Papillary and follicular thyroid carcinomas (PTC and FTC) are prominent malignancies that originate from thyroid follicular cells. PTC is usually diagnosed via preoperative cytology, and large tumor size, clinical node metastasis, and distant metastasis constitute preoperative prognostic factors. Gross extrathyroidal and extranodal tumor extensions have a significant prognostic impact, are evaluated intraoperatively, and are useful for determining the extent of surgery. Aggressive variants, such as tall cell and hobnail variants, a high Ki-67 labeling index (LI), and somatic gene mutations are prognostic factors in postoperative pathological and molecular examinations. In contrast, FTC is generally diagnosed based on the postoperative pathology. Large tumor size and M factors have prognostic value; however, the findings of pathological examinations are very important. FTCs are classified as minimally invasive, encapsulated angioinvasive, and widely invasive FTCs. Widely invasive FTC with vascular invasion (VI) and encapsulated angioinvasive FTCs with extensive VI have a poor prognosis, whereas widely invasive FTC without VI has an excellent prognosis, which is similar to that of minimally invasive FTC. This indicates that VI is a considerably more important prognostic marker than capsular invasion. For postoperative follow-up, dynamic markers such as the thyroglobulin-doubling rate (DR), metastatic tumor volume-DR, and change in neutrophil-to-lymphocyte ratio are important and are useful for evaluating the effectiveness of treatments, such as radioactive iodine therapy and molecular targeted therapy, for recurrent lesions. For clinicians, it is important to accurately evaluate prognostic markers of PTC and FTC in the pre-, intraoperative, and postoperative phases.
甲状腺乳头状癌和滤泡状癌(PTC和FTC)是起源于甲状腺滤泡细胞的常见恶性肿瘤。PTC通常通过术前细胞学检查确诊,肿瘤体积大、临床结节转移和远处转移是术前预后因素。甲状腺外和结节外肿瘤的粗大扩展对预后有重要影响,可在术中进行评估,并有助于确定手术范围。在术后病理和分子检查中,侵袭性变异(如高细胞和蹄甲变异)、高Ki-67标记指数(LI)和体细胞基因突变是预后因素。相比之下,FTC 一般根据术后病理诊断。肿瘤体积大和 M 因子具有预后价值,但病理检查结果非常重要。FTC 可分为微侵袭性 FTC、包裹性血管侵袭性 FTC 和广泛侵袭性 FTC。伴有血管侵犯(VI)的广泛浸润性 FTC 和伴有广泛 VI 的包裹性血管浸润性 FTC 预后较差,而不伴有 VI 的广泛浸润性 FTC 预后较好,与微创性 FTC 的预后相似。这表明,VI 是比囊肿侵犯更重要的预后指标。对于术后随访,甲状腺球蛋白倍增率(DR)、转移性肿瘤体积-DR、中性粒细胞与淋巴细胞比值变化等动态指标非常重要,有助于评估放射性碘治疗和分子靶向治疗等治疗方法对复发病灶的疗效。对于临床医生来说,在术前、术中和术后阶段准确评估 PTC 和 FTC 的预后指标非常重要。
{"title":"Prognostic factors of papillary and follicular carcinomas based on pre-, intra-, and postoperative findings.","authors":"Yasuhiro Ito, Akira Miyauchi","doi":"10.1530/ETJ-24-0196","DOIUrl":"https://doi.org/10.1530/ETJ-24-0196","url":null,"abstract":"<p><p>Papillary and follicular thyroid carcinomas (PTC and FTC) are prominent malignancies that originate from thyroid follicular cells. PTC is usually diagnosed via preoperative cytology, and large tumor size, clinical node metastasis, and distant metastasis constitute preoperative prognostic factors. Gross extrathyroidal and extranodal tumor extensions have a significant prognostic impact, are evaluated intraoperatively, and are useful for determining the extent of surgery. Aggressive variants, such as tall cell and hobnail variants, a high Ki-67 labeling index (LI), and somatic gene mutations are prognostic factors in postoperative pathological and molecular examinations. In contrast, FTC is generally diagnosed based on the postoperative pathology. Large tumor size and M factors have prognostic value; however, the findings of pathological examinations are very important. FTCs are classified as minimally invasive, encapsulated angioinvasive, and widely invasive FTCs. Widely invasive FTC with vascular invasion (VI) and encapsulated angioinvasive FTCs with extensive VI have a poor prognosis, whereas widely invasive FTC without VI has an excellent prognosis, which is similar to that of minimally invasive FTC. This indicates that VI is a considerably more important prognostic marker than capsular invasion. For postoperative follow-up, dynamic markers such as the thyroglobulin-doubling rate (DR), metastatic tumor volume-DR, and change in neutrophil-to-lymphocyte ratio are important and are useful for evaluating the effectiveness of treatments, such as radioactive iodine therapy and molecular targeted therapy, for recurrent lesions. For clinicians, it is important to accurately evaluate prognostic markers of PTC and FTC in the pre-, intraoperative, and postoperative phases.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hyunju Park, Jung Heo, Hyun Jin Ryu, Min-Ji Kim, Young Lyun Oh, Tae Hyuk Kim, Sun Wook Kim, Jae Hoon Chung
Objective: Previous reports suggest that a high body mass index (BMI) increases the risk of thyroid carcinoma. However, it remains unclear whether a high BMI is associated with the risk of BRAFV600E mutation. We aimed to assess whether a high BMI is associated with an increased risk of BRAFV600E mutation.
Design and methods: We screened 6,558 PTC patients who had undergone BRAFV600E mutation testing between January 2009 and December 2017. After exclusion, 6,438 PTC patients were enrolled. We used logistic regression, and restricted cubic spline plots of the adjusted odd ratios (ORs) were illustrated to model the relationship between BMI and BRAFV600E mutation.
