Nonthyroidal illness syndrome(NTIS)is a common finding in critically ill patients,characterized by disruptions in the hypothalamus-pituitary-thyroid axis,resulting in altered levels of thyroxine(T4),triiodothyronine(T...Nonthyroidal illness syndrome(NTIS)is a common finding in critically ill patients,characterized by disruptions in the hypothalamus-pituitary-thyroid axis,resulting in altered levels of thyroxine(T4),triiodothyronine(T3),and reverse T3.This condition,often considered to be an adaptive response aimed at conserving energy,can become maladaptive in prolonged critical illness,contributing to poor outcomes in intensive care unit patients.The pathophysiology of NTIS involves cytokine-driven alterations in thyroid hormone(TH)metabolism,impaired hormone transport,and reduced receptor sensitivity,which-collectively-suppress thyroid function.Despite these insights,the therapeutic role of TH replacement in patients with NTIS remains uncertain.Low doses of levothyroxine and T3 have been trialed,particularly in patients with cardiovascular comorbidities,but clinical studies report conflicting results regarding their impact on mortality and overall patient outcomes.While some evidence suggests potential benefits of T3 administration in specific subgroups,such as patients with septic shock or severe coronavirus disease 2019,robust clinical trials have yet to conclusively demonstrate improved survival or recovery.The heterogeneity in NTIS presen-tation and treatment protocols,as well as the complex nature of TH regulation in critically ill patients,complicates efforts to establish clear guidelines for hormone therapy.Future research should prioritize individualized approaches,optimizing hormone dosing and timing,while aiming to elucidate the long-term effects of such interventions on critically ill patients to improve morbidity and mortality outcomes.展开更多
Pharmaceuticals and personal care products(PPCPs)have been considered as potential contributors to thyroid nodule(TN)and abnormal thyroid homeostasis,but epidemiological evidence is scarce.A total of 1261 individuals ...Pharmaceuticals and personal care products(PPCPs)have been considered as potential contributors to thyroid nodule(TN)and abnormal thyroid homeostasis,but epidemiological evidence is scarce.A total of 1261 individuals comprised of 367 TN patients and 895 controls were recruited from Sichuan,China.The urinary concentrations of fourteen PPCPs were measured.Five thyroid hormones(THs)in serum were determined as indicators of thyroid homeostasis,including thyroid-stimulating hormone,triiodothyronine(T3),thyroxine(T4),free-T3 and free-T4.Serum levels of thyroglobulin antibody(TGAb)and thyroperoxidase antibody(TPOAb)were quantified to identify individual thyroid antibody(TA)statuses.TN patients exhibited higher propyl-paraben(PrP)(median:1.30μg/g Cr)level than controls(0.64μg/g Cr).PrP were significantly associated with TN risk with ORs of 1.060(95%CI:1.002,1.122).The relationship of methyl-paraben with TN risk was nonlinear(p=0.049).PPCP exposurewas significantwith TN risk only in females and TA positive(TPOAb or TGAb)groups,indicating that PPCP susceptibility to TN differs by sex and TA status.Linear regression models showed ethyl-paraben was significantly negatively associated with T4(β:-0.005,95%CI:-0.011,-0.002)and T3(β:-0.007,95%CI:-0.015,-0.002),and positively associated with TPOAb(β:0.059,95%CI:0.000,0.119),suggesting that certain PPCP exposure could affect thyroid homeostasis and autoimmunity.The effects of PPCP exposure on TH and TA levels presented sex-specific.Our findings suggest that PPCP exposure increases TN risk and affects thyroid homeostasis,exhibiting sex and antibody status dependence.展开更多
Molecular testing in thyroid nodules and thyroid cancer is rapidly evolving;care must be used when incorporating molecular testing for thyroid nodules into clinical practice. A clear appreciation of the goals and rest...Molecular testing in thyroid nodules and thyroid cancer is rapidly evolving;care must be used when incorporating molecular testing for thyroid nodules into clinical practice. A clear appreciation of the goals and restraints of molecular testing must be integrated into how physicians use and explain molecular testing to patients. Molecular tests can help rule in cancer for indeterminate thyroid nodules with very specific mutations for thyroid cancer, such as BRAF and RET/PTC, and can help reduce the rates of completion thyroidectomies in this era of de-escalation of the management of thyroid disease. The positive predictive value (PPV) of malignant cytology (Bethesda VI) is 98%;and even though molecular testing improves specificity and PPV, it falls short of this ideal for other mutations. We present a detailed evaluation of the current state of molecular testing and their clinical relevance in the setting of diagnostic utility and their impact on surgical decision-making. By recapitulating the clinical impact of these tests and some of the related drawbacks, we hope to provide adequate up to date information of the appropriate utilization of these tools in the management of indeterminate or suspicious thyroid nodules and highlight future directions on their utilization for the management of thyroid cancer.展开更多
The term thyroid neoplasm incorporates tumors that originate from follicular cells and those that arise from parafollicular cells (C cells). Differentiated thyroid cancer, which originates from follicular cells, inclu...The term thyroid neoplasm incorporates tumors that originate from follicular cells and those that arise from parafollicular cells (C cells). Differentiated thyroid cancer, which originates from follicular cells, includes papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), oncocytic cell carcinoma (Hürthle), poorly differentiated carcinoma, and anaplastic thyroid carcinoma (ATC). PTC tends to have an indolent clinical course with low morbidity and mortality. However, this entity has a broad range of biological and clinical behavior that can result in disease recurrence and death, depending on patient and tumor characteristics and the initial treatment approach. PTC is the most common form of well-differentiated thyroid cancer (WDTC) and based on the most recent statistics, accounts for approximately 89.4% of all thyroid malignancies. PTC appears as an irregular solid or cystic nodule in normal thyroid parenchyma. PTC has the propensity for lymphatic invasion, but it is less likely to have hematogenous spread. Around 11% of patients with PTC present with distant metastases outside the neck and mediastinum. This manuscript with review the current understanding of the epidemiology, pathology, molecular characteristics, prognostic factors, and dynamic risk stratification of PTC centered on an evidence-based and personalized approach.展开更多
Malfunction of the thyroid gland is the second most common endocrine disorder encountered during pregnancy. It is well known that overt disease of the thyroid gland, either hyper or hypo can adversely affect pregnancy...Malfunction of the thyroid gland is the second most common endocrine disorder encountered during pregnancy. It is well known that overt disease of the thyroid gland, either hyper or hypo can adversely affect pregnancy outcome. There is also an ongoing debate surrounding the issue of subclinical hypothyroidism and its effect on the cognitive development of the unborn child. The goal of this paper is to present a systematic review of the literature and the current recommendations for diagnosis and treatment of thyroid disease in pregnancy and postpartum.展开更多
