Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage

Recent development on nanomaterial-based biosensors for identifying thyroid tumor biomarkers

The incidence of thyroid tumors has been increasing yearly over the past decade, making it the fourth highest tumor in women. This places various biological burdens on those affected. Currently, thyroid tumors are primarily diagnosed using percutaneous fine needle aspiration and ultrasound. However, these methods are complex, expensive, and less accurate, and they may fail to detect some thyroid nodules. As an alternative, researchers are focusing on blood-based biomarkers in addition to the traditional diagnostic methods, assisted predominantly by nanomaterials. Early identification of thyroid cancer is crucial as it is highly treatable. Various sensing systems have been developed using nanomaterial-mediated approaches to enhance the detection system. Nanomaterials are effectively applied in biosensors for surface functionalization and are conjugated with biomolecules to improve the interaction with the target analyte. This review discusses nanomaterial-assisted thyroid tumor detection, with a special focus on nanomaterial-based biosensors.

Causal association of sleep traits with the risk of thyroid cancer: A mendelian randomization study

BACKGROUND

This study was to explore the causal associations of sleep traits including sleep duration, snoring, chronotype, sleep disorders, getting up in the morning, sleeplessness/insomnia and nap during day with the risk of thyroid cancer based on Mendelian randomization (MR) analysis.

METHOD

Summary single nucleotide polymorphism (SNP)-phenotype association data were obtained from published genome-wide association studies (GWASs) using the FinnGen and UK Biobank databases. A series of screening processes were performed to select qualified SNPs strongly related to exposure. We applied the inverse variance weighted (IVW), the Mendelian Randomization robust adjusted profile score (MR-RAPS), the Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO), and the Weighted Median to estimate the causal links between sleep traits and the risk of thyroid cancer. Odds ratio (OR) and 95% confidence interval (CI) were calculated.

RESULTS

The IVW results showed that getting up in the morning (OR = 0.055, 95%CI: 0.004-0.741) and napping during day (OR = 0.031, 95%CI: 0.002-0.462) were associated with decreased risk of thyroid cancer in the Italian population. A 1.30-h decrease of sleep duration was associated with 7.307-fold of thyroid cancer risk in the Finnish population (OR = 7.307, 95%CI: 1.642-32.519). Cronotype could decrease the risk of thyroid cancer in the Finnish population (OR = 0.282, 95%CI: 0.085-0.939). Sleep disorders increased the risk of thyroid cancer in the Finnish population (OR = 2.298, 95%CI: 1.194-4.422). The combined results revealed that sleep duration was correlated with increased risk of thyroid cancer (OR = 5.600, 95%CI: 1.458-21.486).

CONCLUSION

Decreased sleep duration was associated with increased risk of thyroid cancer, which indicated the importance of adequate sleep for the prevention of thyroid cancer.

Impaired thyroid hormone sensitivity increases the risk of papillary thyroid cancer and cervical lymph node metastasis

BACKGROUND

The association of thyroid hormone sensitivity with papillary thyroid carcinoma (PTC) is unclear. This study investigated the relationship between the thyroid hormone sensitivity indices and the risk of PTC and the influence of thyroid hormone sensitivity on the aggressive clinicopathologic features of PTC.

METHODS

This retrospective study recruited 1225 PTC patients and 369 patients with benign nodules undergoing surgery in Zhongshan Hospital in 2020. The thyroid hormone sensitivity indices were thyroid feedback quantile-based index (TFQI), TSH index (TSHI) and thyrotropin thyroxine resistance index (TT4RI). We employed logistic regression models to explore the correlation between the thyroid hormone sensitivity indices and the risk of PTC and its cervical lymph node metastasis (LNM).

RESULTS

PTC patients had significantly higher levels of TSH, TFQI, TSHI and TT4RI compared to the patients with benign nodules, but thyroid hormone levels did not differ significantly between the two groups. Logistic regression analysis revealed that the higher levels of TFQI, TSHI, and TT4RI were associated with an increased risk of PTC after adjustment for multiple risk factors (TFQI: OR = 1.92, 95% CI: 1.39-2.65, P < 0.001; TSHI: OR = 2.33, 95% CI:1.67-3.26, P < 0.001; TT4RI: OR = 2.41, 95% CI:1.73-3.36, P < 0.001). In addition, patients with decreased thyroid hormone sensitivity had a higher risk of cervical LNM in multiple logistic regression analysis (TFQI: OR = 1.38, 95% CI:1.03-1.86, P = 0.03; TSHI: OR = 1.37, 95% CI:1.02-1.84, P = 0.04; TT4RI: OR = 1.41, 95% CI:1.05-1.89, P = 0.02).

CONCLUSION

Impaired sensitivity to thyroid hormone was associated with an increased risk of PTC, and it is also associated with a higher risk of cervical LNM in PTC patients.

Thyroid Cancer: A Review

Importance

Approximately 43 720 new cases of thyroid carcinoma are expected to be diagnosed in 2023 in the US. Five-year relative survival is approximately 98.5%. This review summarizes current evidence regarding pathophysiology, diagnosis, and management of early-stage and advanced thyroid cancer.

Observations

Papillary thyroid cancer accounts for approximately 84% of all thyroid cancers. Papillary, follicular (≈4%), and oncocytic (≈2%) forms arise from thyroid follicular cells and are termed well-differentiated thyroid cancer. Aggressive forms of follicular cell-derived thyroid cancer are poorly differentiated thyroid cancer (≈5%) and anaplastic thyroid cancer (≈1%). Medullary thyroid cancer (≈4%) arises from parafollicular C cells. Most cases of well-differentiated thyroid cancer are asymptomatic and detected during physical examination or incidentally found on diagnostic imaging studies. For microcarcinomas (≤1 cm), observation without surgical resection can be considered. For tumors larger than 1 cm with or without lymph node metastases, surgery with or without radioactive iodine is curative in most cases. Surgical resection is the preferred approach for patients with recurrent locoregional disease. For metastatic disease, surgical resection or stereotactic body irradiation is favored over systemic therapy (eg, lenvatinib, dabrafenib). Antiangiogenic multikinase inhibitors (eg, sorafenib, lenvatinib, cabozantinib) are approved for thyroid cancer that does not respond to radioactive iodine, with response rates 12% to 65%. Targeted therapies such as dabrafenib and selpercatinib are directed to genetic mutations (BRAF, RET, NTRK, MEK) that give rise to thyroid cancer and are used in patients with advanced thyroid carcinoma.

Conclusions

Approximately 44 000 new cases of thyroid cancer are diagnosed each year in the US, with a 5-year relative survival of 98.5%. Surgery is curative in most cases of well-differentiated thyroid cancer. Radioactive iodine treatment after surgery improves overall survival in patients at high risk of recurrence. Antiangiogenic multikinase inhibitors and targeted therapies to genetic mutations that give rise to thyroid cancer are increasingly used in the treatment of metastatic disease.

Approach to Thyroid Nodules: Diagnosis and Treatment

Thyroid nodules (TNs) are prevalent and found in up to 50% of individuals. While most TNs are benign, some can be malignant. The evaluation of TNs is crucial to rule out malignancy and identify those requiring surgical intervention. This study aimed to clarify the reported prevalence of TNs, focusing specifically on their various types, assessment and diagnostic processes, current evaluation methods, and evidence-based management. It also provides recommendations for follow-up. TNs are typically found during physical exams or incidentally during imaging procedures. Routine laboratory and clinical evaluations of TNs are common. Ultrasound is the preferred imaging method to determine if a TN needs a biopsy. Fine-needle aspiration (FNA) is crucial in deciding whether surgery or surveillance is necessary. TNs that show suspicious features on the ultrasound may require cytologic analysis to assess the risk of malignancy. The effectiveness of several supplementary molecular tests is still uncertain, although some studies report promising results. The management and treatment approach for TNs primarily depends on the results of FNA cytology and ultrasound characteristics. The optimal treatment strategy for TNs ranges from straightforward follow-ups for low-risk cases to surgical intervention for high-risk patients. Rather than adopting a uniform approach, clinicians should assess each patient on a case-by-case basis using current knowledge and a collaborative, multidisciplinary method.

Use of ultrasound elastography in differentiating benign from malignant thyroid nodules: a prospective study

Purpose

Elastography is a real-time non-invasive ultrasonography modality wherein the tissue stiffness is evaluated by calculating the degree of tissue distortion in response to an external force. This study was undertaken to assess the diagnostic value of elastography in differentiating benign from malignant thyroid nodules.

Methodology

In this prospective comparative study, a total of 52 thyroid nodules from 44 euthyroid patients undergoing fine needle aspiration cytology were assessed. Elastography was performed by a single experienced sonologist, wherein the nodules were graded as per elastography scoring (ES), and the strain ratio (SR) for each nodule was computed. Final histopathology findings of the patients undergoing surgery were compared to elastography findings, and measures of diagnostic accuracy to differentiate between benign and malignant nodules were determined for ES and SR.

Results

Thirty (68.2%) females and 14 (31.8%) males, with a mean age of 45.18 ± 11.23 years, were assessed. Fourteen (31.8%) patients underwent thyroidectomy, and histopathology was reported for 18 (34.6%) nodules. In all, nine (17.3%) nodules were malignant, and 43 (82.7%) nodules were considered benign. ES demonstrated a sensitivity of 88.9%, specificity of 88.3%, PPV of 61.5%, NPV of 97.4%, and accuracy of 88.5% to identify benign thyroid nodules. The mean SR for benign nodules was significantly lower as compared to malignant nodules (2.72 ± 0.62 vs. 4.52 ± 0.75, P < 0.0001). The optimal cut-point value for SR to differentiate benign and malignant thyroid nodules was determined to be 3.8, with the sensitivity, specificity, PPV, NPV, and accuracy being 88.9%, 95.4%, 80%, 94.6%, and 94.2%, respectively.

Conclusion

Ultrasound elastography (ES and SR) demonstrated good diagnostic efficacy to differentiate benign thyroid nodules from the malignant ones, and can be a good supplementary tool to gray-scale ultrasonography. It can also help in reducing the rates of unnecessary fine needle-aspiration biopsy.

