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Sartori PV, Andreani S, De Pasquale L, Pauna I, Bulfamante AM, Aiello PSL, Melcarne R, Giacomelli L, Boniardi M. How to Manage Advanced Differentiated Thyroid Cancer: Step-by-Step Analysis from Two Italian Tertiary Referral Centers. J Clin Med 2024; 13:708. [PMID: 38337400 PMCID: PMC10856418 DOI: 10.3390/jcm13030708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Differentiated thyroid carcinoma (DTC) has an excellent prognosis; however, advanced disease is associated with a worse prognosis and is relatively common. Surgery followed by RAI treatment remains the mainstream treatment for a large majority of patients with high- and intermediate-risk DTC, but its benefits should be carefully weighed against the potential for harm. The aim of this paper is to critically review the experience in treating advanced DTC at two tertiary referral centers in Italy. METHODS Retrospective analysis of 300 patients who underwent surgery for ADTC over 30 years. RESULTS The complication rate was 50.33%. A total of 135 patients (45%) remained at regular follow-up, 118 (87.4%) were alive, while 17 (12.6%) were deceased. The mean overall survival at 12 years was 84.8% with a mean of 238 months. Eleven patients (8.1%) experienced a relapse after a median of 13 months. CONCLUSIONS ADTC patients adequately treated can achieve prolonged survival even in the case of metastasis or disease relapse. Patients with ADTC should be referred to high-volume centers with the availability of an extended multidisciplinary team to receive tailored treatment.
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Affiliation(s)
| | - Sara Andreani
- Endocrine Surgery Unit, Niguarda Hospital, 20162 Milan, Italy; (S.A.); (I.P.); (P.S.L.A.); (M.B.)
| | - Loredana De Pasquale
- Thyroid and Parathyroid Surgery Service-Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy;
| | - Iuliana Pauna
- Endocrine Surgery Unit, Niguarda Hospital, 20162 Milan, Italy; (S.A.); (I.P.); (P.S.L.A.); (M.B.)
| | - Antonio Mario Bulfamante
- Pediatric Otolaryngology Unit, ASST Fatebenefratelli-Sacco, Buzzi Children Hospital, 20162 Milan, Italy;
| | | | - Rossella Melcarne
- Department of Translational and Precision Medicine, Sapienza University of Rome, AOU Umberto I, 00185 Rome, Italy;
| | - Laura Giacomelli
- Department of General and Specialty Surgery, Sapienza University of Rome, AOU Umberto I, 00185 Rome, Italy;
| | - Marco Boniardi
- Endocrine Surgery Unit, Niguarda Hospital, 20162 Milan, Italy; (S.A.); (I.P.); (P.S.L.A.); (M.B.)
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Paparodis R, Livadas S, Karvounis E, Bantouna D, Zoupas I, Angelopoulos N, Imam S, Jaume JC. Elevated Preoperative TPO Ab Titers Decrease Risk for DTC in a Linear Fashion: A Retrospective Analysis of 1635 Cases. J Clin Endocrinol Metab 2023; 109:e347-e355. [PMID: 37440589 DOI: 10.1210/clinem/dgad408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
CONTEXT For some, chronic lymphocytic thyroiditis (Hashimoto thyroiditis) is an important risk factor for differentiated thyroid cancer (DTC). Surgical cohort studies even suggested a potential role for thyroid peroxidase antibodies (TPO-Abs) on that risk. OBJECTIVE Our clinical observations argued against that possibility. We designed the present study to evaluate the relationship of TPO-Abs and DTC in a large patient population. METHODS We recruited individuals who underwent thyroidectomies at 4 different clinical sites (USA: 1 clinic, 2000-2013, and Greece: 3 clinics, 2007-2021). We gathered data on TPO-Abs titers measured with commercially available chemiluminescence immunoassays, and reviewed patients' data including surgical pathology. TPO-Abs of 34 IU/mL or greater was deemed positive (TPO+) and TPO-Abs less than 34 IU/mL was deemed negative (TPO-). Odds ratios (OR) for DTC were calculated with the Fisher exact test and P less than .05 was deemed significant. RESULTS We reviewed data from 8461 consecutive thyroid surgery cases. TPO-Abs titers were available for 1635 individuals: DTC n = 716 (43.8%), benign pathology n = 919 (56.2%), TPO+ n = 540 (33.0%), and TPO- n = 1095 (67.0%). DTC was found at a lower frequency in TPO+ (198/540, 36.7%) compared to TPO- (518/1095, 47.3%) patients, OR 0.64 (0.52-0.80; P < .0001). Rising TPO-Abs titers conferred protection against DTC in a linear fashion: TPO-Abs less than 10 IU/mL: 59.3%, TPO-Abs less than 34 IU/mL: 47.4%, TPO-Abs 34 to 100 IU/mL: 42.6%, TPO-Abs 100 to 500 IU/mL: 32.0%, TPO-Abs greater than 1000 IU/mL: 19.4%; P less than .0001. CONCLUSION Higher TPO-Ab titers appear protective against DTC in our large multicenter cohort of patients who underwent thyroidectomies. Rising preoperative TPO-Abs titers conferred linearly increasing protection against DTC.
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Affiliation(s)
- Rodis Paparodis
- Center for Diabetes and Endocrine Research, College of Medicine and Life Sciences (formerly Medical College of Ohio), University of Toledo, Toledo, OH 43606, USA
- Private Practice, Patras 26221, Greece
| | - Sarantis Livadas
- Division of Endocrinology, Diabetes and Metabolism, Athens Medical Center, Athens 11527, Greece
| | - Evangelos Karvounis
- Endocrine Surgery Center of Excellence, Euroclinic Hospital, Athens 11521, Greece
| | | | - Ioannis Zoupas
- University of Athens Medical School, Athens 10563, Greece
| | | | - Shahnawaz Imam
- Center for Diabetes and Endocrine Research, College of Medicine and Life Sciences (formerly Medical College of Ohio), University of Toledo, Toledo, OH 43606, USA
| | - Juan Carlos Jaume
- Center for Diabetes and Endocrine Research, College of Medicine and Life Sciences (formerly Medical College of Ohio), University of Toledo, Toledo, OH 43606, USA
- Department of Medicine, Edward Hines, Jr. VA Hospital/Loyola University Chicago, Hines, IL 60141, USA
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Lei Z, He Z, Mei Y, Qi X, Yu P, Xu G, Cheng H, Bai R, Deng J. Associations of psychological status and ultrasonic characteristics of thyroid nodules in adults during the COVID-19 pandemic. Front Psychol 2023; 14:1202122. [PMID: 37519348 PMCID: PMC10382619 DOI: 10.3389/fpsyg.2023.1202122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Background The morbidity of thyroid cancer has been increasing in the last decades all over the world. In addition to the more sensitive thyroid nodule screening technology, several social and environmental factors might represent credible candidates for this increase. They include psychological stress, lifestyle-associated risk factors, nutritional deficiencies, and environmental pollutants. Foremost, psychological stress had gained high interest as a possible promoter and a modifiable risk factor for thyroid nodules in recent years. The present study was to investigate the clinical characteristics and psychological status of the population during the peak of coronavirus disease 2019 (COVID-19) and assessed the association of psychosocial determinants and the ultrasonic characteristics of thyroid nodules. Methods In this cross-sectional study, 490 adult subjects who had received at least two doses of COVID-19 vaccine and were not infected with COVID-19, and did not know whether they had thyroid nodules, received thyroid color ultrasound examination and psychological questionnaire survey. Depression, anxiety, and stress were assessed using Depression Anxiety Stress Scales-21 (DASS-21). Sleep quality was rated using the Pittsburgh sleep quality index (PQSI). The characteristics of 243 subjects with thyroid nodules were described and recorded in detail by thyroid color ultrasound, and the correlations between anxiety, depression, sleep quality, clinical indicators, and thyroid nodule ultrasound characteristics were analyzed. Associations between psychological status (mutually adjusted predictors) and ultrasonic characteristics of thyroid nodules (outcome) were modeled using binary logistic regression controlling for sex, age, BMI, TSH, FT3, and FT4. Results Depression was positively correlated with thyroid hypoechoic nodule (OR = 3.720, 95%CI 1.615-8.570), microcalcification of thyroid nodule (OR = 3.638, 95%CI 1.476-8.966), the aspect ratio of thyroid nodule>1 (OR = 3.860, 95%CI 1.052-14.161), the unclear boundary of thyroid nodule (OR = 4.254, 95%CI 1.359-13.312), and the irregular edge of thyroid nodule (OR = 4.134, 95%CI 1.810-9.439). Anxiety was positively correlated with microcalcification of thyroid nodules (OR = 4.319, 95%CI 1.487-11.409). Stress was positively correlated with thyroid hypoechoic nodules (OR = 4.319, 95%CI 1.487-11.409), microcalcification of thyroid nodules (OR = 2.724, 95%CI 1.038-7.151), and the irregular edge of thyroid nodules (OR = 2.478, 95%CI 1.077-5.705). Conclusion This study demonstrates that depression, anxiety, and stress were associated with the morbidity of thyroid nodules and thyroid ultrasound characteristics. During COVID-19, people's negative emotions increased significantly compared to before. Negative emotions might be harmful to thyroid health. Therefore, during periods of high stress, strategies to prevent psychological problems should be implemented to improve thyroid health.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jing Deng
