Pub Date : 2026-02-01DOI: 10.1016/j.eprac.2025.08.007
Laura Croce MD, PhD , Rosaria Maddalena Ruggeri MD, PhD , Marsida Teliti MD , Luca Rossi MD , Elena Petrosino MD , Paolo Caccavale MD , Martina Laganà MD , Spyridon Chytiris MD , Carlo Cappelli MD , Salvatore Cannavò MD , Mario Rotondi MD, PhD
Objective
Thyroid ultrasound (US) is the cornerstone for diagnosing nodular thyroid disease, yet many US examinations are prompted by nonspecific local symptoms (LS) like dysphagia or a palpable neck mass (NM). The clinical utility of such referrals remains debated.
Methods
This multicenter retrospective study analyzed 614 patients diagnosed with thyroid nodules (TNs) via US from 2 endocrinology centers in Italy between December 2021 and October 2022. Patients were grouped based on referral reason: symptomatic TNs, further subdivided into NM and LS, versus nonsymptomatic TNs. Clinical, ultrasonographic, and management data were compared.
Results
Symptomatic TNs accounted for 28.7% of cases (19.2% NM, 9.5% LS). NM patients were younger, more often female, and had larger, often cystic or isthmic-located nodules than nonsymptomatic TN patients. Conversely, LS patients had no significant differences in thyroid volume or nodule size but showed a higher prevalence of gastroesophageal reflux disease. Fine-needle aspiration was more common in the NM group because of larger nodules, but malignancy rates did not differ across groups. Surgical rates were similar, whereas thermal ablation was more frequent in the NM group.
Conclusions
A third of TNs are diagnosed during US prompted by LS, yet only NMs are associated with distinct nodule characteristics. Dysphagia and dysphonia were nonspecific and more related to gastroesophageal reflux disease than TNs. These findings support caution against overuse of US. Demographics, nodule features, and location should guide clinical suspicion and imaging decisions to avoid unnecessary imaging and interventions.
目的：甲状腺超声（US）是诊断甲状腺结节性疾病的基础，然而许多US检查是由非特异性的局部症状引起的，如吞咽困难或可触及的颈部肿块。这种转诊的临床效用仍然存在争议。方法：这项多中心回顾性研究分析了2021年12月至2022年10月期间意大利两个内分泌中心通过US诊断为甲状腺结节（TNs）的614例患者。患者根据转诊原因分组：有症状的TNs (STN)，进一步细分为颈部肿块（NM）和局部症状（LS），与无症状的TNs （nSTN）。比较临床、超声和治疗资料。结果：STNs占28.7%，其中NM 19.2%, LS 9.5%。NM患者较年轻，多为女性，与nSTN患者相比，结节较大，常为囊性或峡部结节。相反，LS患者在甲状腺体积和结节大小上没有显著差异，但胃食管反流的患病率更高。由于较大的结节，FNA在NM组中更常见，但各组间的恶性率没有差异。手术率相似，而热消融在NM组更频繁。结论：三分之一的TNs是由局部症状引起的，但只有颈部肿块与明显的结节特征相关。吞咽困难和发音困难是非特异性的，与胃食管反流的相关性大于tnn。这些发现支持了对过度使用US。人口统计学、结节特征和位置应指导临床怀疑和影像学决定，以避免不必要的影像学和干预。
{"title":"Redefining Thyroid Nodule Evaluation: Demographics, Misleading Symptoms, and Diagnostic Challenges. Insights From a Multicenter Study","authors":"Laura Croce MD, PhD , Rosaria Maddalena Ruggeri MD, PhD , Marsida Teliti MD , Luca Rossi MD , Elena Petrosino MD , Paolo Caccavale MD , Martina Laganà MD , Spyridon Chytiris MD , Carlo Cappelli MD , Salvatore Cannavò MD , Mario Rotondi MD, PhD","doi":"10.1016/j.eprac.2025.08.007","DOIUrl":"10.1016/j.eprac.2025.08.007","url":null,"abstract":"<div><h3>Objective</h3><div>Thyroid ultrasound (US) is the cornerstone for diagnosing nodular thyroid disease, yet many US examinations are prompted by nonspecific local symptoms (LS) like dysphagia or a palpable neck mass (NM). The clinical utility of such referrals remains debated.</div></div><div><h3>Methods</h3><div>This multicenter retrospective study analyzed 614 patients diagnosed with thyroid nodules (TNs) via US from 2 endocrinology centers in Italy between December 2021 and October 2022. Patients were grouped based on referral reason: symptomatic TNs, further subdivided into NM and LS, versus nonsymptomatic TNs. Clinical, ultrasonographic, and management data were compared.</div></div><div><h3>Results</h3><div>Symptomatic TNs accounted for 28.7% of cases (19.2% NM, 9.5% LS). NM patients were younger, more often female, and had larger, often cystic or isthmic-located nodules than nonsymptomatic TN patients. Conversely, LS patients had no significant differences in thyroid volume or nodule size but showed a higher prevalence of gastroesophageal reflux disease. Fine-needle aspiration was more common in the NM group because of larger nodules, but malignancy rates did not differ across groups. Surgical rates were similar, whereas thermal ablation was more frequent in the NM group.</div></div><div><h3>Conclusions</h3><div>A third of TNs are diagnosed during US prompted by LS, yet only NMs are associated with distinct nodule characteristics. Dysphagia and dysphonia were nonspecific and more related to gastroesophageal reflux disease than TNs. These findings support caution against overuse of US. Demographics, nodule features, and location should guide clinical suspicion and imaging decisions to avoid unnecessary imaging and interventions.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 2","pages":"Pages 142-148"},"PeriodicalIF":4.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.eprac.2025.10.001
Shuai Hao MD , Adrianna L. Westbrook MPH , Cynthia Sinha PhD , Daniel S. Hsia MD , Priyathama Vellanki MD
Objective
Heterogeneity in the clinical course of type 2 diabetes in youth presenting with and without diabetic ketoacidosis (DKA) at diagnosis is not well described. We aimed to characterize if presentation of type 2 diabetes with DKA affects rates of insulin discontinuation compared with type 2 diabetes without ketosis (non-DKA).