Activation of mitogen-activated protein kinase signaling and development of papillary thyroid carcinoma in thyroid-stimulating hormone receptor D633H knockin mice

Objective

Nonautoimmune hyperthyroidism (NAH) is rare and occurs due to a constitutively activating thyroid stimulating hormone receptor (TSHR) mutation. In contrast to other thyroid nodules, no further evaluation for malignancy is recommended for hot thyroid nodules. In the first model for NAH in mice nearly all homozygous mice had developed papillary thyroid cancer by 12 months of age.

Methods

To further evaluate these mice, whole exome sequencing and phosphoproteome analysis were employed in a further generation of mice to identify any other mutations potentially responsible and to identify the pathways involved in thyroid carcinoma development.

Results

Only three genes (Nrg1, Rrs1, Rasal2) were mutated in all mice examined, none of which were known primary drivers of papillary thyroid cancer development. Wild-type and homozygous TSHR D633H knockin mice showed distinct phosphoproteome profiles with an enrichment of altered phosphosites found in ERK/mitogen-activated protein kinase (MAPK) signaling. Most importantly, phosphosites with known downstream effects included BRAF p.S766, which forms an inhibitory site: a decrease of phosphorylation at this site suggests an increase in MEK/ERK pathway activation. The decreased phosphorylation at BRAF p.S766 would suggest decreased AMP-activated protein kinase (AMPK) signaling, which is supported by the decreased phosphorylation of STIM1 p.S257, a downstream AMPK target.

Conclusion

The modified phosphoproteome profile of the homozygous mice in combination with human literature suggests a potential signaling pathway from constitutive TSHR signaling and cAMP activation to the activation of ERK/MAPK signaling. This is the first time that a specific mechanism has been identified for a possible involvement of TSH signaling in thyroid carcinoma development.

Anthropometric, dietary, and lifestyle factors and risk of advanced thyroid cancer: The NIH-AARP diet and health cohort study

BACKGROUND

Most patients diagnosed with thyroid cancer have low-risk disease, but some have a higher risk for persistent or recurrent disease and even death from thyroid cancer. Few studies have evaluated potential anthropometric, lifestyle, or dietary risk factors for advanced or aggressive types of thyroid cancer.

METHODS

Using data from a large US cohort study, we examined associations for high-risk thyroid cancer (HRTC) and, separately, low-risk thyroid cancer (LRTC) in relation to anthropometric factors, diet, smoking, and alcohol consumption. The National Institutes of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study included 304,122 participants (124,656 women and 179,466 men) without a history of cancer who completed a mailed questionnaire in 1996-1997 and were followed for cancer incidence through 2011 via linkages with state cancer registries. Hazard ratios (HRs) for anthropometric, dietary, and lifestyle factors in relation to HRTC or LRTC, defined using guidance from the American Thyroid Association initial risk of recurrence classification, were calculated using multivariable-adjusted Cox proportional hazards regression models.

RESULTS

During follow-up (median = 10.1 years), 426 participants were diagnosed with HRTC (n = 95) or LRTC (n = 331). In models combining men and women, baseline waist circumference (per 5 cm, HR = 1.13, 95% confidence interval [CI] 1.01-1.27) and weight gain from age 18 years to baseline age (per 5 kg, HR = 1.14, 95% CI 1.02-1.28) were positively associated with risk of HRTC but not LRTC. In contrast, vegetable intake (per cup equivalents/day, HR = 1.15, 95% CI 1.01-1.30), cigarette smoking (current vs. never, HR = 0.39, 95% CI 0.23-0.68), and alcohol consumption (per drink/day, HR = 0.83, 95% CI 0.70-0.97) were associated with risk of LRTC but not HRTC. The association of LRTC risk with vegetable intake was limited to men, and that of current smoking was more pronounced in women.

CONCLUSIONS

Our findings suggest that greater waist circumference and adulthood weight gain are associated with thyroid cancers at higher risk for recurrence. These results may have implications for the primary prevention of advanced thyroid cancer.

Rotating Night Shift Work, Sleep, and Thyroid Cancer Risk in the Nurses' Health Study 2

Night shift work has been associated with breast, prostate, and colorectal cancer, but evidence on other types of cancer is limited. We prospectively evaluated the association of rotating night shift work, sleep duration, and sleep difficulty with thyroid cancer risk in the Nurses' Health Study 2 (NHS2). We assessed rotating night shift work duration (years) at baseline and throughout follow-up (1989-2015) and sleep characteristics in 2001. Cox proportional hazard models, adjusted for potential confounders, were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for (a) shift work duration, (b) sleep duration, and (c) difficulty falling or staying asleep. We stratified the analyses of night shift work by sleep duration and sleep difficulty. Over 26 years of follow-up, 588 incident cases were identified among 114,534 women in the NHS2 cohort. We observed no association between night shift work and the risk of thyroid cancer. Difficulty falling or staying asleep was suggestively associated with a higher incidence of thyroid cancer when reported sometimes (HR 1.26, 95% CI 0.95, 1.66) and all or most of the time (HR 1.35, 95% CI 1.00, 1.81). Night shift workers (10+ years) with sleep difficulty all or most of the time (HR 1.47; 0.58-3.73) or with >7 h of sleep duration (HR 2.17; 95% CI, 1.21-3.92) had a higher risk of thyroid cancer. We found modest evidence for an increased risk of thyroid cancer in relation to sleep difficulty, which was more pronounced among night shift workers.

Epidemiological, Pathophysiological, and Clinical Considerations on the Interplay between Thyroid Disorders and Type 2 Diabetes Mellitus

Thyroid disorders (TD) and diabetes mellitus (DM) are the two endocrinopathies with the highest prevalence in the general population that frequently coexist. Thyroid dysfunction is more common in people with type 2 diabetes mellitus (T2DM) compared to normoglycemic individuals. Untreated TD can impair glycemic control, increasing the risk of diabetes complications. Hyperinsulinemia can affect the morphology of the thyroid gland by promoting the proliferation of thyroid tissue and increasing the size of thyroid nodules. Metformin can confer benefits in both endocrinopathies, while other antidiabetics, such as sulfonylureas, can negatively affect thyroid function. Animal and human observational data suggest an increased risk of medullary thyroid carcinoma after treatment with glucagon-like peptide-1 receptor agonists. However, randomized trials have so far been reassuring. Furthermore, some observational studies suggest an association between thyroid cancer and T2DM, especially in women. This narrative review aims to shed light on the epidemiological, pathophysiological, and clinical aspects of the interplay between TD and T2DM. Taking into account the important clinical implications of the coexistence of T2DM and TD, proper screening and management strategies are needed for both endocrinopathies to ensure optimal patient care.

Radiofrequency Ablation of Unifocal Papillary Thyroid Microcarcinoma With BRAF V600E Mutation

CONTEXT

To date there is no study on the feasibility of radiofrequency ablation (RFA) for papillary thyroid microcarcinomas (PTMCs) with BRAF V600E mutation.

OBJECTIVE

This study was designed to evaluate the efficiency, safety, and prognosis of ultrasound (US)-guided percutaneous RFA for unifocal PTMCs with BRAF V600E mutation.

MATERIALS AND METHODS

Sixty patients with 60 unifocal BRAF V600E mutation-positive PTMCs who received US-guided RFA between January 2020 and December 2021 were retrospectively analyzed. The mean maximum PTMC tumor diameter was 5.8 ± 1.7 mm (range, 2.5-10.0 mm). All PTMCs were pathologically confirmed by fine needle aspiration or core needle biopsy, and BRAF V600E mutation was confirmed to be positive by real-time fluorescent quantitative polymerase chain reaction. Contrast-enhanced ultrasound (CEUS) was performed immediately after RFA to evaluate whether PTMCs were extendedly ablated. Ultrasound was performed 1, 3, 6, and 12 months after RFA and every 6 months thereafter to evaluate the changes in the ablation zone, local recurrence, and cervical lymph node metastasis (LNM). The complications were recorded and evaluated.

RESULTS

Extended ablation was achieved in all enrolled patients. The ablation zone sizes increased immediately after RFA compared with those of tumors before treatment. One month later, the ablation zone sizes were smaller than immediately after RFA. At the last follow-up assessment, 42 nodules (70.0%) completely disappeared and the ablation zones of 18 nodules (30.0%) showed fissure-like changes. No local recurrence or cervical LNM was detected. Voice change (1.7%) was the only major complication.

CONCLUSION

RFA is effective and safe in treating unifocal PTMCs with BRAF V600E mutation, especially when surgery is not feasible or refused by patients who are unwilling to continue active surveillance.

US Predictors of Papillary Thyroid Microcarcinoma Progression at Active Surveillance

Background Active surveillance (AS) is an accepted strategy for patients with low-risk papillary thyroid microcarcinoma (PTMC). While previous studies have evaluated the prognostic value of US features, results have been inconsistent. Purpose To determine if US features can help predict tumor progression in patients with low-risk PTMC undergoing AS. Materials and Methods This prospective study enrolled 1177 participants with PTMC from three hospitals between June 2016 and January 2021. Participants were self-assigned to either immediate surgery or AS, and those with two or more US examinations in the absence of surgery were included in the analysis. A χ2 test was used to compare estimated tumor progression rate at 4 years between participants stratified according to US features. Multivariable Cox regression analysis was used to assess the association of clinical and US features with overall tumor progression and specific progression criteria. Results Among 699 participants included in the analysis, 68 (mean age, 49 years ± 12 [SD]; 40 female participants) showed tumor progression (median follow-up, 41.4 months ± 16 [SD]). Tumor progression was associated with the US features of diffuse thyroid disease (DTD) (hazard ratio [HR], 2.3 [95% CI: 1.4, 3.7]; P = .001) and intratumoral vascularity (HR, 1.7 [95% CI: 1.0, 3.0]; P = .04) and the participant characteristics of male sex (HR, 2.8 [95% CI: 1.7, 4.6]; P < .001), age less than 30 years (HR, 2.9 [95% CI: 1.2, 6.8]; P = .01), and thyroid-stimulating hormone level of 7 µU/mL or higher (HR, 6.9 [95% CI: 2.7, 17.4]; P < .001). The risk of tumor progression was higher for participants with DTD (14%, P = .001) or intratumoral vascularity (14%, P = .02) than for participants without these features (6%). DTD and intratumoral vascularity were associated with tumor enlargement (HR, 2.7 [95% CI: 1.4, 5.1]; P = .002) and new lymph node metastasis (HR, 5.0 [95% CI: 1.3, 19.4]; P = .02), respectively. Conclusion DTD and intratumoral vascularity were associated with an increased risk of tumor progression in participants with PTMC undergoing AS. Clinical trial registration no. NCT02938702 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Reuter and the review "International Expert Consensus on US Lexicon for Thyroid Nodules" by Durante et al in this issue.