- Health Medical Center, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Dong S, Liu Q, Jiang M, Ma Q, Huang Q, Liu T, Li Y, Ni L, Shi Y. Xiao-Luo-Wan treats propylthiouracil-induced goiter with hypothyroidism in rats through the PI3K-AKT/RAS pathways based on UPLC/MS and network pharmacology. JOURNAL OF ETHNOPHARMACOLOGY 2022; 289:115045. [PMID: 35101570 DOI: 10.1016/j.jep.2022.115045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/14/2021] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Goiter with hypothyroidism occurs in several thyroid diseases. Xiao-Luo-Wan (XLW), which contains Scrophularia ningpoensis Hemsl., Fritillaria thunbergii Miq. and Ostrea gigas Thunberg, has been used as an effective Chinese medicine for the treatment of goiters in China for hundreds of years. Based on clinical observations and experimental studies, XLW also exerts a certain effect on hypothyroidism. However, the therapeutic mechanism of XLW remains unclear. AIM OF THE STUDY The present study aimed to investigate the therapeutic effect of XLW on propylthiouracil (PTU)-induced goiter with hypothyroidism in rats and to uncover the underlying molecular mechanism using ultra high-performance liquid chromatography-mass spectrometry (UPLC/MS), network pharmacology, and molecular docking simulations. MATERIALS AND METHODS After successful modeling, the remaining rats were randomly divided into a model group, an Euthyrox group, an XLW group, and a control group. The corresponding drugs were given by gavage for four consecutive weeks. The growth status was monitored, the relative thyroid weight was calculated, and the total serum T3, T4, and TSH content were detected. Hematoxylin-eosin (H&E) staining was used to observe the pathological changes in the thyroid glands. The chemical components of the XLW were identified by UPLC/MS and the putative targets of XLW were predicted using multiple databases. We performed network pharmacology based on the intersection of goiter/hypothyroidism-related targets and XLW targets. Then, we performed KEGG pathway enrichment analysis, and key targets were further screened using protein-protein interaction (PPI) networks. Finally, molecular docking was used to predict the binding ability of XLW identified components and the key targets. RESULTS XLW significantly increased the levels of T3 and T4, and reduced TSH, increased body weight, and decreased swollen thyroid glands in PTU-induced rats. XLW promoted the morphological recovery of thyroid follicles and epithelial cells. Twenty-one main chemical components of XLW were identified using UPLC/MS. 270 potential gene targets of XLW and 717 known targets of goiter/hypothyroidism disease were obtained by searching the Traditional Chinese Medicine Systems Pharmacology Database (TCMSP), Swiss Target Prediction, and UniProt databases. A total of 83 KEGG pathways were enriched with phosphatidylinositol 3-kinase-protein kinase B (PI3K-AKT) and RAS signaling pathways. PPI analysis revealed nine key targets of kinase-protein kinase B (AKT) 1, interleukin (IL) 6, vascular endothelial growth factor A (VEGFA), tumor necrosis factor (TNF), glyceraldehyde 3-phosphate dehydrogenase (GAPDH), epidermal growth factor receptor (EGFR), GTPase HRas (HRAS), matrix metalloproteinase (MMP) 9, and heat shock protein 90 alpha family class A member 1 (HSP90AA1). Molecular docking verified which drug components had good binding ability to key targets (all ≤5 kcal/mol). CONCLUSION For PTU-induced goiter with hypothyroidism in rats, XLW improves thyroid function, reduces goiter, increases body weight, and promotes the recovery of thyroid follicles and epithelial cells. The underlying molecular mechanism suggests that XLW may regulate thyroid hormone signaling by regulating the PI3K-AKT, RAS, and other signaling pathways. This study provides a pharmacological and biological basis for using XLW to treat goiter with hypothyroidism.
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Affiliation(s)
- Shi Dong
- School of Life Sciences, Beijing University of Chinese Medicine, Liangxiang University Town, Fangshan District, Beijing, 102488, China.
| | - Qunying Liu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Liangxiang University Town, Fangshan District, Beijing, 102488, China.
| | - Miao Jiang
- School of Life Sciences, Beijing University of Chinese Medicine, Liangxiang University Town, Fangshan District, Beijing, 102488, China.
| | - Qihong Ma
- School of Life Sciences, Beijing University of Chinese Medicine, Liangxiang University Town, Fangshan District, Beijing, 102488, China.
| | - Qianqian Huang
- School of Life Sciences, Beijing University of Chinese Medicine, Liangxiang University Town, Fangshan District, Beijing, 102488, China.
| | - Tianhua Liu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Liangxiang University Town, Fangshan District, Beijing, 102488, China.
| | - Yuan Li
- School of Management, Beijing University of Chinese Medicine, Liangxiang University Town, Fangshan District, Beijing, 102488, China.
| | - Lei Ni
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Liangxiang University Town, Fangshan District, Beijing, 102488, China.
| | - Yuanyuan Shi
- School of Life Sciences, Beijing University of Chinese Medicine, Liangxiang University Town, Fangshan District, Beijing, 102488, China; Shenzhen Research Institute, Beijing University of Chinese Medicine, Pingshan District, Shenzhen, 518118, China.
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Maternal Thyroid Disease and the Risk of Childhood Cancer in the Offspring. Cancers (Basel) 2021; 13:cancers13215409. [PMID: 34771572 PMCID: PMC8582383 DOI: 10.3390/cancers13215409] [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] [Received: 09/22/2021] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Maternal thyroid disease, especially hypothyroidism, affects pregnancy and its outcome. In-utero exposure to autoimmune thyroid disease has been reported to associate with childhood ALL in the offspring. We evaluated the risk of childhood cancer in the offspring following exposure to maternal thyroid disease in a case-control setting using registry data. All patients with their first cancer diagnosis below the age of 20 years were identified from the Finnish Cancer Registry (n = 2037) and matched for sex and birth year at a 1:5 ratio to population controls identified from the Medical Birth Registry (n = 10,185). We collected national information on maternal thyroid disease from the Medical Birth Registry, Care Register for Health Care, Register for Reimbursed Drug Purchases and Register of Special Reimbursements. We used conditional logistic regression to analyze childhood cancer risk in the offspring. The adjusted OR for any childhood cancer was 1.41 (95%, CI 1.00-2.00) comparing the offspring of mothers with hypothyroidism and those with normal thyroid function. The risk of lymphomas was increased (adjusted OR for maternal hypothyroidism 3.66, 95%, CI 1.29-10.38). The results remained stable when mothers with cancer history were excluded from the analyses. Maternal hypothyroidism appears to be associated with an increased risk for childhood lymphoma in the offspring. The association exists even after excluding possible familial cancers.
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Zhou L, Chen G, Sheng L, Liu N, Zhang B, Zeng Q, Chen B. Influence Factors for Lymph Node Metastasis in Papillary Thyroid Carcinoma: Hashimoto's Thyroiditis Has a Weak Effect on Central or Lateral Lymph Node Metastasis. Cancer Manag Res 2021; 13:3953-3961. [PMID: 34017198 PMCID: PMC8131014 DOI: 10.2147/cmar.s310773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/24/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose To analyze the effect of Hashimoto’s thyroiditis (HT) concurrent with papillary thyroid cancer (PTC) on cervical lymph node metastasis (LNM). Methods Two thousand nine hundred twenty-six patients who underwent thyroidectomy and lymph node dissection between January 2015 and December 2018 were enrolled in this study. Patient demographics and clinicopathologic features were analyzed. Results Of the total enrolled patients, 598 (20.4%) had concurrent HT. There were 1482 PTC cases with N0, 1033 cases with N1a, and 411 cases with N1b. Patients with HT had lower frequency of extrathyroidal extension (ETE), lymphatic vascular (LV) invasion, high pathological T stage (III+IV) and central LNM rate. Stratifying central LNM by non-ETE or without intrathyroidal spreading, it was further found that central LNM rate in patients with HT was lower than that of patients without HT. However, there was no significant difference in the central LNM rate in patients with PTC stratified by ETE or intrathyroidal spreading. HT with PTC played a weak protective role in N1a, reducing the risk of N1a by 16.4%. Conversely, HT is a risk factor for N1b, increasing the risk by 1.336 times compared to patients without HT. TgAb is an independent risk factor for N1b, which appears related to the promotion of N1b by HT. Conclusion In PTC, HT has a protective effect on central LNM and a risk effect on lateral LNM, although the difference was not significant. This weak protective effect on N1a is more obvious in PTC with less aggressive clinicopathologic characteristics. The risk effect of HT on N1b may be associated with TgAb.
