Diagnosis Of Thyroid Cancer Research Articles

Anxiety and Depression as Potential Predictors for Shorter Time to Undergo Initial Surgical Treatment for Papillary Thyroid Cancer

(1) Background: A pre-existing psychiatric condition may impact decision making by patients and/or physicians following a thyroid cancer diagnosis, such as potentially electing surgery over active surveillance, thus shortening the time to cancer removal. This is the first study to investigate the association between pre-existing anxiety and/or depression and time to receive surgical treatment for thyroid cancer. (2) Methods: Retrospective data were collected from 652 surgical thyroid cancer patients at our institution from 2018 to 2020. We investigated the time between thyroid cancer diagnosis and surgery, comparing patients with pre-existing anxiety and/or depression to those without. (3) Results: Patients with anxiety, depression, and both anxiety and depression had a significantly shorter time between diagnosis and surgery (51.6, 57, and 57.4 days, respectively) compared to patients without (111.9 days) (p = 0.002, p = 0.004, p = 0.003, respectively). (4) Conclusions: Although little is known about the impact of pre-existing psychiatric conditions in the decision-making process for thyroid cancer surgery, this present study showed that anxiety and/or depression may lead to more immediate surgical interventions. Thus, psychiatric history may be an important factor for physicians to consider when counseling patients with thyroid cancer.

Ultrasound microflow patterns help in distinguishing malignant from benign thyroid nodules

BackgroundVascular features are not commonly used to evaluate thyroid nodules by conventional ultrasound due to the low sensitivity. Superb Microvascular Imaging (SMI) is a new ultrasonic Doppler technology that specializes in depicting microvessels and low-speed flow. The objective of this study was to explore the value of microflow features on SMI in differentiating malignant from benign thyroid nodules.MethodsOne hundred and seventy-seven adult patients with thyroid nodules in our center from October 2021 to June 2022 with available histopathological results were recruited, including 125 malignant nodules and 123 benign nodules. Preoperative ultrasound was performed using greyscale, Color Doppler Flow Imaging (CDFI), monochrome SMI (mSMI) and color SMI (cSMI). Vascular features such as flow richness, microflow distribution and microflow patterns of malignant thyroid nodules were compared with those of benign nodules.ResultsPenetrating vessel ≥ 1 (82.4% in the malignant group vs. 30.9% in the benign group, P < 0.001), the crab claw-like pattern (64.0% vs. 10.6%, P < 0.001) and the root hair-like pattern (8.0% vs. 2.4%, P = 0.049) were common in malignant thyroid nodules, among which the crab claw-like pattern was an independent risk factor for malignant thyroid nodules. The wheel-like pattern (1.6% in the malignant group vs. 33.3% in the benign group, P < 0.001) and the arborescent pattern (0 vs. 19.5%, P < 0.001) were more likely to appear in benign nodules. The diagnostic specificities of the crab claw-like pattern and the root hair-like pattern for malignant thyroid nodules were 0.894, 0.976, and the positive predictive values were 0.860, 0.769. The diagnostic specificities of the wheel-like pattern and the arborescent pattern for benign thyroid nodules were 0.984, 1.000, and the positive predictive values were 0.953, 1.000.ConclusionsThe crab claw-like pattern and the root hair-like pattern were microflow characteristics of malignant thyroid nodules. The wheel-like pattern and the arborescent pattern could help exclude the diagnosis of thyroid cancer.

Detecting thyrotropin receptor mRNA from peripheral blood of patients with differentiated thyroid cancer rules out non-aggressive cases.

