European Thyroid Journal最新文献

Background: Management of benign nodular thyroid disease (BNTD) has changed dramatically over the past two decades, as reflected by international guideline recommendations.

Purpose: We sought to document the preferences regarding the management of euthyroid BNTD among thyroid-dedicated members of the Spanish Society of Endocrinology and Nutrition (SEEN) and assess the extent to which present international guideline recommendations have been incorporated into ordinary practice.

Methods: An online survey on the management of a standard case of BNTD among SEEN thyroid experts and exploration of variations in management following different clinical scenarios, in which variables such as sex, age, ultrasound characteristics, fine needle aspiration results or patient preferences change.

Results: Two hundred and eleven (9% SEEN members) participated in the survey. Most of them, 147 (69.7%), recommended periodic monitoring, 43 (20.3%) surgery and 21 (10.0%) minimally invasive procedures (MIP). No participant opted for levothyroxine or radioiodine. Management of BNTD was modified based on patient preferences, both in favour of more aggressive (surgery) and more conservative (MIP or monitoring) options.

Conclusions: The vast majority of Spanish thyroidologists followed the international guideline recommendations for BNTD management. The trend shows the positive impact of the guideline recommendations with a shift towards more conservative management, taking into account patient preference as a binding element in therapeutic decision-making.

Primary congenital hypothyroidism (CH) is the most common neonatal endocrine disorder, and may be etiologically subdivided into thyroid dysgenesis, referring to abnormal thyroid development, and dyshormonogenesis, where a defective thyroid hormone biosynthesis pathway results in inadequate hormone production despite a structurally intact gland. Delayed treatment of neonatal hypothyroidism may result in irreversible neurodevelopmental impairment; therefore, where available, CH screening programs facilitate prompt diagnosis. However, the molecular basis for CH remains unclear in most of the cases. This review summarizes current understanding of the genetic etiologies underlying primary CH and associated phenotypes. Classical genetic causes are discussed in the context of their role in normal thyroid physiology. Genes recently reported to play a role in the pathogenesis of CH are discussed, and novel genomic mechanisms in CH are described.

Metastatic differentiated thyroid cancer (DTC) is responsible for most thyroid cancer-related deaths, with an even worse prognosis for patients with radioactive iodine (RAI)-refractory DTC (RAIR-DTC). While multikinase inhibitors (MKIs) and tyrosine kinase inhibitors (TKIs) offer effective treatments for RAIR-DTC, most patients remain noncurative and eventually experience disease progression. In addition, long-term use of these medications is hindered by adverse events, drug resistance and high cost. Recently, the use of MKIs and TKIs has reignited interest in enhancing RAI incorporation. This approach aims to restore the effectiveness of RAI therapy in patients with RAIR-DTC by using agents that increase RAI uptake, potentially overcoming current treatment challenges. This review covers the molecular mechanisms behind RAI resistance, the definition of RAIR-DTC and the efforts to enhance RAI incorporation through various agents, including those currently undergoing clinical trials.

Background: This study aimed to investigate the changes in histological types and causes of death associated with thyroid carcinoma (TC) before and after the introduction of systemic drug therapy.

Methods: The records of 503 deceased patients treated for TC and with death from TC between January 2005 and June 2024 were reviewed in this retrospective cohort study. Multivariate logistic regression was applied to assess whether the number of patients with anaplastic TC (ATC) at diagnosis and the number of local-related deaths changed before and after the introduction of lenvatinib (i.e. 2005-2014 vs 2015-2024).

Results: Of the 503 patients, 157 (31%) had ATC, 253 (50%) had papillary TC (PTC), 67 (13%) had follicular TC (FTC), 17 (3%) had poorly differentiated TC, and nine (2%) had medullary TC. Respiratory insufficiency was the most common fatal condition, occurring in 192 cases (38%), followed by local-related death in 98 cases (19%) and brain-related conditions in 22 cases (4%). We found no difference in the frequency of patients with ATC at diagnosis (32 vs 30%; P-value = 0.772) and the frequency of local-related deaths (19 vs 20%; P-value = 0.736) between 2005-2014 and 2015-2024. These findings were supported by multivariate logistic regression models that adjusted for other covariates (adjusted P-value = 0.436 and 0.353, respectively).