Results: Among the 6,438 patients, 5,102 (79.2%) had the BRAFV600E mutation, and 4,954 (76.9%) were female. The median BMI was 23.8 (21.6 - 26.2) kg/m2. The primary tumor size was ≤ 1cm in 4,226 patients (65.6 %) and > 1cm in 2,212 patients (34.4 %). The BRAFV600E mutation was significantly associated with high BMI only in patients with primary tumor size > 1cm (OR 1.034; 95% CI 1.003 - 1.065; P = 0.029), whereas no clear association was found in patients with primary tumor size ≤ 1cm (OR 1.007; 95% CI 0.984 - 1.030; P = 0.570). Gender was not a significant factor in either group.
Conclusions: Our study found that a higher BMI was positively associated with BRAFV600E mutation in patients with primary tumor size > 1cm. These results suggest that the association between BMI and BRAFV600E mutation status differs depending on primary tumor size.
{"title":"The association between BMI and BRAFV600E mutation may differ by primary tumor size.","authors":"Hyunju Park, Jung Heo, Hyun Jin Ryu, Min-Ji Kim, Young Lyun Oh, Tae Hyuk Kim, Sun Wook Kim, Jae Hoon Chung","doi":"10.1530/ETJ-23-0255","DOIUrl":"https://doi.org/10.1530/ETJ-23-0255","url":null,"abstract":"<p><strong>Objective: </strong>Previous reports suggest that a high body mass index (BMI) increases the risk of thyroid carcinoma. However, it remains unclear whether a high BMI is associated with the risk of BRAFV600E mutation. We aimed to assess whether a high BMI is associated with an increased risk of BRAFV600E mutation.</p><p><strong>Design and methods: </strong>We screened 6,558 PTC patients who had undergone BRAFV600E mutation testing between January 2009 and December 2017. After exclusion, 6,438 PTC patients were enrolled. We used logistic regression, and restricted cubic spline plots of the adjusted odd ratios (ORs) were illustrated to model the relationship between BMI and BRAFV600E mutation.</p><p><strong>Results: </strong>Among the 6,438 patients, 5,102 (79.2%) had the BRAFV600E mutation, and 4,954 (76.9%) were female. The median BMI was 23.8 (21.6 - 26.2) kg/m2. The primary tumor size was ≤ 1cm in 4,226 patients (65.6 %) and > 1cm in 2,212 patients (34.4 %). The BRAFV600E mutation was significantly associated with high BMI only in patients with primary tumor size > 1cm (OR 1.034; 95% CI 1.003 - 1.065; P = 0.029), whereas no clear association was found in patients with primary tumor size ≤ 1cm (OR 1.007; 95% CI 0.984 - 1.030; P = 0.570). Gender was not a significant factor in either group.</p><p><strong>Conclusions: </strong>Our study found that a higher BMI was positively associated with BRAFV600E mutation in patients with primary tumor size > 1cm. These results suggest that the association between BMI and BRAFV600E mutation status differs depending on primary tumor size.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bernard Goichot, François Lefebvre, Stéphane Vinzio, Anne Cailleux, Jean-Marc Kuhn, Olivier Schneegans, Bodgan Catargi, Olivier Gilly, Philippe Baltzinger, Nicolas Meyer, Philippe Caron
Objective: Subclinical hyperthyroidism (SCH) is common and associated with atrial fibrillation (AF) risk in the elderly. Current guidelines rely on a low level of evidence.
Methods: Randomized clinical trial including patients 50 years and older, with TSH <0.4 mU/L and normal thyroid hormone concentrations. All patients showed autonomy on thyroid scan. They were randomized either to receive radioiodine (I131) or to be monitored and treated only if they underwent AF or evolved towards overt hyperthyroidism. Primary outcome was the onset of new AF. Secondary outcomes were treatment-induced hypothyroidism rate and health-related quality of life.
Results: 144 patients (mean age 65.3±8.9y, 76% female) were randomized, 74 to surveillance and 70 to treatment. Four patients in the surveillance group and one in the treatment group developed AF (p=0.238). However, the patient who developed AF in the treatment group maintained TSH <0.4 mU/L at AF onset. A post-hoc analysis was carried out and showed that when normalization of TSH was considered, the risk of AF was significantly reduced (p=0.0003). In the surveillance group, several patients showed no classical characteristics associated with AF risk, including age>65y or TSH<0.1mU/L. Of 94 patients treated using radioiodine, 25% developed hypothyroidism during follow-up.
Conclusions: Due to recruitment difficulties this study failed to demonstrate that SCH treatment can reduce significantly the incidence of AF in patients older than 50 years with thyroid autonomy even if all the patients who developed AF maintained TSH <0.4 mU/L. This result must be balanced with the increased risk of radioiodine-induced hypothyroidism.
