Search

Steven-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) is a rare immunologic hypersensitivity reaction to stimuli that presents as widespread eruption with mucocutaneous detachment and involvement of other organs. Multiple causes have been noted in literature, including numerous medications. In this report, we present a 52-year-old woman who arrived at the emergency department with a complaint of rash, malaise, and pruritus. She subsequently developed diffuse cutaneous and mucosal detachment. Work-up supported a diagnosis of SJS/TEN secondary to her thyroid replacement therapy, derived from desiccated pig thyroid glands. The patient's natural thyroid medication was discontinued and she responded well to appropriate treatment. This case is unique in that thyroid replacement therapy is not a commonly reported trigger of SJS/TEN. Providers should be aware of the potential for natural thyroid and other animal-derived natural medications to cause adverse reactions such as SJS/TEN.

Background Methods Results Conclusions Metastasis to the thyroid gland from lung adenocarcinoma is rare and challenging to diagnose due to similar histopathological features. This study aimed to analyze the clinicopathological characteristics of and treatment strategies for lung adenocarcinoma metastasis to the thyroid based on 11 years of institutional experience.A retrospective study included patients with lung adenocarcinoma metastasis to the thyroid at our center from 2010 to 2023. Clinicopathological features and clinical outcomes were analyzed.Among 9714 lung adenocarcinoma patients, nine patients (five females, 55.6%) were diagnosed with thyroid metastasis, presenting primarily with cough symptoms. Most patients (88.9%) had synchronous tumors, whereas a minority (11.1%) had metachronous tumors. The median time from primary tumor diagnosis to metastasis was 4.8 months. Most patients developed bilateral thyroid metastases (88.9%). Diagnosis of thyroid metastasis was primarily through fine‐needle aspiration (FNA), with one case misdiagnosed as papillary thyroid carcinoma. Immunohistochemical staining revealed thyroid transcription factor‐1 (TTF‐1) and novel aspartic proteinase of pepsin family A (Napsin‐A) positivity and paired box 8 (PAX8) negativity. Genetic testing found epidermal growth factor receptor mutations in 71.4% of patients. The individualized comprehensive therapy included surgery, chemotherapy, immunotherapy, and targeted and supportive therapy. The median overall survival was 56.0 months, with a progression‐free survival of 12.7 months. Kaplan–Meier (K–M) analysis suggested improved survival with no advanced symptoms (p = 0.03) and targeted therapies (p = 0.05).Lung adenocarcinoma metastasis to the thyroid is a rare disease, with an incidence of 0.1% among lung adenocarcinoma patients. Early treatment after symptom onset and personalized targeted therapies may improve prognosis. Despite rapid disease progression, favorable outcomes can be achieved with comprehensive treatment. [ABSTRACT FROM AUTHOR]

Goiter related to excessive iodine nutrition remains a significant public health issue in some countries. There has been no reported study on long noncoding RNAs (lncRNAs) related to goiters. In this study, goiter was induced by drinking water with excess iodine for 10 or 20 weeks in Kunming mice. Whole transcriptome sequencing results showed that LNC89 expression increased in mice goiter tissues compared to normal thyroid tissues and higher in 20 weeks goiter tissues than in 10 weeks goiter tissues, which were identified by qRT−PCR. Cooperate with human-mouse homologous gene conversion, a new LNC89/LNC60-Col11a2 axis was predicted by LncTar and expression correlation analysis based on whole transcriptome sequencing results. Increased Col11a2 expression was also identified by qRT−PCR and Western blot in the mice goiter tissues. In the human normal thyroid cell line Nthy-ori-3 treated with KI03, LNC60 and Col11a2 expression increased with promoted cell viability, which were reversed by siLNC60 treatment. Furthermore, LNC60 and Col11a2 mRNA levels were found increased in peripheral blood of nodular goiter patients from high water iodine areas of China and have high diagnostic values for nodular goiter while AUC of LNC60 and Col11a2 are 89.97% and 84.85%, respectively. In conclusion, the novel LNC89/LNC60-Col11a2 axis may be involved in the progression of goiter related to iodine excess, providing potential biomarkers and therapeutic targets in the future. [ABSTRACT FROM AUTHOR]

Background: Swellings of the neck are a common presentation encountered by surgeons in outpatient settings, often prompting early medical attention due to their visibility and potential cosmetic concerns. Neck masses can range from reactive lymphadenitis to malignant lesions. Aim of the study: This observational study aimed to investigate the clinical profile and etiopathology of neck masses within the Indian population. Methods: Over a six-month period, patients presenting with neck swellings at the Department of ENT in a multi-speciality government hospital, Delhi, were included. 100 patients were included in the study. Detailed demographic data and presenting symptoms were recorded, along with local examination findings and cytological analysis using fine needle aspiration cytology (FNAC). Results: The study population predominantly consisted of individuals aged 21 to 30 (30%) and 11 to 20 (22%), with females comprising 68% of the total, male to female ratio being 0.6:1. The most common etiologies observed were infective or inflammatory (42%), followed by thyroid-related conditions (35%). Tubercular lymphadenitis was the most common among infective etiology, accounting for 36% of these cases. Notable variations were observed across age groups, with younger demographics showing higher prevalence of benign and inflammatory conditions, while older individuals presented with diverse etiologies including thyroid nodules and salivary gland tumors. Conclusion: The age distribution data of patients presenting with neck masses provides valuable insights into the epidemiology and etiology of such conditions across different age groups. FNAC remains a valuable and cost-effective diagnostic tool for evaluating superficial and deep-seated lesions in the head and neck region. It offers reliable categorization of lesions due to its high sensitivity and specificity. [ABSTRACT FROM AUTHOR]

The animal gut microbiome acts as a crucial link between the host and its environment, playing a vital role in digestion, metabolism, physiology, and fitness. Using 16S rRNA metabarcoding, we investigated the effect of altitude on the microbiome composition of Anatolian Blind Mole Rats (Nannospalax xanthodon) across six locations and three altitudinal groups. We also factored in the host diet, as well as host microsatellite genotypes and thyroid hormone levels. The altitude had a major effect on microbiome composition, with notable differences in the relative abundance of several bacterial taxa across elevations. Contrary to prior research, we found no significant difference in strictly anaerobic bacteria abundance among altitudinal groups, though facultatively anaerobic bacteria were more prevalent at higher altitudes. Microbiome alpha diversity peaked at mid-altitude, comprising elements from both low and high elevations. The beta diversity showed significant association with the altitude. Altitude had a significant effect on the diet composition but not on its alpha diversity. No distinct altitude-related genetic structure was evident among the host populations, and no correlation was revealed between the host genetic relatedness and microbiome composition nor between the host microbiome and the diet. Free thyroxine (FT4) levels increased almost linearly with the altitude but none of the bacterial ASVs were found to be specifically associated with hormone levels. Total thyroxine (TT4) levels correlated positively with microbiome diversity. Although we detected correlation between certain components of the thyroid hormone levels and the microbiome beta diversity, the pattern of their relationship remains inconclusive. [ABSTRACT FROM AUTHOR]

The editorial discusses the controversial relationship between acromegaly, a rare endocrine disorder, and cancer risk. While some studies suggest an increased risk of certain cancers, others do not. Advances in acromegaly treatment have improved disease control and reduced mortality rates. Current data do not support extensive cancer screening beyond standard guidelines, but clinical attention is crucial, especially for elderly patients and those with diabetes mellitus. Further research is needed to understand the impact of acromegaly on cancer risk and refine screening protocols. [Extracted from the article]

Background: Globally, a rising trend has been observed in the prevalence of thyroid disorders, with many demographic and geographic factors influencing its epidemiology. Nonetheless, some cases often go undetected due to the inconsistent and non-specific nature of the clinical symptoms. Therefore, we aimed to determine the trend and relationship between various pathological findings in thyroid disease patients and their demographic factors to aid clinicians in making a prompt diagnosis and treatment plan. Methods: A descriptive correlational study was conducted from January 2020 to May 2022 at Jinnah Postgraduate Medical Center, Karachi. We collected data via random sampling from 258 patients suffering from thyroid disorders. We evaluated baseline patient characteristics, along with, thyroid scan and fine needle aspiration cytology (FNAC) reports, and local thyroid gland examination findings. Results: Out of 258 participants, 192 (74.4%) were females, whereas 66 (25.6%) were males, giving a female: male ratio of 2.9: 1. On local examination, 167 (64.7%) were found to have a solitary nodule, 79 (30.6%) had multinodular goiter. Findings revealed that benign follicular lesions had the highest prevalence (35.3%). Moreover, among the cancerous growth, papillary carcinoma presented the highest cases (12.4%). Of 258 cases, 24 patients had non-surgical interventions, while most (234) had surgical interventions. Total thyroidectomy was the most common procedure opted for by 45.3% (n = 117) of the participants, followed by lobectomy 70 (27.1%), near total thyroidectomy 43 (13.2%), modified radical neck dissection 5 (1.9%). Conclusion: Our study showed that nearly all thyroid-related pathologies were more prevalent amongst females than males, with the majority having an acute to sub-acute clinical presentation. Multinodular goiter was a prominent finding indicating a greater need for screening tools and access to healthcare facilities, especially in rural areas, to allow future studies to compare provinces accurately. Plain Language Summary: Trends of Pathological Findings in Patients with Thyroid Diseases The thyroid gland plays a critical role in the body's developmental and metabolic processes. There has been a worldwide rise in thyroid related diseases. This has been attributed to different factors including geography, smoking, genetics etc. However, often due to the non specific nature of disease, the condition often goes undiagnosed until an advanced disease stage, often causing complications. In this study, we aimed to assess the trends and relationship between the different clinical and pathological findings in thyroid disease patients from Pakistan. About 9.7% of our patients were suffering from hypothyroid while a 28.7% suffered from hyperthyroidism while a remaining majority of 61.6% individuals remained euthyroid. Ultrasound findings showed that 96.8% patients has a thyroid mass/nodule or goiter with the highest proprtion of these individuals being found in the middle age (30-50 years) group. Further majority of the diseased population comprised of females. A greater proportion of our patient population required surgical intervention with total thyroidectomy being the most common procedure (45.3%). It is of great importance to continue researching modern trends, presentation and management protocols for thyroid disease, adding to the existing literature. [ABSTRACT FROM AUTHOR]

