Preoperative Thyroid Research Articles

7466 The Effects Of Various Forms Of Diabetes On Features Of Tumor Aggressiveness In Thyroid Cancer

Abstract Disclosure: R.D. Paparodis: None. E. Karvounis: None. A. Kapezanou: None. S. Livadas: None. G. Simeakis: None. D.P. Askitis: None. I. Androulakis: None. N.G. Angelopoulos: None. D. Zianni: None. A. Rizoulis: None. A. Boniakos: None. I. Perogamvros: None. D. Bantouna: None. J.C. Jaume: None. Introduction: Diabetes has been linked to increased risk for several cancers and aggressiveness of tumor behavior. A link between thyroid cancer and diabetes appears controversial in the literature as of yet. We designed the present study to assess whether autoimmune (type 1 + LADA = DM1) or type 2 diabetes (DM2) are associated with more aggressive thyroid cancers compared to those found in non-diabetic (non-DM) individuals. Methods: We retrospectively reviewed data from patients undergoing thyroid surgery in 10 Endocrinology and Endocrine Surgery Clinics throughout Greece over 2 years. We collected data on history and type of diabetes, pre-existing to the thyroid surgery, its treatments and duration, the preoperative thyroid function tests and the surgical pathology findings. We compared the incidence of various histological types of thyroid cancer and the features of tumor aggressiveness between patients with diabetes and those with normal glucose homeostasis (non-DM) (DM1 vs. DM2 vs. non-DM). Results: Overall, n=808 subjects with thyroid cancer were included: n=571 were females (70.7%), age 47.3 ± 14.3 years, BMI 27.0 ± 5.0 Kg/m2, mean TSH 1.99 ± 2.21 mIU/L; n= 692 were non-DM, n=10 had DM1 and n=107 had DM2. Histology revealed n=5 poorly differentiated / anaplastic, n=13 medullary, n=12 Hürthle cell, n=17 follicular and n=773 papillary thyroid cancers (PTC); n=20 (2.5%) with aggressive histological subtypes of PTC, n=5 (0.6%) with distant metastases (MET), n=199 (24.6%) with extrathyroidal extension (ETE), n=419 (51.9%) with capsular invasion (CI), n=225 (27.8%) with lymph nodes involvement (LNi) and n=23 with cancer recurrence (CR) (2.8%). The incidence of aggressive histological types, CR, MET or number of I-131 treatments were not different between groups (p>0.05). ETE, CI and LNi were significantly more common in non-DM compared to both diabetes groups, while gross ETE was more common in DM2 over DM1 and non-DM (p<0.001). Conclusions: More DM1 than DM2 seem to confer a protective effect on several features of cancer aggressiveness in affected individuals. On the other hand, more DM2 than DM1 seems to significantly promote gross ETE. No effect was observed pertaining to the risk for more aggressive tumors or histological subtypes of PTC. Although aggressiveness of thyroid cancer seems controlled in DM1 and to a lesser degree in DM2 the complex interplay between autoimmunity, hyperglycemia and thyroid cancer biology requires larger sample size to better determine causative effects. Presentation: 6/2/2024

