Pub Date : 2025-01-10DOI: 10.1016/j.eprac.2025.01.001
Jorge Ramires Terrazas, Clarissa Robalinho Penna Marins, Maria Elvira Pizzigatti Correa, Lígia Vera Montali da Assumpção, Denise Engelbrecht Zantut-Wittmann
Objective: To evaluate the characteristics related to oral health and salivary production in patients with differentiated thyroid carcinoma (DTC) after radioiodine therapy (RIT).
Methods: Cross-sectional study, which included patients with DTC after ablative and/or adjuvant RIT. Patients underwent assessment of oral health conditions, subjective assessment of xerostomia, and measurement of salivary flow. Salivary glands were assessed by cervical ultrasound at the time of clinical evaluation.
Results: Sixty-seven DTC patients were included. Oral health was found very good or good in 60% of patients, 84% had no dental plaque or a slight amount, and 53% had normal-looking gums. There was a negative correlation between the salivary flow with activity of RIT ablative, number of RITs received, and total activity of radioiodine administered until oral assessment. Reduction in parotid gland volume on ultrasound was associated with greater number of times receiving RIT, longer time between RIT and patient assessment, greater 131I activity administered.
Conclusion: Good or very good oral health was observed in 60% of patients with DTC after RIT, 15% reported hyposalivation, and 13%, frequent xerostomia. Higher number and higher total activity of radioiodine administered, as well as reduction in the volume and heterogeneous texture of parotid gland on ultrasound were predictive factors of lower salivary flow.
{"title":"Influence of Radioiodine Therapy on Oral Health and Salivary Production in Patients With Differentiated Thyroid Carcinoma.","authors":"Jorge Ramires Terrazas, Clarissa Robalinho Penna Marins, Maria Elvira Pizzigatti Correa, Lígia Vera Montali da Assumpção, Denise Engelbrecht Zantut-Wittmann","doi":"10.1016/j.eprac.2025.01.001","DOIUrl":"10.1016/j.eprac.2025.01.001","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the characteristics related to oral health and salivary production in patients with differentiated thyroid carcinoma (DTC) after radioiodine therapy (RIT).</p><p><strong>Methods: </strong>Cross-sectional study, which included patients with DTC after ablative and/or adjuvant RIT. Patients underwent assessment of oral health conditions, subjective assessment of xerostomia, and measurement of salivary flow. Salivary glands were assessed by cervical ultrasound at the time of clinical evaluation.</p><p><strong>Results: </strong>Sixty-seven DTC patients were included. Oral health was found very good or good in 60% of patients, 84% had no dental plaque or a slight amount, and 53% had normal-looking gums. There was a negative correlation between the salivary flow with activity of RIT ablative, number of RITs received, and total activity of radioiodine administered until oral assessment. Reduction in parotid gland volume on ultrasound was associated with greater number of times receiving RIT, longer time between RIT and patient assessment, greater 131I activity administered.</p><p><strong>Conclusion: </strong>Good or very good oral health was observed in 60% of patients with DTC after RIT, 15% reported hyposalivation, and 13%, frequent xerostomia. Higher number and higher total activity of radioiodine administered, as well as reduction in the volume and heterogeneous texture of parotid gland on ultrasound were predictive factors of lower salivary flow.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970028","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 : 2025-01-03DOI: 10.1016/j.eprac.2024.12.020
Kosma Woliński, Paweł Komarnicki, Adam Maciejewski, Jan Musiałkiewicz, Paweł Gut, Marek Ruchała
Objective: Neuroendocrine tumors (NETs) constitute a diverse group of tumors. NETs are often diagnosed late, due to nonspecific symptoms. Second Primary Malignancies (SPMs) have been reported in up to 25% of NETs and their incidence has been described as negative predictor of overall survival. We aimed to assess the prevalence of SPMs in patients with NETs treated at a specialized center.
Methods: We conducted a retrospective analysis of patients with metastatic well-differentiated gastro-entero-pancreatic neuroendocrine tumors and lung carcinoids treated with Somatostatin Analogs between 2017 and 2019. Control group patients with hormonally inactive pituitary lesions and microprolactinomas hospitalized between 2016 and 2019 were included.
