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Introduction: Among thyroid malignancies, papillary thyroid carcinoma (PTC) is the most common, with the classical variant being the most common subtype. Some histological variants have aggressive behavior, advanced presentation stages, poor clinical outcomes, and may require additional therapy. Due to overlapping cytologic features and heterogeneity of lesions, the PTC classification is not adhered to in conventional reporting practice. This study aimed to classify the PTC cytology cases into a particular cytological variant by applying an algorithmic approach and correlating these variants with histology. Materials and Methods: An analysis of all histopathologically confirmed cases of PTC who had previously been diagnosed with fine needle aspiration cytology (FNAC) from January 2014 to December 2019 was conducted. FNAC samples of thyroid nodules were blindly reviewed and classified into different morphological variants using a stepwise algorithmic approach based on architectural, nuclear, and cytoplasmic features. Results: A review of 77 histologically proven cases of PTC variants or with a predominant area of variant histomorphology was done. One case was inadequate (TBSRTC I), nine cases were benign (TBSRTC II), two were follicular lesions of undetermined significance (TBSRTC III), and 65 cases were suspicious or definite for PTC (TBSRTC V/VI). Retrospective algorithmic cytopathological analysis of 65 cases that are suspicious or definite of PTC (TBSRTC V/VI) showed classical PTC (5), follicular variant-PTC (35), tall cell variant (20), diffuse sclerosing variant (1), warthin-like variant (2), and solid variant (2). Diagnostic accuracy of cytopathology in diagnosing the PTC variants when compared with histopathological diagnosis varied from 81.3% to 100% (mean 78.9%). Cluster analysis justified that our classification showed good agreement with the actual classification based on the cytopathological features identified by the cluster analysis. Conclusion: An awareness of cytomorphological features of aggressive variants may facilitate early and accurate diagnosis and appropriate clinical management with better patient outcomes. FNAC can subclassify PTC into different variants based on this algorithmic approach or aggressive and nonaggressive variants based on certain more frequently observed features. [ABSTRACT FROM AUTHOR]

Acetylcarvacrol is a semi-synthetic product derived from carvacrol and has known activity against ticks. In vertebrates, the thyroid has been used as a bioindicator in toxicity studies due to its sensitivity to external factors. Thus, the objective of this study was to evaluate the toxic effects of acetylcarvacrol in Wistar rats subjected to repeated dose dermal and oral toxicity tests by means of histopathological analysis of the thyroid. For each test, the rats were divided into 4 groups containing 5 animals. In the topical treatment test, acetylcarvacrol was applied to the trichotomized back of each animal at concentrations of 26, 52 and 104 μL/mL for 21 days. In the oral test, the animals were fed acetylcarvacrol by gavage at concentrations of 26, 52 and 104 μL/mL for 30 days. The control groups were treated only with the vehicles. A significant increase in interstitial tissue vascularization was observed in the group treated topically with the highest concentration of acetylcarvacrol compared to the control. No significant changes were observed between the treatment and control groups in the oral experiment. The comparison between the treated groups and their respective controls also showed no differences in the colloid, the follicle and the follicular cells. The reduced occurrence of changes in this tissue suggests relative safety for use in the control of ticks, although caution is needed when using it at high concentrations or for long periods of time. [ABSTRACT FROM AUTHOR]

To determine the rate of re-treatment in patients who receive a full course of teprotumumab therapy for thyroid eye disease (TED) and drivers of re-treatment. Multicenter retrospective study. All patients who received a full course of treatment and had available data at 1 year after initial treatment were included. Charts were reviewed for the following information: age, sex, months since diagnosis of TED, smoking status, and prior treatments. Further, the clinical activity score (CAS), proptosis, and the Gorman diplopia score were reviewed at baseline, at the end of the first course, and at baseline for the second course in those who received it. A logistic regression model was created to review the drivers of re-treatment. Rate of re-treatment and the drivers of re-treatment. One hundred nineteen patients were included from 3 centers across the United States. The overall re-treatment rate was 24% (29/119). No difference was found among the 3 sites (P = 0.6). In univariable analyses, at baseline, no difference was found in proptosis (P = 0.07), diplopia score (P = 0.4), or duration of TED (P = 0.4) between patients who were re-treated and those not re-treated. From the re-treated group, 82% showed a significant proptosis response (≥ 2-mm reduction from baseline) after the initial course, whereas 68% of patients who were not re-treated showed a clinically significant proptosis response (P = 0.16). The mean ± standard deviation difference between the end of the first treatment and at baseline before the second treatment (in those who received it) was 2 ± 2 for CAS, 2 ± 4 mm for proptosis, and 1 ± 1 for diplopia score. Age was the only significant driver of re-treatment (P < 0.05). Re-treated patients were 7 years older than patients who were not re-treated (60 years vs. 53 years; P < 0.05). In patients receiving a full course of teprotumumab therapy, the rate of re-treatment was 24%. Age was the only driver of re-treatment. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

Introduction: Artificial Intelligence (AI) has emerged as a promising tool in the delivery of health care. ChatGPT-4.0 (OpenAI, San Francisco, California) and Llama 2 (Meta, Menlo Park, CA) have each gained attention for their use in various medical applications. Objective: This study aims to evaluate and compare the effectiveness of ChatGPT-4.0 and Llama 2 in assisting with complex clinical decision making in the diagnosis and treatment of thyroid carcinoma. Participants: We reviewed the National Comprehensive Cancer Network® (NCCN) Clinical Practice Guidelines for the management of thyroid carcinoma and formulated up to 3 complex clinical questions for each decision-making page. ChatGPT-4.0 and Llama 2 were queried in a reproducible manner. The answers were scored on a Likert scale: 5) Correct; 4) correct, with missing information requiring clarification; 3) correct, but unable to complete answer; 2) partially incorrect; 1) absolutely incorrect. Score frequencies were compared, and subgroup analysis was conducted on Correctness (defined as scores 1-2 vs 3-5) and Accuracy (scores 1-3 vs 4-5). Results: In total, 58 pages of the NCCN Guidelines® were analyzed, generating 167 unique questions. There was no statistically significant difference between ChatGPT-4.0 and Llama 2 in terms of overall score (Mann-Whitney U-test; Mean Rank = 160.53 vs 174.47, P = 0.123), Correctness (P = 0.177), or Accuracy (P = 0.891). Conclusion: ChatGPT-4.0 and Llama 2 demonstrate a limited but substantial capacity to assist with complex clinical decision making relating to the management of thyroid carcinoma, with no significant difference in their effectiveness. [ABSTRACT FROM AUTHOR]

Background The aim of this study is to estimate the factors at both the individual and community levels related to the adequacy of iodized salt in households in Bangladesh. Methods For this study we utilized the 2019 Multiple Indicator Cluster Survey data. A total of 61 242 households were chosen as samples from Bangladesh. In our study of socio-economic disparities, we applied a concentration indexing method. To identify the factors associated with the adequacy of iodine in salt at both the individual and community levels, we employed multilevel logistic regression. Aside from the multilevel regression used in the study, we also applied spatial analysis. Results The results indicated that the prevalence of iodine adequacy in household salt was found to be 57.8% (95% confidence interval 57.4 to 58.2). Rural areas have a higher concentration of iodine than urban areas. According to the multilevel model, younger women (adjusted odds ratio [aOR] 0.70), Muslim women (aOR 0.89), illiterate women (aOR 0.80) and those from poor households (aOR 0.33) were found to be less likely to consume iodine in concentrated salt compared with their counterparts. Disabled women and those with low media exposure have a lower likelihood of iodine adequacy in salt compared to their reference group. Furthermore, households in urban areas exhibited higher odds of having iodine adequacy in salt compared with households in rural areas. Barisal, Chattogram, Dhaka, Khulna, Mymensingh, Rajshahi and Rangpur Divisions have lower iodine adequacy in salt compared with Sylhet Division. Conclusions The findings reveal that religion, physical disability and exposure to media exert an equal influence on the presence of iodized salt intake. Moreover, women's age, wealth status, education level and the educational background of the household head positively contribute to the adequacy of iodine in household salt. In light of these results, policymakers are advised to prioritize efforts aimed at enhancing iodine concentration, with a particular focus on mass media advertising, especially in rural areas (excluding Sylhet Division). [ABSTRACT FROM AUTHOR]