Background: Riedel’s thyroiditis is a rare form of chronic inflammatory disease affecting the thyroid gland. It is characterised by the replacement of the thyroid parenchyma by fibrous tissue. It also affects the adj...Background: Riedel’s thyroiditis is a rare form of chronic inflammatory disease affecting the thyroid gland. It is characterised by the replacement of the thyroid parenchyma by fibrous tissue. It also affects the adjacent vital structures. Due to its characteristic presentations, Riedel’s thyroiditis may not be immediately diagnosed. Objectives: Through this clinical case, we aimed to describe the pathology and clinical characteristics of Riedel’s thyroiditis and the diagnostic, therapeutic, and progressive modalities. Methods: A 62-year-old woman with no particular pathological history is consulted at the outpatient clinic for anterior cervical swelling that has been present for more than 5 years and is associated with respiratory discomfort and dysphagia to solids. Clinical examination, ultrasound, lab tests and injected cervical computed tomography (CT) were performed. These tests were completed with pathological examination. Results: General conditions were normal. Anterior cervical swelling, marked on the right, of hard consistency, causing cervical shielding with healthy surrounding skin, was observed at the examination. A compressive goitre was first suspected. Thyroid tests showed hypothyroidism. The CT revealed a hypodense goitre with micro-calcifications developed at the expense of the right lobe and exerting a mass effect on the trachea and oesophagus. Aspiration thyroid was not conclusive given the suspicion of the malignant nature of the goitre, and the decision to perform a right loboisthmectomy was taken. Pathological examination of the biopsy showed atrophy of the thyroid parenchyma with dense septal fibrosis punctuated by lymphocytes and extending throughout the tissue associated with inflammation—an appearance in favour of Riedel’s thyroiditis. The patient was treated with Levothyroxine and corticoids. Conclusions: This case points out the challenges in diagnosing Riedel’s Thyroiditis and the complexity of the pathology that requires a rigorous diagnostic approach and appropriate treatment for the best outcome.展开更多
A thyroid storm(TS)or thyrotoxic crisis is an infrequent,life-threatening endocrinological emergency due to the worsening of the hyperthyroid state.Thyroid hormones(THs)influence almost all the body cells and tissues&...A thyroid storm(TS)or thyrotoxic crisis is an infrequent,life-threatening endocrinological emergency due to the worsening of the hyperthyroid state.Thyroid hormones(THs)influence almost all the body cells and tissues'differentiation,growth,and energy metabolism.Consequently,excess THs are expected to lead to profound organ function,regulation,and hemodynamic changes.In addition to their roles in metabolism and thermoregulation,THs play critical role in maintaining cardiovascular homeostasis through both genomic and non-genomic mechanisms.Receptors for THs are expressed in myocardial and vascular endothelial tissues,allowing fluctuations in circulating hormone levels to directly influence cardiovascular function.Excess TS induces a hyper-dynamic cardiovascular state,characterized by increased ventricular contractility and improved systolic and diastolic performance.The chronotropic and inotropic properties of THs result in dysregulation of blood pressure,heart rate,contractility,cardiac output,and systemic vascular resistance.This could lead to serious consequences such as cardiomyopathy,heart failure,and life-threatening arrhythmia,ultimately contributing to cardiocirculatory collapse and cardiac death.The management of TS necessitates a systematic approach that emphasizes the significance of resuscitation and identification of the underlying causes.It is crucial to prioritize assessing cardiac function in patients with TS.This review explores the clinical impact of TS on the heart and its clinical repercussions,emphasizing the intricate molecular and pathophysiological mechanisms and the interplay between TS and key cardiovascular parameters.This review summarizes the current knowledge of pathophysiology,pharmacological and mechanical interventions,ranging from beta-blocker use to the surgical approach.展开更多
The number of newborns born with diseases is increasing recently.Thyroid hormones(THs)are closely related to the growth and development of the newborn in the mother's womb and to the carriage of related diseases a...The number of newborns born with diseases is increasing recently.Thyroid hormones(THs)are closely related to the growth and development of the newborn in the mother's womb and to the carriage of related diseases after birth.Environmental endocrine-disrupting compounds(EDCs)have been proven to harm THs in newborns.Phthalates(PAEs),a typical class of EDCs,are commonly used in toys,childcare materials,and food contact materials,which have been closely connected with neonatal thyroid dysfunction and thyroid-related diseases.As restrictions on PAEs becomemore stringent in neonatal field,numerous PAE alternatives are emerging.Associations between exposure to PAEs and their alternatives and dysfunctions in THs have been explored.Hence,we summarized the body burdens and regional characteristics of PAEs and their alternatives in neonatal urine,cord blood,and meconium.Subsequently,the influences of PAEs and their alternatives on thyroid dysfunction,prematurity,low birth weight,fetal growth restriction,respiratory dysfunction,immune disorders,neurological disorders,and reproductive disorders in newborns were evaluated.Furthermore,we scrutinized the effects of PAEs and their alternatives on the neonatal thyroid from signaling,substance transport,and hormone production to explore the underlying mechanisms of action on neonatal thyroid and thyroid-related disorders.As the declining global trends of healthy newborns and the potential impacts of PAEs and their alternatives on thyroid function,a more comprehensive study is needed to discuss their effects on newborns and their underlying mechanisms.This review facilitates attention to the effects of PAEs and their alternatives on thyroid and thyroid-related disorders in newborns.展开更多
Thyroid nodules,a common disorder in the endocrine system,require accurate segmentation in ultrasound images for effective diagnosis and treatment.However,achieving precise segmentation remains a challenge due to vari...Thyroid nodules,a common disorder in the endocrine system,require accurate segmentation in ultrasound images for effective diagnosis and treatment.However,achieving precise segmentation remains a challenge due to various factors,including scattering noise,low contrast,and limited resolution in ultrasound images.Although existing segmentation models have made progress,they still suffer from several limitations,such as high error rates,low generalizability,overfitting,limited feature learning capability,etc.To address these challenges,this paper proposes a Multi-level Relation Transformer-based U-Net(MLRT-UNet)to improve thyroid nodule segmentation.The MLRTUNet leverages a novel Relation Transformer,which processes images at multiple scales,overcoming the limitations of traditional encoding methods.This transformer integrates both local and global features effectively through selfattention and cross-attention units,capturing intricate relationships within the data.The approach also introduces a Co-operative Transformer Fusion(CTF)module to combine multi-scale features from different encoding layers,enhancing the model’s ability to capture complex patterns in the data.Furthermore,the Relation Transformer block enhances long-distance dependencies during the decoding process,improving segmentation accuracy.Experimental results showthat the MLRT-UNet achieves high segmentation accuracy,reaching 98.2% on the Digital Database Thyroid Image(DDT)dataset,97.8% on the Thyroid Nodule 3493(TG3K)dataset,and 98.2% on the Thyroid Nodule3K(TN3K)dataset.These findings demonstrate that the proposed method significantly enhances the accuracy of thyroid nodule segmentation,addressing the limitations of existing models.展开更多
BACKGROUND Thyroid dysfunction during pregnancy is an important disease affecting the health of mothers and children.Two-dimensional(2D)shear wave elastography(SWE)is the newest ultrasonic elastography technology and ...BACKGROUND Thyroid dysfunction during pregnancy is an important disease affecting the health of mothers and children.Two-dimensional(2D)shear wave elastography(SWE)is the newest ultrasonic elastography technology and its value in differentiating benign and malignant thyroid nodules has been widely recognized.However,the value of 2D SWE in evaluating and predicting thyroid function is unclear.AIM To explore prospectively the value of 2D SWE quantitative analysis for the evaluation of thyroid function in the first trimester.METHODS We included outpatients of reproductive age in the Department of Gynecology in Shanghai Changning Maternity and Infant Health Hospital between March 2023 and March 2024 who had conventional ultrasound examination and 2D SWE of the thyroid.They also underwent transvaginal ultrasound examination to confirm early intrauterine pregnancy and serum thyroid stimulating hormone(TSH)level was measured.The patients were divided into pregnant with normal TSH,pregnant with abnormal TSH,and nonpregnant with normal TSH.Conventional ultrasound and 2D SWE results were compared among the three groups.RESULTS A total of 108 patients were included in the study;57 in the pregnant with normal TSH group,18 in the pregnant with abnormal TSH group and 33 were in the nonpregnant with normal TSH group.Thyroid size,thyroid echotexture,2D SWE quantitative parameters including mean elasticity in the region of interest and maximal elasticity in the region of interest showed no significant differences among the three groups(P>0.05).CONCLUSION Conventional ultrasound and 2D SWE features could not reflect the level of serum TSH.展开更多
