Thyroid Research最新文献

Background: There has been an increasing comprehension and recognition of endocrine dysfunction among both pediatric and adult patients with sickle cell disease (SCD). Thyroid disorders can have significant clinical consequences, including growth retardation and impaired cognitive function. However, there is a disparity in the available data concerning the magnitude and spectrum of thyroid abnormalities in this population. This review aimed to provide a systematic summary and analyses on the status of thyroid function abnormalities in individuals with SCD.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was conducted across Medline/PubMed, Google Scholar, World Health Organization Virtual Health Library Regional Portal, and ScienceDirect. Pooled prevalence and standardized mean difference (SMD) estimates with 95% confidence intervals (CIs) were calculated using Comprehensive Meta-Analysis Software version 3.3.

Results: Nineteen studies met the inclusion criteria and were incorporated into the analyses. Serum thyroid-stimulating hormone (TSH) levels were significantly higher in SCD patients compared to controls (SMD = 1.184; 95% CI, 0.269-2.099; p = 0.011). While non-significant, there was a trend towards lower levels of triiodothyronine (T3), thyroxin (T4), free T3, and free T4 in the SCD group (T3: SMD = -1.746; 95% CI, -3.561-0.070; p = 0.059; T4: SMD = -1.365; 95% CI, -3.030-0.300; p = 0.108; free T3: SMD = -0.384; 95% CI, -1.128-0.356; p = 0.311; free T4: SMD = -1.205; 95% CI, -2.522-0.111; p = 0.073). The pooled prevalence of hypothyroidism and subclinical hypothyroidism among SCD patients was found to be 4.9% and 8.7%, respectively.

Conclusion: Individuals with SCD exhibit a tendency towards elevated TSH levels compared to the general population, with a subset potentially developing thyroid abnormalities, particularly subclinical hypothyroidism. Although not highly prevalent in the SCD population, monitoring thyroid function remains essential due to the potential for progression to overt hypothyroidism and its associated adverse health outcomes.

This is an invitation letter for the principal investigators and cohort studies to join the Consortium on Thyroid and Pregnancy. The inclusion criteria are population-based cohorts with data on maternal thyroid function during pregnancy and any measurement of known groups of endocrine disrupting chemicals.

Background: This study aimed to evaluate the efficacy and safety of thermal ablation in the treatment of patients with Bethesda IV thyroid nodules (follicular neoplasms) by analyzing large-scale data on various outcomes.

Materials and methods: Literature searches were conducted in PUBMED, EMBASE, Web of Science, and the Cochrane Library for studies on the use of thermal ablation in patients with Bethesda IV thyroid nodules published from March 1, 2014, to March 1, 2024. Data on volume change at 12 months; the volume reduction rate (VRR) at 1, 3, 6, and 12 months; the complete disappearance rate (CDR); and the complication rate were evaluated. All the data were analyzed with STATA 15.

Results: Five eligible studies were included. The findings indicate that thermal ablation is both effective and safe. The mean change in tumor volume at 12 months postthermal ablation was characterized by a standardized mean difference (SMD) of -1.13 (95% CI: -1.36 - -0.90, p = 0.000). Specifically, the mean changes in tumor volume at 12 months after radiofrequency ablation (RFA) and microwave ablation (MWA) were - 1.19 (95% CI: -1.75 - -0.64) and - 1.26 (95% CI: -1.71 - -0.81), respectively. The VRRs at 1, 3, 6, and 12 months postthermal ablation were 43% (95% CI: 33 - 53%), 47% (95% CI: 20 - 74%), 69% (95% CI: 62 - 76%), and 85% (95% CI: 79 - 90%), respectively. The VRRs at 12 months after RFA and MWA were 84% (95% CI: 76 - 91%) and 85% (95% CI: 75 - 95%), respectively. The VRR at 12 months, stratified by initial nodule size, was 84% (95% CI: 77 - 91%) and 86% (95% CI: 78 - 94%). The CDR at the final follow-up was 88% (95% CI: 80 - 95%). The complication rate was 4.0% (95% CI: 0.0 - 8.0%), with pain and hoarseness being the most frequently reported complications; no life-threatening complications were documented.