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Affiliation(s)
- Liguang Zhou
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Gang Chen
- Department of General Surgery, Shandong Guoxin Healthcare Group Xinwen Center Hospital, Taian, People's Republic of China
| | - Lei Sheng
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
| | - Nan Liu
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
| | - Bin Zhang
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
| | - Qingdong Zeng
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
| | - Bo Chen
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
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Analyses of the Association between Thyroid Cancer and Osteoporosis/Fracture Histories: A Cross-Sectional Study Using KoGES HEXA Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094732. [PMID: 33946728 PMCID: PMC8124932 DOI: 10.3390/ijerph18094732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/11/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: The purpose of this study was to determine the association among thyroid cancer, osteoporosis and fracture history. (2) Methods: The data collected from 2004 through 2016 for the Korean Genome and Epidemiology Study were retrieved. For a total of 1349 participants with thyroid cancer and 163,629 control participants, the odds ratios (ORs) with 95% confidence intervals (CIs) of osteoporosis and fracture history were evaluated using a logistic regression model. (3) Results: The adjusted ORs of osteoporosis comparing thyroid cancer with the control group were 1.41 (95% CI = 1.18–1.70, p < 0.001) for all participants and 1.43 (95% CI = 1.19–1.71, p < 0.001) for women. The adjusted ORs of fracture history comparing these two groups were not significantly associated within the entire group of participants, men only or women only. (4) Conclusions: The adjusted OR of osteoporosis was significantly higher than 1, comparing thyroid cancer with the control group, especially in women. The adjusted OR of fractures was not significantly higher than 1, comparing the thyroid cancer group with the control group.
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Suh J, Choi HS, Kwon A, Chae HW, Kim HS. Adolescents with thyroid nodules: retrospective analysis of factors predicting malignancy. Eur J Pediatr 2020; 179:317-325. [PMID: 31741093 DOI: 10.1007/s00431-019-03507-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/10/2019] [Accepted: 10/14/2019] [Indexed: 01/10/2023]
Abstract
Thyroid nodules are less common in children than in adults. However, pediatric thyroid nodules have a higher rate of malignancy compared to those in adults, and increased risk of metastasis and recurrence. In the present study, we analyzed the clinical features as well as laboratory and thyroid ultrasound (US) findings of children and adolescents with thyroid nodules to identify predictive factors of thyroid cancer. We retrospectively analyzed 275 patients with thyroid nodules under 18 years of age who visited Severance Children's Hospital between January 2005 and May 2017. Among them, 141 patients who underwent ultrasonography-guided fine needle aspiration biopsy (FNAB), and four patients without FNAB who underwent surgical resection, were included in this study. The remaining 125 patients without FNAB and five patients with follow-up loss after FNAB were excluded. Clinical, laboratory, and US data were evaluated in 145 patients to establish the potential predictive factors of thyroid cancer. Thyroid malignancies were observed in 101 patients. Grade 2 goiters were seen more often in benign nodule group. Hypoechoic nodules, nodules with microcalcifications, abnormal lymph nodes, and irregular margins were findings significantly associated with thyroid cancer. The findings of hypoechoic nodule, nodule with microcalcifications, and abnormal lymph nodes showed statistical significance in predicting thyroid cancer.Conclusion: Hypoechoic nodules, nodules with microcalcifications, and abnormal lymph nodes are predictive factors for thyroid cancer in children. Therefore, further diagnostic evaluations, including FNAB, should be considered in patients with such findings.What is Known:• Thyroid nodules are less common in children than in adults, but pediatric thyroid nodules have a higher rate of malignancy, and also have increased risk of metastasis and recurrence.• Research on ways to predict thyroid cancer have mostly been accomplished in adult patients, and the application of risk stratification system has not been fully satisfactory in children, which requires further studies in pediatric thyroid nodules.What is New:• Hypoechoic nodules, nodules with microcalcifications, and abnormal lymph nodes are predictive factors for thyroid cancer in Korean children.
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Affiliation(s)
- Junghwan Suh
- Department of Pediatrics, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Han Saem Choi
- Department of Pediatrics, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Ahreum Kwon
- Department of Pediatrics, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Hyun Wook Chae
- Department of Pediatrics, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
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Xiao Y, Zhou Q, Xu Y, Yuan SL, Liu QA. Positive thyroid antibodies and risk of thyroid cancer: A systematic review and meta-analysis. Mol Clin Oncol 2019; 11:234-242. [PMID: 31341621 PMCID: PMC6636211 DOI: 10.3892/mco.2019.1886] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/12/2019] [Indexed: 02/06/2023] Open
Abstract
Previous studies assessing the association between thyroid antibodies and the risk of thyroid cancer (TC) have produced inconsistent results. The present study therefore conducted a meta-analysis of the available data. PubMed, Embase and the Cochrane Library were searched for the retrieval of relevant studies and a meta-analysis was conducted to systematically evaluate the association between positive thyroid antibodies and the risk of TC. This search identified 16 articles containing 17 studies on thyroglobulin antibodies (TgAb), which involved a total of 34,488 patients. Positive TgAb was associated with an increased risk of TC [odds ratio (OR)=1.93, 95% confidence interval (CI)=1.64–2.27, I2=67.2%]. Whether to adjust for confounding factors (gender and thyroid nodule number) was the main cause of heterogeneity. A stronger association between positive TgAb and an increased risk of TC was identified in the studies with an unadjusted thyroid nodule number (OR=2.14, 95% CI=1.82–2.52), as compared to those with an adjusted thyroid nodule number (OR=1.61, 95% CI=1.29–2.00; P=0.04). In addition, 12 studies on thyroid peroxidase antibodies (TPOAb) involving 30,007 patients were included. Positive TPOAb was associated with an increased risk of TC (OR=1.50, 95%CI=1.16–1.95, I2=83.0%). No significant heterogeneity was observed in the PTC group. Positive TgAb is an independent risk factor for TC. The association between positive TPOAb and increased risk of TC needs to be further studied.
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Affiliation(s)
- Yang Xiao
- Department of General Surgery, First People's Hospital of Changde City, Changde, Hunan 415003, P.R. China.,Department of General Surgery, Affiliated Changde Hospital, University of South China, Changde, Hunan 415003, P.R. China
| | - Quan Zhou
- Department of Science and Education, First People's Hospital of Changde City, Changde, Hunan 415003, P.R. China
| | - Yong Xu
- Department of General Surgery, First People's Hospital of Changde City, Changde, Hunan 415003, P.R. China
| | - Song-Lin Yuan
- Department of General Surgery, First People's Hospital of Changde City, Changde, Hunan 415003, P.R. China
| | - Qing-An Liu
- Department of General Surgery, First People's Hospital of Changde City, Changde, Hunan 415003, P.R. China
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Sulaieva O, Chernenko O, Chereshneva Y, Tsomartova D, Larin O. Thyroid stimulating hormone levels and BRAFV600E mutation contribute to pathophysiology of papillary thyroid carcinoma: Relation to outcomes? ACTA ACUST UNITED AC 2019; 26:129-135. [PMID: 31097263 DOI: 10.1016/j.pathophys.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 05/02/2019] [Accepted: 05/07/2019] [Indexed: 12/13/2022]
Abstract
AIMS The aim of this study was to evaluate the relation between the level of thyroid stimulating hormone (TSH) and progression of papillary thyroid carcinoma (PTC) with or without BRAFV600E mutation. METHODS The medical records and laboratory data of 547 patients with PTC and 94 patients with follicular adenoma (FA) were collected. The relationship between hormones levels and such end-points as extrathyroid extension (ETE), lymphovascular invasion (LVI) and lymph node metastasis (LNM) was assessed. In addition, age, gender, BRAFV600E mutation status, histological type and Hashimoto's thyroiditis (HT) were considered. KEY FINDINGS Most of the patients with PTC had hormones levels within the normal range, however, serum TSH concentration was significantly higher in PTC comparing with FA (P = 0.022). High levels of TSH in PTC were more frequent among women rather than men (P = 0.03) due to the gender differences in coexisting HT rate (P = 0.003). In contrast, LNM rate was higher in men (P = 0.0014). Coexisting HT significantly decreased the risk of ETE (OR = 0.67; 95%CI 0.44-1.00; P = 0.05) and LNM (OR = 0.59; 95%CI 0.37-0.94; P = 0.028) among males with PTC. However, there was no significant relationship between HT and PTC-related ETE and LNM in females. BRAFV600E mutation was associated with presence of lymphocytic infiltration (P < 0.001) but not with HT (P = 0.08) and violation of thyroid function. CONCLUSION The present study showed the lack of significant relationship between TSH levels and PTC aggressiveness (LNM, TNM stage, BRAFV600E mutation). Higher TSH levels were found in patients with coexisting HT that was associated with female sex and multifocality of PTC.
