Thyroid最新文献

{"title":"Subclinical Hyperthyroidism, Cardiovascular Disease and All-Cause Mortality: Insights from a Large Dutch Primary Care Cohort Study.","authors":"Stan R Ursem, Raymond Noordam, Jesse M van den Berg, Anita Boelen, Petra Jm Elders, Wendy Pj den Elzen, Annemieke C Heijboer","doi":"10.1177/10507256261449444","DOIUrl":"https://doi.org/10.1177/10507256261449444","url":null,"abstract":"<p><strong>Background: </strong>Subclinical hyperthyroidism (SHT) has been associated with adverse cardiovascular outcomes, but the magnitude and consistency of these risks, particularly across demographic subgroups, remain unclear.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using general practitioner (GP) data from the PHARMO Data Network in the Netherlands (2012-2021). Patients with biochemically confirmed SHT (suppressed thyrotropin [TSH] with normal fT4; <i>n</i> = 11,163) were compared with a matched euthyroid reference group (<i>n</i> = 46,058) based on age, sex, and GP practice. Incidence of atherosclerotic complications, atrial fibrillation (AF), heart failure (HF), and all-cause mortality were assessed. Multivariable-adjusted Cox regression models estimated hazard ratios (HRs), adjusting for relevant confounders. Due to data limitations, information on smoking and alcohol use was not available, and medical history concerning comorbid conditions could only be assessed for the one-year period prior to cohort entry.</p><p><strong>Results: </strong>SHT was associated with a significantly increased risk of AF (HR: 1.37, 95% CI: 1.22-1.55), particularly in those with TSH < 0.1 mU/L (HR: 1.60, 1.32-1.94) and in individuals aged 30-49 years (HR 1.88, 1.05-3.36). HF risk was modestly elevated overall (HR: 1.21, 1.04-1.40), with stronger effects in individuals aged 30-49 years (HR: 3.74, 1.52-9.24) and women (HR: 1.31, 1.10-1.56). All-cause mortality was higher in the SHT group (HR: 1.51, 1.38-1.64), especially in men (HR: 1.75, 1.50-2.05) and individuals aged 30-49 years (HR: 2.95, 1.73-5.04). The association with atherosclerotic complications was weak-to-modest (HR: 1.12, 1.00-1.24).</p><p><strong>Conclusions: </strong>SHT is linked to increased risks of AF, HF, and all-cause mortality, with higher relative risks in younger patients. These findings challenge the traditional focus on older populations and underscore the need for individualized risk assessment in SHT.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261449444"},"PeriodicalIF":6.7,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Stratification Tools for Thyroid Cancer: A Systematic Review of Models Combining Ultrasound, Cytology, and Clinical Risk Factors.","authors":"Emma Watts, Zakariya Sattar, Kristien Boelaert, Neil Sharma","doi":"10.1177/10507256261448300","DOIUrl":"https://doi.org/10.1177/10507256261448300","url":null,"abstract":"<p><strong>Background: </strong>The rising incidence of thyroid cancer presents a growing diagnostic and therapeutic challenge. Various risk stratification systems have sought to integrate clinical, ultrasonographic, and, in some cases, cytological features to aid malignancy prognostication. This systematic review aims to critically evaluate risk stratification tools (RSTs) for patients with thyroid nodules, which incorporate multimodal inputs to assess their diagnostic performance and clinical utility in supporting surgical decision-making.</p><p><strong>Methods: </strong>PubMed, Embase, and Cochrane databases were searched from inception to 04/13/2026, identifying studies evaluating multivariable risk prediction models for adult patients undergoing assessment of thyroid nodules. Studies were excluded if the proposed tool failed to incorporate clinical features, ultrasound findings, and cytology results or was not validated with histology. Data extraction encompassed methodology of model development, performance metrics, and approaches to validation. Risk of bias was assessed using the PROBAST+AI tool.</p><p><strong>Results: </strong>Seven studies describing five distinct RSTs met inclusion criteria Thyroid Nodule App (TNAPP), the McGill Thyroid Nodule Score (MTNS), CUT Score, Memorial Sloan Kettering Cancer Centre (MSKCC) nomogram, and Thyroid Prediction Score (TiPS). TiPS demonstrated the highest sensitivity (96.2%) and specificity (97.5%) with area under the curve (AUC) >0.9. The CUT score also showed strong performance (AUC >0.9), particularly in low-to-intermediate risk nodules. TNAPP underperformed (accuracy 50.5%; specificity 27.5%) despite broad clinical inputs. The MTNS and MSKCC, although promising for indeterminate cytology, lacked robust validation. Most models were derived from single-center, retrospective cohorts, limiting generalizability.