Digital Medicine in Thyroidology: A New Era of Managing Thyroid Disease

Understanding the factors of wearable devices among the patients with thyroid cancer: A modified UTAUT2 model

Wearable devices hold promising prospects on a global scale, including in China. Thyroid cancer prevalence is notably high in China.This purpose of this researchwas to provide an updated theoretical model for assessing Chinese thyroid cancer patients' intentions towards wearable devices, based on the UTAUT2 framework, and to ascertain the factors that have an impact on these intents. A cross-sectional study with an institutional focus wasconducted from January 20, 2023, to June 30, 2023, at several general hospitals in China. Five hundred participants were recruited to identify predictors of wearable device use.The questionnaire survey about patients' intentionswas collected using a face-to-face method, employing a random sampling technique for patient selection. Four hundred sixty-nine individuals (93.8%) had the intention to use wearable devices. The intentions were highly impacted by performance expectancy (PE), effort expectancy (EE), social influence (SI), hedonic motivation (HM), price value (PV) and habit (HA). Usage intention (UI)was a statistically predictor of Usage behavior (UB). The facilitating condition(FC) was not significant. Gender positively moderated the relationship between EE and UI. Income positively moderated the relationship between all variables and UI.Overall, the utilization of wearable devices among patients diagnosed with thyroid cancer has demonstrated considerable potential. This study offers a series of suggestions for digital health developers,healthcare decision-makers,doctors and patients.

Empirical Method for Thyroid Disease Classification Using a Machine Learning Approach

There are many thyroid diseases affecting people all over the world. Many diseases affect the thyroid gland, like hypothyroidism, hyperthyroidism, and thyroid cancer. Thyroid inefficiency can cause severe symptoms in patients. Effective classification and machine learning play a significant role in the timely detection of thyroid diseases. This timely classification will indeed affect the timely treatment of the patients. Automatic and precise thyroid nodule detection in ultrasound pictures is critical for reducing effort and radiologists' mistake rate. Medical images have evolved into one of the most valuable and consistent data sources for machine learning generation. In this paper, various machine learning algorithms like decision tree, random forest algorithm, KNN, and artificial neural networks on the dataset create a comparative analysis to better predict the disease based on parameters established from the dataset. Also, the dataset has been manipulated for accurate prediction for the classification. The classification was performed on both the sampled and unsampled datasets for better comparison of the dataset. After dataset manipulation, we obtained the highest accuracy for the random forest algorithm, equal to 94.8% accuracy and 91% specificity.

Association between Thyroid Function and Heart Rate Monitored by Wearable Devices in Patients with Hypothyroidism

BACKGROUND

Heart rate (HR) monitored by a wearable device (WD) has demonstrated its clinical feasibility for thyrotoxicosis subjects. However, the association of HR monitored by wearables with hypothyroidism has not been examined. We assessed the association between serum thyroid hormone concentration and three WD-HR parameters in hypothyroid subjects.

METHODS

Forty-four subjects scheduled for radioactive iodine therapy (RAI Tx) after thyroid cancer surgery were included. Thirty subjects were prepared for RAI Tx by thyroid hormone withdrawal (hypothyroidism group) and 14 subjects by recombinant human thyrotropin (control group). Three WD-HR parameters were calculated from the HR data collected during rest, during sleep, and from 2:00 AM to 6:00 AM, respectively. We analyzed the changes in conventionally measured resting HR (On-site rHR) and WDHR parameters relative to thyroid hormone levels.

RESULTS

Serum free thyroxine (T4) levels, On-site rHR, and WD-HR parameters were lower in the hypothyroid group than in the control group at the time of RAI Tx. WD-HR parameters also reflected minute changes in free T4 levels. A decrease in On-site rHR and WD-HR parameters by one standard deviation (On-site rHR, approximately 12 bpm; WD-HR parameters, approximately 8 bpm) was associated with a 0.2 ng/dL decrease in free T4 levels (P<0.01) and a 2-fold increase of the odds ratio of hypothyroidism (P<0.01). WD-HR parameters displayed a better goodness-of-fit measure (lower quasi-information criterion value) than On-site rHR in predicting the hypothyroidism.

CONCLUSION

This study identified WD-HR parameters as informative and easy-to-measure biomarkers to predict hypothyroidism.

