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Eppe J, Raguet E, Petrossians P, Czaplicki S, Bayrou C, Rollin F, Toppets V, Guyot H. From ultrasound to microscopy: Actualities in thyroid investigation in cattle. PLoS One 2024; 19:e0302997. [PMID: 38696402 PMCID: PMC11065313 DOI: 10.1371/journal.pone.0302997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/04/2024] [Indexed: 05/04/2024] Open
Abstract
Thyroid ultrasonography examination is widely used in human and small animal medicine. However, it has rarely been applied in cattle. The aim of this study was to determine whether the measurements of the thyroid gland by ultrasound examination correlate to those taken during post-mortem examination. A sample of 22 cows and 23 calves was selected for thyroid gland evaluation. An ultrasound scan was performed ante-mortem, followed by euthanasia (for medical reasons) or slaughtered in the food chain and the dissection of the thyroid gland was therefore performed. Post-mortem, the gland was weighed and its dimensions and volume measured. The volume and weight measurements were compared with the predicted ones on US using the formulas available in the literature. Finally, histological examination was performed on thyroid glands. The dimensions of the thyroid gland measured by ultrasonography were significantly different (p<0.05) from those observed post-mortem, except for lobe lengths in calves (p>0.1). However, in calves, there was no systematic bias between the ultrasound and post-mortem examination of the thyroid gland, which were concordant (with an average error of 18%). Cystic lesions were observed on ultrasound in 9/22 cows and could be found on histological examination in 7 of these. Other lesions, such as follicular hypoplasia and hyperplasia, were seen on histological examination but not on ultrasound. Although the ultrasound measurements did not significantly correlate with those taken post-mortem, this examination may allow to differentiate non-standard thyroids in the case of hyperplastic goiter, as demonstrated in other species. This study also describes and illustrates interesting lesions of the thyroid gland in cattle. These findings are innovative in the description of the use of thyroid ultrasound in cattle, although further studies are needed to allow deeper conclusions.
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Affiliation(s)
- Justine Eppe
- Clinical Department of Production Animals, Fundamental and Applied Research for Animals & Health Research Unit (FARAH), Faculty of Veterinary Medicine, University of Liège, Liege, Belgium
| | - Elise Raguet
- Clinical Department of Production Animals, Fundamental and Applied Research for Animals & Health Research Unit (FARAH), Faculty of Veterinary Medicine, University of Liège, Liege, Belgium
| | - Patrick Petrossians
- Department of Endocrinology, University Hospital of Liege, University of Liege, Liege, Belgium
| | - Sébastien Czaplicki
- Department of Veterinary Management of Animal Resources, Fundamental and Applied Research for Animals & Health Research Unit (FARAH), University of Liege, Liege, Belgium
| | - Calixte Bayrou
- Clinical Department of Production Animals, Fundamental and Applied Research for Animals & Health Research Unit (FARAH), Faculty of Veterinary Medicine, University of Liège, Liege, Belgium
| | - Frédéric Rollin
- Clinical Department of Production Animals, Fundamental and Applied Research for Animals & Health Research Unit (FARAH), Faculty of Veterinary Medicine, University of Liège, Liege, Belgium
| | - Vinciane Toppets
- Department of Morphology and Pathology, Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - Hugues Guyot
- Clinical Department of Production Animals, Fundamental and Applied Research for Animals & Health Research Unit (FARAH), Faculty of Veterinary Medicine, University of Liège, Liege, Belgium
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Saenko V, Mitsutake N. Radiation-Related Thyroid Cancer. Endocr Rev 2024; 45:1-29. [PMID: 37450579 PMCID: PMC10765163 DOI: 10.1210/endrev/bnad022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/18/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
Radiation is an environmental factor that elevates the risk of developing thyroid cancer. Actual and possible scenarios of exposures to external and internal radiation are multiple and diverse. This article reviews radiation doses to the thyroid and corresponding cancer risks due to planned, existing, and emergency exposure situations, and medical, public, and occupational categories of exposures. Any exposure scenario may deliver a range of doses to the thyroid, and the risk for cancer is addressed along with modifying factors. The consequences of the Chornobyl and Fukushima nuclear power plant accidents are described, summarizing the information on thyroid cancer epidemiology, treatment, and prognosis, clinicopathological characteristics, and genetic alterations. The Chornobyl thyroid cancers have evolved in time: becoming less aggressive and driver shifting from fusions to point mutations. A comparison of thyroid cancers from the 2 areas reveals numerous differences that cumulatively suggest the low probability of the radiogenic nature of thyroid cancers in Fukushima. In view of continuing usage of different sources of radiation in various settings, the possible ways of reducing thyroid cancer risk from exposures are considered. For external exposures, reasonable measures are generally in line with the As Low As Reasonably Achievable principle, while for internal irradiation from radioactive iodine, thyroid blocking with stable iodine may be recommended in addition to other measures in case of anticipated exposures from a nuclear reactor accident. Finally, the perspectives of studies of radiation effects on the thyroid are discussed from the epidemiological, basic science, and clinical points of view.
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Affiliation(s)
- Vladimir Saenko
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan
| | - Norisato Mitsutake
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan
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3
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Shimura H, Yokoya S, Suzuki S, Iwadate M, Suzuki S, Matsuzuka T, Suzuki S, Hayashi F, Nagao M, Ohira T, Yasumura S, Ohto H, Kamiya K. Confounding factors and biases involved in regional differences in the detection rate of thyroid cancer in the second-round Thyroid Ultrasound Examination: the Fukushima Health Management Survey. JOURNAL OF RADIATION RESEARCH 2023; 64:761-768. [PMID: 37429608 PMCID: PMC10516727 DOI: 10.1093/jrr/rrad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/01/2023] [Indexed: 07/12/2023]
Abstract
In response to concerns about health due to radiation exposure, the Fukushima Prefecture launched the Thyroid Ultrasound Examination program for residents aged 0-18 years at the time of the earthquake. Herein, we considered the confounding factors involved in the regional differences in the development of thyroid cancer. In this study, the 242 065 individuals who participated in both first- and second-round surveys were classified into four groups by address according to their air radiation dose. The number of participants diagnosed as malignant or suspicious for malignancy by cytological examination were 17, 38, 10 and 4 with detection rates of 53.8, 27.8, 21.7 and 14.5 per 100 000 participants in Regions 1, 2, 3 and 4, respectively. Sex (P = 0.0400), age at the time of the primary examination (P < 0.0001) and interval between the first- and second-round surveys (P < 0.0001) were significantly different among the four regions, and these were suspected to be confounding factors affecting regional differences in malignant nodule detection rates. In addition, significant regional differences were observed in the participation rate in the confirmatory examination (P = 0.0037) and the fine needle aspiration cytology implementation rate (P = 0.0037), which could be potential biases. No significant regional differences in the detection of malignant nodules were found in the multivariate logistic regression analysis after adjusting for the survey interval alone or for sex, age and survey interval. The confounding factors and biases identified in this study that may have important impacts on thyroid cancer detection rate should be fully considered in future studies.