Stratifying High-Risk Thyroid Nodules Using a Novel Deep Learning System

INTRODUCTION

The current ultrasound scan classification system for thyroid nodules is time-consuming, labor-intensive, and subjective. Artificial intelligence (AI) has been shown to increase the accuracy of predicting the malignancy rate of thyroid nodules. This study aims to demonstrate the state-of-the-art Swin Transformer to classify thyroid nodules.

MATERIALS AND METHODS

Ultrasound images were collected prospectively from patients who received fine needle aspiration biopsy for thyroid nodules from January 2016 to June 2021. One hundred thirty-nine patients with malignant thyroid nodules were enrolled, while 235 patients with benign nodules served as controls. Images were fed to Swin-T and ResNeSt50 models to classify the thyroid nodules.

RESULTS

Patients with malignant nodules were younger and more likely male compared to those with benign nodules. The average sensitivity and specificity of Swin-T were 82.46% and 84.29%, respectively. The average sensitivity and specificity of ResNeSt50 were 72.51% and 77.14%, respectively. Receiver operating characteristics analysis revealed that the area under the curve of Swin-T was higher (AUC=0.91) than that of ResNeSt50 (AUC=0.82). The McNemar test evaluating the performance of these models showed that Swin-T had significantly better performance than ResNeSt50.Swin-T classifier can be a useful tool in helping shared decision-making between physicians and patients with thyroid nodules, particularly in those with high-risk characteristics of sonographic patterns.

Preoperative Evaluation of Thyroid Cancer: A Review of Current Best Practices

OBJECTIVE

The incidence of thyroid cancer has significantly increased in recent decades. Although most thyroid cancers are small and carry an excellent prognosis, a subset of patients present with advanced thyroid cancer, which is associated with increased rates of morbidity and mortality. The management of thyroid cancer requires a thoughtful individualized approach to optimize oncologic outcomes and minimize morbidity associated with treatment. Because endocrinologists usually play a key role in the initial diagnosis and evaluation of thyroid cancers, a thorough understanding of the critical components of the preoperative evaluation facilitates the development of a timely and comprehensive management plan. The following review outlines considerations in the preoperative evaluation of patients with thyroid cancer.

METHODS

A clinical review based on current literature was generated by a multidisciplinary author panel.

RESULTS

A review of considerations in the preoperative evaluation of thyroid cancer is provided. The topic areas include initial clinical evaluation, imaging modalities, cytologic evaluation, and the evolving role of mutational testing. Special considerations in the management of advanced thyroid cancer are discussed.

CONCLUSION

Thorough and thoughtful preoperative evaluation is critical for formulating an appropriate treatment strategy in the management of thyroid cancer.

Preoperative Thyroid-Stimulating Hormone Levels and Risk of Thyroid Cancer in Post-thyroidectomy Patients for Thyroid Nodules: A Study From a Tertiary Hospital in Western Saudi Arabia

Background Although serum thyroid-stimulating hormone (TSH) is one of the basic investigations to assess thyroid nodules, its role in thyroid oncogenesis remains unclear. Previous literature has conflicting findings regarding TSH levels and the prediction of malignancy. This study aims to investigate the association between TSH levels and the risk of malignancy and advanced staging in patients who underwent thyroidectomy for nodular thyroid disease. Additionally, it aims to assess if higher TSH correlates with malignancy in Bethesda staging III, IV, and V. Methodology This retrospective cohort study was conducted among participants who underwent near-total/total thyroidectomy or hemithyroidectomy at King Abdulaziz Medical City between 2016 and 2021. Results A total of 378 cases were included, and 50.3% of the cases had malignant nodules in the surgical histopathology findings. The median TSH levels were higher in malignant nodules compared to benign ones (1.64 mIU/L versus 1.49 mIU/L; p < 0.001). Additionally, higher TSH levels were not associated with advanced staging or malignancy in patients with Bethesda stage III-V. Conclusions Higher TSH levels are associated with an increased risk of malignancy in patients with nodular thyroid disease. Using TSH levels as an adjunctive tool for identifying high-risk patients with thyroid nodules would aid in management planning.

Global research landscape and trends of papillary thyroid cancer therapy: a bibliometric analysis

Background

Papillary thyroid cancer (PTC) is the most common endocrine malignancy worldwide. The treatment of PTC has attracted extensive attention and discussion from the public and scholars. However, no article has systematically assessed the related literature. Therefore, we conducted a bibliometric and knowledge map analysis to reveal the dynamic scientific developments in the PTC therapy field.

Methods

We retrieved publications related to PTC therapy from the Web of Scientific Core Collection (WoSCC) on May 1, 2023. The bibliometric package in R software, VOSviewer and CiteSpace software were used to analyze countries/regions, institutions, journals, authors, references, and keywords. Then, we systematized and summarized the research landscape, global trends and hot topics of research.

Results

This bibliometric analysis spanned from 2012 to 2022 and involved 18,501 authors affiliated with 3,426 institutions across 87 countries/regions, resulting in the publication of 3,954 papers in 860 academic journals. Notably, the number of publications and citations related to PTC therapy research has exhibited a steady increase over the past decade. China and the United States have emerged as leading contributors in terms of publication count, with the United States also being the most cited country. Furthermore, among the top 10 institutions with the highest number of published papers, half were located in China. Among the journals, Thyroid is ranked first in terms of total publications and citations. The most productive individual author was Miyauchi Akira. While previous research primarily focused on surgery and radioactive iodine therapy, the increasing emphasis on health awareness and advancements in medical technology have led to the emergence of active surveillance, thermal ablation, and genomic analysis as prominent areas of research.

Conclusion

In conclusion, this comprehensive and quantitative bibliometric analysis elucidates the research trends and hotspots within PTC therapy, drawing from a substantial body of publications. This study provides valuable insights into the historical and current landscape of PTC therapy research while also offering guidance for future research directions. This study serves as a valuable resource for researchers and practitioners seeking new avenues of exploration in the field.

An update on the management of thyroid nodules: rationalising the guidelines

BACKGROUND

Guidance for the management of thyroid nodules has evolved over time, from initial evaluation based predominantly on clinical grounds to now including the established role of ultrasound and fine needle aspiration cytology in their assessment. There is, however, significant variation in the management of thyroid nodules depending on which national guidelines are followed. In addition, there are certain clinical situations such as pregnancy and paediatric thyroid nodules that have differing evaluation priorities.

OBJECTIVES

This review aimed to provide an overview of currently accepted practices for the initial investigation and subsequent management of patients with thyroid nodules for the non-specialist. The review also addresses areas of variance between the systems in common clinical use, as well as newer, evolving technologies, including molecular testing in the evaluation of malignancy in thyroid nodules.

Construction and validation of nomograms to reduce completion thyroidectomy by predicting lymph node metastasis in low-risk papillary thyroid carcinoma

CONTEXT

More than 5 central lymph nodes metastases (CLNM) or lateral lymph node metastasis (LLNM) indicates a higher risk of recurrence in low-risk papillary thyroid carcinoma (PTC) and may lead to completion thyroidectomy (CTx) in patients initially undergoing lobectomy.

OBJECTIVE

To screen potentially high-risk patients from low-risk patients by using preoperative and intraoperative clinicopathological features to predict lymph node status.

METHODS

A retrospective analysis of 8301 PTC patients in Wuhan Union Hospital database (2009-2021) was performed according to the 2015 American Thyroid Association (ATA) and 2021 National Comprehensive Cancer Network (NCCN) guidelines, respectively. Logistic regression and best subsets regression were used to identify risk factors. Nomograms were established and externally validated using the Differentiated Thyroid Cancer in China cohort.

RESULTS

More than 5 CLNM or LLNM was detected in 1648 (19.9%) patients. Two predictive models containing age, gender, maximum tumor size, free thyroxine (FT4) and palpable node (all p < 0.05) were established. The nomogram based on NCCN criteria showed better discriminative power and consistency with a specificity of 0.706 and a sensitivity of 0.725, and external validation indicated that 76% of potentially high-risk patients could achieve preoperative conversion of surgical strategy.

CONCLUSIONS

Models based on large cohorts with good predictive performance were constructed and validated. Preoperative low-risk (T1-2N0M0) patients with age younger than 40 years, male gender, large tumor size, low FT4 and palpable nodes may be at high risk of LLNM or more than 5 CLNM, and they should receive more aggressive initial therapy to reduce CTx.

Predictors and a prediction model for positive fine needle aspiration biopsy in C-TIRADS 4 thyroid nodules

Objectives

To screen out the predictors and establish a prediction model of positive fine needle aspiration biopsy (FNAB) in the Chinese Guidelines for Malignant Risk Stratification of Thyroid Nodule Ultrasound (C-TIRADS) 4 thyroid nodules, and this nomogram can help clinicians evaluate the risk of positive FNAB and determine if FNAB is necessary.

Methods

We retrospectively analyzed data from 547 patients who had C-TIRADS 4 thyroid nodules and underwent fine-needle aspiration biopsy (FNAB) at the Second Affiliated Hospital of Chongqing Medical University between November 30, 2021 and September 5, 2022. Patients who met our inclusion criteria were divided into two groups based on positive or negative FNAB results. We compared their ultrasound (US) features, BRAF V600E status, thyroid function, and other general characteristics using univariate and multivariate logistic regression analyses to identify independent predictors. These predictors were then used to construct a nomogram. The calibration plot, area under the curve (AUC), and decision curve analysis were employed to evaluate the calibration, discrimination, and clinical utility of the prediction model.

