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Circadian clock disruption in autoimmune thyroiditis. 自身免疫性甲状腺炎的昼夜节律紊乱。
IF 4.7 2区 医学 Q2 Medicine Pub Date : 2023-08-25 Print Date: 2023-10-01 DOI: 10.1530/ETJ-23-0035
Jinrong Fu, Zihao Fan, Liang He, Qian Liu, He Liu, Yushu Li, Haixia Guan

Objective: A vicious cycle between circadian disruption and escalating immune responses has been described in diverse inflammatory disease. The current study aimed to explore the role of circadian clock disruption in autoimmune thyroiditis (AIT).

Methods: Thirty AIT patients and 30 controls were enrolled and biopsied for thyroid tissues. Alterations of core clock genes expression in AIT thyroid tissues, and its association with serum and tissue inflammatory biomarkers were assessed. For animal studies, C57BL/6J mice administered with porcine thyroglobulin or PBS (as control) combined with adjuvants were sacrificed at four time points to investigate the circadian characteristic of experimental autoimmune thyroiditis (EAT). Light shift (LS) conditions were used to explore the influence of external circadian disturbance on EAT.

Results: The expression of clock genes BMAL1 and PER2 was significantly reduced in thyroid tissues from AIT patients and was negatively correlated to levels of thyroid peroxidase antibodies. In mouse models, diurnal fluctuations of proinflammatory cytokines were demonstrated, and further exposing mice to LS led to overproduction of TNF-α, IFN-γ, and anti-thyroglobulin antibodies. Circadian analysis revealed significant oscillations of Bmal1, Clock, Per2, Cry1, Ror, and Rev-erb, which was broadly disturbed in EAT, LS, and EAT + LS groups.

Conclusions: This study demonstrates that expression pattern of clock genes was disrupted in AIT thyroid, and chronic circadian disruption may aggravate the inflammatory responses in AIT. Whether maintaining a regular circadian rhythm can alleviate autoimmune thyroid diseases warrants further research.

目的:在各种炎症性疾病中,昼夜节律紊乱和免疫反应升级之间存在恶性循环。本研究旨在探讨昼夜节律时钟破坏在自身免疫性甲状腺炎(AIT)中的作用。评估了AIT甲状腺组织中核心时钟基因表达的变化及其与血清和组织炎症生物标志物的关系。在动物研究中,在四个时间点处死施用猪甲状腺球蛋白或PBS(作为对照)与佐剂联合的C57BL/6J小鼠,以研究实验性自身免疫性甲状腺炎(EAT)的昼夜节律特征。结果:AIT患者甲状腺组织中时钟基因BMAL1和PER2的表达显著降低,且与甲状腺过氧化物酶抗体水平呈负相关。在小鼠模型中,证明了促炎细胞因子的昼夜波动,进一步将小鼠暴露于LS会导致TNF-α、IFN-γ和抗甲状腺球蛋白抗体的过量产生。昼夜节律分析揭示了Bmal1、Clock、Per2、Cry1、Ror和Rev-erb的显著振荡,这些振荡在EAT、LS和EAT+LS组中受到广泛干扰。结论:本研究表明,AIT甲状腺中时钟基因的表达模式被破坏,慢性昼夜节律紊乱可能加剧AIT的炎症反应。保持规律的昼夜节律是否可以缓解自身免疫性甲状腺疾病,值得进一步研究。
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引用次数: 0
Bone metastases from differentiated thyroid cancer: characteristics and prognostic factors in a multicenter series. 分化型甲状腺癌症骨转移:多中心系列的特征和预后因素。
IF 4.7 2区 医学 Q2 Medicine Pub Date : 2023-08-23 Print Date: 2023-10-01 DOI: 10.1530/ETJ-23-0086
Ana Piñar-Gutiérrez, Ana R Romero-Lluch, Suset Dueñas-Disotuar, Irene de Lara-Rodríguez, Mª Ángeles Gálvez-Moreno, Tomás Martín-Hernández, Jorge García-Alemán, Guillermo Martínez-de Pinillos, Elena Navarro-González

Objective: The aim of this study is to describe the characteristics, survival and prognostic factors of a cohort of patients with bone metastases (BMs) from differentiated thyroid carcinoma (DTC).

Methods: This was a multicenter retrospective observational study including patients diagnosed with BMs from DTC between 1980 and 2021. A Cox regression was performed to study prognostic factors for 5- and 10-year survival. Kaplan-Meier and log-rank tests were performed for the survival analysis and comparison between groups.

Results: Sixty-three patients were evaluated. Median follow-up from BM diagnosis was 35 (15-68) months. About 30 (48.4%) patients presented with synchronous BMs. Regarding histology, 38 (60.3%) had the papillary variant. BMs were multiple in 32 (50.8%) patients. The most frequent location was the spine (60.3%). Other metastases were present in 77.8%, mainly pulmonary (69.8%). Concerning treatment, 54 (85.9%) patients received I131, with BM uptake in 31 (49.2%) and 25 (39.7%) received treatment with multikinase inhibitors. Regarding complications, 34 (54%) patients had skeletal-related events, 34 (54%) died and 5- and 10-year overall survival was 42.4% and 20.4%, respectively. Significant prognostic factors in the multivariate analysis were the presence of lymph node involvement (hazard ratio (HR): 2.916; 95% confidence interval (CI): 1.013-8.391; P = 0.047) and treatment with I131 (HR 0.214 (95% CI 0.069-0.665); P = 0.008) at 5 years, the presence of other metastases (HR 6.844. 95% CI 1.017-46.05; P = 0.048) and treatment with I131 (HR 0.23 (95% CI 0.058-0.913); P = 0.037) at 10 years.