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Affiliation(s)
- Hiroki Shimura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
- Department of Laboratory Medicine, Fukushima Medical University Fukushima School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
| | - Susumu Yokoya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
- Thyroid and Endocrine Center, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
| | - Satoru Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
| | - Manabu Iwadate
- Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
- Department of Surgery, Minamisoma Municipal General Hospital, 2-54-6 Takamicho, Haramachi-ku, Minamisoma City, Fukushima 975-0033, Japan
| | - Satoshi Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
- Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
| | - Takashi Matsuzuka
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
- Department of Otolaryngology, School of Medicine, Asahi University Hospital, 3-23, Hashimoto-cho, Gifu City, Gifu 500-8523, Japan
| | - Shinichi Suzuki
- Department of Thyroid Therapeutic Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
| | - Fumikazu Hayashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
| | - Masanori Nagao
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
| | - Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
| | - Hitoshi Ohto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
- Research Institute for Radiation Biology and Medicine, Hiroshima, University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8553, Japan
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Sugisawa C, Narumi S, Tanase-Nakao K, Ayako H, Suzuki N, Ohye H, Fukushita M, Matsumoto M, Yoshihara A, Watanabe N, Sugino K, Hishinuma A, Noh JY, Katoh R, Taniyama M, Ito K. Adult Thyroid Outcomes of Congenital Hypothyroidism. Thyroid 2023; 33:556-565. [PMID: 36792927 DOI: 10.1089/thy.2022.0481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND More than 40 years have passed since the introduction of newborn screening for congenital hypothyroidism (CH), and many early diagnosed patients have reached adulthood. Their thyroid morphology and function have been little studied. This cross-sectional, observational study was conducted to characterize the thyroid morphology and function of adult CH patients diagnosed in the framework of newborn screening for CH. METHODS A total of 103 adult CH patients born after 1979 were enrolled at Ito Hospital, Tokyo, Japan, and were classified into Goiter, Normal gland, and Dysgenesis groups based on ultrasonographic findings. For 60 patients, genetic analysis was performed. Thyroid function test results and the proportion of patients with thyroid nodules were compared among the three groups and between 56 female CH patients and 168 non-CH women matched for TSH levels. RESULTS A significantly low serum free T3/free T4 ratio (0.22) was observed in the Dysgenesis group. Thyroid nodules were detected in 14.3% (8/56) of female CH patients, more frequently than in non-CH women. Thyroid nodules were detected the most frequently in the Goiter group (71%, 10/14). Genetic defects were identified in 89% (8/9) of patients belonging to the Goiter group, including thyroglobulin defect (33%, 3/9), thyroid peroxidase defect (33%, 3/9), and dual oxidase 2 defect (22%, 2/9). CONCLUSIONS Our results suggest that adults with thyroid dysgenesis on levothyroxine replacement therapy have relative T3 deficiency. Most adults with goitrous CH have genetic dyshormonogenesis. They are at high risk of developing thyroid nodules. Our findings support the current guideline recommendation that CH patients with dyshormonogenesis should undergo periodic thyroid ultrasonography.
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Affiliation(s)
- Chiho Sugisawa
- Showa Daigaku Fujigaoka Byoin, 26858, 1-30 Fujigaoka, Aoba-ku, Yokohama-si, Kanagawa 227-8501, Japan, Yokohama, Kanagawa, Japan, 227-8501;
| | - Satoshi Narumi
- National Research Institute for Child Health and Development, Molecular Endocrinology, 2-10-1 Ohkura, Setagaya-ku, Tokyo, Japan, 1578535;
| | - Kanako Tanase-Nakao
- National Research Institute for Child Health and Development, Molecular Endocrinology, Tokyo, Japan;
| | | | - Nami Suzuki
- Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, Japan, 150-8308;
| | | | - Miho Fukushita
- Ito Hospital, internal medicine, jingu-mae 4-3-6, Tokyo, Shibuyaku, Japan, 150-8308;
| | | | - Ai Yoshihara
- Ito Hospital, internal medicine, 4-3-6 Jingumae, Shibuya-ku, Tokyo, Japan, 1508308;
| | - Natsuko Watanabe
- Ito Hospital, Internal Medicine, 4-3-6 Jingumae, Shibuya-ku, Tokyo, Japan, 150-8308;
| | - Kiminori Sugino
- Ito Hospital, Surgery, 4-3-6 Jingumae, Shibuyaku, Tokyo, Japan, 150-8308;
| | - Akira Hishinuma
- Dokkyo Medical University, 12756, Department of Infection Control and Clinical Laboratory Medicine, 880 Kitakobayashi, Mibu, Tochigi, Japan, 321-0293;
| | | | - Ryohei Katoh
- Ito Hospital, Department of Pathology, 4-3-6 Jingumae, Shibuya-ku, Tokyo, Tokyo, Japan, 150-8308;
| | - Matsuo Taniyama
- Showa University Fujigaoka Hospital, Internal Medicine, Endocrinology & Metabolism, 1-3- Fujigaoka, Aoba, Yokohama, Kanagawa, Japan, 227-8501;
| | - Koichi Ito
- Ito Hospital, Surgery, 4-3-6 Jingumae, Shibuyaku, Tokyo, Japan, 150-0001;
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5
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Shimura H, Suzuki S, Yokoya S, Iwadate M, Suzuki S, Matsuzuka T, Setou N, Ohira T, Yasumura S, Suzuki S, Ohto H, Kamiya K. A Comprehensive Review of the Progress and Evaluation of the Thyroid Ultrasound Examination Program, the Fukushima Health Management Survey. J Epidemiol 2022; 32:S23-S35. [PMID: 36464297 PMCID: PMC9703930 DOI: 10.2188/jea.je20210271] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
The Great East Japan Earthquake on March 11, 2011, and the subsequent tsunami caused an accident at the Fukushima Daiichi Nuclear Power Plant, in which extensive damage to the nuclear power reactors resulted in massive radioactive contamination. Fukushima Prefecture implemented the Thyroid Ultrasound Examination (TUE) program as part of the Fukushima Health Management Survey project in response to residents' anxieties about health risks due to radiation exposure for residents aged 0-18 years at the time of the nuclear accident. This program consisted of the primary examination and the confirmatory examination. In the primary examination, thyroid nodules and cysts were examined using portable ultrasound apparatuses. The confirmatory examination was performed to have clinical or cytological diagnosis. As of June 30, 2021, 116, 71, 31, 36, and 9 examinees in the first, second, third, and fourth round of surveys, and the survey at age 25 years, respectively, were determined to have nodules cytologically diagnosed as malignant or suspicious for malignancy. The confirmatory examination of the fourth-round survey and the primary and confirmatory examination of fifth-round survey are currently in progress. Together with the low thyroid absorbed radiation dose estimated in the United Nations Scientific Committee on the Effects of Atomic Radiation 2020 report, our results suggested that the increased incidence of childhood thyroid cancer in Fukushima Prefecture was not caused by radiation exposure, but rather by the highly sensitive detection method. As detailed in this review, there were ongoing challenges in our program, such as actions against the risk of overdiagnosis and psychological support for participants and their families.