Methods
This single-center retrospective cohort study included patients (body mass index z-score 2.4, IQR 2.07, 2.65) with a mean age of 15 years (IQR 13, 16), hospitalized for new-onset diabetes with DKA (n = 79) or non-DKA (n = 356) at an academic pediatric institution from January 2019 to December 2021 with follow-up until May 2023. All patients were initiated on insulin and titrated per their care team. Type 1 diabetes was excluded by presence of autoimmune antibodies. Primary outcomes were time to insulin discontinuation of insulin therapy and maintenance of discontinuation.
Results
Time to insulin discontinuation and proportion who discontinued did not differ between DKA and non-DKA groups (48.1% vs 44.7% respectively, P = .58). Trajectory analyses combining DKA and non-DKA groups identified 3 insulin discontinuation groups: early (20.1% within 2 months), late (12.5% within 6 months), and never (67.4%). Multinomial regression shows that DKA at presentation is not associated with early (P = .48) or late insulin discontinuation (P = .70) compared with never discontinuation. Insulin was restarted in 37 participants with median of 20 months (IQR 16, 24) after insulin discontinuation.
Conclusions
Despite not showing differences in insulin discontinuation in youth with new-onset type 2 diabetes with and without DKA at presentation, we identified heterogeneity in duration of insulin treatment in the combined group.
{"title":"Insulin Discontinuation in Youth With New-Onset Type 2 Diabetes Presenting With and Without Diabetic Ketoacidosis","authors":"Shuai Hao MD , Adrianna L. Westbrook MPH , Cynthia Sinha PhD , Daniel S. Hsia MD , Priyathama Vellanki MD","doi":"10.1016/j.eprac.2025.10.001","DOIUrl":"10.1016/j.eprac.2025.10.001","url":null,"abstract":"<div><h3>Objective</h3><div>Heterogeneity in the clinical course of type 2 diabetes in youth presenting with and without diabetic ketoacidosis (DKA) at diagnosis is not well described. We aimed to characterize if presentation of type 2 diabetes with DKA affects rates of insulin discontinuation compared with type 2 diabetes without ketosis (non-DKA).</div></div><div><h3>Methods</h3><div>This single-center retrospective cohort study included patients (body mass index z-score 2.4, IQR 2.07, 2.65) with a mean age of 15 years (IQR 13, 16), hospitalized for new-onset diabetes with DKA (n = 79) or non-DKA (n = 356) at an academic pediatric institution from January 2019 to December 2021 with follow-up until May 2023. All patients were initiated on insulin and titrated per their care team. Type 1 diabetes was excluded by presence of autoimmune antibodies. Primary outcomes were time to insulin discontinuation of insulin therapy and maintenance of discontinuation.</div></div><div><h3>Results</h3><div>Time to insulin discontinuation and proportion who discontinued did not differ between DKA and non-DKA groups (48.1% vs 44.7% respectively, <em>P</em> = .58). Trajectory analyses combining DKA and non-DKA groups identified 3 insulin discontinuation groups: early (20.1% within 2 months), late (12.5% within 6 months), and never (67.4%). Multinomial regression shows that DKA at presentation is not associated with early (<em>P</em> = .48) or late insulin discontinuation (<em>P</em> = .70) compared with never discontinuation. Insulin was restarted in 37 participants with median of 20 months (IQR 16, 24) after insulin discontinuation.</div></div><div><h3>Conclusions</h3><div>Despite not showing differences in insulin discontinuation in youth with new-onset type 2 diabetes with and without DKA at presentation, we identified heterogeneity in duration of insulin treatment in the combined group.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 2","pages":"Pages 194-200"},"PeriodicalIF":4.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.eprac.2025.09.199
Shirui Wang MD, Wan Su MBBCH, Lian Duan MD, PhD, Fengying Gong PhD, Shi Chen MD, Linjie Wang MD, PhD, Hui Pan MD, Lin Lu MD, Huijuan Zhu MD
Objective
Generalized glucocorticoid residestance syndrome is a rare disorder caused by mutations in NR3C1. We aimed to systematically characterize its clinical, biochemical, and genetic features and quantitatively evaluate their inter-relationships.