Conclusions: Our study reflects the management of patients with bone metastases from differentiated thyroid carcinoma in real clinical practice in several centers in southern Spain. Overall survival at 5 and 10 years was lower in patients who were not treated with I131, had nodal involvement and/or had other metastases.

目的:本研究的目的是描述一组分化型甲状腺癌骨转移患者的特征、生存率和预后因素。方法:这是一项多中心回顾性观察性研究,包括1980年至2021年间诊断为DTC BMs的患者。采用Cox回归研究5年和10年生存期的预后因素。Kaplan-Meier和log秩检验用于生存分析和组间比较。结果:63名患者接受了评估。BM诊断的中位随访时间为35(15-68)个月。约有30名(48.4%)患者出现同步骨髓瘤。在组织学方面,38例(60.3%)有乳头状变异。32例(50.8%)患者出现多发性骨髓瘤。最常见的部位是脊柱(60.3%)。其他转移灶存在于77.8%,主要是肺部(69.8%)。在治疗方面,54名(85.9%)患者接受了I131治疗,31名(49.2%)患者接受BM摄取,25名(39.7%)患者接受多激酶抑制剂治疗。在并发症方面,34名(54%)患者发生骨骼相关事件,34人(54%)死亡,5年和10年总生存率分别为42.4%和20.4%。多变量分析中的重要预后因素是淋巴结受累的存在(危险比(HR):2.916;95%置信区间(CI):1.013-8.391;P=0.047)和I131处理(HR 0.214(95%CI 0.069-0.665);P=0.008)、存在其他转移(HR6.844。95%置信区间1.017-46.05;P=0.048)和I131治疗(HR 0.23(95%CI 0.058-0.913);P=0.037)。结论:我们的研究反映了西班牙南部几个中心在实际临床实践中对分化型甲状腺癌骨转移患者的管理。未接受I131治疗、有淋巴结受累和/或有其他转移的患者在5年和10年时的总生存率较低。
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引用次数: 0
The role of transducin β-like 1 X-linked receptor 1 (TBL1XR1) in thyroid hormone metabolism and action in mice. 转导蛋白β样1 X连接受体1(TBL1XR1)在小鼠甲状腺激素代谢和作用中的作用。
IF 4.7 2区 医学 Q2 Medicine Pub Date : 2023-08-14 Print Date: 2023-10-01 DOI: 10.1530/ETJ-23-0077
Yalan Hu, Kim Falize, A S Paul van Trotsenburg, Raoul Hennekam, Eric Fliers, Eveline Bruinstroop, Anita Boelen

Transducin β-like 1 X-linked receptor 1 (TBL1XR1) is a WD40 repeat-containing protein and part of the corepressor complex SMRT/NCoR that binds to the thyroid hormone receptor (TR). We recently described a mutation in TBL1XR1 in patients with Pierpont syndrome. A mouse model bearing this Tbl1xr1 mutation (Tbl1xr1Y446C/Y446C ) displays several aspects of the Pierpont phenotype. Although serum thyroid hormone (TH) concentrations were unremarkable in these mice, tissue TH action might be affected due to the role of TBL1XR1 in the SMRT/NCoR corepressor complex. The aim of the present study was to evaluate tissue TH metabolism and action in a variety of tissues of Tbl1xr1Y446C/Y446C mice. We studied the expression of genes involved in TH metabolism and action in tissues of naïve Tbl1xr1Y446C/Y446C mice and wild type (WT) mice. In addition, we measured deiodinase activity in liver (Dio1 and Dio3), kidney (Dio1 and Dio3) and BAT (Dio2). No striking differences were observed in the liver, hypothalamus, muscle and BAT between Tbl1xr1Y446C/Y446C and WT mice. Pituitary TRα1 mRNA expression was lower in Tbl1xr1Y446C/Y446C mice compared to WT, while the mRNA expression of Tshβ and the positively T3-regulated gene Nmb were significantly increased in mutant mice. Interestingly, Mct8 expression was markedly higher in WAT and kidney of mutants, resulting in (subtle) changes in T3-regulated gene expression in both WAT and kidney. In conclusion, mice harboring a mutation in TBL1XR1 display minor changes in cellular TH metabolism and action. TH transport via MCT8 might be affected as the expression is increased in WAT and kidney. The mechanisms involved need to be clarified.