Thyroid nodules are common,with a prevalence of approximately 70%on thyroid ultrasonography;approximately 5%of these nodules are malignant.Distingui-shing malignant and benign thyroid nodules is critical for clinical ...Thyroid nodules are common,with a prevalence of approximately 70%on thyroid ultrasonography;approximately 5%of these nodules are malignant.Distingui-shing malignant and benign thyroid nodules is critical for clinical management.Clinicians can judiciously select patients for fine-needle aspiration,understand the cytology results and subsequent follow-up,and determine surveillance stra-tegies for non-operated nodules.The challenge in selecting thyroid nodules for fine-needle aspiration is to avoid the diagnosis of small,clinically insignificant cancers without missing more severe diseases.The molecular characteristics of thyroid nodules are critical for their diagnosis and treatment.However,iden-tifying these characteristics is costly and challenging because of unexpected technical difficulties.An imaging association model based on molecular features will bridge the essential link between molecular characteristics and the computed tomography radiomics,then improve diagnostic efficiency,reducing invasive examinations.展开更多
BACKGROUND Thyroid cancer incidence is rising globally,including the Democratic Republic of Congo(DRC).Despite its increasing incidence,limited data exist on physicians’knowledge of thyroid cancer management in the D...BACKGROUND Thyroid cancer incidence is rising globally,including the Democratic Republic of Congo(DRC).Despite its increasing incidence,limited data exist on physicians’knowledge of thyroid cancer management in the DRC.AIM To evaluate the knowledge levels of Congolese physicians regarding the diagnosis and treatment of thyroid nodules and cancers,and to identify existing gaps and areas for improvement.METHODS A descriptive cross-sectional study was conducted from June to August 2024,involving 369 physicians practicing in healthcare facilities across Kinshasa,DRC.Participants were selected using a multi-stage sampling method.Data were collected via a structured questionnaire covering thyroid cancer epidemiology,diagnostic methods,treatment approaches,and prognosis.Data were analyzed using SPSS version 25,employing descriptive and inferential statistics,with a P value≤0.05 being considered as statistically significant.RESULTS Overall response rate was 96.1%.Of all participants,68%were female and 32%were male physicians.General practitioners constituted 84.8%of respondents,with an average age of 34 years.While 53.7%demonstrated adequate knowledge of hypothyroidism management post-thyroidectomy and 61.2%identified the approach for hypoparathyroidism,only 5.1%recognized the need for radiotherapy in metastatic thyroid cancer cases.Awareness of anaplastic thyroid cancer treatment was limited(6.5%),and 90.2%of physicians were unfamiliar with the surgical complications.Moderate understanding was noted in diagnostic protocols,with 44.2%correctly identifying repeat fine-needle aspiration timing in Bethesda I cases.Knowledge of molecular genetics,recurrence risks,and metastasis patterns was remarkably low.CONCLUSION This study highlights significant knowledge gaps among Congolese physicians regarding thyroid cancer management,especially about advanced treatment modalities and molecular genetics.Targeted educational programs and improved access to diagnostic tools are critical to bridging these deficits.Addressing these gaps can enhance the quality of thyroid cancer care and align clinical practices in the DRC with global standards.展开更多
BACKGROUND Accurate preoperative differentiation of benign and malignant thyroid nodules is critical for optimal patient management.However,conventional imaging modalities present inherent diagnostic limitations.AIM T...BACKGROUND Accurate preoperative differentiation of benign and malignant thyroid nodules is critical for optimal patient management.However,conventional imaging modalities present inherent diagnostic limitations.AIM To develop a non-contrast computed tomography-based machine learning model integrating radiomics and clinical features for preoperative thyroid nodule classification.METHODS This multicenter retrospective study enrolled 272 patients with thyroid nodules(376 thyroid lobes)from center A(May 2021-April 2024),using histopathological findings as the reference standard.The dataset was stratified into a training cohort(264 lobes)and an internal validation cohort(112 lobes).Additional prospective temporal(97 lobes,May-August 2024,center A)and external multicenter(81 lobes,center B)test cohorts were incorporated to enhance generalizability.Thyroid lobes were segmented along the isthmus midline,with segmentation reliability confirmed by an intraclass correlation coefficient(≥0.80).Radiomics feature extraction was performed using Pearson correlation analysis followed by least absolute shrinkage and selection operator regression with 10-fold cross-validation.Seven machine learning algorithms were systematically evaluated,with model performance quantified through the area under the receiver operating characteristic curve(AUC),Brier score,decision curve analysis,and DeLong test for comparison with radiologists interpretations.Model interpretability was elucidated using SHapley Additive exPlanations(SHAP).RESULTS The extreme gradient boosting model demonstrated robust diagnostic performance across all datasets,achieving AUCs of 0.899[95%confidence interval(CI):0.845-0.932]in the training cohort,0.803(95%CI:0.715-0.890)in internal validation,0.855(95%CI:0.775-0.935)in temporal testing,and 0.802(95%CI:0.664-0.939)in external testing.These results were significantly superior to radiologists assessments(AUCs:0.596,0.529,0.558,and 0.538,respectively;P<0.001 by DeLong test).SHAP analysis identified radiomic score,age,tumor size stratification,calcification status,and cystic components as key predictive features.The model exhibited excellent calibration(Brier scores:0.125-0.144)and provided significant clinical net benefit at decision thresholds exceeding 20%,as evidenced by decision curve analysis.CONCLUSION The non-contrast computed tomography-based radiomics-clinical fusion model enables robust preoperative thyroid nodule classification,with SHAP-driven interpretability enhancing its clinical applicability for personalized decision-making.展开更多
BACKGROUND Thyroid nodules(TN)are increasingly diagnosed worldwide;investigating the association between TN and colon polyps could be helpful in early detection and management.To our knowledge no meta-analysis has ass...BACKGROUND Thyroid nodules(TN)are increasingly diagnosed worldwide;investigating the association between TN and colon polyps could be helpful in early detection and management.To our knowledge no meta-analysis has assessed the relationship between TN and adenomatous colonic polyps.AIM To assess the association between adenomatous colonic polyps,thyroid-stimulating hormone,and TN.METHODS We searched PubMed,MEDLINE,Cochrane Library,EBSCO,and the first 100 articles in Google for articles published in English from inception until April 2025.We included prospective cohorts,retrospective studies,case-control studies,and cross-sectional studies.The keywords thyroid nodules,adenomatous colon polyps,thyroid volume,metabolic syndrome,insulin resistance,and thyroid malignancy were used.RESULTS Out of 237 articles,25 full texts were reviewed,and 5 full texts were included in the final meta-analysis.No relationship was found between TN,colonic polyps,and thyroid-stimulating hormone levels[odd ratio(OR):1.78,95%confidence interval(CI):0.55-5.74,P=0.33].Colonic polyps were more common among patients with TN when addressing heterogeneity(OR:0.42,95%CI:0.30-0.52,P<0.001 and OR:0.08,95%CI:0.70-0.86,P=0.85).CONCLUSION TN were similar among patients with and without adenomatous colonic polyps.However,TN was more common among colon polyps when addressing the heterogeneity.Thyroid-stimulating hormone was not different between those with and without TN.Age,sex,adiposity,and smoking effects might explain the higher rate observed by the included studies.Further studies controlling for the same are needed.展开更多