Aim: Studies have shown that renal hypertrophy seen in experimental hyperthyroidism induced by thyroxine (T4) is due to angiotensin (Ang) II. However, other renal effects of Ang II in experimental hyperthyroidism have not been investigated. In addition, Ang 1–7 is believed to be protective against renal injury, but its possible role in thyroxine-induced renal injury is not known. The aim of this study is to elaborate the role of Ang II in thyroxine-induced renal injury and the possible protective role of Ang 1–7. We hypothesize that Ang 1–7 will be as protective against thyroxine-induced renal injury as the use of an ACE inhibitor or an Ang II receptor blocker. Methods: Adult Sprague Dawley rats were used in this study and were divided into 5 groups: (1) Control (treated with vehicle), (2) Treated with thyroxine (T4, 100 µg/kg), (3) Treated with T4 and Ang 1–7 (500 µg/kg), (4) Treated with T4 and captopril (20 mg/kg), and (5) Treated with T4 and losartan (10 mg/kg). Parameters tested after fourteen days of treatment were creatinine clearance, protein excretion rate, glomerular volume, renal ACE1 and ACE2 protein expression. Data were compared using One-way-ANOVA followed by Tukey's HSD post hoc test. Results: Thyroxine caused glomerular hypertrophy and proteinuria but had no effect on glomerular filtration rate (GFR). Glomerular hypertrophy was prevented by losartan and captopril, but not by Ang 1–7. Captopril and losartan had no effect on GFR; however, Ang 1–7 caused an increase in GFR in T4-treated rats. The increase in protein excretion rate was prevented by losartan but not by captopril or Ang 1–7. Renal expression of ACE1 protein was not altered in any of the treatment groups except in captopril treated rats were ACE1 expression was increased. Renal ACE2 protein expression was only increased in T4-losartan-treated rats and not affected by any of the other treatments. Conclusion: We conclude that losartan was more protective than captopril against thyroxine-induced renal changes while Ang 1–7 offered no protection. [ABSTRACT FROM AUTHOR]

Poorly differentiated thyroid carcinoma (PDTC) and anaplastic or undifferentiated thyroid carcinomas (ATC) are uncommon malignancies of the thyroid. Anaplastic thyroid cancers represent only 1-2% of all thyroid cancer diagnoses; however, they contribute to 14-50% of fatalities associated with thyroid cancer, with a median survival duration ranging from 3 to 5 months. The majority of patients diagnosed with this disease are aged 65 years or older. Most patients exhibit a rapidly enlarging neck mass, difficulties in swallowing, or alterations in their voice. The 2022 World Health Organization classification introduced PDTC as a subtype of high-grade follicular cell-derived thyroid carcinoma (HGFCTC), whereas also renaming ATC as anaplastic follicular cell-derived thyroid carcinoma. There are evidence which suggests stepwise molecular progression from well-differentiated carcinoma to HGFCTC to ATC manifested by alteration in the MAPK pathway especially BRAF and RAS mutations and gain of secondary aggressive molecular signatures. PDTCs and ATCs are difficult to diagnose due to their rarity and previous equivocal diagnostic criteria. The aim of this study is to present a series of rare and interesting cases of PDTC and undifferentiated/anaplastic thyroid carcinoma accompanied by a concise literature review. [ABSTRACT FROM AUTHOR]

Thyroid hormone dysfunction is frequently observed in patients with chronic illnesses including heart failure, which increases the risk of adverse events. This study examined the effects of thyroid hormones (THs) on cardiac transverse-tubule (TT) integrity, Ca2+ sparks, and nanoscale organization of ion channels in excitation-contraction (EC) coupling, including L-type calcium channel (CaV1.2), ryanodine receptor type 2 (RyR2), and junctophilin-2 (Jph2). TH deficiency was established in adult female rats by propyl-thiouracil (PTU) ingestion for 8 wk; followed by randomization to continued PTU without or with oral triiodo- l -thyronine (T3; 10 µg/kg/day) for an additional 2 wk (PTU + T3). Confocal microscopy of isolated cardiomyocytes (CMs) showed significant misalignment of TTs and increased Ca2+ sparks in thyroid-deficient CMs. Density-based spatial clustering of applications with noise (DBSCAN) analysis of stochastic optical reconstruction microscopy (STORM) images showed decreased (P < 0.0001) RyR2 cluster number per cell area in PTU CMs compared with euthyroid (EU) control myocytes, and this was normalized by T3 treatment. CaV1.2 channels and Jph2 localized within a 210 nm radius of the RyR2 clusters were significantly reduced in PTU myocytes, and these values were increased with T3 treatment. A significant percentage of the RyR2 clusters in the PTU myocytes had neither CaV1.2 nor Jph2, suggesting fewer functional clusters in EC coupling. Nearest neighbor distances between RyR2 clusters were greater (P < 0.001) in PTU cells compared with EU- and T3-treated CMs that correspond to disarray of TTs at the sarcomere z-discs. These results support a regulatory role of T3 in the nanoscale organization of RyR2 clusters and colocalization of CaV1.2 and Jph2 in optimizing EC coupling. NEW & NOTEWORTHY: Thyroid hormone (TH) dysfunction exacerbates preexisting heart conditions leading to an increased risk of premature morbidity/mortality. Triiodo- l -thyronine (T3) optimizes cardiac excitation-contraction (EC) coupling by maintaining myocardial T-tubule (TT) structures and organization of calcium ion channels. Single-molecule localization microscopy shows T3 effects on the clustering of ryanodine receptors (RyR2) with colocalization of L-type calcium channels (CaV1.2) and junctophilin-2 (Jph2) at TT-SR structures. Heart disease with subclinical hypothyroidism/low T3 syndrome may benefit from TH treatment. [ABSTRACT FROM AUTHOR]

Objective To evaluate the accuracy of thyroid imaging reporting and data system (ACR-TIRADS) and the Bethesda system for reporting cytopathology (TBSRCP) classifications for identifying or ruling out thyroid malignancy in relation to the gold standard (post-surgical pathology). Methods This cross-sectional study included 573 patients with single or multiple thyroid nodules. Patients were evaluated using the TIRADS and the TBSRCP classification. The data from a cohort of patients who underwent surgery (77/573, 13.4%) were correlated with post-operative pathology and the relevant clinical features of the patients. Results Of 573 patients, 545 (95.1%) were euthyroid, 24 (4.1%) were hypothyroid, and 4 (0.8%) were hyperthyroid; 419 (73.1%) had benign nodules (Bethesda II), 115 (20.1%) had intermediate (Bethesda III, IV), and 39 (6.8%) had Bethesda V and VI nodules. Four-hundred twenty (73.3%) patients were categorized as TIRADS 2,3, and 153 (26.7%) were categorized as TIRADS 4,5. The Bethesda and TIRADS classifications concorded significantly in thyroid nodule diagnosis (K=14.9%, P<0.001). Thyroid malignancy was significantly associated with microcalcification and interrupted halo, while benign nodules were significantly associated with macrocalcification and complete halo type (P=0.041, P=0.005, respectively). The TBSRCP could significantly detect malignant thyroid nodules with a sensitivity, specificity, PPV, and NPV of 64.1%, 98.1%, 85.0%, and 94.1%, respectively (K=88.2%, P<0.001), while the respective values for the TIRADS classification were 63.5%, 76.0%, 84.6%, and 50.0% (K=34.8%, P=0.001). Conclusion The TIRADS and TBSRCP are essential primary steps for evaluating thyroid nodules and both are complimentary. Hence, each patient with thyroid nodules should be evaluated by both approaches before opting for surgery. Highly suspicious TIRADS categories TR4 and TR5 need further evaluation by fine needle aspiration cytology. [ABSTRACT FROM AUTHOR]

