Endocrine最新文献

Purpose: Randomized clinical trials (RCTs) have shown no benefit of levothyroxine for subclinical hypothyroidism (SCH) in improving well-being, cardiovascular outcomes, or mortality. We aimed to evaluate study procedures' feasibility, safety, and preliminary effects of levothyroxine discontinuation in adults with SCH.

Methods: We conducted a pilot, double-blind, placebo-controlled RCT with 6-month follow-up at a Veterans Affairs Medical Center. Adults with SCH on levothyroxine ≤75 mcg daily were randomized to continue levothyroxine or switch to placebo. The primary outcome was feasibility.

Results: Fifty participants were randomized (32% enrollment rate); five were excluded post-randomization due to unconfirmed SCH, yielding 45 participants (21 levothyroxine, 24 placebo). One patient in the placebo group withdrew for personal reasons (98% completion rate). Participants' mean age was 68.2 years (SD 9.7); 80% were male, and 86.7% were White. At 6 months, there was no statistically significant difference between the placebo and levothyroxine groups in ThyPRO-Hypothyroid Symptoms [28.3 (22.8) vs. 22.9 (19.5)], Tiredness [27.6 (22.8) vs. 32.8 (22.1)], and EQ-5D score [0.750 (0.232) vs. 0.741 (0.180)]. The only notable adverse event was rib fractures in a placebo group participant (TSH 3.04 mIU/L at 6 months). Two participants in the placebo group restarted levothyroxine (n = 1, TSH > 10 mIU/L; n = 1, fatigue).

Conclusion: We demonstrated feasibility of study procedures for discontinuing levothyroxine in patients with SCH and obtained preliminary effects on well-being. The low occurrence of adverse events suggests that levothyroxine discontinuation may be well-tolerated. These findings support conducting a larger multi-site RCT to comprehensively assess the effects of levothyroxine discontinuation.

Clinical trial registration number: NCT04288115.

Purpose: This study aims to evaluate the performance of three large language models (LLMs) in generating patient education materials (PEMs) for thyroid eye disease (TED), intending to improve patients' understanding and awareness of TED.

Methods: We evaluated the performance of ChatGPT-4o, Claude 3.5, and Gemini 1.5 in generating PEMs for TED by designing different prompts. First, we produced TED patient educational brochures based on prompts A and B, respectively. Prompt B asked to make the content simple for sixth graders. Next, we designed two responses to frequently asked questions (FAQs) about TED: standard responses and simplified responses, where the simplified responses were optimized through specific prompts. All generated content was systematically evaluated based on dimensions such as quality, understandability, actionability, accuracy, and empathy. The readability of the content was analyzed using the online tool Readable.com (including FKGL: Flesch-Kincaid Grade Level and SMOG: Simple Measure of Gobbledygook).

Results: Both prompt A and prompt B generated brochures that performed excellently in terms of quality (DISCERN ≥ 4), understandability (PEMAT Understandability ≥70%), accuracy (Score ≥4), and empathy (Score ≥4), with no significant differences between the two. However, both failed to meet the "actionable" standard (PEMAT Actionability <70%). Regarding readability, prompt B was easier to understand than prompt A, although the optimized version of prompt B still did not reach the ideal readability level. Additionally, a comparative analysis of FAQs about TED on Google using LLMs showed that, regardless of whether the response was standard or simplified, the LLM's performance outperformed Google, yielding results similar to those generated by the brochures.

Conclusion: Overall, LLMs, as a powerful tool, demonstrate significant potential in generating PEMs for TED. They are capable of producing high-quality, understandable, accurate, and empathetic content, but there is still room for improvement in terms of readability.

Purpose: The American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) is a widely used ultrasonographic risk-stratification system for thyroid nodules in adults and its use has been increasingly expanding in the pediatric population in recent years. Here, we evaluated the diagnostic performance of ACR-TIRADS in patients aged ≤ 18 years with thyroid nodules.

Methods: We performed a single-center retrospective cohort study of patients aged ≤ 18 years, followed by tertiary care for thyroid nodules. The ACR-TIRADS data were extracted from the image records by two radiologists with expertise in thyroid imaging. Malignancy rates were defined based on cytological examinations, histological diagnosis, or ultrasonographic follow-up concerning nodule characteristics and size.