Diagnostic Performance of Kwak, EU, ACR, and Korean TIRADS as Well as ATA Guidelines for the Ultrasound Risk Stratification of Non-Autonomously Functioning Thyroid Nodules in a Region with Long History of Iodine Deficiency: A German Multicenter Trial

Germany has a long history of insufficient iodine supply and thyroid nodules occur in over 30% of the adult population, the vast majority of which are benign. Non-invasive diagnostics remain challenging, and ultrasound-based risk stratification systems are essential for selecting lesions requiring further clarification. However, no recommendation can yet be made about which system performs the best for iodine deficiency areas. In a German multicenter approach, 1211 thyroid nodules from 849 consecutive patients with cytological or histopathological results were enrolled. Scintigraphically hyperfunctioning lesions were excluded. Ultrasound features were prospectively recorded, and the resulting classifications according to five risk stratification systems were retrospectively determined. Observations determined 1022 benign and 189 malignant lesions. The diagnostic accuracies were 0.79, 0.78, 0.70, 0.82, and 0.79 for Kwak Thyroid Imaging Reporting and Data System (Kwak-TIRADS), American College of Radiology (ACR) TI-RADS, European Thyroid Association (EU)-TIRADS, Korean-TIRADS, and American Thyroid Association (ATA) Guidelines, respectively. Receiver Operating Curves revealed Areas under the Curve of 0.803, 0.795, 0.800, 0.805, and 0.801, respectively. According to the ATA Guidelines, 135 thyroid nodules (11.1%) could not be classified. Kwak-TIRADS, ACR TI-RADS, and Korean-TIRADS outperformed EU-TIRADS and ATA Guidelines and therefore can be primarily recommended for non-autonomously functioning lesions in areas with a history of iodine deficiency.

Associations of Thyroid Hormones and Resting Heart Rate in Patients Referred to Coronary Angiography

Resting heart rate (RHR) is associated with increased risk of cardiovascular morbidity and mortality. Thyroid hormones exert several effects on the cardiovascular system, but the relation between thyroid function and RHR remains to be further established. We evaluated whether measures of thyroid hormone status are associated with RHR in patients referred to coronary angiography. Thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxin (FT4), and RHR were determined in 2795 participants of the Ludwigshafen Risk and Cardiovascular Health (LURIC) Study. Median (25th to 75th percentile) serum concentrations were 1.25 (0.76-1.92) mU/l for TSH, 4.8 (4.2-5.3) pmol/l for FT3 and 17.1 (15.4-19.0) pmol/l for FT4, and mean (±standard deviation) RHR was 68.8 (±11.7) beats/min. Comparing the highest versus the lowest quartile, RHR (beats/min) was significantly higher in the fourth FT4 quartile [3.48, 95% confidence interval (CI): 2.23-4.73; p <0.001] and in the fourth FT3 quartile (2.30, 95% CI: 1.06-3.55; p <0.001), but there was no significant difference for TSH quartiles. In multiple linear regression analyses adjusting for various potential confounders, FT3 and FT4 were significant predictors of RHR (p <0.001 for both). In subgroups restricted to TSH, FT3, and FT4 values within the reference range, both FT3 and FT4 remained significant predictors of RHR (p <0.001 for all). In conclusion, in patients referred to coronary angiography, FT3 and FT4 but not TSH were positively associated with RHR. The relationship between free thyroid hormones and RHR warrants further investigations regarding its diagnostic and therapeutic implications.

Ultrasound risk stratification systems for thyroid nodule: between lights and shadows, we are moving towards a new era

Ultrasound (US) has long played a major role in the assessment of thyroid nodules and their risk of malignancy, and its importance has been further enhanced over the past decade by the development of a number of US-based risk stratification systems (US-RSSs), referred to in some cases as TIRADS (Thyroid Imaging Reporting And Data Systems). The high-risk categories of all currently available US-RSSs display strong associations to cytological diagnostic classes of "malignant/suspicious-for-malignancy" and the low-risk classes are clearly associated to "not neoplastic/benign" cytology. The introduction of these systems has elevated the diagnostic performance of US to a level approaching that of fine-needle aspiration (FNA) cytology. The time seems ripe to exploit this new level of accuracy to reduce the number of FNAs for nodules likely to be benign (i.e., sonographically classified as low-risk with no suspicious clinical features). In the near future, US-RSS could also become the main tool for diagnosing papillary thyroid cancers. The establishment of a new "international TIRADS"-currently in progress-will be critical to guide us towards a new era.