转导素β样1 X连接受体1(TBL1XR1)是一种含有WD40重复序列的蛋白质,也是与甲状腺激素受体(TR)结合的辅压复合物SMRT/NCoR的一部分。我们最近描述了Pierpont综合征患者的TBL1XR1突变。携带该Tb1xr1突变的小鼠模型(Tb1xr1Y446C/Y446C)显示了Pierpont表型的几个方面。尽管这些小鼠的血清甲状腺激素(TH)浓度不显著,但由于TBL1XR1在SMRT/NCoR辅压复合物中的作用,组织TH作用可能受到影响。本研究的目的是评估Tbl1xr1Y446C/Y446C小鼠在各种组织中的组织TH代谢和作用。我们研究了参与TH代谢和作用的基因在幼稚Tbl1xr1Y446C/Y446C小鼠和野生型(WT)小鼠组织中的表达。此外,我们测量了肝脏(Dio1和Dio3)、肾脏(Dio3和Dio1)和BAT(Dio2)中的脱碘酶活性。Tbl1xr1Y446C/Y446C和WT小鼠在肝脏、下丘脑、肌肉和BAT方面没有观察到显著差异。与WT相比,Tbl1xr1Y446C/Y446C小鼠的垂体TRα1 mRNA表达较低,而突变小鼠的Tshβ和T3正调控基因Nmb的mRNA表达显著增加。有趣的是,突变体的WAT和肾脏中Mct8的表达明显更高,导致WAT和肾中T3调节基因表达的(微妙)变化。总之,携带TBL1XR1突变的小鼠在细胞TH代谢和作用方面表现出微小的变化。TH通过MCT8的转运可能受到影响,因为其在WAT和肾脏中的表达增加。需要澄清所涉及的机制。
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引用次数: 0
2023 European Thyroid Association Clinical Practice Guidelines for thyroid nodule management. 2023欧洲甲状腺协会甲状腺结节管理临床实践指南。
IF 4.7 2区 医学 Q2 Medicine Pub Date : 2023-08-14 Print Date: 2023-10-01 DOI: 10.1530/ETJ-23-0067
Cosimo Durante, Laszlo Hegedus, Agnieszka Czarniecka, Ralf Paschke, Gilles Russ, Fernando Schmitt, Paula Soares, Tamas Solymosi, Enrico Papini

With the widespread use of sensitive imaging techniques, which include neck visualization, a conspicuous number of thyroid nodules emerge and demand attention. Most lesions are benign, asymptomatic, and do not warrant treatment. In the case of cancer diagnosis, most are small, intrathyroidal and indolent neoplasms that can safely be managed conservatively. There is a pronounced need for more cost-effective, risk-adapted approaches to the management of this highly prevalent condition, taking the wishes of the patient into consideration. Thus, the present guidelines aim at providing a clinical practice guide for the initial workup and the subsequent management of adult individuals harboring thyroid nodules. Importantly, these guidelines are not intended to cover the management of thyroid malignancy. The manuscript and the specific recommendations were developed by reconciling the best available research evidence with the knowledge and clinical experience of the panelists and updating aspects of a number of previous European Thyroid Association guidelines.

随着包括颈部可视化在内的敏感成像技术的广泛使用,大量甲状腺结节出现并需要关注。大多数病变是良性的,无症状的,不需要治疗。在癌症诊断的情况下,大多数是小的、甲状腺内和无痛性肿瘤,可以安全地保守治疗。考虑到患者的意愿,显然需要更具成本效益、适应风险的方法来管理这种高度流行的疾病。因此,本指南旨在为携带甲状腺结节的成年个体的初步检查和后续管理提供临床实践指南。重要的是,这些指南并不旨在涵盖甲状腺恶性肿瘤的管理。手稿和具体建议是通过将现有的最佳研究证据与小组成员的知识和临床经验相协调,并更新欧洲甲状腺协会先前的一些指南来制定的。
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引用次数: 4
Improvement in neck ultrasound report quality following the implementation of European Thyroid Association guidelines for postoperative cervical ultrasound for thyroid cancer follow-up, a prospective population study. 实施欧洲甲状腺协会甲状腺癌症术后颈部超声随访指南后颈部超声报告质量的改善,一项前瞻性人群研究。
IF 4.7 2区 医学 Q2 Medicine Pub Date : 2023-08-11 DOI: 10.1530/ETJ-23-0110
Jiahui Wu, Xunyang Hu, Paula Seal, Parthiv Amin, Brendan Diederichs, Ralf Paschke

Objective: The aim of this study was to prospectively evaluate the quality of postoperative neck ultrasound (POU) for thyroid cancer patients after implementing European Thyroid Association (ETA) guideline-based POU assessment.

Methods: Our analysis involved 672 differentiated thyroid cancer patients. POU report quality was compared between the implementation radiology group (IRG), which implemented ETA guideline-based assessment in 2018, and all non-implementation radiology groups (NIRG). Differences in POU quality were evaluated before and after the implementation of guideline-based assessment. Additionally, we evaluated the ability of serum thyroglobulin (Tg) level <0.2 ng/mL or between 0.21 and 0.99 ng/mL and normal POU lesion status at 1-year follow-up to predict the absence of persistent disease or relapse at 3-year follow-up.

Results: IRG had significantly higher mean utility scores for POU reports of abnormal thyroid bed nodules compared to NIRG (P < 0.001). IRG's POU reports for suspicious nodules and lymph nodes were considered sufficient in 94% and 85% of cases, respectively, compared to 45% and 68% for NIRG. For patients with normal US lesion status and Tg <0.2 ng/mL or Tg 0.21-0.99 ng/mL at 1-year follow-up, the negative predictive values were 96% for both.

Conclusions: Implementation of 2013 ETA POU-reporting guidelines allowed for the provision of high-quality POU reports, which may lead to increased accuracy in assessing the response to treatment and in estimating the risk of recurrence of thyroid cancer and likely reduce unnecessary repeat POU or FNA.