7466 The Effects of Various Forms of Diabetes on Features of Tumor Aggressiveness in Thyroid Cancer

Abstract Disclosure: R.D. Paparodis: None. E. Karvounis: None. A. Kapezanou: None. S. Livadas: None. G. Simeakis: None. D.P. Askitis: None. I. Androulakis: None. N.G. Angelopoulos: None. D. Zianni: None. A. Rizoulis: None. A. Boniakos: None. I. Perogamvros: None. D. Bantouna: None. J.C. Jaume: None. Introduction: Diabetes has been linked to increased risk for several cancers and aggressiveness of tumor behavior. A link between thyroid cancer and diabetes appears controversial in the literature as of yet. We designed the present study to assess whether autoimmune (type 1 + LADA = DM1) or type 2 diabetes (DM2) are associated with more aggressive thyroid cancers compared to those found in non-diabetic (non-DM) individuals. Methods: We retrospectively reviewed data from patients undergoing thyroid surgery in 10 Endocrinology and Endocrine Surgery Clinics throughout Greece over 2 years. We collected data on history and type of diabetes, pre-existing to the thyroid surgery, its treatments and duration, the preoperative thyroid function tests and the surgical pathology findings. We compared the incidence of various histological types of thyroid cancer and the features of tumor aggressiveness between patients with diabetes and those with normal glucose homeostasis (non-DM) (DM1 vs. DM2 vs. non-DM). Results: Overall, n=808 subjects with thyroid cancer were included: n=571 were females (70.7%), age 47.3 ± 14.3 years, BMI 27.0 ± 5.0 Kg/m[2], mean TSH 1.99 ± 2.21 mIU/L; n= 692 were non-DM, n=10 had DM1 and n=107 had DM2. Histology revealed n=5 poorly differentiated / anaplastic, n=13 medullary, n=12 Hürthle cell, n=17 follicular and n=773 papillary thyroid cancers (PTC); n=20 (2.5%) with aggressive histological subtypes of PTC, n=5 (0.6%) with distant metastases (MET), n=199 (24.6%) with extrathyroidal extension (ETE), n=419 (51.9%) with capsular invasion (CI), n=225 (27.8%) with lymph nodes involvement (LNi) and n=23 with cancer recurrence (CR) (2.8%). The incidence of aggressive histological types, CR, MET or number of I-131 treatments were not different between groups (p>0.05). ETE, CI and LNi were significantly more common in non-DM compared to both diabetes groups, while gross ETE was more common in DM2 over DM1 and non-DM (p<0.001). Conclusions: More DM1 than DM2 seem to confer a protective effect on several features of cancer aggressiveness in affected individuals. On the other hand, more DM2 than DM1 seems to significantly promote gross ETE. No effect was observed pertaining to the risk for more aggressive tumors or histological subtypes of PTC. Although aggressiveness of thyroid cancer seems controlled in DM1 and to a lesser degree in DM2 the complex interplay between autoimmunity, hyperglycemia and thyroid cancer biology requires larger sample size to better determine causative effects. Presentation: 6/2/2024

The Effect of Thyroid Nodule Size and Characteristics on the Accuracy of Fine-Needle Aspiration Biopsy and the Risk of Malignancy

Objective: Ultrasound evaluation of nodule characteristics and FNAB is a simple, cost-effective method. However, its reliability in large nodules is controversial. This study aims to examine the impact of thyroid nodule size and characteristics on malignancy risk and FNAB accuracy as evaluated by ultrasound. Material and Method: This retrospective study included 522 patients who underwent thyroidectomy between January 1, 2020, and January 1, 2024. The data included the patients’ age, gender, preoperative thyroid ultrasound findings, preoperative FNAB pathology findings, operation notes, and postoperative pathology results colleected from hospital archives. Kruskal-Wallis Variance Analysis, ROC (Receiver Operating Characteristics) curve analysis, Bonferroni Corrected Mann-Whitney U Test, Chi-Square Tests, were used at statistical analysis. Results: The median age was 49.45 years. The threshold value for nodule size in the X plane was 27 mm (p27 mm.

Incidental parathyroidectomy after thyroid surgery and relationship with postoperative hypocalcemia: a single tertiary center analysis.

Incidental parathyroidectomy (IP) is a complication seen at varying rates after thyroid surgery, and its relationship with postoperative hypocalcemia has not been clarified. In this study, our goal was to identify the frequency and risk factors for IP in a large patient cohort and assess its correlation with postoperative hypocalcemia. A total of 4052 patients who underwent thyroid surgery between 2008 and 2020 were reviewed retrospectively. The patients were divided into two groups, the IP and non-IP groups, and compared in terms of demographics, surgical procedures, pathological diagnosis, and specimen weight. The relationships between IP and hypocalcemia were also evaluated. There were 587 (14.5%) IPs out of 4052 cases. In these patients, mostly one gland was removed (84.6%), and 23.2% of these glands were intrathyroidal. The rate of transient hypocalcemia was 39.9%, and that of permanent hypocalcemia was 1.7%. Female gender, malignancy, lower preoperative thyroid volume, presence of central lymph node dissection, lower specimen weight, presence of autotransplantation and capsule invasion in malignant cases were determined to be risk factors for IP. After excluding hemithyroidectomy and autotransplantation, transient and permanent hypocalcemia were found to be significantly higher in cases with IP (p < 0.001). Multivariate analysis showed that female sex, no multinodular goiter, central dissection, and low thyroid volume were risk-adjusted independent variables. Our findings highlight the significant role of IP in postoperative hypocalcemia. Given that most IPs are located in the perithyroidal region, precise surgical dissection is vital to preserve parathyroid gland function and prevent IP and subsequent hypocalcemia.