Diffuse lipomatosis of the thyroid (DLT) is an uncommon condition where mature fat cells infiltrate the thyroid gland, disrupting its normal structure. Although rare, it typically manifests as neck enlargement or symptoms of compression, including breathing difficulties, trouble swallowing, and voice changes, which can complicate diagnosis. This report presents a case of a 61-year-old woman with DLT, who exhibited a multinodular goiter and progressive neck swelling, and examines 53 additional cases from the existing literature. The analysis indicates that DLT is frequently misdiagnosed because of its similarities with other thyroid disorders. The precise mechanism underlying its development remains uncertain, but theories include oxygen deprivation in tissues, developmental abnormalities, and disruptions in fat metabolism. Surgical removal is the preferred treatment, especially for patients experiencing symptoms, and has shown favorable long-term outcomes. Additional studies should aim to elucidate the exact cause of DLT and enhance diagnostic precision, particularly in distinguishing it from other fat-containing thyroid lesions such as amyloid goiter and adenolipomas. A deeper understanding of this condition will inform better treatment approaches and enhance patient outcomes for this uncommon but significant thyroid disorder. [ABSTRACT FROM AUTHOR]

Pembrolizumab-related thyroid dysfunction has been associated with better outcomes in metastatic cancer patients. This study aims to examine the outcomes (pathological complete response (pCR) and event-free survival (EFS)) in early-stage triple-negative breast cancer (TNBC) patients receiving preoperative therapy who developed pembrolizumab-related thyroid dysfunction. Patients were divided into four groups based on the occurrence or not of pembrolizumab-related thyroid dysfunction (group A and D, respectively) and, in case of pre-existing thyroid disorder, based on the need for levothyroxine start/adjustment or not (group B and C, respectively). pCR and EFS in groups A, B, and C were compared to the ones in group D. Sixty-four early-stage TNBC patients were included, and the median follow-up was 16.5 months (IQR 12.0-23.8). Multiple patterns of thyroid irAEs were observed (overt hypothyroidism in 56.3%, subclinical thyrotoxicosis in 28.1%, overt thyrotoxicosis and subclinical hypothyroidism in 21.9%, and 21.9% of patients). No statistical difference was found in pCR (chi-square test, P = 0.611) comparing groups A, B, and C to group D. The median EFS in groups A, B, and C and in group D were 16.5 (IQR 12.0-24.0) and 16.0 (IQR 12.0-22.3) months, respectively (log-rank test, P = 0.671). The percentage of patients obtaining pCR was 85.7% in patients developing pembrolizumab-related overt thyrotoxicosis and 42.1% in remaining patients (chi-square test, P = 0.036). The EFS was 16.0 months (IQR 12.0-25.0) in patients developing pembrolizumab--related overt thyrotoxicosis and 16.0 months (IQR 12.0-23.5) in the remaining patients (log-rank test, P = 0.494). In conclusion, multiple patterns of pembrolizumab-related thyroid dysfunction occur in early-stage TNBC. Patients developing pembrolizumab-related overt thyrotoxicosis are more likely to achieve pCR. [ABSTRACT FROM AUTHOR]

Background: The reported risk of malignancies (ROM) remains controversial for fine needle aspiration (FNA) of thyroid nodules in the African American (AA) population. Herein, the ROM along with frequency was assessed for each of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) diagnostic categories. Materials and Methods: The electronic pathology archive of a large academic hospital was retrospectively searched for cytopathology reports of thyroid nodules in AA patients (2010–2019) and Non‐African American (NAA) control cases. The patients' demographic, thyroid nodule characteristics, FNA results using TBSRTC and surgical diagnoses were recorded, whenever available. Results: Three hundred ninety‐one cases were identified, 317 females (81.1%) and 74 males (18.9%) with median age 50.0 (SD = 14.4). The mean size of the nodules was 2.1 cm (SD = 1.4). The Bethesda categories were: 5.4% (I), 35.0% (II), 35.3% (III), 7.7% (IV), 3.3% (V) and 13.3% (VI). The overall ROM of thyroid nodules was 43.8% (89/203) on surgical follow‐up (203/391). The ROM in each Bethesda categories were: 33.3% (I), 11.6% (II), 35.2% (III), 15.8% (IV), 83.3% (V) and 100% (VI) on surgical follow‐up. The frequency of thyroid nodules was higher in AA females; however, the ROM was higher in AA males (48.3%) compared with AA females (41.2%). Conclusion: The ROM in Categories I, II and III was higher than those reported in the TBSRTC while being similar in Categories IV, V and VI. The overall risk of thyroid malignancy in our AA patient population was higher than those in the literature. The overall ROM of thyroid nodules in AA males was higher than of AA females. [ABSTRACT FROM AUTHOR]

Introduction: There are conflicting results on whether the presence of oncocytes modifies the risk of neoplasm (RON) or malignancy (ROM) for thyroid fine‐needle aspirates (FNAs): Atypia of undetermined significance AUS and Follicular Neoplasm, FN, or Oncocytic Neoplasm, ON. To our knowledge, the effect of non‐invasive follicular thyroid neoplasm with papillary‐like nuclear features (NIFTP) has not yet been studied. We compared RON and ROM between follicular type AUS (AUS‐FT) and oncocytic type AUS (AUS‐OT) and between FN and ON. Materials and Methods: We retrospectively analysed all thyroid FNAs with the diagnostic category of AUS‐other or Neoplasm (2005–2015). AUS‐FT had predominance of microfollicles and AUS‐OT had predominance of oncocytes. Histology follow‐up was then reviewed and RON, ROM was then calculated and compared (significant at p < 0.05). We repeated the search for 2018 to evaluate for NIFTP effect. Results: Pre‐NIFTP, 859/5063 cases (17%) were AUS‐FT, AUS‐OT, FN, and ON. Histology follow‐up was available for 297 cases (35%). RON was 83/183 (45%) for AUS‐FT, 35/76 (46%) for AUS‐OT, 15/25 (60%) for FN and 11/13 (85%) for ON. Post‐NIFTP, RON was 11/31 (35%) for AUS‐FT, 5/8 (63%) for AUS‐OT, 1/2 (50%) for FN and 4/5 (80%) for ON. For both periods, RON, ROM of AUS‐FT was not significantly different than AUS‐OT, and no significant differences were observed comparing FN and ON. Conclusion: The predominance of oncocytes does not modify the implied RON, ROM for categories of AUS or FN\ON, even after the adoption of NIFTP. [ABSTRACT FROM AUTHOR]

In this presented study, the aim was to investigate the toxic effects of bisphenol S (BPS), one of the bisphenol A analogues, on the thyroid glands of male Wistar albino rats. Toward this aim, the rats (n = 28) were given a vehicle (control) or BPS at 3 different doses, comprising 20, 100, and 500 mg/kg of body weight (bw) via oral gavage for 28 days. According to the results, BPS led to numerous histopathological changes in the thyroid tissue. The average proliferation index values among the thyroid follicular cells (TFCs) displayed increases in all of the BPS groups, and significant differences were observed in the BPS-20 and BPS-100 groups. The average apoptotic index values in the TFCs were increased significantly in the BPS-500 group. The serum thyroid-stimulating hormone and serum free thyroxine levels did not show significant changes after exposure to BPS; however, the serum free triiodothyronine levels displayed significant decreases in all 3 of the BPS groups. BPS was determined to cause significant increases in the antioxidant enzyme activities of catalase, superoxide dismutase, glutathione-S-transferase, glutathione peroxidase, as well as a significantly decreased content of reduced glutathione. The malondialdehyde level in the thyroid tissue was elevated significantly in the BPS-500 group. The data obtained herein revealed that BPS has thyroid-disrupting potential based on structural changes, follicle cell responses, and biochemical alterations including a decreased serum free triiodothyronine level and increased oxidative stress. [ABSTRACT FROM AUTHOR]

Concepts in thyroid diagnostics are evolving. As cytopathologists, we benefit from understanding the changes taking place in cytopathology practice as well as intersecting areas that may have implications for us. In this review, we discuss recent changes to 1. Classification systems, 2. Ancillary molecular testing modalities, and 3. Key metrics that affect thyroid cytopathology. The recent World Health Organization, Bethesda Thyroid Cytopathology, and American Joint Committee on Cancer classification systems have aspects that are designed to harmonize the clinical, cytopathologic, histomorphologic, and molecular findings for improved communication and patient management. New terminologies such as thyroid follicular nodular disease and low-risk follicular cell-derived thyroid neoplasms are introduced to reflect the subtle biologic nuances involving benign non-neoplastic and low-grade neoplastic conditions. The Bethesda Thyroid Cytopathology System has simplified its terminology, updated risk of malignancy estimates, and expanded the discussions on molecular testing, clinical and imaging assessments, and pediatric cytopathology. There is now a single term for each of the 6 diagnostic categories. The American Joint Committee on Cancer has refined the staging criteria to provide improved stratification of patient prognostication. Molecular testing using next-generation technology now offers large panels of markers that are sensitive for detecting the wide range of thyroid neoplasms. These panels were developed in North America and whether other regions of the world will choose similar tests remain to be seen. Finally, metrics such as molecular-derived risk of malignancy and molecular risk group may be viewed as surrogates of resection information and used to complement diagnostics, management, and quality assurance. • Concepts in thyroid diagnostics are evolving. • Key changes in the WHO, TBSRTC, and AJCC systems harmonize our understanding of histopathology, cytopathology, and staging. • Molecular tests have advanced over the recent years with large next-generation sequencing based panels demonstrating high negative predictive values and sensitivity in detecting low-grade neoplasms. • Molecular information also may provide metrics that enhance our understanding of risk of malignancy, prognostic information, and quality assurance. [ABSTRACT FROM AUTHOR]

