Thyroid Research最新文献

Background: Iodine is essential to thyroid hormone production, and both excess and deficiency can cause thyroid dysfunction in infants. While urinary iodine concentration (UIC) is used to assess population iodine status, there is no gold standard for determining iodine status in individual infants. Our study aimed to examine the clinical use of UIC in the investigation of thyroid dysfunction in hospitalised infants.

Methods: We examined hospital records of infants (age < 24 months) admitted to The Children's Hospital at Westmead who had UIC collected in the context of thyroid dysfunction between 2007-2009 and 2017-2021, two time periods separated by changes in public health measures for iodine nutrition and local clinical practice.

Results: Of 152 infants, 13.8% had UIC in iodine deficient range (WHO population-based definition: UIC < 100 µg/L) and 53.9% in iodine excess range (UIC ≥ 300 µg/L). Highest quartile UIC (> 1432 µg/L) was significantly associated with pre-test clinician suspicion of iodine excess, identification of source of iodine exposure, higher percentage of premature babies, and those with cardiac anomalies or who required surgery. Median free thyroxine (fT4) level was significantly lower in the highest UIC quartile group compared to the lower three quartiles (9.4pmol/L [interquartile range 7.8-vs 13.7] vs. 12.7 pmol/L [10.3-15.6]; p = 0.004). While median TSH was elevated in all UIC quartiles in this group, there were no significant differences in the levels between the UIC quartile groups.

Conclusions: Extremely high random UIC can be helpful to confirm clinical suspicion of iodine excess in hospital-based infants, taken in the context of thyroid dysfunction in critical illness. The degree of thyroid dysfunction associated with high UIC in this clinically complex and often premature patient population may be better measured by the fT4 level rather than the degree of TSH elevation.

Background: Thyroid angiosarcoma is a rare, highly aggressive malignancy of endothelial origin, characterized by rapid growth, invasive behavior, and a high metastatic potential. While most cases are reported from the Alpine regions of Europe, its occurrence elsewhere is exceedingly rare. The aim of our review is to report a case of thyroid angiosarcoma and provide a systematic review of the literature, focusing on clinical presentation, diagnostic strategies, and treatment outcomes.

Methods: A literature search of thyroid angiosarcoma case reports and series was performed according to PRISMA guidelines. Data on clinical features, diagnostic and treatment methods, and clinical outcomes were retrieved and analyzed. Kaplan-Meier survival curve was constructed to assess overall survival.

Results: A systematic review of 72 cases of thyroid angiosarcoma reported in 52 articles was conducted. The median patient age was 66 years, with female predominance (4:3). Most patients presented with a rapidly enlarging thyroid mass and compressive symptoms. Diagnosis required a combination of histopathology and radiologic imaging, with Fine Needle Aspiration Cytology as the initial tool in 47% of patients. Total thyroidectomy was performed in 67% of cases, and 42% of patients received adjuvant therapies. The prognosis remains poor, with a median overall survival of 28 months and a 3-year survival rate of 40%.

Conclusion: This case highlights the aggressive nature of thyroid angiosarcoma, and the challenges associated with its diagnosis and management. The literature review underscores the need for standardized management protocols and further research to improve patient outcomes.

Background and aim: Evidence suggests that the gut microbiota may have a potential impact on thyroid function, given the gut-thyroid axis and the microbiome's involvement in nutrient absorption, immune modulation, and hormone metabolism. Emerging research highlighted that probiotics and synbiotics may influence thyroid hormone regulation, although findings in original studies are inconsistent. Therefore, this meta-analysis aims to evaluate the effects of probiotics and synbiotics oral supplementation on thyroid hormones in adults.

Methods: A systematic search was conducted across major online databases until April 2025. Studies were selected, relevant data extracted, and statistically analyzed using standard mean differences (SMD) and 95% confidence intervals (CI).

Results: The pooled analysis of nine clinical trials showed that probiotics and synbiotics oral supplementation led to a significant reduction in thyroid-stimulating hormone (TSH) (SMD: -1.10, 95%CI: [-1.96, -0.23], p = 0.013), and significantly increase free triiodothyronine (T3) (SMD: 0.98, 95% CI: [0.10, 1.85], p = 0.029) and free thyroxine (T4) (SMD: 1.04, 95%CI: [0.04, 2.05], p = 0.042). Subgroup analyses indicated that supplementation lasting ≤ 8 weeks showed a stronger effect. Additionally, patients with thyroid disorders show higher responsiveness.

