Thyroid Research Articles

HEMANGIOSARCOMA IN RED WOLVES (CANIS RUFUS) AND GRAY WOLVES (CANIS LUPUS) IN HUMAN CARE: SIX CASES.

Wolves are commonly housed in zoological institutions and captive breeding facilities that are essential for maintaining genetic diversity and for the recovery of declining populations. Neoplasia is a common cause of mortality in wolves, but hemangiosarcoma has not previously been described. This condition was diagnosed in four red wolves (Canis rufus) and two gray wolves (Canis lupus) housed at five different institutions between 2008 and 2018. Animals were 11-16 yr of age at the time of presentation. Clinical signs included loss of body condition, abdominal distension, lethargy, weakness, ataxia, and hyporexia. Three animals were mildly anemic. All animals were humanely euthanized within an average of 3 d from onset of clinical signs. Two animals had primary splenic tumors, two had pelvic tumors with one originating from the aorta, and one had a cranial mediastinal mass. Diagnosis was made on postmortem histologic examination in all cases. Four wolves had evidence of metastases with foci in the lungs, lymph nodes, mesentery, liver, subcutis/skeletal muscle, kidney, adrenal, and thyroid gland. Hemangiosarcoma should be considered in geriatric wolves presenting with nonspecific signs, particularly if abdominal distension, free peritoneal fluid, or anemia is present.

Developmental exposures to common environmental pollutants result in long-term Reprogramming of hypothalamic-pituitary axis in mice

Humans are exposed to a range of endocrine disrupting chemicals (EDCs). Many studies demonstrate that exposures to EDCs during critical windows of development can permanently affect endocrine health outcomes. Most experimental studies address changes in secretion of hormones produced by gonads, thyroid gland and adrenals, and little is known about the ability of EDCs to produce long-term changes in the hypothalamic-pituitary (HP) control axes. Here, we examined the long-term effects of three common EDCs on male mouse HP gene expression, following developmental exposures. Pregnant mice were exposed to 0.2 mg/ml solutions of bisphenol S (BPS), 2,2′,4,4′-tetrabromodiphenyl ether (BDE-47), or 3,3′,5,5′-tetrabromobisphenol A (TBBPA) from pregnancy day 8 through lactation day 21 (weaning day). Male offspring were left untreated until postnatal day 140, where pituitaries and hypothalami were collected. Pituitaries were assed for gene expression via RNA sequencing, while specific genes were assessed for expression in hypothalami via RT-qPCR. Differential expression, as well as gene enrichment and pathway analysis, indicated that all three chemicals induced long-term changes, (mostly suppression) in pituitary genes involved in its endocrine function. BPS and BDE-47 produced effects overlapping significantly at the level of effected genes and pathways. All three chemicals altered pathways of gonad and liver HP axes, while BPS altered HP-adrenal and BDE-47 altered HP-thyroid pathways specifically. All three chemicals reduced expression of immune genes in the pituitaries. Targeted gene expression in the hypothalamus indicates down regulation of hypothalamic endocrine control genes by BPS and BDE-47 groups, concordant with changes in the pituitary, suggesting that these chemicals suppress overall HP endocrine function. Interestingly, all three chemicals altered pituitary genes of GPCR-mediated intracellular signaling molecules, key signalers common to many pituitary responses to hormones. The results of this study show that developmental exposures to common EDCs have long-term impacts on hormonal feedback control at the hypothalamic-pituitary level.

Gender Differences In Thyroid Cancer In A Tertiary Care Hospital Bangladesh

Background: The gender disparity in incidence, aggressiveness and prognosis is well established for thyroid cancer but the cause of the disparity is poorly understood. Objective: The main objective of the study was to evaluate the gender difference in thyroid disease. Materials and Methods: This cross sectional study was conducted in the Department of Otolaryngology-Head & Neck Surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2013 to December 2015. The thyroid gland was assessed by palpation in all patients. Estimation of serum TSH concentrations were performed by automated immune chemiluminescent assay. Results: In this study out of 400 thyroid cancer patients, 327 were females and 73 were males. The mean age was almost similar between male and female patients (p=0.245). HOMA-IR was significant higher in female patients than male patients (1.9±0.5 vs 1.7±0.6). FT3, FT4 and TPO antibody were significantly higher in male patients than female patients, whereas TSH level was significantly higher in female patients than male patients (5.7±2.9 vs 4.5±2.8 µIU/mL). In multivariate logistic regression analysis abnormal TSH patient had 3.61 (95% CI 1.66 to 7.81) times more likely to have female. Abnormal FT3 patient had 2.56 (95% CI 1.08 to 6.05) times more likely to have female. Abnormal TSH and FT3 were significantly associated with female patients. Conclusion: Serum TSH and FT3 levels were significantly associated with thyroid cancer especially for females. Our results suggest the necessity of monitoring TSH and FT3 in the population for thyroid cancer risk assessment, especially female.

