Although C6orf15 is highly expressed in certain human cancers, its expression pattern in papillary tumors remains unclear. In this study, we investigated C6orf15 expression in papillary tumors and assessed its potential as a diagnostic biomarker for histopathological evaluation and fine-needle aspiration cytology (FNAC). We collected a total of 87 formalin-fixed and paraffin-embedded (FFPE) thyroid tissue specimens that included: 10 cases with Hashimoto's thyroiditis (HT), 11 with follicular adenomas (FAs), two with non-invasive follicular thyroid neoplasms with papillary-like nuclear feature (NIFTP), six with follicular thyroid carcinomas (FTCs), three with invasive encapsulated follicular variant of papillary thyroid carcinomas (IEFVPTCs), three with medullary thyroid carcinomas (MTCs), and 52 with papillary thyroid carcinomas (PTCs). Additionally, 33 FNAC samples from thyroid nodules were analyzed, comprising three samples of FA, five atypia of undetermined significance (AUS), and 25 cases of PTC. Immunohistochemical (IHC) staining was performed to assess C6orf15 expression in thyroid tumor tissues and FNAC samples. We conducted BRAF V600E mutation analysis via Sanger sequencing and IHC and discerned that C6orf15 expression was absent in normal follicular epithelial cells, FA, NIFTP, TFC, and MTC. The positivity rates for C6orf15 in FFPE samples were as follows: 66.7% for IEFVPTC, 86.5% for PTC, and 60.0% for AUS. In FNAC samples, the positivity rate was 80.0% for PTC. A significant positive correlation was observed between C6orf15 expression and the BRAF V600E mutation in PTC tissues (p<0.001), but no such association was found in FNAC samples (p=0.230). C6orf15 exhibited high expression levels in the majority of IEFVPTC (66.7%), PTC tissues (86.5%), and FNAC samples (80.0%). These findings suggest that C6orf15 constitutes a promising diagnostic biomarker for the classic variant of PTC and is applicable to histopathological assessment and FNAC-based diagnosis.

Chemokines in thyroid cancer: Mechanistic insights and clinical implications.

Approximately 30–50% of Papillary thyroid carcinoma (PTC) patients develop cervical lymph nodes (LNs) metastasis, significantly increasing the risk of disease recurrence and impacting long-term outcomes. We introduced an open-access multicenter lymph node ultrasound image database (LymphUs) specifically designed to advance research in LN assessment for PTC. Ultrasound imaging was performed on PTC patients at two independent clinical centers using standardized acquisition protocols. Experienced radiologists at each center documented sixteen semantic features for each LN. All LNs were annotated with segmentation masks serving as ground truth, and classification into benign or malignant categories was confirmed by fine needle aspiration biopsy results. The LymphUs comprises ultrasound images with segmentation masks from 338 PTC patients with suspected LN metastasis, divided into two center-specific cohorts: 180 patients (81 malignant, 99 benign) and 158 patients (82 malignant, 76 benign). The complete dataset, including semantic features and expert annotations, is freely accessible for research purposes. The LymphUs bridges a critical gap in medical imaging resources by providing a large-scale, multicenter ultrasound database for cervical LN assessment in PTC, supporting diagnostic algorithms, standardized reporting systems, and artificial intelligence applications to enhance preoperative LN staging and treatment planning.

Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal neoplasm, and primary involvement of the thyroid gland is exceedingly rare. TFE3-rearranged PEComas constitute a distinct molecular subset characterized by epithelioid morphology and strong nuclear TFE3 expression. Cytologic descriptions of PEComa are limited, and to date, only three cytologic cases of TFE3-rearranged PEComa or PEComa-like neoplasm have been reported in the literature, none of which involved the thyroid gland. We report a case of thyroid TFE3-rearranged PEComa-like neoplasm in a 25-year-old woman who presented with a palpable thyroid nodule. Fine-needle aspiration using liquid-based cytology revealed a hypercellular specimen composed predominantly of dispersed and loosely cohesive epithelioid cells with enlarged round to oval nuclei, fine chromatin, and frequent intranuclear pseudoinclusions, resulting in an initial interpretation suspicious for papillary thyroid carcinoma. Histologic examination demonstrated a well-circumscribed epithelioid neoplasm with pseudoalveolar architecture supported by a delicate arborizing vascular network. Immunohistochemical studies showed tumor cell positivity for TFE3, cathepsin K, desmin (patchy), and vimentin, with negativity for epithelial, thyroid-specific, melanocytic, and other smooth muscle markers, as well as PAX8, CD10, MiTF, and PAS/PAS-D stains, arguing against metastatic renal cell carcinoma and alveolar soft part sarcoma. The patient underwent surgical resection and remains disease-free after 7.5 years of follow-up. This case represents the first description of the liquid-based cytologic features of a thyroid TFE3-rearranged PEComa-like neoplasm. Awareness of this rare entity and its cytologic overlap with papillary thyroid carcinoma is essential to avoid diagnostic pitfalls in thyroid fine-needle aspiration.

A wrapper-based learning framework for papillary thyroid carcinoma diagnosis using optimized feature selection

Computer-aided diagnosis of papillary thyroid carcinoma based on deep learning technology.

Current evidence regarding radiomics-based assessment of persistent/recurrent cervical lymph node metastasis (CLNM) remains limited, particularly in the field of PET/CT in papillary thyroid cancer (PTC). Therefore, we aimed to construct a prediction model for persistent/recurrent CLNM of PTC by fluoro-18-deoxyglucose ( 18 F-FDG) PET/computed tomography (CT) multimodal radiomics. We retrospectively analyzed postoperative patients with PTC who underwent 18 F-FDG PET/CT at our hospital between June 2021 and June 2024. A total of 425 CLNs (219 metastatic and 206 nonmetastatic) from 158 patients were included, and the patients were randomly assigned to a training set and a test set at a ratio of 7 : 3. Pearson correlation analysis and least absolute shrinkage and selection operator regression were utilized to select PET/CT radiomic features for model development. Five radiomics models were developed based on distinct feature sets: clinical features alone, CT radiomics, PET radiomics, PET/CT radiomics, and integrated PET/CT radiomics combined with clinical features. Subsequently, a nomogram model was built by combining radscore and clinical features. The integrated model demonstrated superior diagnostic accuracy, with areas under the curve (AUCs) of 0.944 in the training set and 0.922 in the test set. PET/CT models demonstrated the following AUCs: PET/CT (0.887), PET (0.834), CT (0.775), and clinical features alone (0.783). A nomogram incorporating clinical features and radscores was then developed, achieving C-indices of 0.937 in the training set and 0.895 in the test set. The integration of PET/CT radiomics and clinical features may provide a noninvasive tool for predicting persistent/recurrent CLNM in postoperative PTC patients, with potential to support clinical decision‑making.

Radiofrequency ablation for nodal recurrence in papillary thyroid carcinoma.

Isolated soft tissue deposits (ISTDs) are believed to be tumor emboli from lymphatic drainage pathways, discontinuous from primary tumors and lacking lymph node architecture. While associated with poor prognosis in various malignancies, characterization of ISTDs in papillary thyroid carcinoma (PTC) is limited. This single-center cohort study examined 11 cases of PTC with ISTDs. Multi-platform next-generation sequencing analyzing driver mutations and tumor suppressor loss of heterozygosity (LOH) was performed on primary tumors, lymph nodes, and ISTDs. Clinical and histopathologic features were compared to a 3:1 matched control cohort. Genomic alterations were identical across paired tumors, lymph nodes, and ISTDs. LOH was present in 78% of cases with driver mutations. Compared to controls, ISTD cases demonstrated increased rates of high lymph node burden (p < 0.01), extranodal extension (p = 0.012), and lymphovascular invasion (p < 0.01). Associated with aggressive disease features, the molecular profiles of ISTDs mirror primary tumors and lymph node metastases.

