Endocrine journal最新文献

{"title":"Soluble tumor necrosis factor receptors in diabetes: risk sensing and receptor-resolved targeting.","authors":"Qi Zhu, Yu Liu, Chen Yang, Tie Li","doi":"10.1507/endocrj.EJ26-0050","DOIUrl":"https://doi.org/10.1507/endocrj.EJ26-0050","url":null,"abstract":"<p><p>Diabetes drives a major burden of kidney failure, cardiovascular disease, and premature mortality, yet current clinical markers incompletely capture individual trajectories of organ decline. Soluble tumor necrosis factor receptors 1 and 2 (sTNFR1/2) have emerged as among the most reproducible circulating predictors of diabetic kidney disease progression, retaining prognostic value after adjustment for estimated glomerular filtration rate (eGFR) and albuminuria across multiple cohorts. Prospective studies in type 2 diabetes also associate higher sTNFR1/2 with incident cardiovascular events and all-cause mortality, supporting a systemic risk phenotype that is not fully explained by baseline kidney measures. Mechanistically, recent work has refined the classical view of tumor necrosis factor (TNF) as a generic inflammatory mediator by identifying proximal checkpoints that govern TNFR1 \"injury-biased\" outputs, including ubiquitination- and lipidation-dependent control of RIPK1, trafficking-dependent restraint of death-receptor signaling, and cross-pathway phosphorylation that retunes downstream complex assembly. In parallel, advances in therapeutic engineering are shifting the field from non-selective TNF neutralization toward receptor-selective modulation, including TNFR1-selective antagonists, allosteric inhibitors, and shedding strategies designed to reduce injury signaling while preserving TNFR2-linked immunoregulatory and reparative programs. This receptor-resolved framework provides a coherent basis for interpreting why soluble receptors outperform circulating TNF as prognostic biomarkers and for developing mechanism-informed interventions in diabetes.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A predictive nomogram for progression-free survival in radioiodine-refractory papillary thyroid carcinoma after reoperation: a longitudinal study in Vietnam.","authors":"Nguyen Thi Nhung, Le Ngoc Ha, Van Dong Hoang, Zhanna Mussazhanova, Hirokazu Kurohama, Katsuya Matsuda, Yuki Matsuoka, Le Thi Khanh Tam, Ngo Thi Minh Hanh, Van Phu Thang Nguyen, Thi Ngoc Anh Nguyen, Tratsiakova Katsiaryna, Michiko Matsuse, Norisato Mitsutake, Masahiro Nakashima","doi":"10.1507/endocrj.EJ25-0565","DOIUrl":"https://doi.org/10.1507/endocrj.EJ25-0565","url":null,"abstract":"<p><p>Radioiodine-refractory (RAI-R) papillary thyroid carcinoma (PTC) with disease progression is associated with poor prognosis. This study aimed to develop a predictive nomogram for progression-free survival (PFS) in RAI-R PTC by integrating clinical, pathological, and mutational features. In this longitudinal study, 145 patients with RAI-R PTC who underwent reoperation for locoregional recurrence were followed for disease progression. A Bayesian model averaging (BMA) approach was employed to identify the optimal model for predicting PFS. Model performance was assessed using time-dependent area under the receiver operating characteristic curve (AUC), Brier scores, and calibration plots. A nomogram for PFS prediction was then developed based on parameters from the optimal model. During a median follow-up of 29.7 months, 38 patients (26.2%) experienced disease progression after reoperation. Among eight candidate variables, BMA identified an optimal model that included four key predictors: treatment response, extrathyroidal/extranodal extension, mitotic count, and coexisting BRAF^V600E and TERT promoter mutations (Dmut). The hazard ratios (95% confidence intervals) were 3.86 (1.54-9.72) for biochemical incomplete response, 9.39 (3.35-26.3) for structural incomplete response, 3.40 (1.69-6.85) for extrathyroidal/extranodal extension, 1.34 (1.13-1.58) for mitotic count, and 6.08 (2.79-13.2) for Dmut. The optimal model demonstrated strong discriminative performance and stability across time points, with AUCs (95% confidence intervals) of 0.905 (0.801-1.000), 0.919 (0.857-0.981), and 0.921 (0.861-0.981) at 12, 24, and 36 months, respectively, and showed good calibration. This study demonstrates that integrating treatment response, extrathyroidal/extranodal extension, mitotic count, and Dmut into a predictive nomogram offers a clinically relevant tool for stratifying progression risk in patients with RAI-R PTC.