</p><p><strong>Conclusions: </strong>RSTs integrating multimodal data may improve thyroid nodule risk stratification, particularly in cases of indeterminate cytology. However, methodological limitations and lack of external validation currently restrict clinical utility. Prospective evaluation in diverse populations is required to identify the most effective and generalizable tools. Until then, RSTs should be used as adjuncts to, not replacements for, clinical judgment and shared decision-making in thyroid nodule assessment.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261448300"},"PeriodicalIF":6.7,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Thyroid Hormone Boost Energy and Plasticity in the Brain as a Mechanism of Action in Antidepressant Augmentation Therapy?","authors":"Roger McIntyre, Sanjay J Mathew, Thomas S Scanlan","doi":"10.1177/10507256261448290","DOIUrl":"https://doi.org/10.1177/10507256261448290","url":null,"abstract":"<p><strong>Background: </strong>Depression is a large and expanding worldwide unmet clinical need that has proven difficult to treat. Thyroid hormone has been used clinically for decades as an augmentation therapy to first-line antidepressants, although the mechanism of action (MOA) behind the beneficial effect of thyroid hormone augmentation is not clear. Here we present a narrative review of the literature to provide an understanding of the known pathophysiology that occurs in depression and the different actions that thyroid hormone promotes in the brain to develop new insight into the mechanism behind the antidepressant activity of thyroid hormone.</p><p><strong>Summary: </strong>We believe this review of published literature illustrates the complex picture of depression pathophysiology and provides new insight into the MOA of thyroid hormones used as augmentation therapy to antidepressants. Impaired monoaminergic neurotransmission is an established pathophysiological hallmark of depression. However, there are other pathways that are impacted, including inflammatory and endocrine responses. Brain bioenergetics is affected, with depressed patients having lower brain ATP levels than healthy subjects. In addition, and perhaps related, depression patients display a loss in brain volume, particularly in the mood control regions of the brain. This is brought about by a dampening in neuroplasticity, the process by which new dendrites and synapses are formed. Here the connection to thyroid hormone augmentation becomes intriguing because thyroid hormone is known to play a role in stimulating neuroplasticity. At the target gene level, brain-derived neurotrophic factor, an initiator and biomarker of neuroplastic changes, is positively regulated by thyroid hormone, as are some of the immediate-early genes implicated in driving neuroplasticity. Thyroid hormone induces neuroplasticity and brain remodeling in a mouse model of behavior associated with increased decision-making and exploration, as well as mouse models of traumatic brain injury and stroke.</p><p><strong>Conclusions: </strong>We propose that thyroid hormone augmentation of antidepressant therapy works by stimulating the processes of neuroplasticity in the regions of the brain that are affected by depression, restoring synaptic connections lost from depression. Since neuroplasticity is an energy-demanding process, the cellular increase in brain bioenergetics stimulated by thyroid hormone action likely drives the initiation and maintenance of plasticity.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261448290"},"PeriodicalIF":6.