BACKGROUND Thermal ablation(TA)has been proved to be effective and safe as minimally invasive treatment method for thyroid nodules.However,patients'experience during the procedures and quality of life varies among...BACKGROUND Thermal ablation(TA)has been proved to be effective and safe as minimally invasive treatment method for thyroid nodules.However,patients'experience during the procedures and quality of life varies among operators.AIM To explore strategy to improve quality of life and subjective experiences during TA for papillary thyroid carcinoma(PTC)based on thermal field management(TFM).METHODS This retrospective propensity-matched cohort study was conducted in a single center.A total of 490 patients with PTC treated with TA from September 2023 to August 2024 were studied and divided into two groups(TFM group and non-TFM group)according to treatment strategies.Propensity score matching(PSM)was used to control for confounding factors.Complications,side effect and com-plaints of patients were compared between the two groups.RESULTS A total of 113 patients(41.7±10.6;31 men,82 women)were assigned to the TFM group,and 377 patients(mean age,41.1±10.7 year;116 men,261 women)were assigned to the non-TFM group.After PSM,a total of 108 patients were included in the TFM group,and 216 patients were included in the non-TFM group.The median follow-up was 10 months(range from 4-15 months).The incidence of voice change in the TFM group was significantly lower than that in the non-TFM group(0.9%vs 6.5%;P=0.049).Although there was no statistically significant difference in rate of pain between the two groups,the proportion of complaining of pain in the TFM group was numerically lower than that in the non-TFM group(3.7%vs 9.7%,P=0.090).CONCLUSION TFM,as a novel procedural optimization technique,can effectively improve quality of life and subjective expe-riences of patients during TA for PTC.展开更多
Thermal ablation has become an established minimally invasive alternative to surgery for papillary thyroid carcinoma,particularly in low-risk patients seeking effective treatment with reduced morbidity.While clinical ...Thermal ablation has become an established minimally invasive alternative to surgery for papillary thyroid carcinoma,particularly in low-risk patients seeking effective treatment with reduced morbidity.While clinical outcomes are favorable,wide variability in complication rates and patient-reported experiences persists across centers and operators,emphasizing the need for strategies that standardize safety and enhance quality of life.Cai et al now introduce thermal field management(TFM),a thoughtful approach that reframes thermal ablation from a purely technical procedure into a precision-guided,patient-centered intervention.By deliberately confining the ablation zone to protect surrounding tissues,TFM addresses complications such as voice change and pain,issues often overlooked in the pursuit of technical success.Their findings,showing reduced complications and improved patient comfort,highlight the value of integrating patient-reported outcomes into routine ablation practice.This places TFM within the broader trajectory of interventional oncology,where precision and patientcenteredness are becoming central goals.If validated in multicenter prospective studies,TFM could extend beyond thyroid cancer and inform the evolution of safer,standardized ablative therapies across multiple organ systems.展开更多
Radioactive iodine(RAI)therapy remains a cornerstone in the management of differentiated thyroid cancer(DTC).The therapeutic efficacy of RAI depends on thyroid-stimulating hormone(TSH)-driven uptake via the sodium-iod...Radioactive iodine(RAI)therapy remains a cornerstone in the management of differentiated thyroid cancer(DTC).The therapeutic efficacy of RAI depends on thyroid-stimulating hormone(TSH)-driven uptake via the sodium-iodide symporter(NIS).Although elevated TSH levels are routinely achieved before RAI administration,the circadian rhythm of TSH,which peaks overnight,is largely overlooked in treatment protocols.Aligning RAI administration with this physiological peak,particularly through evening dosing,may enhance iodine uptake,improve therapeutic efficacy,and reduce systemic exposure.Preclinical data and the known circadian regulation of TSH and NIS support this approach,although clinical validation is lacking.Evening dosing may also improve patient convenience and clinic workflow.However,logistical challenges and the absence of human trials present barriers to implementation.In this narrative review,we synthesize current evidence and tentatively propose the chronotherapeutic alignment of RAI timing as a novel,potentially impactful optimization strategy in DTC management.Prospective studies are needed to evaluate its clinical benefits and feasibility.展开更多
To determine the value of dissecting the recurrent laryngeal nerve during thyroid surgery with respect to preventing recurrent laryngeal nerve injury, we retrospectively analyzed clinical data from 5 344 patients unde...To determine the value of dissecting the recurrent laryngeal nerve during thyroid surgery with respect to preventing recurrent laryngeal nerve injury, we retrospectively analyzed clinical data from 5 344 patients undergoing thyroidectomy. Among these cases, 548 underwent dissection of the recurrent laryngeal nerve, while 4 796 did not. There were 12 cases of recurrent laryngeal nerve injury following recurrent laryngeal nerve dissection （injury rate of 2.2%） and 512 cases of recurrenl laryngeal nerve injury in those not undergoing nerve dissection （injury rate of 10.7%）. This difference remained statistically significant between the two groups in terms of type of thyroid disease, type of surgery, and number of surgeries. Among the 548 cases undergoing recurrent laryngeal nerve dissection, 128 developed anatomical variations of the recurrent laryngeal nerve （incidence rate of 23.4%）, but no recurrent laryngeal nerve injury was found. In addition, the incidence of recurrent laryngeal nerve injury was significantly lower in patients with the infedor parathyroid gland and middle thyroid veins used as landmarks for locating the recurrent laryngeal nerve compared with those with the entry of the recurrent laryngeal nerve into the larynx as a landmark. These findings indicate that anatomical variations of the recurrent laryngeal nerve are common, and that dissecting the recurrent laryngeal nerve during thyroid surgery is an effective means of preventing nerve injury.展开更多
Emil Theodor Kocher and Theodor Billroth pioneered the surgical management of thyroid disease. Their surgical techniques, knowledge of thyroid anatomy, embryology, histology, physiology, and antisepsis practices trans...Emil Theodor Kocher and Theodor Billroth pioneered the surgical management of thyroid disease. Their surgical techniques, knowledge of thyroid anatomy, embryology, histology, physiology, and antisepsis practices transitioned a life-threatening operation to one with acceptable morbidity. The modern head and neck surgeon should have a meticulous surgical technique, combined with a thorough understanding of thyroid embryology and anatomy that is central to the understanding and treatment of the different disease processes of the thyroid gland and the consequences of thyroid gland surgery. In this manuscript we will be examining thyroid gland embryology, anatomy, histology, and physiology that is essential to the practicing thyroid surgeon.展开更多