{"title":"Treatment of subclinical hyperthyroidism in patients older than 50 years: A randomized controlled study.","authors":"Bernard Goichot, François Lefebvre, Stéphane Vinzio, Anne Cailleux, Jean-Marc Kuhn, Olivier Schneegans, Bodgan Catargi, Olivier Gilly, Philippe Baltzinger, Nicolas Meyer, Philippe Caron","doi":"10.1530/ETJ-24-0121","DOIUrl":"https://doi.org/10.1530/ETJ-24-0121","url":null,"abstract":"<p><strong>Objective: </strong>Subclinical hyperthyroidism (SCH) is common and associated with atrial fibrillation (AF) risk in the elderly. Current guidelines rely on a low level of evidence.</p><p><strong>Methods: </strong>Randomized clinical trial including patients 50 years and older, with TSH <0.4 mU/L and normal thyroid hormone concentrations. All patients showed autonomy on thyroid scan. They were randomized either to receive radioiodine (I131) or to be monitored and treated only if they underwent AF or evolved towards overt hyperthyroidism. Primary outcome was the onset of new AF. Secondary outcomes were treatment-induced hypothyroidism rate and health-related quality of life.</p><p><strong>Results: </strong>144 patients (mean age 65.3±8.9y, 76% female) were randomized, 74 to surveillance and 70 to treatment. Four patients in the surveillance group and one in the treatment group developed AF (p=0.238). However, the patient who developed AF in the treatment group maintained TSH <0.4 mU/L at AF onset. A post-hoc analysis was carried out and showed that when normalization of TSH was considered, the risk of AF was significantly reduced (p=0.0003). In the surveillance group, several patients showed no classical characteristics associated with AF risk, including age>65y or TSH<0.1mU/L. Of 94 patients treated using radioiodine, 25% developed hypothyroidism during follow-up.</p><p><strong>Conclusions: </strong>Due to recruitment difficulties this study failed to demonstrate that SCH treatment can reduce significantly the incidence of AF in patients older than 50 years with thyroid autonomy even if all the patients who developed AF maintained TSH <0.4 mU/L. This result must be balanced with the increased risk of radioiodine-induced hypothyroidism.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31Print Date: 2024-08-01DOI: 10.1530/ETJ-24-0068
Fabyan Esberard de Lima Beltrão, Daniele Carvalhal de Almeida Beltrão, Giulia Carvalhal, Fabyanna Lethicia de Lima Beltrão, Jocyel de Brito Oliveira, Hatilla Dos Santos Silva, Helena Mariana Pitangueira Teixeira, Juliana Lopes Rodrigues, Camila Alexandrina Viana de Figueiredo, Ryan Dos Santos Costa, Fabio Hecht, Giciane Carvalho Vieira, Maria da Conceição Rodrigues Gonçalves, Antonio C Bianco, Helton Estrela Ramos
Introduction: The type 2 deiodinase and its Thr92Ala-DIO2 polymorphism have been linked to clinical outcomes in acute lung injury and coronavirus disease 2019 (COVID-19).
Objective: The objective was to identify a potential association between Thr92Ala-DIO2 polymorphism and body composition (appendicular muscle mass, myosteatosis, and fat distribution) and to determine whether they reflect the severity or mortality associated with the disease.
Methods: In this prospective cohort study (June-August 2020), 181 patients hospitalized with moderate-to-severe COVID-19 underwent a non-contrast-enhanced computed tomography (CT) of the thorax to assess body composition, laboratory tests, and genotyping for the Thr92Ala-DIO2 polymorphism.
Results: In total, 181 consecutive patients were stratified into three subgroups according to the genotype: Thr/Thr (n = 64), Thr/Ala (n = 96), and Ala/Ala (n = 21). The prevalence of low muscle area (MA) (< 92 cm²) was 52.5%. Low MA was less frequent in Ala/Thr patients (44.8%) than in Thr/Thr (60.9%) or Ala/Ala patients (61.9%) (P = 0.027). Multivariate logistic regression analysis confirmed that the Thr/Ala allele was associated with a reduced risk of low MA (41% to 69%) and myosteatosis (62% to 72%) compared with Thr/Thr + Ala/Ala (overdominant model). Kaplan-Meier curves showed that patients with low muscle mass and homozygosity had lower survival rates than the other groups. Notably, the heterozygotes with MA ≥92 cm² exhibited the best survival rate.
Conclusion: Thr92Ala-DIO2 heterozygosity is associated with increased skeletal MA and less myosteatosis in patients with COVID-19. The protective effect of Thr92Ala-DIO2 heterozygosity on COVID-19 mortality is restricted to patients with reduced MA.
{"title":"Thr92Ala-DIO2 heterozygosity is associated with skeletal muscle mass and myosteatosis in patients with COVID-19.","authors":"Fabyan Esberard de Lima Beltrão, Daniele Carvalhal de Almeida Beltrão, Giulia Carvalhal, Fabyanna Lethicia de Lima Beltrão, Jocyel de Brito Oliveira, Hatilla Dos Santos Silva, Helena Mariana Pitangueira Teixeira, Juliana Lopes Rodrigues, Camila Alexandrina Viana de Figueiredo, Ryan Dos Santos Costa, Fabio Hecht, Giciane Carvalho Vieira, Maria da Conceição Rodrigues Gonçalves, Antonio C Bianco, Helton Estrela Ramos","doi":"10.1530/ETJ-24-0068","DOIUrl":"10.1530/ETJ-24-0068","url":null,"abstract":"<p><strong>Introduction: </strong>The type 2 deiodinase and its Thr92Ala-DIO2 polymorphism have been linked to clinical outcomes in acute lung injury and coronavirus disease 2019 (COVID-19).</p><p><strong>Objective: </strong>The objective was to identify a potential association between Thr92Ala-DIO2 polymorphism and body composition (appendicular muscle mass, myosteatosis, and fat distribution) and to determine whether they reflect the severity or mortality associated with the disease.</p><p><strong>Methods: </strong>In this prospective cohort study (June-August 2020), 181 patients hospitalized with moderate-to-severe COVID-19 underwent a non-contrast-enhanced computed tomography (CT) of the thorax to assess body composition, laboratory tests, and genotyping for the Thr92Ala-DIO2 polymorphism.</p><p><strong>Results: </strong>In total, 181 consecutive patients were stratified into three subgroups according to the genotype: Thr/Thr (n = 64), Thr/Ala (n = 96), and Ala/Ala (n = 21). The prevalence of low muscle area (MA) (< 92 cm²) was 52.5%. Low MA was less frequent in Ala/Thr patients (44.8%) than in Thr/Thr (60.9%) or Ala/Ala patients (61.9%) (P = 0.027). Multivariate logistic regression analysis confirmed that the Thr/Ala allele was associated with a reduced risk of low MA (41% to 69%) and myosteatosis (62% to 72%) compared with Thr/Thr + Ala/Ala (overdominant model). Kaplan-Meier curves showed that patients with low muscle mass and homozygosity had lower survival rates than the other groups. Notably, the heterozygotes with MA ≥92 cm² exhibited the best survival rate.</p><p><strong>Conclusion: </strong>Thr92Ala-DIO2 heterozygosity is associated with increased skeletal MA and less myosteatosis in patients with COVID-19. The protective effect of Thr92Ala-DIO2 heterozygosity on COVID-19 mortality is restricted to patients with reduced MA.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11301567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141310444","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}
Pub Date : 2024-07-29Print Date: 2024-08-01DOI: 10.1530/ETJ-24-0009
Elisa Minaldi, Virginia Cappagli, Loredana Lorusso, Laura Valerio, Carlotta Giani, Matilde Viglione, Laura Agate, Eleonora Molinaro, Antonio Matrone, Rossella Elisei
Objective: The aim of this study was to assess the clinical impact of hand-foot syndrome (HFS) during treatment with two multikinase inhibitors, sorafenib and lenvatinib, in a large group of patients with advanced thyroid cancer. Moreover, we looked for possible associations between HFS occurrence and clinical and pathological features.