Olanzapine (OLZ) is a second-generation atypical drug that is commonly used to treat schizophrenia. However, it is known to affect male sexual functions, reproductive processes, and spermatogenesis. This study aims to investigate the effectiveness of beetroot extract in reducing the side effects of Olanzapine. The study involved 46 male Wistar rats weighing 150-200 g, administered intraperitoneal doses of OLZ and beetroot extract at (10 mg/kg) daily for six weeks. Thyroid-stimulating hormone (TSH), triiodothyronine (T3), tetraiodothyronine (T4), (T3/T4), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels were measured. The study found that beetroot extract treatment significantly increased thyroidstimulating hormone levels by 81% and TSH by 82% in the third and sixth weeks, while Triiodothyronine levels decreased by 42% and thyroxin levels by 115% in the third and sixth weeks, also, there was a significant decrease in testosterone levels in the group treated with Olanzapine by 108 % in the third week and by 116% in the sixth week when compared to a control group; additionally, the study found a 25% increase in absolute body weight in the beetroot extract group and 26% increase in a combined group treated with Olanzapine compared to Olanzapine. Histological sections of the thyroid gland and testis were taken at the end of the sixth week. OLZ caused atrophy of follicular epithelium in the thyroid gland and shrunken seminiferous tubules, with disorganized germinal epithelium in the testis; however, beetroot extract treatment resulted in normal testicular histology, characterized by regular tubules with stratified germinal epithelium and Leydig cell clusters. However, some sperm aggregation was observed in the tubular luminae. It concluded that administrating beetroot extract (10 mg/kg) daily for six weeks significantly improved the pituitary, thyroid, and fertility in adult white male rats. [ABSTRACT FROM AUTHOR]

The rearranged during transfection (RET) receptor tyrosine kinase is physiologically stimulated by growth factors belonging to the glial cell line-derived neurotrophic factor family and by the growth differentiation factor-15 cytokine. RET plays a critical role in normal development as well as in various human tumors and developmental disorders. This review focuses on mechanisms of RET signaling and their alterations in human diseases. [ABSTRACT FROM AUTHOR]

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Obesity often coexists with thyroid diseases, and the prevalence of these disorders has been on the rise for years. While hypothyroidism can contribute to excess fat tissue, the relationship between Body Mass Index (BMI) and thyroid function hormones is bidirectional. Research confirms that fat tissue reduction can positively impact thyroid function. Thus, delaying the initiation of therapies beyond substitution treatment to achieve optimal weight reduction in individuals with thyroid dysfunction seems unwarranted. The authors summarize current knowledge on this topic in the article. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid cytopathology cases with suspicious for malignancy (SFM) diagnosis often result in resection. However, molecular testing offers details that may provide additional insights. In this study, the molecular profiles of SFM cases from two institutions that routinely used ThyroSeq v3 (TSV3) were examined. Materials and Methods: Following institutional review board approval, SFM thyroid cytopathology cases with TSV3 results were retrieved from the databases of two institutions. Molecular information including molecular‐derived risk of malignancy (MDROM), cytologic‐histologic correlation data, and other related parameters were calculated. Statistical comparisons were made with a p <.05 considered significant. Results: The core data set comprised 114 SFM cases that passed TSV3 quality assurance. All TSV3 results were reported as positive or negative for genomic alterations and all except five cases provided a probability of malignancy estimate. The overall combined baseline MDROM of 75.7% (95% CI, 70.0–81.4) was comparable to the risk of malignancy (74%) published in the Bethesda System. There was a statistically significant difference between the combined MDROMs of resected and unresected cohorts (79.0% vs 58.6%; p =.0153). Interestingly, the MDROMs of the resected cohorts from the two institutions were statistically different (75.0% vs 85.3%; p =.020). Cytologic–histologic correlation revealed malignant outcome in 88.5% of resected cases. Conclusions: Molecular analyses of SFM cases demonstrated higher risk genomic alterations that were associated with histologically overt neoplasms, resulting in increased malignancy outcome compared to baseline. MDROM analysis revealed differences in the cytopathologic practice patterns regarding follicular‐patterned neoplasms at the two institutions. Molecular testing on thyroid suspicious for malignancy diagnosis is associated with increased malignancy outcome among resected cases. Furthermore, molecular‐derived risk of malignancy and other related parameters have the potential to provide insights into nodule characteristics and practice patterns. [ABSTRACT FROM AUTHOR]

Objectives: Anaplastic thyroid cancer (ATC) is the most aggressive and fatal thyroid malignancy. Currently, there still exists a paucity of literature studying the relationship between available ATC‐targeted therapy, immunotherapy, and survival. We aim to investigate how systemic therapies affect survival outcomes in ATC. Methods: A single‐tertiary‐institution chart review of patients diagnosed with advanced‐stage ATC, and who underwent surgery as part of their treatment, was performed between 2000 and 2023, with 41 patients included. Demographics, clinical characteristics, and survival data were collected and analyzed via Kaplan–Meier and Cox proportional hazards analyses. Results: 54% of patients were female, and average age was 67.4 years old. The most common mutations identified were BRAF (15 patients), p53 (9 patients), and p63 (2 patients). A total of 18 patients utilized targeted or immunotherapy, with Trametinib and Dabrafenib (9 patients) as the most common agents used. Two‐year overall survival was 24%, and 5‐year overall survival was 23%, with median survival time of 7.6 months. Kaplan–Meier analysis demonstrated improved survival in patients who received chemotherapy (p = 0.048). Cox proportional hazards analysis demonstrated that patients treated with immunotherapy or targeted therapy had a statistically significant increase in survival compared with patients who did not receive these therapies (p = 0.016). Additionally, females and those with a p63 mutation demonstrated improved survival outcomes (p = 0.010, p = 0.001). Conclusions: Targeted therapy and immunotherapy use should be strongly considered when treating patients with ATC. Further studies into novel drugs targeting immune checkpoints and combination therapy are needed to better optimize treatment of patients with ATC. Level of Evidence: 3 Laryngoscope, 135:478–484, 2025 [ABSTRACT FROM AUTHOR]

Background: Thyroid disorders are common endocrine conditions impacting multiple organs, including the reproductive system and often lead to sexual dysfunction. These effects can vary by gender; for example, women with hypothyroidism frequently experience reduced libido. Low thyroid hormone levels are also linked to vaginal dryness, causing discomfort, especially during intercourse. This study aims to assess the global prevalence of sexual dysfunction in women with thyroid disorders. Methods: Systematic searches were performed across electronic databases, including PubMed, Scopus, Web of Science, Embase, ScienceDirect and Google Scholar, to retrieve studies reporting the prevalence of sexual dysfunction in patients with thyroid disorders up to February 8, 2024. Inclusion criteria comprised studies that reported on the prevalence of female sexual dysfunction (FSD) in patients with thyroid disorders and studies published in English available full text. Exclusion criteria included case studies, intervention studies, studies with incomplete information, repeated studies and those not written in English. Cross-sectional studies were the primary study design included. Data were analyzed using the Comprehensive Meta-Analysis software (Version 2). Results: Analysis of nine studies, involving a total sample size of 1013, found an overall prevalence of sexual dysfunction in women with thyroid disorders to be 44.8% (95% CI: 33.8–56.2). Given the substantial reporting of sexual dysfunction among women with either hypothyroidism or hyperthyroidism, subgroup analyses were conducted. The prevalence of sexual dysfunction was 41.8% (95% CI: 26.3–59) among women with hypothyroidism and 59.6% (95% CI: 50.5–68.1) among those with hyperthyroidism. Conclusion: The notable prevalence of sexual dysfunction in women with thyroid disorders highlights the for increased awareness among this population. Targeted awareness initiatives may help mitigate the occurrence of sexual dysfunction and its adverse effects, improving overall quality of life for affected women. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Background: The thyroid gland, named after the Greek word for "shield," is responsible for critical metabolic processes and is frequently affected by various non-neoplastic conditions, including goitres, thyroiditis, and hyperplastic changes. Non-neoplastic thyroid lesions are primarily benign but may mimic malignancy clinically, the challenge lies in differentiating these from malignant cases to avoid unnecessary surgery. Differentiating these lesions is essential, especially in high-prevalence regions like India, where goitre is endemic. This study assesses FNAC as a primary diagnostic tool for such cases, correlating it with histopathological findings. METHODS: The study involved 220 patients with thyroid swellings who underwent FNAC at a tertiary care centre from August 2016 to August 2018. Patients' clinical histories were recorded, followed by FNAC. Surgical specimens from 78 patients were subsequently evaluated histopathologically to verify FNAC diagnoses. Results: FNAC proved to be highly effective, with an accuracy of 94.87% for diagnosing non-neoplastic thyroid lesions. The study found that most cases were benign, with conditions like colloid nodular goitre (40.45%) and Hashimoto's thyroiditis (31.36%) being most prevalent. Notably, only 5-30% of thyroid nodules turned out to be malignant, emphasizing the importance of accurate preoperative diagnosis. Sensitivity, specificity, and predictive values from the FNAC results were high, confirming FNAC as a reliable first-line diagnostic approach for thyroid lesions. Conclusion: FNAC is a valuable tool in diagnosing nonneoplastic thyroid lesions, offering high diagnostic accuracy and facilitating appropriate management strategies. The study advocates for its continued use in clinical settings, especially in regions with high thyroid disease prevalence. Further studies could enhance FNAC's accuracy, focusing on minimizing false-negative rates and incorporating advanced imaging techniques. [ABSTRACT FROM AUTHOR]