Conclusions: Thermal ablation is a reliable treatment for Bethesda IV thyroid nodules, and RFA and MWA are advantageous treatment strategies. However, more prospective, multicenter, and large-sample studies are needed in the future.

Introduction: Thyroid disease (TD), particularly hypothyroidism, is an important etiology of hyperprolactinemia (HPRL). We conducted a systematic review of the clinical characteristics, management, and outcomes of adults (> 18 years) with this clinical association.

Materials and methods: We searched PUBMED, SCOPUS, and EMBASE to find eligible articles published in English from any date till 15th December 2022.

Results: The final systematic review included 804 patients from 47 articles, of which the majority (85.9%) were females. Menstrual irregularity was the most prominent symptom of HPRL (74.3%). Subclinical hypothyroidism (57.1%) was the most reported TD. Individual patient data were available for 62 patients from 35 studies. The median age was 32 (25-42) years, TSH was 110.25 (50-345.4) mU/L, and PRL level was 60 (37.6-91) ng/ml. On treating TD, 38 (70.4%) patients had complete resolution and 10 (18.5%) had an improvement in HPRL. Of 38 patients with pituitary imaging, 26 (68.4%) showed pituitary enlargement, and 13 (34.2%) showed a suprasellar extension. 13 (76.5%) patients had complete resolution and 3 (17.6%) had an improvement in pituitary enlargement on TD treatment. A positive correlation was observed between higher serum TSH levels and higher serum prolactin levels. Patients with pituitary enlargement on imaging had a higher TSH level compared to those without any pituitary enlargement (Median of 263 (61-602) vs. 50 (24.3-128) mU/L; p-value = 0.01).

Conclusion: Thyroid hormone replacement can lead to resolution of HPRL and pituitary enlargement in the majority of patients with HPRL due to overt or subclinical hypothyroidism without the need for dopamine agonist treatment.

The occurrence of post-radioactive iodine thyroid storm among patients with hyperthyroidism is relatively rare and only a few cases have been reported. We conducted a literature review of cases reported from 1951 to 2023 and determined the risk factors and clinical characteristics of patients who developed thyroid storm. A total of 19 cases were documented and reviewed. The mean age was 51.2 ± 20.1 years (range 7.5 to 75). Approximately two-thirds were females. Major etiologies were diffuse toxic goiter (57.9%) and nodular disease (36.8%). Mean dose was 11.3 ± 7.7 mCi (range 3.3 to 35), with 52.6% receiving less than 10 mCi. Mean interval time from administration to development of thyroid storm was 6.6 ± 5.5 days (range 0.5 to 20). The most common preexisting conditions were weight loss, heart failure, atrial fibrillation, hypertension and coronary artery disease. Thyroxine levels were not routinely measured prior to and during storm. Among those with available data, only 26.3% had hormone levels prior to and during storm. Thyroxine levels during storm (range 19.8 to 65 µg/dL) were higher than levels prior to storm (range 9.6 to 45 µg/dL). Pretreatment regimens varied consisting of no intervention, beta blockers, steroids, reserpine, phenobarbital and anti-thyroid drugs. Treatment regimens are more uniform and consistent with American Thyroid Association recommendations. The mortality rate remains high at ~ 26.3%. Statistical analyses did not show any significant differences. Even though the frequency of this condition is quite rare, it is an important and potentially prognostic condition underscoring the value of this review. The inclusion of this severe adverse effect should be part of patient discussion with emphasis on the need to seek early consultation when severe symptoms appear.

Background: Papillary thyroid carcinoma (PTC) is the most common type of thyroid carcinoma, representing the majority of thyroid cancer cases. Most patients with PTC have an excellent prognosis following treatment, yet approximately 10% face mortality within ten years, primarily due to lymph node metastasis (LNM) or local recurrence. The SIX1 gene, a member of the SIX gene superfamily, encodes a transcription factor integral to the development of certain tissues during embryogenesis. The impact of SIX1 in different subtypes of PTC has not been studied previously.