Evaluation and Comparison of the Dose Received by the Mandible, Maxilla, and Teeth in Two Methods of Three-dimensional Conformal Radiation Therapy and Helical Tomotherapy.

Using three-dimensional conformal radiation treatment (3D-CRT) and helical tomotherapy (HT), this study examines and contrasts the dosage received by the mandible, maxilla, and teeth. Sixteen patients with head-and-neck cancer (H and NC) were the subject of treatment planning at the Seyyed Al-Shohada Hospital in Isfahan, Iran. This study examined target coverage quality, exposure of healthy tissue, and radiation delivery effectiveness. In terms of a number of measures, including D2%, D50%, Dmean, V95%, conformity index (CI), and homogeneity index (HI) for the planning target volume (PTV) and D2%, D98%, Dmean, V95%, CI, and HI for the nodal PTV, HT showed considerable gains over 3D-CRT. The brainstem, D1cc, and D10cc received considerably lower maximum dosages in HT. Measurements of the right and left cochleas (Dmean, V55, and Dmax) revealed decreases in HT, with Dmean revealing the most significant variations. The Dmean and Dmax values for HT significantly decreased in constrictors as well. In terms of several HT-related indicators, the larynx, optic chiasm, optic nerves, oral cavity, mandible, thyroid, and parotid glands all showed considerable decreases. The findings of the comparison of the two treatment approaches revealed that the HT method was more than 50% more effective than the 3D-CRT method in sustaining organs at risk (OARs) and the target volume dose. In general, dosimetric coverage, homogeneity, conformity indices, and the absence of cold and hot patches showed that HT produced targets with greater accuracy than 3D-CRT. In addition, HT outperformed 3D-CRT in protecting important structures (OARs). HT as a result has the potential to be a more effective method of treatment for those with H and NC and involvement of regional lymph nodes.

Role of quantitative imaging biomarkers in an early FDG-PET/CT for detection of immune-related adverse events in melanoma patients: a prospective study.

To evaluate the role of the novel quantitative imaging biomarker (QIB) SUVX% of 18F-FDG uptake extracted from early 18F-FDG-PET/CT scan at 4 weeks for the detection of immune-related adverse events (rAE) in a cohort of patients with metastatic melanoma (mM) patients receiving immune-checkpoint inhibitors (ICI). In this prospective non-interventional, one-centre clinical study, patients with mM, receiving ICI treatment, were regularly followed by 18F-FDG PET/CT. Patients were scanned at baseline, early point at week four (W4), week sixteen (W16) and week thirty-two (W32) after ICI initiation. A convolutional neural network (CNN) was used to segment three organs: lung, bowel, thyroid. QIB of irAE - SUVX% - was analyzed within the target organs and correlated with the clinical irAE status. Area under the receiver-operating characteristic curve (AUROC) was used to quantify irAE detection performance. A total of 242 18F-FDG PET/CT images of 71 mM patients were prospectively collected and analysed. The early W4 scan showed improved detection only for the thyroid gland compared to W32 scan (p=0.047). The AUROC for detection of irAE in the three target organs was highest when SUVX% was extracted from W16 scan and was 0.76 for lung, 0.53 for bowel and 0.81 for thyroid. SUVX% extracted from W4 scan did not improve detection of irAE compared to W16 scan (lung: p = 0.54, bowel: p = 0.75, thyroid: p = 0.3, DeLong test), as well as compared to W32 scan in lungs (p = 0.32) and bowel (p = 0.3). Early time point 18F-FDG PET/CT at W4 did not lead to statistically significant earlier detection of irAE. However, organ 18F-FDG uptake as quantified by SUVX% proved to be a consistent QIB of irAE. To better assess the role of 18F-FDG PET/CT in irAE detection, the time evolution of 18F-FDG PET/CT quantifiable inflammation would be of essence, only achievable in multi centric studies.