Results

Out of 547 patients, 39.3% (215/547) had a positive result on fine-needle aspiration biopsy (FNAB), while 60.7% (332/547) had a negative result. Univariate logistic regression analysis revealed no significant differences in TPOAb, TgAb, TSH, Tg, nodule location, sex, or solid status between the two groups (P>0.05). However, age, nodule size, internal or surrounding blood flow signal, microcalcifications, aspect ratio, morphology, and low echo showed significant differences (P<0.05). Multivariate logistic regression analysis was conducted to explore the correlation between potential independent predictors. The results showed that only age (OR=0.444, 95% Cl=0.296~0.666, P<0.001), low echo (OR=3.549, 95% Cl=2.319~5.432, P<0.001), microcalcifications (OR=2.531, 95% Cl=1.661~3.856, P<0.001), aspect ratio (OR=3.032, 95% Cl=1.819~5.052, P<0.001), and morphology (OR=2.437, 95% Cl=1.586~3.745, P<0.001) were independent predictors for a positive FNAB. These variables were used to construct a prediction nomogram. An ROC curve analysis was performed to assess the accuracy of the nomogram, and AUC=0.793, which indicated good discrimination and decision curve analysis demonstrated clinical significance within a threshold range of 14% to 91%.

Conclusion

In conclusion, 5 independent predictors of positive FNAB, including age (≤45 years old), low echo (yes), microcalcifications (yes), aspect ratio (>1) and morphology (irregular), were identified. A nomogram was established based on the above 5 predictors, and the nomogram can be used as a complementary basis to help clinicians make decisions on FNAB of C-TI-RADS 4 thyroid nodules.

Current controversies in the management of patients with indeterminate thyroid nodules

The management of cytologically indeterminate thyroid nodules remains debatable as their malignancy is difficult to establish. Most nodules have benign postoperative histology, but an accurate assessment of their proclivity for malignant transformation is crucial. Numerous studies have investigated the effects of various tools, including clinical, radiological, and cytological features, as well as biochemical and molecular markers, on the management of these heterogeneous nodules. Collectively, strategies aim to treat malignant nodules and avoid unnecessary surgery for asymptomatic benign nodules. Currently, no clear guidelines for the optimal management of cytologically indeterminate thyroid nodules exist to determine whether a conservative approach with long-term observation or surgical intervention should be selected. Thus, personalized approaches have been recommended. Large-scale multicenter prospective studies are needed to elucidate controversial issues. As this topic has not been comprehensively covered based on publications from the Gulf region, this review aims to shed light on remaining controversies.

Determination of Diagnostic Features of Serum Thyroid Hormones and Thyroglobulin Ratios in Normothyroid Differentiated Thyroid Carcinoma Cases

Objectives

Ultrasonography and fine-needle aspiration biopsy (FNAB) are the gold standard methods in the prediction of benign and malignant thyroid nodules. However, despite being easily applicable, FNAB is an invasive procedure. Less invasive biomarkers should be utilized in the diagnosis of thyroid malignancies. In this study, we aimed to determine the parameters that can be used in the diagnosis of differentiated thyroid cancer (DTC) based on the serum thyroid and thyroglobulin (TG) levels which are routinely checked in patients followed up for thyroid nodules.

Methods

In the study, we evaluated patients who underwent thyroid surgery for nodular diseases between January 2015 and June 2022. Of the 1444 patients evaluated, 919 patients who met the inclusion criteria (normothyroid benign nodular disease or normothyroid DTC) were included in the study. Patients were divided into two groups as benign group (BG) and DTC group (DTCG). We compared patients' pre-operative serum thyroid and TG values and the diagnostic properties of their ratios.

Results

Of the 919 patients included, 517 (56.3%) were in BG and 402 (43.7%) were in DTCG. In DTCG, 318 patients were female and 84 patients were male. The mean age in the DTCG was 47.8 years. Comparison of DTCG and BG revealed a significant difference between T3/T4 ratio (p=0.002), T3/TSH ratio (p≤0.001), T4/TSH ratio (p≤0.001), TG/TSH ratio (p≤0.001), and TSH/TG ratio (p≤0.001). However, evaluation of the specified values by ROC analysis showed that the T3/T4 ratio did not make a significant difference between the two groups (p=0.1), whereas the other values displayed a significant difference (p≤0.001 for T3/TSH, p=0.001 for T4/TSH, p≤0.001 for TG/TSH, and p<0.001 for TSH/TG).

Conclusion

T3/TSH (cutoff =2.183), T4/TSH (cutoff=0.6), and TG/TSH (cutoff=29.67) values were found to be significant tumor markers for the prediction of malignancy in thyroid nodules, and low values were found to be associated with malignancy. TSH/TG (cutoff=0.031) value was also significant in predicting malignancy while high values were found to be associated with malignancy. Thyroid hormone and TG ratios may alter the preferred treatment method for thyroid nodules.

TSH level as a risk factor of thyroid malignancy for nodules in euthyroid patients

Objective

With the increased prevalence of incidental thyroid cancer, determining the predictors of thyroid malignancy has become a source of debate. This study aimed to determine the impact of thyroid stimulating hormone (TSH) levels on rates of thyroid cancer in euthyroid patients.

Methods

A retrospective study included 421 patients who underwent thyroidectomy at a tertiary hospital between 2016 and 2020. Patients' demographics, history of cancer, pre-operative workup and final histology reports were obtained. The study sample was divided into two groups based on the final histopathology (benign vs malignant). The two groups were compared using the appropriate statistical tests to determine the predictors of thyroid cancer in euthyroid patients.

Results

TSH levels were significantly higher in patients with malignant nodules compared to those with benign nodules (1.94 vs 1.62, p = 0.002). It was 1.54 times more likely for thyroid nodules to be malignant when TSH levels were higher (p = 0.038). Meanwhile, larger nodules (> 4 cm) were significantly more prevalent in benign nodules (43.1%) than in malignant nodules (21.1%). Larger nodules decreased the possibility of thyroid cancer by 24% (OR = 0.760, p-value = 0.004).

Conclusions

High TSH levels in euthyroid patients were significantly correlated with the risk of thyroid malignancy. In addition, as Bethesda category proceeded toward malignancy, TSH levels increased. High TSH levels and small nodule diameters can be used as additional parameters in predicting thyroid cancer in euthyroid patients.

Thyroid cancer in pregnancy: diagnosis, management, and treatment

The evaluation and management of cancer during pregnancy requires special care to assure the health and safety of both the mother and fetus. The diagnosis and treatment of thyroid cancer in the non-pregnant patient often involves radioactive iodine exposure. However, radioactive iodine is contraindicated in pregnancy and surgical interventions pose risks to both the mother and fetus. Thus, the management of thyroid cancer during pregnancy is a unique clinical challenge. In this review, we discuss the imaging of thyroid nodules during pregnancy, including the role of CT, MRI, and nuclear Imaging, as well as that of Ultrasound and FNA. The staging and prognosis are discussed along with the management, treatment, and surveillance of thyroid cancer in pregnancy. Finally, the risks to the fetus through treatment are examined. Case examples are provided with an emphasis on the appropriate direction of care from a radiologist's perspective.

The Association of Socioeconomic Factors and Well-Differentiated Thyroid Cancer

INTRODUCTION

Well-differentiated thyroid cancer (WDTC) is the most common thyroid malignancy, and the worldwide incidence is increasing. Early stage disease is curable with surgery. We hypothesized that patients who live at greater distances from health care institutions or have complicating socioeconomic barriers may present with more advanced diseases and have worse outcomes.

METHODS

The National Cancer Database (NCDB) was used to identify patients who were diagnosed with WDTC between 2004 and 2018. Race, ethnicity, insurance status, income status, and distance from residence to health care clinic of diagnosis (great circle distance [GCD]) were analyzed with respect to the severity of disease at presentation (stage) and outcomes. Binary logistic regression and Cox regression were used to determine associations between socioeconomic variables and tumor stage or survival.

RESULTS

The Hispanic (OR: 1.49, CI: 1.45-1.54, P < 0.001) and Asian (OR: 1.49, CI: 1.43-1.55, P < 0.001) populations had higher odds of developing an advanced disease when compared to the White population separately. Patients without insurance displayed higher odds of developing an advanced disease at diagnosis compared to those with insurance (OR: 1.39, CI: 1.31-1.47, P < 0.001). Adjusted-Cox regression analysis of survival revealed that Black patients had detrimental survival outcomes when compared to White patients (HR: 1.24, P < 0.001), and patients with private insurance had improved survival outcomes when compared to those without insurance (HR: 0.58, P < 0.001).

CONCLUSIONS

Hispanic and Asian patients were found to be more likely to present with an advanced disease but also displayed greater overall survival when compared to the White population. The Black population, patients without insurance, and patients with lower income status exhibited worse survival outcomes.

A retrospective study of papillary thyroid carcinoma: Hashimoto's thyroiditis as a protective biomarker for lymph node metastasis

PURPOSE

There is approximately 10%-50% of papillary thyroid carcinoma (PTC) patients with Hashimoto's thyroiditis (HT). In this research, we sought to better understand the role of HT in PTC progression as well as lymph node metastasis.

METHODS

It is a retrospective and cross-sectional study, and 4131 PTC patients who underwent thyroidectomy were finally enrolled. Chi-square test, univariate and multivariate logistic regression analyses were employed to evaluate both the risk factors and the critical roles of HT during PTC metastasis.

RESULT

In this cohort, 1555 patients (37.6%) were diagnosed with HT. According to multivariate analysis, male sex, high levels of TG and TPOAb, tumor extrathyroidal extension, maximum diameter >1 cm, and multifocality were independent risk factors for both central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM). In addition, age <55 years and smoking were risk factors for CLNM, while CLNM was one of the risk factors for LLNM. Furthermore, HT was suggested a valuable protective factor for both CLNM and LLNM. In patients with HT, the total number of central lymph nodes was higher, while the positive rate was lower. Compared with those without HT, age and sex did not predict CLNM and LLNM in patients with HT.

CONCLUSION

HT is considered a protective factor for both CLNM and LLNM in PTC. For patients with HT, surgeons should pay more attention to the preservation of parathyroid gland and the protection of recurrent laryngeal nerve due to less lymph node metastasis. Otherwise, radical operation is highly recommended.