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Affiliation(s)
- Hiroki Shimura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan,Department of Laboratory Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Satoru Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Susumu Yokoya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan,Thyroid and Endocrine Center, Fukushima Medical University, Fukushima, Japan
| | - Manabu Iwadate
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan,Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Satoshi Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan,Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takashi Matsuzuka
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Noriko Setou
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan,Department of Disaster Psychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan,Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan,Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shinichi Suzuki
- Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hitoshi Ohto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan,Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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Goldfarb M, Dinauer C. Differences in the management of thyroid nodules in children and adolescents as compared to adults. Curr Opin Endocrinol Diabetes Obes 2022; 29:466-473. [PMID: 35777975 DOI: 10.1097/med.0000000000000754] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To describe recent advances in the diagnosis and management of thyroid nodules in both children and adults, highlighting differences between the two groups. RECENT FINDINGS Thyroid nodules are less common in children than adults but the risk of malignancy is higher. Screening recommendations for patients with certain genetic syndromes or specific risk factors for thyroid nodules and cancer continue to evolve ultrasound is the most appropriate imaging modality for evaluating thyroid nodules in all patients, but radiographic risk stratification systems validated in adults have not been extensively studied in children. Criteria for proceeding to fine needle aspiration (FNA) biopsy differ some between children and adults, with nodule size being less of a consideration in young patients. Molecular testing continues to improve the diagnostic capabilities of FNA for all age groups, but options for pediatric thyroid nodules are currently limited. In children, only oncogene panels are validated and their exact utility, along with miRNA classifiers, is an evolving area of study. For adults, data support selection of a specific molecular test based on ultrasound characteristics and pretest probability of malignancy. Multiple series have shown that fusion mutations are more common in pediatric thyroid nodules, while point mutations are seen more often in adult thyroid nodules. Molecular data help guide management recommendations regarding the need for surgery when FNA is indeterminate, but clinical use is still being refined. Radiofrequency ablation is a nonoperative approach that has gained significant traction for the treatment of symptomatic benign nodules in adults, but data are currently extremely limited in children. SUMMARY There are difference in the diagnosis and treatment of thyroid nodules in adults and children, the nuances of which are important for clinical management.
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Affiliation(s)
- Melanie Goldfarb
- Center for Endocrine Tumors, Saint Johns Cancer Institute at Providence Saint Johns Health Center, Santa Monica
| | - Catherine Dinauer
- Section of Pediatric Endocrinology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
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7
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Keefe G, Culbreath K, Cherella CE, Smith JR, Zendejas B, Shamberger RC, Richman DM, Hollowell ML, Modi BP, Wassner AJ. Autoimmune Thyroiditis and Risk of Malignancy in Children with Thyroid Nodules. Thyroid 2022; 32:1109-1117. [PMID: 35950619 DOI: 10.1089/thy.2022.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: It is uncertain whether the presence of autoimmune thyroiditis (AIT) increases the risk of thyroid cancer in children with thyroid nodules. This study evaluated the association between AIT and thyroid cancer in pediatric patients with thyroid nodules. Methods: A cross-sectional study was performed of pediatric patients (<19 years old) with a thyroid nodule (≥1 cm) who underwent fine-needle aspiration in an academic pediatric thyroid center. AIT was defined by the presence of thyroid autoantibodies or diffusely heterogeneous sonographic echotexture. The primary outcome was diagnosis of thyroid cancer. The association of AIT with thyroid cancer was evaluated with univariable and multivariable logistic regression. Associations of AIT with subject and nodule characteristics were also assessed. Results: Four hundred fifty-eight thyroid nodules in 385 patients (81% female) were evaluated at a median age of 15.5 years (interquartile range 13.5-17.0). Thyroid cancer was present in 108 nodules (24%). AIT was present in 95 subjects (25%) and was independently associated with an increased risk of thyroid cancer (multivariable odds ratio [OR] 2.19, 95% confidence interval [CI] 1.32-3.62). Thyroid cancer was also independently associated with younger age, nodule size, and solitary nodules, but was not associated with serum thyrotropin concentration. AIT was not associated with the likelihood of subjects undergoing thyroid surgery (p = 0.17). AIT was less commonly associated with follicular thyroid carcinoma than with papillary thyroid carcinoma (OR 0.22, CI 0.05-1.06). Among papillary thyroid carcinomas, AIT was strongly associated with the diffuse sclerosing variant (OR 4.74, CI 1.33-16.9). AIT was not associated with the extent of local, regional, or distant disease at thyroid cancer diagnosis. Conclusions: AIT is independently associated with an increased risk of thyroid cancer in children with thyroid nodules. These findings suggest that the evaluation of thyroid autoantibodies and thyroid echotexture may inform thyroid cancer risk assessment and surgical decision-making in children with thyroid nodules.
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Affiliation(s)
| | | | - Christine E Cherella
- Thyroid Center, Boston, Massachusetts, USA
- Division of Endocrinology, Department of Pediatrics, Boston, Massachusetts, USA
| | - Jessica R Smith
- Thyroid Center, Boston, Massachusetts, USA
- Division of Endocrinology, Department of Pediatrics, Boston, Massachusetts, USA
| | - Benjamin Zendejas
- Department of Surgery, Boston, Massachusetts, USA
- Thyroid Center, Boston, Massachusetts, USA
| | - Robert C Shamberger
- Department of Surgery, Boston, Massachusetts, USA
- Thyroid Center, Boston, Massachusetts, USA
| | - Danielle M Richman
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Monica L Hollowell
- Thyroid Center, Boston, Massachusetts, USA
- Department of Pathology; Boston Children's Hospital, Boston, Massachusetts, USA
| | - Biren P Modi
- Department of Surgery, Boston, Massachusetts, USA
- Thyroid Center, Boston, Massachusetts, USA
| | - Ari J Wassner
- Thyroid Center, Boston, Massachusetts, USA
- Division of Endocrinology, Department of Pediatrics, Boston, Massachusetts, USA
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8
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Cherella CE, Hollowell ML, Smith JR, Zendejas B, Modi BP, Cibas ES, Wassner AJ. Subtype of atypia on cytology and risk of malignancy in pediatric thyroid nodules. Cancer Cytopathol 2022; 130:330-335. [PMID: 35119774 DOI: 10.1002/cncy.22544] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Thyroid nodules with atypia of undetermined significance (AUS) are challenging to manage because of their intermediate risk of malignancy. Subclassification of atypia can refine malignancy risk in adult AUS nodules but has not been evaluated in children. METHODS This was a retrospective cohort study of pediatric patients (<19 years old) who underwent fine-needle aspiration (FNA) of a thyroid nodule with resulting AUS cytology. Atypia was subclassified as nuclear only, architectural only, nuclear and architectural, or oncocytic. The primary outcome was the association between atypia subtype and malignancy. A secondary outcome was the association of atypia subtype with repeat FNA cytology. RESULTS Sixty-eight AUS nodules in 61 patients were analyzed. The median age at FNA was 16.2 years (range, 9.8-18.9 years). Twenty-four nodules (35%) were malignant. Nuclear atypia only was present in 17 nodules (25%), architectural atypia only was present in 27 nodules (40%), nuclear and architectural atypia was present in 20 nodules (29%), and predominantly oncocytic features were present in 4 nodules (6%). The presence of nuclear atypia was associated with a significantly increased rate of malignancy (22 of 37 [59%] vs 2 of 31 [6.5%]; P < .001), whereas architectural atypia was not associated with malignancy (P = .8). Repeat FNA was performed in 42 of 68 nodules (62%). In nodules with initial nuclear and architectural atypia, benign repeat cytology had a high false-negative rate (3 of 6; 50%). CONCLUSIONS Pediatric AUS nodules with nuclear atypia have a high rate of malignancy, but architectural atypia is not associated with malignancy. In nodules with nuclear atypia, repeat FNA may inform clinical decisions regarding the need for resection. In the absence of suspicious clinical features, nodules without nuclear atypia might be considered for observation rather than resection or repeat FNA.