Virtual diagnosis of a combined pathology of the thyroid gland in a child with prolonged febrility

The aim of the study is to show the application of the case method for studying diagnosis of rare diseases on a specific example. The article presents the possibilities of virtual diagnosis of a clinical case — a child with congenital hypothyroidism complicated by fever of unclear genesis. The authors presented a web application that allows reproducing the process of differential diagnosis in order to clarify the genesis of prolonged subfebrile fever. At each stage of virtual diagnosis, a user is supposed to analyze all the information about the patient and make a decision: plan further examination, «refer» the patient to specialists for consultations, while forming diagnostic hypotheses. As a result of passing the case, the integral score — the sum of points for correct answers — is calculated and displayed on the screen. Repeated performing of virtual diagnosis usually increases the score, and, most importantly, helps to consolidate the knowledge necessary for correct diagnosis. Interactive clinical case can be used in the training process of clinical residents, medical students as an additional tool. It can also be applied for pediatricians’ professional upgrade for they can be exposed to this pathology. Application of case method in education allows to guide the learning physician through the stages of virtual diagnosis, to evaluate the accuracy of his decisions and to explain the mistakes made while solving the case.

Thyroïdites : pathologies les plus courantes

AbstractThyroiditis are common conditions, mostly benign and accompanied by a biological disruption in the thyroid function. In fact, their resolution can sometimes be spontaneous. The term ‘thyroiditis’ encompasses several diseases characterized by inflammation of the thyroid gland. Patients often describe a neck pain that may be associated with the presence of a goiter. The causes are multiple. The most common condition is Hashimoto’s thyroiditis, characterized by hypothyroidism. Conversely, Basedow’s thyroiditis is characterized by hyperthyroidism. These are two autoimmune diseases whose diagnosis, in addition to the measurement of thyrotropin and thyroid hormones T4 and T3, relies on the measurement of specific antibodies. There are also iatrogenic thyroiditis: amiodarone, an antiarrhythmic drug prescribed by cardiologists, can cause thyroid dysfunction and requires close monitoring. Postpartum thyroiditis is a transient, sometimes persistent thyroiditis that occurs within a year following a pregnancy or miscarriage. Finally, some thyroiditis have infectious origins, such as De Quervain’s subacute thyroiditis, which is of viral origin. The treatment implemented will be tailored to the aetiology of the thyroiditis and monitored by an endocrinologist.

Embryonic Thyroid Hormone Insufficiency Causes Structural Anomalies in the Embryo of Domestic Chick, Gallus domesticus.

Thyroid hormone (TH) is essential for growth and development, yet its specific role during embryogenesis remains incompletely understood. This study investigates the impact of TH deficiency, induced by thiourea, a known inhibitor of thyroid peroxidase (TPO), on the development of domestic chicks. Thiourea was administered before thyroid gland formation, and its presence in treated embryos was confirmed through liquid chromatography-mass spectrometry. In silico docking revealed a strong interaction between thiourea and the CCP-like domain of TPO, which was corroborated by TPO activity assays showing reduced enzyme function. This reduction in enzyme activity led to lower embryonic TH levels and increased thyroid-stimulating hormone (TSH) secretion. Morphological analysis of newly hatched chicks revealed significant structural anomalies, particularly in lateral plate mesoderm-derived structures, including omphalocele, limb deformities, anophthalmia and craniofacial defects. Alcian blue and Alizarin red staining demonstrated reduced ossification in ribs and forelimbs, while histological analysis showed incomplete abdominal wall closure and abnormal vertebral column development. Haematological profiling of TH-deficient newly hatched chicks revealed significantly lower blood cell counts, highlighting TH's critical role in haematopoiesis. These findings emphasise the multifaceted role of TH in embryonic development, with potential implications for understanding congenital hypothyroidism and its developmental impacts, especially in regions with limited healthcare access.

