Germline polymorphisms of the NOD2 pathway may predict the effectiveness of radioiodine in differentiated thyroid cancer treatment

PURPOSE

Differentiated thyroid cancer (DTC) presents a complex clinical challenge, especially in patients with distant metastases and resistance to standard treatments. This study aimed to investigate the influence of specific genes and their germline single nucleotide polymorphisms (SNPs) linked to both inflammatory processes and other neoplasms on the clinical and pathological characteristics of DTC, particularly their potential impact on radioiodine (RAI) treatment efficacy.

METHODS

This retrospective analysis involved a cohort of 646 patients diagnosed with DTC after thyroidectomy. Study covering 1998-2014, updated in 2023, included 567 women and 79 men (median age: 49; range: 7-83). SNP selection targeted functional significance, while mutational status was assessed by pyrosequencing for comprehensive characterization. Patient genetic profiles were assessed for associations with disease characteristics, RAI response, and cancer pathology.

RESULTS

Significant correlations emerged between certain SNPs and DTC features. Notably, the NOD2 c.802 T > C variant (rs2066842) was identified as a marker distinguishing between papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC). Moreover, the c.802 T allele was associated with an enhanced response to RAI treatment, indicating a more substantial decrease in posttreatment stimulated thyroglobulin (sTg) concentrations. The NFKB1A allele c.126A (rs696) exhibited connections with lower FTC stages and a reduced probability of multifocality.

CONCLUSION

This study explored the molecular mechanisms of particular SNPs, highlighting the role of NOD2 in innate immunity and the stress response, and its potential impact on RAI efficacy. This research underscores the clinical promise of SNP analysis and contributes to personalized treatment strategies for DTC, emphasizing the relevance of genetic factors in cancer progression and treatment outcomes.

Decreased staging of differentiated thyroid cancer in patients with chronic lymphocytic thyroiditis

PURPOSE

The biological association between chronic lymphocytic thyroiditis (CLT) and differentiated thyroid cancer (DTC) has not been elucidated yet. The aim of the study was to assess whether the presence of CLT exerts any influence on clinical or histological presentation of DTC.

METHODS

Nine hundred and seven consecutive patients with DTC treated in the years 1998-2016 were divided into two groups according to the presence or absence of concomitant CLT. The statistical differences were analysed.

RESULTS

Out of 907 patients included in the study, 331 were diagnosed with DTC and CLT (studied group), while 576 patients with DTC but without CLT constituted a control group. The distribution of papillary and follicular thyroid cancer did not differ. In CLT group, the prevalence of pT1 was greater than for pT2-pT4 DTC (P = 0.0003; OR = 1.69, 95% CI 1.27-2.24) compared to controls (68.3 vs. 56.1%, respectively). The presence of multifocal lesions was similar. The thyroid capsule infiltration without extrathyroidal invasion (P < 0.0001; OR = 0.21, 95% CI 0.14-0.31) was more frequent in the studied group, unlike extracapsular invasion, which was significantly more often present in patients with DTC but without CLT (P = 0.004; OR = 1.66; 95% CI 1.17-2.34) as well as nodal involvement (P = 0.048; OR = 0.65, 95% CI 0.42-0.99).

CONCLUSIONS

The collected data indicate a protective role of CLT in preventing the spread of the DTC. The presence of CLT might limit tumour growth to the primary site.

Utility of PET/CT in the diagnosis of recurrent ovarian cancer depending on CA 125 serum level