Conclusions: ATC, including anaplastic transformation from PTC and FTC, still accounts for approximately 40% of thyroid cancer deaths after the introduction of systemic drug therapy. Respiratory insufficiency is the most common immediate cause of death.

Introduction: Current guidelines emphasize active surveillance (AS) over immediate surgery for low-risk papillary thyroid microcarcinomas (PTMCs). Alternative minimally invasive treatments, such as thermal ablation, are being explored. If thyroidectomy is performed, lobectomy is preferred and radioactive iodine (RAI) remnant ablation is not routinely recommended for low-risk PTMC patients.

Aim: This study aimed to assess the approach of Greek endocrinologists toward AS and the management of low-risk PTMCs.

Methods: A web-based survey was conducted among members of the Hellenic Endocrine Society (HES). Two clinical scenarios involving a 60-year-old woman with low-risk PTMC were analyzed. Surveyed endocrinologists were asked whether they would recommend AS, thermal ablation, lobectomy or total thyroidectomy as primary treatment; and if total thyroidectomy was performed in this case, whether they would recommend RAI ablation.

Results: A total of 201 endocrinologists (25% of HES members) participated. As primary treatment for low-risk PTMC, 46.8% recommended total thyroidectomy, 31.3% chose AS, 20.9% opted for lobectomy and 1.0% selected thermal ablation. If total thyroidectomy was performed, 95% considered RAI ablation unlikely and only 5% would use RAI. Demographic characteristics, including age, sex, experience and geographic location, did not significantly influence these choices. The primary reason cited by endocrinologists for noncompliance is skepticism about implementing the guidelines, likely stemming from resource limitations and educational gaps.

Conclusion: One-third of Greek endocrinologists prefer AS for managing low-risk PTMCs. More time and effort may be needed to further shift their clinical approach. Insights from our web survey aim to reduce overtreatment in low-risk PTMC management.

A growing body of evidence has established that thyroid hormone (triiodothyronine, T3) is a key factor in the differentiation and survival of the light-sensing photoreceptors in the retina. These functions include a critical role in generating the cone photoreceptor diversity that is required for color vision. Here, we review some of these functions of T3 and the critical mechanisms that regulate the T3 signal in the mammalian retina. The provision of T3, the active form of thyroid hormone, is determined by developmentally rising levels of T3 and its precursor T4 (thyroxine) in the circulation and by intrinsic control within the retina itself by deiodinase enzymes that deplete or amplify the available level of T3. Dynamic profiles of inactivating (DIO3) and activating (DIO2) deiodinases suggest that the T3 signal is progressively calibrated throughout early development, maturation and later functional maintenance of the retina. However, the benefits of T3 come at a cost: photoreceptors are susceptible to impairment and cell death when T3 signaling becomes imbalanced. These findings have implications regarding the influence of T3 in retinal diseases.

Objective: Patients are increasingly using and requesting LT4/LT3 combination treatment for persistent hypothyroid symptoms, but the efficacy and side effects of long-term therapy remain largely unexplored. This study aimed to describe the patient group experiencing a long-lasting impact of LT4/LT3 and evaluate their quality of life (QoL) and hypothyroid symptoms.

Method: We performed a cross-sectional study of 66 hypothyroid patients who had previously initiated LT4/LT3 combination therapy. The patients were grouped by current treatment into patients still receiving LT4/LT3 treatment (T3 responders) and patients who had discontinued LT3 treatment due to lack of effect (T3 non-responders). ThyPRO was used to evaluate QoL, and a validated symptom score was used to assess hypothyroid symptoms. The paper describes a real-life study that depicts unsatisfied patients as they are met in an outpatient clinic.

Results: The participants had a median age of 56 and had initiated LT4/LT3 combination therapy 5.4 years ago. Fifty-four patients still received LT4/LT3 therapy and 12 patients had discontinued LT3 treatment due to lack of effect. Patients in the T3 responder group experienced a QoL comparable to the background population. Surprisingly, symptom scores in the T3 responder group were at the same levels as seen in Danish females with overt hypothyroidism. Thyoid stimulating hormone (TSH) in the T3 responder group was less than 0.4 mU/L in 38% of patients, indicating overtreatment.

