European Thyroid Journal最新文献

{"title":"TERT promoter mutations in papillary thyroid carcinoma: association with gross extrathyroidal invasion and outcomes.","authors":"Debora Lucia Seguro Danilovic, Livia Elias, Ibere Soares, Giovana Torrezan, Mariana Souza, Rosalinda Camargo, Ana Oliveira Hoff, Suemi Marui, Luiz Kowalski, Peter Kopp","doi":"10.1530/ETJ-26-0128","DOIUrl":"https://doi.org/10.1530/ETJ-26-0128","url":null,"abstract":"<p><strong>Context: </strong>Morbidity of papillary thyroid carcinoma (PTC) is primarily related to locoregional and distant metastases. Extrathyroidal extension (ETE) is associated with adverse outcomes; however, the biological heterogeneity across its degrees-particularly minimal (mETE) versus gross ETE (gETE)-remains incompletely characterized. While BRAFV600E and TERT promoter (TERTp) mutations have been linked to aggressive disease, their contributions to ETE severity are not fully established.</p><p><strong>Objective: </strong>To compare clinical outcomes across different degrees of ETE and evaluate the association between molecular alterations and local aggressiveness in PTC.</p><p><strong>Methods: </strong>A total of 352 PTCs (242 mETE; 81 gETE-T3; 29 gETE-T4) were evaluated for lymph node and distant metastases, disease recurrence/persistence, and response to therapy. BRAFV600E and TERTp (C228T/C250T) mutations were analyzed in 68 mETE and 28 gETE tumors and correlated with clinical outcomes.</p><p><strong>Results: </strong>Increasing ETE severity was associated with progressively higher risks of lymph node and distant metastases, recurrence/persistence, and incomplete response to therapy (all p<0.001), independent of other risk factors. BRAFV600E prevalence did not differ between tumors with mETE (82.4%) and gETE (71.4%). In contrast, TERTp mutations were more frequent in gETE (46.4%) than mETE (16.2%; p=0.002) and were independently associated with gETE, distant metastases, and incomplete response to therapy.</p><p><strong>Conclusions: </strong>Gross ETE is associated with progressively worse clinical outcomes, particularly in gETE-T4 tumors. While BRAFV600E does not distinguish microscopic from macroscopic invasion, TERTp mutations are associated with invasive local behavior, distant metastases, and incomplete response to therapy. These findings suggest that TERTp status may refine risk stratification in PTC with extrathyroidal extension.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcriptomics of thyroid cancer.","authors":"Barbara Jarzab","doi":"10.1530/ETJ-26-0241","DOIUrl":"https://doi.org/10.1530/ETJ-26-0241","url":null,"abstract":"<p><p>The review of achievements in thyroid cancer (TC) transcriptomics aims to show how they have deepened our understanding of the processes underlying malignant transformation and the mechanisms of TC progression. The review starts with the earliest studies on the gene expression profile of papillary thyroid cancer (PTC), briefly describes diagnostic advances enabled by transcriptomic methods, and focuses on mechanisms in which interactions between tumor cells and microenvironment are crucial for the progression from papillary to anaplastic cancer. A deeper understanding of these processes was possible with single-cell RNA-seq. Such studies identified subpopulations in the tumor microenvironment, including cancer-associated fibroblasts (CAFs) and immune cells, that exhibit marked differences in their molecular phenotypes. Taken together, these findings extended the scope of TC transcriptomics beyond the characterization of malignant thyroid cells alone and highlighted the dynamic interactions between tumor cells and surrounding microenvironment. Single-cell RNA-seq of aggressive TC support the concept that stromal remodeling is closely associated with TC dedifferentiation and gives new insights into the mechanisms underlying PTC progression. In conclusion, transcriptomic research has substantially changed our understanding of TC biology. It has provided not only diagnostic tools that enable accurate decisions regarding the need for thyroid surgery in cytologically indeterminate thyroid nodules, but has also enhanced our understanding of the mechanisms underlying the PTC transition to anaplastic cancer. Although conclusions drawn from transcriptomic studies require independent validation, the insights gained from these studies provide a comprehensive view of the mechanisms of TC progression and are likely to find clinical applications.