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Affiliation(s)
| | - Olena Chernenko
- Ukrainian Research and Practical Center for Endocrine Surgery, Ukraine
| | - Yelisaveta Chereshneva
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Russia
| | - Dibahan Tsomartova
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Russia
| | - Oleksandr Larin
- Ukrainian Research and Practical Center for Endocrine Surgery, Ukraine
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11
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Hu Y, Li N, Jiang P, Cheng L, Ding B, Liu XM, He K, Zhu YQ, Liu BL, Cao X, Zhou H, Mao XM. Elevated thyroglobulin level is associated with dysfunction of regulatory T cells in patients with thyroid nodules. Endocr Connect 2019; 8:309-317. [PMID: 30822273 PMCID: PMC6432874 DOI: 10.1530/ec-18-0545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/01/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Thyroid nodules are usually accompanied by elevated thyroglobulin (Tg) level and autoimmune thyroid diseases (AITDs). However, the relationship between Tg and AITDs is not fully understood. Dysfunction of regulatory T cells (Tregs) plays an important role in the development of AITDs. We aimed to evaluate the effects of Tg on the function of Tregs in patients with thyroid nodules. METHODS Tg levels and the functions of Tregs in peripheral blood and thyroid tissues of patients with thyroid nodules from Nanjing First Hospital were evaluated. The effects of Tg on the function of Tregs from healthy donors were also assessed in vitro. The function of Tregs was defined as an inhibitory effect of Tregs on the effector T cell (CD4+ CD25- T cell) proliferation rate. RESULTS The level of Tg in peripheral blood correlated negatively with the inhibitory function of Tregs (R = 0.398, P = 0.03), and Tregs function declined significantly in the high Tg group (Tg >77 μg/L) compared with the normal Tg group (11.4 ± 3.9% vs 27.5 ± 3.5%, P < 0.05). Compared with peripheral blood, the function of Tregs in thyroid declined significantly (P < 0.01), but the proportion of FOXP3+ Tregs in thyroid increased (P < 0.01). High concentration of Tg (100 μg/mL) inhibited the function of Tregs and downregulated FOXP3, TGF-β and IL-10 mRNA expression in Tregs in vitro. CONCLUSIONS Elevated Tg level could impair the function of Tregs, which might increase the risk of AITDs in patient with thyroid nodules.
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Affiliation(s)
- Yun Hu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
- Department of Immunology, Nanjing Medical University, Jiangsu, China
| | - Na Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Peng Jiang
- Department of Thyroid and Breast Surgery, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Liang Cheng
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Bo Ding
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Xiao-Mei Liu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Ke He
- Department of Endocrinology, Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine, Jiangsu, China
| | - Yun-Qing Zhu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Bing-li Liu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Xin Cao
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Hong Zhou
- Department of Immunology, Nanjing Medical University, Jiangsu, China
- Correspondence should be addressed to H Zhou or X-M Mao: or
| | - Xiao-Ming Mao
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
- Correspondence should be addressed to H Zhou or X-M Mao: or
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12
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Özdemir D, Dellal FD, Başer H, Kılıç Yazgan A, Türkölmez Ş, Ersoy R, Çakır B. The Ultrasonographical Features and Cytological Findings of Thyroid Nodules in Patients with Hashimoto Thyroiditis. ANKARA MEDICAL JOURNAL 2018. [DOI: 10.17098/amj.461660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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13
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Lai X, Xia Y, Zhang B, Li J, Jiang Y. A meta-analysis of Hashimoto's thyroiditis and papillary thyroid carcinoma risk. Oncotarget 2017; 8:62414-62424. [PMID: 28977955 PMCID: PMC5617515 DOI: 10.18632/oncotarget.18620] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 05/29/2017] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE It remains inconclusive whether Hashimoto's thyroiditis (HT) predisposes patients to the development of papillary thyroid carcinoma (PTC). We conducted a meta-analysis of the available data to address this question. RESULTS Twenty-seven eligible studies were selected, including 18 archival thyroidectomy studies, 6 fine-needle aspiration (FNA) studies, and 3 selective FNA or thyroidectomy studies. A total of 76,281 patients, including 12,476 cases of thyroid cancer, were included in these studies. The mean rate of PTC among patients with HT ranged from 1.12% (selective FNA or thyroidectomy studies) to 40.11% (thyroidectomy studies). All three types of studies supported the correlation between HT and PTC. The overall pooled odds ratio (OR) of the PTC risk for HT (HT versus non-HT) was 2.12 (95% confidence interval [CI]: 1.78-2.52). METHODS We searched all relevant published studies using the citation databases PubMed and Embase. The ORs and corresponding 95% CIs were calculated by the random-effects model for the association between HT and PTC. CONCLUSIONS Our meta-analysis confirmed that HT predisposed patients to the development of PTC.
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Affiliation(s)
- Xingjian Lai
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Yu Xia
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Bo Zhang
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Jianchu Li
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Yuxin Jiang
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
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14
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Yun JS, Bae JM, Kim KJ, Jung YS, Kim GM, Kim HR, Lee JS, Ko SH, Cha SA, Ahn YB. Increased risk of thyroid diseases in patients with systemic lupus erythematosus: A nationwide population-based Study in Korea. PLoS One 2017; 12:e0179088. [PMID: 28654679 PMCID: PMC5487009 DOI: 10.1371/journal.pone.0179088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/23/2017] [Indexed: 11/18/2022] Open
Abstract
We investigated the association between autoimmune thyroid disease and systemic lupus erythematosus (SLE) using nationwide insurance claims data for the entire Korean population. Claims data for the period 2009-2013 were retrieved from the National Health Insurance System database. SLE and thyroid disease were identified using the International Classification of Diseases codes and medication information. Logistic regression analyses were used to evaluate the association between SLE and thyroid disease. The study used records from 17,495 patients with SLE and 52,485 age- and sex-matched control subjects. A greater prevalence of Graves' disease (0.94% vs. 0.46%, P < 0.001), Hashimoto's thyroiditis (2.68% vs. 0.80%, P < 0.001), and thyroid cancer (1.81% vs. 1.30%, P < 0.001) was observed in SLE patients than in control subjects. Multivariate regression analyses demonstrated that SLE was significantly associated with an increased risk of both autoimmune thyroid disease and thyroid cancer (Graves' disease: odds ratio [OR] 2.07, 95% confidence interval [CI] 1.70-2.53; Hashimoto's thyroiditis: OR 3.42, 95% CI 3.00-3.91; thyroid cancer: OR 1.40, 95% CI 1.22-1.60). Age- and sex- stratified analyses revealed that the risk of autoimmune thyroid disease in SLE patients was increased for all age groups and the female group. An association between thyroid cancer and SLE was identified only in the 20- to 59-year-old age group and in the female group. Using a large population-based study, we demonstrated that patients with SLE are at a greater risk of developing thyroid disease than matched control individuals.
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Affiliation(s)
- Jae-Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jung Min Bae
- Department of Dermatology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ki-Jo Kim
- Division of Rheumatology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Yu Seok Jung
- Department of Dermatology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Gyong Moon Kim
- Department of Dermatology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hyung-Rae Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jun-Seok Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Seon-Ah Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Yu-Bae Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
- * E-mail:
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15
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Huang H, Rusiecki J, Zhao N, Chen Y, Ma S, Yu H, Ward MH, Udelsman R, Zhang Y. Thyroid-Stimulating Hormone, Thyroid Hormones, and Risk of Papillary Thyroid Cancer: A Nested Case-Control Study. Cancer Epidemiol Biomarkers Prev 2017; 26:1209-1218. [PMID: 28377419 DOI: 10.1158/1055-9965.epi-16-0845] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/11/2017] [Accepted: 03/23/2017] [Indexed: 11/16/2022] Open
Abstract
Background: The effects of thyroid-stimulating hormone (TSH) and thyroid hormones on the development of human papillary thyroid cancer (PTC) remain poorly understood.Methods: The study population consisted of 741 (341 women, 400 men) histologically confirmed PTC cases and 741 matched controls with prediagnostic serum samples stored in the Department of Defense Serum Repository. Concentrations of TSH, total T3, total T4, and free T4 were measured in serum samples. Conditional logistic regression models were used to calculate ORs and 95% confidence intervals (CI).Results: The median time between blood draw and PTC diagnosis was 1,454 days. Compared with the middle tertile of TSH levels within the normal range, serum TSH levels below the normal range were associated with an elevated risk of PTC among women (OR, 3.74; 95% CI, 1.53-9.19) but not men. TSH levels above the normal range were associated with an increased risk of PTC among men (OR, 1.96; 95% CI, 1.04-3.66) but not women. The risk of PTC decreased with increasing TSH levels within the normal range among both men and women (Ptrend = 0.0005 and 0.041, respectively).Conclusions: We found a significantly increased risk of PTC associated with TSH levels below the normal range among women and with TSH levels above the normal range among men. An inverse association between PTC and TSH levels within the normal range was observed among both men and women.Impact: These results could have significant clinical implications for physicians who are managing patients with abnormal thyroid functions and those with thyroidectomy. Cancer Epidemiol Biomarkers Prev; 26(8); 1209-18. ©2017 AACR.
