Thyroid最新文献

Background: The American Thyroid Association has stratified RET C634 mutations as high risk. The association between RET C634R mutation and a more aggressive medullary thyroid carcinoma (MTC) behavior compared with other C634 mutations remains inconclusive, possibly due to the lack of large cohorts and long-term outcome data. This study aimed to evaluate the aggressiveness and long-term outcomes of hereditary MTC in patients with different RET codon 634 mutations. Methods: This study is an international, multicenter, retrospective cohort study. Data from patients with hereditary MTC carrying RET codon 634 mutations treated at three tertiary medical centers were retrospectively analyzed. Clinicopathological features and long-term outcomes were compared between patients with the C634R and those with other C634 mutations (C634F/G/S/W/Y). Results: The study cohort included 317 patients (C634R: 133; C634F/G/S/W/Y: 184) from 137 families with a median follow-up of 10.6 years (4.9-16.6 years). Patients with the C634R mutation were slightly younger at the time of initial surgery (27.8 ± 12.1 vs. 31.3 ± 14.9, p = 0.025). Meanwhile, the C634R group showed larger primary tumors (1.9 ± 1.2 vs. 1.5 ± 1.1, p = 0.006). Kaplan-Meier analysis revealed significantly higher cumulative rates and earlier occurrence of lymph node metastases (p = 0.0003) and extrathyroidal extension (ETE; p < 0.0001) in the C634R group. The C634R mutation was significantly associated with distant metastases (hazard ratio [HR]: 2.545 [confidence interval (CI) 1.134-5.713]; p = 0.024). Moreover, multivariable analysis identified RET C634R genotype (HR: 6.488 [CI 1.364-30.862]; p = 0.019), increasing age (HR: 1.082 [CI 1.023-1.144]; p = 0.006), and ETE (HR: 9.695 [CI 2.344-40.105]; p = 0.002) to be significantly associated with worse disease-specific survival. Conclusions: Prognosis varied in hereditary MTC patients with RET C634 mutations. Our data highlight that the RET C634R mutation was associated with greater tumor aggressiveness in MTC and a poorer disease-specific survival.

Background: Estrogen may contribute to a higher prevalence of autoimmune thyroid disease (AITD) in women. However, it is unknown whether estrogen-containing cosmetics may be associated with AITD. This study aimed to (1) measure the estrogen concentration in skincare cosmetics sold in China, (2) examine the thyroid autoantibody levels in nude mice after dermal estrogen application, and (3) explore the relationship between skincare cosmetic use and AITD in the Chinese population in a population-based cross-sectional study and hospital-based case-control study. Methods: Skincare cosmetics of variable type and price were collected from various Chinese retail merchants and online shopping platforms to measure the respective estrogen concentrations in the products. Nude mice were smeared with estrogen on the skin to assess their effects on the thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) levels. A cross-sectional study was conducted in four districts or counties to compare differences in serum TPOAb, TgAb, and thyroid function between cosmetic users and nonusers. A case-control study was conducted in four district hospitals and two city hospitals to explore the association between cosmetic use and AITD. Results: Estriol was detected in 73 of 240 skincare cosmetic products, with a median concentration of 34.58 µg/g. In animal experiments, serum thyroid autoantibodies were significantly increased in mice smeared with (low or high) estriol-containing creams compared with controls (TPOAb, 31.07 ± 6.89 ng/L or 32.22 ± 8.92 ng/L vs. 21.27 ± 6.32 ng/L, p < 0.05; TgAb, 20.94 ± 6.12 ng/L or 19.56 ± 8.35 ng/L vs. 11.28 ± 1.43 ng/L, p < 0.05). In a cross-sectional study, no difference was found in TPOAb, TgAb, and thyroid function between skincare cosmetic users and nonusers (p > 0.05). However, the case-control study revealed a significant association between skincare cosmetics use and the presence of AITD (odds ratio = 1.577, confidence intervals 1.037-2.400, p = 0.033) after adjusting for other related variables. Conclusions: Estriol was found in some skincare cosmetics sold in China. Dermal estriol application could induce thyroid autoimmune reactions in nude mice. Preliminary population-based study data suggest that skincare cosmetic use may be associated with AITD. Prospective cohort studies or randomized controlled trials are needed in the future to confirm a potential association between estriol in skincare cosmetic use and AITD.

Background: Developed by members of the American Thyroid Association (ATA) Clinical Affairs Committee, this executive summary of the 2025 ATA guidelines for adult patients with differentiated thyroid cancer provides a summary of key points and recommendations with an emphasis on notable differences between the 2025 and 2015 guidelines. Summary: The updated guidelines emphasize individualized care through the DATA framework (Diagnosis, risk/benefit Assessment, Treatment decisions, and response Assessment) with the goal of enhancing shared decision-making and personalized care. Highlights include expanded role of molecular diagnostics, refined risk stratification, greater emphasis on active surveillance and lobectomy, inclusion of ablative procedures, and selective use of external beam radiation therapy and chemoradiotherapy. De-escalation of surveillance for low-risk patients and introduction of the concept of complete remission are also new. Conclusions: This executive summary aims to provide a summary of key points and recommendations with an emphasis on notable differences between the 2025 and 2015 guidelines.