Early diagnosis of thyroid cancer is hampered by the inability of fine-needle aspiration biopsy (FNAB) to accurately classify ∼30% of cases while preoperative cancer staging detects lymph nodal involvement in only half of cases. Liquid biopsy may present an accurate, non-invasive alternative for preoperative thyroid nodule assessment. Thyrotropin receptor (TSHR) mRNA, a surrogate marker for circulating cancer cells (CTC), may be an option for early detection of malignancy from peripheral blood, but requires methodological improvements. We aimed to investigate if TSHR mRNA can be detected in low sample volumes by employing an ultrasensitive method - droplet digital PCR (ddPCR). Less than 5mL of blood was collected from 47 patients with thyroid nodules (25 benign and 22 malignant). RNA was isolated from the fraction of mononuclear cells where CTCs segregate. Samples were analysed for the presence of TSHR mRNA by ddPCR. Thyrotropin receptor mRNA was detectable in 4mL sample volumes, with the test having good specificity (80%) but modest diagnostic accuracy (68.1%). Combining TSHR mRNA with ultrasound features and FNAB diagnosis, the test reaches high rule-out performances (sensitivity = 90% and NPV = 88.2%). Strikingly, TSHR mRNA correctly classified all samples with thyroid capsule invasion, lymph node metastasis and extrathyroidal extension. If aggressiveness is defined using these parameters, TSHR mRNA test reaches 100% sensitivity and 100% NPV for detecting high-risk cases. Employing ddPCR for TSHR mRNA improves its measurement by enabling detection in sample volumes common for laboratory testing. The test displays high prognostic performance, showing potential in preoperative risk assessment.

CMTM 6 promotes the development of thyroid cancer by inhibiting NIS activity through activating the MAPK signaling pathway.

Thyroid cancer is the most common type of endocrine cancer. Chemokine-like factor (CKLF)-like MARVEL transmembrane domain containing 6 (CMTM6) is recognized as one of its potential immunotherapy targets. The purpose of this study was to investigate the role and molecular mechanism of CMTM6 in regulating the development of thyroid cancer cells. In this study, expression levels of CMTM6 and the sodium/iodide symporter (NIS) were detected by qRT-PCR. Additionally, colony formation assay and flow cytometry were used to detect cell proliferation and apoptosis, while expression levels of various proteins were assessed using Western blotting. Further, the apoptosis and invasion capacity of cells were investigated by scratch and transwell experiments. Finally, the effect of CMTM6 on the epithelial-mesenchymal transition (EMT) of thyroid cancer cells was determined by immunofluorescence assay, which measured the expression levels of epithelial and mesenchymal phenotypic markers. The results of qRT-PCR experiments showed that CMTM6 was highly expressed in thyroid cancer tissues and cells. In addition, knockdown of CMTM6 expression significantly increased NIS expression. Function experiments demonstrated that small interfering (si)-CMTM6 treatment inhibited the proliferation, migration, invasion, and EMT of thyroid cancer cells, while promoting apoptosis of FTC133 cells. Furthermore, mechanistic studies showed that mitogen-activated protein kinase (MAPK) and extracellular signal-regulated kinase (ERK) phosphorylation were inhibited by si-CMTM6, as demonstrated by Western blot experiments. In conclusion, our findings demonstrated the role of CMTM6 in the metastasis of thyroid cancer. Briefly, CMTM6 exerts its tumor-promoting effect through the MAPK signaling pathway and could potentially be used as a valuable biomarker for thyroid cancer diagnosis and prognosis.

P-68 Misdiagnosed calcitonin negative Medullary thyroid carcinoma as Hurthle cell thyroid adenoma with fine needle aspiration biopsy