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Affiliation(s)
- Christine E Cherella
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Monica L Hollowell
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jessica R Smith
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin Zendejas
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Biren P Modi
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edmund S Cibas
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ari J Wassner
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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9
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Sapuppo G, Tavarelli M, Cannata E, La Spina M, Russo M, Scollo C, Spadaro A, Masucci R, Lo Nigro L, Russo G, Di Cataldo A, Pellegriti G. Risk of Benign and Malignant Thyroid Disorders in Subjects Treated for Paediatric/Adolescent Neoplasia: Role of Morphological and Functional Screening. CHILDREN-BASEL 2021; 8:children8090767. [PMID: 34572198 PMCID: PMC8468117 DOI: 10.3390/children8090767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022]
Abstract
Background: Patients treated for paediatric/adolescent (P/A) neoplasia have a high incidence of both benign and malignant thyroid diseases. Given the high incidence of sequelae, literature data show a clinical benefit of morpho-functional thyroid screening in paediatric/adolescent cancer survivors and a careful lifetime follow-up. Patients and methods: The incidence of thyroid alterations was evaluated in a consecutive series of 343 patients treated with chemotherapy (CHE) and radiotherapy (RTE) or only with CHE for P/A tumours between 1976 and 2018 (mean age at time of primary paediatric malignancy 7.8 ± 4.7 years). All patients underwent thyroidal morpho-functional evaluation between 2000 and 2019. Results: 178 patients (51.9%) were treated only with CHE and 165 (48.1%) with CHE+RTE. A functional and/or structural thyroid disease was diagnosed in 147 (42.5%; 24.2% in CHE and 62.4% in CHE+RTE group; p = 0.0001). Of note, 71 (20.7%) patients with no evidence of disease at first evaluation developed a thyroid alteration during the follow-up. Primitive hypothyroidism was diagnosed in 54 patients (15.7%; 11.2% in CHE vs. 20.6% in CHE+RTE group; p = 0.01) and hyperthyroidism in 4. Sixty-three patients developed thyroid nodules (18.4%; 4.0% in CHE and 14.1% in CHE+RTE group; p < 0.001); thyroid cancer was diagnosed in 30 patients (8.7%; 4.5% in CHE and 12.4% in CHE + RTE group; p = 0.007). Conclusions: In patients treated with CHE+RTE, the prevalence of hypothyroidism and nodular pathology, both malignant and benign, were significantly greater than in patients treated with CHE. However, also in the CHE group, the frequency of thyroid disease is not negligible and the pathogenetic mechanisms remain to be clarified. Our data suggest the clinical benefit of morpho-functional thyroid screening in P/A cancer survivors.
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Affiliation(s)
- Giulia Sapuppo
- Endocrinology, Garibaldi-Nesima Medical Center, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy;
| | - Martina Tavarelli
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
| | - Emanuela Cannata
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Milena La Spina
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Marco Russo
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
| | - Claudia Scollo
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
| | - Angela Spadaro
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
| | - Romilda Masucci
- Garibaldi-Nesima Medical Center, Department of Surgical Oncology, 95122 Catania, Italy;
| | - Luca Lo Nigro
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Giovanna Russo
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Andrea Di Cataldo
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Gabriella Pellegriti
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
- Correspondence:
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10
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Erbaş İC, Erbaş İM, Evliyaoğlu O. Clinical, biochemical, and radiological follow-up results of children and adolescents with Hashimoto's thyroiditis: a single-center experience. J Pediatr Endocrinol Metab 2021; 34:987-994. [PMID: 34126658 DOI: 10.1515/jpem-2021-0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/26/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Hashimoto's thyroiditis (HT) is the most common cause of goiter and acquired hypothyroidism in children and adolescents, especially in areas without endemic iodine deficiency. We aimed to evaluate the follow-up results of children and adolescents diagnosed with HT, including clinical, biochemical, and radiological findings and treatment approaches. METHODS HT patients, who were diagnosed between 2012 and 2018 years in a single-center, were assessed retrospectively. RESULTS Two hundred and twenty-four cases were included in the study, 75.9% of whom were girls (female/male ratio: 3.1) and 66.5% were pubertal. The median age of the cases at first admission was 12.5 (9.2-15) years. The median follow-up period of 196 patients, who continued their follow-up regularly, was 2.1 (0.7-4.8) years. When autoantibody levels were analyzed according to gender, mean anti-Tg levels were higher in girls (p=0.028), whereas anti-TPO levels were similar (p=0.372). A nodule was detected in the ultrasonographic follow-up of 29 (13%) patients. Papillary thyroid carcinoma was observed in 10.3% (n=3) of those with nodules. When the last ultrasonography findings of 188 patients with available radiological follow-up data were compared with their initial evaluation, the rate of heterogeneous parenchymal echogenicity increased significantly (p=0.008). The need for l-thyroxine dosage augmented over time. CONCLUSIONS Although HT is more common in adolescent girls, it can be encountered in both genders and at all ages in childhood. The incidence of malignancy was not higher in patients with nodules associated with HT than the reported incidences of malignancy in nodules not associated with HT.
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Affiliation(s)
- İrem Ceren Erbaş
- Department of Pediatrics, Faculty of Medicine, İstanbul University - Cerrahpaşa, İstanbul, Turkey
| | - İbrahim Mert Erbaş
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Olcay Evliyaoğlu
- Division of Pediatric Endocrinology, Faculty of Medicine, İstanbul University - Cerrahpaşa, İstanbul, Turkey
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11
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Setou N, Suzuki S, Matsuzuka T, Iwadate M, Maeda M, Namekata Y, Yoshida F, Oshima K, Ohira T, Yasumura S, Ohto H, Kamiya K, Yokoya S, Shimura H. Psychosocial support for the examinees and their families during the secondary confirmatory examination:Analyses of support records at first visit. Fukushima J Med Sci 2021; 67:53-63. [PMID: 34373400 PMCID: PMC8460285 DOI: 10.5387/fms.2021-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background and Purpose The Thyroid Ultrasound Examination (TUE) program is conducted as part of the Fukushima Health Management Survey. Following the established criteria, examinees are called in for a secondary confirmation examination, which may induce high anxiety related to a thyroid cancer for both the examinees and their families. Therefore, Fukushima Medical University created the Thyroid Support Team to reduce anxiety. The purpose of this study is to analyze the psychosocial support for examinees and their families through two types of records, and to clarify the current issues and determine future directions of support. Materials and methods We analyzed 223 records of support for the first visit of examinees who attended the secondary confirmatory examination, conducted at Fukushima Medical University from September 2018 to March 2019. Results During the first visit, frequent topics and questions brought up by the examinees and their families were about the “Thyroid Ultrasound Examination (TUE) program” and “Examination findings”. The Thyroid Support Team members assisted them by “Responding to questions”, “Confirming the doctor’s explanation” and “Providing information”. The percentage of people with high anxiety decreased in both examinees and their family members after the examination. The level of anxiety was lower among those who had already taken the secondary confirmatory examination. Family members’ anxiety was significantly higher than that of the examinees, and anxiety levels were highly correlated between examinees and their families. Conclusion The psychosocial support for examinees and their families was important in reducing their anxiety. Currently there are changes in social conditions and various opinions concerning the TUE. Thus, careful explanation and the need for decision-making supports for the examinees and their families increased. Also, we should take into account the aging of the examinees and expanding the available psychosocial support.