Preoperative prediction of central lymph node metastasis in follicular variant of papillary thyroid carcinoma using clinical and ultrasound features.

The most common metastatic site of follicular variant of papillary thyroid carcinoma (FVPTC) is the central lymph nodes, which may be associated with the prognosis and survival of patients. In the present study, we establish a combined model based on preoperative clinical and ultrasound (US) features of FVPTC to predict the risk of central lymph node metastasis (CLNM). From January 2013 to December 2022, 315 patients with FVPTC were enrolled and randomly divided into the training and validation cohorts in a ratio of 7:3. The independent risk factors for CLNM in FVPTC were analysed using univariate and multivariate logistic regression analyses. Then, three different models were established based on clinical and US data. Subsequently, a nomogram was constructed to predict CLNM. Its predictive effect was evaluated via receiver operating characteristic and calibration curve analyses. Backward multivariate regression analysis revealed that age (P=0.001), thyroid peroxidase antibody (TPOAb) (P=0.11), diameter (P=0.047), irregular/lobulated margin (P=0.15), extrathyroidal extension (P=0.001), nodules with macrocalcifications (P=0.009), nodules with microcalcification (P=0.003) and Thyroid Imaging Reporting and Data System (ACR-TI-RADS) category 5 (P=0.33) were independent risk factors for CLNM in FVPTC. The areas under the curve of the matching nomogram in the training (N=221) and validation cohorts (N=94) were 0.841 [95% confidence interval (CI): 0.788-0.895] and 0.735 (95% CI: 0.621-0.872), respectively. Preoperative thyroid US provides useful features for prediction of CLNM. The nomogram constructed based on combining US and clinical features can better predict the risk of CLNM and may facilitate decision-making in clinical settings.

Research progress of ectopic thyroid cancer in thyroglossal duct cyst: A case report and literature review.

Thyroglossal duct carcinoma, a rare clinical condition characterized by ectopic thyroid adenocarcinoma within thyroglossal duct cysts (TGDCs), typically confirmed through intraoperative rapid pathology, this condition generally has a favorable prognosis. Nevertheless, comprehensive treatment guidelines across all disease stages are lacking, the purpose of this study is to report 1 case of the disease and propose the treatment plan for each stage of the disease. A patient presented with thyroid swelling, classified as C-TIRADS 4A following a physical examination. Preoperative thyroid puncture identified papillary thyroid carcinoma, and genetic testing revealed a BRAF gene exon 15-point mutation. Ancillary tests showed a slightly decreased thyroid stimulating hormone (TSH) level (0.172) with no other significant abnormalities. Preoperative fine-needle aspiration cytology (FNAC) confirmed right-side thyroid cancer. Intraoperative exploration uncovered a TGDC and intraoperative rapid pathology confirmed thyroglossal duct carcinoma. A Sistrunk operation and ipsilateral thyroidectomy were performed. Postoperative recovery was satisfactory. Thyroglossal duct carcinoma is a rare disease affecting the neck. Due to limited clinical cases and the favorable prognosis associated with this condition, there is currently no established set of diagnostic and treatment guidelines. According to tumor size, lymph node metastasis, thyroid status and other factors, the corresponding treatment methods were established for each stage of thyroglossal duct cancer, which laid the foundation for the subsequent treatment development of this disease.

Alterations in Body Weight and Composition in Patients With Graves' Disease Treated with Total Thyroidectomy.