Abstract Introduction Medullary carcinoma is a rare thyroid carcinoma, that originates from the malignant proliferation of parafollicular C cells. Medullary thyroid cancer produces calcitonin, and elevated calcitonin level is an essential feature of this tumor, so, most of them are associated with high levels of calcitonin. Calcitonin-negative medullary carcinoma of the thyroid gland is an extremely rare entity and poorly understood primary neuroendocrine carcinoma that is characterized by classic medullary carcinoma of the thyroid morphology without raised serum calcitonin levels. Fine needle biopsy (FNAB) is a diagnostic test done in people with suspected thyroid cancer and it is very important for timely diagnosis and treatment of medullar thyroid cancer, especially when calcitonin levels are in normal range. Clinical Case A 35-year-old woman visited an endocrinologist due to swelling on the left side of the neck. Thyroid ultrasound showed hypoechogenic, heterogenous nodule in the left lobe with dimensions 29×28×35 mm and calcifications. Laboratory tests were normal: thyroid stimulating hormone (TSH) 3,0 mlU/ml; free T4 14,3 pmol/l; anti –thyroid peroxidase antibody (ATPO) 20IU/ml; human thyroglobulin 35IU/ml; calcitonin &amp;lt;2 pg/ml; carcinoembryonic acid (CEA) 0.742ng/ml. The FNAB were performed, with cytological finding for classification group I. Four months after the first biopsy, the FNAB was repeated and Hürthle cells were found, with pronounced degenerative changes as well as pronounced cytological atypia, cytological findings correspond to classification group III. Computed tomography of the neck was performed preoperatively and it showed hypodense nodule (slightly smaller than 4 cm) with numerous calcifications, and no significantly enlarged lymph nodes. Left lobectomy was performed with histopathological findings for Medullary thyroid carcinoma. Immunohistochemical tumor cells were positive for chromogranin A, CD56, focally for thyroglobulin and CK 19, and negative for S-100 and NSE. RET gene mutation analysis was performed and it was negative. Additional diagnostic tests were performed for MEN2A and MEN 2B and they were excluded. Postoperative levels of calcitonin and CEA were in normal range. Conclusion Normal calcitonin levels do not exclude medullar carcinoma. Follow-up and monitoring of the patients with thyroid nodules is very important for timely diagnososis and treatment of medullar carcinoma.

A multitask approach for automated detection and segmentation of thyroid nodules in ultrasound images

An increase in the incidence and diagnosis of thyroid nodules and thyroid cancer underscores the need for a better approach to nodule detection and risk stratification in ultrasound (US) images that can reduce healthcare costs, patient discomfort, and unnecessary invasive procedures. However, variability in ultrasound technique and interpretation makes the diagnostic process partially subjective. Therefore, an automated approach that detects and segments nodules could improve performance on downstream tasks, such as risk stratification. Ultrasound studies were acquired from 280 patients at UCLA Health, totaling 9888 images, and annotated by collaborating radiologists. Current deep learning architectures for segmentation are typically semi-automated because they are evaluated solely on images known to have nodules and do not assess ability to identify suspicious images. However, the proposed multitask approach both detects suspicious images and segments potential nodules; this allows for a clinically translatable model that aptly parallels the workflow for thyroid nodule assessment. The multitask approach is centered on an anomaly detection (AD) module that can be integrated with any UNet architecture variant to improve image-level nodule detection. Of the evaluated multitask models, a UNet with a ImageNet pretrained encoder and AD achieved the highest F1 score of 0.839 and image-wide Dice similarity coefficient of 0.808 on the hold-out test set. Furthermore, models were evaluated on two external validations datasets to demonstrate generalizability and robustness to data variability. Ultimately, the proposed architecture is an automated multitask method that expands on previous methods by successfully both detecting and segmenting nodules in ultrasound.

Comparative Cross Sectional Study Between Accuracy of Ultrasonography and Cytology in Diagnosis of Thyroid Cancer with Final Histopathology Results

Comparative Cross Sectional Study Between Accuracy of Ultrasonography and Cytology in Diagnosis of Thyroid Cancer with Final Histopathology Results

Exploring the potential of myo-inositol in thyroid disease management: focus on thyroid cancer diagnosis and therapy.

Thyroid cancer (TC) is a malignancy that is increasing in prevalence on a global scale, necessitating the development of innovative approaches for both diagnosis and treatment. Myo-inositol (MI) plays a crucial role in a wide range of physiological and pathological functions within human cells. To date, studies have investigated the function of MI in thyroid physiology as well as its potential therapeutic benefits for hypothyroidism and autoimmune thyroiditis. However, research in the field of TC is very restricted. Metabolomics studies have highlighted the promising diagnostic capabilities of MI, recognizing it as a metabolic biomarker for identifying thyroid tumors. Furthermore, MI can influence therapeutic characteristics by modulating key cellular pathways involved in TC. This review evaluates the potential application of MI as a naturally occurring compound in the management of thyroid diseases, including hypothyroidism, autoimmune thyroiditis, and especially TC. The limited number of studies conducted in the field of TC emphasizes the critical need for future research to comprehend the multifaceted role of MI in TC. A significant amount of research and clinical trials is necessary to understand the role of MI in the pathology of TC, its diagnostic and therapeutic potential, and to pave the way for personalized medicine strategies in managing this intricate disease.