Objective: The purpose of this study was to investigate the expression of SIX1 protein in PTC and to explore its relationship with clinical behavior in two subtypes of PTC: classic PTC (C-PTC) and follicular variant PTC (FV-PTC).

Materials and methods: Using immunohistochemistry, the study analyzed 125 primary PTC cases, including 85 cases of C-PTC and 40 cases of FV-PTC.

Results: The study found significant positive associations between high SIX1 expression and several adverse clinical features across the PTC samples. High SIX1 expression was linked with increased tumor size, multifocal tumors, LNM, high-grade tumor features, advanced tumor stage, lymphovascular invasion, perineural invasion, and extrathyroidal extension (ETE). Within the classic PTC subgroup, high SIX1 expression showed significant positive correlations with Tumor size (P = 0.04), Multifocality (P = 0.02) and High-grade features (P = 0.03). In the follicular variant subgroup, high SIX1 expression was significantly associated with Lymph node metastasis (LNM) (P = 0.001), Lymphovascular invasion (P = 0.03), ETE (P = 0.003) and tumor stage (P = 0.007).

Conclusions: The findings of this study indicate that SIX1 expression is a marker of poor prognosis in PTC, suggesting that its high expression is linked with more aggressive tumor characteristics and advanced disease stages. Importantly, the impact of SIX1 expression varies between C-PTC and FV-PTC, predicting distinct prognostic factors in each subtype. This suggests that SIX1 could be utilized not only as a prognostic biomarker but also in developing subtype-specific therapeutic strategies for PTC patients.

Purpose: Orbital metastasis secondary to thyroid carcinoma is an exceedingly rare occurrence. In this case report, we present a rare isolated orbital metastasis of papillary thyroid carcinoma (PTC).

Methods: A case report and literature review study.

Result: A 55-year-old female, who presented with right-sided exophthalmos persisting for seven months and a week-long history of decreased visual acuity. Orbital computed tomography (CT) revealed a solid, isolated, well-circumscribed mass confined to the right intra-conal orbital cavity. Surgical excision via lateral orbitotomy confirmed the diagnosis of metastatic PTC.

Conclusion: Most cases reported in the literature have identified orbital masses concurrently with the initial diagnosis of thyroid carcinoma. In contrast, our patient exhibited ocular symptoms following a prolonged interval after normal post ablative iodine imaging, highlighting a significant delay in metastatic presentation. Moreover, the solid and well-defined nature of the metastatic orbital mass, confined solely to the orbital cavity without evidence of bony destruction, muscle involvement or intracranial extension in this patient, constitutes a distinctive clinical feature rarely documented in existing case reports.

Background: The aim was to investigate which of two different b values (b 500 s/mm² and b 800 s/mm²) are more effective in the differentiation of benign-malignant nodules using Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI).

Materials and methods: Patients presenting with a preoperative diagnosis of nodular goiter or multinodular goiter were included in this study. These patients underwent neck MRI examinations, and their cases were analyzed retrospectively. A total of 26 patients were included in the study. A total of 46 nodules meeting the study criteria were examined. Measurements were performed on Apparent Diffusion Coefficient (ADC) maps of patients at two different b values (b 500 s/mm² and b 800 s/mm²), and the results were compared with histopathological findings.

Results: Out of a total of 46 nodules, 37 were identified as benign, and 9 as malignant based on histopathological analysis. The mean ADC value at b 500 was lower in malignant nodules (1259.65 ± 328.13) compared to benign nodules (19037.48 ± 472.74). Similarly, the mean ADC value at b 800 was lower in malignant nodules (1081.72 ± 200.23) compared to benign nodules (1610.44 ± 418.06). When a cut-off value of 1.1 × 10^- 3 was accepted for the differentiation of pathology, the sensitivity for distinguishing pathology with ADC values at b 500 was 83.3%, with a specificity of 90.0%, and for ADC values at b 800, the sensitivity was 71.4%, with a specificity of 89.7%.