EIF1AX mutation has been identified as a driver mutation for papillary thyroid carcinoma (PTC) by The Cancer Genome Atlas (TCGA) study. Subsequent studies confirmed this mutation in PTC and Anaplastic Thyroid Carcinoma (ATC) but also reported EIF1AX mutation in Follicular nodular disease (FND) and benign thyroid nodules. In this study, we review thyroid nodules with EIF1AX mutation from two institutions: a tertiary care hospital (YNHH, n = 22) and a major cancer referral center (MSKCC, n = 34) and report the varying histomorphology in the context of additional genetic abnormalities and institutional practices. Pathology diagnoses were reviewed according to the WHO 5th edition and correlated with the type of EIF1AX mutation and additional concurrent molecular alterations, if any. Most cases were splice site type mutations. Cases consisted of 9 FND, 7 follicular (FA) or oncocytic adenomas (OA), 2 non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) and 38 follicular-cell derived thyroid carcinomas. Of 8 cases with isolated EIF1AX mutation, 7 were FND, FA or OA (88%) and one was an oncocytic carcinoma (12%). Of 12 cases with EIF1AX and one additional molecular alteration, 9 (75%) were FND, FA or OA, 2 (17%) were NIFTPs and one (8%) was a poorly differentiated thyroid carcinoma. All 36 cases with EIF1AX mutation and ≥ 2 molecular alterations were malignant (100%) and included TP53 and TERT promoter mutations associated with ATC (n = 8) and high-grade follicular cell-derived non-anaplastic carcinoma (HGC, n = 2). Isolated EIF1AX mutation was noted only in thyroid nodules seen at YNHH and were predominantly encountered in benign thyroid nodules including FND. Accumulation of additional genetic abnormalities appears to be progressively associated with malignant tumors. [ABSTRACT FROM AUTHOR]

Ectopic thyroid tissue along the line of descent of thyroid from foramen caecum along thyroglossal duct to the normal anatomic location in neck has been reported. Ectopic thyroid tissue in adrenal gland (ETTAG) is rarely encountered and very few cases have been reported in literature. The most common differential diagnosis to be considered when thyroid follicles are noted in adrenal gland are metastasis from a thyroid malignancy or a teratoma or an ectopic thyroid tissue in adrenal gland. We present a case of an adrenal incidentaloma in a young pregnant female which was diagnosed to be ectopic thyroid tissue in adrenal gland. The review of literature of similar cases of this rare embryological aberrance is discussed. To our knowledge, only 16 such cases have been documented in literature and our case is the first one from Indian subcontinent and the largest documented with respect to size. [ABSTRACT FROM AUTHOR]

Background: Papillary thyroid carcinoma (PTC) with fibromatosis/fasciitis-like/desmoid-type stroma is a rare subtype of PTC,characterized by two distinct components: a classic papillary carcinoma component and a spindle cell proliferationresembling fibromatosis or nodular fasciitis. This stromal component adds a unique dimension to the tumor'spathology, making diagnosis more challenging and potentially leading to misclassification. Case presentation: We present a case of this rare entity which contributes to the growing body of literature by providing additionalmolecular data, which may shed light on the biological behaviour of the fibromatosis-like stroma and its relationshipwith the papillary carcinoma component. This case underscores the importance of recognizing this subtype, as itsspindle cell proliferation could be mistaken for a separate neoplasm or reactive process, resulting in inappropriatemanagement. Conclusions: Increased awareness of this entity will help pathologists avoid diagnostic pitfalls and guide clinicians in developingmore precise treatment plans, addressing both the malignant papillary component and the unique stromal features.This case further enriches the current understanding of the heterogeneity of PTC and highlights the need fortailored management strategies in rare subtypes. [ABSTRACT FROM AUTHOR]

Recent adaptive radiations provide experimental opportunities to parse the relationship between genomic variation and the origins of distinct phenotypes. Sympatric radiations of the charr complex (genus Salvelinus) present a trove for phylogenetic analyses as charrs have repeatedly diversified into multiple morphs with distinct feeding specializations. However, charr species flocks normally comprise only two to three lineages. Dolly Varden charr inhabiting Lake Kronotskoe represent the most extensive radiation described for the genus, containing at least seven lineages, each with defining morphological and ecological traits. Here, we perform the first genome-wide analysis of this species flock to parse the foundations of adaptive change. Our data support distinct, reproductively isolated lineages within the clade. We find that changes in genes associated with thyroid signaling and craniofacial development provided a foundational shift in evolution to the lake. The thyroid axis is further implicated in subsequent lineage partitioning events. These results delineate a genetic scenario for the diversification of specialized lineages and highlight a common axis of change biasing the generation of specific forms during adaptive radiation. [ABSTRACT FROM AUTHOR]

Schwannomas are benign nerve sheath tumours that exhibit a slow rate of growth. In the vast majority of cases, schwannomas manifest as asymptomatic masses. The presence of symptomatic lesions may necessitate surgical removal. The incidence of schwannomas ranges from 4.4 to 5.23 cases per 100,000 population, accounting for approximately 7% of all primary tumours in the central nervous system. There is a limited number of case reports describing schwannomas outside the central nervous system. In rare instances, schwannomas may originate at the level of the thyroid gland. In such cases, incidental neck schwannomas may be mistaken for thyroid or parathyroid tumours. The increasing incidence of thyroid cancer draws more attention to all thyroid nodules, both benign and malignant. Thyroid nodules are detected in up to 65% of autopsies, with only 4–6.5% being malignant. Thyroid tumours are typically diagnosed by USG; however, they are often revealed incidentally during neck CT or MRI for other conditions. To rule out malignancy, tumour verification is required. The modern diagnosis of thyroid cancer is based on fine-needle aspiration (FNA) biopsy and cytology, which is classified according to the Bethesda classification system. However, not all FNAs are informative, and the differential diagnosis and treatment strategies in cases of unsatisfactory results are not standardized, leading to potential intraoperative challenges. We present a case study of a patient with a thyroid nodule that was ultimately diagnosed with a schwannoma of the neck according to core-needle biopsy. [ABSTRACT FROM AUTHOR]

Autoimmune thyroid diseases (AITDs) are among the most prevalent organ-specific autoimmune disorders, with thyroid hormones playing a pivotal role in the gastrointestinal system's structure and function. Emerging evidence suggests a link between AITDs and the gut microbiome, which is a diverse community of organisms that are essential for digestion, absorption, intestinal homeostasis, and immune defense. Recent studies using 16S rRNA and metagenomic sequencing of fecal samples from AITD patients have revealed a significant correlation between a gut microbiota imbalance and the severity of AITDs. Progress in animal models of autoimmune diseases has shown that intervention in the gut microbiota can significantly alter the disease severity. The gut microbiota influences T cell subgroup differentiation and modulates the pathological immune response to AITDs through mechanisms involving short-chain fatty acids (SCFAs), lipopolysaccharides (LPSs), and mucosal immunity. Conversely, thyroid hormones also influence gut function and microbiota composition. Thus, there is a bidirectional relationship between the thyroid and the gut ecosystem. This review explores the pathogenic mechanisms of the gut microbiota and its metabolites in AITDs, characterizes the gut microbiota in Graves' disease (GD) and Hashimoto's thyroiditis (HT), and examines the interactions between the gut microbiota, thyroid hormones, T cell differentiation, and trace elements. The review aims to enhance understanding of the gut microbiota–thyroid axis and proposes novel approaches to mitigate AITD severity through gut microbiota modulation. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Currently pathways to practice in endocrine surgery vary based on location and surgical training programme. International data highlights the impact of surgeon volume on outcomes, and the importance of understanding the learning curve in developing minimum training competencies. This study aims to explore how surgeons obtain competence in endocrine surgery in Australia and New Zealand, and perceptions around competence and scope of practice.A web‐based survey was distributed to fellows practicing endocrine surgery. Participants were invited to complete a semi‐structured interview to explore key themes around competence. Thematic analysis was performed.Responses from 87 surgeons, with 30% practicing primarily in a regional or rural area, showed 94% emphasized post‐fellowship training to be competent in endocrine surgery. Median primary operator procedural volume learning curves were 50 thyroid, 30 parathyroid and 20 laparoscopic adrenalectomy procedures. Semi‐structured interviews with 12 participants identified four major themes: (1) learning opportunities during general surgical education and training programmes alone are insufficient for consultant‐level competence; (2) the importance of sufficient training to develop clinical decision‐making, insight and judgement to appropriately select patients in the management of endocrine disease; (3) expected standards of clinical and technical performance are independent of practice location or context; (4) the importance of multi‐disciplinary teams for complex cases including advanced cancers.Practicing endocrine surgeons acknowledge formal fellowship training is required to achieve competence across technical and non‐technical domains. The definition of competence and expectations regarding technical outcomes are independent of practice location or context. [ABSTRACT FROM AUTHOR]