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Affiliation(s)
- Noriko Setou
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Disaster Psychiatry, School of Medicine, Fukushima Medical University
| | - Satoru Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Takashi Matsuzuka
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,School of Health Sciences, Asahi University
| | - Manabu Iwadate
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Thyroid and Endocrinology, School of Medicine, Fukushima Medical University
| | - Masaharu Maeda
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Disaster Psychiatry, School of Medicine, Fukushima Medical University
| | - Yuko Namekata
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Fusae Yoshida
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Kayoko Oshima
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Hitoshi Ohto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Susumu Yokoya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Thyroid and Endocrine Center, Fukushima Global Medical Science Center, Fukushima Medical University
| | - Hiroki Shimura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Laboratory Medicine, School of Medicine, Fukushima Medical University
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12
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Jiang W, Phillips SA, Newbury RO, Naheedy JH, Newfield RS. Diagnostic utility of fine needle aspiration cytology in pediatric thyroid nodules based on Bethesda Classification. J Pediatr Endocrinol Metab 2021; 34:449-455. [PMID: 33629571 DOI: 10.1515/jpem-2020-0645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The Bethesda system for reporting cytopathology (TBSRTC) has been widely adopted in the management of thyroid nodules. Based on the limited pediatric data available, the implied malignancy risk for each of the categories may be significantly different in pediatrics vs. adults, especially in the indeterminate categories (Bethesda Class III or IV). We report the diagnostic utility of fine needle aspiration (FNA) biopsy at our institution based on the Bethesda system and the risk of malignancy in each category. METHODS We retrospectively reviewed all patients who underwent a thyroid FNA at our tertiary pediatric hospital from 12/1/2002 to 11/30/2018. FNA results were classified according to TBSRTC. Patient demographics, cytology, histopathology, radiological and clinical follow-ups were examined. RESULTS A total of 171 patients were included with 203 cytological samples. Average age at initial FNA was 14.7 years (range 6.9-18.6 years). The numbers of nodules reported for Bethesda categories I-VI were 29, 106, 22, 14, 6 and 26, respectively, and the rate of malignancy was: 13.8, 4.7, 22.7, 35.7, 83.3 and 100%, respectively. Use of ultrasound guidance reduced the non-diagnostic rate from 38.1 to 11.5%. Introduction of on-site adequacy testing further reduced the non-diagnostic rate to 6.5% since 2014. CONCLUSIONS The risk of malignancy for thyroid nodules in this pediatric cohort is higher than reported in adults. However, rates described here are much closer to adult ranges than previously published pediatric cohorts. The addition of adequacy testing improved the non-diagnostic rate of FNA procedures performed with ultrasound guidance.
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Affiliation(s)
- Wen Jiang
- Division of Otolaryngology, Department of Surgery, University of California San Diego, Rady Children's Hospital in San Diego, San Diego, CA, USA
| | - Susan A Phillips
- Division of Endocrinology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital in San Diego, San Diego, CA, USA
| | - Robert O Newbury
- Department of Pathology, University of California San Diego, Rady Children's Hospital in San Diego, San Diego, CA, USA
| | - John H Naheedy
- Department of Radiology, University of California San Diego, Rady Children's Hospital in San Diego, San Diego, CA, USA
| | - Ron S Newfield
- Division of Endocrinology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital in San Diego, San Diego, CA, USA
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13
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Smith JR, Liu E, Church AJ, Asch E, Cherella CE, Srivastava S, Kamihara J, Wassner AJ. Natural History of Thyroid Disease in Children with PTEN Hamartoma Tumor Syndrome. J Clin Endocrinol Metab 2021; 106:e1121-e1130. [PMID: 33347563 DOI: 10.1210/clinem/dgaa944] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Indexed: 01/12/2023]
Abstract
CONTEXT Thyroid ultrasound screening is recommended in children with PTEN hamartoma tumor syndrome (PHTS) due to increased risk of thyroid neoplasia, but the natural history of thyroid disease in children with PHTS is unclear. OBJECTIVE Determine the prevalence and natural history of thyroid disease in children with PHTS. METHODS Retrospective cohort study (1998-2019) in an academic pediatric hospital of individuals with genetically confirmed PHTS diagnosed before age 19 years. Clinical, thyroid ultrasound, and laboratory characteristics are described. Primary outcomes were the prevalence of thyroid nodules ≥10 mm diameter and time course and risk factors for nodule development assessed by Cox regression analysis. Secondary outcomes included thyroid nodule requiring biopsy, other ultrasound findings, and prevalence of autoimmune thyroid disease. RESULTS Among 64 subjects with PHTS, 50 underwent thyroid ultrasound. A thyroid nodule ≥10 mm was diagnosed in 22/50 (44%) subjects at median (range) age 13.3 (7.0-22.9) years. Nodules were diagnosed earlier in females than in males (10.8 [7.0-17.9] vs 14.2 [9.9-22.9] years, P = .009). In multivariate analysis, risk of thyroid nodules was significantly associated with female sex (hazard ratio 2.90, 95% CI 1.16-7.27, P = .02) and inversely associated with the presence of neurologic findings of PHTS (HR 0.27, 95% CI 0.10-0.69, P = .007). Abnormal-appearing lymph nodes with echogenic foci were observed by ultrasound in 20% of subjects, but these were not associated with malignancy. Autoimmune thyroid disease was present in 10/33 (30.3%) of subjects in whom it was assessed. CONCLUSION Thyroid disease is common in children with PHTS. This study supports current consensus recommendations for ultrasound screening.
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Affiliation(s)
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Alanna J Church
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA
| | - Elizabeth Asch
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Junne Kamihara
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ari J Wassner
- Thyroid Center, Boston Children's Hospital, Boston, MA, USA
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14
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Cléro E, Ostroumova E, Demoury C, Grosche B, Kesminiene A, Liutsko L, Motreff Y, Oughton D, Pirard P, Rogel A, Van Nieuwenhuyse A, Laurier D, Cardis E. Lessons learned from Chernobyl and Fukushima on thyroid cancer screening and recommendations in case of a future nuclear accident. ENVIRONMENT INTERNATIONAL 2021; 146:106230. [PMID: 33171378 DOI: 10.1016/j.envint.2020.106230] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/16/2020] [Accepted: 10/18/2020] [Indexed: 05/06/2023]
Abstract
Exposure of the thyroid gland to ionizing radiation at a young age is the main recognized risk factor for differentiated thyroid cancer. After the Chernobyl and Fukushima nuclear accidents, thyroid cancer screening was implemented mainly for children, leading to case over-diagnosis as seen in South Korea after the implementation of opportunistic screening (where subjects are recruited at healthcare sites). The aim of cancer screening is to reduce morbidity and mortality, but screening can also cause negative effects on health (with unnecessary treatment if over-diagnosis) and on quality of life. This paper from the SHAMISEN special issue (Nuclear Emergency Situations - Improvement of Medical And Health Surveillance) presents the principles of cancer screening, the lessons learned from thyroid cancer screening, as well as the knowledge on thyroid cancer incidence after exposure to iodine-131. The SHAMISEN Consortium recommends to envisage systematic health screening after a nuclear accident, only when appropriately justified, i.e. ensuring that screening will do more good than harm. Based on the experience of the Fukushima screening, the consortium does not recommend mass or population-based thyroid cancer screening, as the negative psychological and physical effects are likely to outweigh any possible benefit in affected populations; thyroid health monitoring should however be made available to persons who request it (regardless of whether they are at increased risk or not), accompanied with appropriate information and support.