The aim of this study was to estimate the diagnostic value of common application of CA 125 level measurement and 18F-FDG PET/CT examination in patients with a suspicion of recurrent ovarian cancer. Patients, methods: A retrospective analysis was performed on a group of 68 patients aged 31–77 (average 57.7) with a suspicion of relapsing ovarian cancer who had CA 125 serum level measurement and PET/CT examination done with a maximum interval of 60 days. Results: PET/CT examination result was positive in 33 patients (48.5%) and negative in 35 (51.5%). Level of CA 125 was significantly higher in women with a positive PET/ CT result than in patients with a negative one (average 199.9 U/ml and 15.7 U/ml, respectively, p < 0.001). Nevertheless, comparison of CA 125 level in groups defined according to the localization of the relapse showed no significant differences. Moreover, the ROC analysis revealed that the optimal cut-off point of CA 125 concentration to predict positive PET/CT result was 17.6 U/ml. Area under the curve was 0.91. Sensitivity, specificity and accuracy in prognosticating positive PET/CT result for the selected cut-off point of 17.6 U/ml were 90.9%, 80.0% and 85.3%, respectively. Conclusion: CA 125 level does not depend on the localization of the recurrence. PET/CT is particularly useful in patients with a suspicion of relapsing ovarian cancer with CA 125 value of at least 17.6 U/ml.

Two coexisting heterozygous frameshift mutations in PROP1 are responsible for a different phenotype of combined pituitary hormone deficiency

The role of genetic background in childhood-onset combined pituitary hormone deficiency (CPHD) has been extensively studied. The major contributors are the PROP1, POU1F1, LHX3, LHX4 and HESX1 genes coding transcription factors implicated in pituitary organogenesis. The clinical consequences of mutations encompass impaired synthesis of a growth hormone (GH) and one or more concurrent pituitary hormones (i.e. LH, FSH, TSH, PRL). Manifestation of the disorder may vary due to various mutation impacts on the final gene products or an influence of environmental factors during pituitary organogenesis. We describe the clinical and molecular characteristics of two brothers aged 47 and 39 years presenting an uncommon manifestation of congenital hypopituitarism. Sequencing of the PROP1, POU1F1, LHX3, LHX4 and HESX1 genes was performed to confirm the genetic origin of the disorder. A compound heterozygosity in the PROP1 gene has been identified for both probands. The first change represents a mutational hot spot (c.150delA, p.R53fsX164), whereas the second is a novel alteration (p.R112X) that leads to protein disruption. Based on precise genetic diagnosis, an in silico prediction of a p.R112X mutation on protein architecture was performed. The resulting clinical phenotype was surprisingly distinct compared to most patients with genetic alterations in PROP1 reported in the current literature. This may be caused by a residual activity of a newly identified p.R112X protein that preserves over 70 % of the homeodomain structure. This examination may confirm a key role of a DNA-binding homeodomain in maintaining PROP1 functionality and suggests a conceivable explanation of an unusual phenotype.

Pulsatility index in carotid arteries is increased in levothyroxine-treated Hashimoto disease

The aim of this case-control study was to evaluate carotid hemodynamic variables and traditional cardiovascular risk factors in women with Hashimoto thyroiditis (HT). The study group consisted of 31 females with HT on levothyroxine (L-T4) and 26 euthyroid women with HT without L-T4 matched for age and body mass index (BMI) as controls. Carotid intima-media thickness (CIMT), carotid extra-media thickness (CEMT), and pulsatility indexes in common carotid artery (PI CCA) and in internal carotid artery (PI ICA) were measured. BMI, waist circumference, lipid profile, fasting glucose and insulin levels, and parameters of thyroid function [TSH, free thyroxine (FT4) and antithyroperoxidase antibodies (TPOAbs)] were assessed. The study and the control groups did not differ in age, BMI, waist circumference, lipid profile, fasting glucose, and insulin levels. Results are expressed as median (IQR). Treated HT group had higher FT4 levels than nontreated [17.13 (5.11) pmol/l vs. 14.7 (2.27) pmol/l; p=0.0011] and similar TSH [1.64 (2.08) IU/ml vs. 2.07 (3.14) IU/ml; p=0.5915]. PI CCA and PI ICA were higher in the study group than in controls (p=0.0224 and p=0.0477, respectively). The difference remained statistically significant for PI ICA and PI CCA after adjustment for other variables (coefficient=0.09487; standard error=0.04438; p=0.037 and coefficient=0.1786; standard error=0.0870; p=0.0449, respectively). CIMT and CEMT were similar in both groups (p=0.8746 and p=0.0712, respectively). Women with HT on L-T4 replacement therapy have increased PI in common and internal carotid arteries than nontreated euthyroid HT patients. Therefore, it seems that hypothyroidism, but not autoimmune thyroiditis per se, influences arterial stiffness.