Reinforced Computer-Aided Framework for Diagnosing Thyroid Cancer.

Thyroid cancer is the most pervasive disease in the endocrine system and is getting extensive attention. The most prevalent method for an early check is ultrasound examination. Traditional research mainly concentrates on promoting the performance of processing a single ultrasound image using deep learning. However, the complex situation of patients and nodules often makes the model dissatisfactory in terms of accuracy and generalization. Imitating the diagnosis process in reality, a practical diagnosis-oriented computer-aided diagnosis (CAD) framework towards thyroid nodules is proposed, using collaborative deep learning and reinforcement learning. Under the framework, the deep learning model is trained collaboratively with multiparty data; afterward classification results are fused by a reinforcement learning agent to decide the final diagnosis result. Within the architecture, multiparty collaborative learning with privacy-preserving on large-scale medical data brings robustness and generalization, and diagnostic information is modeled as a Markov decision process (MDP) to get final precise diagnosis results. Moreover, the framework is scalable and capable of containing more diagnostic information and multiple sources to pursue a precise diagnosis. A practical dataset of two thousand thyroid ultrasound images is collected and labeled for collaborative training on classification tasks. The simulated experiments have shown the advancement of the framework in promising performance.

The interplay between crystallinity and the levels of Zn and carbonate in synthetic microcalcifications directs thyroid cell malignancy.

One of the key challenges in diagnosing thyroid cancer lies in the substantial percentage of indeterminate diagnoses of thyroid nodules that have undergone ultrasound-guided fine-needle aspiration (FNA) biopsy for cytological evaluation. This delays the definitive diagnosis and treatment plans. We recently demonstrated that hydroxyapatite microcalcifications (MCs) aspirated from thyroid nodules may aid nodule diagnosis based on their composition. In particular, Zn-enriched MCs have emerged as potential cancer biomarkers. However, a pertinent question remains: is the elevated Zn content within MCs a consequence of cancer, or do the Zn-enriched MCs encourage tumorigenesis? To address this, we treated the human thyroid cancer cell line MDA-T32 with synthetic MC analogs comprising hydroxyapatite crystals with varied pathologically relevant Zn fractions and assessed the cellular response. The MC analogs exhibited an irregular surface morphology similar to FNA MCs observed in cancerous thyroid nodules. These MC analogs displayed an inverse relationship between Zn fraction and crystallinity, as shown by X-ray diffractometry. The zeta potential of the non-Zn-bearing hydroxyapatite crystals was negative, which decreased once Zn was incorporated into the crystal. The MC analogs were not cytotoxic. The cellular response to exposure to these crystals was evaluated in terms of cell migration, proliferation, the tendency of the cells to form multicellular spheroids, and the expression of cancer markers. Our findings suggest that, if thyroid MCs play a role in promoting cancerous behavior in vivo, it is likely a result of the interplay of crystallinity with Zn and carbonate fractions in MCs.

PCR test system in the diagnosis of medullary thyroid cancer

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Case Series of Surgical Treatment in Pediatric Thyroid Carcinoma in a Single Institution.