Central neck dissection: updates on indications and surgical technique

This article aims to describe the indications, pertinent anatomy, and surgical technique of the central neck dissection (CND) as it pertains to carcinomas of the thyroid gland. Further discussed are major complications of the procedure and factors considered in surgical decision making. Therapeutic CND is strongly recommended and widely performed in patients with clinically or radiographically evident nodal disease; however, elective/prophylactic CND requires an informed decision that should be based upon patient specific disease and risk factors. If able, CND should be performed concurrently at the time of thyroidectomy to minimize risk of injury to critical structures such as the recurrent laryngeal nerve and parathyroid glands. When indicated, CND performed by a skilled surgeon reduces the risk of locoregional recurrence and is associated with low overall morbidity.

Correlation between body mass index and lymph node metastasis in papillary thyroid carcinoma: a retrospective clinical study.

Papillary thyroid carcinoma (PTC) is the most common malignant tumor of the thyroid gland, with lymph node metastasis significantly affecting patient prognosis. In recent years, body mass index (BMI) has garnered widespread attention as a potential factor influencing cancer development. This study aimed to explore the relationship between BMI and lymph node metastasis in patients with PTC, particularly focusing on the risk of metastasis in the lateral and central neck compartments. This retrospective study comprised 993 patients who underwent surgical treatment and were pathologically confirmed to have PTC. Patient BMI data were collected, and their relationship with lymph node metastasis in the lateral and central neck compartments was analyzed. Logistic regression models were employed to analyze the correlation between BMI and lymph node metastasis. The study found a significant correlation between BMI and the risk of lateral neck lymph node metastasis in patients (P=0.008), along with a corresponding increase in extrathyroidal extension risk (P=0.02). While elevated BMI did not directly increase the risk of central compartment metastasis, a significant increase was observed in the number of central compartment lymph node metastases (P=0.009) and their proportion among the total central compartment lymph nodes (P=0.01) in patients with higher BMI. Additionally, multifocality, age, and gender were identified as risk factors for lateral neck lymph node metastasis, whereas Hashimoto's thyroiditis did not exhibit a similar impact. This study highlights that higher BMI is an important risk factor for lateral neck lymph node metastasis in patients with PTC and may exacerbate the severity of central compartment lymph node metastasis. These findings underscore the importance of considering BMI in the management of thyroid cancer and provide data support for future prevention and intervention strategies.

Cervical plexus block enhanced pain control for unilateral thermal ablation of thyroid nodules.

Despite being minimally invasive, thermal ablation (TA) of thyroid nodules may still cause significant pain during and shortly afterwards. Conventional analgesia relies on perithyroidal local anesthesia (PLA) with or without sedation. The use of cervical plexus block (CPB) has been extensively studied in thyroidectomy, but never studied in TA of the thyroid gland. This study examined whether adding ultrasound-guided CPB to PLA and sedation could further reduce post-operative pain in unilateral TA of thyroid nodules. Consecutive patients aged ≥18 years undergoing unilateral radiofrequency ablation (RFA) or microwave ablation (MWA) of thyroid nodules were reviewed. Group I patients did not receive CPB, and Group II patients received CPB by bupivacaine injection between the sternocleidomastoid muscle (SCM) and prevertebral fascia on the treatment side. Pain was charted immediately and 4 hours after ablation using a numeric rating scale (NRS) of 0-10. The Quality-of-Recovery-9 (QoR9) questionnaire was completed. Over an 18-month period, 100 patients underwent unilateral thyroid ablation (Group I, n=50; Group II, n=50). Comparable baseline patient demographics, nodule characteristics, ablation parameters were noted (P>0.05). Significantly lower immediate NRS {1 [0-3] vs. 4 [1.3-6], P<0.001}, 4-hour NRS {1 [0-3] vs. 2 [0-4], P=0.04}, and more zero immediate NRS (44% vs. 14%, P=0.001) was observed in Group II. Total QoR9 scores were comparable {16 [12-17] vs. 15 [12-17], P=0.72}. No adverse events occurred. All patients were discharged within the same day. Adding ultrasound-guided CPB further enhanced pain control following unilateral TA of thyroid nodules, without compromising quality of recovery or same-day discharge.

Contrast-enhanced ultrasound image sequences based on radiomics analysis for diagnosis of metastatic cervical lymph nodes from thyroid cancer.