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empirical Thyrotropin-Free Thyroxine Relationship Across the Thyrotropin Spectrum and Implications for Reference Intervals.","authors":"Toshihiko Kasahara","doi":"10.1177/10507256261445291","DOIUrl":"https://doi.org/10.1177/10507256261445291","url":null,"abstract":"<p><strong>Background: </strong>The relationship between thyrotropin (TSH) and free thyroxine (FT4) is commonly assumed to be log-linear. However, this assumption may oversimplify hypothalamic-pituitary-thyroid axis regulation. Characterizing the empirical structure of this relationship could inform the interpretation of thyroid function tests and the validity of current TSH reference intervals. Segmented regression was used to examine the TSH-FT4 relationship to determine whether statistically derived TSH breakpoints corresponded to the current reference limits.</p><p><strong>Methods: </strong>This study retrospectively analyzed 782 paired TSH-FT4 measurements obtained from untreated outpatients (median age, 43 years; interquartile range, 33-54 years) between July 2021 and March 2024. Patients positive for TSH receptor antibodies were excluded. Measurements obtained during treatment with levothyroxine, liothyronine, or antithyroid drugs, as well as those obtained during pregnancy, were also excluded. Segmented regression was used to model FT4 as a function of log-transformed TSH and identify the optimal breakpoints.</p><p><strong>Results: </strong>Model comparison using the Akaike Information Criterion indicated that the two-breakpoint model provided the best fit. Breakpoints occurred at TSH values of 0.22 and 4.25 mIU/L, partitioning the relationship into three segments with distinct slopes. The lower breakpoint closely matched the assay-specific lower reference limit (0.27 mIU/L) but lay below the harmonized lower reference limits in Japan and the United States, whereas the upper breakpoint was close to both the assay-specific upper limit (4.20 mIU/L) and the corresponding harmonized upper limits (4.23 and 4.27 mIU/L, respectively). FT4 changed little across TSH values of 0.22-4.25 mIU/L, consistent with an approximate homeostatic plateau.</p><p><strong>Conclusions: </strong>The TSH-FT4 relationship over the entire functional TSH range is segmented rather than uniformly log-linear, and the interval over which FT4 changes little may represent physiological homeostasis. Population-based TSH reference intervals showed partial concordance with the empirically derived homeostatic range, particularly at the upper end, whereas the lower boundary was less closely aligned. Empirically derived breakpoints and population-based reference intervals may therefore offer complementary perspectives for interpreting borderline biochemical abnormalities.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261445291"},"PeriodicalIF":6.7,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Yield of Thyroid Incidentaloma Evaluation and the Impact of Guideline Variability: Insights from a Retrospective Cohort Study.","authors":"Jeresa I A Willems, Daan J L van Twist, Kristy M Pickwell, Patrick L H van Battum, Rutgert Bianchi, Thijs Sluiter, Marco Medici, Robin P Peeters, Roderick F A Tummers-de Lind van Wijngaarden","doi":"10.1177/10507256261440405","DOIUrl":"https://doi.org/10.1177/10507256261440405","url":null,"abstract":"<p><strong>Introduction: </strong>Thyroid incidentalomas are lesions detected incidentally on imaging performed for unrelated indications. Determining which lesions warrant further evaluation to exclude malignancy introduces a dilemma: intensive diagnostic strategies maximize malignancy detection but increase diagnostic workload, patient burden, and overdiagnosis of indolent cancers, whereas restrictive approaches reduce these harms but risk missing malignancies. Guidelines balance these opposing considerations differently, resulting in substantial variation in recommendations for evaluating conventional imaging-detected thyroid incidentalomas (ultrasound, computed tomography, magnetic resonance imaging). In this study, we aimed to investigate the diagnostic yield of thyroid incidentaloma evaluation and the impact of guideline variability on malignancy detection and diagnostic workload.</p><p><strong>Methods: </strong>We retrospectively assessed all patients referred to Zuyd Thyroid Center (2018-2023) for thyroid nodule evaluation. Data on diagnostic outcomes, treatments, and complications were collected. A guideline-based simulation analysis examined how applying the European Thyroid Association (ETA; most intensive), the American Thyroid Association (ATA), and the Dutch Federation of Medical Specialists (most restrictive) guidelines would affect malignancy detection and diagnostic workload.