Methods
We conducted a systematic literature review, identifying 67 cases from 33 published reports, and included 4 unreported cases from Peking Union Medical College Hospital.
Results
In total, 71 cases from 43 unrelated families were analyzed, encompassing 39 distinct NR3C1 mutations. The most frequent clinical manifestations were symptoms of androgen excess (43.3%), followed by mineralocorticoid excess (38.8%) and glucocorticoid deficiency (14.9%). Elevated post-low-dose dexamethasone suppression test cortisol was the predominant hormonal abnormality (97.8%). Adrenal computed tomography revealed hyperplasia or adenomas in 68.8% of evaluated patients. Compared with heterozygotes, those with homozygous/compound heterozygous mutations presented earlier (19.9 vs 35.5 year old, P = .007), with markedly higher prevalence of hypertension/hypokalemia (90.9% vs 28.6%, odds ratio 25.00 [95% confidence interval 2.95 -211.61], P < .001) and higher cortisol (3.20 [1.19, 2.63] vs 1.40 [0.59, 1.20] × upper limit of normal [ULN], P = .002), adrenocorticotropic hormone (4.81 [1.71, 13.00] vs 1.04 [1.00, 1.76] × ULN, P = .001), and testosterone levels (1.84 [1.34, 2.79] vs 0.89 [0.55, 1.77] × ULN, P = .047). Sensitivity analyses restricted to probands confirmed these associations. Clinical manifestations correlated with elevated cortisol, and lower renin was observed in patients with hypertension/hypokalemia.
Conclusion
This study provided the most comprehensive quantitative synthesis to date of glucocorticoid resistance syndrome, highlighting genotype-phenotype correlations and advancing understanding of its clinical and hormonal spectrum.
目的：广泛性糖皮质激素抵抗综合征是一种由NR3C1基因突变引起的罕见疾病。我们旨在系统地描述其临床、生化和遗传特征，并定量评估它们之间的相互关系。方法：我们进行了系统的文献综述，从33篇已发表的报告中筛选出67例病例，并纳入4例来自北京协和医院的未报告病例。结果：共分析了43个不相关家族的71例病例，包括39种不同的NR3C1突变。最常见的临床表现是雄激素过量（43.3%），其次是矿皮质激素过量（38.8%）和糖皮质激素缺乏（14.9%）。ldst后皮质醇升高是主要的激素异常（97.8%）。肾上腺CT显示68.8%的患者有增生或腺瘤。与杂合的相比,那些纯合子/复合的杂合突变了早些时候(19.9 vs 35.5岁,P = 0.007),高血压患病率明显更高/低血钾(90.9%比28.6%,或25.00 (95% CI 2.95 - -211.61), P < 0.001)和更高的皮质醇(3.20[1.19,2.63]和[0.59,1.20]×1.40 ULN, P = 0.002), ACTH(4.81[1.71, 13.00]和[1.00,1.76]×1.04 ULN, P = 0.001),和睾酮水平(1.84[1.34,2.79]和[0.55,1.77]×0.89 ULN, P = 0.047)。局限于先证者的敏感性分析证实了这些关联。高血压/低血钾患者的临床表现与皮质醇升高、肾素降低相关。结论：本研究提供了迄今为止最全面的糖皮质激素抵抗综合征的定量合成，突出了基因型-表型相关性，并推进了对其临床和激素谱的理解。
{"title":"Glucocorticoid Resistance Syndrome: A Systematic Review of the Genotypes, Phenotypes, and Their Relationships","authors":"Shirui Wang MD, Wan Su MBBCH, Lian Duan MD, PhD, Fengying Gong PhD, Shi Chen MD, Linjie Wang MD, PhD, Hui Pan MD, Lin Lu MD, Huijuan Zhu MD","doi":"10.1016/j.eprac.2025.09.199","DOIUrl":"10.1016/j.eprac.2025.09.199","url":null,"abstract":"<div><h3>Objective</h3><div>Generalized glucocorticoid residestance syndrome is a rare disorder caused by mutations in NR3C1. We aimed to systematically characterize its clinical, biochemical, and genetic features and quantitatively evaluate their inter-relationships.</div></div><div><h3>Methods</h3><div>We conducted a systematic literature review, identifying 67 cases from 33 published reports, and included 4 unreported cases from Peking Union Medical College Hospital.