Background: Voice alteration is a recognized complication of thyroid surgery, impacting the quality of life and communication for affected individuals. In this prospective observational study, the Acoustic Voice Quality Index (AVQI) was employed to assess vocal outcomes after thyroidectomy. Method: Between February 2018 and August 2022, 224 patients underwent Thyroid surgery in our department, of which 74 with differentiated thyroid carcinoma (DTC) were enrolled in accordance with the inclusion criteria. Endoscopic findings and AVQI scores were evaluated before and after surgery (voice analysis was conducted using the Praat software program version 6.0.33). Results: Vocal fold impairment was present in 6.76% of patients after surgery (T1), with full recovery within 3 months. During preadmission evaluation, an AVQI score > 2.35 indicating hoarseness was present in 37 patients (despite normal vocal cord motility). Of these, 25 (67.57%), 26 (70.27%), and 24 (17.76%) maintained this trend at T1, T2, and T3, respectively. No significant variation in mean AVQI values was observed based on gender, age, and central neck dissection. Conclusion: AVQI values did not show significant variations comparing pre- and postoperative values. Thyroid surgery for DTC performed by experienced surgeons does not seem to impact significantly on patients' voice quality. [ABSTRACT FROM AUTHOR]

Gaucher disease (GD), the most common ultra-rare metabolic disorder, results from lipid accumulation. Systemic inflammation, cellular stress, and metabolic dysfunction may influence endocrine function, including the thyroid. This study evaluated thyroid function and morphology in 60 GD patients, alongside carbohydrate and lipid metabolism. Anthropometric, biochemical, and hormonal tests were conducted, including thyroid ultrasound and shear-wave elastography (SWE). Clinical data, bone mineral density (BMD), and body composition (BOD POD) analyses were correlated. Healthy controls, matched for age, sex, and body mass index (BMI), were included. GD patients had higher thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels within normal limits. Hypothyroidism occurred in 7%, elevated anti-thyroid antibodies in 8%, and nodular goiter in 23%. Patients with nodular goiter showed lower platelet counts and higher chitotriosidase and glucosylsphingosine (lysoGb-1) levels. Patients with type 3 GD had larger thyroid volumes and greater stiffness on SWE than patients with type 1 GD. GD patients also exhibited increased metabolic risk, including central obesity and elevated glucose levels. GD patients, despite normal thyroid hormone levels, exhibit subtle alterations in thyroid function indicators. Their increased risk of central obesity and glucose metabolism disorders, alongside higher TSH and FT4 levels, underscores the need for closer monitoring and further investigation. [ABSTRACT FROM AUTHOR]

Objective: To determine the cancer risk in thyroid nodules using ACR TI-RADS. Methods: A retrospective analysis of all thyroid biopsies was performed over a 3-year period (2021 to 2023). Variables including gender, age, history of thyroid cancer or neck irradiation, nodule size and location, TR level, and sonographic features such as punctate echogenic foci (PEF), a very hypoechoic appearance, taller-than-wide shape, and suspected extrathyroidal extension were analyzed. Results: A total of 1140 nodules were assessed in 993 patients, including 740 females (74.5%) and 253 males (25.5%). The mean patient age was 57.1 ± 15.4 years. Variables significantly associated with nodule malignancy included (1) younger age, (2) a prior history of thyroid cancer or neck irradiation, (3) a higher TR level, (4) a taller-than-wide shape in nodules <1 cm, (5) PEF, (6) a very hypoechoic appearance, and (5) suspected extrathyroidal extension (p < 0.05). Gender, nodule location and size were not associated with a higher cancer risk (p > 0.05). Malignancy was found in 40.7% of TR5, 4.8% of TR4, 0.3% of TR3, and 0% of TR1 and 2 nodules. The odds ratios (ORs) for cancer were as follows: TR4 or 5, OR = 19; PEF, OR = 11; a very hypoechoic appearance, OR = 13.3; and suspected extrathyroidal extension, OR = 27.2 (p < 0.01). Conclusions: Higher TR levels, PEF, a very hypoechoic appearance, and suspected extrathyroidal extension are important features for predicting cancer risk. These findings affirm the effectiveness of ACR TI-RADS in nodule risk stratification. [ABSTRACT FROM AUTHOR]

Introduction: Benign multinodular goiter (BMNG) can grow very large and cause compression symptoms, making the operation procedure difficult. However, the recurrence rate of BMNG ranges from 3% to 43%. Reoperative thyroid surgery for BMNG is uncommon and can result in a high rate of complications, including hypoparathyroidism and recurrent laryngeal nerve palsy. Carbon nanoparticles (CNs) have been widely used as a protective agent for the parathyroid gland and as a tracer agent in central lymph node dissection. However, the protection effect of CNs in redoing BMNG has not been well illustrated. This study investigates whether CNs could protect parathyroid glands (PGs) during reoperation for patients with BMNG. Methods: BMNG patients who previously underwent thyroidectomy and received reoperation between January 2019 and January 2022 were retrospectively recruited. The Dunhill approach was employed for all patients. The patients were divided into two groups: the CNs group, who received injection CNs injection 1 hour before the operation (n = 24), and the control group, who underwent thyroid surgery without CNs injection (control group, n = 25). The numbers of PGs preserved in situ , autotransplantation, the accidental removal of the PGs, and the parathyroid hormone level were recorded and analyzed. Results: The results revealed that more PGs were preserved in situ in the CNs group compared to the control group (3.25±0.15 vs 2.60±0.16, P=.007). Moreover, fewer PGs were subjected to autotransplantation and were accidentally discovered in the specimen in the CNs group compared to the control group. Patients who had CNs injection exhibited a lower rate of transient (5/24 vs. 13/25, P=.024) and permanent hypoparathyroidism (2/24 vs. 9/25, P=.020) compared to the control group. [ABSTRACT FROM AUTHOR]

Introduction: Depending on age, sex, and familial longevity, alterations in thyroid status occur frequently and often co-occur with differences in other hormonal axes. However, studies that explore the effects of thyroid status modulation on other hormonal axes remain scarce. We aimed to determine the effects of thyroid status modulation on prolactin, IGF-1, cortisol, LH, testosterone, and SHBG levels. We also explored whether effects differed depending on type of challenge, sex, and familial longevity. Methods: Data were gathered from two single-arm challenge studies comprising an intramuscular injection of 0.1 mg recombinant human TSH (rhTSH, N = 29) or 100 µg T3 orally (N = 27) in healthy older individuals. Changes in hormone concentration profiles relative to baseline were determined for 4 and 5 days, respectively. Results: IGF-1 increased with a maximum of 6.3% (SEM = 1.6%, p = 0.002) in the rhTSH challenge and 8.8% (SEM = 1.6%, p < 0.001) in the T3 challenge, while LH (19.3% [SEM = 6.6%, p = 0.048]), testosterone (13.8% [SEM = 4.7%, p = 0.048]), and SHBG (11.8% [SEM = 3.5%, p = 0.02]) increased significantly in the T3 challenge only. Moreover, prolactin significantly decreased in both rhTSH and T3 challenges (−8.8% [SEM = 3.4%, p = 0.048] and −12.0% [3.3%, p = 0.004], respectively) as did cortisol (−14.8% [SEM = 3.6%, p < 0.001] and −15.6% [SEM = 3.5%, p < 0.001]). There was no significant interaction with type of challenge, sex, or familial longevity, except for prolactin in the rhTSH challenge (p = 0.004) which decreased significantly in men only. Conclusions: Upon modulation of thyroid status, changes were observed in IGF-1, prolactin, and cortisol. In the T3 challenge, LH, testosterone, and SHBG increased in men. Observed changes are hypothesized to be driven by (f)T3. [ABSTRACT FROM AUTHOR]