The prevalence of thyroid carcinoma (TC) among pediatric and adolescent populations is infrequent, yet its global occurrence is escalating. Insufficient information pertaining to TC in the pediatric populace of Indonesia presents issues in the identification and management of patients with this condition. The objective of this study is to provide a detailed account of a collection of pediatric TC cases that were recorded at a tertiary care center throughout an extended interval of eight years. The present study conducted a retrospective data analysis of ten patients who received a diagnosis of TC during the period spanning from 2014 to 2022. The present study focused on analyzing the clinical manifestation, diagnostic measures, treatment modalities, and immediate postoperative consequences of TC. All patients diagnosed with thyroid cancer exhibited the presence of neck lump. Nine patients underwent total thyroidectomy, while one patient underwent isthmolobectomy. The histopathologic evaluation confirmed the diagnosis of thyroid cancer in every individual. There were a significant number of patients, up to 50%, who encountered complications after undergoing surgery. Two patients reported the hoarseness of voice, whereas two other patients experienced the signs of hypocalcemia. Only one patient exhibited both these symptoms simultaneously. The implementation of total thyroidectomy as a surgical intervention in pediatric patients poses a notable challenge. Postoperative monitoring for potential complications following surgery for total thyroidectomy is imperative. The current study provides evidence that the utilization of total thyroidectomy in combination with lymph node dissection as indicated in patients with lymph node metastases in pediatric patients with thyroid carcinoma leads to a significant reduction in the probability of recurrence of lymph node enlargement. During the performance of surgical procedures, meticulous observation plays a key role in mitigating the risk of postoperative complications, such as hypoparathyroidism, hypocalcemia, and injury to the recurrent laryngeal nerve. Thus, it is imperative to conduct follow-up procedures for post-surgical interventions among pediatric patients diagnosed with TC.

Thyroid Incidentalomas: Scrutinizing the Mode of Detection and Evaluating its Contribution to Thyroid Cancer Diagnosis.

In total, 576 patients were analyzed, with a total of 1014 nodules described. In 347 (60.2%) cases, the diagnosis of a thyroid nodule was incidental, mostly during imaging tests for other reasons. Incidental diagnosis occurred among all ranges of nodule diameter and between palpable and non-palpable cases, even within a small proportion of symptomatic cases. In univariate analysis, incidental diagnosis was associated with smaller nodule diameter, non-palpable nodules, asymptomatic cases, older patient age, less advanced stages (T1-2), and conservative management. After multivariate analysis, older age, euthyroidism, and smaller diameter were statistically significant. Incidental diagnosis contributed to the diagnosis of 53.8% of the cases of cancer. Advanced T stages (T3-4) were more common in non-incidental diagnoses. Our results indicate that incidental diagnosis of thyroid nodules is a significant contributor to thyroid cancer diagnosis in all ranges of nodule diameter, especially at earlier stages.

Role of hypermethylated SLC5A8 in follicular thyroid cancer diagnosis and prognosis prediction

ObjectiveThyroid cancer is one of the most frequently reported endocrine system malignancies. It is difficult to distinguish follicular thyroid cancer (FTC) from follicular thyroid adenoma (FTA) during pathological diagnosis in patients without lymph nodes or distant metastases. Therefore, we conducted a retrospective study to investigate the significance of SLC5A8 methylation and expression in the diagnosis and prognosis of FTC.MethodsWe used 165 tissue samples, including FTC (n = 58), thyroid tumors of uncertain malignant potential (TT-UMP, n = 40), and FTA (n = 67), to explore the differences in SLC5A8 methylation and mRNA transcription in different pathological types. Survival analysis was conducted to evaluate the recurrence rate at a 5-year follow-up.ResultsThe SLC5A8 methylation positive rate was higher in patients with thyroglobulin ≥ 40 μg/l and Chol ≥ 5.17 mmol/l, and it was higher in patients with FTC (n = 42, 72.4%) than those with FTA (n = 27, 40.3%) and TT-UMP (n = 23, 57.5%). The relative concentration of SLC5A8 mRNA was lower in patients with FTC than in those with FTA (p < 0.05). At 5-year follow-ups, patients who were SLC5A8 methylation-positive had a higher recurrence rate than those who were methylation-negative.ConclusionsOur current study indicates that SLC5A8 gene methylation occurs more commonly in patients with FTC than in those with FTA. The differences in SLC5A8 methylation and expression among FTA, FTC, and TT-UMP provide an important basis for further exploration of epigenetic changes in the occurrence, development, and prognosis of thyroid cancer. Our findings need to be further validated in larger populations with long-term follow-up in the future.

Applications of machine and deep learning to thyroid cytology and histopathology: a review.