</div></div><div><h3>Results</h3><div>In total, 71 cases from 43 unrelated families were analyzed, encompassing 39 distinct NR3C1 mutations. The most frequent clinical manifestations were symptoms of androgen excess (43.3%), followed by mineralocorticoid excess (38.8%) and glucocorticoid deficiency (14.9%). Elevated post-low-dose dexamethasone suppression test cortisol was the predominant hormonal abnormality (97.8%). Adrenal computed tomography revealed hyperplasia or adenomas in 68.8% of evaluated patients. Compared with heterozygotes, those with homozygous/compound heterozygous mutations presented earlier (19.9 vs 35.5 year old, <em>P</em> = .007), with markedly higher prevalence of hypertension/hypokalemia (90.9% vs 28.6%, odds ratio 25.00 [95% confidence interval 2.95 -211.61], <em>P</em> < .001) and higher cortisol (3.20 [1.19, 2.63] vs 1.40 [0.59, 1.20] × upper limit of normal [ULN], <em>P</em> = .002), adrenocorticotropic hormone (4.81 [1.71, 13.00] vs 1.04 [1.00, 1.76] × ULN, <em>P</em> = .001), and testosterone levels (1.84 [1.34, 2.79] vs 0.89 [0.55, 1.77] × ULN, <em>P</em> = .047). Sensitivity analyses restricted to probands confirmed these associations. Clinical manifestations correlated with elevated cortisol, and lower renin was observed in patients with hypertension/hypokalemia.</div></div><div><h3>Conclusion</h3><div>This study provided the most comprehensive quantitative synthesis to date of glucocorticoid resistance syndrome, highlighting genotype-phenotype correlations and advancing understanding of its clinical and hormonal spectrum.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 2","pages":"Pages 206-217"},"PeriodicalIF":4.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.eprac.2025.10.005
Ana Julia Garcia Pereira MD, PhD , Rafael Loch Batista MD, PhD , Malebranche Berardo Carneiro Cunha-Neto MD , Valter Angelo Sperling Cescato MD, PhD , Gilberto Ochman da Silva MD, PhD , Maria Candida Barisson Villares Fragoso MD, PhD, Livre-Docente , Ines Nobuko Nishimoto PhD , Andrea Glezer MD, PhD , Marcio Carlos Machado MD, PhD
Objective
Endogenous Cushing syndrome is associated with an intrinsic hypercoagulable state and an increased risk of venous thromboembolism (VTE). This study aimed to determine the prevalence and risk factors for VTE in a large cohort of patients with Cushing disease (CD).
Methods
A retrospective study was conducted at a tertiary care center, including 408 patients diagnosed with CD. Clinical, laboratory, hormonal, imaging, and outcome data were analyzed and compared based on the occurrence of VTE events. A control group of 323 patients with clinically nonfunctioning pituitary adenomas, all macroadenomas, who underwent similar surgical procedures, was used for comparison.
Results
VTE events were observed in 35 patients with CD (8.6%) and in 1 patient from the nonfunctioning pituitary adenoma group (0.3%; P < .001). The slight majority of VTE events (54%) occurred in the preoperative period. Logistic regression analysis identified obesity, mood disorders, supraclavicular fossa fullness, leukopenia or leukocytosis, elevated cortisol levels (both serum and 24-hour urinary cortisol), and the presence of postoperative complications (such as infections, cerebrospinal fluid leak, and vasopressin deficiency) as significant risk factors for VTE.
Conclusion
The findings of this study confirm a high prevalence of VTE events in patients with CD, irrespective of the surgical period. Risk factors associated with a higher likelihood of VTE include obesity, severity of hypercortisolism, and the occurrence of postoperative complications. In this patient population, thromboprophylaxis should be considered.