A priori estimation of staff exposure during medical interventional procedures involving the use of ionising radiation is essential to carry out an adequate risk assessment and, therefore, to define the maximum workloads, to choose appropriate dosimeters and additional shielding. To date, research activity has been mainly focused on cardiac procedures, which involve high dose rates, and much attention is paid to the optimisation of radiation protection in this field. The purpose of this retrospective study was to evaluate the dose exposure of different healthcare professionals starting from the Dose Area Products (DAPs) recorded after various interventional (non-cardiac) and surgical procedures. A total of 374 operators, 2829 interventional procedures and 4463 surgical procedures were considered. Estimated thyroid/lens absorbed dose (median-75%) for surgeons/interventionists were as follows (ìSv/procedure). Interventional procedures: endoscopy (107–121)/(85–97) and urology (60–130)/(48–104); surgeries: vascular (68–73)/(55–60), general (28–35)/(22–28), orthopaedic (6–9)/(5–7). After grouping the data of all the procedures, the same estimations are reported for anesthesiologists (15–29)/(13–25), nurses (13–24)/(11–20) and radiographers (15–32)/(12–26). [ABSTRACT FROM AUTHOR]

Autoimmune thyroiditis (AIT), also known as Hashimoto's thyroiditis (HT), is an autoimmune disease that is characterised by elevated thyroid-specific antibody titres. The incidence of AIT is increasing year over year, making it urgent to establish a suitable animal model for this condition, in order to better explore its pathogenesis and potential pharmaceutical mechanisms for treatment. Owing to a lack of basic research on this disease, problems such as disparate modelling methods with unclear and varying success rates make it difficult for researchers to obtain effective information on AIT in the short term. This report summarises and analyzes the current literature on AIT and combines actual operability to explain the selection and specific implementation processes behind the uses of different modelling approaches, to provide a better overall understanding of autoimmune thyroid diseases. [ABSTRACT FROM AUTHOR]

Introduction: In the past 3 decades, thyroid cancer research has surged, becoming the leading topic in clinical thyroidology. Despite this, there's a lack of data identifying key articles, authors, and journals. This study aims to provide insights for authors, physicians, and research labs by highlighting the most influential journals, authors, and research topics in thyroid cancer. Methods: A comprehensive search was conducted using the Scopus database, employing the medical subject heading (MeSH) terms "Thyroid" and "Cancer" in the titles, abstracts, or keywords of articles. The search was limited to English articles in academic medicine journals published between January 1993 and December 2021. Results: The search yielded 21 472 articles across 3076 journals, authored by 13 974 senior authors. The number of journals publishing on thyroid cancer expanded from 29 in 1993 to 733 in 2021, marking an average annual growth of 14%. Article output on the topic increased from 54 in the initial year to 1580 by 2021, with an annual growth rate of 16%. A thematic analysis revealed 369 articles mentioning "BRAF" since 2004, 479 articles on "ultrasound" techniques, 325 on "ablation" methods, and 453 articles focusing on "genetics" in thyroid cancer. The Journal of Clinical Endocrinology and Metabolism emerged as the most prolific, publishing 1017 articles over the 29-year period. Conclusion: This study guides resource allocation towards impactful journals for thyroid cancer researchers, helps identify key contributors for collaboration or mentorship, and provides a framework for similar analyses in other fields. [ABSTRACT FROM AUTHOR]

Background: In South Africa (SA), data on the incidence of thyroid cancer is limited. Papillary thyroid carcinoma is by far the most common malignancy in developed countries; however, a preponderance of follicular thyroid cancer in developing countries, despite iodized salt, has been observed. The aim of this study was to describe the national landscape of thyroid cancer in SA with reference to pathological subtypes, surgical outcomes, and treatments offered. Methods: A multi‐institutional retrospective review of thyroid cancer patients operated on between January 2015 and December 2019 was performed. Public hospitals with associated academic institutions were included. Data were collected from theater registers, pathology, and radiology records. Statistical analysis was done to determine intergroup significance. Results: A total of 464 thyroid cancer cases from 13 centers across five SA provinces were identified. Most patients presented with a mass (67%). Ultrasound was performed in 82% of patients, and 16.3% underwent surgery without pre‐operative cytology. Of the histologically confirmed thyroid cancers, 61.8% were papillary and 22.1% follicular thyroid cancer. There was a significant association between subtype and geographical area, and T‐stage and operation performed. Surgical complication rates included hematoma in 1.8%, post‐operative hypocalcemia in 28.7%, and recurrent laryngeal nerve injury in 3.5%. Conclusion: This first national review describes the landscape of thyroid cancer in SA, revealing considerable differences compared to international studies. It provides valuable insight into the unique South African experience with this disease. In addition, this study serves as an impetus towards a prospective national registry with real‐world data informing contextualized guidelines. [ABSTRACT FROM AUTHOR]

Extraluminal foreign bodies are rare. Fish bone is the most common foreign body ingested by adults, while coin is the most common foreign body ingested among children. Sharp pricking pain is a sign of sharp foreign body (FB) ingestion. If the symptom persists, one should keep in mind the possibility of a migratory foreign body, even if the esophagoscopy results are negative. In order to ensure that foreign bodies are not missed radiologically, there is the role of consultation from a second radiologist to correlate with the patient's symptoms. Here we present an atypical case of recurrent neck abscess due to a migrating fishbone that penetrated the left thyroid lobe and settled in the left lower third neck subcutaneous tissue within two months. [ABSTRACT FROM AUTHOR]

The thyroid gland is one of the major regulator organs of hemostasis in the human body, controlling the functioning of numerous systems. Thyroid hormones exert a modulating effect on the cardiovascular system in particular, ensuring optimal functioning within the normal range. Triiodothyronine (T3), as an active form of thyroid hormone, is mainly responsible for this effect via both genomic and nongenomic mechanisms. It has been reported that overt thyroid disorders are associated with a number of cardiovascular diseases and cardiac mortality. While hyperthyroidism appears to be related to atrial fibrillation and heart failure, the most pronounced cardiovascular complication of hypothyroidism seems to be atherosclerosis. Achieving euthyroidism is of great importance for restoring cardiovascular function. However, depending on the underlying health conditions, this may not be possible for all patients. Furthermore, there has been a growing focus on the role of subclinical thyroid dysfunctions and their impacts on the cardiovascular system in recent years. The pattern of cardiovascular abnormalities in subclinical thyroid disorders appears to parallel that of overt hypothyroidism, suggesting that even mild alterations in thyroid hormone levels may also have effects on the cardiovascular system. The management of subclinical thyroid disease remains controversial. Current evidence suggests that patient age and underlying cardiovascular diseases are major factors in clinical decision-making. [ABSTRACT FROM AUTHOR]

Background: Ectopic organ-associated conditions belong to the larger panel of developmental ailments, and among this challenging medical and surgical chapter, ectopic endocrine glands-related picture is mostly focused on the presence of the ectopic parathyroid and thyroid. Ectopic thyroid tissue within mediastinum (ETTM) stands for a less common ETT site; while, globally, less than 1% of the mediastinum masses are ETTM. Objective: We aim to introduce a rare case of ETTM in a senior lady to whom one-time synchronous thyroidectomy with ETT removal was successfully performed via a minimally invasive modern procedure upon cervicotomy and intra-operatory use of the Cooper thymectomy retractor. Results: The panel of pros and cons with respect to providing endocrine thoracic surgery for ETTM resection in a 73-year-old subject is discussed amid a PubMed search of original English-language original reports from January 2000 until 15 August 2024 in order to identify similar distinct cases (individuals of 70 years or older who underwent surgery for ETTM). Conclusions: 1. We propose the term "three-leaf-clover thyroid" to capture the imaging essence of having an enlargement of both (eutopic) thyroid lobes and ETTM. 2. The modern surgical approach under these circumstances provided a rapid patient recovery with a low rate of complications and a minimum hospital stay. Hence, the procedure may be expanded to older patients after a careful consideration of their co-morbidities and of the need to releasing connected complaints (e.g., a 7-month history of intermittent dyspneea was found in this case with post-operatory remission). 3. The management remains a matter of individualised decision, and age may not be a limiting factor. 4. At the present time, this case adds to the very limited number of similar published cases in the mentioned age group that we could identify (seven patients, aged between 72 and 84; male-to-female ratio of 5 to 2; the rate of malignant ETTM was 3/7); of these cases, not all were reported to have a trans-cervical approach, and none reported the use of the Cooper thymectomy retractor to help the overall surgical procedure. This innovative surgical procedure offers the advantage of avoiding a sternotomy incision which has clear functional and aesthetic implications, while the video-assisted approach allows optimal visualization of the mediastinal anatomy and safe vascular sealing under visual control, without the risk of a major hemorrhage. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of thyroid function on male fertility, focusing on hypo- and hyperthyroidism. Methods: A PubMed/MEDLINE, Web of Science, and Scopus research was performed. Original studies in English published online up to 31 May 2023 were selected and reviewed. The final reference list was defined based on the relevance of each paper to the scope of this review. Results: The available data in animals (31 studies) and human (26 studies) showed conflicting results. However, thyroid dysfunction altered erection and ejaculation both in animal models than in men. Conclusion: Both hypothyroidism and hyperthyroidism seem to cause ejaculation and erectile dysfunction. Hence, Guidelines recommend against the systematic screening for thyroid disorders in the men in sub-fertile couples, but only in men with ejaculation and erectile dysfunction and/or altered semen parameters. [ABSTRACT FROM AUTHOR]