Conclusion: DW-MRI without the need for contrast agent administration is a useful method in the differentiation of benign-malignant thyroid nodules.

Aim: Studies have shown that renal hypertrophy seen in experimental hyperthyroidism induced by thyroxine (T4) is due to angiotensin (Ang) II. However, other renal effects of Ang II in experimental hyperthyroidism have not been investigated. In addition, Ang 1-7 is believed to be protective against renal injury, but its possible role in thyroxine-induced renal injury is not known. The aim of this study is to elaborate the role of Ang II in thyroxine-induced renal injury and the possible protective role of Ang 1-7. We hypothesize that Ang 1-7 will be as protective against thyroxine-induced renal injury as the use of an ACE inhibitor or an Ang II receptor blocker.

Methods: Adult Sprague Dawley rats were used in this study and were divided into 5 groups: (1) Control (treated with vehicle), (2) Treated with thyroxine (T4, 100 µg/kg), (3) Treated with T4 and Ang 1-7 (500 µg/kg), (4) Treated with T4 and captopril (20 mg/kg), and (5) Treated with T4 and losartan (10 mg/kg). Parameters tested after fourteen days of treatment were creatinine clearance, protein excretion rate, glomerular volume, renal ACE1 and ACE2 protein expression. Data were compared using One-way-ANOVA followed by Tukey's HSD post hoc test.

Results: Thyroxine caused glomerular hypertrophy and proteinuria but had no effect on glomerular filtration rate (GFR). Glomerular hypertrophy was prevented by losartan and captopril, but not by Ang 1-7. Captopril and losartan had no effect on GFR; however, Ang 1-7 caused an increase in GFR in T4-treated rats. The increase in protein excretion rate was prevented by losartan but not by captopril or Ang 1-7. Renal expression of ACE1 protein was not altered in any of the treatment groups except in captopril treated rats were ACE1 expression was increased. Renal ACE2 protein expression was only increased in T4-losartan-treated rats and not affected by any of the other treatments.

Conclusion: We conclude that losartan was more protective than captopril against thyroxine-induced renal changes while Ang 1-7 offered no protection.

Background: Differentiated thyroid cancer (DTC) requires long-term follow-up due to the risk of delayed recurrence. Follow-up surveillance involves serial neck ultrasound (US) and thyroglobulin (Tg); however, the optimal frequency and diagnostic performance of neck US outside of specialized thyroid cancer centres in higher risk patients is not well defined. We sought to evaluate the diagnostic performance of US and serial Tg in advanced stage DTC.

Methods: We retrospectively reviewed our thyroid cancer database for patients with stage III and IV DTC from 2006 to 2018, total thyroidectomy, and at least 2 years follow-up to assess recurrence rates. Those with hemi-thyroidectomy or anti-Tg antibodies were excluded. Diagnostic performance of US and Tg were assessed using a composite reference standard of follow-up imaging and pathology. All relevant US were reviewed by a blinded expert radiologist for uniformity.

Results: Of 136 included patients (91 females, mean age 58.9), 26 (19%) had recurrence of DTC over median follow-up of 6.6 years (IQR 5.3-9.3). The sensitivity and specificity of US in diagnosing cervical recurrence were 73.3% (95% CI 0.51-0.96) and 68.3% (95% CI 0.60-0.77) based on historical reports, respectively, and 80% (95% CI 0.60-1.00) and 87.8% (95% CI 0.82-0.93) based on blinded expert review, respectively. Tg had a sensitivity of 95.5% (95% CI 0.89-1.0) and specificity of 96.2% (95% CI 0.92-0.99) in detecting cervical recurrence or distant metastases. False positive US findings on historical US and subsequent review occurred in 38 (28%) and 15 (11%) patients, respectively, while 5 (3.6%) had false positive Tg results.

Conclusion: Serial Tg has better sensitivity and specificity than US for detecting recurrence of advanced stage DTC. Furthermore, re-interpretation of abnormal findings using structured US reporting with a subspecialized reader may improve diagnostic performance of US and improve its utility in clinical care.