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of hypothyroidism with adverse pregnancy outcomes: a single-center cohort study in an iodine-sufficient country.","authors":"Akiko Sankoda, Nagayoshi Umehara, Yusuke Okubo, Shiori Sato, Seiji Wada, Naoko Arata","doi":"10.1507/endocrj.EJ25-0423","DOIUrl":"https://doi.org/10.1507/endocrj.EJ25-0423","url":null,"abstract":"<p><p>Hypothyroidism is reported to associate with adverse pregnancy outcomes. However, there are few reports in iodine-sufficient or -excess areas. We investigated the association of hypothyroidism in early pregnancy with pregnancy outcomes in an iodine-rich area, Japan. We conducted a retrospective cohort study at a tertiary center between 2004 to 2013. The eligible participants were classified into three groups: euthyroidism, subclinical hypothyroidism (SCH), or overt hypothyroidism (OH) groups, based on their thyroid hormone levels in the first trimester of pregnancy (median 11.6 weeks, IQR 10.6-12.6). SCH and OH were defined as elevated TSH levels with normal and low FT4 levels, respectively, using cohort-specific reference ranges in early pregnancy. The primary outcomes were miscarriage, preterm birth, small for gestational age (SGA), and their composite. Multivariate logistic regression analyses and restricted cubic spline analyses fitted to the regression models were performed to analyze the association and dose-dependency. 5,366 pregnant women were classified as euthyroidism, 143 as SCH, and 21 as OH. The composite outcome was not associated with SCH (odds ratio [OR], 0.73; 95%CI, 0.41-1.31), but significantly associated with OH (OR, 3.43; 95%CI, 1.36-8.68). Preterm birth was not associated with SCH (OR, 0.69; 95%CI, 0.28-1.69), but significantly associated with OH (OR, 5.56; 95%CI, 1.98-15.63). In this Japanese single-center cohort, SCH diagnosed in the first trimester was not associated with selected adverse pregnancy outcomes; however, miscarriage risk in early pregnancy could not be adequately assessed. The restricted cubic spline models for the primary outcomes showed J-shaped association with TSH, while the dose-response analysis did not show a clear increase in risk within the reference range of FT4. SCH in early pregnancy was indicated to have no association with the adverse pregnancy outcomes in an iodine-rich area. The risk of adverse pregnancy outcomes was increased exclusively in the low FT4 range.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning-based prediction of impaired arginine vasopressin secretion during hypertonic saline test.","authors":"Satoshi Naito, Daisuke Hagiwara, Masaki Kitamura, Ryosei Ashida, Yohei Kawaguchi, Takashi Miyata, Tomoko Handa, Tomoko Kobayashi, Mariko Sugiyama, Takeshi Onoue, Shintaro Iwama, Hidetaka Suga, Ryoichi Banno, Hiroshi Arima","doi":"10.1507/endocrj.EJ26-0094","DOIUrl":"https://doi.org/10.1507/endocrj.EJ26-0094","url":null,"abstract":"<p><p>Hypertonic saline infusion and water deprivation tests are commonly used to stimulate arginine vasopressin (AVP) for the diagnosis of AVP deficiency (AVP-D); however, these procedures impose a considerable burden on patients. We aimed to develop machine learning models to predict impaired AVP secretion and thereby reduce the need for AVP stimulation testing. This retrospective cohort study included 64 patients who underwent the hypertonic saline test (HST) at Nagoya University Hospital, Japan, between 2018 and 2024. Impaired AVP secretion was defined as a predicted plasma AVP level <1.0 pg/mL at a serum sodium level of 149 mEq/L during the HST. Feature selection was performed using univariate screening and systematic selection procedures. Logistic regression and support vector machine models were developed using baseline clinical and laboratory parameters obtained before the HST and validated using nested cross-validation. The primary outcome was the area under the receiver operating characteristic curve (AUC); secondary outcomes included the sensitivity, specificity, and positive and negative predictive values. Four variables (urinary osmolality, serum sodium, plasma AVP, and blood urea nitrogen) were selected. The logistic regression model achieved an AUC of 0.862 for predicting impaired AVP secretion. Among 35 patients who underwent the HST for suspected AVP-D, at the optimized threshold, the positive and negative predictive values were 100% (14/14 patients) and 33.3% (7/21 patients), respectively. The developed machine learning model can identify a subset of patients with impaired AVP secretion without requiring the HST, potentially reducing the number of patients who need AVP stimulation testing for AVP-D diagnosis.