Background: The current dogma is a life-long follow-up for patients treated for follicular-derived differentiated thyroid cancers (DTC). Our primary objective was to determine the time to recurrence in a series of DTC patients with an excellent response to therapy 6 months after total thyroidectomy and radioiodine therapy. The secondary objectives were to determine the time to suspicion of recurrence and to identify factors associated with recurrence. Methods: This retrospective cohort study included patients treated for DTC between 2008 and 2012 and in remission 6 months after total thyroidectomy and radioiodine treatment. The criteria for remission were negative imaging and suppressed thyroglobulin (Tg) <0.2 ng/mL or rh-TSH-(recombinant human TSH) stimulated Tg <1 ng/mL according to the 2015 ATA (American Thyroid Association) guidelines. Recurrence was defined by cytologically and/or histologically proven cervical lymph node metastasis or the administration of a second radioiodine treatment. Results: Among 721 patients treated for DTC, 158 were excluded because of persistent disease at 6 months, 71 because of missing follow-up data, and 492 were included. The mean and median follow-up time were 7.0 and 7.9 years (interquartile range IQR [2.1–11.3]). Recurrence occurred for 7 patients (1.4%), 1 initially classified as high recurrence risk, 3 as intermediate, and 3 as low risk according to the 2015 ATA guidelines. All relapses occurred within 10 years after initial management (4 within the first 5 years). For patients with recurrence, rise in Tg and/or suspicious lymph nodes were detected in six out of seven cases in the first 8 years and for the last case 10 years after initial surgery. Conclusion: Low and intermediate recurrence risk DTC patients with excellent response 6 months after total thyroidectomy and radioiodine and in remission 10 years later have an extremely low recurrence risk. Follow-up might be undertaken by primary care providers from this time point. These discharge recommendations should be confirmed by further prospective studies. [ABSTRACT FROM AUTHOR]

Background: The "neutral" thyrotropin receptor autoantibodies (N-TSHR-Ab) directed at the TSHR ectodomain's hinge region have been shown to induce thyroid cell damage in vitro. During these earlier studies, we developed a mouse monoclonal antibody (MC1) specific for a peptide (amino acid 322–340) in the region (MC1-Mab) which was able to induce thyroid cell stress and apoptosis when administered in vivo. Methods: In order to examine the effect of in vivo generated N-TSHR-Abs, rather than an acutely administered monoclonal antibody, we immunized Balb/c mice with the hinge region peptide over 18 weeks. Serum TSHR antibodies, specific TSHR hinge region antibodies, serum thyroglobulin (TG) and anti-TG as well as thyroxine and thyrotropin (TSH) levels were examined to evaluate the response to the immunization. Histological examination of the thyroid glands and flow cytometry of spleen T cells, B cells and macrophages were also performed to explore the underlying mechanisms. Results: We found that TSHR-peptide immunized mice developed N-TSHR-Abs against the peptide which resulted in thyroid damage shown by thyroid follicular destruction with follicular cell apoptosis, M1 macrophage infiltration, thyroglobulin release, and induction of thyroglobulin antibodies. This resulted in hypothyroidism with increased TSH levels. Conclusion: This study demonstrated that endogenous neutral antibodies to the TSHR could induce thyroid cell damage from apoptosis and M1 macrophage infiltration and resulted in hypothyroidism. [ABSTRACT FROM AUTHOR]

Although numerous studies have explored the link between polycystic ovary syndrome (PCOS) and thyroid dysfunction, the relationship between polycystic ovary morphology (PCOM) and thyroid issues remains unclear. This study aimed to examine the association between PCOM and subclinical hypothyroidism (SCH) as well as the threshold for thyroid-stimulating hormone (TSH). Data were drawn from the Iranian PCOS prevalence study and the Khuzestan PCOS prevalence study. Eligible participants were divided into two groups: those with PCOM (n = 120) and a control group (n = 630). A logistic regression model was employed to assess the impact of PCOM on SCH, with odds ratios and 95% confidence intervals calculated. Additionally, a quantile regression model was used to evaluate the effect of PCOS on TSH levels. The results indicated no significant association between PCOM and SCH (adjusted OR: 1.38, 95% CI: 0.80–2.37; p = 0.243). Furthermore, after adjusting for confounding factors such as age, body mass index (BMI), and number of pregnancies, no significant differences were found in TSH levels between the PCOM and control groups. The prevalence of SCH and the TSH threshold were similar in both groups. Further comprehensive population-based studies with detailed thyroid evaluations are recommended. [ABSTRACT FROM AUTHOR]

Aim: To determine the ultrasonographic (US) features that could help to distinguish between parathyroid masses abutting the thyroid gland and thyroid masses extending into the parathyroid area. Materials and methods: Two blinded readers retrospectively evaluated the US images of 76 histopathologically confirmed parathyroid masses abutting the thyroid gland and 34 thyroid masses extending into the parathyroid area. Maximal diameter, transverse diameter/anterior-posterior diameter (T/AP) ratio, longitudinal diameter/AP diameter (L/AP) ratio, margin, shape, echogenicity, echotexture, and echogenic interface were evaluated and compared between the two groups. Results: Echogenic interface (p<0.001) and L/AP ratio (p<0.001) were statistically significant US features that differentiated parathyroid and thyroid masses. Other US features did not show any significant differences between the two groups. Interobserver agreement was excellent for all US features. Sensitivity/specificity of the presence of echogenic interface and L/AP ratio >2.0 were 85.5%/100% and 43.2%/82.4% in distinguishing parathyroid from thyroid masses, respectively. Conclusion: The presence of an echogenic interface and L/AP ratio >2.0 were useful US features for differentiating parathyroid masses abutting the thyroid gland from thyroid masses extending into the parathyroid area. [ABSTRACT FROM AUTHOR]

Thyroid immune-related adverse events (irAEs) are associated with programmed cell death protein 1 (PD-1) blockade efficacy in non-small cell lung cancer (NSCLC). However, their independence from PD-L1 expression and quantitative impact on predicting PD-1 blockade efficacy remain unexplored. This multicenter, retrospective, longitudinal study from Korea included 71 metastatic NSCLC patients who underwent PD-L1 expression and thyroid function testing during PD-1 blockade. Disease progression by the Response Evaluation Criteria for Solid Tumors was the main outcome. Three-stage analyses were performed: (1) multivariate Cox regression models adjusted for PD-L1 expression according to thyroid irAEs; (2) subgroup analyses; (3) regrouping and comparing predictivity of current and alternative staging. Patients with thyroid irAE + exhibited a longer progression-free survival [7/20 vs. 34/51, adjusted HR 0.19 (0.07–0.47); P < 0.001] than those with thyroid irAE-, independent of PD-L1 expression; the results remained across most subgroups without interaction. The three groups showed different adjusted HR for disease progression (Group 1: PD L1 + and thyroid irAE + ; Group 2: PD-L1 + or thyroid irAE + : 5.08 [1.48–17.34]; Group 3: PD-L1− and thyroid irAE− : 30.49 [6.60–140.78]). Alternative staging (Group 1 in stage IVB → stage IVA; Group 3 in stage IVA → stage IVB) improved the prognostic value (PVE: 21.7% vs. 6.44%; C-index: 0.706 vs. 0.617) compared with the 8th Tumor–Node–Metastasis staging. Our study suggests thyroid irAEs and PD-L1 expression are independent biomarkers that improve predicting PD-1 blockade efficacy in NSCLC. Thyroid irAEs would be helpful to identify NSCLC patients who benefit from PD-1 blockade in early course of treatment. [ABSTRACT FROM AUTHOR]