Results: One hundred thirty-five patients (85 women, 50 men) with NETs were enrolled. SPMs were more common in NETs compared to control group (P = .029). Twenty-six SPMs were diagnosed in 24 patients (17.8%). The control group comprised 94 patients, among whom 7 patients (7.7%) developed SPMs. Mean (standard deviation) age at the end of follow-up was 64.8 (10.2) years, with duration from NETs diagnosis to the end of follow-up of 5.3 (3.8) years.
Conclusion: The risk of SPMs is high in NETs, with multiple neoplasms diagnosed in over one sixth of patients. Active surveillance for SPMs is strongly indicated and should be integral to the follow-up of NETs.
{"title":"Prevalence of Second Primary Malignancies in Patients With Well-Differentiated Neuroendocrine Tumors.","authors":"Kosma Woliński, Paweł Komarnicki, Adam Maciejewski, Jan Musiałkiewicz, Paweł Gut, Marek Ruchała","doi":"10.1016/j.eprac.2024.12.020","DOIUrl":"10.1016/j.eprac.2024.12.020","url":null,"abstract":"<p><strong>Objective: </strong>Neuroendocrine tumors (NETs) constitute a diverse group of tumors. NETs are often diagnosed late, due to nonspecific symptoms. Second Primary Malignancies (SPMs) have been reported in up to 25% of NETs and their incidence has been described as negative predictor of overall survival. We aimed to assess the prevalence of SPMs in patients with NETs treated at a specialized center.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients with metastatic well-differentiated gastro-entero-pancreatic neuroendocrine tumors and lung carcinoids treated with Somatostatin Analogs between 2017 and 2019. Control group patients with hormonally inactive pituitary lesions and microprolactinomas hospitalized between 2016 and 2019 were included.</p><p><strong>Results: </strong>One hundred thirty-five patients (85 women, 50 men) with NETs were enrolled. SPMs were more common in NETs compared to control group (P = .029). Twenty-six SPMs were diagnosed in 24 patients (17.8%). The control group comprised 94 patients, among whom 7 patients (7.7%) developed SPMs. Mean (standard deviation) age at the end of follow-up was 64.8 (10.2) years, with duration from NETs diagnosis to the end of follow-up of 5.3 (3.8) years.</p><p><strong>Conclusion: </strong>The risk of SPMs is high in NETs, with multiple neoplasms diagnosed in over one sixth of patients. Active surveillance for SPMs is strongly indicated and should be integral to the follow-up of NETs.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930911","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 : 2025-01-01DOI: 10.1016/j.eprac.2024.10.005
Lingqiong Meng MD, PhD , Sue A. Shapses PhD , Xiangbing Wang MD, PhD
Objective
Primary hyperparathyroidism (PHPT) is accompanied by a decreased 25-hydroxyvitamin D (25OHD) and vitamin D binding protein (DBP). High parathyroid hormone (PTH) is associated with elevated interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1), yet the effect of parathyroidectomy (PTX) on DBP and cytokines is not clear. This study aims to prospectively evaluate the effect of PTX on inflammatory profiles, total and free 25OHD, and DBP in patients with PHPT.
Methods
Newly diagnosed patients with PHPT were recruited for the study (n = 70). Twenty-eight patients returned after PTX, 3 months later. Biochemical markers were measured before and after PTX. A group of age and body mass index-matched healthy subjects were included as controls (n = 70).
Results
Before PTX, patients had lower serum DBP (37.5 ± 6.0 vs 41.5 ± 6.1 mg/dL, P < .001) and total 25OHD (30.1 ± 9.5 vs 33.3 ± 7.9 ng/mL, P < .05) but similar free 25OHD when compared to controls. Serum IL-6, C-reactive protein, and MCP-1 were higher in patients with PHPT (P < .05), whereas interleukin-10 was similar to that in controls. PTX increased total and free 25OHD and DBP (P < .001) and decreased serum IL-6 and MCP-1 (P < .05), but not C-reactive protein and interleukin-10. Multiple regression analysis indicated that the preoperative PTH explained a significant portion of the variance of IL-6 and MCP-1 (P < .05).