The sonographic pattern of nodule and thyroid fine needle aspiration cytology in the evaluation of thyroid malignancy risk

Introduction: Thyroid fine-needle aspiration biopsy (TFNAB), which is basically planned according to the ultrasonographic features is of clinical importance; since it helps early diagnosis of malignancy, facilitates the selection of patients who will undergo thyroid surgery and prevents unnecessary surgical procedures. In our study, we aimed to evaluate the adequacy of TFNAB as well as the retrospective investigation of the link between the estimated malignancy risk and the descriptive features, radiologic findings and biopsy cytology of patients who underwent ultrasonography guided TFNAB.Methods: In this study, the ultrasonographic characteristics of 659 thyroid nodules belonging to 523 patients who underwent TFNAB between 2018 and 2021 were evaluated. The correlation between the risk of malignancy and demographic data, thyroid hormone levels, and ultrasonographic characteristics of nodules was examined. The diagnostic accuracy performances of European thyroid imaging reporting and data system (EU-TIRADS) classification prepared by the European Thyroid Association (ETA), the risk classification systems recommended by the American Thyroid Association (ATA) and the Society of Endocrinology and Metabolism of Turkey (TEMD) were compared with The Bethesda System for Reporting Thyroid Cytopathology (Bethesda). The adequacy of biopsy was also evaluated. The data which is obtained from the study was statistically analyzed by means of SPSS 20.0 (Statistical Package for the Social Sciences; SPSS Inc. Chicago, IL, USA) program.Results: In this study, the biopsies of 41 (6.2%) among 659 thyroid nodules appeared to be malignant. A statistically significant correlation was detected between malignancy and hypoechogenicity (p=0.011), microcalcification (p=0.005), irregular margins (p=0.028), and accompanying pathological lymph node (p=0.002). Compared to the surgical pathology results, the accuracy that was closest to that of Bethesda System (AUC: 0.778) (Area Under Curve) was found in EU-TIRADS (AUC:0.715). In the biopsies performed in our own endocrinology clinic (43.7% of the total biopsies), the ratio of non-diagnostic results was found to be 8.3%, whereas it was 29.1% in the biopsies performed in other clinics (56.3% of the total biopsies).Conclusion: It should always be kept in mind that, in the cytologic evaluation, the ultrasonographic nodule pattern recommended by the guidelines is very important in the management of patients, because cytology may show false negative and false positive results as well as unclear or non-diagnostic pathological findings. However, clinicians should also understand that classification systems may have strengths and weaknesses. Our study also emphasizes the importance of how experienced a clinic performing biopsy is as well as the role of cytopathologist in obtaining diagnostic results in biopsy.Keywords: Thyroid nodule, neoplasia, ultrasonography, biopsy fine-needle

Association between dietary habits and incident thyroid cancer: A prospective cohort study

Background

In addition to the thyroid cancer (TC) risk from lifestyle and environmental factors such as radiation exposure, some studies have indicated that diet may affect TC development; however, previous findings are inconsistent. The objective of our study was to investigate the association between dietary habits and TC risk in a Korean population.

Materials and methods

A total of 13,973 participants were selected after excluding ineligible subjects from the Cancer Screenee Cohort at National Cancer Center in Korea from October 2007 to December 2021. Participants were followed until May 2022 to identify incident TC cases. Information on dietary habits and general characteristics was collected using a self-report questionnaire administered at enrollment without keeping track of changes in eating habits during the follow-up period. A Cox proportional hazards model was used to determine the hazard ratio (HR) and 95% confidence interval (CI) of TC risk for each dietary factor.

Results

A total of 138 incident TC cases were identified during the median follow-up period of 7.6 years. Of the 12 dietary habits evaluated, only two habits showed significant associations with TC. A significantly decreased TC risk was found among participants who consumed milk and/or dairy products 5 or more days a week [adjusted HR (aHR), 0.58; 95% CI, 0.39-0.85]. Notably, a stronger protective effect of dairy consumption was observed in participants aged ≥ 50 years (aHR, 0.44; 95% CI, 0.26-0.75), in women (aHR, 0.53; 95% CI, 0.35-0.81), and in non-smokers (aHR, 0.60; 95% CI, 0.39-0.92). There was a reduced risk of TC in participants with meal durations longer than 10 min (aHR, 0.58; 95% CI, 0.41-0.83). However, this association was limited to individuals aged ≥ 50 years (aHR, 0.49; 95% CI, 0.31-0.79), women (aHR, 0.61; 95% CI, 0.41-0.90), and non-smokers (aHR, 0.62; 95% CI, 0.41-0.92).

Conclusion

Our findings suggest that consuming milk and/or dairy products 5 or more days a week and having a meal duration longer than 10 min could be protective factors against TC, especially in individuals aged ≥ 50 years, women and non-smokers. Further prospective studies are needed to investigate the association of dietary intake with specific types of TC.

The associations between thyroid-related hormones and the risk of thyroid cancer: An overall and dose-response meta-analysis

Objective

Thyroid cancer (TC) is one of the most common malignant tumours of the endocrine system. Thyroid-stimulating hormone (TSH) is known as being a risk factor for TC, but other thyroid-related hormones are inconsistently associated with TC. The purpose of this study was to comprehensively evaluate the relationships between thyroid-related hormones and the risk of TC.

Methods

This study utilized searches of PubMed, Embase, Web of Science and Cochrane library up to the date of March 31st, 2022. Additionally, we performed a systematic review of related original studies combining overall and dose-response meta-analyses.

Results

A total of 30, 5 and 7 articles were included in the meta-analyses of TSH, Free triiodothyronine (FT3), free thyroxine (FT4) and TC risk with 58437, 6813 and 7118 participants respectively. An increased risk of TC was associated with high TSH exposure (OR=1.28, 95% CI: 1.19-1.37, P < 0.001) in the overall meta-analysis. For every 1 mU/L increase in TSH, the risk of TC increased by 16%. However, in those studies that used healthy subjects as controls, the association was not statistically significant(P=0.62). Additionally, high serum FT3 demonstrated a reduced risk of TC, with a combined OR of 0.86 in the fixed-effect model (95% CI: 0.81-0.90, P < 0.001). In addition, a statistically significant increase in TC risk was found when FT4 concentrations reached a certain threshold (approximately 2.2 ng/dL) in the dose-response meta-analysis.

Conclusions

Significant associations between thyroid-related hormones and the risk of TC were found in this study. Further research is needed to understand the underlying mechanisms.

The association between serum concentration of thyroid hormones and thyroid cancer: a cohort study

The impact of serum thyroid hormone levels on thyroid cancer risk is unclear. Some studies reported that elevated thyroid-stimulating hormone (TSH) is associated with higher risk for incidence of thyroid cancer, but other studies reported no relationship. We conducted a large cohort study in 164,596 South Korean men and women who were free of thyroid cancer at baseline and underwent health examination with hormone levels of thyroid function. A parametric proportional hazard model was used to evaluate the adjusted hazard ratio (HR) and 95% CI. During 2,277,749.78 person-years of follow-up, 1280 incident thyroid cancers were identified (men = 593, women = 687). Among men, the multivariable-adjusted HR (95% CI) for thyroid cancer comparing low levels of TSH with normal levels of TSH was 2.95 (1.67-5.23), whereas the corresponding HR (95% CI) in women was 1.5 (0.88-2.55). High levels of free T4 and free T3 were also associated with incident thyroid cancer in both men and women. In clinical implication, overt hyperthyroidism is associated with thyroid cancer in both men and women. Within the euthyroid range, the highest tertile of TSH was associated with a lower risk of thyroid cancer than the lowest TSH tertile and the highest FT4 tertile was associated with a higher risk of thyroid cancer than the lowest FT4 tertile in both men and women. Our finding indicates that low levels of TSH and high levels of FT4, even within the normal range, were associated with an increased risk of incident thyroid cancer.

Sleep quality of patients with papillary thyroid carcinoma: a prospective longitudinal study with 5-year follow-up

We evaluated the pre- and postoperative sleep quality of patients with newly diagnosed papillary thyroid carcinoma (PTC) who underwent thyroid surgery, and investigated the factors associated with persistent poor sleep quality. The Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale, and Stanford sleepiness scale were used to estimate sleep quality and daytime sleepiness. Face-to-face surveys were conducted preoperatively, and 1, 4, and 10 months after thyroid surgery. The PSQI was administered during a telephone interview about after 5 years after surgery. Forty-six patients (mean age 47.3 ± 10.1 years) with PTC (11 males, 35 females) were included in this study. Twenty-one participants underwent lobectomy and 25 underwent total thyroidectomy. Preoperatively, 35 (76.1%) patients showed poor sleep quality. PSQI scores at postoperative 1, 4, and 10 months were significantly lower than preoperative scores (p < 0.001). Postoperative 5-year PSQI scores decreased significantly compared to the preoperative scores (p < 0.001). Patients newly diagnosed with PTC suffered from sleep disturbance before and after surgery for at least 10 months, recovering to a comparable rate of sleep disturbance with the general population by 5 years after surgery. Higher preoperative PSQI score was at risk for prolonged poor sleep quality in patients with PTC.

Primary squamous cell carcinoma of thyroid gland: 11 case reports and a population-based study

Background

Primary squamous cell carcinoma of thyroid gland (PSCCT) is a highly aggressive malignant tumor associated with a poor prognosis. Due to the rare case, there is a knowledge gap on the features of PSCCT. There is limited understanding of the treatment and molecular biology of this tumor. More genomic work and relevant perspective work need to be done.

Methods

We retrospectively reviewed the medical information of patients with PSCCT diagnosed from December 2009 to December 2020 at The First Affiliated Hospital of Guangxi Medical University. In addition, we conducted an electronic search of the paper in CNKI, Wanfang, VIP, PubMed, Embase, Web of Science, and ProQuest databases by recently updated articles. Survival analysis was conducted using the Kaplan–Meier method.

Results

There were only 11 patients met the study’s inclusion criteria in our institution. The patients ranged in age from 25 to 68 years old and female preponderance (M:F = 1:1.7). The median survival time was 6 months, and 1-year survival rate was 33.3%. Fifty-three patients’ individual data from 45 articles were selected for analysis. The median age at diagnosis was 63 years and female preponderance (M:F = 1:2.5). The commonest complaint was the anterior neck mass (77.3%), followed by hoarseness (32.1%). The median survival time was 9 months, and the overall 1-, 2-, and 5-year survival rate was 39.8%, 33.7%, and 26.9%, respectively. The log-rank method shows that age, tumor size, lymph node status, M stage, surgical range, and tracheal status were the relevant factors affecting the prognosis. In contrast, gender, treatment modality, and resection margin were not prognostic factors. On multivariable analysis, age and M stage were associated with overall survival.