This review synthesises past research into how machine and deep learning can improve the cyto- and histopathology processing pipelines for thyroid cancer diagnosis. The current gold-standard preoperative technique of fine-needle aspiration cytology has high interobserver variability, often returns indeterminate samples and cannot reliably identify some pathologies; histopathology analysis addresses these issues to an extent, but it requires surgical resection of the suspicious lesions so cannot influence preoperative decisions. Motivated by these issues, as well as by the chronic shortage of trained pathologists, much research has been conducted into how artificial intelligence could improve current pipelines and reduce the pressure on clinicians. Many past studies have indicated the significant potential of automated image analysis in classifying thyroid lesions, particularly for those of papillary thyroid carcinoma, but these have generally been retrospective, so questions remain about both the practical efficacy of these automated tools and the realities of integrating them into clinical workflows. Furthermore, the nature of thyroid lesion classification is significantly more nuanced in practice than many current studies have addressed, and this, along with the heterogeneous nature of processing pipelines in different laboratories, means that no solution has proven itself robust enough for clinical adoption. There are, therefore, multiple avenues for future research: examine the practical implementation of these algorithms as pathologist decision-support systems; improve interpretability, which is necessary for developing trust with clinicians and regulators; and investigate multiclassification on diverse multicentre datasets, aiming for methods that demonstrate high performance in a process- and equipment-agnostic manner.

Knowledge, attitude, and practice towards thyroid nodules and cancer among patients: a cross-sectional study.

This study aimed to explore the knowledge, attitude, and practice (KAP) towards thyroid nodules (TN) and thyroid cancer (TC) among patients. This cross-sectional study enrolled patients with TN or TC at the Second Affiliated Hospital of the University of South China between September 2022 and February 2023. A self-administered questionnaire was developed to collect demographic information of the participants, and their knowledge, attitude and practice (KAP) towards TN and TC. A total of 510 valid questionnaires were collected. Among the participants, 102 (20.00%) were male, and 197 (38.63%) had the diagnosis of TC. The knowledge, attitude and practice scores were 5.76 ± 3.09 (possible range: 0-12), 31.07 ± 2.73 (possible range: 9-45), and 18.97 ± 2.92 (possible range: 5-25), respectively. Multivariate logistic regression showed that age of above 50 years old (OR = 0.27, 95%CI: 0.12-0.64, p = 0.003), junior college or bachelor's degree and above (OR = 4.97, 95%CI: 1.74-14.20, p = 0.003), monthly income of 5,000-10,000 CNY (OR = 2.02, 95%CI: 1.09-3.74, p = 0.025) and > 10,000 CNY (OR = 5.67, 95%CI: 2.49-12.94, p < 0.001) were independently associated with knowledge. The good knowledge (OR = 3.87, 95%CI: 1.89-7.95, p < 0.001), high school or technical secondary school (OR = 0.52, 95%CI: 0.30-0.88, p = 0.016), and monthly income of 5,000-10,000 CNY (OR = 2.02, 95%CI: 1.13-3.63, p = 0.018) were independently associated with practice. Patients demonstrated poor knowledge, moderate attitude, and proactive practice towards TN and TC.

Exploration of aminopeptidase N as new biomarker for early diagnosis of thyroid cancer

False-positive diagnosis and overdiagnosis are ongoing issues in clinical diagnosis of thyroid cancer. Identifying new disease markers is crucial for early diagnosis and improved treatment. Aminopeptidase N (APN) is a promising biomarker for cancer diagnosis due to its critical roles in tumor invasion, metastasis, angiogenesis, and other processes. However, its potential as biomarker for thyroid cancer diagnosis needs further investigation. This study developed an ultra-sensitive near-infrared fluorescence probe, LAN-apn, to investigate the expression level of APN in thyroid cancer and evaluate its potential as biomarker of thyroid cancer. LAN-apn could accurately and sensitively determine APN through fluorescence method (DL = 0.069 ng/mL) and colorimetric method (DL = 4.5 ng/mL). In addition, LAN-apn allowed for successful fluorescence imaging of APN in thyroid cancer cells and thyroid cancer tumors both in vivo and in vitro, and confirmed that APN was significantly upregulated in thyroid cancer. Therefore, APN may become a new biomarker for thyroid cancer diagnosis, and LAN-apn could be used as a new imaging tool for the study of APN-thyroid cancer relationship and the early diagnosis of thyroid cancer.

