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
BACKGROUND Papillary thyroid cancer(PTC)often recurs following surgical excision,necessitating reliable long-term screening techniques after initial management.Ultrasound scans have a poor predictive value and biopsy ...BACKGROUND Papillary thyroid cancer(PTC)often recurs following surgical excision,necessitating reliable long-term screening techniques after initial management.Ultrasound scans have a poor predictive value and biopsy and genetic testing have a low sensitivity.Biomarker detection,including thyroglobulin,has reduced accuracy as residual thyroid tissue remains following surgery.Serum/tissue microRNA detection offers a promising alternative to screen for thyroid malignancy.Based on our previous systematic review,miR-146,miR-221 and miR-222 appear most strongly associated with PTC.AIM To perform a systematic review and meta-analysis,evaluating the use of circulating miR-146,miRNA-221 and miR-222 in PTC diagnosis and staging.METHODS A systematic literature search of MEDLINE,Scopus and the EMBASE library was performed.Human participants of any age,sex or geographical distribution were considered.Original studies assessing the diagnostic and prognostic accuracy of circulating serum miRNAs in histologically-confirmed PTC were included.Proportion and regression meta-analyses(logit-transformed)were conducted.PRISMA guidelines were followed throughout the process.RESULTS Among the 1530 studies screened,6 met the inclusion criteria,reporting non-overlapping populations.For the diagnosis of PTC vs benign nodules(BN),the pooled sensitivity of miR-146 was 80.7%(95%CI:65.2%-90.4%),specificity was 66.9%(95%CI:55.5%-76.6%),and false positive rate was 33.1%(95%CI:23.4%-44.5%).Pooled sensitivity,specificity and false positive rate of miR-222 for diagnosis of PTC vs BN was 64.3%(95%CI:50.3%-76.2%),88.8%(95%CI:82.4%-93%)and 11.2%(95%CI:7%-17.6%)respectively.Pooled sensitivity,specificity and false positive rate of miR-221 in this population demonstrated reduced accuracy.Pooled sensitivity and specificity of PTC vs healthy controls for total serum miRNAs were 82%(95%CI:77%-86%)and 84%(95%CI:76%-90%)respectively.The summary area under receiver operating characteristic curve value for the same analysis was 0.89(95%CI:0.86-0.92).CONCLUSION miRNA-146 and miRNA-222 were most sensitive,validating their efficacy in PTC diagnosis.Larger studies are needed for confident population generalisability.Use of two-MRNA types in conjunction needs to be assessed.展开更多
BACKGROUND Post-thyroidectomy patients frequently experience depressive symptoms triggered by surgical trauma,fluctuating thyroid hormone levels,and the psychological burden of long-term surveillance;however,large-sca...BACKGROUND Post-thyroidectomy patients frequently experience depressive symptoms triggered by surgical trauma,fluctuating thyroid hormone levels,and the psychological burden of long-term surveillance;however,large-scale multivariableadjusted risk-factor data remain scarce.AIM To determine the prevalence and predictors of postoperative depression,and propose tailored mitigation strategies.METHODS We enrolled 108 consecutive patients who underwent thyroidectomies at The First Affiliated Hospital of Hebei North University between January 2023 and January 2025.Depression was assessed using the Self-Rating Depression Scale(SDS),while coping styles and social support were evaluated using the Medical Coping Modes Questionnaire and Perceived Social Support Scale.Logistic regression was used to identify independent risk and protective factors.RESULTS The mean SDS score was 52.58±10.20;62 patients(57.4%)met the criteria for depression(mild 32.4%,moderate 15.7%,severe 9.3%).Univariate analyses revealed higher depression rates among patients aged≥60 years,those with≤highschool education,monthly family income<3000 yuan,131I therapy,and avoidance/surrender coping;and lower social support(P<0.05).Multivariate regression showed income<3000 yuan(OR=5.26,95%CI:1.89-14.60),131I therapy(OR=5.70,95%CI:1.91-17.01),and avoidance/surrender coping(OR=4.77,95%CI:1.51-15.11)as independent risk factors,whereas higher social support was protective(OR=0.22,95%CI:0.09-0.54).CONCLUSIONDepression is common after thyroidectomy,and is driven by socioeconomic,treatment-related,and psychosocialfactors.Targeted interventions that address coping skills and bolster social support should be integrated intopostoperative care.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
Objectives:Metastatic spread to the lung is one of the leading causes of fatal outcomes in thyroid cancer,but the underlying molecular mechanisms remain unclear.To investigate how exosomal microRNA-17-5p(miR-17-5p)pro...Objectives:Metastatic spread to the lung is one of the leading causes of fatal outcomes in thyroid cancer,but the underlying molecular mechanisms remain unclear.To investigate how exosomal microRNA-17-5p(miR-17-5p)promotes lung metastasis in thyroid cancer within the framework of the“seed and soil”hypothesis.Methods:Serum exosomes from thyroid cancer lung metastasis patients and controls were analyzed for miR-17,which was elevated in metastatic cases.miR-17 was transfected into embryonic lung fibroblasts(MRC-5),and their supernatants were cocultured with thyroid cancer cells(Cal62).Cell proliferation and migration were evaluated using colony formation,Ki67 staining,and Transwell assays.Interleukin-6(IL-6)/interleukin-8(IL-8)levels and nuclear factor kappa-B(NF-κB)/nuclear factor kappa-B repressing factor(NKRF)expression were analysed by enzyme-linked immunosorbent assays(ELISA)and western blot.In vivo models verified the metastatic-promoting effect of miR-17.Results:miR-17-5p was significantly enriched in serum exosomes of metastatic patients.In MRC-5 cells,it suppressed NKRF,NF-κB signaling,and increased secretion of IL-6 and IL-8,enhancing Cal62 proliferation and migration.Animal experiments confirmed its role in promoting tumor growth and lung metastasis.Conclusions:Exosomal miR-17-5p remodels the pulmonary microenvironment into a pro-inflammatory niche,facilitating thyroid cancer colonization and offering a potential therapeutic target.展开更多
Objective:To investigate the application effect of dexmedetomidine in anesthesia for thyroid cancer(TC)surgery.Methods:A total of 90 patients admitted to our hospital from January 2023 to December 2023 were selected a...Objective:To investigate the application effect of dexmedetomidine in anesthesia for thyroid cancer(TC)surgery.Methods:A total of 90 patients admitted to our hospital from January 2023 to December 2023 were selected as the study subjects.The patients were divided into an observation group(given continuous intravenous infusion of dexmedetomidine during surgery)and a control group(given continuous intravenous infusion of an equal volume of sodium chloride injection during surgery)by lottery method,and the anesthesia indicators of the two groups were compared.Results:The dosages of remifentanil and propofol in the observation group were lower than those in the control group(p<0.05);the incidence of complications in the observation group was lower than that in the control group(p<0.05);the Visual Analogue Scale(VAS)scores of the observation group at 4 h,12 h,24 h,and 48 h postoperatively,both at rest and during activity,were lower than those of the control group(p<0.05).Conclusion:During surgery for TC patients,continuous intravenous infusion of dexmedetomidine can reduce the dosage of anesthetic drugs and the incidence of anesthesia-related complications,alleviate postoperative pain,and is worthy of promotion and application.展开更多