Plain Language Summary What is this summary about? This is a plain language summary of a clinical research study. The study investigated the effects of a drug called anamorelin for people in Japan with advanced gastrointestinal cancer (colon, rectum, stomach or pancreas) who also had a condition called cachexia. People with cachexia have a loss of appetite, severe weight loss, loss of body fat, and loss of muscle. Anamorelin has been shown in previous research studies to improve appetite and increase lean body mass (the total weight of the body, not counting fat) and overall body weight. In this study, participants were given anamorelin (100 mg daily) for 12 weeks. What did the researchers find out? 31 out of 49 participants (63%) had an increase in their lean body mass, with an average increase of almost 2 kg, which was seen from week 3 of the study. Participants also experienced an improvement in their appetite and overall body weight. The researchers found that anamorelin did not cause a large number of serious side effects. What do the results mean? This study found that anamorelin can help people with advanced gastrointestinal cancer and cachexia to increase their lean body mass and overall body weight, regain their appetite and improve their nutritional status. Since this study was done, the use of anamorelin for cachexia in people with gastrointestinal cancer has been approved for use in Japan. Tweetable Abstract A study of 3 trials to learn how well larotrectinib works and how safe it is for people with TRK fusion-positive thyroid cancer [ABSTRACT FROM AUTHOR]

Early screening methods for the thyroid gland include palpation and imaging. Although palpation is relatively simple, its effectiveness in detecting early clinical signs of the thyroid gland may be limited, especially in children, due to the shorter thyroid growth time. Therefore, this constitutes a crucial foundational work. However, accurately determining the location and size of the thyroid gland in children is a challenging task. Accuracy depends on the experience of the ultrasound operator in current clinical practice, leading to subjective results. Even among experts, there is poor agreement on thyroid identification. In addition, the effective use of ultrasound machines also relies on the experience of the ultrasound operator in current clinical practice. In order to extract sufficient texture information from pediatric thyroid ultrasound images while reducing the computational complexity and number of parameters, this paper designs a novel U-Net-based network called DC-Contrast U-Net, which aims to achieve better segmentation performance with lower complexity in medical image segmentation. The results show that compared with other U-Net-related segmentation models, the proposed DC-Contrast U-Net model achieves higher segmentation accuracy while improving the inference speed, making it a promising candidate for deployment in medical edge devices in clinical applications in the future. [ABSTRACT FROM AUTHOR]

Objective To determine the activity levels of 131I in the thyroids of nuclear medicine staff in Guangzhou, estimate the internal radiation dose received by these staff, and assess their internal radiation risk. Methods From September to November 2023, a convenience sampling method was used to select 50 nuclear medicine staff from four hospitals in Guangzhou that conduct nuclear medicine diagnostics and treatments. A portable RT31EPT15 thyroid measurement device was used to directly measure the activity levels of 131I in the thyroids of the staff. The intake of 131I was estimated, and the annual committed effective dose was derived. Results Among these 50 nuclear medicine staff, 7 individuals were found to have detectable levels of 131I in their thyroids, with a detection rate of 14%. There were no statistically significant differences in detection rates among different genders and job positions (P > 0.05). Among 7 individuals with detectable 131I, the activity levels ranged from 60.8 to 143.6 Bq, with a mean of 84.1 Bq and a median of 83.7 Bq. The annual effective dose levels for physicians, technicians, and nurses were 0.29 mSv/year, 0.38 mSv/year, and 0.54 mSv/year, respectively. Conclusions The annual effective dose values of internal radiation for these 50 nuclear medicine staff in four hospitals in Guangzhou were within the standard limits. However, the risk of internal radiation exposure should not be overlooked. Routine monitoring of internal radiation doses among nuclear medicine staff should be conducted to ensure their occupational health. [ABSTRACT FROM AUTHOR]

Background: Thyroid-associated ophthalmopathy (TAO) involves tissue expansion and inflammation, potentially causing a hypoxic microenvironment. Hypoxia-inducible factor (HIF)-1α is crucial in fibrosis and adipogenesis, which are observed in TAO progression. We investigated the effects of hypoxia on orbital fibroblasts (OFs) in TAO, focusing on the role of HIF-1α in TAO progression. Methods: OFs were isolated from TAO and non-TAO patients (as controls). In addition to HIF-1α, adipogenic differentiation markers including peroxisome proliferator-activated receptor γ (PPARγ) and CCAAT/enhancer binding protein (CEBP) were measured by Western blot, and phenotype changes were evaluated by Oil Red O staining under both normoxia and hypoxia. To elucidate the effect of HIF-1α inhibition, protein expression changes after HIF-1α inhibitor treatment were evaluated under normoxia and hypoxia. Results: TAO OFs exhibited significantly higher HIF-1α expression than non-TAO OFs, and the difference was more distinct under hypoxia than under normoxia. Oil Red O staining showed that adipogenic differentiation of TAO OFs was prominent under hypoxia. Hypoxic conditions increased the expression of adipogenic markers, namely PPARγ and CEBP, as well as HIF-1α in TAO OFs. Interleukin 6 levels also increased in response to hypoxia. The effect of hypoxia on adipogenesis was reduced at the protein level after HIF-1α inhibitor treatment, and this inhibitory effect was sustained even with IGF-1 stimulation in addition to hypoxia. Conclusion: Hypoxia induces tissue remodeling in TAO by stimulating adipogenesis through HIF-1α activation. These data could provide insights into new treatment strategies and the mechanisms of adipose tissue remodeling in TAO. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid disorders are common in Indian adult population. Current management guidelines from the American Thyroid Association (ATA) recommend diagnostic ultrasonography for all patients with thyroid nodules. However, suspicious and few overlapping characteristics of benign and malignant thyroid nodules makes FNAC unquestionable. Unwanted suspicion leads to excessive unnecessary biopsies and insufficient lower suspicion leads to under-diagnosis or missing of thyroid malignancies. Hence, making accurate decision of whether a nodule is potentially malignant or not is crucial. Aims and objectives: To study the USG features of thyroid lesions in patients with thyroid disorders and correlate these USG findings with FNAC in the diagnosis of thyroid lesions. Methods: The cross-sectional study was done for 18 months among patients of thyroid disorders coming to the Radio-diagnosis department of Muzaffarnagar Medical College for routine USG scan for thyroid lesions. A sample of 50 patients was taken among the age group of 10-75years who gave consent for FNAC and did not have any bleeding disorders. Sonographic evaluation of the thyroid gland was done by characterising its size, shape, echogenicity, vascularity and presence or absence of nodules. The respective nodules were assed for suspicious patterns and FNAC of the nodules was done to correlate the radiological with pathological diagnosis. Results: As per the study, with good sensitivity and specificity, radiological examination of thyroid lesions by USG showed significant correlation with pathological evaluation of thyroid lesions by FNAC examination. A strong positive correlation between the two diagnostic procedures was seen. The correlation was statistically significant, with a P < 0.05. Conclusion: Thyroid gland ultrasound is a non-invasive, cost-effective and patient compliant technique in assessing and diagnosing thyroid swellings which can be performed as the initial investigation before FNAC examination for quickly assessing thyroid nodules, their vascularity and identifying benign from malignant lesions. This would avoid unnecessary invasion and its related complications like puncturing an highly vascular nodule which could be determined on USG itself. [ABSTRACT FROM AUTHOR]

Simple Summary: The Hermann's tortoise (Testudo hermanni), or Mediterranean tortoise, is one of the two native species of terrestrial tortoises that inhabit the Iberian Peninsula. This is a vulnerable species protected by legislation and subjected to conservation and captive breeding programs. The present study is the first to simultaneously evaluate the four-season variations in corticosterone and total triiodothyronine in semi-captive adults and juvenile individuals of Western Hermann's tortoises (T. hermanni hermanni). The current investigation revealed that corticosterone concentrations changed seasonally depending on the sex, whereas total triiodothyronine changed seasonally in both sexes. Juvenile individuals did not show seasonal variations in any of the evaluated hormones. Overall, this study adds evidence and provides novel information about the seasonal variations in corticosterone and total triiodothyronine in adult and juvenile individuals of this protected species. The Mediterranean tortoise Testudo hermanni inhabits different regions bordering the northwestern Mediterranean. This species is vulnerable, protected by legislation, and involved in various breeding and reintroduction programs. Wild populations face numerous environmental and anthropogenic stressors that can potentially interfere with their conservation. While seasonal changes in stress-response biomarkers, such as glucocorticoids and thyroid hormones, have been widely studised in mammals and birds, there is a paucity of research in reptile species. Therefore, the present study aimed to evaluate the seasonal fluctuations in corticosterone and total triiodothyronine levels in adult and juvenile Hermann's tortoises (Testudo hermanni) as a measure of the physiological stress response. Blood samples were collected seasonally (winter, spring, summer, and autumn) and posteriorly analyzed by using a specific and validated enzyme immunoassay for both hormones, respectively. The results showed that corticosterone levels varied seasonally and differed between sexes, whereas total triiodothyronine levels changed seasonally but did not differ between sexes. Notably, juveniles exhibited no seasonal changes in either corticosterone or total triiodothyronine levels. Additionally, no correlation between blood extraction duration and hormonal concentrations was observed. This study is pioneering in its comprehensive evaluation of corticosterone and total triiodothyronine changes across all four seasons, including winter, and its focus on juvenile Hermann's tortoises. [ABSTRACT FROM AUTHOR]