Aims: The phosphatase and tensin homologue (PTEN) hamartoma tumour syndrome (PHTS) is a genetic disorder with variable clinical presentation and increased lifetime risk of multiorgan malignancies. The thyroid gland is commonly affected with follicular nodular disease (FND) and follicular cell‐derived carcinomas. Histopathological and immunohistochemical assessment of thyroid disease in PHTS is essential to identify patients at‐risk. Methods and results: In all, 30 PHTS patients with available thyroidectomy specimen material (2000–2023) and 31 control patients with FND and "adenomatous nodules" were retrieved. Histologic criteria, including the frequency of adenomatous‐type nodules versus hyperplastic‐type nodules, background and nodular lipomatous metaplasia, chronic lymphocytic thyroiditis, cytoplasmic clearing of follicular cells in nodules, nodule‐in‐nodule appearance, and spectrum of nuclear atypia between nodules were evaluated in both cohorts and a Thyroid Histomorphologic PHTS Score (THiPS) system was established with a cutoff of 4 points or higher being considered concerning for PHTS. In all, 27 PHTS (90%) and five control (16.1%) cases had THiPS ≥4. A PTEN immunohistochemical stain was evaluated in 25 cases of each cohort and showed nuclear and cytoplasmic loss of expression in all or most of the nodules of 24/25 PHTS cases. In 3/25 control cases, two with THiPS ≥4, had loss of expression in one to multiple nodules. Conventional papillary thyroid carcinomas in PHTS patients retained PTEN cytoplasmic expression. Conclusions: Our study supports that, although not specific, the finding of multiple histologic features is found more frequently in patients with PHTS compared to the non‐PHTS control group. The THiPS system has high sensitivity for thyroid specimens from patients with PHTS. [ABSTRACT FROM AUTHOR]

Endocrine disorders in pregnancy are common. Good outcomes can be achieved with multi-disciplinary care in pregnancy. The primary objective of this review is to provide the reader with an overview of national guidelines and recent advances regarding the care of women with endocrine disorders in pregnancy. We have outlined care for a broad range of conditions ranging from diabetes and thyroid disorders, to the rarer conditions such as phaeochromocytoma. [ABSTRACT FROM AUTHOR]

Background: To investigate whether combining the flipped classroom approach with Peyton's four-step method can enhance teaching effectiveness in ultrasound (US) zoning of the thyroid and cervical lymph nodes for standardized residency training. Methods: A total of 66 resident training students were randomly divided into a control group and an observation group. The control group received traditional teaching methods, including "see one, do one" learning, lecture-based learning (LBL), and case-based learning (CBL). The observation group was taught using Peyton's four-step teaching method, the flipped classroom approach, and CBL. Assessments were conducted through skill operation and clinical case analysis. A questionnaire survey was used to evaluate student satisfaction. Assessment scores and questionnaire ratings between the two teaching methods were compared. Results: 1) Assessment results demonstrated higher scores in skill operation and clinical case analysis for the observation group compared to the control group [(87.64 ± 3.72) vs. (80.48 ± 5.92) points, (87.94 ± 4.46) vs. (82.85 ± 4.24) points]. 2) The questionnaire survey indicated that resident trainees taught using Peyton's four-step method showed greater improvement in learning interest [(4.61 ± 0.57) vs. (3.70 ± 0.85) points] and experienced reduced exam pressure compared to the control group [(4.52 ± 0.62) vs. (3.21 ± 0.70) points]. These differences were statistically significant (P < 0.05). Conclusion: Peyton's four-step approach combined with the flipped classroom method improved resident training students' scores in skill operation and clinical case analysis for ultrasound zoning of the thyroid and cervical lymph nodes. It also stimulated learning interest and alleviated exam pressure, making it an effective teaching method for enhancing standardized US training outcomes in resident education. [ABSTRACT FROM AUTHOR]

Background: Atrioventricular block (AVB) is rare in hyperthyroidism (HTH). Little is known about the true prevalence, clinical course, optimal management, and outcomes of different types of AVBs in patients with HTH. To address these uncertainties, we aimed to conduct a systematic review by combining the available literature to provide more meaningful data regarding AVBs in HTH. Methods: We systematically searched PubMed, Scopus, Embase, and Google Scholar for articles reporting patients who developed AVB in the context of HTH. Data were analysed in STATA 16. The main outcomes included types of AVB, frequency of pacemaker insertion, and resolution of AVB. The systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO) with the identification number CRD42022335598. Results: A total of 56 studies (39 case reports, 12 case series, 3 conference abstracts, 1 retrospective study, and 1 prospective observational study) with 87 patients were included in the analysis, with a mean age of 39.1 ± 17.6 years. Females constituted 65.7% (n = 48) of the cohort. Complete heart block (CHB) was the most commonly reported AVB (N = 45, 51.7%), followed by first-degree AVB (16.1%) and second-degree AVB (14.9%). Overall, 21 patients underwent pacing. A permanent pacemaker was inserted in one patient with second-degree AVB and six patients with CHB. Mortality was reported in one patient with CHB. The clinical course and management of HTH and AVBs did not differ in patients with CHB or lower-degree blocks. Apart from lower rates of goitre and more use of carbimazole in those who underwent pacing, no differences were found when compared to the patients managed without pacing. Conclusion: Current data suggest that CHB is the most common type of AVB in patients with HTH. Most patients can be managed with anti-thyroid management alone. Additionally, whether pacemaker insertion alters the clinical outcomes needs further exploration. [ABSTRACT FROM AUTHOR]

Purpose: To assess diffusion tensor imaging (DTI) in differentiating benign from malignant thyroid nodules. Methods: A retrospective analysis was done on 55 patients with thyroid nodules who had undergone DTI. The fraction anisotropy (FA) and mean diffusivity (MD) of the thyroid nodules were measured using region of interest (ROI) by two observers. The final diagnosis was malignant and benign, as proved by pathological examination. Results: The mean MD of benign thyroid nodules (1.84 ± 0.42 and 1.90 ± 0.37 × 10-3mm2/s) was significantly higher (p <.001) than malignant nodules (0.95 ± 0.46 and 0.97 ± 0.41 × 10-3mm2/s) as scored by both observers. The cut-off values of 1.45 and 1.50 × 10-3mm2/s were used to differentiate malignant from benign thyroid nodules with the areas under the curve (AUC) of 0.926 and 0.937, respectively. The mean FA of benign thyroid nodules (0.23 ± 0.07 and 0.24 ± 0.08) was significantly lower (p <.001) than malignant nodules (0.48 ± 0.21 and 0.49 ± 0.18). The FA cut-off value of ≤0.32 and 0.33 was used for differentiating malignant from benign thyroid nodules with an AUC of 0.877 and 0.881, respectively. A combination of MD and FA values was used to differentiate benign from malignant thyroid nodules with an AUC of 0.932 and an accuracy of 87%. There was an excellent agreement between both observers for FA and MD (K = 0.939, 0.929). Conclusion: The DTI is a non-invasive, non-contrast imaging tool that can differentiate benign from malignant thyroid nodules. [ABSTRACT FROM AUTHOR]

Purpose: Serum Thyrotropin (TSH) levels in the elderly have been reported to be inconsistent in different studies. One of the difficulties in determining the effect of aging on TSH levels is that TSH levels are influenced by various factors, including thyroid-related factors. Therefore, this study aimed to assess the effect of aging on TSH levels while controlling for thyroid factors. Patients and Methods: This study included a total of 343 subjects, who underwent thyroidectomy, levothyroxine (LT4) supplementation and withdraw. All participants were divided into young(18– 44year old), middle(45– 59year old), and old age(> 60year old) groups based on their age. The clinical data of the subjects were reviewed, and analyzed based on their age. Results: With LT4 supplementation, there was no difference in free triiodothyronine (FT3), free thyroxine (FT4), and TSH levels among the three age groups. However, after approximately 4 weeks of LT4 withdrawal, the TSH levels of the three groups showed significant differences. The median stimulated TSH levels were 100, 83.1, and 64.6 mIU/L in the young, middle, and old age groups, respectively (P< 0.01). Moreover, the percentages of subjects, with TSH levels higher than 100 mIU/L, were 63.2%, 33.1%, and 12.9% (P< 0.01) in the young, middle, and old age groups, respectively. Spearman correlation analysis (R=− 0.42, P< 0.01) and partial correlation analysis (R=− 0.44, P< 0.01) revealed an inverse correlation between age and TSH levels after LT4 withdrawal. Conclusion: Aging plays an important role in TSH regulation. Age was inversely related to the stimulated TSH levels. The effect of senescence on TSH levels, as well as the underlying regulatory mechanisms, warrant further investigation. [ABSTRACT FROM AUTHOR]

Background: Metastatic carcinomas to the jaws are a rare occurrence. Most notable primary sources within the literature are breast, lung and kidney, followed by GI, prostate and thyroid. In almost all instances, there is a primary site already identified, but very occasionally the metastases are the first sign of a problem. Notable other, less obvious, clinical expressions of malignancy are weight loss, loss of appetite, fever and chills. Again, these can present with no obvious site of a primary cancer. A unique feature of our case is the lack of primary symptoms. Case Description: The patient initially presented for teeth extraction a year previously, followed by a slow but eventually large expansion of the left mandibular ramus. The underlying radiolucency gave no apparent signs or symptoms suggestive of malignancy. Incisional biopsy showed a glandular neoplastic proliferation with apparent thyroid follicles noted at the margins. Special imaging and immunostains confirmed a tissue origin in the thyroid gland. The patient was referred to Otolaryngology for definitive treatment. The jaw lesion was treated by radical surgical excision and the neck site was treated, after microscopic confirmation of a follicular thyroid carcinoma, via total thyroidectomy. Practical Implications: This case illustrates the importance of interdisciplinary treatment and how it can lead to an optimal outcome for the patient's prognosis. [ABSTRACT FROM AUTHOR]