Metastasis of fallopian tube carcinoma to the thyroid gland: A case report

Objective: To investigate the mechanism through which timosaponin AⅢ (TAⅢ)-based liposomes loaded with auranofin (AUF) (T-AUF-LPs) induce ferroptosis in anaplastic thyroid carcinoma cells. Methods: T-AUF-LPs were prepared using the thin-film hydration method, and their physicochemical properties and stability were characterized. Additionally, conventional liposomes (C-AUF-Lips) were prepared using cholesterol as the membrane material. Cellular uptake efficiency was evaluated in CAL-62 cells using coumarin-6-labeled liposomes. Cell viability was assessed via CCK-8 assay. The role of ferroptosis was confirmed using the inhibitor Ferrostatin-1 (Fer-1) and flow cytometric analysis of cell death. The expression of ferroptosis-related markers (ACSL4, NCOA4, GPX4) were detected using RT-qPCR and Western blot. Levels of intracellular iron, glutathione (GSH), and lipid peroxidation were measured. A nude mouse tumor xenograft model was established to evaluate the in vivo antitumor efficacy of T-AUF-LPs, and hematoxylin-eosin (HE) staining was performed to assess potential systemic toxicity. Results: T-AUF-LPs appeared as uniformly distributed spherical particles with an average size of (119.40±3.11) nm, which was significantly smaller than that of the conventional liposomes C-AUF-LPs (P＜0.001). The zeta potential of T-AUF-LPs was (-12.07±0.65) mV, lower than that of C-AUF-LPs (P=0.002). Furthermore, CAL-62 cells exhibited significantly enhanced cellular uptake of T-AUF-LPs compared to C-AUF-LPs. Cell experiments demonstrated that among the established groups, i.e., Control, TAⅢ, AUF, AUF+TAⅢ, C-AUF-LPs, and T-AUF-LPs, the T-AUF-LPs group exhibited the lowest half-maximal inhibitory concentration (IC50=0.66 μmol/L) and the highest CAL-62 cell mortality (14.7±1.3)%. Furthermore, this group showed significantly elevated lipid peroxidation (2.07±0.28), increased iron content (4.64±0.17), and markedly reduced glutathione (GSH) levels (0.11±0.05). At the molecular level, mRNA expression of ACSL4 and NCOA4 was up-regulated (13.10±0.94 and 7.52±0.49, respectively), while GPX4 mRNA was down-regulated (0.16±0.21). Consistently, ACSL4 and NCOA4 protein expression was increased (1.30±0.06 and 1.13±0.31, respectively), whereas GPX4 protein expression was decreased (0.31±0.18).Notably, pretreatment with the ferroptosis inhibitor Fer-1 significantly reversed T-AUF-LPs-induced cell death, reducing mortality to (8.8±0.8)%. Animal studies demonstrated that among all groups, tumor growth was most significantly suppressed in the T-AUF-LPs group, which exhibited the smallest tumor volume on day 15 post-inoculation. No significant body weight loss was observed in nude mice, and histopathological assessment of the heart, liver, lungs, and kidneys revealed no apparent toxic damage. In tumor tissues of the T-AUF-LPs group, mRNA expression of ACSL4 and NCOA4 was significantly up-regulated (1.59±0.29 and 8.65±3.48, respectively), while GPX4 mRNA expression was markedly down-regulated (0.11±0.01). Consistently, ACSL4 and NCOA4 protein levels were increased (1.26±0.31 and 1.14±0.39, respectively), whereas GPX4 protein expression was significantly reduced (0.56±0.12). Conclusion: T-AUF-LPs inhibited the growth of anaplastic thyroid carcinoma cells by activating the ferroptosis pathway.