Objective:The varying environmental exposure to iodine has long been a topic of interest,particularly given the noticeable increase in the incidence of papillary thyroid carcinoma(PTC)compared to other histopathologic...Objective:The varying environmental exposure to iodine has long been a topic of interest,particularly given the noticeable increase in the incidence of papillary thyroid carcinoma(PTC)compared to other histopathological subtypes globally.This rise in thyroid cancer incidence has been attributed to several factors,including improved detection of early tumors,a higher prevalence of modifiable individual risk factors,and differing exposure to environmental risk factors such as iodine levels.This study aims to explore the epigenetic mechanisms that promote thyroid cancer progression under excess iodine exposure.Materials and methods:This study outlines the following strategy:(i)risk factors were identified through statistical analysis of questionnaire responses in a retrospective iatrogenic study;(ii)following the identification of risk factors,RNA sequencing was performed using tissues from iodine-adequate(IA)and iodine-excess(IE)regions;(iii)candidate hub genes were selected via bioinformatics analysis;(iv)molecular biological techniques were employed to verify the functionality of the key gene.Results:Through careful selection,we focused on SPSB4,a ubiquitin ligase previously unreported in relation to both iodine and thyroid cancer.By optimizing the dosage of PTC cell line activities,we determined how varying iodine levels can either enhance or impair the vitality of thyroid cancer cells.As anticipated,migration and invasion assays revealed significant changes when SPSB4 function was disrupted at the critical dose of KIO3.Conclusion:In terms of epigenetic alterations,SPSB4 emerges as a promising candidate for further investigation,particularly in understanding thyroid cancer progression and potential carcinogenesis.Moreover,E3 ubiquitin ligases,including SPSB4,play a role in orchestrating adipose thermogenesis to maintain body temperature during cold stimuli.This study could also shed light on the influence of iodine on thermogenesis mediated by SPSB4 under cold conditions,while suggesting future exploration of SPSB4's effects on thyroid cancer in colder regions.展开更多
Thyroid cancer is a common endocrine malignancy with a rising incidence.Pa-tients often suffer from mental pain due to concerns about recurrence,treatment-related side-effect,and body image changes.Demographic factors...Thyroid cancer is a common endocrine malignancy with a rising incidence.Pa-tients often suffer from mental pain due to concerns about recurrence,treatment-related side-effect,and body image changes.Demographic factors like age,gender,physiological factors such as somatic symptoms and disease stage,co-gnitive-regulatory factors including negative and positive thinking,and social factors like work,economy,education level,and social support all influence their mental state.Existing interventions,including nursing,psychological,and tra-ditional Chinese medicine-based methods,have some benefits but face limitations like short-term effectiveness and lack of standardization.Future research should focus on creating better-defined,long-term,and widely applicable intervention programs and explore positive psychology-based approaches to improve patients'mental well-being and quality of life.展开更多
BACKGROUND Thyroid malignancies,while accounting for a small proportion of cancer diagnoses globally,have demonstrated a consistent upward trend in occurrence across diverse populations,with gender-specific analyses r...BACKGROUND Thyroid malignancies,while accounting for a small proportion of cancer diagnoses globally,have demonstrated a consistent upward trend in occurrence across diverse populations,with gender-specific analyses revealing a disproportionate burden among women.Despite the characteristically indolent nature of most thyroid carcinomas and their associated high survival rates,emerging evidence points to significant unmet needs regarding psychosocial adaptation and neuropsychiatric sequelae in this growing survivor population.The spectrum of mental health conditions,ranging from affective and anxiety disorders to cognitive impairments,presents substantial barriers to functional recovery and may potentially influence disease trajectories through complex psychoneuroimmunological pathways.Clinical observations consistently report elevated rates of mood disturbances and executive function deficits persisting throughout the cancer continuum,from active treatment into extended follow-up periods.These findings highlight a critical knowledge gap in understanding the dynamic interplay between thyroid cancer biology,its therapeutic interventions,and the development of treatment-resistant psychiatric manifestations that complicate long-term patient care.AIM To analyse the factors influencing the poor prognosis of patients surviving longterm differentiated thyroid cancer with psychiatric disorders and to construct a prediction model.METHODS Forty-eight patients with mental disorders combined with differentiated thyroid cancer who were treated in our hospital during the period of March 2018 to March 2023 were retrospectively selected as the study subjects(thyroid cancer group),and 30 cases each of patients with mental disorders combined with benign thyroid nodules(benign nodules group)and patients with mental disorders alone(mental disorders group),who were treated during the same time period,were selected as controls.The patients with differentiated thyroid cancer were further divided into a poor prognosis group(10 cases)and a good prognosis group(38 cases).The study outcome was poor prognosis as shown by whole body bone imaging within 2 years after thyroid cancer surgery.Factors influencing poor prognosis in survivors of differentiated thyroid cancer were analyzed by univariate and multivariate logistic regression analyses,receiver operating characteristic(ROC)curve analysis was used to assess the predictive efficacy of these factors for poor prognosis,and the DeLong test was used to determine whether there was a statistically significant difference in the area under the curve(AUC)of the model.RESULTS One-way logistic regression analysis showed that tumour diameter[odds ratio(OR)=19.190,P=0.002],T-stage(OR=7.692,P=0.018),extra-glandular infiltration(OR=37.000,P=0.003),degree of differentiation(OR=24.667,P=0.008),serum free T3(OR=22.348,P=0.025),serum free T4(FT4)(OR=1.158,P=0.002),total bilirubin(TBil)(OR=1.792,P=0.004),albumin(OR=0.675,P=0.003),cortisol(OR=1.180,P=0.003),norepinephrine(OR=1.047,P=0.002),angiotensin II(OR=1.975,P=0.002),and superoxide dismutase(OR=0.515,P=0.005)all increased the risk of poor prognosis in patients with psychiatric disorders and long-term differentiated thyroid cancer.Multifactorial logistic regression analysis showed that tumour diameter(OR=16.570,P=0.021),extraglandular infiltration(OR=53.145,P=0.010),FT4(OR=1.186,P=0.007),and TBil(OR=2.823,P=0.048)were independent risk factors for poor prognosis of patients with psychiatric disorders with long-term differentiated thyroid cancer,and the regression equation was:Y=2.808×tumour diameter+3.973×extra-glandular infiltration+0.171×FT4+1.038×TBil-88.138.ROC analysis showed that the predictive power of the overall model(AUC=0.992,P=0.000)was significantly higher than that of independent risk factors(DeLong test P<0.05).CONCLUSION Tumour diameter,extra-glandular infiltration,FT4,and TBil are independent risk factors for poor prognosis in patients with psychiatric disorders with long-term differentiated thyroid cancer,and the combination of these factors is of higher value in predicting the prognosis of patients.These risk factors can be used as a basis to develop a reasonable prognostic management plan in clinical practice for patients with long-term differentiated thyroid cancer with mental disorders,so as to improve the prognosis and quality of life of patients.展开更多