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Nondiagnostic Thyroid Fine Needle Aspiration Cytology Nodules Based on TI-RADS Risk Assessment.","authors":"Reettika Chanda, Sana Ghaznavi, John Timothy Lysack, Moosa Khalil, Laura Neuburger, James N Scott","doi":"10.1530/ETJ-26-0237","DOIUrl":"https://doi.org/10.1530/ETJ-26-0237","url":null,"abstract":"<p><strong>Objective: </strong>The high prevalence of thyroid nodules and the frequent occurrence of nondiagnostic (ND) results on fine-needle aspiration (FNA) necessitates malignancy risk stratification to balance cancer detection while avoiding unnecessary repeat biopsies. This study evaluated malignancy rates and management strategies for nodules with ND cytology, stratified by the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) score.</p><p><strong>Methods: </strong>This retrospective study analyzed 342 consecutive patients with initial ND ultrasound-guided (USG) thyroid FNA from a high volume, two-practitioner clinic between January 2019 and June 2024. Data collected from chart review included Bethesda cytopathology classifications, management approaches, and final histopathological diagnosis when available.</p><p><strong>Results: </strong>Among 3717 thyroid FNAs performed during the study period, 342 (9.2%) were ND on initial sampling. TI-RADS (TR) distribution for ND nodules was: TR1 9.6%, TR2 9.9%, TR3 28.1%, TR4 45.3%, TR5 7.0%. Initial management comprised repeat FNA in 170 (49.7%) patients, ultrasound (US) surveillance in 101 (29.5%), surgery in 17 (5.0%); 54 (15.8%) patients were lost to follow-up. Of repeat FNAs, 47 (27.6%) remained ND. Among 33 surgical cases, malignancy was identified in 6 (1.8%) index nodules with initial ND cytology. Five malignancies occurred in TR4 nodules and one in a TR5 nodule. Importantly, there were no malignancies among 17 resected TR1-3 nodules.</p><p><strong>Conclusion: </strong>For experienced practitioners in a high-volume clinic, ND thyroid FNA cytology carries a low overall observed risk of malignancy (1.8%). TI-RADS scores should be taken into consideration to guide management decisions for ND cytology nodules between repeat FNA, US surveillance, or surgery.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intranodular Lactate for Thyroid Nodule Assessment: Universal Performance and Maximum Impact in Indeterminate Cytology.","authors":"Luis-Mauricio Hurtado-Lopez, Blanca-Estela Monroy-Lozano, Erich Basurto-Kuba, Abraham Pulido-Cejudo, Edgar-Rafael Montes-de-Oca-Duran","doi":"10.1530/ETJ-26-0216","DOIUrl":"https://doi.org/10.1530/ETJ-26-0216","url":null,"abstract":"<p><strong>Objective: </strong>Thyroid nodules with indeterminate cytology often undergo diagnostic surgery despite a relatively low risk of malignancy, and molecular testing is limited by cost and availability. Because the Warburg effect is independent of cytological category, we evaluated intranodular lactate across all Bethesda categories, with emphasis on indeterminate cytology.</p><p><strong>Methods: </strong>Prospective, cross-sectional study of 338 surgically treated thyroid nodules at a single tertiary referral center, with histopathology as the reference standard. Nodules were classified according to the Bethesda System and TI-RADS. Lactate was measured with a portable analyzer from the solid component of each nodule and from extranodular thyroid parenchyma, with capillary lactate as a systemic control. Performance was assessed by ROC analysis, sensitivity, specificity, likelihood ratios, and Bayesian post-test probabilities.</p><p><strong>Results: </strong>Lactate increased progressively from extranodular parenchyma (1.85 ± 0.49 mmol/L) to benign (2.30 ± 0.96) and malignant nodules (4.69 ± 1.92 mmol/L; p < 0.0001). The optimal cutoff was 3.0 mmol/L (AUC 0.90 overall; 0.83 in Bethesda III-IV), with 91% sensitivity and 83% specificity. Negative predictive value was 92% for Bethesda I/III/IV/V and 95.6% for Bethesda III/IV. Lactate did not differ between classic and follicular papillary carcinoma subtypes (p = 0.34), and no extranodular sample affected by lymphocytic thyroiditis exceeded the cutoff. Estimated relative reduction in diagnostic surgery was 61.7% (Bethesda III-IV) and 48.5% (Bethesda III-V).</p><p><strong>Conclusions: </strong>Intranodular lactate is a feasible, low-cost metabolic biomarker that performs consistently across cytological categories, with greatest clinical value in Bethesda I, III, and IV nodules, where it may substantially reduce unnecessary diagnostic surgery.