Results: The cohort comprised 58 patients (65 nodules). The majority were female (70.7%), with a mean age of 14.0 ± 3.4 years and 27.5% had at least one risk factor for thyroid malignancy. The malignancy rate was 20.7% (N = 12). We could not reassess the ultrasound images of 9 patients; therefore, for this analysis, 49 patients (56 nodules) were included. The TIRADS nodule classifications were as follows: 8 TR1 (14.3%), 18 TR2 (32.1%), 15 TR3 (26.8%), 7 TR4 (12.5%), and 8 TR5 (14.3%). The ACR-TIRADS interobserver agreement was high, with a free marginal kappa of 0.86 [95% confidence interval (CI): 0.75, 0.97]. All TR1, TR2, and TR3 nodules were benign, and 8 cases of thyroid malignant neoplasm in the TR4 (N = 1) and TR5 (N = 7) groups resulted in malignancy rates of 14.3 and 87.5%, respectively. Remarkably, the TR5 nodules exhibited a positive predictive value of 87.5%, negative predictive value of 97.9%, sensitivity of 87.5%, and specificity of 97.9% for predicting malignancy. We did not identify a cutoff of nodule size for predicting malignancy - area under the receiver operating characteristic curve (AUC) of 0.58 (95% CI 0.38-0.80).

Conclusion: ACR-TIRADS effectively stratifies malignancy risk in pediatric thyroid nodules, with TR5 nodules showing particularly high malignancy risk. Clinical risk factors combined with ultrasound characteristics provide better malignancy prediction than nodule size alone in this population.

Purpose: Assessing body composition is essential for evaluating metabolic syndrome (MS) and nonalcoholic fatty liver disease (NAFLD). However, studies on the relationship between these conditions and dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) in children and adolescents remain limited. This study aimed to investigate the associations between DXA and BIA parameters, and their utility in predicting MS and NAFLD in the youth.

Methods: Data from the Korea National Health and Nutrition Examination Survey 2009-2011 and 2022 were analyzed, including 1661 children and adolescents who underwent DXA, and 359 who underwent BIA; 712 were matched through propensity score matching. Pearson correlation and logistic regression analyses (with MS and NAFLD as dependent variables) were used to assess associations between DXA and BIA parameters. Predictive performance was evaluated using area under the receiver operating characteristic (ROC) curve comparisons.

Results: Pearson correlation analyses revealed significant positive correlations between DXA and BIA parameters. In the logistic regression analyses, fat-related parameters were positively associated with MS and NAFLD, whereas muscle-related parameters showed negative associations, even after adjusting for age and sex. In the ROC analyses, BIA body fat mass had the highest predictive performance for both MS and NAFLD, followed by DXA body fat mass and percentage of body fat. Fat-related parameters were superior to muscle-related parameters for predicting MS and NAFLD.

Conclusion: BIA and DXA are useful tools for assessing MS and NAFLD in children and adolescents, and their complementary use enhances predictive accuracy, particularly through fat-related parameters.

Purpose: Type 1 diabetes mellitus (T1D) is a chronic autoimmune disease frequently associated with other autoimmune diseases. This study aims to evaluate the prevalence of additional autoimmunity in adults with T1D and its association with glycemic control, chronic complications, and other comorbidities.

Methods: We performed a cross-sectional study in adult patients with T1D, followed at the Endocrinology Department of a tertiary hospital, between May 2022 and May 2024. Clinical data collected included glycemic control (HbA1c and continuous glucose monitoring [CGM] parameters), diabetes complications, and other comorbidities. These parameters were compared according to the history of autoimmune diseases. Statistical analysis was performed using parametric and non-parametric tests, ANCOVA and logistic regression models, unadjusted and adjusted for age and sex.

Results: Of the 439 participants (48.8% female and mean age 36.8 ± 14.1 years), 33.8% had at least one autoimmune disease, predominantly Hashimoto's thyroiditis (28.8%) and celiac disease (3.9%), with higher prevalence in women (p < 0.001). HbA1c (7.7 ± 1.3 vs. 7.8 ± 1.4%, p = 0.53) and CGM-derived parameters, such as glucose management indicator (7.4 ± 0.9 vs. 7.4 ± 0.8%, p = 0.44) and time in range (58.7 ± 18.9 vs. 56.6 ± 16.5%, p = 0.84), were similar in patients with and without autoimmune diseases.

Conclusions: Over one fourth of patients with T1D had a concomitant autoimmune disease. Our results suggest that the presence of other autoimmune diseases may not preclude the attainment of similar glycemic targets. Given the high risk of autoimmunity in T1D, systematic screening and personalized treatment should be considered. Prospective studies are warranted to explore the long-term implications on metabolic control and cardiovascular outcomes.