Thyroid cancer(TC)is one of the most common endocrine system tumors,and its incidence continues to increase worldwide.Although most TC patients have a good prognosis,especially with continuous advancements in surgery,...Thyroid cancer(TC)is one of the most common endocrine system tumors,and its incidence continues to increase worldwide.Although most TC patients have a good prognosis,especially with continuous advancements in surgery,radioactive iodine therapy,chemotherapy,endocrine therapy and targeted therapy,the effectiveness of disease treatment has significantly improved.However,there are still some cases with a higher risk of death and greater aggressiveness.In these more challenging advanced or highly aggressive cases,tyrosine kinase inhibitors appear to be an effective treatment option.Unfortunately,these drugs are less than ideal in terms of efficacy because of their toxicity and potential for intrinsic or acquired resistance.Therefore,exploring new strategies targeting the metabolic characteristics of TC cells and overcoming drug resistance barriers in existing treatments have become key topics in the current field of TC research.In recent years,lipid metabolic reprogramming has gained attention as an important aspect of cancer development.Lipid metabolic reprogramming not only participates in the formation of the cell membrane structure,but also plays an important role in signal transduction and promoting cell proliferation.In particular,fatty acid(FA)metabolic reprogramming has attracted widespread attention and plays an important role in multiple aspects such as tumor growth,metastasis,enhanced invasive ability,immune escape,and drug resistance.Although TC is considered a disease that is highly dependent on specific types of metabolic activities,a comprehensive understanding of the specific mechanism of action of FA metabolic reprogramming in this process is lacking.This article aims to review how FA metabolic reprogramming participates in the occurrence and development of TC,focusing on the impact of abnormal FA metabolic pathways and changes in the expression and regulation of related genes over the course of this disease.By examining the complex interactions between FA metabolic disorders and carcinogenic signaling pathways in depth,we aim to identify new therapeutic targets and develop more precise and effective treatments for TC.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
Refractory thyroid cancer is frequently associated with a poor prognosis,necessitating alternative therapeutic approaches.Tyrosine kinase inhibitors(TKIs)have emerged as a promising treatment option,showing generally ...Refractory thyroid cancer is frequently associated with a poor prognosis,necessitating alternative therapeutic approaches.Tyrosine kinase inhibitors(TKIs)have emerged as a promising treatment option,showing generally favorable clinical outcomes in these challenging cancer subtypes.However,the existing body of research is constrained by small sample sizes and variable findings,limiting the ability to directly compare the efficacy of different TKI agents.This study aimed to bridge that gap through a network meta-analysis,evaluating the relative efficacy and safety of various TKIs in managing refractory thyroid cancer.Utilizing systematic keyword searches in databases such as PubMed,Cochrane Library,Embase,Scopus,Web of Science,and ClinicalTrials.gov,we identified studies that met predefined inclusion criteria.Extracted data were analyzed using Bayesian network meta-analysis methods via R software to ensure a comprehensive assessment.Our findings highlighted specific advantages of certain TKIs for various clinical outcomes.In terms of progression-free survival(PFS),Anlotinib and Apatinib showed notable efficacy.For the objective response rate(ORR),Cabozantinib and Lenvatinib demonstrated superior effectiveness,while for disease control rate(DCR),Apatinib and Lenvatinib were advantageous.Regarding safety profiles,Cabozantinib emerged as the safest option for all-grade adverse events(AEs),with Anlotinib showing a higher risk.For severe AEs(grade 3 or higher),Sorafenib proved to be the safest,while Apatinib carried the highest risk.In summary,Anlotinib,Apatinib,Lenvatinib,and Cabozantinib offered significant benefits for PFS,ORR,and DCR in patients with refractory thyroid cancer.However,Anlotinib and Apatinib were associated with higher AE rates,underlining the importance of balancing efficacy with safety.Cabozantinib and Vandetanib,while exhibiting comparatively safer profiles,showed moderate efficacy.These insights underscored the necessity for tailored treatment decisions that carefully weigh the benefits and risks of each TKI agent.展开更多
Objective:This study aims to estimate the thyroid cancer(TC)burden and trends from 1990 and 2021 among working-age population(WAP),at the global,regional,and national levels.Methods:Based on the Global Burden of Disea...Objective:This study aims to estimate the thyroid cancer(TC)burden and trends from 1990 and 2021 among working-age population(WAP),at the global,regional,and national levels.Methods:Based on the Global Burden of Disease 2021 study,this cross-sectional study included data on TC incidence and mortality for WAP aged 15-64 years across 204 countries and territories from 1990 to 2021.The age-standardized incidence rate(ASIR)and age-standardized mortality rate(ASMR)of TC were used to estimate the disease burden.Temporal trends of ASIR and ASMR were estimated by average annual percentage changes(AAPCs)based on age-period-cohort models.Relative inequality of TC burden across 204 countries was estimated by the slope index of concentration index.Results:Globally,ASIR of TC increased from 2.27 per 100,000 population to 3.41 per 100,000 population from1990 to 2021,with AAPC of 1.59%[95%confidence interval(95%CI):1.54,1.64];in contrast,ASMRs were stable at 0.31 per 100,000 population.Females had a higher disease burden than males,and adults aged 45-64 years accounted for more than 55%of the TC cases.Across regions and countries,North Africa and Comoros experienced the highest increase in ASIR,with AAPCs of 2.97%and 7.73%,respectively.All socio-demographic index(SDI)regions experienced a significant increase in ASIR,and regions with high and high-middle SDI experienced a significant decrease in ASMR.Global ASIR burden and ASMR burden were revealed to be concentrated mainly in higher-SDI and lower-SDI countries,respectively,with the concentration index in both sexes of 0.16(95%CI:0.13,0.19)and-0.14(95%CI:-0.18,-0.10)in 2021.Conclusions:Over the past three decades,the incidence burden of TC among the global WAP remarkably increased.International and regional policies for TC controls are supposed to be updated timely,to handle the current increasing burden and geographic disparities among WAP.展开更多
Nursing care during the perioperative period of thyroid cancer plays a crucial role in the recovery of patients.With the development of medical technology,Western medicine nursing techniques have matured in the periop...Nursing care during the perioperative period of thyroid cancer plays a crucial role in the recovery of patients.With the development of medical technology,Western medicine nursing techniques have matured in the perioperative period,including preoperative risk assessment and airway management,intraoperative neuromonitoring nursing coordination,postoperative drainage,and incision management.However,single Western medicine nursing often cannot fully meet the multifaceted needs of patients,especially in emotional nursing and the management of postoperative adverse reactions.The involvement of traditional Chinese medicine nursing techniques provides an effective complement to nursing work.Through integrated Chinese and Western medicine nursing,it is possible not only to improve patients’preoperative anxiety and postoperative nausea and vomiting but also to effectively manage postoperative pain,enhancing the overall comfort and recovery speed of patients.展开更多
