Metabolic dysfunction-associated steatotic liver disease(MASLD)has become the most prevalent chronic liver disease worldwide,affecting approximately 32%-38%of the adult population and posing a growing public health bu...Metabolic dysfunction-associated steatotic liver disease(MASLD)has become the most prevalent chronic liver disease worldwide,affecting approximately 32%-38%of the adult population and posing a growing public health burden.MASLD represents a continuous disease spectrum ranging from simple steatosis to metabolic dysfunction-associated steatohepatitis(MASH),progressive hepatic fibrosis,cirrhosis,and ultimately hepatocellular carcinoma(HCC).The pathological core of MASLD lies in disruption of hepatic lipid metabolic homeostasis,characterized by an imbalance among de novo lipogenesis,fatty acidβ-oxidation,and very-low-density lipoprotein(VLDL)-mediated lipid export.This metabolic disequilibrium subsequently drives inflammatory injury and fibrotic progression.Among the multiple regulatory pathways involved,thyroid hormone(TH)signaling has emerged as a central regulator of hepatic metabolic homeostasis.The liver is a major peripheral target organ of TH action,where TH predominantly exerts its metabolic effects through thyroid hormone receptorβ(TRβ).Large-scale epidemiological studies and metaanalyses have demonstrated that hypothyroidism is significantly associated with increased MASLD prevalence,more severe histological injury,and advanced hepatic fibrosis,suggesting that dysregulation of TH signaling may participate throughout the entire MASLD disease spectrum.At the molecular level,TH regulates hepatic lipid metabolism by coordinating suppression of lipogenesis,enhancement of mitochondrial fatty acid oxidation,and promotion of VLDL assembly and secretion through integrated genomic actions of the T3-TRβaxis and non-genomic signaling pathways.Across different stages of MASLD,TH signaling exerts stagedependent protective effects.In the steatosis stage,TH improves metabolic flexibility by modulating insulin sensitivity,glucose metabolism,and lipid droplet clearance,thereby alleviating early lipotoxic stress.During progression to MASH,TH attenuates inflammatory amplification by improving mitochondrial homeostasis,suppressing activation of the NOD-like receptor family pyrin domain containing 3(NLRP3)inflammasome,and modulating the gut-liver axis microenvironment.In advanced stages,TH signaling influences hepatic stellate cell activation and extracellular matrix deposition,partly through interaction with the transforming growth factor-β(TGF-β)/SMAD pathway,while alterations in intrahepatic TH availability,mediated by dynamic changes in iodothyronine deiodinase 1(DIO1),contribute to fibrosis progression and hepatocellular dedifferentiation.In hepatocellular carcinoma,coordinated downregulation of TRβand DIO1 establishes a tumor-associated hypothyroid state that promotes metabolic reprogramming and tumor progression.The clinical relevance of TH signaling in MASLD has been underscored by the recent approval of Resmetirom,a liver-targeted TRβ-selective agonist,for the treatment of non-cirrhotic MASH with moderate-to-severe fibrosis(F2-F3).This approval represents a landmark transition from mechanistic understanding to metabolismcentered precision therapy in MASLD.Clinical trials have demonstrated that Resmetirom not only improves key histological endpoints,including MASH resolution and fibrosis regression,but also favorably modulates atherogenic lipid profiles,highlighting the therapeutic potential of selectively targeting hepatic TH pathways.This review systematically summarizes the multidimensional regulatory roles of TH across the MASLD disease spectrum and discusses emerging diagnostic and therapeutic implications of THbased interventions,aiming to inform future mechanistic research and optimize clinical management strategies.展开更多