Conclusion: Probiotics and synbiotics supplementation may beneficially modulate thyroid function, demonstrated by a significant reduction in TSH levels and increases in free T3 and free T4, particularly among individuals with thyroid disorders. These findings support the potential role of microbiome-targeted interventions as adjunctive strategies in managing thyroid dysfunction. However, further large-scale, long-term RCTs are needed to confirm their clinical efficacy and to establish standardized protocols for their use in routine care.

Background: The preoperative cervical lymph node metastasis (CLNM) status in patients with papillary thyroid carcinoma (PTC) critically determines the type of lymph node dissection performed. Currently, ultrasonography is the primary method for initial CLNM screening in PTC patients. This study aims to analyze the efficacy of an ultrasonic-characteristics-based scoring system in diagnosing lymph node metastasis in PTC and construct a predictive nomogram.

Methods: The imaging findings, fine-needle aspiration (FNA) results, and surgical pathology data from 269 suspected CLNM cases at Peking University Shenzhen Hospital, spanning from July 2021 to October 2022, were retrospectively analyzed. We identified specific ultrasound characteristics and assigned scores based on our clinical experience. The diagnostic performance of the ultrasound scoring system was assessed by plotting receiver operating characteristic (ROC) curves and calculating the area under the curve (AUC). Additionally, a nomogram was developed using least absolute shrinkage and selection operator (LASSO)-logistic regression. The nomogram's discrimination was evaluated using ROC analysis, its accuracy was assessed with calibration curves, and its clinical utility was determined by decision curve analysis (DCA).

Results: In this study, factors such as age, sex, lymph node length, thickness, aspect ratio, shape, hilum status, echogenicity, microcalcification, cystic necrosis, blood flow pattern, and the ultrasonic score were included in the analysis. The ultrasound score had the highest (AUC = 0.914, 95% confidence interval [CI]: 0.880-0.950), with an optimal cutoff value of 2.5. A score of 3 or higher had a diagnostic sensitivity for CLNM of 81.1%, specificity of 85.2%, positive predictive value (PPV) of 83.1%, negative predictive value (NPV) of 83.4%, and Kappa value of 0.664. Subsequent LASSO regression analysis identified sex, hyperechogenicity, peripheral disordered blood flow, and the ultrasonic score as independent predictors of CLNM, which were incorporated into a logistic regression-based predictive nomogram. The model exhibited strong discriminatory performance in both the training set (AUC = 0.933, 95% CI: 0.820-0.910) and the test set (AUC = 0.958, 95% CI: 0.790-0.890) for distinguishing PTC with and without CLNM. Furthermore, calibration curves and decision curve analysis (DCA) confirmed the model's good fit and favorable clinical net benefit.

Conclusion: The ultrasonic scoring method and the Nomogram have significant clinical utility in the preoperative assessment of CLNM in PTC, reducing unnecessary FNA procedures, and are simple and practical for clinical application.

Clinical trial number: Not applicable.

Background: Dysthyroid Optic Neuropathy (DON) is a sight-threatening complication of Thyroid Eye Disease (TED). This study aims to identify the risk and predictive factors for DON in a multi-ethnic TED cohort.

Methods: Retrospective, cohort study of consecutive TED patients attending a multidisciplinary service over an 11-year period. Consecutive patients aged over 18 years old with a minimum of 6 months follow-up post-diagnosis of TED were included. We compared those patients with DON and those without (no-DON) to determine which factors were more prevalent in patients with DON.

Results: There were 26 and 516 consecutive patients with DON and no-DON. The DON prevalence in the cohort was 5.0%. The DON group had a Mean Age at TED Diagnosis (MATD) of 57.8 vs. 46.1 years in the no-DON group. The mean presenting CAS, TRAb and Gorman Diplopia Score (GDS) were significantly higher 3.73 ± 1.80, 2.76 ± 1.05 and 11.31 ± 11.90 vs. 0.54 ± 0.80, 0.48 ± 0.90 and 6.95 ± 9.22 in the DON compared to the no-DON group respectively (p = 0.00, p = 0.00 and p = 0.04). On multivariable regression, we found the following risk factors for developing DON (Odds Ratios): MATD ≥ 53 years (5.2 p = 0.00), presenting CAS ≥ 4 (P = 0.00), presenting GDS ≥ 3 (7.5 p = 0.00), diabetes (5.7 p = 0.00), and baseline TRAb ≥ 5.0 IU/L (2.9 p = 0.04).