Background and objective: Thyroid cancer is the most common endocrine malignancy. This report aims to describe the pattern of thyroid cancer presentations at King Abdulaziz University Hospital, Jeddah. Methods: This w...Background and objective: Thyroid cancer is the most common endocrine malignancy. This report aims to describe the pattern of thyroid cancer presentations at King Abdulaziz University Hospital, Jeddah. Methods: This was a retrospect chart review of all thyroid cancer cases diagnosed between 2001 and 2010 at King Abdulaziz University Hospital, Jeddah. We documented patients’ demographic and clinical data, including age at diagnosis, tumor type and size, extrathyroidal extension, and metastasis. Results: A total of 114 thyroid cancer cases were diagnosed from 2001 through 2010. Females comprise the majority of cases (female to male ratio of 4:1). The mean ages of patients diagnosed with different thyroid cancers were: papillary thyroid cancer, 39.6 years;follicular thyroid cancer, 43.2 years;medullary thyroid cancer, 55.8 years;and anaplastic thyroid cancer, 46.0 years. Papillary thyroid cancer was diagnosed in 88 cases (77%), follicular thyroid cancer in 19 cases (17%), medullary thyroid cancer in 5 cases (4%), and anaplastic thyroid cancer in 2 cases (2%). Conclusion: Thyroid cancers are more common among females. The disease is diagnosed at a relatively young age among our patients (40 years). Papillary thyroid cancer is the most common type of thyroid cancer.展开更多
Background: Thyroid cancers commonly display slow evolution with local and or regional extension. The classic presentation is a painless nodule of the thyroid region in a euthyroid patient. Sometimes, the nodule is di...Background: Thyroid cancers commonly display slow evolution with local and or regional extension. The classic presentation is a painless nodule of the thyroid region in a euthyroid patient. Sometimes, the nodule is discovered only on ultrasonography. Cervical lymph node is often seen in papillary thyroid cancer due to their propensity to invade lymph node. This means that follicular thyroid cancers are more insidious. Observation: We report a painless slow-growing lesion of the scalp revealing a skull metastasis of thyroid cancer. Despite catastrophic intraoperative bleeding, a total removal was achieved. Lessons: Thus, in addition to local and regional control in the management of thyroid cancers, distant metastasis should be surgically removed to provide the best chance to prolong the patient’s survival. Moreover, neurosurgeon must be prepared to deal with massive bleeding in skull metastasis of thyroid cancer.展开更多
The cumulative evidence over the past decades has shown that the incidence of differentiated thyroid carcinoma(DTC)has exponentially increased.Approximately 10%of patients with DTC exhibit recurrent or metastatic dise...The cumulative evidence over the past decades has shown that the incidence of differentiated thyroid carcinoma(DTC)has exponentially increased.Approximately 10%of patients with DTC exhibit recurrent or metastatic disease,and about two-thirds of the latter will be defined as refractory to radioactive iodine(RAIR)treatment.Since this condition implies 10-year survival rates less than 10% after detection,using available treatments,such as systemic and targeted therapies,have become increasingly relevant.The initiation of these treatments aims to reach stabilization,tumor volume reduction,and/or symptom improvement and it should be decided by highly specialized endocrinologists/oncologists on the basis of patient’s features.Considering that despite enlarged progression-free survival was proven,multikinase inhibitors remain non-curative,their benefits last for a limited time and the side effects potentially cause harm and quality of life reduction.In this context,molecular testing of cancer cells provides a promising spectrum of targeted therapies that offer increased compatibility with individual patient needs by improving efficacy,progression free survival,overall survival and adverse events profile.This review article aims to provide a summary of the current therapeutic strategies in advanced RAIR-DTC,including approved target therapies as well as those for off-label use,RAI resensitization agents,and immunotherapy.展开更多
Objective: Preablative stimulated thyroglobulin (ps-Tg) has the potential to be used in identifying distant metastatic differentiated thyroid carcinoma (DM-DTC), but its single level can be affected by remnant thyroid...Objective: Preablative stimulated thyroglobulin (ps-Tg) has the potential to be used in identifying distant metastatic differentiated thyroid carcinoma (DM-DTC), but its single level can be affected by remnant thyroid tissue and thyrotropin (TSH). The objective of this retrospective study was to evaluate the value of serial ps-Tg measurements in identifying DM-DTC specifically. Methods: A total of 317 DTC patients with serial measurements of ps-Tg, TSH and anti-Tg antibody were divided into M1 (n=72) and M0 (n=245) according to the presence of distant metastasis (DM) or not. The initial psTg measurement, with a corresponding TSH exceeding 30 mu IU/mL, was marked as Tg1, and ps-Tg measured right before radioactive iodine (RAI) therapy was defined as Tg2, with a median interval of 8 days. Delta Tg denotes Tg2-Tg1, and Delta TSH denotes TSH2-TSH1. Tg1, Tg2, Delta Tg, and Delta Tg/Delta TSH were tested for efficacy in identifying DM-DTC using receiver operating characteristic (ROC) curve analysis, and further compared with chest computed tomography (CT) and posttreatment whole-body RAI scan (RxWBS). Results: Compared with single ps-Tg measurement (Tg1 or Tg2), both Delta Tg and Delta Tg/Delta TSH were more narrowly distributed around zero in the M0 group, which made their distribution in the M1 group more distinguished in a relatively dispersed way. Delta Tg/Delta TSH manifested a higher accuracy (88.64%) and specificity (90.20%) in identifying DM-DTC than Tg1 or Tg2 measurements, with a much higher specificity than chest CT (90.20% vs. 66.00%) and a much higher sensitivity than RxWBS (83.33% vs. 61.11%). Conclusions: Serial ps-Tg measurements even over as short an interval as 8 days hold incremental value in identifying DM-DTC. Delta Tg/Delta TSH is a specific early biochemical marker for DM-DTC.展开更多
The aim of the present study was to examine the relationship between the protein expression of vascular endothelial growth factor（VEGF） and lymph node metastasis（LNM） in papillary thyroid cancer（PTC）. VEGF-relat...The aim of the present study was to examine the relationship between the protein expression of vascular endothelial growth factor（VEGF） and lymph node metastasis（LNM） in papillary thyroid cancer（PTC）. VEGF-related articles that had been published until August 2016 were searched from the Pub Med, EMBASE, and MEDLINE to identify the risk factors of LNM in PTC. Rev Man 5.3 software was used for the meta-analysis. Finally, 9 articles met the inclusion criteria and were included in our meta-analysis. LNM was found to be present in 176 of 318 patients（57.8%） with high VEGF expression and in 71 of 159 patients（47.0%） with low VEGF expression. The overall OR was 2.81（95% confidence interval, 1.49–5.29）. LNM occurred more frequently in patients with high VEGF expression than in those with low VEGF expression（P=0.001）. Heterogeneity was markedly decreased in the subgroup analyses of LNM in terms of the patients＇ country of origin and the detection methods. Our meta-analysis concluded that the VEGF protein expression is associated with LNM in PTC.展开更多