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term survival in MIRAGE syndrome: Insights into systemic manifestations and management with review of literature.","authors":"Yuki Yamada, Hidehito Kondo, Masashi Nishida, Zenro Kizaki, Kanako Tanase-Nakao, Satoshi Narumi, Jun Mori","doi":"10.1507/endocrj.EJ25-0656","DOIUrl":"https://doi.org/10.1507/endocrj.EJ25-0656","url":null,"abstract":"<p><p>MIRAGE syndrome is a multisystemic disorder with a poor prognosis, caused by gain-of-function mutations in the SAMD9 gene. To date, no comprehensive reports on the systemic manifestations and management of MIRAGE syndrome in adult survivors. Here, we present the case of a 22-year-old man long-term survivor of MIRAGE syndrome with a wide range of clinical presentations and complications. From the neonatal period, he exhibited the core features of MIRAGE syndrome: myelodysplasia, recurrent infection, growth retardation, adrenal hypoplasia, atypical external genitalia, and enteropathy. Additionally, brain imaging at 5 years of age revealed new findings, including basal ganglia and white matter lesions, calcification, infarction, and ventricular enlargement. Subsequently, proteinuria was detected at 6 years of age, which gradually progressed to end-stage renal disease. At 21 years of age, he received a living-donor kidney transplant from his father, the first transplant reported for this syndrome. Genetic analysis identified a congenital SAMD9 mutation (p.Gln1286Lys) and three acquired reversion mutations. These revision mutations mitigated his hematologic complications but did not fully restore immune function. In addition to persistent immunological and endocrine dysfunction, the patient has developed progressive neurological and metabolic abnormalities over time. Multidisciplinary management, including prophylactic intravenous immunoglobulin therapy, renal replacement therapy and transplantation, and endocrine support, was provided and may have contributed to his long-term survival. This case highlights the evolving clinical spectrum of MIRAGE syndrome and underscores the importance of careful longitudinal monitoring for patients who survive beyond early childhood.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ZFP36-ferroptosis axis as a key renal protective pathway in diabetic kidney disease.","authors":"Anni Li, Yuxuan Ye, Huimin Cao, Jiawei Hu, Min Shi, Juan Zhang, Yiyuan Zhang, Yuting Liu, Bixia Gu, Hong Zhang","doi":"10.1507/endocrj.EJ25-0648","DOIUrl":"https://doi.org/10.1507/endocrj.EJ25-0648","url":null,"abstract":"<p><p>Diabetic Kidney Disease (DKD) is strongly related to ferroptosis, an iron-dependent form of programmed cell death characterized by the accumulation of lipid peroxides. While ferroptosis is a pivotal mediator in DKD pathogenesis, its upstream regulatory mechanism remains poorly defined, thus impeding the development of targeted therapeutic strategies. In this study, by integrating multi-omics clinical data (GSE96804 and GSE104954) and combining machine learning algorithms, the RNA-binding protein ZFP36 was screened out as the core regulatory factor of ferroptosis in DKD. The results revealed that the expression level of ZFP36 in the DKD group was significantly lower than that in the normal group. Functional experiments demonstrated that overexpression of ZFP36 could significantly alleviate lipid peroxidation, iron ion accumulation, and cellular fibrosis, thereby inhibiting ferroptosis and alleviating kidney damage. Transcriptome analysis further revealed that ZFP36 regulated key genes related to oxidative stress and iron metabolism. Additionally, molecular docking simulations revealed strong binding affinity between ZFP36 and bioactive natural products such as berberine and astragalus, providing a potential mechanism for its renal protective effect. Overall, ZFP36 was hereby established as an important inhibitor of ferroptosis in DKD, highlighting its potential as both a biomarker and a therapeutic target for its precision diagnosis and intervention.