for Young Top-notch Talents of Yunnan Province.

Temporal trends of thyroid cancer in China and globally from 1990 to 2021: an analysis of the global burden of Disease Study 2021

The incidence of thyroid cancer (TC) is increasing annually worldwide, with a growing burden. This study aims to analyze temporal trends in the burden of TC by age and sex in China and globally from 1990 to 2021, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs) rates, and to predict future trends. We obtained data on TC in China and globally from 1990 to 2021 from the Global Burden of Disease (GBD) database. Using the Joinpoint regression model, we calculated and analyzed the trends in age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR). Specifically, we estimated the annual percent change (APC), the average annual percent change (AAPC), and the corresponding 95% confidence intervals (95% CI) for each metric. Additionally, we conducted a decomposition analysis to investigate the impact of aging, population growth, and epidemiological factors on the incidence and mortality rates of TC. Furthermore, the autoregressive integrated moving average (ARIMA) model was employed to predict the burden of TC from 2022 to 2036.  From 1990 to 2021, the ASIR for TC in China increased from 1.249 (95% uncertainty interval [UI]: 1.009-1.473) per 100,000 to 2.473 (95% UI: 1.993-3.088) per 100,000. Conversely, the ASMR decreased from 0.473 (95% UI: 0.403-0.550) per 100,000 to 0.387 (95% UI: 0.307-0.472) per 100,000. Both males and females demonstrated an upward trajectory in ASIR. However, while the ASMR for females decreased, that for males showed an overall increase despite a decline in the last decade. The age of peak onset for TC ranged from 30 to 79 years, whereas the age of peak mortality was between 50 and 89 years. The analysis using the AAPC indicates that the growth in the ASIR (AAPC = 2.242, 95% CI: 2.112-2.371) and ASPR (AAPC = 2.975, 95% CI: 2.833-3.117) in China exceeds the global rate. Furthermore, the reduction in ASMR (AAPC = -0.651, 95% CI: -0.824 - -0.479) and ASDR (AAPC = -0.590, 95% CI: -0.787 - -0.392) in China is also more pronounced than globally. Decomposition analysis indicates that the increasing TC burden in China is primarily driven by population aging, whereas globally, population growth plays a more significant role. Projections based on predictive models suggest that from 2021 to 2036, the ASIR for both China and the global population is expected to continue rising, while the ASMR is anticipated to decline further.  The incidence rates of TC in China and globally have shown a continuous upward trend, which is expected to persist over the next 15 years. Additionally, although the number of male TC cases is relatively lower compared to females, the overall ASMR and ASDR for males have shown an upward trend, despite a slight decline in recent years. This highlights the need to enhance prevention, diagnosis, and treatment measures, and to develop differentiated screening and treatment strategies based on age and sex.

Characteristics and survival of adults with differentiated thyroid cancer in a Peruvian hospital

BACKGROUND

Motivation for the study. There are few clinical and survival studies in Peru on thyroid cancer.

BACKGROUND

Main findings. Between the years 2010 to 2020, differentiated thyroid cancer was more frequent in women with early-stage disease, but survival was lower at five years compared to reports from other countries.

BACKGROUND

Implications. Thyroid cancer has increased in recent decades worldwide. It is important to have specialized and decentralized centers for the initial management and follow-up of these patients to avoid long-term complications or fatal outcomes and to have updated epidemiological information.

BACKGROUND

This study aimed at studying the clinical and anatomopathological characteristics, treatment and survival of patients with differentiated thyroid cancer. A retrospective cohort study was conducted with data from 150 patients from a Peruvian hospital between the years 2010 to 2020. Characteristics and survival (Kaplan-Meier method) were described. The mean age was 48.3 years, 130 participants (86.7%) were women and the most frequent histologic type was papillary 94.6%. Of the participants, 74.2% had TNM stage I, 70.7% had total thyroidectomy and 68.7% received radioactive iodine. Overall survival at 5 years was 89.3%, being lower in those with TNM stage IV and higher in those who used radioactive iodine. In conclusion, in a hospital in Cusco, differentiated thyroid cancer was more frequent in women and survival was lower compared to reports from other countries.

Neck Schwannoma Masking as Thyroid Tumour: Into the Deep of Diagnostics and Anatomy

Schwannomas are benign nerve sheath tumours that exhibit a slow rate of growth. In the vast majority of cases, schwannomas manifest as asymptomatic masses. The presence of symptomatic lesions may necessitate surgical removal. The incidence of schwannomas ranges from 4.4 to 5.23 cases per 100,000 population, accounting for approximately 7% of all primary tumours in the central nervous system. There is a limited number of case reports describing schwannomas outside the central nervous system. In rare instances, schwannomas may originate at the level of the thyroid gland. In such cases, incidental neck schwannomas may be mistaken for thyroid or parathyroid tumours. The increasing incidence of thyroid cancer draws more attention to all thyroid nodules, both benign and malignant. Thyroid nodules are detected in up to 65% of autopsies, with only 4-6.5% being malignant. Thyroid tumours are typically diagnosed by USG; however, they are often revealed incidentally during neck CT or MRI for other conditions. To rule out malignancy, tumour verification is required. The modern diagnosis of thyroid cancer is based on fine-needle aspiration (FNA) biopsy and cytology, which is classified according to the Bethesda classification system. However, not all FNAs are informative, and the differential diagnosis and treatment strategies in cases of unsatisfactory results are not standardized, leading to potential intraoperative challenges. We present a case study of a patient with a thyroid nodule that was ultimately diagnosed with a schwannoma of the neck according to core-needle biopsy.