Conclusion
These findings suggest that PTH may upregulate the production of MCP-1 and IL-6 and downregulate circulating DBP in patients with PHPT that are normalized by PTX. The exact mechanism of IL-6 and MCP-1 on DBP, vitamin D metabolites, and clinical outcomes in patients with PHPT is an area requiring further study.
{"title":"Parathyroidectomy Reduces Inflammatory Cytokines and Increases Vitamin D Metabolites in Patients With Primary Hyperparathyroidism","authors":"Lingqiong Meng MD, PhD , Sue A. Shapses PhD , Xiangbing Wang MD, PhD","doi":"10.1016/j.eprac.2024.10.005","DOIUrl":"10.1016/j.eprac.2024.10.005","url":null,"abstract":"<div><h3>Objective</h3><div>Primary hyperparathyroidism (PHPT) is accompanied by a decreased 25-hydroxyvitamin D (25OHD) and vitamin D binding protein (DBP). High parathyroid hormone (PTH) is associated with elevated interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1), yet the effect of parathyroidectomy (PTX) on DBP and cytokines is not clear. This study aims to prospectively evaluate the effect of PTX on inflammatory profiles, total and free 25OHD, and DBP in patients with PHPT.</div></div><div><h3>Methods</h3><div>Newly diagnosed patients with PHPT were recruited for the study (<em>n</em> = 70). Twenty-eight patients returned after PTX, 3 months later. Biochemical markers were measured before and after PTX. A group of age and body mass index-matched healthy subjects were included as controls (<em>n</em> = 70).</div></div><div><h3>Results</h3><div>Before PTX, patients had lower serum DBP (37.5 ± 6.0 vs 41.5 ± 6.1 mg/dL, <em>P</em> < .001) and total 25OHD (30.1 ± 9.5 vs 33.3 ± 7.9 ng/mL, <em>P</em> < .05) but similar free 25OHD when compared to controls. Serum IL-6, C-reactive protein, and MCP-1 were higher in patients with PHPT (<em>P</em> < .05), whereas interleukin-10 was similar to that in controls. PTX increased total and free 25OHD and DBP (<em>P</em> < .001) and decreased serum IL-6 and MCP-1 (<em>P</em> < .05), but not C-reactive protein and interleukin-10. Multiple regression analysis indicated that the preoperative PTH explained a significant portion of the variance of IL-6 and MCP-1 (<em>P</em> < .05).</div></div><div><h3>Conclusion</h3><div>These findings suggest that PTH may upregulate the production of MCP-1 and IL-6 and downregulate circulating DBP in patients with PHPT that are normalized by PTX. The exact mechanism of IL-6 and MCP-1 on DBP, vitamin D metabolites, and clinical outcomes in patients with PHPT is an area requiring further study.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 1","pages":"Pages 52-58"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460847","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 : 2025-01-01DOI: 10.1016/j.eprac.2024.10.007
Huda Al-Bahadili MD , Jennifer Powers Carson PhD , Alexander Markov MD , Sina Jasim MD, MPH
Objective
Thyroid disorders are common. Serum thyroid stimulating hormone is frequently measured and is the single best initial biomarker to diagnose thyroid disease. Automated immunoassays used to evaluate thyroid function are susceptible to interferences that can affect test results and therefore clinical decisions. In this comprehensive review, our aim is to discuss common assay and drug interferences leading to abnormal thyroid function tests.
Methods
Authors conducted a literature review of PubMed to include studies on drug related and laboratory assay interferences leading to primary and secondary thyroid dysfunction in addition to interferences with thyroid hormone replacement and thyroid function tests.
Results
Overall, there are several assay interferences as well as drug interferences leading to primary thyroid dysfunction including iodine-containing drugs such as amiodarone, lithium, immune checkpoint inhibitors and tyrosine kinase inhibitors, drug interferences leading to secondary thyroid dysfunction such as glucocorticoids, and drug interferences affecting thyroid hormone absorption, metabolism, and thyroid binding globulin levels. In addition, assay interferences from biotin, heterophile antibodies, macro-thyrotropin or anti-streptavidin antibodies may occur without underlying thyroid dysfunction, leading to abnormal thyroid function tests.