Methods: We retrospectively evaluated 239 patients with advanced thyroid cancer: 165 treated with lenvatinib and 74 with sorafenib. Statistical analyses were performed to verify which features could be correlated with HFS development.
Results: HFS was observed in 35/74 (47.4%) and in 43/165 (26.7%) patients treated with sorafenib or lenvatinib, respectively. The median latency from the drug beginning and HFS appearance was 27 days for sorafenib and 2.9 months for lenvatinib. G3/G4 toxicity was observed in 16/35 (45.7%) patients treated with sorafenib and only in 3/43 (7%) treated with lenvatinib. Drug dose reduction due to HFS was required in 19/74 (25.7%) and 3/165 (1.8%) patients treated with sorafenib and lenvatinib, respectively. HFS occurrence was significantly associated with a longer duration of therapy in both groups.
Conclusion: HFS was a frequent adverse event during both lenvatinib and sorafenib therapy, with a higher frequency and toxicity grade during sorafenib treatment. HFS was the most frequent reason for drug reduction or discontinuation in patient treated with sorafenib. Early diagnosis of HFS is important to allow early intervention, possibly in a multidisciplinary setting, and to avoid treatment discontinuation, which is highly relevant to obtain the maximum effectiveness of systemic therapy.
{"title":"Hand-foot syndrome in sorafenib and lenvatinib treatment for advanced thyroid cancer.","authors":"Elisa Minaldi, Virginia Cappagli, Loredana Lorusso, Laura Valerio, Carlotta Giani, Matilde Viglione, Laura Agate, Eleonora Molinaro, Antonio Matrone, Rossella Elisei","doi":"10.1530/ETJ-24-0009","DOIUrl":"10.1530/ETJ-24-0009","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to assess the clinical impact of hand-foot syndrome (HFS) during treatment with two multikinase inhibitors, sorafenib and lenvatinib, in a large group of patients with advanced thyroid cancer. Moreover, we looked for possible associations between HFS occurrence and clinical and pathological features.</p><p><strong>Methods: </strong>We retrospectively evaluated 239 patients with advanced thyroid cancer: 165 treated with lenvatinib and 74 with sorafenib. Statistical analyses were performed to verify which features could be correlated with HFS development.</p><p><strong>Results: </strong>HFS was observed in 35/74 (47.4%) and in 43/165 (26.7%) patients treated with sorafenib or lenvatinib, respectively. The median latency from the drug beginning and HFS appearance was 27 days for sorafenib and 2.9 months for lenvatinib. G3/G4 toxicity was observed in 16/35 (45.7%) patients treated with sorafenib and only in 3/43 (7%) treated with lenvatinib. Drug dose reduction due to HFS was required in 19/74 (25.7%) and 3/165 (1.8%) patients treated with sorafenib and lenvatinib, respectively. HFS occurrence was significantly associated with a longer duration of therapy in both groups.</p><p><strong>Conclusion: </strong>HFS was a frequent adverse event during both lenvatinib and sorafenib therapy, with a higher frequency and toxicity grade during sorafenib treatment. HFS was the most frequent reason for drug reduction or discontinuation in patient treated with sorafenib. Early diagnosis of HFS is important to allow early intervention, possibly in a multidisciplinary setting, and to avoid treatment discontinuation, which is highly relevant to obtain the maximum effectiveness of systemic therapy.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11301531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491499","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}
Pub Date : 2024-07-29Print Date: 2024-08-01DOI: 10.1530/ETJ-24-0123
Andrea Leoncini, Chiara Camponovo, Gaetano Paone, Elena Gamarra, Giorgio Treglia, Pierpaolo Trimboli
Objective: Thyroid nodule (TN) is usually managed according to Thyroid Imaging And Reporting Data Systems (TIRADS) with the major aim to reduce as much as possible unnecessary fine-needle aspiration cytologies (UN-FNACs). Since the assessment of autonomously functioning thyroid nodule (AFTN) according to TIRADS is heterogeneous, that virtually benign entity may increase the rate of UN-FNAC. This study retrospectively analyzed the appropriateness of TIRADS-based FNAC indication in AFTNs, also looking at the impact of TSH and nodule size.