BACKGROUND The imbalance of hormone levels in the body is closely related to the occurrence and progression of schizophrenia,especially thyroid hormones.AIM To study the relationship between triiodothyronine(T3),thyro...BACKGROUND The imbalance of hormone levels in the body is closely related to the occurrence and progression of schizophrenia,especially thyroid hormones.AIM To study the relationship between triiodothyronine(T3),thyroxine(T4),free T3(FT3),free T4(FT4),thyroid stimulating hormone(TSH)and schizophrenia.METHODS In this study,100 schizophrenia patients were selected from our hospital between April 2022 and April 2024.Their clinical data were analyzed retrospectively.Based on the Positive and Negative Syndrome Scale(PANSS)score,patients were divided into mild(1-3 points,n=39),moderate(4 points,n=45),and severe groups(5-7 points,n=16).Additionally,55 healthy individuals served as a control group.Venous blood samples were collected to measure T3,T4,FT3,FT4,TSH,and cortisol concentrations,analyzing their relationship with PANSS scores.RESULTS The serum levels of T3,FT3,FT4,TSH and cortisol in the schizophrenia group were lower than those in the control group(P<0.05).With the increase of the severity of the disease,the concentrations of T3 and T4 decreased,while the con-centrations of TSH and cortisol increased(P<0.05).The concentrations of TSH and cortisol were positively correlated with the PANSS score,while T3 and T4 were negatively correlated with the PANSS score(P<0.05).The receiver ope-rating characteristic curve results showed that T3,T4,TSH,and cortisol had good efficacy in the diagnosis of schizophrenia.Logistic results showed that decreased T3 level,decreased T4 level,decreased TSH level and increased cortisol level may be independent risk factors for schizophrenia.CONCLUSION Thyroid hormone levels are associated with the severity of schizophrenia symptoms,which can provide new solutions for the diagnosis and treatment of schizophrenia.展开更多
文摘Nonthyroidal illness syndrome(NTIS)is a common finding in critically ill patients,characterized by disruptions in the hypothalamus-pituitary-thyroid axis,resulting in altered levels of thyroxine(T4),triiodothyronine(T3),and reverse T3.This condition,often considered to be an adaptive response aimed at conserving energy,can become maladaptive in prolonged critical illness,contributing to poor outcomes in intensive care unit patients.The pathophysiology of NTIS involves cytokine-driven alterations in thyroid hormone(TH)metabolism,impaired hormone transport,and reduced receptor sensitivity,which-collectively-suppress thyroid function.Despite these insights,the therapeutic role of TH replacement in patients with NTIS remains uncertain.Low doses of levothyroxine and T3 have been trialed,particularly in patients with cardiovascular comorbidities,but clinical studies report conflicting results regarding their impact on mortality and overall patient outcomes.While some evidence suggests potential benefits of T3 administration in specific subgroups,such as patients with septic shock or severe coronavirus disease 2019,robust clinical trials have yet to conclusively demonstrate improved survival or recovery.The heterogeneity in NTIS presen-tation and treatment protocols,as well as the complex nature of TH regulation in critically ill patients,complicates efforts to establish clear guidelines for hormone therapy.Future research should prioritize individualized approaches,optimizing hormone dosing and timing,while aiming to elucidate the long-term effects of such interventions on critically ill patients to improve morbidity and mortality outcomes.
基金supported by the National Natural Science Foundation of China(Nos.21976046 and 42177412)the Ministry of Education of China(No.B17025).
文摘Pharmaceuticals and personal care products(PPCPs)have been considered as potential contributors to thyroid nodule(TN)and abnormal thyroid homeostasis,but epidemiological evidence is scarce.A total of 1261 individuals comprised of 367 TN patients and 895 controls were recruited from Sichuan,China.The urinary concentrations of fourteen PPCPs were measured.Five thyroid hormones(THs)in serum were determined as indicators of thyroid homeostasis,including thyroid-stimulating hormone,triiodothyronine(T3),thyroxine(T4),free-T3 and free-T4.Serum levels of thyroglobulin antibody(TGAb)and thyroperoxidase antibody(TPOAb)were quantified to identify individual thyroid antibody(TA)statuses.TN patients exhibited higher propyl-paraben(PrP)(median:1.30μg/g Cr)level than controls(0.64μg/g Cr).PrP were significantly associated with TN risk with ORs of 1.060(95%CI:1.002,1.122).The relationship of methyl-paraben with TN risk was nonlinear(p=0.049).PPCP exposurewas significantwith TN risk only in females and TA positive(TPOAb or TGAb)groups,indicating that PPCP susceptibility to TN differs by sex and TA status.Linear regression models showed ethyl-paraben was significantly negatively associated with T4(β:-0.005,95%CI:-0.011,-0.002)and T3(β:-0.007,95%CI:-0.015,-0.002),and positively associated with TPOAb(β:0.059,95%CI:0.000,0.119),suggesting that certain PPCP exposure could affect thyroid homeostasis and autoimmunity.The effects of PPCP exposure on TH and TA levels presented sex-specific.Our findings suggest that PPCP exposure increases TN risk and affects thyroid homeostasis,exhibiting sex and antibody status dependence.
文摘Molecular testing in thyroid nodules and thyroid cancer is rapidly evolving;care must be used when incorporating molecular testing for thyroid nodules into clinical practice. A clear appreciation of the goals and restraints of molecular testing must be integrated into how physicians use and explain molecular testing to patients. Molecular tests can help rule in cancer for indeterminate thyroid nodules with very specific mutations for thyroid cancer, such as BRAF and RET/PTC, and can help reduce the rates of completion thyroidectomies in this era of de-escalation of the management of thyroid disease. The positive predictive value (PPV) of malignant cytology (Bethesda VI) is 98%;and even though molecular testing improves specificity and PPV, it falls short of this ideal for other mutations. We present a detailed evaluation of the current state of molecular testing and their clinical relevance in the setting of diagnostic utility and their impact on surgical decision-making. By recapitulating the clinical impact of these tests and some of the related drawbacks, we hope to provide adequate up to date information of the appropriate utilization of these tools in the management of indeterminate or suspicious thyroid nodules and highlight future directions on their utilization for the management of thyroid cancer.
文摘The term thyroid neoplasm incorporates tumors that originate from follicular cells and those that arise from parafollicular cells (C cells). Differentiated thyroid cancer, which originates from follicular cells, includes papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), oncocytic cell carcinoma (Hürthle), poorly differentiated carcinoma, and anaplastic thyroid carcinoma (ATC). PTC tends to have an indolent clinical course with low morbidity and mortality. However, this entity has a broad range of biological and clinical behavior that can result in disease recurrence and death, depending on patient and tumor characteristics and the initial treatment approach. PTC is the most common form of well-differentiated thyroid cancer (WDTC) and based on the most recent statistics, accounts for approximately 89.4% of all thyroid malignancies. PTC appears as an irregular solid or cystic nodule in normal thyroid parenchyma. PTC has the propensity for lymphatic invasion, but it is less likely to have hematogenous spread. Around 11% of patients with PTC present with distant metastases outside the neck and mediastinum. This manuscript with review the current understanding of the epidemiology, pathology, molecular characteristics, prognostic factors, and dynamic risk stratification of PTC centered on an evidence-based and personalized approach.
文摘Malfunction of the thyroid gland is the second most common endocrine disorder encountered during pregnancy. It is well known that overt disease of the thyroid gland, either hyper or hypo can adversely affect pregnancy outcome. There is also an ongoing debate surrounding the issue of subclinical hypothyroidism and its effect on the cognitive development of the unborn child. The goal of this paper is to present a systematic review of the literature and the current recommendations for diagnosis and treatment of thyroid disease in pregnancy and postpartum.
