Thyroid Research最新文献

Background: Intravenous methylprednisolone (IVMP) is a first-line treatment for active moderate-severe or sight-threatening thyroid eye disease (TED), but the presence of systemic infections such as latent tuberculosis (TB) or chronic hepatitis B virus (HBV) act as relative contraindications due to the risk of reactivation. There is limited data to guide clinicians in this high-risk group.

Methods: A retrospective case series was conducted involving five TED patients with relative contraindications to immunosuppression. Each patient included had a EUGOGO severity of moderate-to-severe. Multidisciplinary team (MDT) input guided treatment planning. Patients either received IVMP with or without mycophenolate mofetil (MMF) alongside management of their systemic infection or were observed. TED outcomes, infection status, and adverse events were monitored.

Results: Three patients had latent TB and received isoniazid ± rifampicin prophylaxis with two having conservative TED management, due to high-risk features of their TB, and one receiving IVMP with MMF. Two patients had chronic HBV and underwent IVMP therapy with tenofovir or entecavir. No systemic infection progression or adverse events were observed during follow-up. All treated patients showed improvement in Clinical Activity Score (CAS) and improved or stable Graves' Ophthalmopathy Quality of Life (GO-QOL) scores.

Conclusions: Immunosuppression can be safely initiated in TED patients with systemic infections using a multidisciplinary approach. Early screening, judicious patient selection, coordinated care, and prophylactic treatment are key to balancing efficacy with risk mitigation.

Background: Poorly differentiated thyroid carcinoma (PDTC) is a rare, aggressive thyroid malignancy. While thyroid cancer has been reported in monozygotic twins, the occurrence of PDTC in this context is exceptionally uncommon. Such cases may offer unique insights into the interplay between genetic and environmental factors in thyroid cancer development.

Case presentation: We report the case of 67-year-old monozygotic twin sisters, both diagnosed with thyroid malignancies with discordant histology. Patient A presented with a 5.5 cm PDTC with local invasion and distant metastases. She underwent total thyroidectomy and lymphadenectomy followed by radioactive iodine (RAI) therapy. Patient B had a history of recurrent papillary thyroid carcinoma (PTC) over several years, managed with multiple surgeries and RAI. Despite their identical genetic background, the twins developed distinct thyroid cancer subtypes, with varying ages of onset and clinical courses.

Discussion: This case highlights the heterogeneous presentation of thyroid malignancies in genetically identical individuals, suggesting a potential role for environmental or epigenetic factors in tumorigenesis. A review of the literature on thyroid cancer in monozygotic twins indicates a general pattern of similar pathology and age at diagnosis, contrasting with the discordant phenotypes seen in our patients. PDTC poses diagnostic and therapeutic challenges due to its aggressive nature and limited response to conventional therapies. Advances in molecular profiling and targeted treatments may help improve management and outcomes.

Conclusion: The occurrence of discordant thyroid cancer subtypes in monozygotic twins is exceedingly rare and emphasizes the need for further studies exploring genetic and epigenetic contributions to thyroid cancer. Understanding these factors is critical for developing personalized approaches to diagnosis, treatment, and prevention.

In our review, we present possible hypotheses that might explain how sodium glucose cotransporter 2 (SGLT2) inhibitors affect thyroid function. We describe mutual interactions between thyroid hormones and the development of diabetes and obesity. We show the effects of other antihyperglycemic drugs on thyroid hormone changes. We demonstrate how endocrine-disrupting chemicals (EDCs) may act as potential triggers for the development of thyroid disease, obesity and diabetes, and how SGLT2 inhibitors may constitute a potential protective barrier against their negative effects. We describe mechanisms of the immunomodulatory and antioxidant effects of flozins, that may reduce the risk of autoimmune thyroid disease (AITD). We describe beneficial effects of flozins on heart and kidney function, that may also contribute to thyroid protection. Finally, we present a hypothesis of a possible favourable effect of SGLT2 inhibitors on Graves' orbitopathy (GO), myocardial protection in hyperthyroidism, and a reduction in the risk of thyroid cancer. Aim of our work is to summarise current evidence and hypotheses regarding SGLT2 inhibitors and thyroid function. However, it should be borne in mind that there are still limited clinical evidence about impact of flozins on thyroid metabolism.Clinical trial number Not applicable.

Background and aim: Papillary thyroid carcinoma (PTC) is the most common form of thyroid malignancy, and activating mutations in the RAS gene family have been implicated in its pathogenesis and clinical behavior. This study aimed to evaluate the role of RAS mutations in clinical outcomes of patients with PTC.

Methods: We conducted a comprehensive literature search of PubMed, Scopus, and WOS. Eligible studies included data on RAS mutation prevalence and at least one of the predefined endpoints. Hazard ratios (HR) for recurrence-free survival (RFS), odds ratios (OR) for mortality, distant metastasis, and tumor recurrence, and mean differences (MD) for tumor size were used as effect sizes.

Results: A total of 22 studies, involving 4727 patients, were included in this analysis. The pooled prevalence of RAS mutations was 20% (95% CI: 14%-28%). Presence of RAS mutation was associated with significantly higher odds of distant metastasis (OR = 3.12, 95% CI: 1.48-6.59, p < 0.01), while no significant associations were found with RFS (HR = 1.05, 95% CI: 0.52-2.13, p = 0.88), overall mortality (OR = 2.01, 95% CI: 0.60-6.70, p = 0.21), tumor recurrence (OR = 0.35; 95% CI: 0.08-1.61, p = 0.13). Moreover, our findings revealed no significant differences in tumor size between RAS-positive and RAS-negative cases (MD = 0.01, 95% CI: -0.73-0.72, p = 0.96).

Conclusions: RAS mutations are present in 20% of PTC cases and are associated with increased risk of distant metastasis. However, these mutations were not significantly associated with other clinical outcomes. These findings support the integration of RAS mutation testing into postoperative risk stratification to identify patients who may benefit from more intensive surveillance and personalized therapeutic strategies.