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Affiliation(s)
- Enora Cléro
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France.
| | - Evgenia Ostroumova
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Claire Demoury
- Risk and Health Impact Assessment Unit, Sciensano, Brussels, Belgium
| | - Bernd Grosche
- Federal Office for Radiation Protection (BfS), Munich, Germany
| | - Ausrele Kesminiene
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Liudmila Liutsko
- Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Deborah Oughton
- Norwegian University of Life Sciences (NMBU), Center for Environmental Radioactivity (CERAD), Aas, Norway
| | | | - Agnès Rogel
- Santé publique France, Saint-Maurice, France
| | - An Van Nieuwenhuyse
- Risk and Health Impact Assessment Unit, Sciensano, Brussels, Belgium; Centre for Environment and Health, Department of Public Health and Primary Care, Leuven, Belgium
| | - Dominique Laurier
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Elisabeth Cardis
- Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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15
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Sakamoto A, Matsuzuka T, Yamaya Y, Suzuki S, Iwadate M, Suzuki S, Hashimoto Y, Suzuki O, Suzuki S, Yokoya S, Ohira T, Yasumura S, Ohto H, Kamiya K, Shimura H. Cytological examination of the thyroid in children and adolescents after the Fukushima Nuclear Power Plant accident: the Fukushima Health Management Survey. Endocr J 2020; 67:1233-1238. [PMID: 32814723 DOI: 10.1507/endocrj.ej20-0235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Fukushima Daiichi Nuclear Power Plant accident occurred on March 11 2011, following the Great East Japan Earthquake and tsunami. Radioactive materials, including I-131, were released into the environment after the accident. Shortly after, the prefectural government initiated the Fukushima Health Management Survey for monitoring the long-term health conditions of the residents of Fukushima Prefecture. In the survey, thyroid ultrasonography was scheduled for all people aged 18 years or younger who were living in Fukushima Prefecture at the time of disaster. The total number of examinees was approximately 370,000 in the Preliminary Baseline Survey (PBLS), and 380,000 in the first Full-scale Survey (FSS). First, thyroid ultrasonography was performed as the Primary Examination. When a thyroid nodule that meets the fine needle aspiration cytology (FNAC) guideline is detected, thyroid FNAC is performed. By the end of June 2017, the cytological specimens of 187 examinees had been interpreted as Malignant or Suspicious for Malignancy (SFM). In this article, the cytological results of whole categories are presented using the criteria of The Bethesda System for Reporting Thyroid Cytopathology. The total numbers of examinees with SFM or Malignant in PBLS and at the first FSS were 106 (62.0%) and 71 (38.0%), respectively. The data of the cytological results of SFM and Malignant were already reported. However, this is the first report of cytological data from categories other than SFM and Malignant. The results of the current study will contribute to future research into the thyroid conditions of children and adolescents.
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Affiliation(s)
- Atsuhiko Sakamoto
- Thyroid Examination Expert Committee, Diagnostic Criteria Subcommittee for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Pathology and Laboratory Medicine, Omori Red Cross Hospital, Tokyo 143-8527, Japan
| | - Takashi Matsuzuka
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Yukie Yamaya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Satoru Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Manabu Iwadate
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Thyroid and Endocrinology, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Satoshi Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Thyroid and Endocrinology, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Yuko Hashimoto
- Department of Pathology, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Osamu Suzuki
- Department of Pathology, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Shinichi Suzuki
- Department of Thyroid and Endocrinology, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Susumu Yokoya
- The Thyroid and Endocrine Center, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
| | - Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hitoshi Ohto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8553, Japan
| | - Hiroki Shimura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Laboratory Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
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16
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Shibata A, Saji S, Kamiya K, Yasumura S. Trend in Cancer incidence and mortality in Fukushima between 2008 and 2015. J Epidemiol 2020; 31:653-659. [PMID: 32963211 PMCID: PMC8593570 DOI: 10.2188/jea.je20200202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Cancer incidence in Fukushima Prefecture, especially thyroid cancer, has been a public concern, since the Tokyo Electric Power Company Fukushima Daiichi Nuclear Power Plants accident following the Great East Japan Earthquake on March 11, 2011; however, cancer incidence for Fukushima residents before and after the accident based on a population-based cancer registry (PBCR) has not been known worldwide. Methods We obtained the corrected-incidence data for invasive cancers newly diagnosed from 2008 through 2015 from the Fukushima Cancer Registry. We checked data quality indicators for PBCRs to confirm comparability. We calculated age-standardized annual incidence and mortality of cancer for all-site, thyroid, and leukemia by calendar year and sex, as we did for Tochigi Prefecture and all of Japan as references for comparison. We applied joinpoint trend analysis to test an apparent trend in incidence and mortality. Results The corrected incidence data from the Fukushima Cancer Registry had sufficient quality comparable to other PBCRs. For the age-standardized annual incidence by sex and cancer type in Fukushima and Tochigi, we did not detect any joinpoint in trend with statistical significance. Cancer incidence gently increased from 2008 through 2015 nationwide. Incidence and mortality of cancer for Fukushima before the accident was very close to that for Tochigi. Conclusions We interpreted the incidence statistics of cancer for Fukushima residents from 2008 through 2015. Our results will provide fundamental statistics for subsequent researchers to assess the relationship between the disaster and cancer incidence among Fukushima residents in the long term.
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Affiliation(s)
- Akiko Shibata
- Center for Cancer Control and Information Services, National Cancer Center
| | - Shigehira Saji
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Medical Oncology, Fukushima Medical University School of Medicine
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Research Institute for Radiation Biology and Medicine, Hiroshima University
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Public Health, Fukushima Medical University School of Medicine
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17
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Takahashi H, Yasumura S, Takahashi K, Ohira T, Ohtsuru A, Midorikawa S, Suzuki S, Shimura H, Ishikawa T, Sakai A, Suzuki S, Yokoya S, Tanigawa K, Ohto H, Kamiya K. Nested matched case control study for the Japan Fukushima Health Management Survey's first full-scale (second-round) thyroid examination. Medicine (Baltimore) 2020; 99:e20440. [PMID: 32629628 PMCID: PMC7337421 DOI: 10.1097/md.0000000000020440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Since Fukushima nuclear accident in 2011, thyroid ultrasound examinations have been conducted. The first full-scale examination detected 71 thyroid-cancer cases. This study examined whether radiation exposure was associated with thyroid-cancer incidence.Subjects were participants in the baseline screening and newborns during the 2011 fiscal year. Under nested matched case-control study design, 10 controls per each case were selected by matching the age, sex, baseline screening results, and interval between examinations. With 3 dose levels of external radiation: 1.3 + mSv (upper), 0.8 to 1.3 (middle), and 0.0 to 0.8 (reference), we applied 2 logistic models adjusting for 3 participation-proportions (primary, secondary, and fine-needle aspiratory cytology), overweight, and the B-result of baseline screening (Model 1), and past medical history, family history of thyroid cancer, and frequencies of eating seafood and seaweed in addition to the parameters in Model 1 (Model 2). We examined each model in 3 ways: (a) excluding subjects with a missing radiation exposure dose; and substituting (b1) median or (b2) mean dose of the municipality with missing dose.Odds ratios (ORs) of middle-dose exposure were (a) 1.35 (0.46-3.94), (b1) 1.55 (0.61-3.96), and (b2) 1.23 (0.50-3.03) for Model 1, and (a) 1.18 (0.39-3.57), (b1) 1.31 (0.49-3.49), and (b2) 1.02 (0.40-2.59) for Model 2. For upper-dose exposure, similar results were obtained. Past medical history was significantly associated (odds ratio = 2.04-2.08) with both (b1) and (b2) in Model 2.No significant associations were obtained between the external radiation exposure and thyroid-cancer incidence.