Background: The number of retrieved lymph nodes (rLN) is an important surgical metric associated with survival in cancer. However, its association with oncological outcomes in patients with papillary thyroid cancer (PTC) with lateral lymph node (LN) metastasis (N1b disease) has not been investigated. Methods: This retrospective cohort study included patients with PTC and N1b disease (N = 1003) who underwent lateral neck dissection and categorized them by total number of rLNs. We investigated the association of the categories with recurrence or cancer-specific mortality (CSM) using multivariable Cox proportional hazard models. The optimal number of rLNs associated with low recurrence rate or CSM were identified using restricted cubic spline analysis. Survival analyses across subgroups were performed according to adequate (the estimated total number of rLN at which CSM appeared to be lowest) and inadequate groups. Results: At initial surgery, the median total number of rLNs and positive number of LNs was 36.0 (25.0-49.0) and 9.0 (5.0-14.0), respectively. During a median follow-up of 90.0 (73.0-129.0) months, recurrence and CSM were detected in 165 and 30 patients, respectively. A higher total number of rLNs was inversely associated with the adjusted hazard ratio (aHR) for recurrence (0.50, 0.51, 0.33, and 0.28; p for trend = 0.001) and CSM (0.33, 0.13, 0.02, and 0.04; p for trend 0.002). The estimated total number of rLNs associated with the lowest recurrence rate and CSM were 32 and 33, respectively. Compared with the inadequate rLNs group, the adequate rLNs group (≥33 total rLNs) showed better prognosis in the entire group (aHR 0.51 [0.35-0.73], p < 0.001; recurrence) (aHR 0.14 [0.04-0.47], p = 0.001; CSM) and various subgroups. Conclusions: rLNs are associated with recurrence and CSM in patients with PTC and N1b disease, with outcomes appearing to improve at approximately 32-33. This finding suggests that rLNs may serve as a potential quality indicator for neck dissection in PTC. Our finding is mostly applicable to more aggressive disease, and further prospective confirmatory research is warranted.

Background: Radiofrequency and other ablative treatments for thyroid nodules and thyroid malignancies are increasingly being adopted into clinical practice. The safety of these procedures with respect to the recurrent laryngeal nerve (RLN) is not well-characterized. Summary: Our current understanding of RLN injury with thermal ablation procedures is nascent. Review of surgical literature and practices offers a framework for voice and laryngeal evaluation and reveals important features of RLN injury. At present, current strategies to mitigate and manage RLN injury in thyroid ablation procedures are offered by physicians of varying specialties and are empirical. An in-depth understanding of lessons learned from surgical management of the thyroid and RLN should optimize the safety of thermal ablation procedures. Critically examining commonly recommended ablation techniques through a surgical framework may provide practical insights that can be used to minimize the risk of RLN injury. Conclusions: Further work is needed to characterize the risk of thermal injury to the RLN in ablation procedures. Research should address the safety and efficacy of hydrodissection and cold irrigation techniques.

Background: Remote-access thyroid and parathyroid surgery has emerged as a safe and effective alternative to conventional transcervical approaches, particularly valued for its superior cosmetic outcomes. However, global adoption remains inconsistent, hindered by variability in clinical indications, geographic and economic factors, learning curves, and training infrastructure. This international consensus statement aims to provide comprehensive, evidence-based guidance on patient selection, surgeon training, surgical approaches, and expected outcomes. An expert panel was convened with representatives nominated by six leading international societies The Asia-Pacific Society of Thyroid Surgery, American Head and Neck Society, American Association of Endocrine Surgeons, American Thyroid Association, European Society of Endocrine Surgeons, and Latin American Thyroid Society. A modified Delphi process, consistent with Conducting and Reporting of Delphi Studies guidelines, was used. Expert subgroups performed targeted literature reviews and formulated recommendations, which were refined through multiple rounds of anonymous electronic voting. Consensus was defined a priori as ≥80% agreement on a 5-point Likert scale. Summary: A total of 23 consensus statements were established. These include recommendations on minimum surgeon volume requirements, structured training pathways (including cadaveric dissection and proctoring), and patient eligibility based on disease characteristics. The four most commonly utilized remote-access approaches-transoral, gasless transaxillary, bilateral axillo-breast, and retroauricular-each offer distinct advantages and limitations. With an experienced surgeon, these techniques demonstrate oncologic and surgical outcomes comparable with open surgery, with notable improvements in cosmetic satisfaction. Approach-specific complications and extended operative times were acknowledged. The importance of informed consent and the development of high-volume centers of excellence was emphasized. Conclusions: This international consensus statement provides structured, evidence-informed recommendations to support the safe and effective implementation of remote-access thyroid and parathyroid surgery. Widespread dissemination and adoption of these recommendations may improve patient outcomes and promote global standardization of care.