Thyroid hormones affect plasma ghrelin and obestatin levels

Using radioimmunoassay, the effects of thyroid hormones on plasma total ghrelin (Gh) and obestatin (Ob) concentrations were evaluated in thyrotoxic patients with an excess of thyroid hormones and in hypothyroid patients lacking endogenous thyroid hormones. 24 patients with thyrotoxicosis, 25 hypothyroid patents after total thyreoidectomy performed due to thyroid cancer, and 17 control subjects were examined. Compared with the controls, the ghrelin and obestatin were elevated in hypothyroidism, while they were decreased in thyrotoxicosis. The plasma Gh and Ob levels differ depending on the thyroid function. In thyroid hormones deficiency, plasma Gh and Ob are increased, while in patients with excess of thyroid hormones, the levels of both Gh and Ob are definitely lower. Gh/Ob ratio is higher in hypothyroidism than in control subjects and thyrotoxic patients.

[The evaluation of goiter frequency and iodine prophylaxis efficiency in children population in Wielkopolska area from 1992 to 1998]

The aim of the study was to compare the current state and efficiency of iodine prophylaxis during the last six years. The study included 800 children from the rural and urban area (462 children in 1992 and 338 children in 1998) with the proportional sex and age (8-13 years) distribution, 24.936 newborns (9875 in 1992/1993 and 15.061 - mostly in the early part of 1998). The thyroid size (by USG), serum thyroglobulin (TG) concentration, urinary iodine (UI) concentration, %age of neonatal-TSH above 5 micro U/ml were evaluated using current ICCIDD and WHO criteria. The prevalence of goiter detected in children population in 1992 was 26% (recount by current criteria), in the early part of 1998 it was reduced to 21%. Parallelly, mean urinary iodine concentration increased from 49 micro g/l to 79 micro g/l. The reduction of goiter prevalence was associated with the reduction of mean serum thyroglobulin concentration from 26 ng/ml to 18 ng/ml. In the group of newborns the %age of TSH results above 5 micro U/ml decreased from 6 to 2.6%. Generally, the study proved significant increase of iodine prophylaxis efficiency in Wielkopolska Region in the period of the last six years, but it is still the area with mild iodine deficiency, which suggests the necessity of using other forms of iodine prophylaxis except for salt iodization. The obtained results suggest the necessity to extend the study on the role of other goitrogenic factors, which are probably present in the whole Wielkopolska Region.

[Accuracy of ultrasound-guided fine-needle aspiration biopsy in diagnosis of changes in thyroid nodular lesions]

The aim of this study was to compare the results of US-FNAB with definitive histological examination of thyroid nodular lesions. 590 patients who underwent surgery were reviewed (473 females, 117 males, ranging in age from 9 to 81 years, average 36 years). Histological evaluation of cytologically diagnosed benign nodules revealed nodular goiter in 407 cases (91.5%), Hashimoto's thyroiditis in 2 (0.4%), follicular adenoma in 31 (7%), papillary carcinoma in 2 (0.4%) and follicular carcinoma in 3 (0.7%). In the cytological group of follicular nodule (n = 71) histological diagnoses included: nodular goiter in 11 cases (15.5%), follicular adenoma in 36 (50.7%), papillary carcinoma in 2 (2.8%), follicular carcinoma in 20 (28.2%). The diagnosis of papillary carcinoma (n = 65) was confirmed histologically in 59 cases (90.8%), in the remaining 6 cases Hashimoto's thyroiditis and medullary carcinoma were diagnosed. In the cases diagnosed cytologically as medullary carcinoma (n = 8) histological diagnoses included: medullary carcinoma in 7 cases (87.5%). The cytological diagnosis of anaplastic carcinoma (n = 1) was confirmed histologically. These results support the value of US-FNAB in the diagnostics of thyroid neoplasms. US-FNAB performance was as follows: sensitivity 78%, specificity 97%, accuracy 92%, 2.3% of false positive and 6.1% of false negative results.