文摘Background: Riedel’s thyroiditis is a rare form of chronic inflammatory disease affecting the thyroid gland. It is characterised by the replacement of the thyroid parenchyma by fibrous tissue. It also affects the adjacent vital structures. Due to its characteristic presentations, Riedel’s thyroiditis may not be immediately diagnosed. Objectives: Through this clinical case, we aimed to describe the pathology and clinical characteristics of Riedel’s thyroiditis and the diagnostic, therapeutic, and progressive modalities. Methods: A 62-year-old woman with no particular pathological history is consulted at the outpatient clinic for anterior cervical swelling that has been present for more than 5 years and is associated with respiratory discomfort and dysphagia to solids. Clinical examination, ultrasound, lab tests and injected cervical computed tomography (CT) were performed. These tests were completed with pathological examination. Results: General conditions were normal. Anterior cervical swelling, marked on the right, of hard consistency, causing cervical shielding with healthy surrounding skin, was observed at the examination. A compressive goitre was first suspected. Thyroid tests showed hypothyroidism. The CT revealed a hypodense goitre with micro-calcifications developed at the expense of the right lobe and exerting a mass effect on the trachea and oesophagus. Aspiration thyroid was not conclusive given the suspicion of the malignant nature of the goitre, and the decision to perform a right loboisthmectomy was taken. Pathological examination of the biopsy showed atrophy of the thyroid parenchyma with dense septal fibrosis punctuated by lymphocytes and extending throughout the tissue associated with inflammation—an appearance in favour of Riedel’s thyroiditis. The patient was treated with Levothyroxine and corticoids. Conclusions: This case points out the challenges in diagnosing Riedel’s Thyroiditis and the complexity of the pathology that requires a rigorous diagnostic approach and appropriate treatment for the best outcome.
文摘A thyroid storm(TS)or thyrotoxic crisis is an infrequent,life-threatening endocrinological emergency due to the worsening of the hyperthyroid state.Thyroid hormones(THs)influence almost all the body cells and tissues'differentiation,growth,and energy metabolism.Consequently,excess THs are expected to lead to profound organ function,regulation,and hemodynamic changes.In addition to their roles in metabolism and thermoregulation,THs play critical role in maintaining cardiovascular homeostasis through both genomic and non-genomic mechanisms.Receptors for THs are expressed in myocardial and vascular endothelial tissues,allowing fluctuations in circulating hormone levels to directly influence cardiovascular function.Excess TS induces a hyper-dynamic cardiovascular state,characterized by increased ventricular contractility and improved systolic and diastolic performance.The chronotropic and inotropic properties of THs result in dysregulation of blood pressure,heart rate,contractility,cardiac output,and systemic vascular resistance.This could lead to serious consequences such as cardiomyopathy,heart failure,and life-threatening arrhythmia,ultimately contributing to cardiocirculatory collapse and cardiac death.The management of TS necessitates a systematic approach that emphasizes the significance of resuscitation and identification of the underlying causes.It is crucial to prioritize assessing cardiac function in patients with TS.This review explores the clinical impact of TS on the heart and its clinical repercussions,emphasizing the intricate molecular and pathophysiological mechanisms and the interplay between TS and key cardiovascular parameters.This review summarizes the current knowledge of pathophysiology,pharmacological and mechanical interventions,ranging from beta-blocker use to the surgical approach.
基金supported by the National Natural Science Foundation of China(No.22225605)the National Key Research and Development Program of China(No.2023YFC3706600)the Strategic Priority Research Program of the Chinese Academy of Sciences(No.XDB0750200).
文摘The number of newborns born with diseases is increasing recently.Thyroid hormones(THs)are closely related to the growth and development of the newborn in the mother's womb and to the carriage of related diseases after birth.Environmental endocrine-disrupting compounds(EDCs)have been proven to harm THs in newborns.Phthalates(PAEs),a typical class of EDCs,are commonly used in toys,childcare materials,and food contact materials,which have been closely connected with neonatal thyroid dysfunction and thyroid-related diseases.As restrictions on PAEs becomemore stringent in neonatal field,numerous PAE alternatives are emerging.Associations between exposure to PAEs and their alternatives and dysfunctions in THs have been explored.Hence,we summarized the body burdens and regional characteristics of PAEs and their alternatives in neonatal urine,cord blood,and meconium.Subsequently,the influences of PAEs and their alternatives on thyroid dysfunction,prematurity,low birth weight,fetal growth restriction,respiratory dysfunction,immune disorders,neurological disorders,and reproductive disorders in newborns were evaluated.Furthermore,we scrutinized the effects of PAEs and their alternatives on the neonatal thyroid from signaling,substance transport,and hormone production to explore the underlying mechanisms of action on neonatal thyroid and thyroid-related disorders.As the declining global trends of healthy newborns and the potential impacts of PAEs and their alternatives on thyroid function,a more comprehensive study is needed to discuss their effects on newborns and their underlying mechanisms.This review facilitates attention to the effects of PAEs and their alternatives on thyroid and thyroid-related disorders in newborns.
文摘Thyroid nodules,a common disorder in the endocrine system,require accurate segmentation in ultrasound images for effective diagnosis and treatment.However,achieving precise segmentation remains a challenge due to various factors,including scattering noise,low contrast,and limited resolution in ultrasound images.Although existing segmentation models have made progress,they still suffer from several limitations,such as high error rates,low generalizability,overfitting,limited feature learning capability,etc.To address these challenges,this paper proposes a Multi-level Relation Transformer-based U-Net(MLRT-UNet)to improve thyroid nodule segmentation.The MLRTUNet leverages a novel Relation Transformer,which processes images at multiple scales,overcoming the limitations of traditional encoding methods.This transformer integrates both local and global features effectively through selfattention and cross-attention units,capturing intricate relationships within the data.The approach also introduces a Co-operative Transformer Fusion(CTF)module to combine multi-scale features from different encoding layers,enhancing the model’s ability to capture complex patterns in the data.Furthermore,the Relation Transformer block enhances long-distance dependencies during the decoding process,improving segmentation accuracy.Experimental results showthat the MLRT-UNet achieves high segmentation accuracy,reaching 98.2% on the Digital Database Thyroid Image(DDT)dataset,97.8% on the Thyroid Nodule 3493(TG3K)dataset,and 98.2% on the Thyroid Nodule3K(TN3K)dataset.These findings demonstrate that the proposed method significantly enhances the accuracy of thyroid nodule segmentation,addressing the limitations of existing models.
基金Supported by the Natural Science Foundation of Shanghai,No.22ZR1458200Medical Ph.D Innovative Talent Base Project of Changning District,No.RCJD2021B09+1 种基金Key Specialty of Changning District,No.20231004Shanghai Changning Maternity and Infant Health Hospital Start-Up Project,No.2020Y-14.
文摘BACKGROUND Thyroid dysfunction during pregnancy is an important disease affecting the health of mothers and children.Two-dimensional(2D)shear wave elastography(SWE)is the newest ultrasonic elastography technology and its value in differentiating benign and malignant thyroid nodules has been widely recognized.However,the value of 2D SWE in evaluating and predicting thyroid function is unclear.AIM To explore prospectively the value of 2D SWE quantitative analysis for the evaluation of thyroid function in the first trimester.METHODS We included outpatients of reproductive age in the Department of Gynecology in Shanghai Changning Maternity and Infant Health Hospital between March 2023 and March 2024 who had conventional ultrasound examination and 2D SWE of the thyroid.They also underwent transvaginal ultrasound examination to confirm early intrauterine pregnancy and serum thyroid stimulating hormone(TSH)level was measured.The patients were divided into pregnant with normal TSH,pregnant with abnormal TSH,and nonpregnant with normal TSH.Conventional ultrasound and 2D SWE results were compared among the three groups.RESULTS A total of 108 patients were included in the study;57 in the pregnant with normal TSH group,18 in the pregnant with abnormal TSH group and 33 were in the nonpregnant with normal TSH group.Thyroid size,thyroid echotexture,2D SWE quantitative parameters including mean elasticity in the region of interest and maximal elasticity in the region of interest showed no significant differences among the three groups(P>0.05).CONCLUSION Conventional ultrasound and 2D SWE features could not reflect the level of serum TSH.