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of TP53 Mutational Status and Survival in Anaplastic Thyroid Cancer Treated with Dabrafenib Plus Trametinib.","authors":"Ricardo Rodrigues, Tiago Nunes da Silva, Ana Saramago, Daniela Cavaco, Saudade André, Raquel Dias, Miguel Rito, Valeriano Leite, Branca Maria Cavaco","doi":"10.1530/ETJ-26-0135","DOIUrl":"https://doi.org/10.1530/ETJ-26-0135","url":null,"abstract":"<p><strong>Objective: </strong>Anaplastic thyroid cancer (ATC) is an extremely aggressive tumour, with high mortality rates. Dabrafenib plus Trametinib (DT) has significantly impacted the survival of patients with BRAF p.V600E ATC, with noticeable variations in survival between patients. TP53 is frequently mutated in ATC, but its impact on DT response is still unclear. We aimed to investigate the association between TP53 mutational status and clinical outcomes in ATC patients treated with DT.</p><p><strong>Methods: </strong>BRAF positive ATC patients (n=25) treated with DT between 2018 and 2026 were included. Response was assessed by RECIST 1.1. TP53 association with clinicopathological features was evaluated. Four BRAF-mutant cell lines were used: two TP53 mutant (T235, T238) and two TP53 wild-type (OCUT1, IHH4).</p><p><strong>Results: </strong>TP53 mutations, detected in ATC from 10 patients, were associated with a significantly lower overall survival (6.5 vs 21 months; p<0.01), and a trend towards shorter progression-free survival (7 vs 19 months; p=0.09), and duration of response (5.5 vs 9 months; p=0.09). No significant associations were found between TP53 mutations and sex, primary tumour size, N and M stage, or PI3K pathway alterations. Complementary in vitro experiments across multiple BRAF p.V600E cell lines provided mechanistic support for these clinical observations, demonstrating that TP53-mutant cells consistently exhibited reduced sensitivity to combined DT therapy.</p><p><strong>Conclusions: </strong>This study suggested that TP53 mutations represent a prognostic factor, associated with worse survival in patients with BRAF p.V600E ATC undergoing DT treatment, highlighting the potential clinical value of incorporating TP53 profiling into patient management.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary thyroid dysfunction and changes in the gonadal axis and SHBG in adult men: a prospective cohort study.","authors":"Reinier Petrus van Otzel, Stien Somers, Nick Narinx, Jennifer Nyamaah, Leen Antonio, Dirk Vanderschueren, Sandra Nuyts, Karel David, Brigitte Decallonne","doi":"10.1530/ETJ-26-0111","DOIUrl":"10.1530/ETJ-26-0111","url":null,"abstract":"<p><strong>Objective: </strong>Thyroid dysfunction modulates the hypothalamic-pituitary-gonadal axis in men, potentially altering sex hormone bioavailability. Prior studies relied on immunoassays for the measurement of sex steroids. We investigated the effect of primary thyroid dysfunction on testosterone (T) and estradiol (E2) in men, using high-specificity liquid chromatography-tandem mass spectrometry (LC-MS/MS).</p><p><strong>Methods: </strong>In this prospective cohort study, adult men with newly diagnosed hyperthyroidism or hypothyroidism were evaluated at diagnosis and at the first follow-up visit. Changes in serum markers of gonadal function were assessed: follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, sex hormone-binding globulin (SHBG), total and calculated free testosterone, total estradiol, and total testosterone:estradiol (T:E2) ratio.</p><p><strong>Results: </strong>Sixteen men with hyperthyroidism and eleven with hypothyroidism were included. In the hyperthyroid cohort, total T, total E2, and SHBG levels decreased during treatment (P = 0.0131, P = 0.0063, and P = 0.0003), while free T, total T:E2 ratio, FSH, LH, and prolactin remained unchanged. In the hypothyroid cohort, increased SHBG, LH, and FSH levels were observed during levothyroxine treatment (P = 0.0014, P = 0.0117, and P = 0.0039), while total and free T, total E2, and prolactin remained unchanged. In the subgroup with overt hypothyroidism, the total T:E2 ratio increased during levothyroxine treatment.</p><p><strong>Conclusion: </strong>In hyperthyroid males during treatment, short-term changes in the gonadal axis are mainly mediated by reduced SHBG, without changes in free T, gonadotropins, or T:E2 ratio. In hypothyroid males, SHBG and gonadotropins increased under levothyroxine supplementation. These findings highlight the importance of assessing SHBG when evaluating the male gonadal axis during thyroid dysfunction.