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights from maturity-onset diabetes of the young into impaired insulin secretion in type 2 diabetes.","authors":"Yukio Horikawa, Yoshihiro Takahashi, Kazuyoshi Hosomichi","doi":"10.1507/endocrj.EJ26-0092","DOIUrl":"https://doi.org/10.1507/endocrj.EJ26-0092","url":null,"abstract":"<p><p>Monogenic diabetes arises from pathogenic variants in a single gene that are sufficient to cause disease predisposition. In general, a greater functional impact of genetic abnormalities is associated with an earlier age of onset. Accordingly, monogenic diabetes encompasses a wide clinical spectrum, including neonatal diabetes mellitus presenting within the first six months of life, and maturity-onset diabetes of the young (MODY) typically manifesting from childhood to early adulthood; both diabetic types exhibit impaired insulin secretory capacity. Although MODY is currently classified as diabetes of monogenic defect with impaired insulin secretion, it has become evident that mutations in rare MODY subtypes exhibit reduced pathogenic effects and low penetrance. In addition, observed differences in the clinical phenotypes caused by the same mutation, even in the same family, might be caused by other phenotypic modifying factors. Furthermore, their clinical expression is influenced, at least in part, by environmental factors, such as the intrauterine environment. Nevertheless, identification of the causative genes underlying monogenic diabetes has elucidated previously unrecognized molecular mechanisms responsible for the impaired insulin secretion. These findings have not only revealed novel therapeutic targets but have also provided important insights into the pathophysiology of common type 2 diabetes mellitus in the Japanese population, a multifactorial disease in which defective insulin secretion plays a central role.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-affinity IgG-mediated macro-TSH: diagnostic limitations of peak-based gel filtration chromatography-a case report with review of literature.","authors":"Toshihiko Kasahara","doi":"10.1507/endocrj.EJ26-0019","DOIUrl":"https://doi.org/10.1507/endocrj.EJ26-0019","url":null,"abstract":"<p><p>Macro-thyroid-stimulating hormone (macro-TSH) is a well-recognized cause of spuriously elevated TSH results. However, its characterization still relies largely on gel filtration chromatography (GFC), which may fail to detect macro-TSH associated with unstable or low-affinity immune complexes. In particular, when second-line screening tests, such as polyethylene glycol (PEG) precipitation, strongly suggest macro-TSH but GFC shows no distinct high-molecular-weight TSH fraction, macro-TSH may be incorrectly ruled out as the source of interference. A 43-year-old woman treated with levothyroxine for subclinical hypothyroidism showed persistently elevated TSH despite high-normal free thyroxine levels and no clinical signs of hypothyroidism. PEG precipitation and Protein G treatment resulted in TSH recovery rates of 8% and 23%, respectively, indicating macro-TSH mediated by immunoglobulin G, while heterophile and assay-specific interferences were considered unlikely. GFC under neutral conditions revealed a subtly broadened TSH distribution without a distinct high-molecular-weight peak. Quantitative peak analysis showed increased full width at half maximum and area under the curve, with values approximately 1.5- to 2-fold higher than those in controls in both the initial and repeat runs, confirming significant peak broadening. Under acidic conditions, the patient's TSH elution profile completely overlapped with those of the controls, supporting the presence of macro-TSH due to low-affinity TSH-IgG complexes. This case highlights the diagnostic challenge posed by macro-TSH, particularly in cases involving low-affinity antibody interactions. It underscores the importance of assessing the overall elution profile rather than relying solely on peak position. Recognizing such atypical presentations can prevent unnecessary thyroid hormone treatment and improve diagnostic accuracy.