目的:本研究的目的是在实施欧洲甲状腺协会(ETA)指南的甲状腺癌症患者术后颈部超声(POU)评估后,对其质量进行前瞻性评估。方法:对672例分化型甲状腺癌症患者进行分析。比较了2018年实施ETA指南评估的实施放射学组(IRG)和所有非实施放射学组的POU报告质量。在实施基于指南的评估之前和之后,评估POU质量的差异。此外,我们评估了血清甲状腺球蛋白(Tg)水平的能力。对于US病变状态和Tg正常的患者结论:2013年ETA POU报告指南的实施允许提供高质量的POU报告,这可能会提高评估治疗反应和估计甲状腺癌症复发风险的准确性,并可能减少不必要的重复POU或FNA。
{"title":"Improvement in neck ultrasound report quality following the implementation of European Thyroid Association guidelines for postoperative cervical ultrasound for thyroid cancer follow-up, a prospective population study.","authors":"Jiahui Wu,&nbsp;Xunyang Hu,&nbsp;Paula Seal,&nbsp;Parthiv Amin,&nbsp;Brendan Diederichs,&nbsp;Ralf Paschke","doi":"10.1530/ETJ-23-0110","DOIUrl":"10.1530/ETJ-23-0110","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to prospectively evaluate the quality of postoperative neck ultrasound (POU) for thyroid cancer patients after implementing European Thyroid Association (ETA) guideline-based POU assessment.</p><p><strong>Methods: </strong>Our analysis involved 672 differentiated thyroid cancer patients. POU report quality was compared between the implementation radiology group (IRG), which implemented ETA guideline-based assessment in 2018, and all non-implementation radiology groups (NIRG). Differences in POU quality were evaluated before and after the implementation of guideline-based assessment. Additionally, we evaluated the ability of serum thyroglobulin (Tg) level <0.2 ng/mL or between 0.21 and 0.99 ng/mL and normal POU lesion status at 1-year follow-up to predict the absence of persistent disease or relapse at 3-year follow-up.</p><p><strong>Results: </strong>IRG had significantly higher mean utility scores for POU reports of abnormal thyroid bed nodules compared to NIRG (P < 0.001). IRG's POU reports for suspicious nodules and lymph nodes were considered sufficient in 94% and 85% of cases, respectively, compared to 45% and 68% for NIRG. For patients with normal US lesion status and Tg <0.2 ng/mL or Tg 0.21-0.99 ng/mL at 1-year follow-up, the negative predictive values were 96% for both.</p><p><strong>Conclusions: </strong>Implementation of 2013 ETA POU-reporting guidelines allowed for the provision of high-quality POU reports, which may lead to increased accuracy in assessing the response to treatment and in estimating the risk of recurrence of thyroid cancer and likely reduce unnecessary repeat POU or FNA.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2023-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6c/9e/ETJ-23-0110.PMC10448586.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10425832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Longitudinal trajectories of maternal TSH in healthy pregnant women in Catalonia. 在加泰罗尼亚健康孕妇母体TSH的纵向轨迹。
IF 4.7 2区 医学 Q2 Medicine Pub Date : 2023-08-11 DOI: 10.1530/ETJ-23-0016
Berta Soldevila, Inés Velasco, Carla Muñoz, Yesika Díaz, Laia Egea-Cortés, Laura Ferrer-Escopiñan, Alejandra Pérez-Montes de Oca, Raquel Martínez-Mondejar, Jordi Casabona, Manel Puig-Domingo

Objective: Longitudinal evaluation of thyroid function throughout pregnancy in the same subject could offer precise information about its dynamics as a physiological mechanism of adaption to the requirements. In this study, we evaluated longitudinal trajectories of maternal thyroid function during pregnancy by a latent class growth analysis and explored their association with maternal-fetal outcomes.

Methods: A prospective observational study was carried out, including 414 healthy pregnant women, from the first trimester to delivery. Thyroid function and autoimmunity were measured in the three trimesters. Clinical data during pregnancy were obtained. Longitudinal mixed model techniques were performed to explore trajectories of gestational thyroid function.

Results: Three different longitudinal trajectories were obtained from maternal thyrotropin (TSH) levels: low-increasing TSH (class 1) in 86% of cases, high-increasing TSH (class 2) in 9.7%, and decreasing TSH (class 3) in 4.3%. No statistical differences in free thyroxine levels were found among the three classes. Differences in maternal age (P = 0.027) and initial maternal weight (P = 0.043) were observed among the groups. In logistic regression analysis, maternal age correlated with longitudinal trajectories. The three longitudinal classes remain when women with thyroid autoimmunity (TAI) are excluded. Multinomial logistic regression showed maternal age correlated with longitudinal trajectories independently of TAI status.

Conclusions: Three differentiated TSH trajectories were found in healthy pregnant women living in Catalonia, as previously described. No association with obstetric outcomes was observed in these different chronological thyroid pathways, but maternal age might condition the longitudinal mechanism of thyroid function regulation throughout pregnancy.