Thyroid cancer (TC) prone to cervical lymph node (CLN) metastasis both before and after surgery. Ultrasonography (US) is the first-line imaging method for evaluating the thyroid gland and CLNs. However, this assessment relies mainly on the subjective judgment of the sonographer and is very much dependent on the sonographer's experience. This prospective study was designed to construct a machine learning model based on contrast-enhanced ultrasound (CEUS) videos of CLNs to predict the risk of CLN metastasis in patients with TC. Patients who were proposed for surgical treatment due to TC from August 2019 to May 2020 were prospectively included. All patients underwent US of CLNs suspected of metastasis, and a 2-minute imaging video was recorded. After target tracking, feature extraction, and feature selection through the lymph node imaging video, three machine learning models, namely, support vector machine, linear discriminant analysis (LDA), and decision tree (DT), were constructed, and the sensitivity, specificity, and accuracy of each model for diagnosing lymph nodes were calculated by leave-one-out cross-validation (LOOCV). A total of 75 lymph nodes were included in the study, with 42 benign cases and 33 malignant cases. Among the machine learning models constructed, the support vector machine had the best diagnostic efficacy, with a sensitivity of 93.0%, a specificity of 93.8%, and an accuracy of 93.3%. The machine learning model based on US video is helpful for the diagnosis of whether metastasis occurs in the CLNs of TC patients.

Locoregional Treatments in Peritoneal Metastasis from Gastric Cancer

Background: Liver cancer is among the top five causes of cancer death globally. Hepatocellular Carcinoma (HCC) accounts for up to 90% of primary liver neoplasms in adults. The incidence of thyroid me-tastasis from HCC is rare and estimated from 0.8 to 12%. This report describes a 51-year-old man presenting with hypercalcemia and known metastatic HCC with new metastasis to the thyroid gland. Case Report: A 51-year-old male was admitted due to symptomatic hypercalcemia. His medical history included HCC with metastasis to the retroperitoneal lymph nodes diagnosed one year prior. Computed tomography revealed an enlarging liver mass, diffuse lymphadenopathy and many osseous lytic lesions. Ultrasound of the neck revealed abnormal right cervical lymph nodes and a heterogeneous mass replacing the right thyroid gland. Biopsy of the right cervical lymph node immunohistochemical stained positive for PAN-K, Glypican-3, HepPar1 and Anti-Arginase and negative for p40 and CEA-poly, supporting the diagnosis for metastatic HCC. His hospital course was complicated by dysphagia, spontaneous bacterial peritonitis and acute-on-chronic liver failure. Despite aggressive resuscitation, he continued to decline and ultimately pursued hospice care. Conclusion: This case illustrates the need to have a high index of suspicion for thyroid metastasis in HCC patients presenting with a new-onset cervical mass, dysphagia or hypercalcemia. Metastatic cancer to the thyroid gland is generally considered a poor prognostic factor, as seen in this case with the rapid decline. This case demonstrates an extremely rare presentation of HCC with metastasis to the thyroid gland.

Subacute thyroiditis during pregnancy: clinical characteristics of seven cases.

There are few reports of subacute thyroiditis (SAT) during pregnancy. This study aimed to clarify the clinical characteristics of SAT in pregnant patients. Seven patients diagnosed with SAT during pregnancy at our institution from January 2004 to December 2021 were identified, and their clinical findings were retrospectively examined. At SAT diagnosis, the median age was 34 (range: 31-42) years, the median duration of pregnancy was 5 (4-24) weeks, and all patients had neck pain but no fever. On laboratory examination, median (range) free thyroxine, free triiodothyronine, and C-reactive protein levels were 2.66 (1.14-7.77) ng/dL, 7.1 (3.3-16.1) pg/mL, and 2.22 (0.42-5.79) mg/dL, respectively, and all patients had a hypoechoic lesion of the thyroid gland. Three patients (43%) were treated with steroids, and three patients (43%) received replacement therapy with levothyroxine for hypothyroidism following destructive thyroiditis. There were no pregnancy complications in any of the cases. These seven patients (pregnancy group) were compared with 217 non-pregnant female patients (non-pregnancy group) aged 31 to 42 years who were diagnosed with SAT at our institution from 2016 to 2019. The frequency of body temperatures above 37°C was lower in the pregnancy group than in the non-pregnancy group (0% vs 65%). Patients who develop SAT during pregnancy may have less fever than non-pregnant patients with SAT. There were no pregnancy complications in the pregnancy group in this study. This suggests that adverse pregnancy outcomes may be avoided by the appropriate management of SAT, including hypothyroidism after destructive thyroiditis.