Conclusion

The median overall survival was 6–9 months of PSCCT. Age and M stage are predictors of PSSCT.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12957-022-02814-9.

Prospects of Testing Diurnal Profiles of Expressions of TSH-R and Circadian Clock Genes in Thyrocytes for Identification of Preoperative Biomarkers for Thyroid Carcinoma

Thyroid Nodules (TN) are frequent but mostly benign, and postoperative rate of benign TN attains the values from 70% to 90%. Therefore, there is an urgent need for identification of reliable preoperative diagnosis markers for patients with indeterminate thyroid cytology. In this study, an earlier unexplored design of research on preoperative biomarkers for thyroid malignancies was proposed. Evaluation of reported results of studies addressing the links of thyroid cancer to the circadian clockwork dysfunctions and abnormal activities of Thyroid-Stimulating Hormone (TSH) and its receptor (TSH-R) suggested diagnostic significance of such links. However, there is still a gap in studies of interrelationships between diurnal profiles of expression of circadian clock genes and TSH-R in indeterminate thyroid tissue exposed to different concentrations of TSH. These interrelationships might be investigated in future in vitro experiments on benign and malignant thyrocytes cultivated under normal and challenged TSH levels. Their design requires simultaneous measurement of diurnal profiles of expression of both circadian clock genes and TSH-R. Experimental results might help to bridge previous studies of preoperative biomarkers for thyroid carcinoma exploring diagnostic value of diurnal profiles of serum TSH levels, expression of TSH-R, and expression of circadian clock genes.

The Inverse Association of Serum Magnesium with Papillary Thyroid Cancer in Thyroid Nodules: a Cross-Sectional Survey Based on Thyroidectomy Population

Magnesium is considered to play a role in preventing cancer. However, the association between serum magnesium and papillary thyroid cancer (PTC) remains unknown. We retrospectively reviewed records of all patients who underwent thyroidectomy with thyroid nodules confirmed pathologically as benign nodule or PTC at our institution from January 2016 to December 2020. Data including demographic characteristics, laboratory tests, and pathological features were analyzed in 5709 adult patients eventually. The subjects with benign nodules had a higher mean serum magnesium level than those with PTC (P < 0.001), and the proportions of PTCs decreased across quartiles of serum magnesium within the normal range. After adjustment for confounders, patients with the lowest quartile of serum magnesium had a higher prevalence of PTC than those with the highest quartile (OR = 1.421, 95%CI: 1.125-1.795, P for trend = 0.005), and the risk of PTC was 0.863 (95%CI: 0.795-0.936) for a per-SD change in serum magnesium. The contribution of serum magnesium remained in subgroup analysis (P for interaction for all analyses > 0.05). Based on the ROC curve, the cut-off value of serum magnesium used to differentiate benign nodules from PTCs was 935 μmol/L. Combining serum magnesium with other clinical indicators can improve the efficacy of predicting PTC. Our results showed that lower serum magnesium within the normal range was associated with a greater risk of PTC among patients with thyroid nodules considering thyroidectomy. Serum magnesium may be an independent protective factor against PTC and provide additional information on the odds of malignancy in uncertain thyroid nodules in combination with other clinical factors.

Towards De-Implementation of low-value thyroid care in older adults

PURPOSE OF REVIEW

This review discusses the current literature regarding low-value thyroid care in older adults, summarizing recent findings pertaining to screening for thyroid dysfunction and management of hypothyroidism, thyroid nodules and low-risk differentiated thyroid cancer.

RECENT FINDINGS

Despite a shift to a "less is more" paradigm for clinical thyroid care in older adults in recent years, current studies demonstrate that low-value care practices are still prevalent. Ineffective and potentially harmful services, such as routine treatment of subclinical hypothyroidism which can lead to overtreatment with thyroid hormone, inappropriate use of thyroid ultrasound, blanket fine needle aspiration biopsies of thyroid nodules, and more aggressive approaches to low-risk differentiated thyroid cancers, have been shown to contribute to adverse effects, particularly in comorbid older adults.

SUMMARY

Low-value thyroid care is common in older adults and can trigger a cascade of overdiagnosis and overtreatment leading to patient harm and increased healthcare costs, highlighting the urgent need for de-implementation efforts.

Diagnostic Efficacy of Thyrotropin to Thyroglobulin Ratio in Correlation with Histopathology of Euthyroid Patient Having Solitary Thyroid Nodule

In patients with solitary thyroid nodules, the first course of action is to determine whether the nodule is benign or malignant. Many investigations are used to differentiate between benign and malignant nodules so as to avoid surgery in those who don't need it. Among these, FNAC and USG are commonly used in association with clinical features but there are drawbacks of each technique. The present study was undertaken to assess the diagnostic effectivity of thyrotropin (also known as TSH) to thyroglobulin ratio in correlation with histopathology in euthyroid patients having solitary thyroid nodule. This is a prospective study carried out on 48 euthyroid cases of solitary thyroid nodule. All patients subjected to FNAC, USG, thyrotropin and thyroglobulin assay. Then, they underwent surgery and histopathological examination (HPE) of the specimens done. Finally, the histopathology reports were correlated with the thyrotropin to thyroglobulin ratio in order to evaluate their sensitivity and specificity by statistical methods. The sensitivity and specificity of thyrotropin to thyroglobulin ratio was 100% and 100% respectively. All malignant lesions according to thyrotropin to thyroglobulin ratio were confirmed by histopathology indicating its excellence. Therefore, TSH to thyroglobulin ratio helps in planning the correct management and avoids second surgery. It was found that serum TSH:Tg is a safe, reliable and effective diagnostic modality with a high sensitivity and specificity and is the single best investigation for preoperative evaluation of solitary thyroid nodule to differentiate between benign and malignant nodules.

Differentiate Thyroid Follicular Adenoma from Carcinoma with Combined Ultrasound Radiomics Features and Clinical Ultrasound Features

Noninvasive differentiating thyroid follicular adenoma from carcinoma preoperatively is of great clinical value to decrease the risks resulted from excessive surgery for patients with follicular neoplasm. The purpose of this study is to investigate the accuracy of ultrasound radiomics features integrating with ultrasound features in the differentiation between thyroid follicular carcinoma and adenoma. A total of 129 patients diagnosed as thyroid follicular neoplasm with pathologically confirmed follicular adenoma and carcinoma were enrolled and analyzed retrospectively. Radiomics features were extracted from preoperative ultrasound images with manually contoured targets. Ultrasound features and clinical parameters were also obtained from electronic medical records. Radiomics signature, combined model integrating radiomics features, ultrasound features, and clinical parameters were constructed and validated to differentiate the follicular carcinoma from adenoma. A total of 23 optimal features were selected from 449 extracted radiomics features. Clinical and ultrasound parameters of sex (p = 0.003), interior structure (p = 0.035), edge (p = 0.02), platelets (p = 0.007), and creatinine (p = 0.001) were associated with the differentiation between benign and malignant follicular neoplasm. The values of area under curves (AUCs) of the radiomics signature, clinical model, and combined model were 0.772 (95% CI: 0.707-0.838), 0.792 (95% CI: 0.715-0.869), and 0.861 (95% CI: 0.775-0.909), respectively. A final corrected AUC of 0.844 was achieved for the combined model after internal validation. Radiomics features from ultrasound images combined with ultrasound features and clinical factors are feasible to differentiate thyroid follicular carcinoma from adenoma noninvasive before operation to decrease the unnecessary of diagnostic thyroidectomy for patients with benign follicular adenoma.

A comparative analysis of histologic types of thyroid cancer between career firefighters and other occupational groups in Florida

BACKGROUND

Florida Firefighters experience a higher risk of thyroid cancer than non-firefighters. This study examines whether the histologic types and tumor stage of thyroid cancer is different among firefighters compared to other occupational groups.

METHODS

Eligible cases were firefighters (n = 120) identified in a linkage of Florida Cancer Data System (FCDS) registry records (1981-2014) and Florida State Fire Marshal's Office employment and certification records, and non-firefighters classified into: blue-collar (n = 655), service (n = 834), white-collar (n = 4,893), and other (n = 1,789). Differences in thyroid histologic type (papillary, follicular, and rare/other less common forms of thyroid cancer), tumor stage, and age at diagnosis were evaluated using multinomial logistic regression models comparing blue-collar, service, white-collar, and other occupational groups with firefighters. Univariate odds ratios as well as odds ratios adjusted for age, gender, race, tumor stage, and year of diagnosis (aOR) and 95% confidence intervals (95%CI) were reported.

RESULTS

Service (aOR = 4.12; 95%CI: 1.25-13.65), white-collar (aOR = 3.51; 95%CI: 1.08-11.36), and blue-collar (aOR = 4.59; 95%CI: 1.40-15.07) workers had significantly higher odds of being diagnosed with rare histologic types of thyroid cancer vs papillary type compared to firefighters. Service (aOR = 0.42; 95%CI: 0.27-0.66), white-collar (aOR = 0.39; 95%CI: 0.26-0.59), blue-collar (aOR = 0.36; 95%CI: 0.23-0.56), and other (aOR = 0.34; 95%CI: 0.22-0.53) occupational groups have a significantly lower odds of being diagnosed with rare vs papillary type at a younger age (30-49 years) vs 50-69 years compared to firefighters. However, stage at diagnosis was not significantly different among occupational groups.

CONCLUSION

Firefighters diagnosed with thyroid cancer experience a higher odds of papillary compared to rare histologic types of thyroid cancer relative to other workers; there is no evidence of an increased odds of late-stage diagnosis in firefighters relative to other worker groups. Firefighters may benefit from routine screening and active surveillance of suspected thyroid tumors especially given the excellent treatment outcomes available for those diagnosed with early-stage papillary thyroid tumors.

Serum TSH Level as a Simple Efficient Tool to Assess the Risk of Thyroid Malignancy in Euthyroid Patients with Indeterminate Cytology - A Cohort Study

Context

A significant number of fine-needle aspiration cytology (FNAC) for thyroid nodules is reported as indeterminate. Expensive molecular testing can give a clue to the possibility of malignancy in this group. The effectiveness of serum thyroid-stimulating hormone (TSH) levels as a diagnostic tool in euthyroid patients with indeterminate cytology has not been previously studied, especially in the Indian population.