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13622973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The efficacy and safety of microwave ablation in benign large thyroid nodules (≥4 cm).","authors":"Hongye Gu, Chaonan Li, Yunhao Luo, Yunjun Liu, Chao Feng, Zhe Song, Jun Luo","doi":"10.1530/ETJ-26-0013","DOIUrl":"10.1530/ETJ-26-0013","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate the safety and efficacy of ultrasound-guided single-session microwave ablation for benign thyroid nodules >4 cm by comparing outcomes with smaller nodules (<4 cm).</p><p><strong>Methods: </strong>This retrospective single-center study (2016-2023) analyzed 1,107 patients with 1,463 pathologically confirmed benign thyroid nodules stratified by maximum diameter into four groups: ≤20, 20-40, 40-60, and ≥60 mm. Standardized follow-up was performed at 1, 3, 6, 12, and 24 months post-microwave ablation and then annually. Volume reduction ratio, maximum diameter reduction ratio, recurrence rate, and complications were assessed.</p><p><strong>Results: </strong>The cohort (127 males and 980 females) had a mean age of 45.8 ± 12.7 years and a mean maximum nodule diameter of 28.9 ± 14.6 mm. Complication rates significantly increased with nodule size (2.59, 5.55, 13.36, and 16.67%, respectively; P < 0.001). Technical efficacy exceeded 90% across all groups (P > 0.05). Volume reduction ratio improved significantly over time across all groups, with statistical differences at 1, 6, 12, and ≥24 months (all P < 0.001) but not at 3 months (P = 0.085). The ≤20 mm group achieved the highest volume reduction ratio at ≥24 months (96% ± 14%).</p><p><strong>Conclusion: </strong>Ultrasound-guided single-session microwave ablation is safe and effective for large benign thyroid nodules, providing significant volume reduction with acceptable complication profiles while reducing treatment burden.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":"15 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13622974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tipping the balance: thyroid hormones as modulators of the sensitive harmony of innate immunity.","authors":"Esmée Hoen, Anne H van der Spek, Anita Boelen","doi":"10.1530/ETJ-26-0166","DOIUrl":"10.1530/ETJ-26-0166","url":null,"abstract":"<p><p>Thyroid hormones (THs) are increasingly recognized as important regulators of innate immune cell function. As innate immune cells are essential for combating infections, TH status may, therefore, be a determinant of susceptibility to developing infections. Investigations into the effects of THs on various innate immune cells, including monocytes, macrophages, dendritic cells, and neutrophils, have revealed that these cells express all TH components and that their immune functions are modulated by TH status. Experimental studies in animals have demonstrated that hypothyroidism is associated with increased mortality during infections, largely due to impaired pathogen clearance and elevated pathogen loads. While the impact of THs on infection outcomes is well investigated in animal models, their role in human susceptibility to infection remains underappreciated. This review examines the clinical evidence for altered infection risk in both hypo- and hyperthyroid states, including rare syndromes of reduced sensitivity to thyroid hormone, and combines clinical data with mechanistic studies at the cellular level. Collectively, these findings highlight the critical role of THs in host defense and underscore the need for further research into their clinical relevance in human infectious diseases.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disease burden and long-term psychosocial outcomes in children and young adults with Graves' disease.","authors":"Klara Gewert, Ruzan Udumyan, Gabriel Sjölin, Göran Wallin, Bengt Hallengren, Jan Calissendorff, Mats Holmberg, Selwan Khamisi, Helena Filipsson Nyström, Tereza Planck","doi":"10.1530/ETJ-26-0144","DOIUrl":"10.1530/ETJ-26-0144","url":null,"abstract":"<p><strong>Background: </strong>Research in paediatric Graves' disease (GD) has predominantly focused on endocrine treatment outcomes. There is limited knowledge about associations with other diseases and long-term psychosocial outcomes.</p><p><strong>Objective: </strong>We aimed to compare disease burden and psychosocial outcomes between patients with GD in childhood/young adulthood and an unexposed population cohort.</p><p><strong>Methods: </strong>This cohort study used prospectively collected data from medical records and multiple Swedish registers. Patients diagnosed with GD aged <21 years (n = 87, of whom 55 were <18 years) in 2003-2005 were included. Each patient was matched with 10 individuals without GD.