Medullary thyroid cancer: single-cell transcriptome and tumor evolution

BackgroundMedullary thyroid cancer (MTC) is a rare neuroendocrine tumor that originates from the parafollicular C cells of thyroid gland. Understanding the fundamental pathophysiology of MTC is essential for clinical management. Single-cell RNA sequencing (scRNA-seq) technology is a powerful tool for identifying distinct cell types, offering a new biological foundation for comprehending the MTC ecosystem and developing precise treatment.MethodsFormalin fixed and paraffin-embedded (FFPE) samples of primary and adjacent non-cancerous tissues of three MTC cases were collected, and single-cell transcriptome data of MTC were obtained by using scRNA-seq technology. Annotated cell subpopulations were categorized and functionally enriched by principal component analysis, differential gene expression, and cell clustering analysis, to explore the biological process of tumor evolution that may be involved in each cell subpopulation. The copy number variation (CNV) profile was used to distinguish the malignancy of parafollicular thyroid cells, and the evolutionary trajectories of normal cells and tumor cells were revealed by the proposed time series analysis. The highly expressed genes in each cell subpopulation were analyzed by the FindAllMarker function of Seurat software, and verified by immunohistochemistry and fluorescence in situ hybridization. The prognostic value of specific cell subtypes was validated using large-scale public datasets.ResultsA total of 32,544 cells were obtained from the MTC tissue samples and 11,751 cells from the adjacent non-cancerous samples, which were classified into 7 heterogenous subpopulations by using R package of Seurat module. Copy number variations (CNVs) were significantly higher in tumor tissues than in adjacent non-tumor samples, predominantly enriched in subtypes C2 and C4. In addition, the pseudo-time for trajectory analysis suggested that the evolution of MTC tumor cells might begin with the C2 subtype, then transition to the early cancer subgroup C3, and further differentiate into four major malignant cell subpopulations C0, C1, C5 and C6. Survival analysis of a thyroid cancer cohort using the TCGA dataset revealed that high expression of genes linked to the C0 subcluster was correlated with poorer overall survival compared to low expression. Immunohistochemical staining showed that MAP3K4 was highly expressed in MTC tissues compared to adjacent non-cancerous tissues. Fluorescence in situ hybridization also confirmed the amplification of these two genes in MTC samples.ConclusionsBy conducting scRNA-seq on FFPE samples, we mapped the single-cell transcriptome of MTC, uncovering the tumor heterogeneity and unique biological features of each cellular subpopulation. The biological roles of identified tumor cell subpopulations such as C0 and C3 subtypes of parafollicular cells suggested the potential to discover new therapeutic targets and biomarkers for MTC, providing valuable insights for future translational and clinical research.

Metastasis of clear cell renal cell carcinoma to the thyroid gland resembling papillary thyroid cancer: a case report

Metastasis of clear cell renal cell carcinoma to the thyroid gland resembling papillary thyroid cancer: a case report

Pathology diagnosis of intraoperative frozen thyroid lesions assisted by deep learning

BackgroundThyroid cancer is a common thyroid malignancy. The majority of thyroid lesion needs intraoperative frozen pathology diagnosis, which provides important information for precision operation. As digital whole slide images (WSIs) develop, deep learning methods for histopathological classification of the thyroid gland (paraffin sections) have achieved outstanding results. Our current study is to clarify whether deep learning assists pathology diagnosis for intraoperative frozen thyroid lesions or not.MethodsWe propose an artificial intelligence-assisted diagnostic system for frozen thyroid lesions that applies prior knowledge in tandem with a dichotomous judgment of whether the lesion is cancerous or not and a quadratic judgment of the type of cancerous lesion to categorize the frozen thyroid lesions into five categories: papillary thyroid carcinoma, medullary thyroid carcinoma, anaplastic thyroid carcinoma, follicular thyroid tumor, and non-cancerous lesion. We obtained 4409 frozen digital pathology sections (WSI) of thyroid from the First Affiliated Hospital of Sun Yat-sen University (SYSUFH) to train and test the model, and the performance was validated by a six-fold cross validation, 101 papillary microcarcinoma sections of thyroid were used to validate the system’s sensitivity, and 1388 WSIs of thyroid were used for the evaluation of the external dataset. The deep learning models were compared in terms of several metrics such as accuracy, F1 score, recall, precision and AUC (Area Under Curve).ResultsWe developed the first deep learning-based frozen thyroid diagnostic classifier for histopathological WSI classification of papillary carcinoma, medullary carcinoma, follicular tumor, anaplastic carcinoma, and non-carcinoma lesion. On test slides, the system had an accuracy of 0.9459, a precision of 0.9475, and an AUC of 0.9955. In the papillary carcinoma test slides, the system was able to accurately predict even lesions as small as 2 mm in diameter. Tested with the acceleration component, the cut processing can be performed in 346.12 s and the visual inference prediction results can be obtained in 98.61 s, thus meeting the time requirements for intraoperative diagnosis. Our study employs a deep learning approach for high-precision classification of intraoperative frozen thyroid lesion distribution in the clinical setting, which has potential clinical implications for assisting pathologists and precision surgery of thyroid lesions.