Objective:Non-diagnostic thyroid nodules(Bethesda I)account for 5%-20%of all thyroid nodules.Accurate differentiation of benign and malignant nodules can reduce unnecessary surgeries and repeat biopsies.Herein we eval...Objective:Non-diagnostic thyroid nodules(Bethesda I)account for 5%-20%of all thyroid nodules.Accurate differentiation of benign and malignant nodules can reduce unnecessary surgeries and repeat biopsies.Herein we evaluated the diagnostic efficacy of multigene testing in non-diagnostic thyroid nodules and developed a predictive model integrating molecular and clinical data.Methods:In this prospective cohort study,1,175 patients with thyroid nodules were evaluated for inclusion,of which 218 patients with Bethesda I nodules met our inclusion criteria.The primary outcome was diagnostic accuracy of molecular testing,and the secondary outcome was the performance of a predictive model integrating molecular and clinical data.Results:Final histopathology identified 165 benign and 53 malignant nodules.Molecular testing detected 10distinct point mutations and seven gene fusions.Among benign nodules,147 tested negative and 18 tested positive,whereas 44 malignant nodules tested positive and nine tested negative.In nodules with ultrasound grades 4-5 and fine-needle aspiration cytology(FNAC)results categorized as non-diagnostic,molecular testing achieved sensitivity of 83.00%,specificity of 89.00%,positive predictive value(PPV)of 71.00%,negative predictive value(NPV)of94.20%,and overall accuracy of 87.60%.The predictive model incorporated 18 clinical and 19 molecular features.Eleven non-zero predictors were selected via least absolute shrinkage and selection operator(LASSO),and the model achieved area under curve(AUC)of 0.95 in the training set and 0.96 in the testing set.Decision curve analysis indicated greater net benefit compared with conventional diagnostic approaches.Conclusions:Molecular testing significantly improved diagnostic accuracy for Bethesda I thyroid nodules.Integrating molecular and clinical data enabled the development of a robust predictive model,facilitating precise,individualized patient management and reducing the need for repeat FNAC and unnecessary surgeries.展开更多
Background:Collision medullary and papillary thyroid carcinoma(MTC/PTC)is a rare entity,constituting less than 1%of all thyroid malignancies.The concurrent presence of these malignancies in patients with autoimmune th...Background:Collision medullary and papillary thyroid carcinoma(MTC/PTC)is a rare entity,constituting less than 1%of all thyroid malignancies.The concurrent presence of these malignancies in patients with autoimmune thyroid disease,such as Graves’disease,is even more uncommon.Calcitonin(Ctn)is considered one of the key MTC biomarkers.Mixed tumors may alter this relationship.Case Description:We report the case of a 55-year-old female with a history of Graves’disease,who underwent total thyroidectomy for persistent dysthyroid orbitopathy.Histopathological analysis revealed a 9-mm collision MTC/PTC tumor in the left thyroid lobe,confirmed through immunohistochemical staining.Postoperative evaluation demonstrated lymph node metastases,necessitating central and left lateral neck dissection.Postoperative serum markers(calcitonin,carcinoembryonic antigen,thyroglobulin)declined significantly following surgery and radioiodine therapy.Conclusion:Subcentimeter collision MTC-PTC tumors can be aggressive,challenging size-based management thresholds.Treatment should integrate MTC and PTC protocols,with Ctn,carcinoembryonic antigen(CEA),and thyroglobulin monitored in tandem.Larger datasets are needed to refine Ctn prognostic thresholds in mixed tumors.展开更多
Currently,thyroid diseases are prevalent worldwide;therefore,it is necessary to develop techniques that help doctors improve their diagnostic skills for such diseases.In previous studies,2-dimensional convolutional ne...Currently,thyroid diseases are prevalent worldwide;therefore,it is necessary to develop techniques that help doctors improve their diagnostic skills for such diseases.In previous studies,2-dimensional convolutional neural network(2D CNN)techniques were employed to classify thyroid nodules as benign and malignant without detecting the presence of thyroid nodules in the obtained ultrasound images.To address this issue,we propose a 3-dimensional convolutional neural network(3D CNN)for thyroid nodule detection.The proposed CNN exploits the 3D information and spatial features contained in ultrasound images and generates distinctive features during its training using multiple samples,even for small nodules.In contrast,a 2D CNN only depends on spatial features.In this study,we used two datasets of 2210 ultrasound images obtained from the Sultan Abdul Aziz Shah Hospital in Malaysia,and a public open dataset,Digital Database Thyroid Image(DDTI).We created folders containing three images each,processed the images and extracted volumetric features suitable for the 3-dimensional convolutional neural network(3D CNN).The proposed model was assessed using four metrics:accuracy,recall,precision and F1 score.The results showed that the accuracy of the model in predicting the presence of thyroid nodules in ultrasound images was 96%.In conclusion,this study could help radiologists in hospitals and medical centres in classifying ultrasound images and detecting thyroid nodules.展开更多