</p><p><strong>Results: </strong>Over the 17-year follow-up (median: 15.5 years), patients with GD had significantly higher recorded rates of 'endocrine, nutritional, and metabolic diseases' (hazard ratio (HR): 11.7; 6.9-19.7; P < 0.001) and 'diseases of the digestive system' (HR: 7.2; 2.2-23.9; P = 0.001) compared with the matched population cohort. During the first 10 years after diagnosis, patients with GD had an increased risk of having ≥2 primary diagnoses besides GD (risk ratio (RR): 4.3; 2.4-8.0; P < 0.001), ≥3 days of hospitalization (RR: 5.5; 2.7-10.9; P < 0.001), >60 consecutive days of sick leave (RR: 2.1; 1.1-4.1; P = 0.027), and receiving disability pension (RR: 4.3; 2.2-8.3; P < 0.001). Furthermore, patients with GD were less likely to have completed more than compulsory education by the age of 30 years (RR: 0.4; 0.17-0.91; P = 0.029).</p><p><strong>Conclusion: </strong>Childhood/early adulthood GD leads to increased healthcare needs and socio-economic challenges, marked by more hospitalizations, sick leaves, disability pensions, and lower educational levels. These results highlight the often chronic nature of GD, emphasizing the need for more research to reduce long-term effects.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of patients with low-risk differentiated thyroid cancer with an excellent response to initial therapy.","authors":"Carlos Garcia-Regal, Jhonatan Quiñones-Silva, Noemi Brox-Torrecilla, Alberto Martinez-Lorca, Ignacio Ruz-Caracuel, Héctor Pian Arias, Sonsoles Aso Manso, Ana Maria Garcia Cano, Marta Rosillo, Patricia Luengo, Belén Porrero Guerrero, Maria Isabel García Gómez Muriel, Cristina Familiar Casado, María Josefa Pamplona Civera, Victoria Alcázar Lázaro, Miguel Paja, María Guadalupe Guijarro de Armas, Paloma Iglesias Bolaños, Pablo Valderrabano","doi":"10.1530/ETJ-26-0223","DOIUrl":"10.1530/ETJ-26-0223","url":null,"abstract":"<p><strong>Objective: </strong>Patients with differentiated thyroid carcinoma (DTC) classified as low risk of recurrence and an excellent response to initial treatment should have a particularly low risk of recurrence. Our objective was to assess the recurrence rate in these patients to support follow-up de-escalation.</p><p><strong>Methods: </strong>A multicenter retrospective study was conducted in six Spanish hospitals, including consecutive patients diagnosed with low-risk DTC between 2015 and 2018 with an excellent response to initial therapy.</p><p><strong>Results: </strong>A total of 379 patients were included, with a median follow-up of 6.7 years. Response to therapy at the last follow-up, according to the 2015 ATA/Momesso criteria, was excellent in 349 patients (92.1%), indeterminate in 29 (7.6%), and biochemical incomplete in 1 (0.3%). The overall incidence of indeterminate response was 11.8 events per 1,000 person-years, peaking at year 3 of follow-up and dropping to nearly zero after year 7. PTC and RAI treatment were associated with a lower probability of developing an indeterminate response (P = 0.02 and P = 0.03, respectively). When applying the 2025 ATA criteria, the excellent response rate increased to 95.8% and neither papillary histology nor RAI treatment was significantly associated (P = 0.07 and P = 0.61, respectively). During follow-up, indeterminate/suspicious findings on ultrasound were observed in 39 patients (10.3%). FNA was performed in 20 of these, none of which found recurrence.</p><p><strong>Conclusions: </strong>Recurrences in patients with low risk of recurrence and an excellent response to initial therapy are extremely infrequent. These data support follow-up de-escalation in this population.</p><p><strong>Significance statement: </strong>In this multicenter retrospective study of low-risk DTC patients with an excellent response to initial treatment, no recurrences were observed among 379 patients after a median follow-up of 6.7 years. The overall incidence rate of indeterminate response was 11.8 events per 1,000 person-years, peaking around year 3 after surgery and progressively declining thereafter, approaching zero after year 7. Using the 2025 ATA response-to-therapy criteria, 95.8% of patients maintained an excellent response at the last follow-up, and no variable was associated with the development of an indeterminate response. These findings support follow-up de-escalation.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13622975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}