Indications and technique for transoral thyroid gland and parathyroid gland surgery

The conventional Kocher collar incision is the standard access to the thyroid and parathyroid glands. Although the incision length has been significantly shortened in recent years with this approach, there is increasing interest among patients in asurgical technique without visible scars in the décolleté. Transoral endoscopic thyroid gland surgery via the vestibular approach (TOETVA) is amodern technique that can be learned relatively quickly and leaves no visible scars because it is carried out exclusively through anatural orifice (natural orifice transluminal endoscopic surgery, NOTES). For retrieval of larger specimens, the transoral approach can be combined with aretroauricular access and thus covers alarger range of indications. The indications must be strictly followed, analogous to conventional surgery. Once the transoral access has been established, the operation is carried out as in open surgery but strictly from cranial to caudal. The classical complications are comparable to the results of conventional surgery. Specific complications include perioral, mandibular or cervical dysesthesia and hypesthesia.

Explainable Machine Learning Models for Predicting Recurrence in Differentiated Thyroid Cancer

Aim: Differentiated thyroid cancer (DTC) is a common type of cancer that originates in the thyroid gland. This study aimed to predict the recurrence of differentiated thyroid carcinoma, in patient with well-DTC, using explainable machine learning (XAI) models. Material and Methods: The study utilized a dataset from the UCI Machine Learning Repository, which included 383 patients and 13 candidate predictors. After a variable selection process using distance correlation, only four predictors (Response, Risk, T, and N) were retained for model building. Two XAI models, Fast Interpretable Greedy-Tree Sums (FIGS) and Explainable Boosting Machines (EBM), were employed. Results: The EBM model slightly outperformed the FIGS model in terms of accuracy. The study found that the most influential predictors of Well-DTC recurrence were the response to DTC treatment, risk status according to the American Thyroid Association classification, tumor size (T), and lymph node metastasis (N). Conclusion: In conclusion, this study successfully identified key risk factors for DTC recurrence using XAI models, providing interpretable insights for clinical decision-making and potential for personalized treatment strategies.

Evaluation of thyroid hormones in type 1 diabetes mellitus

Background and objective: Increased blood sugar levels (hyperglycemia) and lack of insulin are a hallmark of Type 1 diabetes mellitus (T1DM), which is a chronic autoimmune illness results from the destruction of pancreatic beta –cells. The most common causes of hypothyroidism and hyperthyroidism are autoimmune diseases Hashimoto's thyroiditis and Graves’ disease, respectively. Because type 1 diabetes includes autoimmunity as a pathophysiological trigger, it is not uncommon to investigate patients with both diabetes and thyroid problems. The aim of the study is to evaluate serum thyroid hormones in patients with type1 diabetes mellitus. Methods: In this study 104 participants were included, 52 patients with type1 diabetes, and 52 healthy individuals. Blood samples were taken, and serum thyroid hormones levels were measured and the results of cases and controls were analyzed and compared using SPSS program. Results: It was found that the levels of T4 among non- diabetic participants were higher than those of diabetic patients. (P &lt;0.001). There is a negative correlation between BMI and fasting blood glucose in T1 diabetic patients according to regression test it has been shown that any increase in the FBG leads to decrease in the BMI. Conclusion: The present study shows that type 1 diabetes mellitus may affect thyroid gland and thyroid hormone levels, that may result in thyroid dysfunction.