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
文摘Metabolic dysfunction-associated steatotic liver disease(MASLD)has become the most prevalent chronic liver disease worldwide,affecting approximately 32%-38%of the adult population and posing a growing public health burden.MASLD represents a continuous disease spectrum ranging from simple steatosis to metabolic dysfunction-associated steatohepatitis(MASH),progressive hepatic fibrosis,cirrhosis,and ultimately hepatocellular carcinoma(HCC).The pathological core of MASLD lies in disruption of hepatic lipid metabolic homeostasis,characterized by an imbalance among de novo lipogenesis,fatty acidβ-oxidation,and very-low-density lipoprotein(VLDL)-mediated lipid export.This metabolic disequilibrium subsequently drives inflammatory injury and fibrotic progression.Among the multiple regulatory pathways involved,thyroid hormone(TH)signaling has emerged as a central regulator of hepatic metabolic homeostasis.The liver is a major peripheral target organ of TH action,where TH predominantly exerts its metabolic effects through thyroid hormone receptorβ(TRβ).Large-scale epidemiological studies and metaanalyses have demonstrated that hypothyroidism is significantly associated with increased MASLD prevalence,more severe histological injury,and advanced hepatic fibrosis,suggesting that dysregulation of TH signaling may participate throughout the entire MASLD disease spectrum.At the molecular level,TH regulates hepatic lipid metabolism by coordinating suppression of lipogenesis,enhancement of mitochondrial fatty acid oxidation,and promotion of VLDL assembly and secretion through integrated genomic actions of the T3-TRβaxis and non-genomic signaling pathways.Across different stages of MASLD,TH signaling exerts stagedependent protective effects.In the steatosis stage,TH improves metabolic flexibility by modulating insulin sensitivity,glucose metabolism,and lipid droplet clearance,thereby alleviating early lipotoxic stress.During progression to MASH,TH attenuates inflammatory amplification by improving mitochondrial homeostasis,suppressing activation of the NOD-like receptor family pyrin domain containing 3(NLRP3)inflammasome,and modulating the gut-liver axis microenvironment.In advanced stages,TH signaling influences hepatic stellate cell activation and extracellular matrix deposition,partly through interaction with the transforming growth factor-β(TGF-β)/SMAD pathway,while alterations in intrahepatic TH availability,mediated by dynamic changes in iodothyronine deiodinase 1(DIO1),contribute to fibrosis progression and hepatocellular dedifferentiation.In hepatocellular carcinoma,coordinated downregulation of TRβand DIO1 establishes a tumor-associated hypothyroid state that promotes metabolic reprogramming and tumor progression.The clinical relevance of TH signaling in MASLD has been underscored by the recent approval of Resmetirom,a liver-targeted TRβ-selective agonist,for the treatment of non-cirrhotic MASH with moderate-to-severe fibrosis(F2-F3).This approval represents a landmark transition from mechanistic understanding to metabolismcentered precision therapy in MASLD.Clinical trials have demonstrated that Resmetirom not only improves key histological endpoints,including MASH resolution and fibrosis regression,but also favorably modulates atherogenic lipid profiles,highlighting the therapeutic potential of selectively targeting hepatic TH pathways.This review systematically summarizes the multidimensional regulatory roles of TH across the MASLD disease spectrum and discusses emerging diagnostic and therapeutic implications of THbased interventions,aiming to inform future mechanistic research and optimize clinical management strategies.