To evaluate the segmentation performance and total metabolic tumor volume (TMTV) prediction accuracy of 2D and 3D nnU-Net models under two-label and three-label strategies for metastatic differentiated thyroid carcinoma (DTC) on FDG PET/CT images. A total of 194 patients with FDG-avid metastatic DTC who underwent PET/CT prior to iodine-131 treatment (2009-2022) were retrospectively analyzed. The dataset was divided into Cohort 1 (n = 160) for five-fold cross-validation and Cohort 2 (n = 34) for independent testing. Both 2D and 3D nnU-Net architectures were trained under two-label and three-label schemes. Segmentation performance was assessed using the Dice similarity coefficient (DSC). TMTV prediction was evaluated using the coefficient of determination (R2) and error analyses. Under the two-label scheme, mean DSC values in Cohort 1 were 0.63 ± 0.28 (2D) and 0.60 ± 0.34 (3D), and in Cohort 2 were 0.60 ± 0.31 and 0.50 ± 0.32, respectively. Under the three-label scheme, mean DSC values in Cohort 1 were 0.66 ± 0.28 (2D) and 0.70 ± 0.30 (3D), and in Cohort 2 were 0.61 ± 0.33 and 0.61 ± 0.35, respectively. For TMTV prediction, R2 values in Cohort 1 were 0.33 (2D) and 0.06 (3D) under the two-label scheme, while 0.20 (2D) and 0.12 (3D) under the three-label scheme. In Cohort 2, R2 values were 0.87 (2D) and 0.80 (3D) for the two-label scheme, and 0.86 (2D) and 0.84 (3D) for the three-label scheme. Error analyses demonstrated systematic underestimation of TMTV across architectures and labeling strategies. The 2D and 3D nnU-Net models demonstrated comparable performance for segmentation and TMTV prediction under both two-label and three-label strategies. While labeling strategy influenced segmentation metrics, systematic underestimation of TMTV was observed across architectures.

The association between BRAF V600E mutation and clinicopathological features of papillary thyroid carcinoma (PTC) remains controversial. This study aimed to explore its prognostic value via meta-analysis. Databases including PubMed, Cochrane Library, Embase, and Web of Science were systematically searched for studies published before June 1, 2025. Pooled odds ratio (OR) with 95% confidence interval (CI) was used as the effect size, analyzed by R 4.4.2. A total of 26 studies (2010-2024) involving 13,999 patients were included. BRAF V600E mutation was significantly positively associated with capsular invasion (OR=1.80, 95% CI:1.16-2.78) and extrathyroidal extension (OR=1.62, 95% CI:1.36-1.94), and negatively associated with concomitant Hashimoto's thyroiditis (OR=0.55, 95% CI:0.32-0.94). A marginal association trend was observed with gender, with male patients showing a higher likelihood of harboring the BRAF V600E mutation (OR=1.26, 95% CI:1.10-1.44, P=0.0525), while no significant associations were found with age, tumor size, multifocality, central or lateral lymph node metastasis. BRAF V600E mutation correlates with specific clinicopathological features of PTC and serves as a potential prognostic predictor.

Though follicular thyroid carcinoma can be confirmed postoperatively by the histological findings of capsular or vascular invasion, preoperative diagnosis of follicular-patterned lesions has long been a diagnostic challenge. This study seeks to establish a machine-learning (ML) model based on clinical, US, and CEUS features for the differential diagnosis of thyroid follicular-patterned lesions (TFPLs). Patients with surgical pathologically confirmed TFPLs who underwent preoperative US and CEUS between January 2013 to April 2023 were enrolled in this retrospective study. We utilized five ML algorithms (logistic regression, random forest [RF], k-nearest neighbor [KNN], support vector machine [SVM], and elastic net [EN]) to construct an optimized model via US, CEUS and clinical data for the differential diagnosis of TFPLs. Model performance was evaluated with sensitivity, area under the precision-recall curve (AUPRC), and area under the receiver operating characteristic curve (AUROC). 114 patients were finally included. The sensitivities of the five ML algorithms (Logistic, RF, KNN, SVM, EN) were 0.93, 0.97, 0.93, 0.97, 0.93 for the training set, and 0.40, 1.00, 0.80, 1.00, 0.60 for the test set. The AUPRCs were 0.91, 0.97, 0.99, 0.91, 0.91 for the training set, and 0.65, 0.71, 0.38, 0.57, 0.65 for the test set. The AUROCs were 0.95, 0.98, 0.99, 0.89, 0.93 for the training set. When applied to the test set, the RF model had a significantly higher AUROC value (0.92; 95% CI: 0.88, 0.96) than other ML algorithms (0.91, 0.89, 0.91, 0.91, P < .05) with significant features including peripheral halo sign, thyroglobulin, rim enhancement, peak intensity and wash-out time. Our ML model integrating clinical, US, and CEUS features achieved high sensitivity for preoperative differentiation of TFPLs, potentially guiding surgical planning-a step toward clinical use that requires CEUS standardization and external validation. This study was registered at www.chictr.org.cn (no. ChiCTR2200066254, date: November 29, 2022).