目的:对同一受试者在妊娠期间的甲状腺功能进行纵向评估,以提供其动态作为适应需求的生理机制的准确信息。在这项研究中,我们通过潜在类生长分析评估了怀孕期间母亲甲状腺功能的纵向轨迹,并探讨了它们与母胎结局的关系。方法:一项前瞻性观察研究,包括414名健康孕妇,从妊娠早期到分娩。在妊娠三个月检测甲状腺功能和自身免疫。获得妊娠期临床资料。采用纵向混合模型技术探索妊娠甲状腺功能的发展轨迹。结果:母体促甲状腺激素(TSH)水平有三种不同的纵向轨迹:86%的病例TSH低升高(1类),9.7%的病例TSH高升高(2类),4.3%的病例TSH降低(3类)。三组间游离甲状腺素水平无统计学差异。各组产妇年龄(P = 0.027)、初始体重(P = 0.043)差异均有统计学意义。在logistic回归分析中,母亲年龄与纵向轨迹相关。当排除甲状腺自身免疫(TAI)的妇女时,这三个纵向分类仍然存在。多项逻辑回归显示,母亲年龄与纵向轨迹相关,与TAI状态无关。结论:如前所述,在生活在加泰罗尼亚的健康孕妇中发现了三个不同的TSH轨迹。在这些不同的时间顺序甲状腺通路中没有观察到与产科结局的关联,但母亲年龄可能会影响整个妊娠期间甲状腺功能调节的纵向机制。
{"title":"Longitudinal trajectories of maternal TSH in healthy pregnant women in Catalonia.","authors":"Berta Soldevila, Inés Velasco, Carla Muñoz, Yesika Díaz, Laia Egea-Cortés, Laura Ferrer-Escopiñan, Alejandra Pérez-Montes de Oca, Raquel Martínez-Mondejar, Jordi Casabona, Manel Puig-Domingo","doi":"10.1530/ETJ-23-0016","DOIUrl":"10.1530/ETJ-23-0016","url":null,"abstract":"<p><strong>Objective: </strong>Longitudinal evaluation of thyroid function throughout pregnancy in the same subject could offer precise information about its dynamics as a physiological mechanism of adaption to the requirements. In this study, we evaluated longitudinal trajectories of maternal thyroid function during pregnancy by a latent class growth analysis and explored their association with maternal-fetal outcomes.</p><p><strong>Methods: </strong>A prospective observational study was carried out, including 414 healthy pregnant women, from the first trimester to delivery. Thyroid function and autoimmunity were measured in the three trimesters. Clinical data during pregnancy were obtained. Longitudinal mixed model techniques were performed to explore trajectories of gestational thyroid function.</p><p><strong>Results: </strong>Three different longitudinal trajectories were obtained from maternal thyrotropin (TSH) levels: low-increasing TSH (class 1) in 86% of cases, high-increasing TSH (class 2) in 9.7%, and decreasing TSH (class 3) in 4.3%. No statistical differences in free thyroxine levels were found among the three classes. Differences in maternal age (P = 0.027) and initial maternal weight (P = 0.043) were observed among the groups. In logistic regression analysis, maternal age correlated with longitudinal trajectories. The three longitudinal classes remain when women with thyroid autoimmunity (TAI) are excluded. Multinomial logistic regression showed maternal age correlated with longitudinal trajectories independently of TAI status.</p><p><strong>Conclusions: </strong>Three differentiated TSH trajectories were found in healthy pregnant women living in Catalonia, as previously described. No association with obstetric outcomes was observed in these different chronological thyroid pathways, but maternal age might condition the longitudinal mechanism of thyroid function regulation throughout pregnancy.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2023-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/60/ab/ETJ-23-0016.PMC10448591.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10256927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ethanol ablation of thyroid cysts in the young with a focus on efficacy and quality of life. 乙醇消融治疗年轻人甲状腺囊肿的疗效和生活质量。
IF 4.7 2区 医学 Q2 Medicine Pub Date : 2023-08-11 DOI: 10.1530/ETJ-23-0085
Milan Halenka, Hana Munteanu, Radko Obereigneru, Roman Dohnal, David Karasek, Jan Schovanek

Objective: Ultrasound-guided percutaneous ethanol injection therapy (US-PEIT) is used in patients with recurrent symptomatic thyroid cysts as a credible alternative to surgery. Young patients commonly do not wish to undergo surgery and prefer ethanol ablation, if available. The effect of this approach on quality of life is an essential factor in deciding on the treatment options, especially in the young with a long life expectancy and no comorbidity.

Methods: We performed US-PEIT in a cohort of young patients, 15-30 years, from 2015 to 2020. The patients' general quality of life (QoL), self-reported compression symptoms and neck appearance were evaluated.

Results: The cohort comprised 59 patients with 63 cysts, more women than men, with a mean age of 23.8 years. About 1.5 mL of injected alcohol were needed to reach a 90.7% mean cyst volume reduction ratio in 12 months. The method did not fail in any of the patients; a single US-PEIT session was undertaken in 46% of them. The procedure significantly improved each of the patients' symptoms with a significant total score difference (P < 0.001). The total symptom score correlated with the initial cyst volume (P = 0.002; r = 0.395). The mean QoL score by SF-36 6 months after the last US-PEIT was significantly different for physical component summary 56.5 (P < 0.001) but not different for mental component summary 47.7 (P = 0.125), compared to age-corresponding norms.