Ultrasound elastography is a promising new technique in the evaluation of the thyroid nodule. It allows for "virtual palpation" of the nodule, even smaller ones which may not be otherwise palpable clinically. Ultrasound elastography was developed to obtain information on tissue stiffness non-invasively. Due to the superficial location of the thyroid gland, lack of sonological interferences like bowel gas shadow, easy availability of USG, and no need for patient preparation, it is easy and feasible to obtain information regarding the stiffness in the organ or nodule objectively, even by beginners. Elastography is a technique that uses ultrasound to analyse the elasticity of a nodule by measuring the amount of distortion that occurs when the nodule is subjected to external pressure. Shear wave elastography (SWE) provides quantitative assessment in the form of elasticity indices (Emaximum, Emean, Eminimum), and the stiffness of thyroid nodules can be evaluated with shear wave elastography. Malignant thyroid nodules tend to have higher shear wave elastography index. This was a prospective study. All patients with suspicious thyroid nodules who presented to head and neck oncology OPD with thyroid swelling with TIRADS score 3 or 4 and Bethesda III/IV were evaluated from December 2022 to February 2023. All the patients were screened with ultrasound, and reporting was done as per the ACR TIRADS reporting system following which elastography score was given based on the stiffness of the nodule. They further underwent FNAC from the suspicious thyroid nodule. Thyroidectomy was done as per department protocol. Twenty-four patients (38 nodules) were evaluated. There were seven males and 17 female patients included in the study. There were 23 malignant nodules in the final histopathology of the resected specimen. The sensitivity of TIRADS was 82.6%, specificity was 80%, for elastography specificity was 69.6%, sensitivity was 60%, for BETHESDA specificity was 66.7%, and sensitivity was 81.3%. The combined sensitivity and specificity for all three modalities combined were 93.33% and 95.6%. Receiver operator curve (ROC) analysis showed the area under the curve for USG TIRADS was 0.895, for elastography was 0.879, and for FNAC Bethesda was 0.902. AUC for combined tests ES + BETHESD was 0.800 (p = 0.013), TIRADS + BETHESDA was 0.833(p <.01), and for TIRADS + ES + BETHSDA AUC was 0.967 (p = 0.00). Ultrasound elastography can be used as an adjunctive tool along with routine grey scale ultrasound for characterising suspicious thyroid nodules. [ABSTRACT FROM AUTHOR]

Malignant glomus tumors are rare mesenchymal tumors arising from the smooth muscle cells of the glomus body. Primary malignant glomus tumors of the thyroid are atypical. An 80-year-old man presented with a right thyroid tumor on computed tomography (CT) and was suspected of having multiple bilateral pulmonary metastases. The right lobe of the thyroid gland was accompanied by a low-density tumor and calcification inside, and infiltration into the trachea and cervical esophagus was deduced. Core needle biopsy (CNB) confirmed that round to polygonal atypical cells were growing in sheet form around the vascular endothelial cells. Immunohistochemistry results were positive for vimentin and smooth muscle actin (SMA) but negative for pan-cytokeratin and S-100 protein. Chemotherapy with doxorubicin was initiated. However, due to the progression of the disease, doxorubicin was replaced with pazopanib. His condition deteriorated further, and he died 3 months after the treatment. Overall, this disease has a poor prognosis. [ABSTRACT FROM AUTHOR]

The study aims to evaluate multiparametric magnetic resonance imaging (MRI) for differentiating Follicular thyroid neoplasm (FTN) from non-FTN and malignant FTN (MFTN) from benign FTN (BFTN). We retrospectively analyzed 702 postoperatively confirmed thyroid nodules, and divided them into training (n = 482) and validation (n = 220) cohorts. The 133 FTNs were further split into BFTN (n = 116) and MFTN (n = 17) groups. Employing univariate and multivariate logistic regression, we identified independent predictors of FTN and MFTN, and subsequently develop a nomogram for FTN and a risk score system (RSS) for MFTN prediction. We assessed performance of nomogram through its discrimination, calibration, and clinical utility. The diagnostic performance of the RSS for MFTN was further compared with the performance of the Thyroid Imaging Reporting and Data System (TIRADS). The nomogram, integrating independent predictors, demonstrated robust discrimination and calibration in differentiating FTN from non-FTN in both training cohort (AUC = 0.947, Hosmer-Lemeshow P = 0.698) and validation cohort (AUC = 0.927, Hosmer-Lemeshow P = 0.088). Key risk factors for differentiating MFTN from BFTN included tumor size, restricted diffusion, and cystic degeneration. The AUC of the RSS for MFTN prediction was 0.902 (95% CI 0.798–0.971), outperforming five TIRADS with a sensitivity of 73.3%, specificity of 95.1%, accuracy of 92.4%, and positive and negative predictive values of 68.8% and 96.1%, respectively, at the optimal cutoff. MRI-based models demonstrate excellent diagnostic performance for preoperative predicting of FTN and MFTN, potentially guiding clinicians in optimizing therapeutic decision-making. [ABSTRACT FROM AUTHOR]

Medullary thyroid carcinoma (MTC) can either be sporadic, often via mutually exclusive RET or RAS alterations, or inherited via a RET germline alteration. Germline testing is recommended for all patients diagnosed with MTC. RAS p.Q61R immunohistochemistry (RASQ61R-IHC) can identify a subset of RAS-mutated MTCs on resections, but whether this could be applied pre-operatively to cytology specimens remains unclear. Herein, we assessed RASQ61R-IHC in a tri-institutional cohort of cytologic and histologic MTC specimens with available molecular and germline data. Thirty-four fine needle aspirates with cell blocks were identified between three institutions from 2009 to 2024 with corresponding histology. Tumor sequencing and germline data were recorded, if available. RASQ61R-IHC was scored on staining intensity with documentation of membranous accentuation. Sensitivity, specificity, positive predictive (PPV), and negative predictive values (NPV) were calculated. Of the MTCs, 29% were germline-mutated, and 71% were sporadic. Among all sporadic MTCs (n = 22), 41% were RET-altered, 27% were RAS-altered, and 31.8% did not have available data. With any RASQ61R-IHC staining considered positive, sensitivity, specificity, PPV, and NPV for detecting RAS p.Q61R-mutated MTCs were 100%, 72.7%, 45.4%, and 100%, respectively. Requiring a stain score of > 1 and/or membranous accentuation for a true positive changed sensitivity, specificity, PPV, and NPV to 100%, 100%, 100%, and 100%, respectively. RASQ61R-IHC membranous staining was 100% predictive of RET-negative germline testing. RASQ61R-IHC, when requiring a score > 1 and/or membranous stain accentuation for true positive, had high sensitivity and specificity for RAS p.Q61R mutation in cytologic and surgical MTC specimens. Moreover, RASQ61R-IHC is a rapid and inexpensive modality that could potentially tailor which MTC patients undergo germline testing. [ABSTRACT FROM AUTHOR]

Thyroid autoimmune diseases, such as Hashimoto thyroiditis and Graves disease, are significantly more prevalent in women than in men, suggesting underlying biological differences in immune system function and regulation between sexes. Plasma B cells are crucial in autoimmunity due to their role in producing antibodies targeting self-antigens, but their presence in the thyroids of women without clinical autoimmune diseases remains largely unexplored. This study investigates the infiltration of plasma B cells in female thyroids specifically excluding those with any clinical signs of autoimmune diseases. Using bulk RNA-seq analysis, we identified significant sex differences in gene expression profiles, particularly in genes associated with plasma B cells. Single-cell RNA-seq and spatial transcriptomic analyses further revealed that the CXCL13-CXCR5 signaling axis plays a pivotal role in recruiting and organizing plasma B cells within the thyroid tissue. These findings suggest that the inherent presence of plasma B cells in the female thyroid, driven by CXCL13, may contribute to the higher risk of developing autoimmune thyroid diseases in women. Our study provides new insights into the immune landscape of the thyroid and underscores the importance of understanding sex-specific differences in immune cell distribution and function. [ABSTRACT FROM AUTHOR]