Use of 99Tcm-MIBI scintigraphy in the evaluation of perfusion improvement after myocardial revascularization with the use of the left internal thoracic artery

In spite of successful revascularization, in a significant group of patients myocardial ischaemia is present after surgery. The final effect of surgery depends on preoperative left ventricular function, initial coronary artery status, completeness of revascularization, the use of arterial or venous grafts, and many other factors. The aim of our 99Tcm-MIBI scintigraphy study was to examine the improvement of perfusion in the left anterior descending artery (LAD) vascular territory after revascularization with the use of the left internal thoracic artery (LITA), with respect to the LAD diameter and use of additional venous graft to diagonal artery. The study group consisted of 45 subjects (42 male, three female) aged 34-68 years (mean age 50.9+/-8.3 years) recruited from patients in whom LITA was grafted into LAD. The operation and postoperative period was uneventful in all patients. Two weeks before, and 3-4 months after surgery, dipyridamole-rest sestamibi SPECT were performed. The revascularization significantly improved both stress (deltaPI = 0.77+/-0.66; P < 0.001) and rest (deltaPI = 0.32+/-0.60; P < 0.001) perfusion of the LAD territory. The improvement was slightly better in patients who received two grafts (deltaPI = 1.42+/-0.91) for the LAD territory in comparison to the group revascularized only with LITA (deltaPI = 0.80+/-0.69; P = patients who received an arterial bypass to the LAD artery the perfusion was abnormal in all eight patients after anterior myocardial infarction and in 39% of patients without a history of infarction. The perfusion improvement was the best when the diameter of LAD was > or = 1.5 mm (deltaPI = 0.88+/-0.95). The independent predictors of perfusion improvement were the number of segments with reversible perfusion defect within the revascularized area (beta = 0.84, P < 0.001), the diameter of revascularized artery (beta = 0.17, P = 0.03) and the presence of pathological Q wave at preoperative ECG (beta = -0.20, P = 0.02). We conclude that the degree of perfusion improvement in the LAD territory after revascularization with the use of LITA depends on the diameter of bypassed coronary artery, completeness of revascularization and the reversibility of preoperative perfusion defect.

[Evaluation of thyroid structure and function in patients with Turner syndromes]

The aim of our study was an estimation of thyroid structure and function in 37 patients with Turner syndrome aged from 19 to 60 years and in control group of healthy women. In each case the following studies were performed: cytogenetic examination, thyroid ultrasonography, serum total and free thyroid hormones, TSH, thyroglobulin (Tg), thyroid hormones binding globulin (TBG), antithyroglobulin and antithyroperoxidase antibodies (anti-Tg and anti-TPO) levels. In Turner syndrome ultrasonographic volume of the thyroid was significantly lower than in control group (11.03 vs 16.98 cm3). Abnormalities of thyroid function were found in 8 (22%) studied cases (subclinical primary hypothyroidism in 16%, full-clinical primary hypothyroidism in 3% and hyperthyroidism in course of Graves disease in 3%). Serum elevated antithyroid antibodies were present in 62% cases of Turner syndrome and were significantly higher than in control group (16%). In Turner syndrome thyroid diseases are more frequent than in healthy population. Every patient with Turner syndrome needs routine diagnostics of the thyroid structure and function.