{"title":"Prevalence and Associated Risk Factors for Venous Thromboembolism in a Large Cohort of Patients With Cushing Disease","authors":"Ana Julia Garcia Pereira MD, PhD , Rafael Loch Batista MD, PhD , Malebranche Berardo Carneiro Cunha-Neto MD , Valter Angelo Sperling Cescato MD, PhD , Gilberto Ochman da Silva MD, PhD , Maria Candida Barisson Villares Fragoso MD, PhD, Livre-Docente , Ines Nobuko Nishimoto PhD , Andrea Glezer MD, PhD , Marcio Carlos Machado MD, PhD","doi":"10.1016/j.eprac.2025.10.005","DOIUrl":"10.1016/j.eprac.2025.10.005","url":null,"abstract":"<div><h3>Objective</h3><div>Endogenous Cushing syndrome is associated with an intrinsic hypercoagulable state and an increased risk of venous thromboembolism (VTE). This study aimed to determine the prevalence and risk factors for VTE in a large cohort of patients with Cushing disease (CD).</div></div><div><h3>Methods</h3><div>A retrospective study was conducted at a tertiary care center, including 408 patients diagnosed with CD. Clinical, laboratory, hormonal, imaging, and outcome data were analyzed and compared based on the occurrence of VTE events. A control group of 323 patients with clinically nonfunctioning pituitary adenomas, all macroadenomas, who underwent similar surgical procedures, was used for comparison.</div></div><div><h3>Results</h3><div>VTE events were observed in 35 patients with CD (8.6%) and in 1 patient from the nonfunctioning pituitary adenoma group (0.3%; <em>P</em> < .001). The slight majority of VTE events (54%) occurred in the preoperative period. Logistic regression analysis identified obesity, mood disorders, supraclavicular fossa fullness, leukopenia or leukocytosis, elevated cortisol levels (both serum and 24-hour urinary cortisol), and the presence of postoperative complications (such as infections, cerebrospinal fluid leak, and vasopressin deficiency) as significant risk factors for VTE.</div></div><div><h3>Conclusion</h3><div>The findings of this study confirm a high prevalence of VTE events in patients with CD, irrespective of the surgical period. Risk factors associated with a higher likelihood of VTE include obesity, severity of hypercortisolism, and the occurrence of postoperative complications. In this patient population, thromboprophylaxis should be considered.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 2","pages":"Pages 227-235"},"PeriodicalIF":4.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.eprac.2025.10.003
Raviv Allon MD , Dor Atias MD , Nofar Ben-Basat MD , Guy Melamed BSc , Yaki Saciuk MPH , Tal Patalon MD
Objective
Thyroid function screening during pregnancy remains controversial, particularly regarding whether it should be universal or limited to high-risk groups. In addition, there is variability in the degree of surveillance, and recent American Thyroid Association guidelines suggest that risk groups should be followed throughout pregnancy. This study compares thyroid function surveillance between pregnant women following partial thyroidectomy and the general pregnant population.
Methods
In this national retrospective matched cohort study, data from the Maccabi Healthcare Services database were analyzed for pregnancies from 2002 to 2023 in women aged ≥18 years. The exposure group included pregnancies in women with a history of partial thyroidectomy, and the nonexposure group had no thyroidectomy. The primary outcome was the frequency of serum thyroid-stimulating hormone (TSH) measurements during pregnancy. The secondary outcome was the incidence of gestational hypothyroidism, defined as elevated TSH or initiation of levothyroxine during pregnancy.
Results
A total of 718 pregnancies in 465 partial thyroidectomy women and 929 022 pregnancies in 398 472 women in the general population were included. TSH was measured in 81% of pregnancies in the partial thyroidectomy group versus 62% in the general population (P < .01). Testing across all 3 trimesters was 18% compared to 3% (P < .01). The prevalence of elevated TSH was significantly higher in the partial thyroidectomy group (9% vs 4%, P < .01).
Conclusion
Thyroid screening during pregnancy remains suboptimal. Pregnancies following partial thyroidectomy receive more frequent monitoring, suggesting recognition of their high-risk status. Findings highlight the need for better implementation of risk-based surveillance.
目的：孕期甲状腺功能筛查仍然存在争议，特别是关于是否应该普遍或仅限于高危人群。此外，监测程度存在差异，最近的ATA指南建议在整个妊娠期间都应遵循风险群体。本研究比较了甲状腺部分切除术后孕妇和普通孕妇的甲状腺功能监测情况。方法：在这项国家回顾性匹配队列研究中，分析了MHS数据库中2002-2023年年龄≥18岁妇女的妊娠数据。暴露组包括有甲状腺部分切除术史的孕妇，非暴露组没有甲状腺切除术。主要结果是妊娠期间血清TSH测量的频率。次要结局是妊娠期甲状腺功能减退的发生率，定义为妊娠期间TSH升高或开始使用左旋甲状腺素。结果：465例甲状腺部分切除术妇女中有718例妊娠，398,472例普通人群中有929,022例妊娠。甲状腺部分切除术组81%的孕妇测量TSH，而普通人群为62% （P < 0.01）。三个妊娠期的检测率分别为18%和3% （P < 0.01）。甲状腺部分切除术组TSH升高的发生率明显高于对照组（9% vs. 4%, P < 0.01）。结论：孕期甲状腺筛查仍不理想。甲状腺部分切除术后的妊娠接受更频繁的监测，提示对其高危状态的认识。调查结果强调需要更好地实施基于风险的监测。
{"title":"Thyroid Function Testing During Pregnancy After Partial Thyroidectomy Versus the General Population: A Nationwide Retrospective Cohort","authors":"Raviv Allon MD , Dor Atias MD , Nofar Ben-Basat MD , Guy Melamed BSc , Yaki Saciuk MPH , Tal Patalon MD","doi":"10.1016/j.eprac.2025.10.003","DOIUrl":"10.1016/j.eprac.2025.10.003","url":null,"abstract":"<div><h3>Objective</h3><div>Thyroid function screening during pregnancy remains controversial, particularly regarding whether it should be universal or limited to high-risk groups. In addition, there is variability in the degree of surveillance, and recent American Thyroid Association guidelines suggest that risk groups should be followed throughout pregnancy. This study compares thyroid function surveillance between pregnant women following partial thyroidectomy and the general pregnant population.