Background/Objectives: There is evidence of overtreatment in patients with subclinical hypothyroidism (SCH). We aimed to identify the proportion of patients treated for SCH and the determinants of thyroid hormone therapy initiation. Methods: We included a random sample of adult Veterans diagnosed with SCH from 1 January 2016 to 31 December 2018 and conducted univariate and multivariable logistic regression to identify factors associated with levothyroxine initiation. Results: Out of 229 Veterans with SCH [90.0% male, 87.2% White, 99.1% non-Hispanic, median age (interquartile range; IQR) 68 (17) years], 27.5% were treated with levothyroxine. The treated group had a higher proportion of White patients (95.2% vs. 84.2%, p = 0.039), a higher thyrotropin level [median (IQR), 6.98 (2.06) mIU/L vs. 6.14 (1.10) mIU/L, p = 0.0002], a higher proportion of patients with thyrotropin level ≥ 10 mIU/L (11.1% vs. 3.0%, p = 0.021), a lower frequency of confirmatory thyroid testing before initiating levothyroxine (49.2% vs. 97.0%, p < 0.0001), and a similar frequency of thyroid autoimmunity testing (3.2% vs. 0.6%, p = 0.18) compared to the untreated group. In a multivariable logistic regression analysis, White race (OR = 4.50, 95% CI 1.19 to 17.08, p = 0.026) and index thyrotropin level [OR = 1.71, 95% CI 1.24 to 2.35, p = 0.001; for every SD increase (1.6 mIU/L)] were associated with higher odds of treatment. Conclusions: Three in 10 Veterans with SCH received levothyroxine, often based on a single abnormal thyroid test without autoimmunity assessment. White race and higher thyrotropin level were linked to increased odds of starting treatment, indicating potential disparities and the influence of SCH severity on decision-making. [ABSTRACT FROM AUTHOR]

Papillary thyroid cancer (PTC) is the 8th most common cancer among women overall. Licorice contains over 300 active compounds, many of them with anti-cancer properties. Glycyrrhetinic acid (GA) is a major component of licorice. The aim of this study was to investigate the potential anti-proliferative effects of licorice and GA on PTC cell cultures. Licorice extract (LE) was produced from the root and tested on BCPAP and K1 cell lines, as well as GA and aldosterone. We used the MTT test to investigate the anti-proliferative activity, the wound healing test for the migratory activity, and finally, we analyzed cell cycle distribution, apoptosis, and oxidative stress after LE, GA, or aldosterone incubation. Both LE and GA reduced cell viability at 48 h and cell migration at 24 h in both PTC cultures. Aldosterone reduced cell migration only in K1 cells. LE and GA induced cell cycle arrest in the G0/G1 phase in the BCPAP cell line, while LE and aldosterone induced it in the K1 culture. GA but not LE increased the apoptosis rate in both cell lines, whereas LE but not GA increased oxidative stress in both cultures. This study presents the first evidence of the in vitro anti-proliferative and anti-migratory activity of LE and GA on PTC. [ABSTRACT FROM AUTHOR]

Tumors originating from thyroid follicular cells are the most common endocrine tumors, with rising incidence. Despite a generally good prognosis, up to 20% of patients experience recurrence and persistence, highlighting the need to identify the underlying molecular mechanisms. Dicer1 has been found to be altered in papillary thyroid cancer (PTC). Studies suggest that Dicer1 functions as a haploinsufficient tumor suppressor gene: partial loss promotes tumorigenesis, while complete loss prevents it. To investigate the effects of partial or total Dicer1 loss in PTC in vitro, we generated stable Dicer1 (+/−) cell lines from TPC1 using CRISPR-Cas9, though no Dicer1 (−/−) lines could be produced. Therefore, siRNA against Dicer1 was transfected into Dicer1 (+/−) cell lines to further decrease its expression. Transcriptomic analysis revealed changes in proliferation and cell locomotion. BrdU staining indicated a slow-down of the cell cycle, with fewer cells in S phase and more in G0-G1-phase. Additionally, transwell assays showed decreased invasion and migration after Dicer1 knockdown by siRNA. Moreover, Dicer1 overexpression led to decreased proliferation, invasion, and increased apoptosis. Our findings deepen the understanding of Dicer1's role in thyroid cancer, demonstrating that both complete elimination and overexpression of Dicer1 inhibit thyroid oncogenesis, highlighting Dicer1 as a promising target for novel therapeutic strategies. [ABSTRACT FROM AUTHOR]

Simple Summary: Non-iodine avid differentiated thyroid cancer (DTC) may be a diagnostic problem, especially in patients with an indeterminate response to treatment (i.e., with thyroglobulin (Tg) concentration in the range of 1–10 ng/mL). PET/CT with [18F]FDG may be a useful technique for visualizing non-iodine avid DTC lesions. Presented study assessed the usefulness of using exogenous stimulation with recombinant human TSH (rhTSH) before PET/CT with [18F]FDG in detecting non-iodine avid foci of DTC in patients with elevated sTg and negative 131I WBS and the usefulness of Tg concentration in predicting a positive result of [18F]FDG PET/CT in this type of patients and to determine the optimal Tg cut-off point for obtaining a positive [18F]FDG PET/CT result. In a retrospective analysis including 73 patients with DTC suspected of having non-iodine avid recurrence or metastases there was no effect of rhTSH stimulation on the sensitivity and specificity of PET/CT, but a positive impact on the number of lesions visible in the examination was observed. Moreover, rhTSH stimulation allowed for visualization of non-iodine avid lesions with lower Tg concentration. Introduction: Non-iodine avid metastases of differentiated thyroid cancer (DTC) can be found using PET/CT with a fluorine-18-labeled glucose analog ([18F]FDG). There are ongoing discussions on the appropriateness of using exogenous thyrotropin (TSH) stimulation before this examination. Material and Methods: In a retrospective study, 73 PET/CT scans with [18F]FDG performed after exogenous stimulation with recombinant human TSH (rhTSH) and without such stimulation were analyzed. All analyzed patients were suspected of having non-iodine-avid foci of DTC. Results: The stimulation with rhTSH before the PET/CT did not affect the percentage of positive results: 37.5% (18/48) with rhTSH and 40% (10/25) without rhTSH (p = 0.83). The analysis of the ROC curves established the cut-off thyroglobulin point for a positive PET/CT result separately for both subgroups. There was no statistically significant difference between obtaining a positive PET/CT result and the baseline thyroglobulin concentration (both stimulated and unstimulated). The exogenous stimulation of TSH prior to the PET/CT had no effect on the [18F]FDG uptake in the PET/CT lesions. Conclusions: PET/CT with [18F]FDG remains a useful method for the diagnosis of non-iodine-avid DTC lesions; in the presented group, a positive effect of rhTSH stimulation on the number of DTC foci visible in the PET/CT was found, but without affecting its effectiveness. [ABSTRACT FROM AUTHOR]

Metformin treatment decreases elevated concentrations of anterior pituitary hormones. The aim of this prospective, cohort study was to investigate whether hyperthyroidism modulates the impact of metformin on gonadotroph secretory function. The study population included 48 postmenopausal women with untreated type 2 diabetes or prediabetes, 24 of whom had coexisting grade 1 subclinical hyperthyroidism. Both groups were matched for age, insulin sensitivity, and gonadotropin levels. Over the entire study period, all participants were treated with metformin (2.55–3 g daily). Plasma glucose, insulin, thyroid‐stimulating hormone (TSH), total and free thyroid hormones, follicle‐stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, adrenocorticotropic hormone (ACTH), and insulin‐like growth factor‐1 (IGF‐1) were assayed at entry and 6 months later. At baseline, the study groups differed in levels of TSH and thyroid hormones but not in body mass index, blood pressure, glucose homeostasis markers (fasting glucose, homeostatic model assessment 1 of insulin resistance ratio [HOMA1‐IR], and glycated hemoglobin [HbA1c]), and the remaining hormones. There were no differences between both groups in the degree of reduction in plasma glucose and HbA1c in response to metformin treatment. Although metformin decreased HOMA1‐IR in both groups, this effect was stronger in women with hyperthyroidism than with normal thyroid function (−50 ± 20% vs −30 ± 15%). Similar relationships were observed for FSH (−43 ± 21% vs −21 ± 12%). Only in hyperthyroid women did the drug reduce LH concentration (by 35 ± 17%). Metformin did not affect circulating levels of TSH, total and free thyroxine, total and free triiodothyronine, estradiol, prolactin, ACTH, and IGF‐1. The obtained results indicate that hyperthyroidism enhances the gonadotropin‐lowering effects of metformin, as well as the fact that this agent has a neutral effect on the hypothalamic–pituitary–thyroid axis in case of its overactivity. [ABSTRACT FROM AUTHOR]