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endocrine disorders in pediatric medulloblastoma survivors treated with X-ray or proton beam therapy: a single-institution retrospective study.","authors":"Naoya Kaneko, Shuntaro Morikawa, Megumi Endo, Nozomi Hishimura, Liu Zhitong, Takeshi Yamaguchi, Hisato Segoe, Jutaro Abe, Kazumi Oura, Saori Sawai, Minako Sugiyama, Yukayo Terashita, Shinsuke Hirabayashi, Yuko Cho, Akie Nakamura, Yukitomo Ishi, Seishin Takao, Yuto Matsuo, Shigeru Yamaguchi, Takayuki Hashimoto, Atsushi Manabe","doi":"10.1507/endocrj.EJ25-0442","DOIUrl":"https://doi.org/10.1507/endocrj.EJ25-0442","url":null,"abstract":"<p><p>Medulloblastoma, a common pediatric central nervous system disease, is managed with surgery, chemotherapy, and craniospinal irradiation (CSI) delivered with either X-rays or protons. Proton-beam CSI, introduced to protect the surrounding tissues, may reduce endocrine toxicity. In this single-institution retrospective observational study, we evaluated adverse endocrine events in 14 patients diagnosed with medulloblastoma before 13 years of age: 9 and 5 received X-ray and proton beam CSI, respectively. In the X-ray therapy group, the median age at diagnosis was 4.2 (range: 1.4-12.5) years, the median post-radiation follow-up was 19.5 (9.7-34.7) years, and the median CSI dose was 25.2 (23.4-36.0) Gy. The proton beam therapy group showed corresponding medians of 9.4 (5.3-11.7) years, 6.9 (5.4-8.1) years, and 23.4 (23.4-36.0) Gy. Five years after radiation therapy completion, the incidence of growth hormone deficiency was 44% (4/9) and 60% (3/5) in the X-ray and proton beam therapy groups, respectively. However, primary hypothyroidism and central hypothyroidism were exclusively observed in the X-ray therapy group, in 33% (3/9) and 11% (1/9) of patients. Given the short follow-up period for the proton beam therapy group, the difference in the occurrence rates of gonadal dysfunction and adrenal insufficiency is currently unknown. Our findings suggest that, at ≤5 years after the completion of radiation therapy, radiation-induced hypothyroidism was observed only in patients treated with X-ray therapy and not in those treated with proton beam therapy. Further studies with larger cohorts and longer follow-up periods are required to clarify this possible advantage and to refine radiation therapy protocols.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147671463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early predictors of 6-month thyroid-stimulating antibody levels after radioactive iodine therapy for Graves' disease: implications for pregnancy planning.","authors":"Seigo Tachibana, Yuji Nagayama, Takashi Fukuda, Yusuke Taguchi, Daisuke Tatsushima, Yusuke Mori, Hisakazu Shindo, Hiroshi Takahashi, Shinya Sato, Hiroyuki Yamashita","doi":"10.1507/endocrj.EJ25-0651","DOIUrl":"https://doi.org/10.1507/endocrj.EJ25-0651","url":null,"abstract":"<p><p>Current guidelines recommend a 6-month contraception period following radioactive iodine therapy (RAIT) for Graves' disease (GD), based primarily on radiation safety considerations; however, they do not account for the post-treatment surge in thyroid-stimulating antibodies (TSAb), which poses risks for fetal and neonatal GD. This retrospective study aimed to identify factors influencing TSAb trajectories and construct a predictive model for TSAb levels at 6 months after RAIT. We analyzed 82 patients who underwent RAIT, with TSAb values standardized to the upper limit of normal (ULN) to account for different assay methods. Multivariable linear regression identified the duration of antithyroid drug and potassium iodide administration, pre-RAIT TSAb levels, changes in TSAb at 3 months (3M), fractional reduction in TW at 3M, and assay method as significant predictors of TSAb levels at 6 months (adjusted R² = 0.87). A prediction score derived from this model demonstrated excellent diagnostic performance. Receiver operating characteristic analysis yielded an area under the curve of 0.99 for predicting TSAb >3.3 ULN, corresponding to the threshold for fetal GD monitoring at approximately 20 weeks of gestation, and 0.94 for TSAb >1.0 ULN. The prediction score significantly outperformed single predictors, including baseline TSAb levels and early post-TSAb changes. In conclusion, we developed a highly accurate predictive model for TSAb levels at 6 months after RAIT by integrating early post-treatment data with pre-RAIT clinical parameters. This model enables identification of patients at risk of persistent TSAb elevation, supporting individualized counseling regarding pregnancy planning beyond the conventional 6-month contraception period.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}