Aims

This study was conducted to evaluate the predictive efficacy of serum TSH in the early diagnosis and treatment of malignancy.

Settings and Design

This is a retrospective cross-sectional study on a cohort of patients who presented to our department with complaints of thyroid swelling and underwent thyroidectomy.

Methods and Material

Euthyroid patients who underwent thyroid surgery for newly diagnosed thyroid nodules with FNAC reported as indeterminate cytology were included in our study. Based on the histopathological report, the patients were divided into two groups and into quartiles based on TSH values.

Statistical Analysis Used

The mean difference in the numerical variables between groups was compared using the independent two-sample 't' test for parametric data and Mann-Whitney 'u' test for non-parametric data. A logistic regression analysis was done with age, sex, TSH level and nodule size as dependant variables and malignancy as the independent variable.

Results

There were 211 patients in group A and 93 in group B. Patients with malignancy confirmed on final histopathology showed higher serum TSH levels compared to benign nodules (2.93 ± 1.067 vs 1.73 ± 1.051, P = <0.001). The mean TSH levels of all types of malignant nodules correlated with our test model (>2.185 mIU/L).

Conclusions

Serum TSH above 2.185 mIU/mL is a good predictor of malignancy in indeterminate nodules. It is an inexpensive, safe and reliable diagnostic screening test for the risk of malignancy in an indeterminate nodule.

Saliva microbiome changes in thyroid cancer and thyroid nodules patients

Objective

Thyroid disease has been reported to associate with gut microbiota, but the effects of thyroid cancer and thyroid nodules on the oral microbiota are still largely unknown. This study aimed to identify the variation in salivary microbiota and their potential association with thyroid cancer and thyroid nodules.

Methods

We used 16S rRNA high-throughput sequencing to examine the salivary microbiota of thyroid cancer patients (n = 14), thyroid nodules patients (n = 9), and healthy controls (n = 15).

Results

The alpha-diversity indices Chao1 and ACE were found to be relatively higher in patients with thyroid cancer and thyroid nodules compared to healthy controls. The beta diversity in both the thyroid cancer and thyroid nodules groups was divergent from the healthy control group. The genera Alloprevotella, Anaeroglobus, Acinetobacter, unclassified Bacteroidales, and unclassified Cyanobacteriales were significantly enriched in the thyroid cancer group compared with the healthy control group. In contrast, the microbiome of the healthy controls was mainly composed of the genera Haemophilus, Lautropia, Allorhizobium Neorhizobium Pararhizobium Rhizobium, Escherichia Shigella, and unclassified Rhodobacteraceae. The thyroid nodules group was dominated by genre uncultured Candidatus Saccharibacteria bacterium, unclassified Clostridiales bacterium feline oral taxon 148, Treponema, unclassified Prevotellaceae, Mobiluncus, and Acholeplasma. In contrast, the genera unclassified Rhodobacteraceae and Aggregatibacter dominated the healthy control group. The study also found that clinical indicators were correlated with the saliva microbiome.

Conclusion

The salivary microbiota variation may be connected with thyroid cancer and thyroid nodules.

Assessment of Preoperative TSH Serum Level and Thyroid Cancer Occurrence in Patients with AUS/FLUS Thyroid Nodule Diagnosis

Thyroid-stimulating hormone (TSH) is a growth factor associated with the initiation and progression of well-differentiated thyroid cancer (WDTC). Atypia of undetermined significance and follicular lesion of undetermined significance (AUS/FLUS) are the most uncertain cytological diagnoses of thyroid nodules. The aim of the study was to determine the association of histopathological diagnosis with preoperative serum TSH levels in patients with AUS/FLUS thyroid nodule diagnosis. Among 5028 individuals with thyroid nodules, 342 (6.8%) with AUS/FLUS diagnoses were analyzed. The frequency of all histopathology diagnoses was assessed for associations with preoperative serum TSH levels. The median TSH concentration was significantly higher in patients with AUS/FLUS diagnosis and histopathology of WDTC than in patients with the same cytology result and histopathology of a benign tumor (p < 0.0001). The diagnostic potential of serum TSH level was determined to evaluate risk of malignancy in patients with thyroid nodules classified into the Bethesda III category. ROC analysis showed the TSH concentration at a cutoff point of 2.5 mIU/L to be an acceptable prognostic factor for WDTC. For this optimal cutoff point, the AUC was 0.877, the sensitivity was 0.830, and the specificity was 0.902. Preoperative serum TSH levels in patients with AUS/FLUS thyroid tumor diagnosis should be taken into consideration in the decision-making process and clinical management.

The Association between Blood Concentrations of PCDD/DFs, DL-PCBs and the Risk of Type 2 Diabetes Mellitus and Thyroid Cancer in South Korea

Background and Objectives: Epidemiological studies have inconsistently shown an association between dioxin and risk of type 2 diabetes mellitus (T2DM) and cancer. This study aims to examine the effects of blood concentration of dioxin-like polychlorinated biphenyls (DL-PCBs) and polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/DFs) on T2DM and thyroid cancer. Methods: We conducted a nested case–control study within the Korean cancer prevention study-II (KCPS-II) consisting of 15 thyroid cancer cases, 30 T2DM cases, and 55 controls. A total of 500 samples were used in 100 pooling samples. An average value of a pooled sample was calculated weighted by the blood volume of each sample. Results: The study population included 100 participants from the KCPS-II (median (IQR) baseline age, 54.06 [21.04] years; 48 women). The toxic equivalents of PCDD/DFs showed a significant positive association with T2DM and thyroid cancer, after adjustments for potential confounders (T2DM ORs  =  1.23; 95% CI  =  1.05–1.43; thyroid cancer ORs  =  1.34; 95% CI  =  1.12–1.61). Conclusion: In this study, both T2DM and thyroid cancer were associated with the blood concentrations of PCDD/DFs. The association between PCDD/DFs and T2D was found among women but not among men. Our findings suggest that further biochemical in vivo research and epidemiologic studies are needed to clarify the association between dioxins concentrations and diseases.

Association of Ozone Exposures with the risk of thyroid nodules in Hunan Province: a population-based cohort study

BACKGROUND

Increasing evidence associates air pollution with thyroid dysfunction, whereas the potential relationship between exposure to ozone (O₃) and Thyroid Nodules (TNs) is unclear.

METHODS

This retrospective cohort study investigated the association between O₃ exposure and TNs in Hunan province, enrolling 191,357 Chinese adults who lived in Hunan province from January 2009 to December 2019 and received voluntary medical examinations. Individual exposure levels to O₃ from 2010 to 2019 were measured on account of participants' residential addresses at the district level. Associations of O₃ exposure with the risk of incidental TNs were assessed by restricted cubic splines and surveyed as odds ratios after adjusting for demographic factors.

RESULTS

In total, 81,900 adults were newly diagnosed with TNs during the study period. Age-standardized TNs detection rate in Hunan province increased from 25.9 to 46.3% between 2010 and 2019, with the greatest annual percent change being 8.1 [95% CI, 7.3-8.8]. A similar trend has been found in all tumor sizes, ages, and both sexes. O₃ exposure presented a statistically significant dose-dependent positive correlation (greater than 0.036 ppm) with TNs. Similarly, long-term exposure to high levels of O₃ (1-year average O₃ concentrations exceeding 0.0417 ppm) was found positively associated with increased TSH levels.

CONCLUSIONS

High-level O₃ exposure in the long term was associated with an increase in TSH. Consequently, increased TSH was related to the increased risk of TNs. Being exposed to high-level O₃ in the long term was related to the increased detection rates of TNs in Hunan province, which could be mediated by TSH.

Thyrotropin/Thyroglobulin ratio in combination with thyroid u/s to assess malignancy risk stratification of thyroid nodules

Objective: we aimed to asses if thyrotropin/thyroglobulin ratio has a significant value in detection of malignant thyroid nodules. Design: Retrospective analysis. Material and Methods: This study included finally 100 subject collected as outpatient’s endocrinology clinic of ALHuessine university hospital or admitted at oncology institute of Tanta. Patients who had history of thyroid diseases or surgery, those with abnormal levels of anti- thyroglobulin antibodies, cases without simultaneous measurement of serum anti Tg., with history of current use of thyroid hormone replacement therapy were excluded from this study. Clinico pathological features, as well as serumTSH, Tg, and TSH/Tg were compared between histopathologically benign and malignant groups. Results: Data related to 100 subjects (40%) normal  and 60(60%) patients  with thyroid nodules were analyzed, 30 patients (50%) were malignant thyroid nodules and 30 patients (50%) were benign.The malignant patients exhibited significantly higher TSH, TSH/Tg, , and a lower Tg compared to the benign patients (p<0.05 for each). Conclusion: Preoperative TSH/Tg could be used as a predictive marker for differ-entiating between benign and malignant thyroid nodules.

Utility of Fine-Needle Aspirations to Diagnose Pediatric Thyroid Nodules

INTRODUCTION

Risk of malignancy for pediatric thyroid nodules classified according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is not well defined. Correlations between risk of malignancy and ancillary clinical data remain inconclusive. We report a single institutional experience of fine-needle aspiration (FNA) to improve upon current management paradigm of thyroid nodules.

METHODS

A retrospective chart review of 575 thyroid nodules was performed of 324 patients who underwent 340 FNAs between 2008 and 2018 at the Children's Hospital of Philadelphia. Demographics, ultrasound (US) characteristics, FNA cytology, surgical pathology, and ancillary data were reviewed.

RESULTS

The rate of malignancy according to TBSRTC was 0.0% for category I, 0.8% for category II, 15.6% for category III, 54.5% for category IV, 100.0% for category V, and 100.0% for category VI. The cumulative Thyroid Imaging Reporting and Data System (TI-RADS) score was significantly correlated with benign and malignant nodules on pathology (p < 2.2e-16). Distribution of TI-RADS for cytologically indeterminate nodules with benign or malignant pathology revealed significant differences for composition (p = 3.20e-8) and echogenic foci (p = 0.005) but not for echogenicity (p = 0.445), shape (p = 0.160), margins (p = 0.220), and size (p = 0.105). Distributions of thyroid-stimulating hormone levels between benign and malignant patients was significant (p = 1.58e-3).