As thyroid disorders are common amongst the elderly, this study aims to evaluate the reference interval (RI) for thyroid stimulating hormone (TSH) in healthy adults aged 70 years and over.A proposed RI was determined from the Australian participants of the ASPirin in Reducing Events in the Elderly (ASPREE) randomised trial. Participants had no history of cardiovascular disease, thyroid cancer, dementia, or life-threatening illnesses. Participants prescribed with any thyroid-related medication at baseline were excluded. TSH levels were measured using a commercial chemiluminescence microparticle immunoassay. The RI was determined using the middle 95th percentile of the logarithmic transformed data of baseline TSH. Cox proportional hazard regression models were used to validate the RI by assessing disease incidence over time.A total of 10,995 participants had baseline TSH measures. Median (IQR) age was 73.9 (71.8–77.3) years. We propose a RI of 0.34–3.75 mU/L. TSH levels did not differ by age or sex. At baseline, there was no association between symptoms associated with thyroid disease and levels of TSH. Over the follow-up period of up to 11 years, no association was seen between baseline TSH levels and relevant disease outcomes for participants within the RI.From a group of initially healthy, community-dwelling adults aged >=70 years, we propose a RI of TSH to best represent euthyroidism. This concentration was not associated with an increased risk of thyroid related symptoms or outcomes, confirming its appropriateness for clinical use. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the effectiveness of reflex molecular testing at identifying thyroid malignancy in indeterminate thyroid nodules (ITNs) since its implementation at our institution. Method: Identified all ITNs at our institution from January 2010 to October 2020. Calculated the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of ThyroSeq since the initiation of universal reflex testing of all first-time ITNs beginning in March 2016. Analyze effect on frequency of diagnostic surgeries. Results: Study group: March 2016 to October 2020, 378 ITNs underwent ThyroSeq (318 Bethesda III and 60 Bethesda IV). Mean age 52 years, 35.9% male, 61.1% female. 145 surgically excised with overall resection rate of 38.4% (III: 32.7%; IV 68%). Final histology: 49 malignant with overall rate of malignancy (ROM) of ITNs at 33.8% (III: 31.7%; IV: 39%). ThyroSeq sensitivity for ITNs at 84% (III 78.8%, IV 93.8%). ThyroSeq NPV for ITNs at 86% (III 84%, IV 93.3%). ThyroSeq specificity for ITNs at 52% (III 50.7%, IV 56%). ThyroSeq PPV for ITNs at 47% (III 42.6%, IV 57.7%). Control group: From January 2010 to February 2016 there were 242 ITNs (152 Bethesda III, 90 Bethesda IV). Mean age 52.6 years, 25.8% male, 74.2% female. 157 cases were surgically excised, with an overall resection rate of 64.9% (III: 57.2%; IV: 77.8%). Final histology: 32 malignant, with overall ROM of ITNs at 20.4% (III: 27.6%; IV: 11.4%). Conclusion: The initiation of universal Thyroseq (sensitivity 84% and NPV 86%) of ITNs at our institution has significantly decreased our percentage of diagnostic lobectomies, with a decreased resection rate of 26.5%. [ABSTRACT FROM AUTHOR]

Purpose: To systematically review published studies on the prevalence of the thyroid foramen (TF), perform a meta-analysis to generate pooled prevalence estimates, and identify factors associated with its presence. Methods: A systematic literature search was conducted in Google Scholar, PubMed, and Journal Storage databases. Studies reporting the prevalence of the thyroid foramen were included without language or date restrictions. Quality assessment was performed using AQUA tool. A random-effects meta-analysis was performed with subgroup analyses. Heterogeneity was assessed using Higgins' I2 statistics, and publication bias was evaluated using funnel plots and Egger's test. Results: Out of 271 entries, 38 studies met the inclusion criteria, comprising 3,030 subjects from various continents. The overall TF prevalence was 24.5% (95% CI: 19.2-29.8%, I2 = 93.44%), with unilateral TF present in 16.9% and bilateral TF in 6.2%. Prevalence was highest in North America (31.4%,) and lowest in Africa (12.3%). No significant prevalence difference was found between adults and younger populations (p = 0.15). Publication bias, or the small-study effect, was detected (p < 0.01). Conclusion: This meta-analysis reveals a 24.5% overall prevalence of TF, with significant heterogeneity primarily explained by geographical differences. The TF's clinical relevance necessitates awareness among surgeons and radiologists to avoid complications during laryngeal surgeries and prevent misdiagnosis in imaging studies. [ABSTRACT FROM AUTHOR]

Langerhans cell histiocytosis (LCH) is a group of diseases that cause damage by local or widespread accumulation of atypical histiocytes in various tissues such as skin, bone, lung, liver, lymph nodes, mucocutaneous tissues, and endocrine organs. LCH was detected as a result of a total thyroidectomy biopsy performed on a 43-yearold female patient with a solitary euthyroid nodule following weight loss and an increase in the size of the thyroid nodule during outpatient clinic checks. Patient's whole body positron emission tomography. The case of LCH with isolated thyroid involvement is very rare, and a limited number of cases have been presented on this subject. In addition, it will contribute to the literature since there are fewer than ten LCH cases with thyroid involvement. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Near-infrared indocyanine green angiography allows experienced surgeons to reliably evaluate parathyroid gland vitality during thyroid and parathyroid operations in order to predict postoperative function. To facilitate equal performance between surgeons, we developed an automatic computational quantification method using computer vision that portrays expert interpretation of visualized parathyroid gland near-infrared indocyanine green angiographic fluorescence signals. Methods Near-infrared indocyanine green-parathyroid gland angiography video recordings (Fluobeam® LX, Fluoptics, Grenoble—part of Getinge—Göteborg) from patients undergoing endocrine cervical surgery in a high-volume unit were used for model development. Computation (MATLAB, Mathworks, Ireland) included segmentation-identification of the parathyroid gland (by autofluorescence), image stabilization (by linear translation) and adjusted time-fluorescence intensity profile generation. Relative upslope and maximum intensity ratios then trained a simple logistic regression model based on expert interpretation and outcome (including hypoparathyroidism), with subsequent unseen testing for validation. Results The model was trained on 37 patient videos (45 glands, 29 judged well perfused by parathyroid gland angiography experts), achieving feature data separation with 100% accuracy, and tested on 22 unseen videos (27 glands, 15 judged well perfused), including four in real time. Segmentation-guided parathyroid gland detection correctly identified all parathyroid glands during unseen testing along with three additional non-parathyroid gland regions (90% positive predictive value). Subsequent time-fluorescence intensity profile extraction with vitality prediction was shown feasible in all cases within 5 min, with a 96.3% model accuracy (sensitivity and specificity were 93.3 and 100% respectively) when compared with expert judgement. Conclusion Automatic parathyroid gland perfusion quantification using simple machine learning computational methods discriminates parathyroid gland perfusion in concordance with expert surgeon interpretation, providing a means for near-infrared indocyanine green-parathyroid gland signal evaluation. [ABSTRACT FROM AUTHOR]

Background: Hypoparathyroidism with hypocalcemia is the most frequent complication after thyroid surgery. Many risk factors have been involved in the development of this complication, with conflicting results. Incidental parathyroidectomy (IP) may be a frequent cause of postoperative hypocalcemia. In this study, we have evaluated the risk factors associated with the IP in a single-center cohort of patients undergoing thyroid surgery. Patients and methods: The incidence and the risk factors for IP were evaluated in 799 patients scheduled for surgical treatment for thyroid disease between January 2018 and December 2023. Parathyroid hormone levels and serum calcium levels, together with the histological specimens, were evaluated in all patients. Results: Post-operative temporary hypocalcemia was present in 239 (29.9%) patients. A total of 144 patients (21.9%) had an incidental parathyroidectomy. Younger patients (<40 years) had the highest risk of having an incidental parathyroidectomy (RR 1.53 (95% CI 1.084–2.161), OR 1.72 (95% CI 1.091–2.710), p = 0.014). Moreover, thyroid cancer (RR 1.4 (95 CI 1.114–1.882) OR 1.68 (95% CI 1.145–2.484), p < 0.05) and the neck dissection (RR 1.75 (95% CI 1.409–2.198) OR 2.38 (95% CI 1.644–3.460), p < 0.001) were strongly associated with the risk of incidental parathyroidectomy. Conclusions: Younger female patients with thyroid cancer and neck dissection were at the highest risk of incidental parathyroidectomy. A meticulous surgical dissection, together with imaging methods for the detection of the parathyroid glands, may reduce the incidence of this complication. [ABSTRACT FROM AUTHOR]

Introduction: Surgery is still the main line of treatment for papillary thyroid cancer (PTC) with a current trend for de-intensified treatment based on an excellent prognosis. The role of a routine prophylactic central neck dissection (PCND) is still debated as its impact on oncologic outcomes has never been cleared by a randomized clinical trial. In this study, we aimed to report our long-standing experience in PCND and its potential contemporary role in the treatment of PTC. Methods: A retrospective institutional review was performed on all patients who underwent operation for PTC including PCND between 1998 and 2021. The primary outcomes were the rate of central lymph node metastases (CLNMs), cancer recurrence and incidence of complications. Survivals were analyzed using the Kaplan–Meier estimator and Cox proportional hazard models. Results: A total of 657 patients were included in this study with a median follow-up of 78 months (48–114 months). Two hundred and one patients presented occult CLNMs (30.6%). The presence of a pathological node represented the unique reason for a completion thyroidectomy and I131 therapy in 12.5% of the population. Age lower than 55 years, microscopic or macroscopic extra-thyroid extension (ETE) and multifocality were independent factors predicting CLNMs. The rate of recurrence in the whole population was 2.7% (18 patients). Five-year and ten-year disease-free survival (DFS) was 96.5% (94.7–97.7) and 93.3% (90.3–95.5), respectively. Two patients relapsed in the central neck compartment (0.3%). Age (>55 years), pathological staging (pT) and extranodal extension (ENE) were independent factors associated with a worse DFS. The rate of temporary and permanent vocal fold palsy was 12.8% and 1.8%, respectively, and did not depend on the type of surgical procedure performed. Hypoparathyroidism was temporary in 42.2% and permanent in 11.9% of the patients. A sub-analysis upon cT1b-T2 patients treated primarily with thyroid lobectomy and ipsilateral PCND demonstrated a 2.6% rate of permanent hypoparathyroidism. Conclusions: PCND allows for a high disease-free survival and a proper selection of patients needing adjuvant treatment, in particular, those treated with a unilateral procedure. On the other hand, bilateral approach is burdened by a not-neglectable rate of permanent hypoparathyroidism. [ABSTRACT FROM AUTHOR]