Conclusions: US-PEIT is a safe and effective method for the young, leading to improvements in cosmetic and subjective complaints, and should also be considered as first-line treatment in the young.

目的:超声引导下经皮乙醇注射治疗(US-PEIT)用于复发性症状性甲状腺囊肿患者,作为一种可靠的替代手术治疗方法。年轻患者通常不希望接受手术,如果可以的话,他们更喜欢乙醇消融。这种方法对生活质量的影响是决定治疗方案的重要因素,特别是在预期寿命长且无合并症的年轻人中。方法:我们在2015年至2020年期间对15-30岁的年轻患者进行了US-PEIT。评估患者的总体生活质量(QoL)、自我报告的压迫症状和颈部外观。结果:本组59例患者共63个囊肿,女性多于男性,平均年龄23.8岁。在12个月内,大约需要1.5 mL的酒精注射才能达到90.7%的平均囊肿体积缩小率。该方法在任何患者中都没有失败;其中46%的人进行了一次US-PEIT会话。该方法显著改善了每例患者的症状,总评分差异显著(P < 0.001)。症状总评分与初始囊肿体积相关(P = 0.002;R = 0.395)。在最后一次US-PEIT后6个月,SF-36的平均生活质量评分与年龄对应的标准相比,身体成分总结为56.5 (P < 0.001),而精神成分总结为47.7 (P = 0.125),差异无统计学意义。结论:US-PEIT对于年轻人是一种安全有效的方法,可以改善美容和主观抱怨,也应考虑作为年轻人的一线治疗方法。
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引用次数: 0
Use of lenvatinib in the treatment of radioiodine-refractory differentiated thyroid cancer: a multidisciplinary perspective for daily practice. 乐伐替尼在治疗放射性碘难治性分化型甲状腺癌症中的应用:日常实践的多学科视角。
IF 3.5 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-08-08 DOI: 10.1530/ETJ-23-0068
Jaume Capdevila, Desiree' Deandreis, Cosimo Durante, Sophie Leboulleux, Markus Luster, Romana Netea-Maier, Kate Newbold, Susanne Singer, Gerasimos P Sykiotis, Beate Bartes, Kate Farnell, Laura Deborah Locati

Background: Most thyroid cancers of follicular origin have a favorable outcome. Only a small percentage of patients will develop metastatic disease, some of which will become radioiodine refractory (RAI-R). Important challenges to ensure the best therapeutic outcomes include proper, timely, and appropriate diagnosis; decisions on local, systemic treatments; management of side effects of therapies; and a good relationship between the specialist, patients, and caregivers.

Methods: With the aim of providing suggestions that can be useful in everyday practice, a multidisciplinary group of experts organized the following document, based on their shared clinical experience with patients with RAI-R differentiated thyroid cancer (DTC) undergoing treatment with lenvatinib. The main areas covered are patient selection, initiation of therapy, follow-up, and management of adverse events.

Conclusions: It is essential to provide guidance for the management of RAI-R DTC patients with systemic therapies, and especially lenvatinib, since compliance and adherence to treatment are fundamental to achieve the best outcomes. While the therapeutic landscape in RAI-R DTC is evolving, with new targeted therapies, immunotherapy, etc., lenvatinib is expected to remain a first-line treatment and mainstay of therapy for several years in the vast majority of patients and settings. The guidance herein covers baseline work-up and initiation of systemic therapy, relevance of symptoms, multidisciplinary assessment, and patient education. Practical information based on expert experience is also given for the starting dose of lenvatinib, follow-up and monitoring, as well as the management of adverse events and discontinuation and reinitiating of therapy. The importance of patient engagement is also stressed.

背景:大多数滤泡性甲状腺癌都有良好的预后。只有一小部分患者会发展为转移性疾病,其中一些会成为放射性碘难治性疾病(RAI-R)。确保最佳治疗结果的重要挑战包括正确、及时和适当的诊断;关于局部、系统治疗的决定;治疗副作用的管理;以及专家、患者和护理人员之间的良好关系。方法:为了提供在日常实践中有用的建议,一个多学科专家组根据他们与正在接受乐伐替尼治疗的RAI-R分化型癌症(DTC)患者的共同临床经验,组织了以下文件。涵盖的主要领域包括患者选择、治疗开始、随访和不良事件管理。结论:必须为RAI-R DTC患者的全身治疗管理提供指导,尤其是乐伐替尼,因为依从性和坚持治疗是获得最佳结果的基础。虽然RAI-R DTC的治疗前景正在演变,但随着新的靶向疗法、免疫疗法等的出现,乐伐替尼有望在未来几年内继续成为绝大多数患者和环境中的一线治疗和主要治疗药物。本文的指导涵盖了基线检查和系统治疗的开始、症状的相关性、多学科评估和患者教育。还提供了基于专家经验的实用信息,用于乐伐替尼的起始剂量、随访和监测,以及不良事件的管理、停药和重新开始治疗。还强调了患者参与的重要性。
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引用次数: 0
Voice and swallowing symptoms after thyroid surgery assessed using the ThyVoice online platform. 使用ThyVoice在线平台评估甲状腺手术后的声音和吞咽症状。
IF 4.7 2区 医学 Q2 Medicine Pub Date : 2023-08-01 DOI: 10.1530/ETJ-23-0008
Radu Mihai

Objective: The aim of this multicentre study was to investigate the progression of patient-reported outcomes after thyroid surgery, with emphasis on voice and swallowing difficulties.