Conclusion: LT4/LT3 treatment was well-tolerated with no side effects and high QoL, but patients still experienced many symptoms.

Objective: The final surgical pathology report follows the patient throughout their cancer journey. For locoregionally advanced cancers, lack of surgeon-pathologist communication can lead to understaging, adversely impacting management. Our study aims to improve the accuracy of staging grossly invasive thyroid cancer by introducing an anatomic checklist, enhancing surgeon-pathologist communication.

Methods: We studied 35 consecutive patients with either gross extrathyroidal or extranodal extension, 29 of whom underwent primary resections requiring AJCC staging. Surgeon A initially only dictated an operative report. Surgeon B transmitted an anatomic checklist to the pathologist in addition to the standard operative note. Final pathology reports were reviewed for AJCC staging accuracy. Surgeon A transitioned to submission of an anatomic checklist for his final six cases.

Results: 13 of the 14 final pathology reports without a checklist were understaged. All 15 cases with a surgeon completed anatomic checklist were accurately staged. There was a statistically significant improvement in the accuracy of staging reported in the final pathology reports when an anatomic checklist was submitted as compared to when it was not (P < 0.01, Fisher exact test, two-tailed). All final pathology reports for recurrent cases without a checklist failed to define the anatomic parts that were resected. The time to complete the checklist was less than 90 s.

Conclusion: A surgeon-completed anatomic checklist allows pathologists to more accurately stage grossly invasive thyroid cancers. This rapidly completed form eliminates the need for pathologists to analyze the operative note and facilitates both risk of recurrence and AJCC stage determination.

This manuscript reviews the evolution of newborn screening for primary congenital hypothyroidism (CH) and explores future strategies to enhance diagnostic accuracy. Over the past few decades, newborn screening has expanded globally, significantly reducing the incidence of severe forms of the disease. However, challenges persist, especially regarding the overdiagnosis of mild cases of primary CH, which may not require treatment. Omic sciences may help researchers to enhance the understanding of primary CH and to uncover new biomarkers to identify mild cases with altered proteomic and/or metabolic profiles associated with the need for treatment. Record-linkage studies can help deepen knowledge on the long-term outcomes of affected children identified through newborn screening. Nevertheless, despite 50 years of newborn screening for primary CH, a minority of newborns currently benefit from this critically important public health intervention. Efforts should be done to expand access to newborn screening globally, especially for those born in developing countries.

Background: Selection between open thyroidectomy (OT) and minimally invasive (endoscopic/robotic) thyroidectomy for patients with thyroid cancer has been a subject of considerable debate. Comprehensive analysis of the short-term outcomes of endoscopic thyroidectomy (ET), robotic-assisted thyroidectomy (RT) and open thyroidectomy (OT) for thyroid cancer using a large-scale dataset is important.

Methods: This cohort study evaluated the outcomes of patients receiving ET, RT or OT for thyroid cancer from January 1, 2003, to December 31, 2022. Propensity score matching (PSM) was performed among patients treated with ET, RT or OT to balance covariates distribution. This study involved single-institution patients (aged 18-70) who had undergone ET, RT or OT for thyroid cancer.

Results: The study included 11,066 thyroid cancer patients (OT group- mean (SD) age: 42.45 (10.84) years; ET group- mean (SD) age: 36.75 (9.32) years and RT group- mean (SD) age: 40.27 (10.42) years). After PSM for demographic and clinical characteristics, 908 matched pairs of patients (ET vs OT) and 1480 matched pairs (RT vs OT) were included for further analysis. Complication analysis revealed that RT was associated with a lower rate of transient hypoparathyroidism (339 (22.9%) vs 687 (46.4%); P < 0.001), a lower rate of permanent hypoparathyroidism (4 (0.3%) vs 16 (1.1%); P = 0.012) and a lower rate of transient recurrent laryngeal nerve injury (63 (4.3%) vs 89 (6.0%); P = 0.037).

Conclusion: This cohort study analyzed the short-term outcomes between ET, RT and OT in a large sample of patients with thyroid cancer over a period of two decades. PSM provided a comparable cohort, and the results suggested the advantage of RT, which reduced Clavien-Dindo grade Ⅰ complications in the surgical treatment of thyroid cancer.