Aims: This study examines the global burden of type 1 diabetes (T1D) among adolescents and young adults (15-39 years) from 1990-2021, with projections to 2045.

Methods: Using data from the Global Burden of Disease (GBD) 2021, we analyzed T1D prevalence, incidence, deaths, disability-adjusted life years (DALYs), and annual percent change (AAPC), with regional and gender differences.

Results: In 2021, global T1D prevalence among 15-39-year-olds was 7.34 million cases (95% UI: 5.94-9.00 million), with males accounting for 50.66%. Incidence was 196,104 cases (141,606-277,782), with 55.31% males. From 1990-2021, prevalence increased from 200.11-246.89 per 100,000 (AAPC 0.68), and incidence rose from 5.10-6.59 per 100,000 (AAPC 0.83). In 2021, there were 16,135 deaths and 1.40 million DALYs, with 54.94% attributed to males. Death rates decreased (AAPC -0.35). Middle SDI regions had the highest prevalence (1.86 million) and incidence (54,541), while high SDI areas had the highest rates. Low-middle SDI areas had the most deaths (5170) and DALYs (419,772). South Asia had the highest prevalence (1.73 million), incidence (46,310), deaths (5189), and DALYs (413,293). India, the USA, and China had the highest prevalence and incidence, while Finland, Canada, and Italy had the highest rates. By 2045, T1D incidence is projected to reach 571,556 cases, predominantly affecting those aged 15-19 years.

Conclusion: The rising burden of T1D among adolescents and young adults underscores the need for targeted interventions and healthcare policies, particularly in high-risk regions.

Purpose: Although calcitonin (CT)-secreting neuroendocrine neoplasms (NENs) represent a relevant differential diagnosis for medullary thyroid carcinoma, the paucity of data makes it difficult to define their prevalence and biology. The purpose of this study was to evaluate important clinical features of CT-secreting NENs.

Methods: We retrospectively analysed all CT-secreting NENs in a series of 1216 patients with NENs of all primary locations treated at a national referral centre over a course of 20 years. We performed necessary laboratory, histopathological, morphological and functional work-up. Statistical analysis was performed with SPSS, with a p value ≤ 0.05 considered as significant.

Results: We identified 71 patients with CT-secreting NENs that predominantly originated from the pancreas and lung. The majority of tumours were of a higher grade and were mostly metastatic (91.5%). Almost one-third of the tumours (32.4%) co-secreted another hormone(s). Diarrhoea was rarely present (21.1%) and was not correlated with CT values (p = 0.174). The calcitonin level did not correlate with the Ki67 index but was correlated with the presence of metastatic disease (p = 0.008). The median overall survival was 15.0 ± 4.7 months (95% CI 5.8–24.2). A total of 64.8% of patients had CT values above 100 pg/mL. Although this group had significantly shorter survival (p = 0.048), this was proven to be the effect of more frequent metastatic disease.

Conclusion: Calcitonin secretion seems to be a marker of more aggressive tumour behaviour. We suggest that CT measurements should be more systematic, at least for pancreatic and lung NENs.

Purpose: Given the heightened cardiovascular risk in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), identifying dietary patterns associated with reduced cardiovascular risk is essential. This study aimed to investigate the association between adherence to various dietary patterns and cardiovascular disease (CVD) mortality in a middle-aged Korean MASLD population.

Methods: Baseline data from 32,091 adults aged 40 years and older enrolled in the Korean Genome and Epidemiology Study (KoGES) between 2004 and 2013 were analyzed. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire, and principal component analysis was applied to identify distinct dietary patterns. The primary outcome was CVD mortality, assessed using Cox proportional hazards models adjusted for confounders, including age, sex, body mass index, smoking status, alcohol intake, physical activity, total calorie intake, hypertension, diabetes, and dyslipidemia.

Results: Adherence to the Korean Mediterranean-style diet was associated with a significantly reduced risk of CVD mortality in MASLD patients, with those in the highest Korean Mediterranean-style diet pattern quartile having a 33% lower risk than those in the lowest quartile (hazards ratio: 0.67, 95% confidence interval: 0.45-1.00, p = 0.048). Other dietary patterns, including the processed food and dairy diet, animal protein-rich diet, grain-based diet, as well as refined carbohydrate and fat-rich diet, were not significantly associated with CVD mortality.

Conclusions: Adherence to Korean Mediterranean-style diet pattern was associated with a lower risk of CVD mortality in Korean adults with MASLD, highlighting its potential as an effective dietary strategy for managing cardiovascular risk in MASLD patients, even in non-Western populations.