Conclusion
For appropriate patient management, it is imperative to identify assay interferences when discrepancies between clinical presentation and thyroid function test results are noted.
{"title":"The Complex Web of Interferences With Thyroid Function Tests","authors":"Huda Al-Bahadili MD , Jennifer Powers Carson PhD , Alexander Markov MD , Sina Jasim MD, MPH","doi":"10.1016/j.eprac.2024.10.007","DOIUrl":"10.1016/j.eprac.2024.10.007","url":null,"abstract":"<div><h3>Objective</h3><div>Thyroid disorders are common. Serum thyroid stimulating hormone is frequently measured and is the single best initial biomarker to diagnose thyroid disease. Automated immunoassays used to evaluate thyroid function are susceptible to interferences that can affect test results and therefore clinical decisions. In this comprehensive review, our aim is to discuss common assay and drug interferences leading to abnormal thyroid function tests.</div></div><div><h3>Methods</h3><div>Authors conducted a literature review of PubMed to include studies on drug related and laboratory assay interferences leading to primary and secondary thyroid dysfunction in addition to interferences with thyroid hormone replacement and thyroid function tests.</div></div><div><h3>Results</h3><div>Overall, there are several assay interferences as well as drug interferences leading to primary thyroid dysfunction including iodine-containing drugs such as amiodarone, lithium, immune checkpoint inhibitors and tyrosine kinase inhibitors, drug interferences leading to secondary thyroid dysfunction such as glucocorticoids, and drug interferences affecting thyroid hormone absorption, metabolism, and thyroid binding globulin levels. In addition, assay interferences from biotin, heterophile antibodies, macro-thyrotropin or anti-streptavidin antibodies may occur without underlying thyroid dysfunction, leading to abnormal thyroid function tests.</div></div><div><h3>Conclusion</h3><div>For appropriate patient management, it is imperative to identify assay interferences when discrepancies between clinical presentation and thyroid function test results are noted.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 1","pages":"Pages 92-101"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544449","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 : 2025-01-01DOI: 10.1016/j.eprac.2024.09.004
Areeba Fareed MBBS , Laura Ghanem MBBS , Rayyan Vaid MBBS , Zoha Iftikhar MBBS , Adeel Ur Rehman MBBS , Ayesha Sarwar MBBS , Muhammad Iqbal Asif MBBS
Background
Obesity, a pervasive global health challenge affecting more than 2 billion people, requires comprehensive interventions. Traditional approaches, including lifestyle modification, and diverse drugs targeting a gastrointestinal hormone, including glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 (Liraglutide, Semaglutide, Exenatide, Albiglutide, Dulaglutide, Lixisenatide, Orlistat, Phentermine/Topiramate, Lorcaserin, Sibutramine, and Rimonabant) offer tailored strategies; yet their effectiveness is limited and some drugs were taken off the market. Moreover, various surgical modalities, such as Roux-en-Y Bypass surgery, sleeve gastrectomy, intragastric balloons, biliopancreatic diversion with duodenal switch, laparoscopic adjustable gastric band, and vagal nerve blockade can be considered but are associated with numerous side effects and require careful monitoring. Consequently, there is a pressing need for novel anti-obesity treatments.
Methods
This comprehensive review was based on the available data to discuss the traditional pharmaceutical and surgical therapeutical strategies for obesity, going further to discuss tirzepatide's mode of action, its outcomes for obesity, and the associated side effects.
Results
In this landscape, tirzepatide, initially designed for type 2 diabetes management, emerges as a potential game-changer. Functioning as a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, it not only addresses control but also introduces a fresh perspective on weight reduction. This review intricately explores tirzepatide's mechanism, dissecting insights from clinical studies and positioning it as a major force in obesity treatment.
Conclusions
In the middle of significant shifts in obesity management, tirzepatide presents itself as a promising and cost-effective intervention. Its Food and Drug Administration approval marks a milestone in the realm of obesity therapeutics. Going beyond a recapitulation of findings, the conclusion emphasizes the imperative for ongoing exploration and vigilant safety monitoring in tirzepatide's application.