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Affiliation(s)
- Huang Huang
- Department of Surgery, Yale School of Medicine, Yale Cancer Center, New Haven, Connecticut
| | - Jennifer Rusiecki
- Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Department of Preventive Medicine & Biostatistics, Bethesda, Maryland
| | - Nan Zhao
- Yale School of Public Health, New Haven, Connecticut
| | - Yingtai Chen
- Yale School of Public Health, New Haven, Connecticut.,Cancer Institute & Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuangge Ma
- Yale School of Public Health, New Haven, Connecticut
| | - Herbert Yu
- Yale School of Public Health, New Haven, Connecticut.,Epidemiology Program, University of Hawaii Cancer Center, Hawaii
| | - Mary H Ward
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Robert Udelsman
- Endocrine Neoplasia Institute, Miami Cancer Center, Miami, Florida
| | - Yawei Zhang
- Department of Surgery, Yale School of Medicine, Yale Cancer Center, New Haven, Connecticut. .,Yale School of Public Health, New Haven, Connecticut
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16
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Liu G, Wu K, Sheng Y. Elucidation of the molecular mechanisms of anaplastic thyroid carcinoma by integrated miRNA and mRNA analysis. Oncol Rep 2016; 36:3005-3013. [PMID: 27599582 DOI: 10.3892/or.2016.5064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/24/2016] [Indexed: 11/06/2022] Open
Abstract
To elucidate the complex molecular mechanisms of anaplastic thyroid carcinoma (ATC), the mRNA and miRNA expression profiles of ATC were systematically explored. A total of 55 common differentially expressed genes (DEGs) were obtained from two mRNA expression datasets including 23 ATC samples and 24 paired normal samples. Gene expression levels of three randomly selected DEGs, VCAN, COL5A1 and KCNJ16, were examined using RT-PCR in 10 ATC samples. Notably, the ATC and normal samples were clearly classified into two groups based on their common DEGs. Moreover 23 common DEGs, such as TG, NKX2-1, KCNJ16 and CTHRC1, were predicted to be the potential targets of 17 identified miRNAs in ATC. Meanwhile, several miRNA target genes were associated with biological processes related to tumor progression such as angiogenesis, cell migration or growth and potassium channel regulation. In summary, the poor prognosis of ATC is possibly caused via complex biological processes. Firstly, angiogenesis was activated by the high expression of CTHRC1, VCAN and POSTN, providing necessary nutrition for tumor cells. Then tumor distant metastasis was induced via stimulation of cell migration and cell growth or regulation of cell-cell interaction. Moreover, intracellular potassium concentration changes promoted ATC progression indirectly. Hence, identification of these critical DEGs was valuable in understanding the molecular mechanisms of ATC.
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Affiliation(s)
- Guoping Liu
- Department of Breast Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Kainan Wu
- Department of Breast Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Yuan Sheng
- Department of Breast Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
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17
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Acceleration of tumor growth due to dysfunction in M1 macrophages and enhanced angiogenesis in an animal model of autoimmune disease. J Transl Med 2016; 96:468-80. [PMID: 26808709 DOI: 10.1038/labinvest.2015.166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/04/2015] [Accepted: 12/16/2015] [Indexed: 01/15/2023] Open
Abstract
Both autoimmunity and tumor immunity are immune responses against self-tissues or cells. However, the precise similarity or difference between them remains unclear. In this study, to understand a novel mechanism of tumor immunity, we performed transplantation experiments with a murine autoimmune model, C57BL/6J (B6)/lpr mice. A melanoma cell line, B16F10 cells, or granulocyte macrophage colony-stimulating factor- overexpressing B16F10 (B16F10/mGM) cells were transplanted into B6 or B6/lpr mice. Tumor growth by transplanted B16F10/mGM cells was significantly accelerated in B6/lpr mice compared with that in B6 mice. The accumulation of M1 macrophages in the tumor tissues of B6/lpr recipient mice was significantly lower compared with that in the control mice. In vitro co-culture experiment showed that impaired differentiation into M1 macrophages was observed in B6/lpr mice. The number of tumor vessels and vascular endothelial growth factor (VEGF) expression were also significantly enhanced in the tumor tissues of B6/lpr mice compared with those in the B6 mice. Moreover, VEGF expression was correlated with the increased expression of hypoxia-inducible factor-1α in the tumor tissues of B6/lpr mice. These results suggest that dysfunctional tumor immunity and enhanced angiogenesis in autoimmunity influence tumor growth.
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18
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He LZ, Zeng TS, Pu L, Pan SX, Xia WF, Chen LL. Thyroid Hormones, Autoantibodies, Ultrasonography, and Clinical Parameters for Predicting Thyroid Cancer. Int J Endocrinol 2016; 2016:8215834. [PMID: 27313612 PMCID: PMC4893455 DOI: 10.1155/2016/8215834] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/23/2016] [Indexed: 11/18/2022] Open
Abstract
Our objective was to evaluate thyroid nodule malignancy prediction using thyroid function tests, autoantibodies, ultrasonographic imaging, and clinical data. We conducted a retrospective cohort study in 1400 patients with nodular thyroid disease (NTD). The thyroid stimulating hormone (TSH) concentration was significantly higher in patients with differentiated thyroid cancer (DTC) versus benign thyroid nodular disease (BTND) (p = 0.004). The receiver operating characteristic curve of TSH showed an AUC of 0.58 (95% CI 0.53-0.62, p = 0.001), sensitivity of 74%, and specificity of 57% at a cut-off of 1.59 mIU/L. There was an incremental increase in TSH concentration along with the increasing tumor size (p < 0.001). Thyroglobulin antibody (TgAb) concentration was associated with an increased risk of malignancy (p = 0.029), but this association was lost when the effect of TSH was taken into account (p = 0.11). Thyroid ultrasonographic characteristics, including fewer than three nodules, hypoechoic appearance, solid component, poorly defined margin, intranodular or peripheral-intranodular flow, and punctate calcification, can be used to predict the risk of thyroid cancer. In conclusion, our study suggests that preoperative serum TSH concentration, age, and ultrasonographic features can be used to predict the risk of malignancy in patients with NTD.
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Affiliation(s)
- Lin-zheng He
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Department of Endocrinology, Chengdu First People's Hospital, Chengdu 610041, China
| | - Tian-shu Zeng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- *Tian-shu Zeng:
| | - Lin Pu
- Department of Endocrinology, Chengdu First People's Hospital, Chengdu 610041, China
| | - Shi-xiu Pan
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wen-fang Xia
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Lu-lu Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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19
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Hadjisavva IS, Dina R, Talias MA, Economides PA. Prevalence of Cancer in Patients with Thyroid Nodules in the Island of Cyprus: Predictive Value of Ultrasound Features and Thyroid Autoimmune Status. Eur Thyroid J 2015; 4:123-8. [PMID: 26279998 PMCID: PMC4521064 DOI: 10.1159/000430438] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 04/11/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the prevalence of thyroid carcinoma in patients who underwent ultrasound-guided fine needle aspiration biopsy (USgFNA) of thyroid nodules in the island of Cyprus. Ultrasound features as well as the presence of autoimmune thyroid disease were evaluated as risk factors for malignancy. METHODS 322 consecutively examined patients (272 females/50 males, age 13-81) underwent USgFNA of thyroid nodules in a referral endocrine clinic between July 2007 and July 2009. The ultrasonographic characteristics examined were: echogenicity, margin irregularity, composition, calcifications, presence of increased vasculature and nodule size. The presence or absence of autoimmune thyroid disease was recorded. RESULTS From the 548 nodules examined, 74 (13.6%) were classified as THY3, 4 or 5. 75 patients (123 nodules) underwent surgical resection. 46 patients (64 nodules) proved to have thyroid carcinoma by histology. There was a significant correlation of suspicious/malignant cytology with solid composition, hypoechogenicity, irregular margins and the presence of calcifications. A significant association was also noted between the presence of positive antithyroglobulin antibodies (p < 0.05) and Graves' disease (p = 0.01) with suspicious/malignant cytology. CONCLUSION The overall prevalence of thyroid cancer was 14.3%. Ultrasound characteristics were highly predictive of thyroid malignancy. Thyroid autoimmunity should be considered as a risk factor.