Thyrotoxicosis causes excess energy expenditure, resulting in weight loss, despite increased appetite, and changes in body composition, which are typically reversible with the normalization of thyroid hormone levels. However, patients with hyperthyroidism due to Graves' disease are sometimes hesitant to undergo treatment because of the perceived morbidity associated with weight gain. Therefore, obtaining data to explain the details of such weight gain to these patients is important. This study aimed to investigate changes in body weight and composition in patients with Graves' disease after total thyroidectomy. In total, 21 patients with Graves' disease who underwent total thyroidectomy were enrolled. Among them, nine patients were hyperthyroid (group A) and 12 were euthyroid (group B, control) immediately before surgery. Body weight, height, and body composition using bioelectrical impedance were measured preoperatively and five months postoperatively. In all patients, body weight, body mass index, and skeletal muscle mass, but not fat mass, significantly increased postoperatively. In individual groups, a significant increase in skeletal muscle and fat masses was observed solely in groups A and B, respectively. Furthermore, a significant positive correlation between preoperative thyroid function and differences in skeletal muscle mass preoperatively and postoperatively was found. Our study shows that the normalization of thyroid function using thyroidectomy in patients with Graves' disease is accompanied by weight gain, mainly due to an increase in skeletal muscle mass. These data are clinically significant because they enable physicians to explain to patients that weight gain after surgical treatment for Graves' disease is favorable and reassure them of their concern.

A machine learning-based diagnosis modeling of IgG4 Hashimoto's thyroiditis.

This study aims to develop a non-invasive diagnosis model using machine learning (ML) for identifying high-risk IgG4 Hashimoto's thyroiditis (HT) patients. A retrospective cohort of 93 HT patients and a prospective cohort of 179 HT patients were collected. According to the immunohistochemical and pathological results, the patients were divided into IgG4 HT group and non-IgG4 HT group. Serum TgAb IgG4 and TPOAb IgG4 were detected by ELISAs. A logistic regression model, support vector machine (SVM) and random forest (RF) were used to establish a clinical diagnosis model for IgG4 HT. Among these 272 patients, 40 (14.7%) were diagnosed with IgG4 HT. Patients with IgG4 HT were younger than those with non-IgG4 HT (P < 0.05). Serum levels of TgAb IgG4 and TPOAb IgG4 in IgG4 HT group were significantly higher than those in non-IgG4 HT group (P < 0.05). There were no significant differences in gender, disease duration, goiter, preoperative thyroid function status, preoperative TgAb or TPOAb levels, and thyroid ultrasound characteristics between the two groups (all P > 0.05). The accuracy, sensitivity, and specificity were 57%, 78%, and 79% for logistic regression model of IgG4 HT, 80 ± 7%, 84.7% ± 2.6%, and 75.4% ± 9.6% for the RF model and 78 ± 5%, 89.8% ± 5.7%, and 64.7% ± 5.7% for the SVM model. The RF model works better than SVM. The area under the ROC curve of RF ranged 0.87 to 0.92. A clinical diagnosis model for IgG4 HT established by RF model might help the early recognition of the high-risk patients of IgG4 HT.

Overweight as a biomarker for concomitant thyroid cancer in patients with Graves' disease.

The incidence of concomitant thyroid cancer in Graves' disease varies and Graves' disease can make the diagnosis and management of thyroid nodules more challenging. Since the majority of Graves' disease patients primarily received non-surgical treatment, identifying biomarkers for concomitant thyroid cancer in patients with Graves' disease may facilitate planning the surgery. The aim of this study is to identify the biomarkers for concurrent thyroid cancer in Graves' disease patients and evaluate the impact of being overweight on cancer risk. This retrospective cohort study analyzed 122 patients with Graves' disease who underwent thyroid surgery at Seoul St. Mary's Hospital (Seoul, Korea) from May 2010 to December 2022. Body mass index (BMI), preoperative thyroid function test, and thyroid stimulating hormone receptor antibody (TR-Ab) were measured. Overweight was defined as a BMI of 25 kg/m² or higher according to the World Health Organization (WHO). Most patients (88.5%) underwent total or near-total thyroidectomy. Multivariate analysis revealed that patients who were overweight had a higher risk of malignancy (Odds ratios, 3.108; 95% confidence intervals, 1.196-8.831; p = 0.021). Lower gland weight and lower preoperative TR-Ab were also biomarkers for malignancy in Graves' disease. Overweight patients with Graves' disease had a higher risk of thyroid cancer than non-overweight patients. A comprehensive assessment of overweight patients with Graves' disease is imperative for identifying concomitant thyroid cancer.