Methods: Cases diagnosed with AFTN on scintigraphy were searched. Patients who had undergone AFTN treatment, were on medications or supplementation that could affect thyroid function, or had multiple AFTNs were excluded. The AFTNs were assessed according to ACR-TIRADS.
Results: Forty-eight AFTNs were included of which 37.5% had FNAC indication according to TIRADS. The FNAC indication rate in the case of TSH lower than 0.4 mIU/L was significantly higher than in other cases (P = 0.0078). The most accurate TSH cut-off and AFTN size associated with UN-FNAC were ≤ 0.41 mIU/L and > 22 mm, respectively. The multivariate analysis showed that both TSH and nodule size were independent predictors of UN-FNAC with OR of 6.65 and 6.46, respectively. According to these data, the rate of FNAC indication dropped to 4.16%.
Conclusion: Inappropriate FNACs in AFTNs are primarily observed in patients with low TSH and large AFTN. Since these cases typically undergo scintigraphy, the risk of TIRADS-based UN-FNAC is clinically negligible. There is no need for integrating other imaging procedures into the TIRADS model.
{"title":"Risk of TIRADS-based inappropriate FNAC in autonomous thyroid nodules is clinically negligible.","authors":"Andrea Leoncini, Chiara Camponovo, Gaetano Paone, Elena Gamarra, Giorgio Treglia, Pierpaolo Trimboli","doi":"10.1530/ETJ-24-0123","DOIUrl":"10.1530/ETJ-24-0123","url":null,"abstract":"<p><strong>Objective: </strong>Thyroid nodule (TN) is usually managed according to Thyroid Imaging And Reporting Data Systems (TIRADS) with the major aim to reduce as much as possible unnecessary fine-needle aspiration cytologies (UN-FNACs). Since the assessment of autonomously functioning thyroid nodule (AFTN) according to TIRADS is heterogeneous, that virtually benign entity may increase the rate of UN-FNAC. This study retrospectively analyzed the appropriateness of TIRADS-based FNAC indication in AFTNs, also looking at the impact of TSH and nodule size.</p><p><strong>Methods: </strong>Cases diagnosed with AFTN on scintigraphy were searched. Patients who had undergone AFTN treatment, were on medications or supplementation that could affect thyroid function, or had multiple AFTNs were excluded. The AFTNs were assessed according to ACR-TIRADS.</p><p><strong>Results: </strong>Forty-eight AFTNs were included of which 37.5% had FNAC indication according to TIRADS. The FNAC indication rate in the case of TSH lower than 0.4 mIU/L was significantly higher than in other cases (P = 0.0078). The most accurate TSH cut-off and AFTN size associated with UN-FNAC were ≤ 0.41 mIU/L and > 22 mm, respectively. The multivariate analysis showed that both TSH and nodule size were independent predictors of UN-FNAC with OR of 6.65 and 6.46, respectively. According to these data, the rate of FNAC indication dropped to 4.16%.</p><p><strong>Conclusion: </strong>Inappropriate FNACs in AFTNs are primarily observed in patients with low TSH and large AFTN. Since these cases typically undergo scintigraphy, the risk of TIRADS-based UN-FNAC is clinically negligible. There is no need for integrating other imaging procedures into the TIRADS model.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11301566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141537799","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}
Pub Date : 2024-07-13Print Date: 2024-08-01DOI: 10.1530/ETJ-24-0089
Zhaoqi Zhang, Josef Yu, Eva Rainer, Lindsay Hargitai, Zewen Jiang, Georgios Karanikas, Tatjana Traub-Weidinger, Richard Crevenna, Marcus Hacker, Shuren Li
Objective: Correct diagnosis and prognostic evaluation of medullary thyroid cancer (MTC) are crucial to treat patients. The purpose of this study was to evaluate the diagnostic and prognostic value of [18F]F-DOPA PET/CT in patients with MTC.
Methods: We reviewed MTC patients who underwent [18F]F-DOPA PET/CT from June 2008 to November 2023. Clinical characteristics, follow-up data, and the following [18F]F-DOPA PET/CT parameters were recorded: maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), and SUVmean of multiple organs. The diagnostic value of PET/CT for the detection of tumor lesions was calculated. Serum basal calcitonin (bCt) and stimulated calcitonin (sCt) were determined. Receiver operating characteristics, Kaplan-Meier, and Cox regression analyses were performed.
Results: In total, 109 patients (50 women, 59 men; average age, 55 ± 14 years) were included in the analysis. The patient-related sensitivity, specificity, and accuracy of [18F]F-DOPA PET/CT were 95%, 93%, and 94%, respectively. The lesion-related sensitivity, specificity, and accuracy were 65%, 99%, and 72%, respectively. The optimal cutoff values of bCt, sCt, and CEA to obtain positive [18F]F-DOPA PET/CT results were 64 pg/mL, 1808 pg/mL, and 4 µg/L, respectively. Patients with negative [18F]F-DOPA PET/CT had longer overall survival than patients with positive [18F]F-DOPA PET/CT results (P = 0.017). Significant positive correlations were found between bCt, sCt, and CEA with SUVmax, SUVmean, and MTV of [18F]F-DOPA PET/CT (P < 0.001). [18F]F-DOPA PET/CT results and MTV may be useful for the evaluation of the prognosis of patients with recurrent MTC, while age and MTV were independent prognostic factors in patients with primary MTC. For all patients, SUVmean of the left kidney, liver, aorta, and pancreas might be used to independently predict OS.
Conclusion: [18F]F-DOPA PET/CT had great value for diagnosis and prognostic assessment in patients with MTC. The DOPA PET/CT parameter SUVmean and MTV showed significant association with OS.