Objective： To study the clinical characteristics, treatment, and prognosis of thyroid cancer in children and adolescents. Methods： We performed a retrospective analysis of clinical data from 83 cases of thyroid canc...Objective： To study the clinical characteristics, treatment, and prognosis of thyroid cancer in children and adolescents. Methods： We performed a retrospective analysis of clinical data from 83 cases of thyroid cancer in children and adolescents from January 1990 to December 2010. We compared extra-thyroid extension, lymph node metastasis, distant metastasis, and prognosis between pediatric patients 〈12 years of age （27 cases） and those 〉 12 years of age （56 cases）. All the patients agreed to undergo thyroidectomy and endocrine therapy, and the consent was obtained from parents or guardians. Results： Histopathology included papillary carcinoma in 67 cases, papillary carcinoma with partial follicular growth pattern in 1 case, papillary carcinoma with squamous metaplasia in 4 cases, follicular carcinoma in 7 cases, medullary carcinoma in 3 cases, and poorly differentiated carcinoma in 1 case. The total lymph node metastasis rate was 78.31%. Patients ≤12 years of age showed a higher rate of lymph node me- tastasis than the older group （92.59% vs. 71.43%, P=0.028）. The incidence rate in females in the older group was higher than that in the younger group （80.36% vs. 59.26%, P=0.041）. There were no significant differences in extra-thyroid extension, distant metastasis, survival rate, or recurrent disease between the two groups. Conclusions： The lymph node metastasis of thyroid cancer is higher in patients ≤12 years of age than in those 〉12 years of age; the incidence rate is higher in females than in males. Childhood thyroid cancer has a good prognosis, surgery being the most effective treatment. Choosing a reasonable surgery method and comprehensive postoperative treatment can achieve a cure and satisfactory survival rate.展开更多
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BACKGROUND Papillary thyroid cancer(PTC)often recurs following surgical excision,necessitating reliable long-term screening techniques after initial management.Ultrasound scans have a poor predictive value and biopsy and genetic testing have a low sensitivity.Biomarker detection,including thyroglobulin,has reduced accuracy as residual thyroid tissue remains following surgery.Serum/tissue microRNA detection offers a promising alternative to screen for thyroid malignancy.Based on our previous systematic review,miR-146,miR-221 and miR-222 appear most strongly associated with PTC.AIM To perform a systematic review and meta-analysis,evaluating the use of circulating miR-146,miRNA-221 and miR-222 in PTC diagnosis and staging.METHODS A systematic literature search of MEDLINE,Scopus and the EMBASE library was performed.Human participants of any age,sex or geographical distribution were considered.Original studies assessing the diagnostic and prognostic accuracy of circulating serum miRNAs in histologically-confirmed PTC were included.Proportion and regression meta-analyses(logit-transformed)were conducted.PRISMA guidelines were followed throughout the process.RESULTS Among the 1530 studies screened,6 met the inclusion criteria,reporting non-overlapping populations.For the diagnosis of PTC vs benign nodules(BN),the pooled sensitivity of miR-146 was 80.7%(95%CI:65.2%-90.4%),specificity was 66.9%(95%CI:55.5%-76.6%),and false positive rate was 33.1%(95%CI:23.4%-44.5%).Pooled sensitivity,specificity and false positive rate of miR-222 for diagnosis of PTC vs BN was 64.3%(95%CI:50.3%-76.2%),88.8%(95%CI:82.4%-93%)and 11.2%(95%CI:7%-17.6%)respectively.Pooled sensitivity,specificity and false positive rate of miR-221 in this population demonstrated reduced accuracy.Pooled sensitivity and specificity of PTC vs healthy controls for total serum miRNAs were 82%(95%CI:77%-86%)and 84%(95%CI:76%-90%)respectively.The summary area under receiver operating characteristic curve value for the same analysis was 0.89(95%CI:0.86-0.92).CONCLUSION miRNA-146 and miRNA-222 were most sensitive,validating their efficacy in PTC diagnosis.Larger studies are needed for confident population generalisability.Use of two-MRNA types in conjunction needs to be assessed.
基金Supported by Clinical Study on Perioperative Issues Related to Thyroidectomy,No.20241209Risk Factors and Coping Strategies for Postoperative Cough in Thyroid Nodules,No.2322152DResearch on Individualized Surgical Treatment Strategies for Thyroid Tumors Jicai Pre-recovery,No.[2020]397.
文摘BACKGROUND Post-thyroidectomy patients frequently experience depressive symptoms triggered by surgical trauma,fluctuating thyroid hormone levels,and the psychological burden of long-term surveillance;however,large-scale multivariableadjusted risk-factor data remain scarce.AIM To determine the prevalence and predictors of postoperative depression,and propose tailored mitigation strategies.METHODS We enrolled 108 consecutive patients who underwent thyroidectomies at The First Affiliated Hospital of Hebei North University between January 2023 and January 2025.Depression was assessed using the Self-Rating Depression Scale(SDS),while coping styles and social support were evaluated using the Medical Coping Modes Questionnaire and Perceived Social Support Scale.Logistic regression was used to identify independent risk and protective factors.RESULTS The mean SDS score was 52.58±10.20;62 patients(57.4%)met the criteria for depression(mild 32.4%,moderate 15.7%,severe 9.3%).Univariate analyses revealed higher depression rates among patients aged≥60 years,those with≤highschool education,monthly family income<3000 yuan,131I therapy,and avoidance/surrender coping;and lower social support(P<0.05).Multivariate regression showed income<3000 yuan(OR=5.26,95%CI:1.89-14.60),131I therapy(OR=5.70,95%CI:1.91-17.01),and avoidance/surrender coping(OR=4.77,95%CI:1.51-15.11)as independent risk factors,whereas higher social support was protective(OR=0.22,95%CI:0.09-0.54).CONCLUSIONDepression is common after thyroidectomy,and is driven by socioeconomic,treatment-related,and psychosocialfactors.Targeted interventions that address coping skills and bolster social support should be integrated intopostoperative care.
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 grants from the National Natural Science Foundation of China(Nos.82173125,81974374)General Support Projects of the Health Commission of Binhai New Area(2023BWKY024)Tianjin Key Medical Discipline Construction Project(TJYXZDXK044A).
文摘Objectives:Metastatic spread to the lung is one of the leading causes of fatal outcomes in thyroid cancer,but the underlying molecular mechanisms remain unclear.To investigate how exosomal microRNA-17-5p(miR-17-5p)promotes lung metastasis in thyroid cancer within the framework of the“seed and soil”hypothesis.Methods:Serum exosomes from thyroid cancer lung metastasis patients and controls were analyzed for miR-17,which was elevated in metastatic cases.miR-17 was transfected into embryonic lung fibroblasts(MRC-5),and their supernatants were cocultured with thyroid cancer cells(Cal62).Cell proliferation and migration were evaluated using colony formation,Ki67 staining,and Transwell assays.Interleukin-6(IL-6)/interleukin-8(IL-8)levels and nuclear factor kappa-B(NF-κB)/nuclear factor kappa-B repressing factor(NKRF)expression were analysed by enzyme-linked immunosorbent assays(ELISA)and western blot.In vivo models verified the metastatic-promoting effect of miR-17.Results:miR-17-5p was significantly enriched in serum exosomes of metastatic patients.In MRC-5 cells,it suppressed NKRF,NF-κB signaling,and increased secretion of IL-6 and IL-8,enhancing Cal62 proliferation and migration.Animal experiments confirmed its role in promoting tumor growth and lung metastasis.Conclusions:Exosomal miR-17-5p remodels the pulmonary microenvironment into a pro-inflammatory niche,facilitating thyroid cancer colonization and offering a potential therapeutic target.