In the present paper, we tried to build a basic convolutional neural network model and a transfer learning model on it to distinguish follicular adenoma (FA) and follicular carcinoma (FC) of thyroid in fine needle aspiration cytology (FNAC). We selected histopathology proven cases of FA (25 cases) and FC (29 cases). In each case, the best May Grunwald Giemsa stained smear was selected and 10 to 11 representative microphotographs were taken by Olympus microscope (Olympus DP74) in 40× objectives from the most representative area of the smear. There were total 347 microphotographs in FA and 229 microphotographs of FC. The images were divided into training (406 images, 70%), validation (89 images, 15%) and test set (81 images, 15%). The basic (scratch) model of convolutional neural network (CNN) was built in Python 3.11.11. We subsequently, also used a transfer learning model by a pre-trained MobileNetV2 in the same images. We ran the model in Jupyter notebook for 15 epochs with 13 steps in each epoch. The sensitivity and specificity of the base model were 72.41% and 88.46%, respectively. The accuracy, precision and F1 score were 82.71%, 77.78% and 75.00%. The area under the curve (AUC) of receiver operating characteristic (ROC) was 0.85. The sensitivity and specificity of the transfer learning model are 82.76% and 92.31%, respectively. The accuracy, precision and F1 score were 88.89%, 85.71% and 84.21%. The area under the curve (AUC) of receiver operating characteristic (ROC) is 0.94. We built a CNN base model and transfer learning model (MobileNetV2) and successfully distinguished FA and FC in thyroid FNAC. To the best of our knowledge, this is the first study of CNN in thyroid follicular tumours.

Introduction Radioiodine-refractory papillary thyroid carcinoma (RAIR PTC) and anaplastic thyroid carcinoma (ATC) are clinically challenging thyroid cancer states, yet the molecular continuum between radioiodine refractoriness, anaplastic transformation and targeted drug sensitivity remains unclear. We hypothesised that RAIR and ATC share a common transcriptional axis that can be distilled into a transferable signature to prioritise targeted therapies in RAIR-like models. Methods We integrated RNA-seq and microarray cohorts (TCGA-THCA, one RAIR vs. radioiodine-avid PTC cohort, and five ATC cohorts) to derive RAIR/ATC gene modules and annotate pathway activity (MSigDB Hallmark). A single-sample RAIR signature was applied to TCGA tumours and DepMap thyroid cell lines. We combined RAIR scores with PRISM drug-response AUC data (18 thyroid cell lines) to quantify differential sensitivity (ΔAUC) and trained an interpretable multimodal ridge model integrating cell and drug features to predict AUC. External transferability and pharmacology-oriented mechanisms were assessed in an independent thyroid RNA-seq cohort (GSE126698) using ssGSEA and mechanism-relevant pathways. Results RAIR and ATC upregulated modules converged on an EMT–angiogenesis–inflammatory/interferon axis, with ATC representing a more extreme state. The RAIR signature stratified TCGA tumours with graded activation of these programs and was largely independent of BRAF and TERT promoter status, while preserving pathway associations when transferred to DepMap. In PRISM, VEGFR/KDR and RAF/BRAF inhibitor classes showed the most negative class-averaged ΔAUC values, indicating preferential activity in RAIR-high thyroid lines. The multimodal ridge model improved AUC prediction over cell-only or drug-only baselines and was concordant with class-level sensitivity patterns. In GSE126698, RAIR scores retained robust associations with hypoxia and interferon/inflammatory programs and aligned with drug-mechanism pathways including KRAS signaling up and PI3K–AKT–mTOR signaling. Initial in vitro validation in a single RAIR-high/ATC-like thyroid cancer model provided proof-of-concept support for these predictions, with sorafenib showing dose-dependent cytotoxicity and suppression of RAF–MAPK signalling. Conclusion A module-based RAIR signature captures a disease-focused component of a broader RAIR–ATC axis, transfers to cell-line models and can be embedded into an interpretable multimodal framework for drug-response prediction and targeted drug-class prioritisation, prioritising VEGFR/KDR and RAF/BRAF inhibitor classes as candidates for further translational evaluation in RAIR-like thyroid models.