Methods: An online platform was used to collect replies to standardised questionnaires (voice handicap index, VHI; voice-related quality of life, VrQoL; EAT-10) preoperatively and at 2-6 weeks and 3-6-12 months after surgery.

Results: A total of 236 patients were recruited from five centres that contributed with median of 11 cases (range 2-186 cases). Average symptoms scores showed voice changes lasting up to 3 months: VHI increased from 41 ± 15 (preop) to 48 ± 21 (6 weeks) and returned to 41 ± 15 at 6 months. Similarly, VrQoL increased from 12 ± 4 to 15 ± 6 and returned to 12 ± 4 (6 months). Severe voice changes (VHI > 60) were reported in 12% of patients preop, 22% at 2 weeks, 18% at 6 weeks, 13% at 3 months and 7% at 12 months. Only five patients with normal preoperative voice had persistent severe voice changes after 6-12 months. Those with severe voice changes at 2 weeks (median VHI 70.5, IQR 65-81) had significant improvement by 6 months (median VHI 54, IQR 39-65) (P < 0.001). Swallowing assessment showed a median preop score of 0 (IQR 0-3) increasing to a median of 2 (IQR 0-8) at 2 weeks and normal values afterwards.

Conclusion: The ThyVoice online platform allows the assessment of patient-reported outcome measures in thyroid surgery. Voice morbidity appears to be more frequent than commonly reported, and this risk should the quoted during informed consent. Swallowing difficulties are mild but significant in the first 2 weeks.

目的:本多中心研究的目的是调查甲状腺手术后患者报告的预后进展,重点是声音和吞咽困难。方法:采用在线平台收集标准化问卷(语音障碍指数,VHI;语音相关生活质量,VrQoL;术前、术后2-6周和3-6-12个月时的EAT-10)。结果:共从5个中心招募了236例患者,中位数为11例(范围2-186例)。平均症状评分显示声音变化持续时间长达3个月:VHI从术前的41±15增加到48±21(6周),6个月时又恢复到41±15。VrQoL从12±4增加到15±6,再恢复到12±4(6个月)。术前有12%的患者报告了严重的声音改变(VHI > 60), 2周时为22%,6周时为18%,3个月时为13%,12个月时为7%。只有5例术前声音正常的患者在6-12个月后出现持续严重的声音改变。2周时嗓音变化严重的患者(中位VHI为70.5,IQR为65-81)在6个月时有显著改善(中位VHI为54,IQR为39-65)(P < 0.001)。吞咽评估显示术前评分中位数为0 (IQR 0-3),在2周时增加到中位数2 (IQR 0-8),之后恢复正常。结论:ThyVoice在线平台可以评估甲状腺手术中患者报告的结果。声音发病率似乎比通常报道的更频繁,这一风险应在知情同意期间引用。吞咽困难是轻微的,但在前两周很明显。
{"title":"Voice and swallowing symptoms after thyroid surgery assessed using the ThyVoice online platform.","authors":"Radu Mihai","doi":"10.1530/ETJ-23-0008","DOIUrl":"https://doi.org/10.1530/ETJ-23-0008","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this multicentre study was to investigate the progression of patient-reported outcomes after thyroid surgery, with emphasis on voice and swallowing difficulties.</p><p><strong>Methods: </strong>An online platform was used to collect replies to standardised questionnaires (voice handicap index, VHI; voice-related quality of life, VrQoL; EAT-10) preoperatively and at 2-6 weeks and 3-6-12 months after surgery.</p><p><strong>Results: </strong>A total of 236 patients were recruited from five centres that contributed with median of 11 cases (range 2-186 cases). Average symptoms scores showed voice changes lasting up to 3 months: VHI increased from 41 ± 15 (preop) to 48 ± 21 (6 weeks) and returned to 41 ± 15 at 6 months. Similarly, VrQoL increased from 12 ± 4 to 15 ± 6 and returned to 12 ± 4 (6 months). Severe voice changes (VHI > 60) were reported in 12% of patients preop, 22% at 2 weeks, 18% at 6 weeks, 13% at 3 months and 7% at 12 months. Only five patients with normal preoperative voice had persistent severe voice changes after 6-12 months. Those with severe voice changes at 2 weeks (median VHI 70.5, IQR 65-81) had significant improvement by 6 months (median VHI 54, IQR 39-65) (P < 0.001). Swallowing assessment showed a median preop score of 0 (IQR 0-3) increasing to a median of 2 (IQR 0-8) at 2 weeks and normal values afterwards.</p><p><strong>Conclusion: </strong>The ThyVoice online platform allows the assessment of patient-reported outcome measures in thyroid surgery. Voice morbidity appears to be more frequent than commonly reported, and this risk should the quoted during informed consent. Swallowing difficulties are mild but significant in the first 2 weeks.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/93/4f/ETJ-23-0008.PMC10305707.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9760634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Iodine avidity in papillary and poorly differentiated thyroid cancer is predicted by immunohistochemical and molecular work-up. 通过免疫组化和分子检查预测乳头状甲状腺癌和分化较差的甲状腺癌的碘特异性。
IF 4.7 2区 医学 Q2 Medicine Pub Date : 2023-07-28 DOI: 10.1530/ETJ-23-0099
Joachim N Nilsson, Jonathan Siikanen, Vincenzo Condello, Kenbugul Jatta, Ravi Saini, Christel Hedman, Catharina Ihre Lundgren, C Christofer Juhlin

Background: Successful radioiodine treatment of differentiated thyroid cancer requires iodine avidity: that is, the concentration and retention of iodine in cancer tissue. Several parameters have previously been linked with lower iodine avidity. However, a comprehensive analysis of which factors best predict iodine avidity status, and the magnitude of their impact, is lacking.