{"title":"Charting New Territories in Obesity Management- Traditional Techniques to Tirzepatide","authors":"Areeba Fareed MBBS , Laura Ghanem MBBS , Rayyan Vaid MBBS , Zoha Iftikhar MBBS , Adeel Ur Rehman MBBS , Ayesha Sarwar MBBS , Muhammad Iqbal Asif MBBS","doi":"10.1016/j.eprac.2024.09.004","DOIUrl":"10.1016/j.eprac.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Obesity, a pervasive global health challenge affecting more than 2 billion people, requires comprehensive interventions. Traditional approaches, including lifestyle modification, and diverse drugs targeting a gastrointestinal hormone, including glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 (Liraglutide, Semaglutide, Exenatide, Albiglutide, Dulaglutide, Lixisenatide, Orlistat, Phentermine/Topiramate, Lorcaserin, Sibutramine, and Rimonabant) offer tailored strategies; yet their effectiveness is limited and some drugs were taken off the market. Moreover, various surgical modalities, such as Roux-en-Y Bypass surgery, sleeve gastrectomy, intragastric balloons, biliopancreatic diversion with duodenal switch, laparoscopic adjustable gastric band, and vagal nerve blockade can be considered but are associated with numerous side effects and require careful monitoring. Consequently, there is a pressing need for novel anti-obesity treatments.</div></div><div><h3>Methods</h3><div>This comprehensive review was based on the available data to discuss the traditional pharmaceutical and surgical therapeutical strategies for obesity, going further to discuss tirzepatide's mode of action, its outcomes for obesity, and the associated side effects.</div></div><div><h3>Results</h3><div>In this landscape, tirzepatide, initially designed for type 2 diabetes management, emerges as a potential game-changer. Functioning as a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, it not only addresses control but also introduces a fresh perspective on weight reduction. This review intricately explores tirzepatide's mechanism, dissecting insights from clinical studies and positioning it as a major force in obesity treatment.</div></div><div><h3>Conclusions</h3><div>In the middle of significant shifts in obesity management, tirzepatide presents itself as a promising and cost-effective intervention. Its Food and Drug Administration approval marks a milestone in the realm of obesity therapeutics. Going beyond a recapitulation of findings, the conclusion emphasizes the imperative for ongoing exploration and vigilant safety monitoring in tirzepatide's application.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 1","pages":"Pages 102-113"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282249","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 : 2025-01-01DOI: 10.1016/j.eprac.2024.09.015
Thaer Idrees MD , Ammar A. Rashied MS , Brian Kim MD
Objective
Fine needle aspiration (FNA) of thyroid nodules is the gold standard screening test for thyroid malignancy. Unfortunately, FNA may produce insufficient material for diagnosis. If nodules requiring FNA with a higher risk for nondiagnostic (ND) cytology could be identified pre-procedure, this might allow better patient guidance and potentially facilitate an altered approach to FNA.
Methods
The literature investigating risk factors for ND cytology was reviewed, including studies of patient factors, sonographic or nodule factors, and procedural factors. Twenty-five studies that included assessment of at least two potential factors in ND outcomes for initial FNA were identified. Individual factors were evaluated in terms of the general consensus of studies reporting either a positive significant association with ND cytology or no association.
Results
Most patient and nodule factors lack consensus as far as their association with ND cytology across these studies. Factors where there are some consensuses include practitioner experience, depth of nodule, and cystic content; however, hypervascularity of the nodule does not appear to have a consensus.
Conclusion
A number of study design improvements suggested by this review could realistically be incorporated into higher powered future studies. Novel factors such as tissue composition anterior to the nodule or the age of the patient could also be investigated in future work. Operator experience is the most convincing procedural factor, and approaches to future studies of the FNA technique itself are proposed. That said, the factors with consensus among studies can be seen leading candidates for this future research, and the published studies illuminate a number of as yet unexplored factors that could in many cases be studied retrospectively.