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Affiliation(s)
- Irini S. Hadjisavva
- Economides Nicosia Endocrinology Center, Open University of Cyprus, Nicosia, Cyprus, London, UK
| | - Roberto Dina
- Department of Cellular Pathology, Hammersmith Hospital, Imperial College Healthcare Trust, London, UK
| | - Michael A. Talias
- Healthcare Management Postgraduate Program, Open University of Cyprus, Nicosia, Cyprus, London, UK
| | - Panayiotis A. Economides
- Economides Nicosia Endocrinology Center, Open University of Cyprus, Nicosia, Cyprus, London, UK
- *Dr. Panayiotis A. Economides, MD, PhD, FACE, Economides Nicosia Endocrinology Center, 9 Iona Nicolaou, Engomi 2406, Nicosia (Cyprus), E-Mail
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20
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Cao L, Tong H, Xu G, Liu P, Meng H, Wang J, Zhao X, Tang Y, Jin J. Systemic lupus erythematous and malignancy risk: a meta-analysis. PLoS One 2015; 10:e0122964. [PMID: 25885411 PMCID: PMC4401738 DOI: 10.1371/journal.pone.0122964] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 02/16/2015] [Indexed: 01/11/2023] Open
Abstract
Background Pilot studies have estimated cancer incidence in patients with systemic lupus erythematous (SLE). However, the results have been inconclusive. To ascertain the correlation between SLE and malignancy more comprehensively and precisely, we conducted a meta-analysis. Methods PubMed, the Cochrane Library and Embase databases through June 2014, were searched to identify observational studies evaluating the association between SLE and malignancy. The outcomes from these studies were measured as relative risks (RRs). A random or fixed effects model was chosen to calculate the pooled RR according to heterogeneity test. Between-study heterogeneity was assessed by estimating I2 index. Publication bias was assessed by Egger’s test. Results A total of 16 papers, including 59,662 SLE patients, were suitable for the meta-analysis. Of these papers, 15 reported RRs for overall malignancy, 12 for non-Hodgkin lymphoma (NHL) and lung cancer, 7 for bladder cancer, 6 for Hodgkin lymphoma (HL) and leukemia, 5 for skin melanoma, and liver and thyroid cancers, 4 for multiple myeloma (MM), and esophageal and vaginal/vulvar cancers and 3 for laryngeal and non-melanoma skin cancers. The pooled RRs were 1.28 (95% CI, 1.17–1.41) for overall cancer, 5.40 (95% CI, 3.75–7.77) for NHL, 3.26(95% CI, 2.17–4.88) for HL, 2.01(95% CI, 1.61–2.52) for leukemia, 1.45(95% CI, 1.04–2.03) for MM, 4.19(95% CI, 1.98–8.87) for laryngeal cancer, 1.59 (95% CI, 1.44–1.76) for lung cancer, 1.86(95% CI, 1.21–2.88) for esophageal cancer, 3.21(95% CI, 1.70–6.05) for liver cancer, 3.67(95% CI, 2.80–4.81) for vaginal/vulvar cancer, 2.11(95% CI, 1.12–3.99) for bladder cancer, 1.51(95% CI, 1.12–2.03) for non-melanoma skin cancer, 1.78(95% CI, 1.35–2.33) for thyroid cancer, and 0.65(95% CI, 0.50–0.85) for skin melanoma. Only the meta-analyses of overall malignancy, NHL, and liver and bladder cancers produced substantial heterogeneity (I2, 57.6% vs 74.3% vs 67.7% vs 82.3%). No apparent publication bias was detected except for NHL studies. Conclusions Our data support an association between SLE and malignancy, not only demonstrating an increased risk for NHL, HL, leukemia, and some non-hematologic malignancies, including laryngeal, lung, liver, vaginal/vulvar, and thyroid malignancies, but also a reduced risk for skin melanoma. Although an increased risk of MM, and esophageal, bladder and non-melanoma skin cancers was identified from the accumulated data in these studies, this observation requires confirmation.
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Affiliation(s)
- Lihong Cao
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Hongyan Tong
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Gaixiang Xu
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Ping Liu
- School of Population Health, the University of Western Australia, Perth, Australia
| | - Haitao Meng
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jinghan Wang
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Xiaoying Zhao
- Department of Hematology, the Second Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
| | - Yongmin Tang
- Department of Hematology, the Affiliated Children’s Hospital of Zhejiang University, Hangzhou, People’s Republic of China
| | - Jie Jin
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- * E-mail:
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Tessier-Cloutier B, Clarke AE, Pineau CA, Keeling S, Bissonauth A, Ramsey-Goldman R, Lee J, Bernatsky S. What investigations are needed to optimally monitor for malignancies in SLE? Lupus 2015; 24:781-7. [DOI: 10.1177/0961203315575587] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 02/05/2015] [Indexed: 11/17/2022]
Abstract
Objective The overall cancer incidence risk in systemic lupus erythematosus (SLE) is approximately 15%–20% more than in the general population. Nevertheless, to date, the optimal malignancy screening measures in SLE remain undefined. Our objective is to determine what investigations are needed to optimally monitor for malignancies in SLE in order to inform upcoming Canadian Rheumatology Association recommendations. Methods We conducted a systematic search looking at three scientific sources, Embase, Medline and Cochrane, in an attempt to identify cancer screening recommendations for patients with SLE. We used a filter for observational studies and included articles published in 2000 and onward. Results The initial search strategy led to 986 records. After removal of duplicates and articles unrelated to SLE, we were left with 497 titles. From those, 79 research articles on cancer incidence in SLE were isolated and reviewed. Of the 79 original research papers, 25 offered screening recommendations, 14 suggested additional cancer screening whereas 11 studies simply promoted adherence to general population screening measures. The suggestions for more rigorous screening included recommending human papilloma virus testing in addition to routine cervical screening, and/or that cervical screening should be performed annually and/or suggested urine cancer screening in SLE patients with a history of cyclophosphamide exposure. Conclusions We found no original research studies directly comparing cancer screening strategies in SLE. Generally, authors recommend adherence to general population screening measures, particularly cervical screening. This, possibly with adding targeted screening in special cases (e.g. annual urine cytology in patients with prior cyclophosphamide exposure, and considering existing lung cancer screening guidelines for past heavy smokers), may be a reasonable approach for cancer screening in SLE.
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Affiliation(s)
- B Tessier-Cloutier
- McGill University Health Centre, Division of Clinical Epidemiology, Montreal, Canada
| | - A E Clarke
- University of Calgary, Division of Rheumatology, Calgary, Canada
| | - C A Pineau
- Montreal General Hospital, Division of Rheumatology, Montreal, Canada
| | - S Keeling
- University of Alberta, Division of Rheumatology, Edmonton, Canada
| | - A Bissonauth
- University of Alberta, Division of Rheumatology, Edmonton, Canada
| | - R Ramsey-Goldman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J Lee
- McGill University Health Centre, Division of Clinical Epidemiology, Montreal, Canada
| | - S Bernatsky
- McGill University Health Centre, Division of Clinical Epidemiology, Montreal, Canada
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Cho YA, Kong SY, Shin A, Lee J, Lee EK, Lee YJ, Kim J. Biomarkers of thyroid function and autoimmunity for predicting high-risk groups of thyroid cancer: a nested case-control study. BMC Cancer 2014; 14:873. [PMID: 25421041 PMCID: PMC4289269 DOI: 10.1186/1471-2407-14-873] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 11/13/2014] [Indexed: 01/26/2023] Open
Abstract
Background A remarkable increase in the number of thyroid cancer cases has been reported in recent years; however, the markers to predict high-risk groups have not been fully established. Methods We conducted a case–control study (257 cases and 257 controls) that was nested in the Cancer Screenee Cohort Study between August 2002 and December 2010; the mean follow-up time for this study was 3.1 ± 2.2 years. The levels of total triiodothyronine (TT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), thyroglobulin (Tg), anti-thyroperoxidase antibody (TPOAb), and anti-thyroglobulin antibody (TgAb) were measured using samples with pre-diagnostic status. Logistic regression models were used to examine the association between thyroid function/autoimmunity and thyroid cancer risk. Results When the markers were categorized by the tertile distributions of the control group, the highest tertile of FT4 (OR = 1.73, 95% CI = 1.11 - 2.69) and the middle tertile of TSH (OR = 1.77, 95% CI = 1.14 - 2.74) were associated with an increased risk of thyroid cancer by multivariate analyses. In addition, an elevated risk for thyroid cancer was found in subjects with TPOAb levels above 30 IU/mL (OR = 8.47, 95% CI = 5.39 - 13.33 for 30–60 IU/mL and OR = 4.48, 95% CI = 2.59 - 7.76 for ≥60 IU/mL). Stratified analyses indicated that some of these associations differed by sex, BMI, smoking status, and the duration of follow-up. Conclusions This study demonstrated that the levels of biomarkers of thyroid function/autoimmunity, particularly the presence of TPOAb, might be used as diagnostic markers for predicting thyroid cancer risk. Our findings suggest that careful monitoring of thyroid biomarkers may be helpful for identifying Korean populations at high-risk for thyroid cancer. Electronic supplementary material The online version of this article (doi:10.1186/1471-2407-14-873) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | - Jeongseon Kim
- Division of Cancer Epidemiology and Prevention, Molecular Epidemiology Branch, Research Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si 410-769, Gyeonggi-do, Korea.