Conclusion: Patients with diabetes, increased MATD, and high presenting CAS, GDS, and TRAb are at increased risk of developing DON in our cohort. Clinicians should be especially vigilant of the risk of sight-threatening complications in TED patients with more than one of the above risk factors.

Background: Immune checkpoint inhibitor (ICI) therapy is used in the management of advanced malignancies. Thyroid function abnormalities have been reported, but more evidence is needed to substantiate the subtypes and course of thyroid disease associated with this treatment.

Case presentation: A 51-year-old woman with metastatic pancreatic cancer and no previous history of autoimmune disease was referred to the Endocrine Department six days after the initiation of combined treatment with ipilimumab (anti-CTLA-4) and nivolumab (anti-PD-1). At the initial endocrinologic assessment, the patient had biochemical overt thyrotoxicosis with suppressed thyroid stimulating hormone < 0.01 mIU/L (reference range (RR), 0.3-4.5 mIU/L), elevated total thyroxine (TT4) > 309 nmol/L (> 24.0 µg/dL) (RR, 60-140 nmol/L; 4.7-10.9 µg/dL), and total triiodothyronine (TT3) 7.0 nmol/L (454.5 ng/dL) (RR, 1.1-2.5 nmol/L; 71.4-162.3 ng/dL). Despite marked biochemical thyrotoxicosis, the patient presented with few symptoms. TSH-receptor antibodies (TRAb) were negative, as were thyroid peroxidase antibodies, whereas elevated levels of thyroglobulin antibodies were found. Thyroid ultrasound revealed an enlarged, heterogeneous hypoechoic gland with increased vascularity. High-dose antithyroid drug (ATD) therapy were followed by a decline in thyroid hormone levels (after one week of treatment: TT4: >309 nmol/L (> 24.0 µg/dL); TT3: 1.8 nmol/L (116.9 ng/dL); after two weeks: TT4: 164 nmol/L (12.7 µg/dL); TT3: 0.9 nmol/L (58.4 ng/dL)). After five weeks, the patient developed biochemical hypothyroidism. Thus, ATD therapy was discontinued, and levothyroxine was initiated.

Conclusion: This case report illustrates with a short time frame from the initiation of ICI therapy the onset of thyrotoxicosis, followed by the development of thyroid insufficiency. This case highlights the challenges associated with subtyping the cause of thyroid dysfunction in patients treated with ICIs. Further, this case highlights the importance of clinical awareness and close monitoring of thyroid function in patients receiving immunotherapy.

Objective: To investigate the clinical characteristics and causal gene mutations in a family with multinodular goiter (MNG).

Methods: A proband and eight family members were enrolled in the study. All participants underwent clinical examination and laboratory tests. Whole exome sequencing was performed on selected individuals. Peripheral venous samples were collected from the subjects, and genomic DNA was extracted. DNA library construction and exome capture were performed on an Illumina HiSeq 4000 platform. The data were analyzed, and Sanger sequencing was used to confirm that there was a variant in the original DNA and to evaluate the inheritance pattern in the family members. MNG tissue obtained from two family members was sequenced by whole exome sequencing.

Results: The proband and four family members were diagnosed with MNG and had undergone thyroidectomy, one of whom was pathologically diagnosed with papillary thyroid microcarcinoma. Thyroid function tests of all family members were normal. Exome sequence analysis identified a heterozygous variant, NM_177438.3:c.2035 A > G (NP_803187.1:p.Ile679Val), in exon 12 of the DICER1 gene in the proband and six family members. The variant was consistent with an autosomal dominant inheritance pattern. However, somatic DICER1 mutation was not detected.