基金supported by Military Key Clinical Speciality(No.51561Z23612)Chongqing Talents Project(No.cstc2022ycjh-bgzxm0091)。
文摘Objective:Non-diagnostic thyroid nodules(Bethesda I)account for 5%-20%of all thyroid nodules.Accurate differentiation of benign and malignant nodules can reduce unnecessary surgeries and repeat biopsies.Herein we evaluated the diagnostic efficacy of multigene testing in non-diagnostic thyroid nodules and developed a predictive model integrating molecular and clinical data.Methods:In this prospective cohort study,1,175 patients with thyroid nodules were evaluated for inclusion,of which 218 patients with Bethesda I nodules met our inclusion criteria.The primary outcome was diagnostic accuracy of molecular testing,and the secondary outcome was the performance of a predictive model integrating molecular and clinical data.Results:Final histopathology identified 165 benign and 53 malignant nodules.Molecular testing detected 10distinct point mutations and seven gene fusions.Among benign nodules,147 tested negative and 18 tested positive,whereas 44 malignant nodules tested positive and nine tested negative.In nodules with ultrasound grades 4-5 and fine-needle aspiration cytology(FNAC)results categorized as non-diagnostic,molecular testing achieved sensitivity of 83.00%,specificity of 89.00%,positive predictive value(PPV)of 71.00%,negative predictive value(NPV)of94.20%,and overall accuracy of 87.60%.The predictive model incorporated 18 clinical and 19 molecular features.Eleven non-zero predictors were selected via least absolute shrinkage and selection operator(LASSO),and the model achieved area under curve(AUC)of 0.95 in the training set and 0.96 in the testing set.Decision curve analysis indicated greater net benefit compared with conventional diagnostic approaches.Conclusions:Molecular testing significantly improved diagnostic accuracy for Bethesda I thyroid nodules.Integrating molecular and clinical data enabled the development of a robust predictive model,facilitating precise,individualized patient management and reducing the need for repeat FNAC and unnecessary surgeries.
文摘Background:Collision medullary and papillary thyroid carcinoma(MTC/PTC)is a rare entity,constituting less than 1%of all thyroid malignancies.The concurrent presence of these malignancies in patients with autoimmune thyroid disease,such as Graves’disease,is even more uncommon.Calcitonin(Ctn)is considered one of the key MTC biomarkers.Mixed tumors may alter this relationship.Case Description:We report the case of a 55-year-old female with a history of Graves’disease,who underwent total thyroidectomy for persistent dysthyroid orbitopathy.Histopathological analysis revealed a 9-mm collision MTC/PTC tumor in the left thyroid lobe,confirmed through immunohistochemical staining.Postoperative evaluation demonstrated lymph node metastases,necessitating central and left lateral neck dissection.Postoperative serum markers(calcitonin,carcinoembryonic antigen,thyroglobulin)declined significantly following surgery and radioiodine therapy.Conclusion:Subcentimeter collision MTC-PTC tumors can be aggressive,challenging size-based management thresholds.Treatment should integrate MTC and PTC protocols,with Ctn,carcinoembryonic antigen(CEA),and thyroglobulin monitored in tandem.Larger datasets are needed to refine Ctn prognostic thresholds in mixed tumors.
基金supported by the Ministry of Higher Education under the Fundamentals Research Grant Scheme(FRGS/1/2024/ICT02/UPM/02/5).
文摘Currently,thyroid diseases are prevalent worldwide;therefore,it is necessary to develop techniques that help doctors improve their diagnostic skills for such diseases.In previous studies,2-dimensional convolutional neural network(2D CNN)techniques were employed to classify thyroid nodules as benign and malignant without detecting the presence of thyroid nodules in the obtained ultrasound images.To address this issue,we propose a 3-dimensional convolutional neural network(3D CNN)for thyroid nodule detection.The proposed CNN exploits the 3D information and spatial features contained in ultrasound images and generates distinctive features during its training using multiple samples,even for small nodules.In contrast,a 2D CNN only depends on spatial features.In this study,we used two datasets of 2210 ultrasound images obtained from the Sultan Abdul Aziz Shah Hospital in Malaysia,and a public open dataset,Digital Database Thyroid Image(DDTI).We created folders containing three images each,processed the images and extracted volumetric features suitable for the 3-dimensional convolutional neural network(3D CNN).The proposed model was assessed using four metrics:accuracy,recall,precision and F1 score.The results showed that the accuracy of the model in predicting the presence of thyroid nodules in ultrasound images was 96%.In conclusion,this study could help radiologists in hospitals and medical centres in classifying ultrasound images and detecting thyroid nodules.
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.