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Słowińska-Klencka D, Woźniak-Oseła E, Popowicz B, Sporny S, Klencki M. Repeat FNA Significantly Lowers Number of False Negative Results in Patients with Benign Nodular Thyroid Disease and Features of Chronic Thyroiditis. Int J Endocrinol 2014; 2014:967381. [PMID: 24812559 PMCID: PMC4000634 DOI: 10.1155/2014/967381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 03/22/2014] [Indexed: 11/17/2022] Open
Abstract
Purpose. The aim of the study was to compare the risk of thyroid malignancy and efficacy of repeat FNA in patients with thyroid nodules diagnosed cytologically as benign lesion (BL) with features of chronic thyroiditis (BL-CT) and BL without CT features (BL-nCT). Methods. The analysis included 917 patients with BL-CT and 7046 with BL-nCT in the first FNA. Repeat biopsy was carried out in 787 patients of BL-CT and 5147 of BL-nCT; 218 patients of BL-CT and 2462 of BL-nCT were operated; in 88 cases of BL-CT and 563 of BL-nCT both ways of follow-up were available. Results. Outcome of repeat cytology implied surgery more frequently in patients with BL-CT than with BL-nCT-3.2% versus 1.9%, P < 0.05. Incidence of cancer (including incidentalomas) was higher in patients with BL-CT operated after one benign cytology than in patients with two benign FNA outcomes: 10.8% versus 1.6%, P < 0.05. In patients with BL-nCT that difference was not significant: 3.2% versus 2.6%. Conclusions. Patients with thyroid nodules diagnosed as BL with CT features have higher risk of malignancy than patients with BL without CT features. Repeat biopsy significantly lowers percentage of FN results in patients with BL-CT in the first FNA.
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Affiliation(s)
- Dorota Słowińska-Klencka
- Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Sterlinga Street No 5, 91-425 Lodz, Poland
- *Dorota Słowińska-Klencka:
| | - Ewa Woźniak-Oseła
- Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Sterlinga Street No 5, 91-425 Lodz, Poland
| | - Bożena Popowicz
- Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Sterlinga Street No 5, 91-425 Lodz, Poland
| | - Stanisław Sporny
- Department of Dental Pathomorphology, Chair of Pathomorphology, Medical University of Lodz, Pomorska Street No. 251, 92-213 Lodz, Poland
| | - Mariusz Klencki
- Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Sterlinga Street No 5, 91-425 Lodz, Poland
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Azizi G, Keller JM, Lewis M, Piper K, Puett D, Rivenbark KM, Malchoff CD. Association of Hashimoto's thyroiditis with thyroid cancer. Endocr Relat Cancer 2014; 21:845-52. [PMID: 25217233 PMCID: PMC4187247 DOI: 10.1530/erc-14-0258] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This prospective study investigates the relationship between Hashimoto's thyroiditis (HT) and thyroid cancer (TC) in patients with thyroid nodules (TNs). We prospectively examined 2100 patients with 2753 TNs between January 5, 2010 and August 15, 2013. A total of 2023 patients with 2669 TNs met the inclusion criteria of TN ≥5 mm and age ≥18 years. Each patient had blood drawn before fine-needle aspiration biopsy (FNAB) for the following measurements: TSH, free thyroxine, free tri-iodothyronine, thyroid peroxidase antibody (TPOAb), and antithyroglobulin antibody (TgAb). Diagnosis of TC was based on pathology analysis of thyroidectomy tissue. The associations of TC with the independent variables were determined by univariate and multivariate logistic regression analysis and reported as adjusted odds ratio (OR) with 95% CI. A total of 248 malignant nodules were found in 233 patients. There was an association of TC with both increased serum TgAb concentration and age<45 years. An elevated serum TgAb concentration was found in 10.2% of patients (182 of 1790) with benign nodules as compared with 20.6% of patients (48 of 233) with malignant nodules (P≤0.0001). TgAb (OR=2.24: CI=1.57, 3.19) and TSH ≥1 μIU/ml (OR (95% CI)) OR: 1.49 (1.09, 2.03) were significant predictors of TC in multivariate analysis controlling for age and gender. TC was not associated with serum concentrations of TPOAb. In patients with TN, elevated serum concentration of TgAb and TSH ≥1 μIU/ml are independent predictors for TC. The association between HT and TC is antibody specific.
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Affiliation(s)
- G Azizi
- Wilmington Endocrinology1717 Shipyard Boulevard, Suite 220, Wilmington, North Carolina 28403, USAWilmington Pathology Associates1915 South 17th Street, Suite 100, Wilmington, North Carolina 28401, USAChildren's Hospital Colorado13123 East 16th Avenue, Aurora, Colorado 80045, USACarolina Arthritis1710 South 17th Street, Wilmington, North Carolina 28401, USAUniversity of Connecticut Health Center263 Farmington Avenue, Farmington, Connecticut 06030, USA
| | - J M Keller
- Wilmington Endocrinology1717 Shipyard Boulevard, Suite 220, Wilmington, North Carolina 28403, USAWilmington Pathology Associates1915 South 17th Street, Suite 100, Wilmington, North Carolina 28401, USAChildren's Hospital Colorado13123 East 16th Avenue, Aurora, Colorado 80045, USACarolina Arthritis1710 South 17th Street, Wilmington, North Carolina 28401, USAUniversity of Connecticut Health Center263 Farmington Avenue, Farmington, Connecticut 06030, USA
| | - M Lewis
- Wilmington Endocrinology1717 Shipyard Boulevard, Suite 220, Wilmington, North Carolina 28403, USAWilmington Pathology Associates1915 South 17th Street, Suite 100, Wilmington, North Carolina 28401, USAChildren's Hospital Colorado13123 East 16th Avenue, Aurora, Colorado 80045, USACarolina Arthritis1710 South 17th Street, Wilmington, North Carolina 28401, USAUniversity of Connecticut Health Center263 Farmington Avenue, Farmington, Connecticut 06030, USA
| | - K Piper
- Wilmington Endocrinology1717 Shipyard Boulevard, Suite 220, Wilmington, North Carolina 28403, USAWilmington Pathology Associates1915 South 17th Street, Suite 100, Wilmington, North Carolina 28401, USAChildren's Hospital Colorado13123 East 16th Avenue, Aurora, Colorado 80045, USACarolina Arthritis1710 South 17th Street, Wilmington, North Carolina 28401, USAUniversity of Connecticut Health Center263 Farmington Avenue, Farmington, Connecticut 06030, USA
| | - D Puett
- Wilmington Endocrinology1717 Shipyard Boulevard, Suite 220, Wilmington, North Carolina 28403, USAWilmington Pathology Associates1915 South 17th Street, Suite 100, Wilmington, North Carolina 28401, USAChildren's Hospital Colorado13123 East 16th Avenue, Aurora, Colorado 80045, USACarolina Arthritis1710 South 17th Street, Wilmington, North Carolina 28401, USAUniversity of Connecticut Health Center263 Farmington Avenue, Farmington, Connecticut 06030, USA
| | - K M Rivenbark
- Wilmington Endocrinology1717 Shipyard Boulevard, Suite 220, Wilmington, North Carolina 28403, USAWilmington Pathology Associates1915 South 17th Street, Suite 100, Wilmington, North Carolina 28401, USAChildren's Hospital Colorado13123 East 16th Avenue, Aurora, Colorado 80045, USACarolina Arthritis1710 South 17th Street, Wilmington, North Carolina 28401, USAUniversity of Connecticut Health Center263 Farmington Avenue, Farmington, Connecticut 06030, USA
| | - C D Malchoff
- Wilmington Endocrinology1717 Shipyard Boulevard, Suite 220, Wilmington, North Carolina 28403, USAWilmington Pathology Associates1915 South 17th Street, Suite 100, Wilmington, North Carolina 28401, USAChildren's Hospital Colorado13123 East 16th Avenue, Aurora, Colorado 80045, USACarolina Arthritis1710 South 17th Street, Wilmington, North Carolina 28401, USAUniversity of Connecticut Health Center263 Farmington Avenue, Farmington, Connecticut 06030, USA
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25
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Azizi G, Keller J, Lewis M, Puett D, Rivenbark K, Malchoff C. Performance of elastography for the evaluation of thyroid nodules: a prospective study. Thyroid 2013; 23:734-40. [PMID: 23136893 DOI: 10.1089/thy.2012.0227] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In the ultrasound evaluation of masses, elastography measures stiffness, which may predict malignancy. Studies of small or selected subgroups suggest that elastography may be useful in the evaluation of thyroid nodules (TNs). We prospectively tested the hypothesis that TN stiffness, as measured by strain elastography (SE), is an independent predictor of thyroid cancer (TC) in unselected TNs. METHODS In 706 unselected patients with 912 TNs meeting the ATA criteria for a fine-needle aspiration biopsy (FNAB), we first performed conventional thyroid ultrasound and SE. Nodule stiffness was graded from least to most stiff by an elastography score (ES) of ES 0 to ES 3. Surgical resection was recommended for FNAB results that were not clearly benign. Bivariate and multivariate regression analyses identified the independent predictors of TC. RESULTS There were 86 malignant TNs. ES was a significant predictor of TC (p=0.0001). The prevalence of TC was 57 of the 158 TNs (36.1%) for the ES 3 group, 12 of the 158 TNs (7.7%) for the ES 2 group, 16 of the 565 TNs (2.8%) for the ES 1 group, and 1 of the 33 TNs (3%) for the ES 0 group. By multivariate regression analysis, the independent predictors of TC were ES, microcalcifications, hypoechogenicity, and isthmus location. The positive predictive value (PPV) of ES was 36.1%, which was similar to the PPV of microcalcifications (35.9%), but greater compared with hypoechogenicity (13.6%) and isthmus location (16.9%). The negative predictive value (NPV) of ES was 97.2%, which was better than any other predictor for malignancy. CONCLUSIONS We conclude that TN stiffness measured by elastography is an independent predictor of TC with a PPV that is equal to or greater than that of conventional ultrasonographic characteristics. NPV was greater than any other predictor of malignancy.