Effect of dual fluorescence imaging in identifying central lymph nodes and parathyroid glands during thyroid cancer surgery

Objective: To investigate the effect of dual fluorescence imaging in identifying central lymph nodes and parathyroid glands during thyroid cancer surgery. Methods: This study was a cross-sectional study. Patients who underwent surgery for papillary thyroid cancer (PTC) at the Department of Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University between January 2022 and September 2023 were included. All patients underwent thyroid lobectomy or total resection, and central lymph node dissection was performed at the same time. During the operation, tracing injection of mitoxantrone hydrochloride and 785 nm and 660 nm dual fluorescence imaging technique were used to measure the fluorescence intensity (FI) of parathyroid glands, central lymph nodes and background. After correcting to obtain the standardized FI, the paired t-test was used to compare the standardized FI of the parathyroid glands and central lymph nodes, and the Spearman's rank correlation analysis was used to analyze the relationship between the standardized FI and various clinical indicators. Results: The study included 30 patients (8 males and 22 females), with a mean age of (41.8±10.4) years. A total of 76 parathyroid glands and 234 central lymph nodes were identified under dual fluorescence imaging, and the standardized FI of parathyroid glands was less than that of central lymph nodes (44.7±16.8 vs 99.5±28.4, P<0.001). The visualization rate, false rate and miscut rate of parathyroid glands under 785 nm wavelength excitation light were 98.7% (76/77), 0 (0/77) and 1.3% (1/77), respectively (one case with no visualization and miscutting parathyroid gland was the encapsulated type). The visualization rate of central lymph nodes under 660 nm wavelength excitation light was 98.7% (234/237). There was no significant correlation between FI and clinical indicators such as gender, age, height, weight, body mass index, preoperative thyroid stimulating hormone, thyroglobulin antibody, thyroid microsomal antibody, serum calcium, parathyroid hormone level and surgical procedure (all P>0.05). Conclusion: Dual fluorescence imaging of central lymph nodes and parathyroid glands can improve the ability to identify parathyroid gland while assisting central lymph node dissection.

Combining radiomics with thyroid imaging reporting and data system to predict lateral cervical lymph node metastases in medullary thyroid cancer.

Medullary Thyroid Carcinoma (MTC) is a rare type of thyroid cancer. Accurate prediction of lateral cervical lymph node metastases (LCLNM) in MTC patients can help guide surgical decisions and ensure that patients receive the most appropriate and effective surgery. To our knowledge, no studies have been published that use radiomics analysis to forecast LCLNM in MTC patients. The purpose of this study is to develop a radiomics combined with thyroid imaging reporting and data system (TI-RADS) model that can use preoperative thyroid ultrasound images to noninvasively predict the LCLNM status of MTC. We retrospectively included 218 MTC patients who were confirmed from postoperative pathology as LCLNM negative (n=111) and positive (n=107). Ultrasound features were selected using the Student's t-test, while radiomics features are first extracted from preoperative thyroid ultrasound images, and then a two-step feature selection approach was used to select features. These features are then used to establish three regularized logistic regression models, namely the TI-RADS model (TM), the radiomics model (RM), and the radiomics-TI-RADS model (RTM), in 5-fold cross-validation to determine the likelihood of the LCLNM. The Delong's test and decision curve analysis (DCA) were used to evaluate and compare the performance of the models. The ultrasound features of margin and TI-RADS level, and a total of 12 selected radiomics features, were significantly different between the LCLNM negative and positive groups (p<0.05). The TM, RM, and RTM yielded an averaged AUC of 0.68±0.05, 0.78±0.06, and 0.82±0.05 in the 5-fold cross-validation dataset, respectively. RM and RTM are statistically better than TM (p<0.05 and p<0.001) according to Delong test. DCA demonstrates that RTM brings more benefit than TM and RM. We have developed a joint radiomics-based model for noninvasive prediction of the LCLNM in MTC patients solely using preoperative thyroid ultrasound imaging. It has the potential to be used as a complementary tool to help guide treatment decisions for this rare form of thyroid cancer.

Enhancing malignancy prediction in thyroid nodules: A multimodal ultrasound radiomics approach in TI-RADS category 4 lesions.