BackgroundIntratumor heterogeneity (ITH) plays an important role in patients’ clinical outcomes. The prognostic impact of ITH and its influencing factors is unclear in papillary thyroid carcinoma (PTC), which deserves further investigation.MethodsThe Mutation Annotation Format (MAF) and clinical features were collected from The Cancer Genome Atlas Thyroid Cancer (TCGA‐THCA) cohort. We first assessed the influence of ITH on the prognosis of patients. We used the Mutant Allele Tumor Heterogeneity score to evaluate and represent ITH. Then we explored the potential factors associated with ITH. Finally, we predicted possible pathways involved in ITH.ResultsAmong 4 prognostic outcomes, higher ITH was mainly related to poor disease‐free interval (DFI) (HR = 2.64, p = 0.01), and ITH had potential value for predicting DFI. Further, we identified BRAF mutation and thyroid differentiation score (TDS) as key factors independently influencing ITH (all p < 0.05), especially TDS, which had a favorable ability and obtained good net benefit in predicting ITH. TDS maintained a stable negative effect on ITH. In contrast, BRAF mutation positively correlated with ITH in univariable regression (β = 0.196). Through performing sensitivity, regression, subgroup, interaction effect, and mediation analyses, we identified that TDS played a suppression effect in the impact of BRAF mutation on ITH. Finally, we revealed that the propionate metabolism pathway was most strongly associated with ITH.ConclusionsITH is associated with DFI in patients with PTC and deserves more attention. TDS and BRAF mutation are the key influencing factors of ITH, but TDS exerts a suppression effect on the impact of BRAF mutation on ITH.

Most previous studies aimed to establish etiological signatures of thyroid tumors compared sporadic papillary thyroid carcinomas (sPTC) and PTC that develop in individuals exposed to ionizing radiation during childhood. However, such approaches may lead to a biased signature combining exposure markers independent of the carcinogenic process and markers of radiation-induced carcinogenesis. We analyzed the miRNome (Affymetrix) and transcriptome (RNA sequencing) of a series of normal thyroid tissues and PTC from Ukrainian individuals contaminated with iodine-131 released by the Chornobyl Nuclear Power Plant in 1986 at high (> 0.5Gy; N = 9) or low (< 50mGy; N = 12) thyroid radiation doses, and from unexposed Ukrainian individuals (N = 28). First, the six sample groups were analyzed jointly using partial least squares discriminant analysis (sPLS-DA) to assess whether normal tissues and PTC shared common multi-omic signatures associated with exposure history, independent of carcinogenesis. Next, we applied a multiblock sPLS-DA (DIABLO) to isolate markers associated with exposure in the three normal tissue groups. Then, using the remaining miR and genes from the datasets not associated with exposure, we searched for a multi-omics signature associated with a difference in the carcinogenic process. sPLS-DA analysis of the six sample groups showed that normal tissues and PTC from exposed individuals shared a common multi-omics signature (58 miR/snoRNA, 50 genes) compared to unexposed samples. Our DIABLO analysis identified 44 miR/snoRNA and 45 genes exposure signatures distinguishing exposed from unexposed normal tissues. These signatures, when applied to PTC groups, supported that PTC developed after radiation exposure exibited exposure markers independent of any carcinogenic process. In addition to this exposure signature, we identified 39 miR/snoRNA and 64 genes signatures that identified the PTC developed after radiation exposure which deviated significantly from the sPTC profile. Normal tissues and PTC from exposed individuals exhibit a common molecular long-term memory of exposure history. Furthermore, PTC developed after radiation exposure display dose-dependent molecular specificities compared to sPTC. As PTC associated with low doses are mainly subclinical sPTC revealed by screening in the post-Chornobyl population, the proposed multi-omic signature could be attributable to sPTC developed in an exposed thyroid gland.