Short-term pre-surgical treatment with somatostatin analogues, octreotide and lanreotide, in acromegaly

Eighteen patients with symptoms of active acromegaly were treated with somatostatin analogues for 4 weeks before surgery. Both before and after the treatment, levels of growth hormone (GH), prolactin (PRL), insulin growth factor -I (IGF-I), luteotropin (LH), folliculostimulin (FSH) and subunit alpha of glycoprotein hormones were estimated. Glucose tolerance test, magnetic resonance imaging (MRI) examination, sight acuity and field of vision tests were also performed. The same tests were performed on ten control patients with clinically and biochemically active acromegaly, subjected to surgery but not treated with somatostatin analogues. In six patients treated with somatostatin analogues GH levels decreased significantly to less than 5 ng/ml and in two patients remained elevated while in 10 patients GH level decreased and ranged from 6.1 to 42.9 ng/ml. In 13 patients we observed a decrease in IGF-I to normal levels (<400 ng/dl) and in 3 patients we noted a decrease to levels slightly higher than normal. There was also a slight decrease in alpha subunit concentration. In the glucose inhibition test 4 patients demonstrated normalized GH levels. In patients with elevated PRL and TSH levels, treatment with somatostatin analogues induced their decrease. No changes were observed in levels of LH and FSH. After therapy MRI examination disclosed a decrease in tumor volume in two patients (by 20 and 25%, respectively) and no changes in tumor size in 16 patients. The two patients with a decreased tumor volume also showed normalized glucose tolerance tests. All patients manifested an improved clinical condition. Neurosurgeons disclosed a decreased tumor consistency which greatly facilitated surgical procedure. Our studies documented favourable effects of somatostatin analogues on the assayed hormone levels, and on the general condition of the patients as well as on the course of the surgical procedure itself.

[Prevalence of goiter in children of the Poznan province]

The aim of our study was the evaluation of goiter prevalence in the children in Poznań and surrounding towns and villages. In 3065 children 4-16 years old the thyroid size and serum concentration of T3, T4 and TSH were determined. Our results indicate that the goiter prevalence in the group of investigated children was 20%. We also observed that the changes in the concentration of thyroid hormones and TSH were not associated with the clinical symptoms of thyroid gland dysfunction.

[Influence of radioactive contamination and iodine prophylaxis after the Czernobyl disaster on thyroid morphology and function of the Poznan region]

The radioactive contamination of Poznań Region was recognized after Chernobyl accident as average. The predicted values of minimal (inhalation) and maximal (inhalation and ingestion) committed dose equivalent to the thyroid varied from 2.5 (min) to 24.7 (max) mSv in different groups of adults and children. To follow up the results of iodine prophylaxis and some aspects of possible thyroid gland morphological and functional changes 11086 persons were carefully investigated clinically and biochemically. Among these 11086 persons were 42.6% males and 57.4% females both adults from 17 till 40 year and children up do 16 years. The following parameters were reviewed: pregnancy, time of residence in the region, thyroid abnormalities, family history concerning thyroid diseases, iodine intake in April and May 1986 with possible side effects, changes in the thyroid size observed before and after 1986, degree and kind of thyroid enlargement, serum concentration of T3, T4, TSH, ATMA and ATG titre and finally the effectiveness of thyroid blockade at 24, 48 and 72 h after ingestion of Lugol's solution. Side effects of the ingestion of potassium iodide from 30-70 mg were observed in 153 cases, 36 of them consulted medical doctors but in no case the side effects (dominated by vomiting) threatened the life. In the investigated group were 144 pregnant women. Majority, because 88% of them delivered the baby on or after time and 6.9% before time, 4.9% of natural abortions were noted but non artificial. In the group of children thyroid gland abnormalities before 1986 were reported in 3 cases in 23 after 1986 it is after Chernobyl accident. This information is interesting but needs more precise analysis of different dependencies occurring. The data obtained indicated the existence in Poznań. Region the goiter endemy because 27.5% of investigated children and adults had goiter classified as grades O-B, I, II and III. The elevation or diminution of T3 values were noted in 1164 cases, for T4 in 418 cases and for TSH in 1412 cases. The presence of antimembrane and antithyroglobulin antibodies were observed in 303 cases. All persons with changes observed in thyroid morphology and function are periodically controlled and the results will be published separately. The investigations performed and results presented concern the early aspects of radioactive contamination and effects of iodine prophylaxis. The answer regarding late effects including thyroid cancer needs further multi year studies for which the clinical material investigated in different parts of Poland and well documented should be used as model group for further periodical studies.