</div></div><div><h3>Methods</h3><div>In this national retrospective matched cohort study, data from the Maccabi Healthcare Services database were analyzed for pregnancies from 2002 to 2023 in women aged ≥18 years. The exposure group included pregnancies in women with a history of partial thyroidectomy, and the nonexposure group had no thyroidectomy. The primary outcome was the frequency of serum thyroid-stimulating hormone (TSH) measurements during pregnancy. The secondary outcome was the incidence of gestational hypothyroidism, defined as elevated TSH or initiation of levothyroxine during pregnancy.</div></div><div><h3>Results</h3><div>A total of 718 pregnancies in 465 partial thyroidectomy women and 929 022 pregnancies in 398 472 women in the general population were included. TSH was measured in 81% of pregnancies in the partial thyroidectomy group versus 62% in the general population (<em>P</em> < .01). Testing across all 3 trimesters was 18% compared to 3% (<em>P</em> < .01). The prevalence of elevated TSH was significantly higher in the partial thyroidectomy group (9% vs 4%, <em>P</em> < .01).</div></div><div><h3>Conclusion</h3><div>Thyroid screening during pregnancy remains suboptimal. Pregnancies following partial thyroidectomy receive more frequent monitoring, suggesting recognition of their high-risk status. Findings highlight the need for better implementation of risk-based surveillance.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 2","pages":"Pages 157-163"},"PeriodicalIF":4.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145307254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.eprac.2025.12.014
Malini Gupta MD, ECNU, FACE , Kaniksha Desai MD, ECNU, FACE , Rokshana Thanadar MD, FACE , Anupam Kotwal MD, FACE , Ana-Maria Chindris MD, ECNU
At the 34th meeting of the American Association of Clinical Endocrinology, held on May 15–17 2025 in Orlando, Florida, the “Thyroid Year in Review,” presented by Dr. Malini Gupta, summarized fourteen carefully selected peer-reviewed articles published between May 2024 and March 2025 relevant for the practicing endocrinologist. These articles were chosen for addressing unanswered questions or highlighting new directions that shape the field of thyroidology, acknowledging that many other outstanding studies have also advanced the discipline. While the Thyroid Year-in-Review was presented by a single thyroid expert who selected the most impactful papers of the year, this summary was further reviewed by the AACE Thyroid disease state network (DSN), a group of endocrinologists from both academic and private practice settings, to provide complementary clinical perspectives with their insights, highlighting the importance of the papers and how the key findings and interpretations apply to everyday endocrine practice. The publications of interest cover topics including thyroid nodules and cancer, autoimmune thyroid dysfunction, thyroid disease in pregnancy, the interplay between sleep and thyroid function, aging and thyroid physiology, and the rapidly expanding role of artificial intelligence in thyroidology and are summarized in Table 1.
{"title":"Thyroid: Year-in-Review 2024-2025","authors":"Malini Gupta MD, ECNU, FACE , Kaniksha Desai MD, ECNU, FACE , Rokshana Thanadar MD, FACE , Anupam Kotwal MD, FACE , Ana-Maria Chindris MD, ECNU","doi":"10.1016/j.eprac.2025.12.014","DOIUrl":"10.1016/j.eprac.2025.12.014","url":null,"abstract":"<div><div>At the 34th meeting of the American Association of Clinical Endocrinology, held on May 15–17 2025 in Orlando, Florida, the “Thyroid Year in Review,” presented by Dr. Malini Gupta, summarized fourteen carefully selected peer-reviewed articles published between May 2024 and March 2025 relevant for the practicing endocrinologist. These articles were chosen for addressing unanswered questions or highlighting new directions that shape the field of thyroidology, acknowledging that many other outstanding studies have also advanced the discipline. While the Thyroid Year-in-Review was presented by a single thyroid expert who selected the most impactful papers of the year, this summary was further reviewed by the AACE Thyroid disease state network (DSN), a group of endocrinologists from both academic and private practice settings, to provide complementary clinical perspectives with their insights, highlighting the importance of the papers and how the key findings and interpretations apply to everyday endocrine practice. The publications of interest cover topics including thyroid nodules and cancer, autoimmune thyroid dysfunction, thyroid disease in pregnancy, the interplay between sleep and thyroid function, aging and thyroid physiology, and the rapidly expanding role of artificial intelligence in thyroidology and are summarized in Table 1.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 2","pages":"Pages 280-285"},"PeriodicalIF":4.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145849150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.eprac.2026.01.001
{"title":"Retraction notice to: Retatrutide and Ketoacidosis: Previously Unreported Adverse Effect of the New Triple Agent","authors":"","doi":"10.1016/j.eprac.2026.01.001","DOIUrl":"10.1016/j.eprac.2026.01.001","url":null,"abstract":"","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 2","pages":"Page 301"},"PeriodicalIF":4.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146147278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.eprac.2025.09.197
Lorenzo Scappaticcio MD, PhD , Nicole Di Martino PhD , Rita Matrone MD , Pamela Ferrazzano , Michela Di Nuzzo MD , Alessandra Volatile MD , Giovanni Cozzolino MD , Carla Carbone MD , Miriam Longo MD, PhD , Maria Ida Maiorino MD, PhD , Giovanni Docimo MD, PhD , Pierpaolo Trimboli MD, PhD , Giuseppe Bellastella MD, PhD , Katherine Esposito MD, PhD
Objective
We aimed to evaluate thyroid-related and generic health-related quality of life (HRQoL), using the Thyroid-related Patient-Reported Outcome (ThyPRO)-39 and the Short Form Health Survey (SF)-36, before and 6 and 12 months after ethanol ablation (EA) for cystic thyroid nodules (CTNs), respectively.