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Affiliation(s)
- Hideto Takahashi
- National Institute of Public Health, Saitama
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima
| | - Kunihiko Takahashi
- Department of Biostatistics M&D Data Science Center Tokyo Medical and Dental University
| | - Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Epidemiology
| | - Akira Ohtsuru
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Radiation Health Management
| | - Sanae Midorikawa
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Radiation Health Management
| | - Satoru Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Hiroki Shimura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Laboratory Medicine
| | - Tetsuo Ishikawa
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Radiation Physics and Chemistry
| | - Akira Sakai
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Radiation Life Sciences
| | - Shinichi Suzuki
- Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine
| | - Susumu Yokoya
- Thyroid and Endocrine Center, Fukushima Medical University, Fukushima
| | - Koichi Tanigawa
- Fukushima Global Medical Science Center, Fukushima Medical University
| | - Hitoshi Ohto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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18
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Allen N, Desai N, Song C, Yu J, Prasad U, Francis G. Clinical features may help to identify children and adolescents with greatest risk for thyroid nodules. J Endocrinol Invest 2020; 43:925-934. [PMID: 31927747 DOI: 10.1007/s40618-019-01176-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Thyroid nodules (TN) are detected in a small number of asymptomatic children and adolescents but are more frequently malignant (22-26%) than in adults leading some clinicians to perform thyroid ultrasound (US) for all children with goiter or autoimmune thyroiditis (AIT). Our study was designed to determine if suspicious clinical features predict the presence of TN in children with goiter or AIT so that US could be performed on those at highest risk. METHODS This was a retrospective review of 223 children and adolescents with goiter or AIT evaluated at a single institution. US was not performed on all patients. It is our practice to define glands that are large, firm, or nodular to palpation as "suspicious". Suspicious glands were interrogated by US and if TN was confirmed, this was further evaluated by fine-needle aspiration followed by surgery if indicated. RESULTS The median age was 12.9 years with 74.4% female. TN were confirmed by US in 16.6% of all patients but only 4.8% of those with AIT. By univariate analysis, TN were more common in those with family history of TN or differentiated thyroid carcinoma (DTC), thyroid asymmetry, and lower thyrotropin (TSH) levels. Differentiated thyroid carcinoma (DTC) was identified in 10.8% of TN and 1.8% of all patients. Firmness was significantly more common in patients with DTC (p = 0.0013). CONCLUSION TN were less common in those with AIT than reported in previous studies, suggesting that clinical features might fail to identify the majority of TN in patients with AIT. However, patients with asymmetric thyroid and a family history of TN or DTC have greatest risk for TN.
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Affiliation(s)
- N Allen
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
| | - N Desai
- Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
| | - C Song
- Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
| | - J Yu
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - U Prasad
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, USA
| | - G Francis
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Texas Health Science Center at San Antonio, 7301 Floyd Curl Drive, San Antonio, TX, 78229, USA.
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19
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Ohtsuru A, Midorikawa S, Ohira T, Suzuki S, Takahashi H, Murakami M, Shimura H, Matsuzuka T, Yasumura S, Suzuki SI, Yokoya S, Hashimoto Y, Sakai A, Ohto H, Yamashita S, Tanigawa K, Kamiya K. Incidence of Thyroid Cancer Among Children and Young Adults in Fukushima, Japan, Screened With 2 Rounds of Ultrasonography Within 5 Years of the 2011 Fukushima Daiichi Nuclear Power Station Accident. JAMA Otolaryngol Head Neck Surg 2019; 145:4-11. [PMID: 30489622 DOI: 10.1001/jamaoto.2018.3121] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Ultrasonographic (US) screening for thyroid cancer was performed in the Fukushima Health Management Survey after the 2011 Fukushima Daiichi nuclear power station accident. Clinical characteristics of thyroid cancers screened by US among children and young adults during the first 5 years after the accident were analyzed. Objectives To evaluate the number of detected thyroid cancers by age group within 5 years of the Fukushima Daiichi nuclear power station accident and to compare the basic clinical characteristics and demographic patterns in first- and second-round examinations. Design, Setting, and Participants In this observational study, 324 301 individuals 18 years or younger at the time of accident were included. Patients received a cytologic diagnosis of malignant or suspected malignant thyroid cancer during the first (fiscal years 2011-2013) or second round (fiscal years 2014-2015) of screening. Number of detected cases of cancer was evaluated, correcting for the number of examinees by age group at the time of the accident and for the incidence of detected cancers according to age group at the time of the screening (age groups were divided into 3-year intervals). Results were compared using the age-specific incidence of unscreened cancers from a national cancer registry. Main Outcomes and Measures Clinical baseline characteristics of the patients and the age-specific number and incidence of thyroid cancers detected during the second round. Results Among 299 905 individuals screened in the first round (50.5% male; mean [SD] age at screening, 14.9 [2.6] years), malignant or suspected thyroid cancer was diagnosed in 116. Among 271 083 individuals screened in the second round (50.4% male; age at screening, 12.6 [3.2] years), malignant or suspected thyroid cancer was diagnosed in 71. The most common pathologic diagnosis in surgical cases was papillary thyroid cancer (149 of 152 [98.0%]). The distribution pattern by age group at the time of the accident, where the number of detected thyroid cancer cases was corrected by the number of examinees, increased with older age in both screening rounds. This demographic pattern was similar between the first and second examinations. The distribution pattern of the incidence rate by age group at the time of screening in the second round also increased with older age. The incidence rate detected by screening was 29 cases per 100 000 person-years for those aged 15 to 17 years, 48 cases per 100 000 person-years for those aged 18 to 20 years, and 64 cases per 100 000 person-years for those aged 21 to 22 years. Conclusions and Relevance Large-scale mass US screening of young people resulted in the diagnosis of a number of thyroid cancers, with no major changes in overall characteristics within 5 years of the 2011 Fukushima nuclear power station accident. These results suggest that US screening can identify many detectable cancers from a large pool of nonclinical and subclinical thyroid cancers among individuals of a relatively young age, in an age-dependent manner.
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Affiliation(s)
- Akira Ohtsuru
- Department of Radiation Health Management, Fukushima Medical University, Fukushima, Japan.,Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Sanae Midorikawa
- Department of Radiation Health Management, Fukushima Medical University, Fukushima, Japan.,Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Epidemiology, Fukushima Medical University, Fukushima, Japan
| | - Satoru Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Hideto Takahashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Michio Murakami
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Health Risk Communication, Fukushima Medical University, Fukushima, Japan
| | - Hiroki Shimura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Laboratory Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takashi Matsuzuka
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Public Health, Fukushima Medical University, Fukushima, Japan
| | - Shin-Ichi Suzuki
- Department of Thyroid and Endocrinology, Fukushima Medical University, Fukushima, Japan
| | - Susumu Yokoya
- Thyroid and Endocrine Center, Fukushima Medical University, Fukushima, Japan
| | - Yuko Hashimoto
- Department of Pathology, Fukushima Medical University, Fukushima, Japan
| | - Akira Sakai
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Radiation Life Sciences, Fukushima Medical University, Fukushima, Japan
| | - Hitoshi Ohto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Shunichi Yamashita
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Koichi Tanigawa
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Research Institute of Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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20
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Yamamoto H, Hayashi K, Scherb H. Association between the detection rate of thyroid cancer and the external radiation dose-rate after the nuclear power plant accidents in Fukushima, Japan. Medicine (Baltimore) 2019; 98:e17165. [PMID: 31517868 PMCID: PMC6750239 DOI: 10.1097/md.0000000000017165] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A thyroid cancer ultrasonography screening for all residents 18 years old or younger living in the Fukushima prefecture started in October 2011 to investigate the possible effect of the radiological contamination after the Fukushima Daiichi Nuclear Power Plant accidents as of March 12 to 15, 2011. Thyroid cancer in 184 cases was reported by February 2017. The question arises to which extent those cancer cases are a biological consequence of the radiation exposure or an artefactual result of the intense screening of a large population.Experiences with the Chernobyl accident suggest that the external dose may be considered a valid surrogate for the internal dose of the thyroid gland. We, therefore, calculated the average external effective dose-rate (μSv/h) for the 59 municipalities of the Fukushima prefecture based on published data of air and soil radiation. We further determined the municipality-specific absolute numbers of thyroid cancers found by each of the two screening rounds in the corresponding municipality-specific exposed person-time observed. A possible association between the radiation exposure and the thyroid cancer detection rate was analyzed with Poisson regression assuming Poisson distributed thyroid cancer cases in the exposed person-time observed per municipality.The target populations consisted of 367,674 and 381,286 children and adolescents for the 1st and the 2nd screening rounds, respectively. In the 1st screening, 300,476 persons participated and 270,489 in the 2nd round. From October 2011 to March 2016, a total of 184 cancer cases were found in 1,079,786 person-years counted from the onset of the exposure to the corresponding examination periods in the municipalities. A significant association between the external effective dose-rate and the thyroid cancer detection rate exists: detection rate ratio (DRR) per μSv/h 1.065 (1.013, 1.119). Restricting the analysis to the 53 municipalities that received less than 2 μSv/h, and which represent 176 of the total 184 cancer cases, the association appears to be considerably stronger: DRR per μSv/h 1.555 (1.096, 2.206).The average radiation dose-rates in the 59 municipalities of the Fukushima prefecture in June 2011 and the corresponding thyroid cancer detection rates in the period October 2011 to March 2016 show statistically significant relationships.