MASK CLASSIFICATION SEGMENTATION METHOD BASED ON GROUPED CONVOLUTION AND SPATIAL PYRAMIDAL CONVOLUTION MODEL FOR THYROID CANCER IDENTIFICATION

Ultrasound plays different roles in the whole process of thyroid cancer management. With the advancement of ultrasound imaging technology and diagnostic level, it is gradually becoming an irreplaceable role in the diagnosis and treatment of thyroid cancer. However, the diagnosis of thyroid cancer by means of sonographic features is subjective and highly dependent on the operator’s experience and knowledge. To avoid unnecessary puncture biopsies, alleviate anxiety and improve diagnostic efficiency, in this paper, we utilize a purely convolutional model with a pyramid structure strategy to extract sonographic features at different scales. Combined with a per-pixel classification segmentation method, which is different from the previous mainstream, it is used for the intelligent recognition of thyroid cancer. Finally, the experimental results show that our radiologists achieve better performance than five mainstream segmentation methods in four metrics (Sensitivity, Jarccard, Dice, ASD) on the thyroid cancer dataset. It provides the possibility to help radiologists to overcome diagnostic subjectivity and obtain accurate, reproducible and more objective diagnostic results.

Clinical Diagnosis and Management of Thyroid Cancer

The thyroid gland is the largest organ of the endocrine system. Disorders of the thyroid gland present the most common clinical manifestations compared to other organs of the endocrine system. Thyroid Cancer has a high incidence is one of the leading causes of death worldwide and accounted for 7.6 million deaths (13% of all deaths) in 2008 and this figure continues to increase every year. Along with the increasing prevalence of thyroid cancer in Indonesia, this study was conducted to find out the proper diagnosis and management of thyroid cancer

Per- and polyfluoroalkyl substances (PFAS) exposure and thyroid cancer risk

Although per- and polyfluoroalkyl substances (PFAS) exposure is a potential contributor to the increasing thyroid cancer trend, limited studies have investigated the association between PFAS exposure and thyroid cancer in human populations. We therefore investigated associations between plasma PFAS levels and thyroid cancer diagnosis using a nested case-control study of patients with thyroid cancer with plasma samples collected at/before cancer diagnosis. 88 patients with thyroid cancer using diagnosis codes and 88 healthy (non-cancer) controls pair-matched on sex, age (±5 years), race/ethnicity, body mass index, smoking status, and year of sample collection were identified in the BioMe population (a medical record-linked biobank at the Icahn School of Medicine at Mount Sinai in New York); 74 patients had papillary thyroid cancer. Eight plasma PFAS were measured using untargeted analysis with liquid chromatography-high resolution mass spectrometry and suspect screening. Associations between individual PFAS levels and thyroid cancer were evaluated using unconditional logistic regression models to estimate adjusted odds ratios (ORadj) and 95% confidence intervals (CI). There was a 56% increased rate of thyroid cancer diagnosis per doubling of linear perfluorooctanesulfonic acid (n-PFOS) intensity (ORadj, 1.56, 95% CI: 1.17-2.15, P=0.004); results were similar when including patients with papillary thyroid cancer only (ORadj, 1.56, 95% CI: 1.13-2.21, P=0.009). This positive association remained in subset analysis investigating exposure timing including 31 thyroid cancer cases diagnosed ≥1 year after plasma sample collection (ORadj, 2.67, 95% CI: 1.59-4.88, P<0.001). This study reports associations between exposure to PFAS and increased rate of (papillary) thyroid cancer. Thyroid cancer risk from PFAS exposure is a global concern given the prevalence of PFAS exposure. Individual PFAS studied here are a small proportion of the total number of PFAS supporting additional large-scale prospective studies investigating thyroid cancer risk associated with exposure to PFAS chemicals. National Institutes of Health grants and The Andrea and Charles Bronfman Philanthropies.