{"title":"The role of [18F]F-DOPA PET/CT in diagnostic and prognostic assessment of medullary thyroid cancer: a 15-year experience with 109 patients.","authors":"Zhaoqi Zhang, Josef Yu, Eva Rainer, Lindsay Hargitai, Zewen Jiang, Georgios Karanikas, Tatjana Traub-Weidinger, Richard Crevenna, Marcus Hacker, Shuren Li","doi":"10.1530/ETJ-24-0089","DOIUrl":"10.1530/ETJ-24-0089","url":null,"abstract":"<p><strong>Objective: </strong>Correct diagnosis and prognostic evaluation of medullary thyroid cancer (MTC) are crucial to treat patients. The purpose of this study was to evaluate the diagnostic and prognostic value of [18F]F-DOPA PET/CT in patients with MTC.</p><p><strong>Methods: </strong>We reviewed MTC patients who underwent [18F]F-DOPA PET/CT from June 2008 to November 2023. Clinical characteristics, follow-up data, and the following [18F]F-DOPA PET/CT parameters were recorded: maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), and SUVmean of multiple organs. The diagnostic value of PET/CT for the detection of tumor lesions was calculated. Serum basal calcitonin (bCt) and stimulated calcitonin (sCt) were determined. Receiver operating characteristics, Kaplan-Meier, and Cox regression analyses were performed.</p><p><strong>Results: </strong>In total, 109 patients (50 women, 59 men; average age, 55 ± 14 years) were included in the analysis. The patient-related sensitivity, specificity, and accuracy of [18F]F-DOPA PET/CT were 95%, 93%, and 94%, respectively. The lesion-related sensitivity, specificity, and accuracy were 65%, 99%, and 72%, respectively. The optimal cutoff values of bCt, sCt, and CEA to obtain positive [18F]F-DOPA PET/CT results were 64 pg/mL, 1808 pg/mL, and 4 µg/L, respectively. Patients with negative [18F]F-DOPA PET/CT had longer overall survival than patients with positive [18F]F-DOPA PET/CT results (P = 0.017). Significant positive correlations were found between bCt, sCt, and CEA with SUVmax, SUVmean, and MTV of [18F]F-DOPA PET/CT (P < 0.001). [18F]F-DOPA PET/CT results and MTV may be useful for the evaluation of the prognosis of patients with recurrent MTC, while age and MTV were independent prognostic factors in patients with primary MTC. For all patients, SUVmean of the left kidney, liver, aorta, and pancreas might be used to independently predict OS.</p><p><strong>Conclusion: </strong>[18F]F-DOPA PET/CT had great value for diagnosis and prognostic assessment in patients with MTC. The DOPA PET/CT parameter SUVmean and MTV showed significant association with OS.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11301540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141431728","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}
Pub Date : 2024-07-09Print Date: 2024-08-01DOI: 10.1530/ETJ-24-0007
Chae Won Chung, Kyungsik Kim, Sue K Park, Dal Lae Ju, Young Joo Park, Choong Ho Shin, Jong Kwan Jun, June-Key Chung, Yoon Ju Song, Young Ah Lee, Gi Jeong Cheon, Sun Wook Cho
Objective: This study aimed to assess selenium status in South Korean pregnant women and its impact on maternal thyroid function and pregnancy outcomes.
Methods: 'Ideal Breast Milk (IBM) Cohort Study' included 367 pregnant women out of 442 participants and categorized into three groups based on plasma selenium levels: deficient (< 70 μg/L), suboptimal (70-99 μg/L), and optimal (≥ 100 μg/L). During the second or third trimester, various blood parameters, including selenium, thyroid-stimulating hormone, free T4, free T3, and anti-thyroid peroxidase antibody levels, were measured. Thyroid parenchymal echogenicity was assessed as another surrogate marker for thyroid autoimmunity using ultrasonography.
Results: The median plasma selenium was 98.8 (range: 46.7-206.4) μg/L, and 30 individuals (8%) were categorized as deficient, while 164 (45%) were classified in the suboptimal group. Selenium deficiency was associated with markers of autoimmune thyroiditis, including positive anti-thyroid peroxidase antibody results (13.3 (deficient) vs 4.6 (optimal) %, P = 0.031) and thyroid parenchymal heterogeneity on ultrasound (33.3 (deficient) vs 14.6 (suboptimal) vs 17.3 (optimal) %, P = 0.042), independently of gestational age. The incidence of severe preeclampsia was higher in the group not taking selenium supplements, particularly among those with twin pregnancies, compared to the group taking selenium supplements (0 (selenium supplement) vs 9.0 (no supplement) %, P = 0.015).
Conclusion: Pregnant women experience mild selenium deficiency, which can lead to significant health issues including maternal thyroid autoimmunity and obstetrical complications during pregnancy. Guidelines for appropriate selenium intake according to the stage of pregnancy and the number of fetuses are needed.