文摘Objective:To investigate the application effect of dexmedetomidine in anesthesia for thyroid cancer(TC)surgery.Methods:A total of 90 patients admitted to our hospital from January 2023 to December 2023 were selected as the study subjects.The patients were divided into an observation group(given continuous intravenous infusion of dexmedetomidine during surgery)and a control group(given continuous intravenous infusion of an equal volume of sodium chloride injection during surgery)by lottery method,and the anesthesia indicators of the two groups were compared.Results:The dosages of remifentanil and propofol in the observation group were lower than those in the control group(p<0.05);the incidence of complications in the observation group was lower than that in the control group(p<0.05);the Visual Analogue Scale(VAS)scores of the observation group at 4 h,12 h,24 h,and 48 h postoperatively,both at rest and during activity,were lower than those of the control group(p<0.05).Conclusion:During surgery for TC patients,continuous intravenous infusion of dexmedetomidine can reduce the dosage of anesthetic drugs and the incidence of anesthesia-related complications,alleviate postoperative pain,and is worthy of promotion and application.
基金supported by National Natural Science Foundation of China(8183000355)。
文摘Objective:The varying environmental exposure to iodine has long been a topic of interest,particularly given the noticeable increase in the incidence of papillary thyroid carcinoma(PTC)compared to other histopathological subtypes globally.This rise in thyroid cancer incidence has been attributed to several factors,including improved detection of early tumors,a higher prevalence of modifiable individual risk factors,and differing exposure to environmental risk factors such as iodine levels.This study aims to explore the epigenetic mechanisms that promote thyroid cancer progression under excess iodine exposure.Materials and methods:This study outlines the following strategy:(i)risk factors were identified through statistical analysis of questionnaire responses in a retrospective iatrogenic study;(ii)following the identification of risk factors,RNA sequencing was performed using tissues from iodine-adequate(IA)and iodine-excess(IE)regions;(iii)candidate hub genes were selected via bioinformatics analysis;(iv)molecular biological techniques were employed to verify the functionality of the key gene.Results:Through careful selection,we focused on SPSB4,a ubiquitin ligase previously unreported in relation to both iodine and thyroid cancer.By optimizing the dosage of PTC cell line activities,we determined how varying iodine levels can either enhance or impair the vitality of thyroid cancer cells.As anticipated,migration and invasion assays revealed significant changes when SPSB4 function was disrupted at the critical dose of KIO3.Conclusion:In terms of epigenetic alterations,SPSB4 emerges as a promising candidate for further investigation,particularly in understanding thyroid cancer progression and potential carcinogenesis.Moreover,E3 ubiquitin ligases,including SPSB4,play a role in orchestrating adipose thermogenesis to maintain body temperature during cold stimuli.This study could also shed light on the influence of iodine on thermogenesis mediated by SPSB4 under cold conditions,while suggesting future exploration of SPSB4's effects on thyroid cancer in colder regions.
文摘Thyroid cancer is a common endocrine malignancy with a rising incidence.Pa-tients often suffer from mental pain due to concerns about recurrence,treatment-related side-effect,and body image changes.Demographic factors like age,gender,physiological factors such as somatic symptoms and disease stage,co-gnitive-regulatory factors including negative and positive thinking,and social factors like work,economy,education level,and social support all influence their mental state.Existing interventions,including nursing,psychological,and tra-ditional Chinese medicine-based methods,have some benefits but face limitations like short-term effectiveness and lack of standardization.Future research should focus on creating better-defined,long-term,and widely applicable intervention programs and explore positive psychology-based approaches to improve patients'mental well-being and quality of life.
文摘BACKGROUND Thyroid malignancies,while accounting for a small proportion of cancer diagnoses globally,have demonstrated a consistent upward trend in occurrence across diverse populations,with gender-specific analyses revealing a disproportionate burden among women.Despite the characteristically indolent nature of most thyroid carcinomas and their associated high survival rates,emerging evidence points to significant unmet needs regarding psychosocial adaptation and neuropsychiatric sequelae in this growing survivor population.The spectrum of mental health conditions,ranging from affective and anxiety disorders to cognitive impairments,presents substantial barriers to functional recovery and may potentially influence disease trajectories through complex psychoneuroimmunological pathways.Clinical observations consistently report elevated rates of mood disturbances and executive function deficits persisting throughout the cancer continuum,from active treatment into extended follow-up periods.These findings highlight a critical knowledge gap in understanding the dynamic interplay between thyroid cancer biology,its therapeutic interventions,and the development of treatment-resistant psychiatric manifestations that complicate long-term patient care.AIM To analyse the factors influencing the poor prognosis of patients surviving longterm differentiated thyroid cancer with psychiatric disorders and to construct a prediction model.METHODS Forty-eight patients with mental disorders combined with differentiated thyroid cancer who were treated in our hospital during the period of March 2018 to March 2023 were retrospectively selected as the study subjects(thyroid cancer group),and 30 cases each of patients with mental disorders combined with benign thyroid nodules(benign nodules group)and patients with mental disorders alone(mental disorders group),who were treated during the same time period,were selected as controls.The patients with differentiated thyroid cancer were further divided into a poor prognosis group(10 cases)and a good prognosis group(38 cases).The study outcome was poor prognosis as shown by whole body bone imaging within 2 years after thyroid cancer surgery.Factors influencing poor prognosis in survivors of differentiated thyroid cancer were analyzed by univariate and multivariate logistic regression analyses,receiver operating characteristic(ROC)curve analysis was used to assess the predictive efficacy of these factors for poor prognosis,and the DeLong test was used to determine whether there was a statistically significant difference in the area under the curve(AUC)of the model.RESULTS One-way logistic regression analysis showed that tumour diameter[odds ratio(OR)=19.190,P=0.002],T-stage(OR=7.692,P=0.018),extra-glandular infiltration(OR=37.000,P=0.003),degree of differentiation(OR=24.667,P=0.008),serum free T3(OR=22.348,P=0.025),serum free T4(FT4)(OR=1.158,P=0.002),total bilirubin(TBil)(OR=1.792,P=0.004),albumin(OR=0.675,P=0.003),cortisol(OR=1.180,P=0.003),norepinephrine(OR=1.047,P=0.002),angiotensin II(OR=1.975,P=0.002),and superoxide dismutase(OR=0.515,P=0.005)all increased the risk of poor prognosis in patients with psychiatric disorders and long-term differentiated thyroid cancer.Multifactorial logistic regression analysis showed that tumour diameter(OR=16.570,P=0.021),extraglandular infiltration(OR=53.145,P=0.010),FT4(OR=1.186,P=0.007),and TBil(OR=2.823,P=0.048)were independent risk factors for poor prognosis of patients with psychiatric disorders with long-term differentiated thyroid cancer,and the regression equation was:Y=2.808×tumour diameter+3.973×extra-glandular infiltration+0.171×FT4+1.038×TBil-88.138.ROC analysis showed that the predictive power of the overall model(AUC=0.992,P=0.000)was significantly higher than that of independent risk factors(DeLong test P<0.05).CONCLUSION Tumour diameter,extra-glandular infiltration,FT4,and TBil are independent risk factors for poor prognosis in patients with psychiatric disorders with long-term differentiated thyroid cancer,and the combination of these factors is of higher value in predicting the prognosis of patients.These risk factors can be used as a basis to develop a reasonable prognostic management plan in clinical practice for patients with long-term differentiated thyroid cancer with mental disorders,so as to improve the prognosis and quality of life of patients.