文摘Thyroid nodules are common,with a prevalence of approximately 70%on thyroid ultrasonography;approximately 5%of these nodules are malignant.Distingui-shing malignant and benign thyroid nodules is critical for clinical management.Clinicians can judiciously select patients for fine-needle aspiration,understand the cytology results and subsequent follow-up,and determine surveillance stra-tegies for non-operated nodules.The challenge in selecting thyroid nodules for fine-needle aspiration is to avoid the diagnosis of small,clinically insignificant cancers without missing more severe diseases.The molecular characteristics of thyroid nodules are critical for their diagnosis and treatment.However,iden-tifying these characteristics is costly and challenging because of unexpected technical difficulties.An imaging association model based on molecular features will bridge the essential link between molecular characteristics and the computed tomography radiomics,then improve diagnostic efficiency,reducing invasive examinations.
文摘BACKGROUND Thyroid cancer incidence is rising globally,including the Democratic Republic of Congo(DRC).Despite its increasing incidence,limited data exist on physicians’knowledge of thyroid cancer management in the DRC.AIM To evaluate the knowledge levels of Congolese physicians regarding the diagnosis and treatment of thyroid nodules and cancers,and to identify existing gaps and areas for improvement.METHODS A descriptive cross-sectional study was conducted from June to August 2024,involving 369 physicians practicing in healthcare facilities across Kinshasa,DRC.Participants were selected using a multi-stage sampling method.Data were collected via a structured questionnaire covering thyroid cancer epidemiology,diagnostic methods,treatment approaches,and prognosis.Data were analyzed using SPSS version 25,employing descriptive and inferential statistics,with a P value≤0.05 being considered as statistically significant.RESULTS Overall response rate was 96.1%.Of all participants,68%were female and 32%were male physicians.General practitioners constituted 84.8%of respondents,with an average age of 34 years.While 53.7%demonstrated adequate knowledge of hypothyroidism management post-thyroidectomy and 61.2%identified the approach for hypoparathyroidism,only 5.1%recognized the need for radiotherapy in metastatic thyroid cancer cases.Awareness of anaplastic thyroid cancer treatment was limited(6.5%),and 90.2%of physicians were unfamiliar with the surgical complications.Moderate understanding was noted in diagnostic protocols,with 44.2%correctly identifying repeat fine-needle aspiration timing in Bethesda I cases.Knowledge of molecular genetics,recurrence risks,and metastasis patterns was remarkably low.CONCLUSION This study highlights significant knowledge gaps among Congolese physicians regarding thyroid cancer management,especially about advanced treatment modalities and molecular genetics.Targeted educational programs and improved access to diagnostic tools are critical to bridging these deficits.Addressing these gaps can enhance the quality of thyroid cancer care and align clinical practices in the DRC with global standards.
基金Supported by the Science and Technology Development Fund of Nanjing Medical University,No.NMUB20230037the Youth Scientific Research Nurturing Fund of Jiangbei Campus of Zhongda Hospital Affiliated with Southeast University,No.JB2024Q01.
文摘BACKGROUND Accurate preoperative differentiation of benign and malignant thyroid nodules is critical for optimal patient management.However,conventional imaging modalities present inherent diagnostic limitations.AIM To develop a non-contrast computed tomography-based machine learning model integrating radiomics and clinical features for preoperative thyroid nodule classification.METHODS This multicenter retrospective study enrolled 272 patients with thyroid nodules(376 thyroid lobes)from center A(May 2021-April 2024),using histopathological findings as the reference standard.The dataset was stratified into a training cohort(264 lobes)and an internal validation cohort(112 lobes).Additional prospective temporal(97 lobes,May-August 2024,center A)and external multicenter(81 lobes,center B)test cohorts were incorporated to enhance generalizability.Thyroid lobes were segmented along the isthmus midline,with segmentation reliability confirmed by an intraclass correlation coefficient(≥0.80).Radiomics feature extraction was performed using Pearson correlation analysis followed by least absolute shrinkage and selection operator regression with 10-fold cross-validation.Seven machine learning algorithms were systematically evaluated,with model performance quantified through the area under the receiver operating characteristic curve(AUC),Brier score,decision curve analysis,and DeLong test for comparison with radiologists interpretations.Model interpretability was elucidated using SHapley Additive exPlanations(SHAP).RESULTS The extreme gradient boosting model demonstrated robust diagnostic performance across all datasets,achieving AUCs of 0.899[95%confidence interval(CI):0.845-0.932]in the training cohort,0.803(95%CI:0.715-0.890)in internal validation,0.855(95%CI:0.775-0.935)in temporal testing,and 0.802(95%CI:0.664-0.939)in external testing.These results were significantly superior to radiologists assessments(AUCs:0.596,0.529,0.558,and 0.538,respectively;P<0.001 by DeLong test).SHAP analysis identified radiomic score,age,tumor size stratification,calcification status,and cystic components as key predictive features.The model exhibited excellent calibration(Brier scores:0.125-0.144)and provided significant clinical net benefit at decision thresholds exceeding 20%,as evidenced by decision curve analysis.CONCLUSION The non-contrast computed tomography-based radiomics-clinical fusion model enables robust preoperative thyroid nodule classification,with SHAP-driven interpretability enhancing its clinical applicability for personalized decision-making.
文摘BACKGROUND Thyroid nodules(TN)are increasingly diagnosed worldwide;investigating the association between TN and colon polyps could be helpful in early detection and management.To our knowledge no meta-analysis has assessed the relationship between TN and adenomatous colonic polyps.AIM To assess the association between adenomatous colonic polyps,thyroid-stimulating hormone,and TN.METHODS We searched PubMed,MEDLINE,Cochrane Library,EBSCO,and the first 100 articles in Google for articles published in English from inception until April 2025.We included prospective cohorts,retrospective studies,case-control studies,and cross-sectional studies.The keywords thyroid nodules,adenomatous colon polyps,thyroid volume,metabolic syndrome,insulin resistance,and thyroid malignancy were used.RESULTS Out of 237 articles,25 full texts were reviewed,and 5 full texts were included in the final meta-analysis.No relationship was found between TN,colonic polyps,and thyroid-stimulating hormone levels[odd ratio(OR):1.78,95%confidence interval(CI):0.55-5.74,P=0.33].Colonic polyps were more common among patients with TN when addressing heterogeneity(OR:0.42,95%CI:0.30-0.52,P<0.001 and OR:0.08,95%CI:0.70-0.86,P=0.85).CONCLUSION TN were similar among patients with and without adenomatous colonic polyps.However,TN was more common among colon polyps when addressing the heterogeneity.Thyroid-stimulating hormone was not different between those with and without TN.Age,sex,adiposity,and smoking effects might explain the higher rate observed by the included studies.Further studies controlling for the same are needed.