目的本研究旨在评估韩国孕妇的硒状况及其对母体甲状腺功能和妊娠结局的影响:血浆硒的中位数为 98.8(范围为 46.7-206.4)微克/升,30 人(8%)被归为缺硒组,164 人(45%)被归为次优组。硒缺乏与自身免疫性甲状腺炎的标志物有关,包括抗甲状腺过氧化物酶抗体阳性结果(13.3 [缺乏] vs. 4.6 [最佳] %,P=0.031)和超声检查甲状腺实质异质性(33.3 [缺乏] vs. 14.6 [次佳] vs. 17.3 [最佳] %,P=0.042),与胎龄无关。与服用硒补充剂的孕妇组相比,未服用硒补充剂的孕妇组,尤其是双胎孕妇组,重度子痫前期的发生率更高(0 [Se 补充剂] vs. 9.0 [未补充剂] %,P=0.015):孕妇轻度缺硒可导致严重的健康问题,包括母体甲状腺自身免疫和孕期产科并发症。需要根据妊娠阶段和胎儿数量制定适当的硒摄入量指南。
{"title":"Selenium levels and their association with thyroid autoimmunity and severe preeclampsia in pregnancy: Insights from a prospective ideal breast milk cohort study.","authors":"Chae Won Chung, Kyungsik Kim, Sue K Park, Dal Lae Ju, Young Joo Park, Choong Ho Shin, Jong Kwan Jun, June-Key Chung, Yoon Ju Song, Young Ah Lee, Gi Jeong Cheon, Sun Wook Cho","doi":"10.1530/ETJ-24-0007","DOIUrl":"10.1530/ETJ-24-0007","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess selenium status in South Korean pregnant women and its impact on maternal thyroid function and pregnancy outcomes.</p><p><strong>Methods: </strong>'Ideal Breast Milk (IBM) Cohort Study' included 367 pregnant women out of 442 participants and categorized into three groups based on plasma selenium levels: deficient (< 70 μg/L), suboptimal (70-99 μg/L), and optimal (≥ 100 μg/L). During the second or third trimester, various blood parameters, including selenium, thyroid-stimulating hormone, free T4, free T3, and anti-thyroid peroxidase antibody levels, were measured. Thyroid parenchymal echogenicity was assessed as another surrogate marker for thyroid autoimmunity using ultrasonography.</p><p><strong>Results: </strong>The median plasma selenium was 98.8 (range: 46.7-206.4) μg/L, and 30 individuals (8%) were categorized as deficient, while 164 (45%) were classified in the suboptimal group. Selenium deficiency was associated with markers of autoimmune thyroiditis, including positive anti-thyroid peroxidase antibody results (13.3 (deficient) vs 4.6 (optimal) %, P = 0.031) and thyroid parenchymal heterogeneity on ultrasound (33.3 (deficient) vs 14.6 (suboptimal) vs 17.3 (optimal) %, P = 0.042), independently of gestational age. The incidence of severe preeclampsia was higher in the group not taking selenium supplements, particularly among those with twin pregnancies, compared to the group taking selenium supplements (0 (selenium supplement) vs 9.0 (no supplement) %, P = 0.015).</p><p><strong>Conclusion: </strong>Pregnant women experience mild selenium deficiency, which can lead to significant health issues including maternal thyroid autoimmunity and obstetrical complications during pregnancy. Guidelines for appropriate selenium intake according to the stage of pregnancy and the number of fetuses are needed.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11301555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418495","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}
Pub Date : 2024-07-03Print Date: 2024-08-01DOI: 10.1530/ETJ-23-0129
Kenneth Ka Hei Lai, Fatema Mohamed Ali Abdulla Aljufairi, Jake Uy Sebastian, Yingying Wei, Ruofan Jia, Karen Kar Wun Chan, Elaine Yuen Ling Au, Alan Chun Hong Lee, Chiu Ming Ng, Hunter Kwok Lai Yuen, Wilson Wai Kuen Yip, Alvin Lerrmann Young, George Pak Man Cheng, Clement Chee Yung Tham, Chi Pui Pang, Kelvin Kam Lung Chong
Purpose: This study aims to report correlations between thyroid-stimulating immunoglobulin (TSI) and both clinical and radiological parameters in recent-onset symptomatic thyroid eye disease (TED) patients.
Methods: A prospective cohort study of TED patients managed at the Chinese University of Hong Kong from January 2014 to May 2022. Serum TSI levels were determined with the functional assay. Outcomes included the Clinical Activity Score (CAS), marginal reflex distance1 (MRD1), extraocular muscle motility restriction (EOMy), exophthalmos, and diplopia. The radiological assessment included cross-sectional areas and signal of extraocular muscles on STIR-sequence MRI.
Results: A total of 255 (197 female) treatment-naive patients, with an average onset age of 50 ± 14 years (mean ± s.d.), were included. Elevated pre-treatment TSI level was observed in 223 (88%) patients. There was a weak positive correlation between TSI and CAS (r = 0.28, P = 0.000031), MRD1 (r = 0.17, P = 0.0080), and the size of the levator palpebrae superioris/superior rectus complex (r = 0.25, P = 0.018). No significant correlation existed between TSI and STIR signals. The AUC and optimal cut-off value for clinical active TED were 0.67 (95% CI: 0.60-0.75) and 284% (specificity: 50%, sensitivity: 85%). In total, 64 patients received intravenous methylprednisolone (IVMP) during the study interval, and they had a higher baseline TSI level than those who did not have IVMP (P = 0.000044). Serial post-IVMP TSI among the 62 patients showed a significant reduction compared to the baseline level (P < 0.001). Both the baseline and post-IVMP TSI levels, and percentages of TSI changes were comparable between patients who responded and did not respond to the first course of IVMP.
Conclusion: TSI can be a serum biomarker for the diagnosis, prognosis, and treatment response of TED. Further validation should be warranted.