CONCLUSIONS

Nodules with TI-RADS scores >3 should undergo FNA, irrespective of size; surgical resection is recommended for nodules classified as TBSRTC category IV and V due to high risk of malignancy. US surveillance instead of FNA can be performed for nodules with TI-RADS scores ≤3.

Clinical Factors Predictive of Lymph Node Metastasis in Thyroid Cancer Patients: A Multivariate Analysis

BACKGROUND

Early-stage thyroid cancers have excellent survival. However, lymph node metastases (LNM) confer a worse prognosis and are not always known preoperatively. Therefore, investigation on the clinical and histological factors predictive of LNM in thyroid cancers was conducted to tailor the extent of surgery and radioactive iodine therapy.

STUDY DESIGN

Multivariate logistic regressions were performed based on retrospective data from thyroid cancer patients seen between 2013 and 2020 at a single institution.

RESULTS

Among 913 patients, mean age was 49.4 years, 76.5% were female, 58.3% were White, 21.2% were Black, and 27.9% had LNM. In the multivariate analyses in which the outcome was LNM, White (odds ratio [OR] 1.74, 95% CI 0.98 to 3.15, p = 0.064) and Hispanic patients (OR 2.36, 95% CI 0.97 to 5.77, p = 0.059) trended toward higher risk of LNM compared to Black patients, whereas age (OR 0.98, 95% CI 0.97 to 1.00, p = 0.008) showed protective effect. Tumor size (OR 1.04, 95% CI 1.01 to 1.07, p = 0.007), extrathyroidal extension (OR 2.46, 95% CI 1.53 to 3.97, p < 0.001), lymphovascular invasion (OR 6.30, 95% CI 3.68 to 11.14, p < 0.001), and multifocality (OR 1.47, 95% CI 1.01 to 2.12, p = 0.042) were associated with higher risk of LNM. In another model with outcome as >5 LNM, tumor size (OR 1.07, 95% CI 1.03 to 1.11, p = 0.001), age (OR 0.95, 95% CI 0.93 to 0.97, p < 0.001), extrathyroidal extension (OR 3.20, 95% CI 1.83 to 5.61, p < 0.001), and lymphovascular invasion (OR 6.82, 95% CI 3.87 to 12.17, p < 0.001) remained significant predictors.

CONCLUSION

Our analyses demonstrated and confirmed that age, tumor size, extrathyroidal extension, and lymphovascular invasion are independent predictors of significant LNM, thereby conferring higher risk of recurrence. Risk of LNM based on these patient characteristics should be considered when planning an operative approach.

Thyroid Hemiagenesis: Narrative Review and Clinical Implications

Thyroid Hemiagenesis (THA) is an uncommon, congenital anomaly defined by the absence of one thyroid lobe with or without the isthmus. Reports suggest it may be found more often in regions endemic for hypothyroidism. Genetic abnormalities are thought to have a role based on findings in monozygotic twins. Most cases are sporadic, however familiar clusters have also been documented. It is found more frequently in females. A majority of patients report no symptoms and THA is found incidentally during investigations or intraoperatively. THA is usually associated with normal thyroid function, but it can present with thyroid hypofunction.

Since a majority of patients are asymptomatic, there are no specific recommendations for management. Ultrasound imaging and thyroid scintigraphy using technetium or iodine are useful in diagnosis. Its clinical importance occurs when the remnant thyroid lobe requires excision leading to the lifelong requirement for thyroxine supplementation.

Published English literature (Medline, PubMed, and Embase databases) was searched. Medical subject headings (MeSH) terms used were “thyroid hemiagenesis,” “one thyroid lobe,” and “thyroid aplasia”. Case reports, case series, and original articles were selected to provide a framework for this review.

Articles reviewed were published in the past 20 years. The association of THA with thyroid cancer was explored. In this group, the F:M ratio was 3.25:1. Left THA constituted 53% of cases, right THA in 29.4%, and isthmus absence in 17.6% of cases. Also, the authors investigated the link between THA and hyperparathyroidism, both left and right THA are seen in an equal number of cases in the hyperparathyroidism subgroup. In patients with THA and Grave’s disease, left THA was seen in a majority of cases (86.7%), while an equal number of left and right THA was observed in patients with Hashimoto’s thyroiditis. In addition, congenital abnormalities associated with THA were observed, the left THA was seen in 60% and right THA in 40% of cases of this subgroup.

The summative review provided a detailed insight into the epidemiology, aetiopathogenesis, genetics, symptomatology, diagnosis, and treatment for THA by combining findings and results from almost a hundred research papers from around the world. THA remains a poorly understood, often incidentally detected, abnormality in euthyroid patients undergoing investigations and treatment for other thyroid disorders.

The risk of perchlorate and iodine on the incidence of thyroid tumors and nodular goiter: a case-control study in southeastern China

BACKGROUND

The incidence rates of thyroid tumors and nodular goiter show an upward trend worldwide. There are limited reports on the risk of perchlorate and iodine on thyroid tumors, but evidence from population studies is scarce, and their impact on thyroid function is still uncertain. Therefore, the objective of this study was to investigate the association of perchlorate and iodine with the risk of nodular goiter (NG), papillary thyroid microcarcinoma (PTMC), and papillary thyroid carcinoma (PTC) and to assess the correlation between perchlorate and iodine with thyroid function indicators.

METHODS

A case-control population consisting of 184 pairs of thyroid tumors and nodular goiter matched by gender and age (±2 years) was recruited in this study. Serum and urine samples were collected from each participant. Thyroid function indicators in serum were tested by automatic chemical immunofluorescence, and perchlorate and iodine levels in urine were determined by ultra-high performance liquid chromatography tandem-mass spectrometry and inductively coupled plasma-mass spectrometry, respectively. Conditional logistic regressions and multiple linear regressions were used to analyze the associations.

RESULTS

Urinary perchlorate concentration was significantly higher in total cases, NG and PTC than in the corresponding controls (P < 0.05). Perchlorate was positively associated with PTC (OR = 1.058, 95% CI: 1.009, 1.110) in a non-linear dose-response relationship, but there was no association between perchlorate and NG or PTMC. Iodine was not associated with the risk of thyroid tumors and NG and did not correlate with the thyroid function indicators. Furthermore, perchlorate showed a positive correlation with thyroid stimulating hormone (TSH) at iodine adequate levels (P < 0.05), and a negative correlation with free triiodothyronine (FT3) and a positive correlation with thyroglobulin antibody (TgAb) at iodine more than adequate or excess levels (P < 0.05).

CONCLUSIONS

Perchlorate can increase the risk of PTC in a non-linear dose-response relationship and disturb the thyroid hormone homeostasis and thyroid autoantibody levels.

Different types of diabetes mellitus and risk of thyroid cancer: A meta-analysis of cohort studies

OBJECTIVE

Sex-specific thyroid cancer risk exists in patients diagnosed with diabetes mellitus (DM). However, thyroid cancer risk in different types of DM is still unclear. This meta-analysis aims to identify the real correlation between different types of DM and thyroid cancer risk in both sexes.

METHODS

Studies were identified by an electronic search of PubMed, EMBASE, and Cochrane Library on 16 January 2022. A random-effects model was used to estimate the relative risks (RRs). The Cochran's Q and I² statistics were computed to detect heterogeneity between studies.

RESULTS

In comparison with non-DM counterparts, patients with DM had a 1.32-fold higher risk of thyroid cancer (95% CI, 1.22-1.44) with 1.26-fold (95% CI, 1.12-1.41) in men and 1.36-fold (95% CI, 1.22-1.52) in women, respectively. Subgroup analysis by the type of DM showed that the RR of thyroid cancer in patients with type 2 diabetes was 1.34 (95% CI, 1.17-1.53) in the study population with 1.32 (95% CI, 1.12-1.54) in men and 1.37 (95% CI, 1.12-1.68) in women, respectively; the RR of thyroid cancer was 1.30 (95% CI, 1.17-1.43) in patients with gestational diabetes; the risk of thyroid cancer in patients with type 1 diabetes was 1.51-fold in women but not in men. Although there were some heterogeneities, it did not affect the above results of this study.

CONCLUSION

This study indicates that, compared with non-DM individuals, patients with any type of DM have an elevated thyroid cancer risk. This positive correlation between type 2 diabetes and thyroid cancer risk exists in both men and women.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, CRD42022304028.

Risk of malignancy in cytologically indeterminate thyroid nodules harboring thyroid stimulating hormone receptor mutations

OBJECTIVES

To evaluate the frequency and risk of malignancy of TSHRpI568T mutations discovered in indeterminate thyroid nodules (ITN) within the Veracyte CLIA laboratory undergoing Afirma^® Genomic Sequencing Classifier (GSC) testing, and to evaluate a broader cohort of TSHR variants and their categorization as Afirma GSC benign (GSC-B) or suspicious (GSC-S). Finally, we seek to assess the risk of malignancy (ROM) of this group of TSHR mutated ITN in the GSC-S category.

METHODS

ITN submitted to Veracyte for Afirma GSC testing between October 2017 and February 2022 were analyzed for TSHR variants and rates of GSC-B and GSC-S were calculated based upon BIII or IV cytology, by TSHR variant codon amino acid (AA) substitution, age, and gender. For GSC-S samples, surgical pathology reports were requested, and the rate of malignancy was calculated.

RESULTS

Five percent of the ITN samples harbored an isolated TSHR variant and 5% of those were classified as GSC-S. Among TSHRpI568T samples, 96% were GSC-B and of the GSC-S samples, 21% were malignant. Among an unselected group of TSHR, absent TSHRpI568T mutations, 16.3% of GSC-S samples were malignant, all but one with codon mutations in the transmembrane subdomains of the TSHR. This prompted a dedicated evaluation of transmembrane codons which revealed a malignancy rate of 10.7% among GSC-S nodules. In total, 13/85 (15.3%) TSHR mutated ITN with Afirma GSC-S results were found to be malignant.

CONCLUSIONS

TSHR variants are rare in ITN, and most are categorized as benign under Afirma GSC testing which carries a < 4% risk of malignancy. For GSC-S ITN with TSHR mutations, the risk of malignancy is ≥= 15%, which is clinically meaningful and may alter treatment or monitoring recommendations for patients.