Conclusions: The germline variant NM_177438.3:c.2035 A > G (NP_803187.1:p.Ile679Val) in DICER1 gene was first reported in individuals affected with DICER1-related conditions. It is important to take a detailed family history of patients with MNG. Genetic analysis can help diagnose DICER1 syndrome.

Context: Thyroid hormones play an essential role in lipid metabolism. The association of thyroid function and dyslipidemia in women has been mostly studied in the general population, and epidemiological evidence during pregnancy is scarce.

Objective: We investigated the association of preconception thyroid function and autoimmunity with serum lipid biomarkers during pregnancy among 142 pregnant women enrolled in the Environment and Reproductive Health (EARTH) Study (2005 - 2017) who were seeking treatment at a fertility center.

Methods: Before conception, we measured biomarkers of thyroid function and autoimmunity including thyroid stimulating hormone (TSH), free thyroxine (fT₄), total thyroxine (TT₄), free triiodothyronine (fT₃), total triiodothyronine (TT₃), thyroid peroxidase antibodies (TPOAb), and thyroglobulin antibodies (TgAb). During pregnancy, we assessed lipid biomarkers including serum levels of total triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), non-HDL, and low-density lipoprotein (LDL) cholesterol. Linear regression models were used to study these associations while adjusting for age, body mass index, physical activity, multifetal gestation, infertility diagnosis and trimester of lipid measurement.

Results: We observed a negative association between preconception serum TT₃ and HDL cholesterol levels during pregnancy (β estimate = -8.6, 95% CI = -16.2, -1.1), and a smaller negative association for TT₄ with HDL (β estimate = -0.2, 95% CI = -4.0, 0.0). When stratified by trimester, these associations were stronger for those with lipids measured in the 3^rd trimesters but were not observed for lipids measured in the 1^st and 2^nd trimesters. We also found that each 0.1 unit increase in the preconception fT₃: fT₄ ratio was associated with higher total cholesterol (β estimate = 32.4, 95% CI = 1.93, 62.6), non-HDL (β estimate = 35.8, 95% CI = 5.63, 65.9) and LDL (β estimate = 32.1, 95% CI = 4.48, 59.7) cholesterol in 3^rd trimester, but no association for those with lipids measured in earlier trimesters. No other associations were found for the other examined exposures and outcomes.

Conclusions: This study showed that some preconception biomarkers of thyroid function were associated with serum lipid levels during pregnancy. These results highlight the importance of thyroid function during the preconception window, and its potential impact on cholesterol levels at different time periods in the pregnancy.

Background: Patients with thyroid eye disease may develop dysthyroid optic neuropathy (DON), which is commonly treated via orbital decompression surgery. This study aims to identify preoperative factors that can predict postoperative best corrected visual acuity (BCVA) in patients with DON and to classify recovery rates based on these prognostic factors.

Methods: We retrospectively assessed thirty-two patients (51 orbits) diagnosed with DON who underwent orbital decompression.

Results: Univariate and multivariate mixed effects analysis revealed that preoperative BCVA was the strongest predictor of postoperative BCVA (p < 0.0001). Other significant prognostic factors were extraocular muscle hypertrophy (p = 0.01), visual field mean deviation (p = 0.009), retinal nerve fiber layer thickness (p = 0.01), and afferent pupillary defect (p < 0.0001). We then stratified outcomes by the strongest prognostic factor, preoperative BCVA, which demonstrated that 17 of 19 (89.5%) orbits with preoperative BCVA < logMAR 0.20 (20/32 Snellen) achieved acceptable final vision (defined as better than logMAR 0.40 or 20/50 Snellen), compared to 16 of 20 (80%) orbits with preoperative BCVA logMAR 0.20-0.60 (20/32-20/80 Snellen), and only 3 of 11 (27.3%) orbits with preoperative BCVA > logMAR 0.60 (20/80 Snellen). Patients with preoperative BCVA of logMAR 0.60 (20/80 Snellen) or better had > 80% chance of recovering with acceptable final vision after surgery, compared to a < 30% chance for patients with preoperative BCVA worse than logMAR 0.60 (20/80 Snellen).

Conclusions: These results highlight preoperative BCVA as the strongest predictor of DON outcome and suggest that earlier intervention prior to substantial BCVA deterioration may yield better results.

Level of evidence: 3: Retrospectively Registered.