基金Supported by National High Level Hospital Clinical Research Funding,No.2022-NHLHCRF-PY-07National Natural Science Foundation of China,No.62176268.
文摘BACKGROUND Thermal ablation(TA)has been proved to be effective and safe as minimally invasive treatment method for thyroid nodules.However,patients'experience during the procedures and quality of life varies among operators.AIM To explore strategy to improve quality of life and subjective experiences during TA for papillary thyroid carcinoma(PTC)based on thermal field management(TFM).METHODS This retrospective propensity-matched cohort study was conducted in a single center.A total of 490 patients with PTC treated with TA from September 2023 to August 2024 were studied and divided into two groups(TFM group and non-TFM group)according to treatment strategies.Propensity score matching(PSM)was used to control for confounding factors.Complications,side effect and com-plaints of patients were compared between the two groups.RESULTS A total of 113 patients(41.7±10.6;31 men,82 women)were assigned to the TFM group,and 377 patients(mean age,41.1±10.7 year;116 men,261 women)were assigned to the non-TFM group.After PSM,a total of 108 patients were included in the TFM group,and 216 patients were included in the non-TFM group.The median follow-up was 10 months(range from 4-15 months).The incidence of voice change in the TFM group was significantly lower than that in the non-TFM group(0.9%vs 6.5%;P=0.049).Although there was no statistically significant difference in rate of pain between the two groups,the proportion of complaining of pain in the TFM group was numerically lower than that in the non-TFM group(3.7%vs 9.7%,P=0.090).CONCLUSION TFM,as a novel procedural optimization technique,can effectively improve quality of life and subjective expe-riences of patients during TA for PTC.
文摘Thermal ablation has become an established minimally invasive alternative to surgery for papillary thyroid carcinoma,particularly in low-risk patients seeking effective treatment with reduced morbidity.While clinical outcomes are favorable,wide variability in complication rates and patient-reported experiences persists across centers and operators,emphasizing the need for strategies that standardize safety and enhance quality of life.Cai et al now introduce thermal field management(TFM),a thoughtful approach that reframes thermal ablation from a purely technical procedure into a precision-guided,patient-centered intervention.By deliberately confining the ablation zone to protect surrounding tissues,TFM addresses complications such as voice change and pain,issues often overlooked in the pursuit of technical success.Their findings,showing reduced complications and improved patient comfort,highlight the value of integrating patient-reported outcomes into routine ablation practice.This places TFM within the broader trajectory of interventional oncology,where precision and patientcenteredness are becoming central goals.If validated in multicenter prospective studies,TFM could extend beyond thyroid cancer and inform the evolution of safer,standardized ablative therapies across multiple organ systems.
文摘Radioactive iodine(RAI)therapy remains a cornerstone in the management of differentiated thyroid cancer(DTC).The therapeutic efficacy of RAI depends on thyroid-stimulating hormone(TSH)-driven uptake via the sodium-iodide symporter(NIS).Although elevated TSH levels are routinely achieved before RAI administration,the circadian rhythm of TSH,which peaks overnight,is largely overlooked in treatment protocols.Aligning RAI administration with this physiological peak,particularly through evening dosing,may enhance iodine uptake,improve therapeutic efficacy,and reduce systemic exposure.Preclinical data and the known circadian regulation of TSH and NIS support this approach,although clinical validation is lacking.Evening dosing may also improve patient convenience and clinic workflow.However,logistical challenges and the absence of human trials present barriers to implementation.In this narrative review,we synthesize current evidence and tentatively propose the chronotherapeutic alignment of RAI timing as a novel,potentially impactful optimization strategy in DTC management.Prospective studies are needed to evaluate its clinical benefits and feasibility.
基金supported by the National Natural Science Foundation of China, No. 81271088the Natural Science Foundation of Shanghai, No. 11ZR1423600
文摘To determine the value of dissecting the recurrent laryngeal nerve during thyroid surgery with respect to preventing recurrent laryngeal nerve injury, we retrospectively analyzed clinical data from 5 344 patients undergoing thyroidectomy. Among these cases, 548 underwent dissection of the recurrent laryngeal nerve, while 4 796 did not. There were 12 cases of recurrent laryngeal nerve injury following recurrent laryngeal nerve dissection （injury rate of 2.2%） and 512 cases of recurrenl laryngeal nerve injury in those not undergoing nerve dissection （injury rate of 10.7%）. This difference remained statistically significant between the two groups in terms of type of thyroid disease, type of surgery, and number of surgeries. Among the 548 cases undergoing recurrent laryngeal nerve dissection, 128 developed anatomical variations of the recurrent laryngeal nerve （incidence rate of 23.4%）, but no recurrent laryngeal nerve injury was found. In addition, the incidence of recurrent laryngeal nerve injury was significantly lower in patients with the infedor parathyroid gland and middle thyroid veins used as landmarks for locating the recurrent laryngeal nerve compared with those with the entry of the recurrent laryngeal nerve into the larynx as a landmark. These findings indicate that anatomical variations of the recurrent laryngeal nerve are common, and that dissecting the recurrent laryngeal nerve during thyroid surgery is an effective means of preventing nerve injury.
文摘Emil Theodor Kocher and Theodor Billroth pioneered the surgical management of thyroid disease. Their surgical techniques, knowledge of thyroid anatomy, embryology, histology, physiology, and antisepsis practices transitioned a life-threatening operation to one with acceptable morbidity. The modern head and neck surgeon should have a meticulous surgical technique, combined with a thorough understanding of thyroid embryology and anatomy that is central to the understanding and treatment of the different disease processes of the thyroid gland and the consequences of thyroid gland surgery. In this manuscript we will be examining thyroid gland embryology, anatomy, histology, and physiology that is essential to the practicing thyroid surgeon.
文摘BACKGROUND The imbalance of hormone levels in the body is closely related to the occurrence and progression of schizophrenia,especially thyroid hormones.AIM To study the relationship between triiodothyronine(T3),thyroxine(T4),free T3(FT3),free T4(FT4),thyroid stimulating hormone(TSH)and schizophrenia.METHODS In this study,100 schizophrenia patients were selected from our hospital between April 2022 and April 2024.Their clinical data were analyzed retrospectively.Based on the Positive and Negative Syndrome Scale(PANSS)score,patients were divided into mild(1-3 points,n=39),moderate(4 points,n=45),and severe groups(5-7 points,n=16).Additionally,55 healthy individuals served as a control group.Venous blood samples were collected to measure T3,T4,FT3,FT4,TSH,and cortisol concentrations,analyzing their relationship with PANSS scores.RESULTS The serum levels of T3,FT3,FT4,TSH and cortisol in the schizophrenia group were lower than those in the control group(P<0.05).With the increase of the severity of the disease,the concentrations of T3 and T4 decreased,while the con-centrations of TSH and cortisol increased(P<0.05).The concentrations of TSH and cortisol were positively correlated with the PANSS score,while T3 and T4 were negatively correlated with the PANSS score(P<0.05).The receiver ope-rating characteristic curve results showed that T3,T4,TSH,and cortisol had good efficacy in the diagnosis of schizophrenia.Logistic results showed that decreased T3 level,decreased T4 level,decreased TSH level and increased cortisol level may be independent risk factors for schizophrenia.CONCLUSION Thyroid hormone levels are associated with the severity of schizophrenia symptoms,which can provide new solutions for the diagnosis and treatment of schizophrenia.