Abstract Background Thyroid lobectomy (TL) is the gold standard approach for small (&amp;lt;2cm) low-risk papillary thyroid carcinomas (PTC), yet it leads to postoperative hypothyroidism in approximately 60% of cases. Active surveillance or parenchyma-sparing thyroidectomy (PST) (isthmectomy or tumour enucleation) may represent conservative but safe options. This study evaluated the efficacy and safety of PST compared with TL in patients with low-risk PTC who declined active surveillance. Methods A prospective study started in December 2023. Eligible patients had PTC ≤15mm without extrathyroidal extension or lymph node metastasis, with a tumour–capsule distance of ≥2 and &amp;lt;10mm. All patients received comprehensive counselling and freely choose between PST and TL. The primary endpoint was structural recurrence, defined by postoperative ultrasound. Secondary endpoints included complication rate, operative time, and the need for and dosage of levothyroxine therapy. Results Sixty-three patients were enrolled: 27 (42.9%) underwent PST and 36 (57.1%) TL. Baseline and histological features did not differ between groups. No positive surgical margins or disease recurrence at 6 months were observed in both groups. Complication rate was similar between groups (3.7% vs. 5.6%; p=0.732). TL was associated with a longer operative time (40 vs. 30 minutes; p&amp;lt;0.001), a higher rate of levothyroxine requirement at 6 months (52.8% vs. 18.5%; p=0.005), and a higher levothyroxine dosage (72.7 vs. 65.5 μg/day; p=0.028). Conclusion PST appears safe and effective for selected patients with small, low-risk PTC and offers improved preservation of thyroid function. These preliminary findings support its potential role as a conservative surgical option.

Histoplasmosis is a systemic fungal infection primarily involving the lungs. Dissemination to the vocal cords and bilateral adrenal glands is exceedingly rare. This case report illustrates the clinical and radiological manifestations of the disease at these atypical sites, providing crucial insights for clinical differential diagnosis. We present a 50-year-old male patient admitted with recurrent fever and weight loss, with a history of diabetes mellitus and bat exposure. Imaging studies revealed a nodule in the left thyroid lobe (ACR TI-RADS 5), bilateral adrenal space-occupying lesions, and multiple pulmonary nodules. Fine-needle aspiration cytology of the thyroid nodule was suspicious for papillary thyroid carcinoma. Collectively, these findings suggested a radiological diagnosis of bilateral adrenal metastases. Ultimately, pathological examination of the adrenal biopsy confirmed the diagnosis of disseminated histoplasmosis. A comprehensive evaluation revealed involvement of the adrenal glands and vocal cord, with suspected pulmonary involvement. The patient experienced clinical improvement following antifungal therapy and was discharged. This case highlights that histoplasmosis can manifest as a disseminated infection in individuals with impaired immunity. When lesions present as nodules or masses on imaging, they are prone to misdiagnosis as metastatic disease or other neoplastic processes. Pathological examination remains paramount for definitive diagnosis. This report aims to increase clinicians' awareness of atypical presentations of histoplasmosis and emphasizes the critical importance of integrating epidemiological history, radiological findings, and pathological analysis for comprehensive diagnosis.