Methods
We conducted a prospective cohort study on consecutive patients treated with EA for cytologically benign and symptomatic CTNs at our university hospital over a period of 4 years. Patients were included if they had the ability to complete self-administered questionnaires in Italian and they had 1-year follow-up.
Results
We included 104 nodules (median volume, 15.6 [7.0-32.0] mL) from 104 patients. Six and 12 months after treatment, ThyPRO-39 scores had largely (ie, effect size >0.5) and significantly (P value adjusted <.001) improved across all scales compared with baseline. Six and 12 months after treatment, SF-36 scores had largely and significantly (P value adjusted <.001) improved across all scales. Nodule size, but no sex, age, or body mass index, positively and significantly influenced (worsening) the general quality of life item of ThyPRO-39 at baseline and at 6-month and 12-month follow-ups.
Conclusion
EA of symptomatic and benign CTNs is associated with a great improvement of HRQoL scores of ThyPRO-39 and SF-36 at 6-month and 12-month follow-ups. Both physical and mental domains of HRQoL are positively affected by EA of CTNs. Risk factors for remaining HRQoL deficits 1 year after EA need further exploration.
{"title":"Quality of Life After Ethanol Ablation of Thyroid Nodules: A 1-Year Follow-Up Study","authors":"Lorenzo Scappaticcio MD, PhD , Nicole Di Martino PhD , Rita Matrone MD , Pamela Ferrazzano , Michela Di Nuzzo MD , Alessandra Volatile MD , Giovanni Cozzolino MD , Carla Carbone MD , Miriam Longo MD, PhD , Maria Ida Maiorino MD, PhD , Giovanni Docimo MD, PhD , Pierpaolo Trimboli MD, PhD , Giuseppe Bellastella MD, PhD , Katherine Esposito MD, PhD","doi":"10.1016/j.eprac.2025.09.197","DOIUrl":"10.1016/j.eprac.2025.09.197","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to evaluate thyroid-related and generic health-related quality of life (HRQoL), using the Thyroid-related Patient-Reported Outcome (ThyPRO)-39 and the Short Form Health Survey (SF)-36, before and 6 and 12 months after ethanol ablation (EA) for cystic thyroid nodules (CTNs), respectively.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study on consecutive patients treated with EA for cytologically benign and symptomatic CTNs at our university hospital over a period of 4 years. Patients were included if they had the ability to complete self-administered questionnaires in Italian and they had 1-year follow-up.</div></div><div><h3>Results</h3><div>We included 104 nodules (median volume, 15.6 [7.0-32.0] mL) from 104 patients. Six and 12 months after treatment, ThyPRO-39 scores had largely (ie, effect size >0.5) and significantly (<em>P</em> value adjusted <.001) improved across all scales compared with baseline. Six and 12 months after treatment, SF-36 scores had largely and significantly (<em>P</em> value adjusted <.001) improved across all scales. Nodule size, but no sex, age, or body mass index, positively and significantly influenced (worsening) the general quality of life item of ThyPRO-39 at baseline and at 6-month and 12-month follow-ups.</div></div><div><h3>Conclusion</h3><div>EA of symptomatic and benign CTNs is associated with a great improvement of HRQoL scores of ThyPRO-39 and SF-36 at 6-month and 12-month follow-ups. Both physical and mental domains of HRQoL are positively affected by EA of CTNs. Risk factors for remaining HRQoL deficits 1 year after EA need further exploration.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 2","pages":"Pages 149-156"},"PeriodicalIF":4.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.eprac.2025.10.002
Wen-Xiu Xu MS , Ji-Hong Duan MS , Fan Wu MS
Objective
Primary aldosteronism (PA) is a clinical syndrome caused by endocrine disorders. This study developed a risk prediction nomogram model for patients with PA based on least absolute shrinkage and selection operator (LASSO)-logistic regression and evaluated the predictive performance of this nomogram model.