Iodine is a micronutrient that is required for thyroid hormone synthesis. The iodide cycle in thyroid hormone synthesis consists of a series of transport, oxidation, organification, and binding/coupling steps in thyroid follicular cells. Common sources of iodine include the consumption of an iodine-rich diet or iodine-fortified foods, the administration of amiodarone, iodine-containing supplements, or iodinated contrast media, and other miscellaneous sources. Methods to assess population iodine status include the measurement of urinary iodine concentrations, blood thyroglobulin levels, prevalence of elevated neonatal thyrotropin levels, and thyroid volume. Although excessive iodine intake or exposure is generally well tolerated, an acute iodine load may result in thyroid dysfunction (hypothyroidism or hyperthyroidism) in certain susceptible individuals due to the failure to escape from the Wolff–Chaikoff effect and to the Jod–Basedow phenomenon, respectively. In this review, we discuss the associations between excessive iodine intake or exposure, with particular focus on iodinated contrast media as a common source of excess iodine in health care settings, and risks of incident thyroid dysfunction. We also summarize the risks of iodine excess in vulnerable populations and review current guidelines regarding the screening and monitoring of iodinated contrast–induced thyroid dysfunction. Finally, we discuss the long-term potential nonthyroidal health risks associated with iodine excess and suggest the need for more data to define safe upper limits for iodine intake, particularly in high-risk populations. [ABSTRACT FROM AUTHOR]

Thyroid eye disease (TED) is the most common extra thyroidal manifestation of Graves' disease (GD). It may also present in those who are hypothyroid or euthyroid. The characteristic clinical manifestations of TED, chemosis, lid swelling, proptosis, and diplopia, are driven by a combination of inflammation and extracellular matrix modification. It has recently emerged that 1 of the major drivers of this molecular signature is the overexpression of the IGF-1 receptor [IGF-1R]) on key effector cells in TED pathogenesis. The overexpression of the IGF-1R is coupled with a dysregulation of the IGF-1R axis, which links other pathways that modulate inflammation, such as fibrosis and extracellular matrix organization, in patients with TED. This overexpression is also found to persist from the acute stage into the chronic phase. Teprotumumab, a fully human IgG1 monoclonal antibody that inhibits the IGF-1R, recently gained approval in the United States for the treatment of TED. In phase 2 and phase 3 clinical studies, teprotumumab showed efficacy in reducing inflammation, proptosis, diplopia, and burden on quality of life in patients who were treated. Postintroduction studies have confirmed the results of the phase 2 and phase 3 studies. Since 2020, more than 5800 patients have been treated with teprotumumab, and it appears to be well tolerated. The American Thyroid Association and the European Thyroid Association have recommended it as first-line therapy for patients with moderate to severe TED who display features of proptosis and diplopia. [ABSTRACT FROM AUTHOR]

During a nuclear accident, numerous products of nuclear fission are released, including isotopes of radioactive iodine. Among them is iodine-131, with a half-life of 8.02 days, which emits β radiation. For decades, it has been effectively and safely used in medicine. However, in the event of a nuclear accident, uncontrolled exposure can have harmful biological effects. The main sources of internal contamination with iodine-131 are contaminated air, food and water. The most exposed organ is the thyroid gland, where radioactive iodine accumulates via the Na+/I− symporter (NIS). NIS does not distinguish between radioactive iodine isotopes and the stable isotope iodine-127, which is essential for the synthesis of thyroid hormones. Exposure to radioactive iodine during a nuclear accident is primarily associated with papillary thyroid cancer, whose incidence begins to increase a few years after exposure. Children and adolescents are at the highest risk, and the risk is particularly significant for individuals living in iodine-deficient areas. Ensuring an adequate iodine supply is therefore crucial for lowering the risk of the harmful effects of exposure to radioactive iodine at the population level. Protecting the thyroid with potassium iodide tablets significantly reduces radiation exposure, as stable iodine prevents the entry of radioactive iodine into the thyroid. Such protection is effective only within a narrow time window - a few hours before and after the exposure and is recommended only for those under 40 years of age, as the risks of excessive iodine intake outweigh the potential benefits in older individuals. [ABSTRACT FROM AUTHOR]

Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a recently defined thyroid nodule category characterized by follicular architecture with papillary nuclear features but lacking classical papillary carcinoma features like papillae or psammoma bodies. The diagnosis of NIFTP is based on histological examination and excludes cases with high-risk mutations like BRAFV600E. NIFTP carries a low risk of recurrence and distant metastasis, prompting a more conservative surgical approach compared to classical papillary thyroid carcinoma. The management of NIFTP typically involves lobectomy with postoperative monitoring of thyroglobulin levels and performing neck ultrasounds. While the identification of NIFTP represents a significant advancement in thyroid cancer diagnosis, challenges remain in refining preoperative diagnostic tools and establishing optimal long-term follow-up strategies. The objective of this review is to provide a comprehensive overview of NIFTP, including its histopathological characteristics, molecular profile, clinical presentation, diagnostic criteria, management strategies, and future research directions. [ABSTRACT FROM AUTHOR]

Background/Objectives: Hypothyroidism can profoundly affect growth, particularly if it insidiously arises during early childhood. Congenital hypothyroidism is now detected through newborn screening, significantly improving the overall growth outcomes of these children. Conversely, acquired hypothyroidism often results in delayed somatic growth and shorter stature, with many affected children initially remaining non-symptomatic. The main objective of this review is to summarize the current knowledge about the impacts of acquired hypothyroidism on children's growth outcomes. Methods: We performed a literature review to analyze growth and final height in children with acquired hypothyroidism, matching the following keywords: "hypothyroidism & growth", "hypothyroidism & height", "hypothyroidism & stature", "hypothyroidism & development", "hypothyroidism & auxological parameters". We reviewed each article that met the eligibility criteria, and after a thorough selection, we included 16 studies. Results: Growth arrest is frequently noted as a symptom in hypothyroidic children, with substantial portions of affected children presenting below the third percentile for height. The timing of diagnosis significantly influences growth outcomes: those diagnosed during puberty tend to experience less catch-up growth due to accelerated skeletal maturation. Even if thyroxine replacement can induce rapid catch-up growth, it may be incomplete if treatment begins during puberty or if there is a markedly prolonged deficiency of thyroid hormones. While levothyroxine therapy typically results in some degree of catch-up growth, many children do not reach their expected genetic height. Conclusions: This review highlights the necessity of both early diagnosis and treatment of acquired hypothyroidism. Even if many children show improvements in height velocity post-treatment, the complete normalization of growth may remain elusive. [ABSTRACT FROM AUTHOR]

Thyroid function plays a seminal role in the growth and development of children, and alterations in signaling pathways which interfere with the biosynthesis, transport, and metabolism of thyroid hormones might impact on the skin of such patients: this review explores the relationship between different thyroid disorders and dermatological manifestations with a particular focus on the pediatric population. Common cutaneous conditions associated with thyroid dysfunction may include chronic urticaria, vitiligo, and alopecia, which can be early harbingers of an underlying endocrine disruption. This review also highlights the growing cognizance of a "thyroid–skin axis", with thyroid hormones influencing many physiologic processes within the skin such as keratinocyte proliferation, hair growth, and epidermal differentiation. A precocious recognition of abnormal dermatological signs can be crucial in pediatric patients for a timely diagnosis before any development of complications and for personalized treatments of an underlying thyroid disorder, which can even be symptomless at an initial phase. Despite the lack of standardized guidelines for managing dermatologic manifestations occurring in thyroid diseases, a regular screening to identify endocrine dysfunction is recommended in those children who present chronic urticaria, vitiligo, or alopecia, though further research is needed to decipher mechanisms involved in the thyroid-skin partnership and develop more targeted management approaches. [ABSTRACT FROM AUTHOR]

Abstract This study aims to examine the ultrasonic characteristics of perithyroid fascial spaces following in vivo hydrodissection, validating their visualization through a comparative analysis with anatomical references. A retrospective review was conducted on data from 2390 patients (631 males and 1759 females, median age 46 years, 25–75% interquartile range 26–69 years) who underwent microwave ablation for thyroid tumors, including 1436 benign nodules and 954 papillary thyroid carcinomas. Detailed descriptions of perithyroid fascial spaces and the hydrodissection strategy were provided. Ultrasonic characteristics of fascial spaces during hydrodissection were documented and systematically compared with anatomical references. Hydrodissection was successfully performed in all cases according to the protocol. Isolating fluid was injected into classic anatomical spaces: anterior cervical (58.5%), pretracheal (71.8%, including Berry’s ligament in 196 cases), retropharyngeal (43.7%), and carotid (1.2%). Additionally, US revealed two new spaces—perilymphatic (4.1%) and tracheoesophageal groove (3.7%)—with corresponding anatomical structures. The US-identified fascial structures aligned with their anatomical positions and distribution. US-guided hydrodissection facilitates the visualization of the fascial space, making it possible to study the microenvironment physiology and pathology of fascia in vivo.