文摘Thyroid cancer(TC)is one of the most common endocrine system tumors,and its incidence continues to increase worldwide.Although most TC patients have a good prognosis,especially with continuous advancements in surgery,radioactive iodine therapy,chemotherapy,endocrine therapy and targeted therapy,the effectiveness of disease treatment has significantly improved.However,there are still some cases with a higher risk of death and greater aggressiveness.In these more challenging advanced or highly aggressive cases,tyrosine kinase inhibitors appear to be an effective treatment option.Unfortunately,these drugs are less than ideal in terms of efficacy because of their toxicity and potential for intrinsic or acquired resistance.Therefore,exploring new strategies targeting the metabolic characteristics of TC cells and overcoming drug resistance barriers in existing treatments have become key topics in the current field of TC research.In recent years,lipid metabolic reprogramming has gained attention as an important aspect of cancer development.Lipid metabolic reprogramming not only participates in the formation of the cell membrane structure,but also plays an important role in signal transduction and promoting cell proliferation.In particular,fatty acid(FA)metabolic reprogramming has attracted widespread attention and plays an important role in multiple aspects such as tumor growth,metastasis,enhanced invasive ability,immune escape,and drug resistance.Although TC is considered a disease that is highly dependent on specific types of metabolic activities,a comprehensive understanding of the specific mechanism of action of FA metabolic reprogramming in this process is lacking.This article aims to review how FA metabolic reprogramming participates in the occurrence and development of TC,focusing on the impact of abnormal FA metabolic pathways and changes in the expression and regulation of related genes over the course of this disease.By examining the complex interactions between FA metabolic disorders and carcinogenic signaling pathways in depth,we aim to identify new therapeutic targets and develop more precise and effective treatments for TC.
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The Natural Science Foundation of Fujian,China(Grant No.2021J01397)Fujian Provincial Health Technology Project(Grant No.2022GGA010)Fujian Provincial Joint Funding Project of Scientific and Technological Innovation(Grant No.2023Y9347).
文摘Refractory thyroid cancer is frequently associated with a poor prognosis,necessitating alternative therapeutic approaches.Tyrosine kinase inhibitors(TKIs)have emerged as a promising treatment option,showing generally favorable clinical outcomes in these challenging cancer subtypes.However,the existing body of research is constrained by small sample sizes and variable findings,limiting the ability to directly compare the efficacy of different TKI agents.This study aimed to bridge that gap through a network meta-analysis,evaluating the relative efficacy and safety of various TKIs in managing refractory thyroid cancer.Utilizing systematic keyword searches in databases such as PubMed,Cochrane Library,Embase,Scopus,Web of Science,and ClinicalTrials.gov,we identified studies that met predefined inclusion criteria.Extracted data were analyzed using Bayesian network meta-analysis methods via R software to ensure a comprehensive assessment.Our findings highlighted specific advantages of certain TKIs for various clinical outcomes.In terms of progression-free survival(PFS),Anlotinib and Apatinib showed notable efficacy.For the objective response rate(ORR),Cabozantinib and Lenvatinib demonstrated superior effectiveness,while for disease control rate(DCR),Apatinib and Lenvatinib were advantageous.Regarding safety profiles,Cabozantinib emerged as the safest option for all-grade adverse events(AEs),with Anlotinib showing a higher risk.For severe AEs(grade 3 or higher),Sorafenib proved to be the safest,while Apatinib carried the highest risk.In summary,Anlotinib,Apatinib,Lenvatinib,and Cabozantinib offered significant benefits for PFS,ORR,and DCR in patients with refractory thyroid cancer.However,Anlotinib and Apatinib were associated with higher AE rates,underlining the importance of balancing efficacy with safety.Cabozantinib and Vandetanib,while exhibiting comparatively safer profiles,showed moderate efficacy.These insights underscored the necessity for tailored treatment decisions that carefully weigh the benefits and risks of each TKI agent.
文摘Objective:This study aims to estimate the thyroid cancer(TC)burden and trends from 1990 and 2021 among working-age population(WAP),at the global,regional,and national levels.Methods:Based on the Global Burden of Disease 2021 study,this cross-sectional study included data on TC incidence and mortality for WAP aged 15-64 years across 204 countries and territories from 1990 to 2021.The age-standardized incidence rate(ASIR)and age-standardized mortality rate(ASMR)of TC were used to estimate the disease burden.Temporal trends of ASIR and ASMR were estimated by average annual percentage changes(AAPCs)based on age-period-cohort models.Relative inequality of TC burden across 204 countries was estimated by the slope index of concentration index.Results:Globally,ASIR of TC increased from 2.27 per 100,000 population to 3.41 per 100,000 population from1990 to 2021,with AAPC of 1.59%[95%confidence interval(95%CI):1.54,1.64];in contrast,ASMRs were stable at 0.31 per 100,000 population.Females had a higher disease burden than males,and adults aged 45-64 years accounted for more than 55%of the TC cases.Across regions and countries,North Africa and Comoros experienced the highest increase in ASIR,with AAPCs of 2.97%and 7.73%,respectively.All socio-demographic index(SDI)regions experienced a significant increase in ASIR,and regions with high and high-middle SDI experienced a significant decrease in ASMR.Global ASIR burden and ASMR burden were revealed to be concentrated mainly in higher-SDI and lower-SDI countries,respectively,with the concentration index in both sexes of 0.16(95%CI:0.13,0.19)and-0.14(95%CI:-0.18,-0.10)in 2021.Conclusions:Over the past three decades,the incidence burden of TC among the global WAP remarkably increased.International and regional policies for TC controls are supposed to be updated timely,to handle the current increasing burden and geographic disparities among WAP.
文摘Nursing care during the perioperative period of thyroid cancer plays a crucial role in the recovery of patients.With the development of medical technology,Western medicine nursing techniques have matured in the perioperative period,including preoperative risk assessment and airway management,intraoperative neuromonitoring nursing coordination,postoperative drainage,and incision management.However,single Western medicine nursing often cannot fully meet the multifaceted needs of patients,especially in emotional nursing and the management of postoperative adverse reactions.The involvement of traditional Chinese medicine nursing techniques provides an effective complement to nursing work.Through integrated Chinese and Western medicine nursing,it is possible not only to improve patients’preoperative anxiety and postoperative nausea and vomiting but also to effectively manage postoperative pain,enhancing the overall comfort and recovery speed of patients.