{"title":"Nondiagnostic Fine Needle Aspiration of Thyroid Nodules: Review of Predisposing Factors","authors":"Thaer Idrees MD , Ammar A. Rashied MS , Brian Kim MD","doi":"10.1016/j.eprac.2024.09.015","DOIUrl":"10.1016/j.eprac.2024.09.015","url":null,"abstract":"<div><h3>Objective</h3><div>Fine needle aspiration (FNA) of thyroid nodules is the gold standard screening test for thyroid malignancy. Unfortunately, FNA may produce insufficient material for diagnosis. If nodules requiring FNA with a higher risk for nondiagnostic (ND) cytology could be identified pre-procedure, this might allow better patient guidance and potentially facilitate an altered approach to FNA.</div></div><div><h3>Methods</h3><div>The literature investigating risk factors for ND cytology was reviewed, including studies of patient factors, sonographic or nodule factors, and procedural factors. Twenty-five studies that included assessment of at least two potential factors in ND outcomes for initial FNA were identified. Individual factors were evaluated in terms of the general consensus of studies reporting either a positive significant association with ND cytology or no association.</div></div><div><h3>Results</h3><div>Most patient and nodule factors lack consensus as far as their association with ND cytology across these studies. Factors where there are some consensuses include practitioner experience, depth of nodule, and cystic content; however, hypervascularity of the nodule does not appear to have a consensus.</div></div><div><h3>Conclusion</h3><div>A number of study design improvements suggested by this review could realistically be incorporated into higher powered future studies. Novel factors such as tissue composition anterior to the nodule or the age of the patient could also be investigated in future work. Operator experience is the most convincing procedural factor, and approaches to future studies of the FNA technique itself are proposed. That said, the factors with consensus among studies can be seen leading candidates for this future research, and the published studies illuminate a number of as yet unexplored factors that could in many cases be studied retrospectively.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 1","pages":"Pages 85-91"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343892","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 : 2025-01-01DOI: 10.1016/j.eprac.2024.10.004
Nikolaos Angelopoulos MD, PhD , Dimitrios G. Goulis MD, PhD , Ioannis Chrisogonidis MD, PhD , Sarantis Livadas MD, PhD , Rodis Paparodis MD , Ioannis Androulakis MD, PhD , Ioannis Iakovou MD, PhD
Objective
The challenge of selecting thyroid nodules for fine needle aspiration (FNA) cytology has led to the development of the Thyroid Imaging Reporting and Data System, primarily in 2 formats: European Thyroid Imaging Reporting and Data System (EU-TIRADS) and American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS). Clinical observations suggest imperfect risk assessment for TIRADS 3 nodules ≥20 mm. This study aimed to evaluate the efficacy of TIRADS systems in distinguishing benign from malignant nodules in this subgroup.
Methods
From May 2023 to March 2024, 1094 patients with thyroid nodules were referred for ultrasound at a University Hospital. Data on clinical, ultrasound, cytological, and histopathological parameters were collected. Nodules ≥20 mm were categorized by EU-TIRADS and ACR-TIRADS, and their predictive performance for malignancy was assessed through postthyroidectomy histopathology or FNA cytology (Bethesda classification).
Results
Two hundred sixty-seven patients (mean age 60.3 ± 14.3 years; 46 men, 221 women) with 308 nodules were analyzed. Twenty-two malignancies and 286 benign nodules were recorded. Recalculating European Thyroid Imaging Reporting and Data System 3 performance using 25-mm and 30-mm thresholds (ACR-modified EU-TIRADS) avoided 24% and 41% of FNAs, respectively, while ACR-TIRADS would prevent 26.6% (P > .05). Two malignancies were missed.
Conclusion
EU-TIRADS and ACR-TIRADS show similar efficacy when using a 25 mm FNA threshold. Raising the cutoff for FNA in European Thyroid Imaging Reporting and Data System 3 nodules could reduce unnecessary procedures but may increase the risk of missed malignancies, impacting patient outcomes.