Background: Laser ablation (LA) is a minimally invasive treatment. It has been widely used since the early 2000s to induce volume reduction of symptomatic benign thyroid nodules. Up to 40% of laser-treated nodules have been reported to achieve a volume reduction of <50% (technique inefficacy) at 12 months and tend to regrow over time. Objective: This study aimed to assess the optimal baseline volume and energy to be delivered to minimize technique inefficacy. Methods: This was a retrospective study. Data were collected, including baseline volume, energy delivered, and 12-month volume reduction ratio (VRR) of spongiform nodules (EU-TIRADS 2) treated with LA between 2010 and 2020. Based on these data, the optimal baseline volume and energy to be delivered were calculated to maximize the rate of nodules with technique efficacy (VRR ≥ 50% at 12-month follow-up). Results: A total of 205 patients with spongiform nodules were included in this study. The energy delivered was positively associated with VRR. However, no association was observed between baseline volume and VRR. Delivering energy ≥500 J/mL to nodules with a mean baseline volume of 11.4 ± 4 mL resulted in technique efficacy in 83% of cases. Conclusion: Treating spongiform nodules with a baseline volume of ≤15 mL and delivering energy ≥500 J/mL are key factors for achieving a relevant rate of technique efficacy. [ABSTRACT FROM AUTHOR]

Background: Prostate cancer patients, undergo imaging procedures, with [68Ga]Ga-PSMA-11 PET/CT (prostate-specific membrane antigen based positron emission tomography/computed tomography) utilized for primary and secondary staging. PSMA thyroid incidentalomas (PTI) are discovered in the thyroid gland while imaging prostate cancer patients with [68Ga]Ga-PSMA-11 PET/CT. Aims: The aim of the study was to determine the clinical significance of PTIs detected on [68Ga]Ga-PSMA-11 PET/CT. Another goal was to identify a possible threshold for the maximum standardized uptake value (SUVmax), above which a malignant growth could be suspected. Study design: A retrospective cross-sectional study. Methods: 769 patients with prostat cancer who underwent [68Ga]Ga-PSMA-11 PET/CT scans in the nuclear medicine department of a tertiary care hospital between January 2020 and December 2022 were retrospectively screened in this study. We analyzed 67 patients in whom PTI was detected. Patients who exceeded the inclusion criteria had their thyroid ultrasonography and ultrasonography -guided fine needle aspiration findings analyzed. Results: PTI was discovered in 67 patients (8%). 42 patients who met the inclusion and exclusion criteria were included in the study. Of the 4 malignant patients (9.5%) in the study population, 2 were classified as TIRADS 3 and 2 were classified as TIRADS 4. The cut-off SUVmax value was found to be 5.6. With 100% sensitivity and 47.37% specificity, a cutoff SUVmax of 5.3 was determined through receiver–operator characteristic analysis in order to predict malignant cytology. Conclusion: PTI is a significant clinical finding; most of diffuse and focal uptakes are frequently related to benign diseases. Each center should establish its own a possible SUVmax cut-off over which a malignant lesion should be suspected. [ABSTRACT FROM AUTHOR]

Background/Objectives: Fibroblast growth factor 21 (FGF21) is a hormonal regulator of lipid and glucose metabolism exerting protection against atherosclerosis by multiple actions on the blood vessels, liver, and adipose tissues. We aimed to investigate serum FGF21 level and its relation to thyroid hormones and metabolic parameters among patients with Hashimoto's thyroiditis (HT). Methods: Eighty patients with HT on levothyroxine treatment and eighty-two age- and BMI-matched adults without thyroid disease serving as controls were enrolled. Serum FGF21 concentrations were determined with an enzyme-linked immunosorbent assay. Results: Median serum FGF21 level was significantly lower in HT patients compared with controls (74.2 (33.4–148.3) pg/mL vs. 131.9 (44.8–236.3) pg/mL; p = 0.03). We found a positive correlation between FGF21 and age, triglyceride, total cholesterol, and low-density lipoprotein cholesterol in both groups, while thyroid stimulating hormone and C-reactive protein showed a positive correlation, and thyroxine had an inverse correlation with FGF21 only in control subjects. According to multiple regression analyses, thyroid status is the main predictor of FGF21 in healthy controls, while it is not a significant predictor of FGF21 among HT patients on levothyroxine supplementation therapy. Conclusions: Our results indicate that the physiological role of thyroid function in the regulation of FGF21 synthesis is impaired in HT patients, which may contribute to the metabolic alterations characteristic of HT patients. [ABSTRACT FROM AUTHOR]

Quercetin is the most abundant flavonoid present in fruits and vegetables. For its antiproliferative, antiviral, anti-inflammatory and antioxidants activities, it is an active ingredient of several herbal remedies and is available as a nutraceutical. Experimental studies performed in vitro have demonstrated that quercetin inhibits growth and function in normal thyroid cells and may act as a thyroid disruptor. These effects have also been confirmed in vivo using rodent models. Some studies have reported the ability of quercetin to interfere with the metabolism of thyroid hormones, since it inhibits the 5′-deiodinase type 1 (D1) activity in the thyroid, as well as in the liver. Besides the effects on normal thyroid cells, several experiments performed in vitro have shown a potential therapeutic role of quercetin in thyroid cancer. Indeed, quercetin inhibits the growth, the adhesion and the migration of thyroid cancer cells, and it also has redifferentiation properties in some thyroid cancer cell lines. In conclusion, these data suggest that, although its effects can be of benefit in hyperthyroidism and thyroid cancer, caution is required in the use of high doses of quercetin due to its anti-thyroid properties. Further in vivo studies are certainly needed to confirm these hypotheses. [ABSTRACT FROM AUTHOR]

Objectives: To establish superb microvascular imaging (SMI) based thyroid imaging reporting and data system (SMI TI-RADS) for risk stratification of malignancy in thyroid nodules. Methods: In total, 471 patients, comprising 643 thyroid nodules, who received conventional ultrasound (US), SMI, and a final diagnosis were extensively analyzed. A qualitative assessment of US features of the nodules was performed followed by univariable and multivariable logistic regression analyses, leading to the construction of the SMI TI-RADS, which was further verified using internal and external validation cohorts. Results: Among the stand-alone US, predictive factors were the shape and margins of the nodules, echogenicity and echogenic foci, vascularity, extrathyroidal extension, ring-SMI patterns, penetrating vascularity, flow-signal enlarged, and vascularity area ratio. SMI TI-RADS depicted an enhanced area under the receiver operating characteristic curve (AUC) of 0.94 (95% CI: 0.92, 0.96; p < 0.001 relative to other stratification systems), a 79% biopsy yield of malignancy (BYM, 189/240 nodules), and a 21% unnecessary biopsy rate (UBR, 51/240 nodules). In the verification cohorts, we demonstrated AUCs, malignancy biopsy yields, and unnecessary biopsy rates of 0.88 (95% CI: 0.83, 0.94), 79% (59/75 nodules), and 21% (16/75 nodules) for the internal cohort, respectively, and 0.91 (95% CI: 0.85, 0.96), 72% (31/43 nodules), and 28% (12/43 nodules) for the external cohort, respectively. Conclusion: SMI TI-RADS was found to be superior in diagnostic sensitivity, specificity, and efficiency than existing TI-RADSs, showing better stratification of the malignancy risk, and thus decreasing the rate of unnecessary needle biopsy. Critical relevance statement: To develop an imaging and data system based on conventional US and SMI features for stratifying the malignancy risk in thyroid nodules. Key Points: SMI features could improve thyroid nodule risk stratification. SMI TI-RADS showed superior diagnostic efficiency and accuracy for biopsy guidance. SMI TI-RADS can provide better guidance for clinical diagnosis and treatment of thyroid nodules. [ABSTRACT FROM AUTHOR]

Among developing countries, the prevalence of being underweight is rising when compared with the over-weight and obese population in young adults have been a major public concern that will shape the future of every individual's health. The present study aims to provide recent estimates of the prevalence of under-weight, overweight, and obese and its influencing factors and complications in younger adults. Among 1004, the overall prevalence rates of underweight, overweight and obese were found to be 18.8%, 12.3% and 3.7% respectively. The majority of the participants were newly diagnosed with prediabetes and prehypertension conditions, and nearly a quarter had a possible risk of developing thyroid and polycystic ovarian syndrome. Management of these health consequences decreases the progression of the risks that should be prevented [ABSTRACT FROM AUTHOR]