To explore the diagnostic value of intralesional and perilesional radiomics based on multimodal ultrasound (US) images in predicting the malignant ACR TIRADS 4 thyroid nodules (TNs). A total of 297 cases of TNs in patients who underwent preoperative thyroid grayscale US and shear wave elastography (STE) were enrolled (training cohort: n = 150, internal validation cohort: n = 77, external validation cohort: n = 70). Regions of interests (ROIs) were delineated on grayscale US images and STE images, and then an isotropic expansion of 1.0, 1.5, 2.0, 2.5, and 3.0 mm was applied. Predictive models were established using recursive feature elimination-support vector machines (RFE-SVM) based on radiomics features calculated by random forest. The perilesional ROI1.5mm expansion achieved the highest area under curve (AUC) (AUC: 0.753 for grayscale US, 0.728 for STE; 95% confidence interval (CI): 0.664-0.743, 0.684-0.739, respectively). The joint model had the highest AUC values of 0.936 in the training dataset, 0.926 in internal dataset, and 0.893 in external dataset. The calibration curve showed good consistency and the decision curve indicated a greater clinical net benefit of the joint model. Joint model containing perilesional radiomics (1.5 mm) had significant value in predicting the malignant ACR TIRADS 4 TNs.

Factors affecting need for hormone replacement after thyroid lobectomy

Aims: The aim of this study is to determine the incidence and risk factors of postoperative hormone replacement in patients who underwent thyroid lobectomy.&#x0D; Methods: Patients who underwent thyroid lobectomy in our clinic between January 2015 and January 2021 were retrospectively scanned. Age, gender, preoperative hemogram and thyroid function tests (TFT) were screened. During postoperative follow-up, current TFT, height, weight, thyroid hormone replacement status and hypothyroidism symptoms were questioned. Pathology reports were examined.&#x0D; Results: The pathology (patological examination results of specimen of the patients) were nodular hyperplasia in 81.1% (n=30) and Papillary thyroid carcinoma (PTC) in 18.9% (n=7). While the need for hormone replacement developed in 37.8% (n=14) of the patients in the postoperative follow-up, it did not develop in 62.2% (n=23). It was determined that high preoperative thyroid stimulating hormone (TSH) significantly increased the need for postoperative hormone replacement (p

Association of preoperative thyroid hormone replacement with perioperative complications after major abdominal surgery

ObjectiveTo determine the association between preoperative thyroid hormone replacement and complications following major abdominal surgery. MethodsA retrospective case series was performed of patients enrolled in the Michigan Surgical Quality Collaborative (MSQC) who underwent major abdominal surgery at an academic institution over a 10-year period. The principal explanatory variable was preoperative thyroid hormone replacement. Primary outcomes were morbidity, mortality and length of stay. Results2700 patients were identified. On multivariate analysis correcting for established predictors of operative morbidity, patients on preoperative thyroid replacement had a 1.5- fold increased risk of serious morbidity(p ​= ​0.01), and a 1.7- fold greater risk for serious sepsis(p ​= ​0.04). Thyroid replacement was associated with longer length of stay(p ​< ​0.001). While there was a high degree of missing data for surgical approach (31.1 ​% missing data), results suggest that patients on thyroid hormone replacement were more likely to undergo an open rather than minimally invasive surgery(p ​< ​0.01). Open surgery was associated with greater risk of serious morbidity(p ​= ​0.003) and longer length of stay(p ​< ​0.001). ConclusionsPreoperative thyroid hormone replacement independently predicts operative morbidity and length of stay following major abdominal surgery.

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.

Risk factors for parapharyngeal and retropharyngeal metastases in papillary thyroid cancer: a matched case-control study.

To analyze risk factors for parapharyngeal (PP) and retropharyngeal (RP) metastases in papillary thyroid cancer (PTC). A matched case-control study was conducted, comprising 130 age- and sex-matched cases of PTC. Among these cases, 50 had PP/RP metastases, 50 had central and/or lateral neck lymph node metastases, and 30 showed no lymph node metastases. Preoperative thyroid function test, computed tomography images, and postoperative pathological findings were collected. Associations between cases were assessed using univariate conditional logistic regression analysis, followed by multivariate conditional logistic regression analysis, and backward stepwise selection to predict risk factors for PP/RP metastases. The study found that thyroglobulin was significantly associated with the development of PP/RP metastases [136.10(16.55-312.60) vs. 27.60(10.28-55.62) vs. 8.74(6.35-21.10) P < 0.001]. The study concludes that thyroglobulin is a significant risk factor for PP/RP metastases in PTC. This finding emphasizes the importance of monitoring thyroglobulin levels in PTC patients to identify those at risk of developing PP/RP metastases.