{"title":"Diagnostic Performance of European and American College of Radiology Thyroid Imaging Reporting and Data System Classification Systems in Thyroid Nodules Over 20 mm in Diameter","authors":"Nikolaos Angelopoulos MD, PhD , Dimitrios G. Goulis MD, PhD , Ioannis Chrisogonidis MD, PhD , Sarantis Livadas MD, PhD , Rodis Paparodis MD , Ioannis Androulakis MD, PhD , Ioannis Iakovou MD, PhD","doi":"10.1016/j.eprac.2024.10.004","DOIUrl":"10.1016/j.eprac.2024.10.004","url":null,"abstract":"<div><h3>Objective</h3><div>The challenge of selecting thyroid nodules for fine needle aspiration (FNA) cytology has led to the development of the Thyroid Imaging Reporting and Data System, primarily in 2 formats: European Thyroid Imaging Reporting and Data System (EU-TIRADS) and American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS). Clinical observations suggest imperfect risk assessment for TIRADS 3 nodules ≥20 mm. This study aimed to evaluate the efficacy of TIRADS systems in distinguishing benign from malignant nodules in this subgroup.</div></div><div><h3>Methods</h3><div>From May 2023 to March 2024, 1094 patients with thyroid nodules were referred for ultrasound at a University Hospital. Data on clinical, ultrasound, cytological, and histopathological parameters were collected. Nodules ≥20 mm were categorized by EU-TIRADS and ACR-TIRADS, and their predictive performance for malignancy was assessed through postthyroidectomy histopathology or FNA cytology (Bethesda classification).</div></div><div><h3>Results</h3><div>Two hundred sixty-seven patients (mean age 60.3 ± 14.3 years; 46 men, 221 women) with 308 nodules were analyzed. Twenty-two malignancies and 286 benign nodules were recorded. Recalculating European Thyroid Imaging Reporting and Data System 3 performance using 25-mm and 30-mm thresholds (ACR-modified EU-TIRADS) avoided 24% and 41% of FNAs, respectively, while ACR-TIRADS would prevent 26.6% (<em>P</em> > .05). Two malignancies were missed.</div></div><div><h3>Conclusion</h3><div>EU-TIRADS and ACR-TIRADS show similar efficacy when using a 25 mm FNA threshold. Raising the cutoff for FNA in European Thyroid Imaging Reporting and Data System 3 nodules could reduce unnecessary procedures but may increase the risk of missed malignancies, impacting patient outcomes.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 1","pages":"Pages 72-79"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497251","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 : 2025-01-01DOI: 10.1016/j.eprac.2024.09.018
James R. Howe MD , Yusuf Menda MD , Chandrikha Chandrasekharan MBBS , Andrew M. Bellizzi MD , Dawn E. Quelle PhD , M. Sue O’Dorisio MD, PhD , Joseph S. Dillon MB, BCh
The Iowa Neuroendocrine Tumor (NET) Clinic was founded and developed by two remarkable physicians, Thomas and Sue O’Dorisio. Tom was an Endocrinologist and close friend and colleague of Aaron Vinik. Both men were pioneers in studies of gastrointestinal hormones and the management of patients with NETs. Sue was a Pediatric Oncologist and research scientist with great expertise in new drug development and clinical trials. She and Tom were leaders in bringing somatostatin analogs and somatostatin-conjugated radioligands to the clinic for the therapy and diagnosis of NETs. All three physicians received lifetime achievement awards for their contributions to the field of NETs. This is the story of how the Iowa NET Clinic developed over the years to become a model for the multidisciplinary mantagement of patients with NETs, culminating in its designation as a European Neuroendocrine Tumor Society NET Center of Excellence, and the receipt of a Specialized Project of Research Excellence (SPORE) grant for the study of NETs from the National Institutes of Health.
爱荷华州神经内分泌肿瘤（NET）诊所是由两位杰出的医生托马斯-奥多里西奥和苏-奥多里西奥创建和发展起来的。汤姆是内分泌科医生，也是亚伦-维尼克的好友和同事。两人都是研究胃肠激素和治疗 NET 患者的先驱。苏是一名儿科肿瘤学家和研究科学家，在新药开发和临床试验方面拥有丰富的专业知识。她和汤姆是将体生长激素类似物和体生长激素结合放射配体应用于临床治疗和诊断 NET 的领军人物。这三位医生都因其在 NET 领域的贡献获得了终身成就奖。这就是爱荷华州NET诊所多年来如何发展成为多学科治疗NET患者典范的故事，该诊所最终被指定为欧洲神经内分泌肿瘤协会NET卓越中心，并获得了美国国立卫生研究院的NET研究专项卓越研究项目（SPORE）资助。
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Pub Date : 2025-01-01DOI: 10.1016/j.eprac.2024.10.003
Aditi Kumar MBBS , Mona Vahidi Rad MD , Alyssa K. McGary MS , Janna C. Castro BS , Curtiss B. Cook MD
Purpose
Determine the association between clinical and demographic factors and 30-day readmission risk after pituitary surgery.