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Affiliation(s)
- Hidehiko Yamamoto
- Osaka Red Cross Hospital Attached Facility of Physically Handicapped Children, 5-30 Fudegasaki-cho, Tennouji-ku
| | - Keiji Hayashi
- Hayashi Children's Clinic, 4-6-11-1F Nagata, Joto-ku, Osaka-Shi Osaka, Japan
| | - Hagen Scherb
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Computational Biology, Ingolstädter Landstr. 1, D-85764 Neuherberg, Germany
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21
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Kushchayeva YS, Kushchayev SV, Startzell M, Cochran E, Auh S, Dai Y, Lightbourne M, Skarulis M, Brown RJ. Thyroid Abnormalities in Patients With Extreme Insulin Resistance Syndromes. J Clin Endocrinol Metab 2019; 104:2216-2228. [PMID: 30657911 PMCID: PMC6482021 DOI: 10.1210/jc.2018-02289] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/11/2019] [Indexed: 12/16/2022]
Abstract
CONTEXT Insulin and leptin may increase growth and proliferation of thyroid cells, underlying an association between type 2 diabetes and papillary thyroid cancer (PTC). Patients with extreme insulin resistance due to lipodystrophy or insulin receptor mutations (INSR) are treated with high-dose insulin and recombinant leptin (metreleptin), which may increase the risk of thyroid neoplasia. OBJECTIVE The aim of this study was to analyze thyroid structural abnormalities in patients with lipodystrophy and INSR mutations and to assess whether insulin, IGF-1, and metreleptin therapy contribute to the thyroid growth and neoplasia in this population. DESIGN Thyroid ultrasound characteristics were analyzed in 81 patients with lipodystrophy and 11 with INSR (5 homozygous; 6 heterozygous). Sixty patients were taking metreleptin. RESULTS The prevalence of thyroid nodules in children with extreme insulin resistance (5 of 30, 16.7%) was significantly higher than published prevalence for children (64 of 3202; 2%), with no difference between lipodystrophy and INSR. Body surface area-adjusted thyroid volume was larger in INSR homozygotes vs heterozygotes or lipodystrophy (10.4 ± 5.1, 3.9 ± 1.5, and 6.2 ± 3.4 cm2, respectively. Three patients with lipodystrophy and one INSR heterozygote had PTC. There were no differences in thyroid ultrasound features in patients treated vs not treated with metreleptin. CONCLUSION Children with extreme insulin resistance had a high prevalence of thyroid nodules, which were not associated with metreleptin treatment. Patients with homozygous INSR mutation had thyromegaly, which may be a novel phenotypic feature of this disease. Further studies are needed to determine the etiology of thyroid abnormalities in patients with extreme insulin resistance.
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Affiliation(s)
- Yevgeniya S Kushchayeva
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health, Bethesda, Maryland
| | | | - Megan Startzell
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health, Bethesda, Maryland
| | - Elaine Cochran
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health, Bethesda, Maryland
| | - Sungyoung Auh
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health, Bethesda, Maryland
| | - Yuhai Dai
- Clinical Core Laboratory, National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health, Bethesda, Maryland
| | - Marissa Lightbourne
- National Institute of Child Health and Human Development/National Institutes of Health, Bethesda, Maryland
| | - Monica Skarulis
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health, Bethesda, Maryland
| | - Rebecca J Brown
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health, Bethesda, Maryland
- Correspondence and Reprint Requests: Rebecca J. Brown, MD, National Institutes of Health, Building 10, Room 6-5940, 10 Center Drive, Bethesda, Maryland 20892. E-mail:
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22
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Bian H, Wang Y, Chen W, Zhang Y, Zhuang Z, Xia R, Dai H, Feng J, Pu W, Chen L, Cai W, Hu W, Liu Y. Multiple Organ Lesions in a Case of Contamination With Multiple Radionuclides After 38 Years. Dose Response 2018; 16:1559325818815019. [PMID: 30559637 PMCID: PMC6291884 DOI: 10.1177/1559325818815019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/05/2018] [Accepted: 10/25/2018] [Indexed: 11/15/2022] Open
Abstract
The patient was contaminated with multiple radionuclides 38 years ago due to an accident. To investigate the effects of radionuclide contamination on humans, he has been followed up by examinations for many years. Long-term effects gradually emerge in these years. Lung cancer was diagnosed by medical examinations. Besides, chronic gastritis with intestinal metaplasia was indicated by gastroscopic biopsies, while colorectal polyps found by colonoscopy. All 13 colorectal polyps were removed, and radical surgery for lung cancer was performed. Fortunately, pathological examinations indicated that it was early lung cancer. The ground glass nodule (GGN) in left lung identified during the follow-up will be resected when needed. It is speculated that multiple manifestations of the patient may be related to radiation, and different lesions in the organs may be related to systemic adaptive response. However, longer follow-up is needed due to a lack of effective and direct evidence. This work is expected to provide experiences for similar patients' treatment and follow-up.
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Affiliation(s)
- Huahui Bian
- Department of Nuclear Accident Medical Emergency, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Youyou Wang
- Department of Nuclear Accident Medical Emergency, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Weibo Chen
- Department of Nuclear Accident Medical Emergency, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yusong Zhang
- Department of Nuclear Accident Medical Emergency, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhixiang Zhuang
- Department of Oncology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Rui Xia
- Department of Oncology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Hong Dai
- Department of Nuclear Accident Medical Emergency, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Junchao Feng
- Department of Nuclear Accident Medical Emergency, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wangyang Pu
- Department of Oncology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Lei Chen
- Department of Oncology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wu Cai
- Department of Medical Imaging, the Second Affiliated Hospital of Soochow University, Suzhou,China
| | - Wentao Hu
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
- Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou, China
| | - Yulong Liu
- Department of Nuclear Accident Medical Emergency, The Second Affiliated Hospital of Soochow University, Suzhou, China
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
- Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou, China
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