Methods: Quantitative measurements of iodine avidity in surgical specimens (primary tumour and lymph node metastases) of 28 patients were compared to immunohistochemical expression of the thyroid-stimulating hormone receptor, thyroid peroxidase (TPO), pendrin, sodium-iodide symporter (NIS) and mutational status of BRAF and the TERT promoter. Regression analysis was used to identify independent predictors of poor iodine avidity.

Results: Mutations in BRAF and the TERT promoter were significantly associated with lower iodine avidity for lymph node metastases (18-fold and 10-fold, respectively). Membranous NIS localisation was found only in two cases but was significantly associated with high iodine avidity. TPO expression was significantly correlated with iodine avidity (r = 0.44). The multivariable modelling showed that tumour tissue localisation (primary tumour or lymph node metastasis), histological subtype, TPO and NIS expression and TERT promoter mutation were each independent predictors of iodine avidity that could explain 68% of the observed variation of iodine avidity.

Conclusions: A model based on histological subtype, TPO and NIS expression and TERT promoter mutation, all evaluated on initial surgical material, can predict iodine avidity in thyroid cancer tissue ahead of treatment. This could inform early adaptation with respect to expected treatment effect.

背景:分化型甲状腺癌的成功放射碘治疗需要碘渴求度:即碘在癌组织中的浓度和保留率。以前有几个参数与碘渴求度较低有关。然而,目前还缺乏对哪些因素能最好地预测碘依从性状态及其影响程度的全面分析:方法:将28例患者手术标本(原发肿瘤和淋巴结转移瘤)中碘有价性的定量测量结果与促甲状腺激素受体、甲状腺过氧化物酶(TPO)、垂体促甲状腺激素(pendrin)、钠碘合体(NIS)的免疫组化表达以及BRAF和TERT启动子的突变状态进行比较。通过回归分析确定了碘反应不良的独立预测因素:结果:BRAF和TERT启动子的突变与淋巴结转移的低碘渴求度显著相关(分别为18倍和10倍)。膜性NIS定位仅在两个病例中发现,但与高碘效价显著相关。TPO的表达与碘相关性很高(r = 0.44)。多变量模型显示,肿瘤组织定位(原发肿瘤或淋巴结转移)、组织学亚型、TPO和NIS表达以及TERT启动子突变都是碘有染性的独立预测因素,可解释68%的碘有染性观察变化:基于组织学亚型、TPO和NIS表达以及TERT启动子突变的模型可在治疗前预测甲状腺癌组织中的碘嗜性。这可以为预期治疗效果的早期调整提供依据。
{"title":"Iodine avidity in papillary and poorly differentiated thyroid cancer is predicted by immunohistochemical and molecular work-up.","authors":"Joachim N Nilsson, Jonathan Siikanen, Vincenzo Condello, Kenbugul Jatta, Ravi Saini, Christel Hedman, Catharina Ihre Lundgren, C Christofer Juhlin","doi":"10.1530/ETJ-23-0099","DOIUrl":"10.1530/ETJ-23-0099","url":null,"abstract":"<p><strong>Background: </strong>Successful radioiodine treatment of differentiated thyroid cancer requires iodine avidity: that is, the concentration and retention of iodine in cancer tissue. Several parameters have previously been linked with lower iodine avidity. However, a comprehensive analysis of which factors best predict iodine avidity status, and the magnitude of their impact, is lacking.</p><p><strong>Methods: </strong>Quantitative measurements of iodine avidity in surgical specimens (primary tumour and lymph node metastases) of 28 patients were compared to immunohistochemical expression of the thyroid-stimulating hormone receptor, thyroid peroxidase (TPO), pendrin, sodium-iodide symporter (NIS) and mutational status of BRAF and the TERT promoter. Regression analysis was used to identify independent predictors of poor iodine avidity.</p><p><strong>Results: </strong>Mutations in BRAF and the TERT promoter were significantly associated with lower iodine avidity for lymph node metastases (18-fold and 10-fold, respectively). Membranous NIS localisation was found only in two cases but was significantly associated with high iodine avidity. TPO expression was significantly correlated with iodine avidity (r = 0.44). The multivariable modelling showed that tumour tissue localisation (primary tumour or lymph node metastasis), histological subtype, TPO and NIS expression and TERT promoter mutation were each independent predictors of iodine avidity that could explain 68% of the observed variation of iodine avidity.</p><p><strong>Conclusions: </strong>A model based on histological subtype, TPO and NIS expression and TERT promoter mutation, all evaluated on initial surgical material, can predict iodine avidity in thyroid cancer tissue ahead of treatment. This could inform early adaptation with respect to expected treatment effect.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10388652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10300284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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European Thyroid Journal
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