Can texture analysis of T2-weighted MRI be used to predict extrathyroidal extension in papillary thyroid carcinoma?

Determining the presence of extrathyroidal extension (ETE) is important for established of different surgical protocol and postoperative patient management in patients with papillary thyroid carcinoma (PTC). The correlation relationship between texture features from T2-weighted imaging (T2WI) and ETE has not been explored extensively. This study aimed to explore the value of T2-weighted magnetic resonance imaging - based whole tumor texture analysis in predict extrathyroidal extension with PTC. In this retrospectively study, 76 patients with pathologically proven PTC were recruited, who received surgical resection and underwent preoperative thyroid magnetic resonance imaging. Based on histo-pathologically findings, patients were classified into ETE and no ETE groups. ETE group was further divided into 2 subgroups (minimal ETE and extensive ETE). Whole-tumor texture analysis was independently performed by 2 radiologists on axial T2WI images. Nine histogram and gray-level co-occurrence matrix (GLCM) texture features were automatically extracted. Univariate and multivariate analysis were performed to determine risk factors associated with ETE. Predictive performance was evaluated by receiver operating characteristic (ROC) analysis. Interobserver agreement, confirmed by intraclass correlation coefficients (ICCs) ranging from 0.78 to 0.89, was excellent for texture analysis between 2 radiologists. T2WI image derived entropy, standard deviation, energy and correlation have significant difference between PTC with and without ETE (all P < .05). Among these, entropy showed the best diagnostic efficiency with the area under ROC curve of 0.837, diagnostic threshold of 5.86, diagnostic sensitivity and specificity of 81.5% and 75.6%, respectively. Additionally, the multivariate analysis revealed that high entropy was an independent risk factor of ETE (odds ratio, OR = 19.348; 95%CI, 4.578-81.760; P = .001). The findings indicate a significant association between texture features of the primary tumor based on T2WI and the presence of ETE in PTC. These results have the potential to help predict ETE preoperatively in patients with PTC, offering valuable insights for clinical decision-making.

Perioperative hormone level changes and their clinical implications in patients with pituitary adenoma: a retrospective study of 428 cases at a single center.

This study employs case data analysis to elucidate alterations in hormone levels pre and post-surgery among patients with pituitary adenoma. Moreover, it investigates the influence of various associated factors on endocrine function. A retrospective analysis was conducted on clinical data from 428 patients who underwent surgical treatment within a short period at a single center. Statistical methods were employed to examine detailed hormone level fluctuations before and after surgery in patients with pituitary adenoma, along with their interrelations with different factors. Between January 2016 and October 2022, a total of 428 consecutive patients with pituitary adenoma underwent surgical treatment. Of these, 232 were males and 196 were females, with an average age of 45.91 years (range: 16-84, standard deviation: 12.18). Univariate analysis indicated that females exhibited a higher susceptibility to preoperative endocrine dysfunction (p < 0.05). Conversely, males, patients with larger tumor volumes, and older patients were more prone to preoperative pituitary insufficiency. Postoperatively, the most substantial remission rate occurred in prolactin (77.4%), followed by growth hormone (GH) (71.8%) and cortisol (4/6). The highest recovery rate in functions was observed in growth hormone secretion function (80%), followed by pituitary-adrenal axis hormone secretion function (56.3%) and pituitary-thyroid axis hormone secretion function (47.5%). The most noteworthy incidence of newly developed postoperative endocrine deficiencies was found in the pituitary-adrenal axis (31.8%), while the occurrence rates of deficiencies in other axes were relatively low. The elevated postoperative remission rate of growth hormone correlated with a higher surgical resection rate and lower preoperative growth hormone levels. Additionally, lower preoperative prolactin levels corresponded to a higher remission rate of prolactin postoperatively. Furthermore, the restoration of postoperative thyroid hormone secretion function was associated with higher preoperative free thyroxine levels. Reduced postoperative cortisol secretion function was linked to multiple surgeries and an extended interval between hormone retesting and surgery. Surgical intervention effectively ameliorates endocrine disorders in pituitary adenoma patients, thereby mitigating symptoms and enhancing their quality of life. Preoperative management of growth hormone and prolactin levels facilitates an increased remission rate of these hormones post pituitary adenoma surgery. Patients displaying preoperative thyroid hormone secretion dysfunction should be considered for active supplementation therapy. Whenever feasible, complete tumor resection is recommended. For patients undergoing reoperation or multiple surgeries, vigilant postoperative cortisol monitoring and supplementation should be thoughtfully administered.