Methods
A total of 325 patients who underwent etiological screening for hypertension at our hospital after referral from primary hospitals or outpatient consultation from January 2024 to March 2025 were included, including 212 with PA and 113 with essential hypertension. The LASSO regression model was used to screen variables, and multivariate logistic regression analysis was performed to identify independent risk factors for PA, with a corresponding nomogram model constructed. The discriminative ability of the model was evaluated using receiver operating characteristic curves, while the calibration of the model was assessed via the Hosmer-Lemeshow goodness-of-fit test and calibration curves.
Results
The LASSO regression identified a total of 14 potential risk factors, including age, smoking, family history of hypertension, coronary heart disease, obstructive sleep apnea hypopnea syndrome (OSAHS), etc. Logistic regression analysis revealed that OSAHS (odds ratio [OR] = 4.006, 95% CI = 1.366-11.749, P = .011), potassium (OR = 0.253, 95% CI = 0.068-0.940, P = .040), aldosterone (upright) (OR = 1.282, 95% CI = 1.147-1.433, P < .001), and renin (upright) (OR = 0.735, 95% CI = 0.668-0.808, P < .001) were independent risk factors for PA (P < .05). A nomogram model was constructed based on the above results. The area under the curve values of the training and validation sets were 0.976 (95% CI = 0.958-0.995) and 0.924 (95% CI = 0.859-0.990), respectively. The calibration curves of both sets were close to the ideal curves. For both sets, the Hosmer-Lemeshow test showed P > .05, indicating good clinical utility.
Conclusion
We identified 4 independent risk factors for PA using LASSO-logistic regression, including OSAHS, serum potassium, aldosterone (upright), and renin (upright). Furthermore, the nomogram model constructed in this study demonstrates good clinical utility for the early diagnosis of PA patients.
{"title":"Establishment and Validation of a Nomogram for Primary Aldosteronism Patients: Using the Least Absolute Shrinkage and Selection Operator (LASSO)-Logistic Regression Model","authors":"Wen-Xiu Xu MS , Ji-Hong Duan MS , Fan Wu MS","doi":"10.1016/j.eprac.2025.10.002","DOIUrl":"10.1016/j.eprac.2025.10.002","url":null,"abstract":"<div><h3>Objective</h3><div>Primary aldosteronism (PA) is a clinical syndrome caused by endocrine disorders. This study developed a risk prediction nomogram model for patients with PA based on least absolute shrinkage and selection operator (LASSO)-logistic regression and evaluated the predictive performance of this nomogram model.</div></div><div><h3>Methods</h3><div>A total of 325 patients who underwent etiological screening for hypertension at our hospital after referral from primary hospitals or outpatient consultation from January 2024 to March 2025 were included, including 212 with PA and 113 with essential hypertension. The LASSO regression model was used to screen variables, and multivariate logistic regression analysis was performed to identify independent risk factors for PA, with a corresponding nomogram model constructed. The discriminative ability of the model was evaluated using receiver operating characteristic curves, while the calibration of the model was assessed via the Hosmer-Lemeshow goodness-of-fit test and calibration curves.</div></div><div><h3>Results</h3><div>The LASSO regression identified a total of 14 potential risk factors, including age, smoking, family history of hypertension, coronary heart disease, obstructive sleep apnea hypopnea syndrome (OSAHS), etc. Logistic regression analysis revealed that OSAHS (odds ratio [OR] = 4.006, 95% CI = 1.366-11.749, <em>P</em> = .011), potassium (OR = 0.253, 95% CI = 0.068-0.940, <em>P</em> = .040), aldosterone (upright) (OR = 1.282, 95% CI = 1.147-1.433, <em>P</em> < .001), and renin (upright) (OR = 0.735, 95% CI = 0.668-0.808, <em>P</em> < .001) were independent risk factors for PA (<em>P</em> < .05). A nomogram model was constructed based on the above results. The area under the curve values of the training and validation sets were 0.976 (95% CI = 0.958-0.995) and 0.924 (95% CI = 0.859-0.990), respectively. The calibration curves of both sets were close to the ideal curves. For both sets, the Hosmer-Lemeshow test showed <em>P</em> > .05, indicating good clinical utility.</div></div><div><h3>Conclusion</h3><div>We identified 4 independent risk factors for PA using LASSO-logistic regression, including OSAHS, serum potassium, aldosterone (upright), and renin (upright). Furthermore, the nomogram model constructed in this study demonstrates good clinical utility for the early diagnosis of PA patients.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 2","pages":"Pages 218-226"},"PeriodicalIF":4.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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