文摘Background and objective: Thyroid cancer is the most common endocrine malignancy. This report aims to describe the pattern of thyroid cancer presentations at King Abdulaziz University Hospital, Jeddah. Methods: This was a retrospect chart review of all thyroid cancer cases diagnosed between 2001 and 2010 at King Abdulaziz University Hospital, Jeddah. We documented patients’ demographic and clinical data, including age at diagnosis, tumor type and size, extrathyroidal extension, and metastasis. Results: A total of 114 thyroid cancer cases were diagnosed from 2001 through 2010. Females comprise the majority of cases (female to male ratio of 4:1). The mean ages of patients diagnosed with different thyroid cancers were: papillary thyroid cancer, 39.6 years;follicular thyroid cancer, 43.2 years;medullary thyroid cancer, 55.8 years;and anaplastic thyroid cancer, 46.0 years. Papillary thyroid cancer was diagnosed in 88 cases (77%), follicular thyroid cancer in 19 cases (17%), medullary thyroid cancer in 5 cases (4%), and anaplastic thyroid cancer in 2 cases (2%). Conclusion: Thyroid cancers are more common among females. The disease is diagnosed at a relatively young age among our patients (40 years). Papillary thyroid cancer is the most common type of thyroid cancer.
文摘Background: Thyroid cancers commonly display slow evolution with local and or regional extension. The classic presentation is a painless nodule of the thyroid region in a euthyroid patient. Sometimes, the nodule is discovered only on ultrasonography. Cervical lymph node is often seen in papillary thyroid cancer due to their propensity to invade lymph node. This means that follicular thyroid cancers are more insidious. Observation: We report a painless slow-growing lesion of the scalp revealing a skull metastasis of thyroid cancer. Despite catastrophic intraoperative bleeding, a total removal was achieved. Lessons: Thus, in addition to local and regional control in the management of thyroid cancers, distant metastasis should be surgically removed to provide the best chance to prolong the patient’s survival. Moreover, neurosurgeon must be prepared to deal with massive bleeding in skull metastasis of thyroid cancer.
文摘The cumulative evidence over the past decades has shown that the incidence of differentiated thyroid carcinoma(DTC)has exponentially increased.Approximately 10%of patients with DTC exhibit recurrent or metastatic disease,and about two-thirds of the latter will be defined as refractory to radioactive iodine(RAIR)treatment.Since this condition implies 10-year survival rates less than 10% after detection,using available treatments,such as systemic and targeted therapies,have become increasingly relevant.The initiation of these treatments aims to reach stabilization,tumor volume reduction,and/or symptom improvement and it should be decided by highly specialized endocrinologists/oncologists on the basis of patient’s features.Considering that despite enlarged progression-free survival was proven,multikinase inhibitors remain non-curative,their benefits last for a limited time and the side effects potentially cause harm and quality of life reduction.In this context,molecular testing of cancer cells provides a promising spectrum of targeted therapies that offer increased compatibility with individual patient needs by improving efficacy,progression free survival,overall survival and adverse events profile.This review article aims to provide a summary of the current therapeutic strategies in advanced RAIR-DTC,including approved target therapies as well as those for off-label use,RAI resensitization agents,and immunotherapy.
基金supported by the Ministry of Health Industry Special Scientific Research Projects of China (No. 201202012)the National Natural Science Foundation of China (No. 81571714)
文摘Objective: Preablative stimulated thyroglobulin (ps-Tg) has the potential to be used in identifying distant metastatic differentiated thyroid carcinoma (DM-DTC), but its single level can be affected by remnant thyroid tissue and thyrotropin (TSH). The objective of this retrospective study was to evaluate the value of serial ps-Tg measurements in identifying DM-DTC specifically. Methods: A total of 317 DTC patients with serial measurements of ps-Tg, TSH and anti-Tg antibody were divided into M1 (n=72) and M0 (n=245) according to the presence of distant metastasis (DM) or not. The initial psTg measurement, with a corresponding TSH exceeding 30 mu IU/mL, was marked as Tg1, and ps-Tg measured right before radioactive iodine (RAI) therapy was defined as Tg2, with a median interval of 8 days. Delta Tg denotes Tg2-Tg1, and Delta TSH denotes TSH2-TSH1. Tg1, Tg2, Delta Tg, and Delta Tg/Delta TSH were tested for efficacy in identifying DM-DTC using receiver operating characteristic (ROC) curve analysis, and further compared with chest computed tomography (CT) and posttreatment whole-body RAI scan (RxWBS). Results: Compared with single ps-Tg measurement (Tg1 or Tg2), both Delta Tg and Delta Tg/Delta TSH were more narrowly distributed around zero in the M0 group, which made their distribution in the M1 group more distinguished in a relatively dispersed way. Delta Tg/Delta TSH manifested a higher accuracy (88.64%) and specificity (90.20%) in identifying DM-DTC than Tg1 or Tg2 measurements, with a much higher specificity than chest CT (90.20% vs. 66.00%) and a much higher sensitivity than RxWBS (83.33% vs. 61.11%). Conclusions: Serial ps-Tg measurements even over as short an interval as 8 days hold incremental value in identifying DM-DTC. Delta Tg/Delta TSH is a specific early biochemical marker for DM-DTC.
文摘The aim of the present study was to examine the relationship between the protein expression of vascular endothelial growth factor（VEGF） and lymph node metastasis（LNM） in papillary thyroid cancer（PTC）. VEGF-related articles that had been published until August 2016 were searched from the Pub Med, EMBASE, and MEDLINE to identify the risk factors of LNM in PTC. Rev Man 5.3 software was used for the meta-analysis. Finally, 9 articles met the inclusion criteria and were included in our meta-analysis. LNM was found to be present in 176 of 318 patients（57.8%） with high VEGF expression and in 71 of 159 patients（47.0%） with low VEGF expression. The overall OR was 2.81（95% confidence interval, 1.49–5.29）. LNM occurred more frequently in patients with high VEGF expression than in those with low VEGF expression（P=0.001）. Heterogeneity was markedly decreased in the subgroup analyses of LNM in terms of the patients＇ country of origin and the detection methods. Our meta-analysis concluded that the VEGF protein expression is associated with LNM in PTC.
文摘Objective： To study the clinical characteristics, treatment, and prognosis of thyroid cancer in children and adolescents. Methods： We performed a retrospective analysis of clinical data from 83 cases of thyroid cancer in children and adolescents from January 1990 to December 2010. We compared extra-thyroid extension, lymph node metastasis, distant metastasis, and prognosis between pediatric patients 〈12 years of age （27 cases） and those 〉 12 years of age （56 cases）. All the patients agreed to undergo thyroidectomy and endocrine therapy, and the consent was obtained from parents or guardians. Results： Histopathology included papillary carcinoma in 67 cases, papillary carcinoma with partial follicular growth pattern in 1 case, papillary carcinoma with squamous metaplasia in 4 cases, follicular carcinoma in 7 cases, medullary carcinoma in 3 cases, and poorly differentiated carcinoma in 1 case. The total lymph node metastasis rate was 78.31%. Patients ≤12 years of age showed a higher rate of lymph node me- tastasis than the older group （92.59% vs. 71.43%, P=0.028）. The incidence rate in females in the older group was higher than that in the younger group （80.36% vs. 59.26%, P=0.041）. There were no significant differences in extra-thyroid extension, distant metastasis, survival rate, or recurrent disease between the two groups. Conclusions： The lymph node metastasis of thyroid cancer is higher in patients ≤12 years of age than in those 〉12 years of age; the incidence rate is higher in females than in males. Childhood thyroid cancer has a good prognosis, surgery being the most effective treatment. Choosing a reasonable surgery method and comprehensive postoperative treatment can achieve a cure and satisfactory survival rate.