Background: The prognosis and disease course of medullary thyroid carcinoma (MTC) can vary widely among patients. Effective risk stratification is important for ensuring timely treatment and personalized follow-up. Biomarkers can enhance risk stratification and guide the development of targeted anticancer therapies and imaging techniques. While numerous studies have explored various immunohistochemical biomarkers in MTC, an overview is still lacking. This study aimed to provide a comprehensive overview of immunohistochemical biomarkers and their role in the prognosis of MTC patients, with a primary focus on overall survival (OS). Methods: This review was preregistered in PROSPERO (CRD42023469437). A systematic search was performed using the online medical databases Embase, MEDLINE (Ovid), and Cochrane. Quality was assessed using an adapted scoring system based on the REMARK criteria and the Quality in Prognosis Studies tool. The primary outcome was OS. Secondary outcomes included other types of survival and associations with clinicopathological risk factors and recurrence. Results: Of 2992 studies, 108 were included, investigating 170 unique biomarkers and with sample sizes ranging from 11 to 327 participants. The majority (72%) were reported in only one article. A minority of studies were rated as high quality (28%). Markers of proliferation Ki-67 (Ki-67) and programmed cell death-ligand 1 (PD-L1) were significantly associated with OS (hazard ratio [HR]: 6.67, confidence interval [CI]: 1.43-31.18 and HR: 3.34, CI: 1.18-9.51). Conclusions: Our systematic review provides a comprehensive synthesis of the literature on immunohistochemical biomarkers in MTC and highlights the need for high-quality validation studies. Our meta-analysis confirms the prognostic value of Ki-67, although with varying certainty due to large differences in study quality. Furthermore, we describe the association of PD-L1 positivity with poorer OS, increased recurrence, and more aggressive clinicopathological features, which supports the rationale for further investigating the potential of anti-PD-1/PD-L1 immunotherapy for advanced MTC.

Background: The optimal surgical extent for isthmus-confined papillary thyroid carcinoma (PTC) remains unclear. We aimed to evaluate the clinicopathological characteristics, surgical complications, and recurrence rates based on the extent of resection. Methods: This retrospective cohort study included 345 patients who underwent thyroidectomy for solitary isthmus-confined PTC at two affiliated tertiary centers from 2013 to 2022. Patients were excluded if they had multifocal PTC with lobar involvement, large tumors (>4 cm), suspected extrathyroidal extension (ETE), clinically positive lymph nodes (LNs), or aggressive histological subtypes. Clinicopathological features, surgical complication rates, and recurrence rates were compared among the total thyroidectomy (TT), lobectomy (L), and isthmusectomy (I) groups. This retrospective cohort study used propensity score matching (PSM), resulting in two groups of 85 patients: TT/L and I. Results: Among the 345 included patients, 89 underwent TT, 30 underwent L, and 226 underwent I. After PSM, 170 patients were analyzed. The mean age was 48.2 years, and the mean tumor size was 0.8 cm. Microcarcinoma accounted for 71.8% of cases. The rates of ETE (65.3%), multifocality (9.4%), BRAF mutation (75.3%), and Hashimoto's thyroiditis (19.4%) were observed without significant differences between the TT/L and I groups. Risk stratification for central LN metastasis showed no significant difference (high-risk: 21.2% vs. 27.1%, p = 0.353). No recurrence or distant metastasis was observed in either group during a median follow-up of 4.3 years. Median follow-up was longer in the TT/L group (6.1 years [interquartile range (IQR): 4.0-8.5] vs. 3.6 years [IQR: 2.1-4.9], p < 0.001). Major complications were more frequent in TT/L group: transient/permanent hypocalcemia (14.1%/1.2% vs. 0%/0%) and transient vocal cord palsy (3.5% vs. 0%). Levothyroxine dependency was significantly higher in the TT/L group in terms of usage (90.6% vs. 34.1%, p < 0.001), average administered dose (85.5 ± 45.1 µg vs. 21.9 ± 33.2 µg, p < 0.001), and duration (5.2 ± 3.1 years vs. 0.9 ± 1.3 years, p < 0.001). Newly noted thyroid lesions occurred more frequently in the I group (1.3% vs. 10.6%, p = 0.039). Conclusions: Isthmusectomy may be considered for carefully selected patients with isthmus-confined PTC. Validation in long-term prospective studies is warranted.