Methods
Patients undergoing pituitary surgery between January 2018 and December 2022 were retrospectively reviewed. Cases were extracted from a converged electronic health record that included surgeries performed at the Midwest, Southeast, and Southwest campuses of the same healthcare Enterprise. Variables were compared between patients with 30-day readmission following discharge after pituitary surgery (N = 83) and a randomly sampled patient cohort with pituitary surgery but no readmission within 30 days (N = 174).
Results
In a multivariable regression model looking at the relationship between patient characteristics and readmission risk, every increase in the Medicare Severity Diagnosis Related Group score resulted in a nearly 2.3-fold increase in the risk of readmission (OR = 2.335, 95% CI 1.050, 5.562, P = .045). The presence of arginine vasopressin deficiency increased the odds of readmission by more than 2-fold (OR = 2.784, 95% CI 1.118, 7.124, P = .029). The Midwest site was observed to have a nearly 67% decrease in readmission risk compared to the Southwest site (OR = 0.334, 95% CI 0.134, 0.813, P = .016), with the Southeast site being comparable to the Southwest.
Conclusion
Our study identifies postoperative arginine vasopressin deficiency, greater co-morbidities, and geographic location as risk factors for 30-day readmission after pituitary surgery. Further investigation is required to determine how site-specific care processes can be adopted to lower readmission risk at other locations in the same healthcare enterprise.
{"title":"Factors Associated With 30-Day Readmissions After Transsphenoidal Pituitary Surgery","authors":"Aditi Kumar MBBS , Mona Vahidi Rad MD , Alyssa K. McGary MS , Janna C. Castro BS , Curtiss B. Cook MD","doi":"10.1016/j.eprac.2024.10.003","DOIUrl":"10.1016/j.eprac.2024.10.003","url":null,"abstract":"<div><h3>Purpose</h3><div>Determine the association between clinical and demographic factors and 30-day readmission risk after pituitary surgery.</div></div><div><h3>Methods</h3><div>Patients undergoing pituitary surgery between January 2018 and December 2022 were retrospectively reviewed. Cases were extracted from a converged electronic health record that included surgeries performed at the Midwest, Southeast, and Southwest campuses of the same healthcare Enterprise. Variables were compared between patients with 30-day readmission following discharge after pituitary surgery (<em>N</em> = 83) and a randomly sampled patient cohort with pituitary surgery but no readmission within 30 days (<em>N</em> = 174).</div></div><div><h3>Results</h3><div>In a multivariable regression model looking at the relationship between patient characteristics and readmission risk, every increase in the Medicare Severity Diagnosis Related Group score resulted in a nearly 2.3-fold increase in the risk of readmission (OR = 2.335, 95% CI 1.050, 5.562, <em>P</em> = .045). The presence of arginine vasopressin deficiency increased the odds of readmission by more than 2-fold (OR = 2.784, 95% CI 1.118, 7.124, <em>P</em> = .029). The Midwest site was observed to have a nearly 67% decrease in readmission risk compared to the Southwest site (OR = 0.334, 95% CI 0.134, 0.813, <em>P</em> = .016), with the Southeast site being comparable to the Southwest.</div></div><div><h3>Conclusion</h3><div>Our study identifies postoperative arginine vasopressin deficiency, greater co-morbidities, and geographic location as risk factors for 30-day readmission after pituitary surgery. Further investigation is required to determine how site-specific care processes can be adopted to lower readmission risk at other locations in the same healthcare enterprise.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 1","pages":"Pages 28-33"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460845","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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