{"title":"Epidemiology of thyroid-stimulating immunoglobulin in recent-onset symptomatic thyroid eye disease.","authors":"Kenneth Ka Hei Lai, Fatema Mohamed Ali Abdulla Aljufairi, Jake Uy Sebastian, Yingying Wei, Ruofan Jia, Karen Kar Wun Chan, Elaine Yuen Ling Au, Alan Chun Hong Lee, Chiu Ming Ng, Hunter Kwok Lai Yuen, Wilson Wai Kuen Yip, Alvin Lerrmann Young, George Pak Man Cheng, Clement Chee Yung Tham, Chi Pui Pang, Kelvin Kam Lung Chong","doi":"10.1530/ETJ-23-0129","DOIUrl":"10.1530/ETJ-23-0129","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to report correlations between thyroid-stimulating immunoglobulin (TSI) and both clinical and radiological parameters in recent-onset symptomatic thyroid eye disease (TED) patients.</p><p><strong>Methods: </strong>A prospective cohort study of TED patients managed at the Chinese University of Hong Kong from January 2014 to May 2022. Serum TSI levels were determined with the functional assay. Outcomes included the Clinical Activity Score (CAS), marginal reflex distance1 (MRD1), extraocular muscle motility restriction (EOMy), exophthalmos, and diplopia. The radiological assessment included cross-sectional areas and signal of extraocular muscles on STIR-sequence MRI.</p><p><strong>Results: </strong>A total of 255 (197 female) treatment-naive patients, with an average onset age of 50 ± 14 years (mean ± s.d.), were included. Elevated pre-treatment TSI level was observed in 223 (88%) patients. There was a weak positive correlation between TSI and CAS (r = 0.28, P = 0.000031), MRD1 (r = 0.17, P = 0.0080), and the size of the levator palpebrae superioris/superior rectus complex (r = 0.25, P = 0.018). No significant correlation existed between TSI and STIR signals. The AUC and optimal cut-off value for clinical active TED were 0.67 (95% CI: 0.60-0.75) and 284% (specificity: 50%, sensitivity: 85%). In total, 64 patients received intravenous methylprednisolone (IVMP) during the study interval, and they had a higher baseline TSI level than those who did not have IVMP (P = 0.000044). Serial post-IVMP TSI among the 62 patients showed a significant reduction compared to the baseline level (P < 0.001). Both the baseline and post-IVMP TSI levels, and percentages of TSI changes were comparable between patients who responded and did not respond to the first course of IVMP.</p><p><strong>Conclusion: </strong>TSI can be a serum biomarker for the diagnosis, prognosis, and treatment response of TED. Further validation should be warranted.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11301541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283432","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}
Inês Cosme, Ana Figueiredo, Sara Pinheiro, Valeriano Leite
Thyroid carcinoma (TC) incidence increased over the past 50 years. The explanation for this is not consensual.
Objective: Compare incidental vs. non-incidental TC (ITC vs. NITC) regarding demographic, clinical, histological data and 5-year clinical outcomes.
Design: Retrospective analysis of 225 papillary TC (PTC) cases that completed a 5-year follow-up.
Methods: Created 2 groups: ITC (including the incidentalomas) and NITC (cases of palpable or visible nodules or with thyroid compressive complaints).
Results: Included 225 PTC (122 were ITC). There were 95 women in ITC and 78 in NITC. ITC patients were significantly older (53.3±14.8 vs 47.2±17.7, p=0.006). Groups had no differences in family history of TC. ITC mean tumour size was smaller (19.1±9.2 vs 28.6±16.2, p<0.01). Tumours >20mm comprised 36.1% of ITC and 58.2% of NITC. We found no differences in tumour multifocality, histological thyroiditis, aggressive PTC subtypes, capsule or lymph-vascular invasion and gross extrathyroidal extension. There were no differences regarding the number of patients submitted to RAI or in RAI activity. pTMN staging showed higher prevalence of T3a and T4 cases (p<0.01), and M1 status (p=0.025) in NITC. There were no differences in the rates of persistence of disease. Logistic regression showed that the diagnostic modality had no impact on the 5-year clinical outcome.
Conclusions: ITC patients were older and had smaller tumours. NITC showed no worst histological features or 5-year clinical outcome. Approximately, one third of ITC had diameters >20mm. As even large tumours can be ITC, overdiagnosis can be the most likely cause for the TC increasing incidence.
{"title":"INCIDENTALLY VS. NON-INCIDENTALLY DIAGNOSED PAPILLARY THYROID CARCINOMA: ARE THERE DIFFERENCES?","authors":"Inês Cosme, Ana Figueiredo, Sara Pinheiro, Valeriano Leite","doi":"10.1530/ETJ-24-0106","DOIUrl":"10.1530/ETJ-24-0106","url":null,"abstract":"<p><p>Thyroid carcinoma (TC) incidence increased over the past 50 years. The explanation for this is not consensual.</p><p><strong>Objective: </strong>Compare incidental vs. non-incidental TC (ITC vs. NITC) regarding demographic, clinical, histological data and 5-year clinical outcomes.</p><p><strong>Design: </strong>Retrospective analysis of 225 papillary TC (PTC) cases that completed a 5-year follow-up.</p><p><strong>Methods: </strong>Created 2 groups: ITC (including the incidentalomas) and NITC (cases of palpable or visible nodules or with thyroid compressive complaints).</p><p><strong>Results: </strong>Included 225 PTC (122 were ITC). There were 95 women in ITC and 78 in NITC. ITC patients were significantly older (53.3±14.8 vs 47.2±17.7, p=0.006). Groups had no differences in family history of TC. ITC mean tumour size was smaller (19.1±9.2 vs 28.6±16.2, p<0.01). Tumours >20mm comprised 36.1% of ITC and 58.2% of NITC. We found no differences in tumour multifocality, histological thyroiditis, aggressive PTC subtypes, capsule or lymph-vascular invasion and gross extrathyroidal extension. There were no differences regarding the number of patients submitted to RAI or in RAI activity. pTMN staging showed higher prevalence of T3a and T4 cases (p<0.01), and M1 status (p=0.025) in NITC. There were no differences in the rates of persistence of disease. Logistic regression showed that the diagnostic modality had no impact on the 5-year clinical outcome.</p><p><strong>Conclusions: </strong>ITC patients were older and had smaller tumours. NITC showed no worst histological features or 5-year clinical outcome. Approximately, one third of ITC had diameters >20mm. As even large tumours can be ITC, overdiagnosis can be the most likely cause for the TC increasing incidence.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11301558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141537798","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}