Incidence of post-surgical hypoparathyroidism (POSH) after total thyroidectomy

Post-surgical hypoparathyroidism (POSH) is a recognised complication of total thyroidectomy, leading to hypocalcaemia and its associated adverse effects. This retrospective study aimed to determine the incidence of POSH and identify perioperative predictors for its development. Data from patients who underwent total or completion thyroidectomy between January 2017 and July 2022 were retrospectively analysed. The incidence of POSH was assessed, and patients were categorised into transient or prolonged POSH at six months postoperatively. Potential predictors for POSH were investigated including gender, histological diagnosis, and preoperative thyroid function. A total of 133 adult patients were included in the study. The incidence of patients recovering from transient POSH within six months was 15%, and 5% had prolonged POSH beyond six months of surgery. Parathyroid hormone (PTH) levels normalised in 83% of prolonged POSH patients within 14–33 months, reducing the incidence of persistent POSH to 0.75%. Despite normal PTH levels, overall, 3% had persistent marginally low calcium levels (mean 2.11 mmol/L) in keeping with relative parathyroid insufficiency. Histological diagnosis of malignancy was the only significant risk factor for both transient and prolonged POSH (RR 2.95, CI 1.54 to 5.67, p = 0.001) in this cohort. Cautious capsular dissection during thyroidectomy and protection of the parathyroid glands and vascular supply produce a low incidence of POSH. Although the vast majority of patients with POSH recover after six months, hypocalcaemia may persist due to relative parathyroid insufficiency, requiring long-term calcium supplementation. Further research is needed to determine the best strategies for preventing and treating this condition.

Investigation of pre-operative demographic, biochemical, sonographic and cytopathological findings in low-risk thyroid neoplasms.

The present article analyses pre-operative demographic, biochemical, sonographic and histopathological characteristics of low-risk thyroid neoplasms (LRTNs), with a focus on four subgroups, "well-differentiated carcinoma-not otherwise specified" (WDC-NOS), "non-invasive follicular thyroid neoplasm with papillary like nuclear features" (NIFTP), "well-differentiated tumours of uncertain malignant potential" (WDT-UMP) and "follicular tumour of uncertain malignant potential" (FT-UMP). The study retrospectively analyzed the histopathology of 2453 malignant thyroids and the final analyses included 99 cases diagnosed with LRTNs. The demographic and clinical features, pre-operative thyroid function, ultrasonography results, cytopathology results, histopathology results and prognostic classifications were assessed. The groups were similar demographic characteristics and the majority of clinical data, including comorbidities, thyroid function tests, thyroid cancer/neck radiotherapy history. NIFTPs represented 69.7% of all LRTNs. All (100%) WDT-UMPs had solitary nodules. Index nodule volume differed among the groups (p = .036), it was the lowest in WDC-NOS [0.68 (0.63-0.72 cc)] and highest in FT-UMP [12.6 (0.5-64 cc)]. Echogenicity findings were similar. Index nodule TIRADS demonstrated a significant difference (p = .021) but index nodule halo sign and BETHESDA scores were similar in all groups. The diameter, localisation and multicentric structure of LRTNs were again similar for all groups. Finally, prognostic scores suggested similar outcomes in all groups. The majority of LRTNs were NIFTPs in our population and all WDT-UMPs were solitary lesions. Index nodule volume was the most essential discriminating sonographic finding but further research must be performed before discriminatory potential can be described.