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Affiliation(s)
- Ghobad Azizi
- Wilmington Endocrinology, Wilmington, North Carolina 28403, USA.
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Boi F, Minerba L, Lai ML, Marziani B, Figus B, Spanu F, Borghero A, Mariotti S. Both thyroid autoimmunity and increased serum TSH are independent risk factors for malignancy in patients with thyroid nodules. J Endocrinol Invest 2013; 36:313-20. [PMID: 22931861 DOI: 10.3275/8579] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM To assess the relevance of thyroid autoimmunity and TSH as risk factors for malignancy in thyroid nodules (TN). SUBJECTS AND METHODS Retrospective analysis on 2053 patients with single/prevalent TN submitted to fine needle aspiration cytology (FNAC). Anti-thyroid autoantibodies (ATA) [anti-thyroperoxidase (TPOAb), anti-thyroglobulin (TgAb)] and TSH were measured. Cytology was classified as benign (class II), indeterminate (class III), and suspicious or malignant (class IV). Histology was available in 301 patients. Associations of malignancy with independent variables were determined by multivariate logistic regression analysis. RESULTS Higher prevalence of class IV (14.2% vs 6.8%: p<0.001) and class III (23.5% vs 17.1%: p<0.001) were found in ATA+ vs ATA- TN. Histology confirmed increased prevalence of cancer in ATA+ (p<0.05) TN and in those with diffuse lymphocytic thyroid infiltration (p<0.05). Interestingly, the prevalence of malignancies observed in operated class III nodules was strikingly lower in ATA+ (1/20, 5%), than in ATA- patients (34/67, 50.7%; p<0.001). Increased independent odds ratio (OR) for malignancy was conferred by any ATA [OR 2.21; 95% confidence interval (CI)=1.49-3.29, p<0.0001]; TPOAb (OR 2.15; CI=1.42-3.25, p<0.0001) and TgAb (OR 1.67; CI=1.05-2.67, p<0.05), by serum TSH>1.0 μUI/ml (OR 1.95; CI=1.01-3.76, p<0.05), and by young age (10-29 yr: OR 2.09; CI=1.02-4.26, p<0.05). A formula was calculated to assess the relative contribution of ATA, TSH, and age to the risk of TN malignancy. CONCLUSIONS Both thyroid autoimmunity and increased TSH represent independent risk factors for TN malignancy.
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Affiliation(s)
- F Boi
- Endocrinology Unit, Department of Medical Sciences M Aresu, University of Cagliari, Cagliari, Italy.
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Bernatsky S, Ramsey-Goldman R, Labrecque J, Joseph L, Boivin JF, Petri M, Zoma A, Manzi S, Urowitz MB, Gladman D, Fortin PR, Ginzler E, Yelin E, Bae SC, Wallace DJ, Edworthy S, Jacobsen S, Gordon C, Dooley MA, Peschken CA, Hanly JG, Alarcón GS, Nived O, Ruiz-Irastorza G, Isenberg D, Rahman A, Witte T, Aranow C, Kamen DL, Steinsson K, Askanase A, Barr S, Criswell LA, Sturfelt G, Patel NM, Senécal JL, Zummer M, Pope JE, Ensworth S, El-Gabalawy H, McCarthy T, Dreyer L, Sibley J, St Pierre Y, Clarke AE. Cancer risk in systemic lupus: an updated international multi-centre cohort study. J Autoimmun 2013; 42:130-5. [PMID: 23410586 DOI: 10.1016/j.jaut.2012.12.009] [Citation(s) in RCA: 200] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 11/23/2012] [Accepted: 12/13/2012] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To update estimates of cancer risk in SLE relative to the general population. METHODS A multisite international SLE cohort was linked with regional tumor registries. Standardized incidence ratios (SIRs) were calculated as the ratio of observed to expected cancers. RESULTS Across 30 centres, 16,409 patients were observed for 121,283 (average 7.4) person-years. In total, 644 cancers occurred. Some cancers, notably hematologic malignancies, were substantially increased (SIR 3.02, 95% confidence interval, CI, 2.48, 3.63), particularly non-Hodgkin's lymphoma, NHL (SIR 4.39, 95% CI 3.46, 5.49) and leukemia. In addition, increased risks of cancer of the vulva (SIR 3.78, 95% CI 1.52, 7.78), lung (SIR 1.30, 95% CI 1.04, 1.60), thyroid (SIR 1.76, 95% CI 1.13, 2.61) and possibly liver (SIR 1.87, 95% CI 0.97, 3.27) were suggested. However, a decreased risk was estimated for breast (SIR 0.73, 95% CI 0.61-0.88), endometrial (SIR 0.44, 95% CI 0.23-0.77), and possibly ovarian cancers (0.64, 95% CI 0.34-1.10). The variability of comparative rates across different cancers meant that only a small increased risk was estimated across all cancers (SIR 1.14, 95% CI 1.05, 1.23). CONCLUSION These data estimate only a small increased risk in SLE (versus the general population) for cancer over-all. However, there is clearly an increased risk of NHL, and cancers of the vulva, lung, thyroid, and possibly liver. It remains unclear to what extent the association with NHL is mediated by innate versus exogenous factors. Similarly, the etiology of the decreased breast, endometrial, and possibly ovarian cancer risk is uncertain, though investigations are ongoing.
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Affiliation(s)
- Sasha Bernatsky
- McGill University Health Centre, 687 Pine Avenue, V Building, Montreal, Quebec H3A 1A1, Canada.
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Stack BC, Tuttle RM. Ultrasonographic characterization of cervical lymphadenopathy in chronic autoimmune thyroiditis. Thyroid 2013; 23:137-8. [PMID: 23167267 DOI: 10.1089/thy.2012.0558] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kiss E, Kovacs L, Szodoray P. Malignancies in systemic lupus erythematosus. Autoimmun Rev 2009; 9:195-9. [PMID: 19643208 DOI: 10.1016/j.autrev.2009.07.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Accepted: 07/20/2009] [Indexed: 12/01/2022]
Abstract
Systemic lupus erythematosus (SLE) is a prototypical systemic autoimmune disease, characterized by a wide array of symptoms and organ involvements, leading to varying disease courses and outcome, and ranging from mild to severe types. In patients with SLE, the incidence and risk of malignancy development is increased, and mostly non-Hodgkin's lymphoma (NHL), cervical cancer, as well as bronchial carcinomas occur. Besides others, the common genetic predisposition, chronic antigen stimulus, disproportional immune responses, as well as the chronic administration of immunosuppressive medications can contribute to the development of malignancies in lupus. In this review we present the molecular pathology, as well as the epidemiological and clinical aspects of malignancies in patients with SLE.
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Affiliation(s)
- Emese Kiss
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
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