</p><p><strong>Results: </strong>Of 1825 referred patients, 630 (34.5%) had one or more incidentalomas (median age 66 years [interquartile range 54-74]; 70.6% female). Malignancy rate was significantly higher for nuclear imaging-detected incidentalomas than for conventional imaging (21.1% vs. 1.8%, <i>p</i> < 0.001). In the guideline-based simulation analysis, ETA recommended evaluating all cases, while ATA (without clinical warning signs) evaluated 85.3%, both identifying all malignancies. The Dutch guideline avoided evaluation in 96.9% of patients, missing 7 malignancies among 528 unevaluated cases (1.3%), all subtypes with good prognosis even if left undetected.</p><p><strong>Conclusions: </strong>Conventional imaging-detected incidentalomas carry a low malignancy risk, resulting in a high diagnostic workload to detect few malignancies. More restrictive evaluation criteria can substantially reduce diagnostic burden but may miss a small number of low-risk malignancies. These findings highlight the need for improved selection criteria that minimize unnecessary procedures while ensuring detection of clinically relevant malignancies.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261440405"},"PeriodicalIF":6.7,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Menopause-Related Health Outcomes in Women with Differentiated Thyroid Carcinoma Receiving Long-Term TSH Suppression after Total Thyroidectomy.","authors":"Burcu Candemir, Safak Akın, Mustafa Candemir, Nese Ersoz Gulcelik","doi":"10.1177/10507256261442839","DOIUrl":"https://doi.org/10.1177/10507256261442839","url":null,"abstract":"<p><strong>Background: </strong>There is uncertainty regarding whether thyroid-stimulating hormone (TSH) suppression therapy in postmenopausal women with differentiated thyroid cancer (DTC) is associated with menopause-specific health concerns. This study aimed to determine whether prolonged TSH suppression confers an additional burden on postmenopausal health by comprehensively evaluating cardiovascular health (CVH), quality of life (QoL), muscle mass, and bone health using menopause-specific assessment tools.</p><p><strong>Methods: </strong>A cross-sectional study was conducted involving three groups of postmenopausal women 107 patients with DTC receiving TSH suppression therapy following total thyroidectomy for ≥3 years, 80 women receiving levothyroxine (LT4) replacement for primary hypothyroidism, and 97 euthyroid controls. Women with cognitive impairment, a history of osteoporosis, or cardiovascular disease were excluded. CVH was assessed using Life's Essential 8 (LE8) score, carotid intima-media thickness (cIMT), and electrocardiography. QoL was assessed using the Utian QoL (UQoL) Scale, cognition by the Mini-Mental State Examination, body composition by bioelectrical impedance analysis, and bone density by dual-energy X-ray absorptiometry.</p><p><strong>Results: </strong>Women with DTC demonstrated significantly lower LE8 scores, lower UQoL scores, higher cIMT values, higher prevalence of osteoporosis, and reduced muscle mass than those in the other two groups (<i>p</i> < 0.001, <i>p</i> < 0.001, <i>p</i> < 0.001, <i>p</i> = 0.003, and <i>p</i> = 0.017, respectively). Multivariable regression analysis revealed that cumulative LT4 dose was independently associated with lower LE8 and UQoL scores (β = -0.354, <i>p</i> < 0.001; and β = -0.396, <i>p</i> < 0.001, respectively), while higher serum TSH levels were positively associated with both LE8 and UQoL scores (β = 0.271, <i>p</i> = 0.002; and β = 0.487, <i>p</i> < 0.001, respectively).</p><p><strong>Conclusions: </strong>Prolonged TSH suppression may adversely affect postmenopausal health, particularly in low-risk, disease-free women with DTC. The primary clinical implication of these findings is the need to avoid unnecessary long-term TSH suppression. Menopause-specific assessment tools may have a complementary role in selected patients in whom TSH suppression remains clinically indicated.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261442839"},"PeriodicalIF":6.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Predictors of Poor Emotional Functioning in Patients with Differentiated Thyroid Carcinoma.","authors":"Gerasimos P Sykiotis, Athina Mageiropoulou, Akram Al-Ibraheem, Monica Pinto, Ioannis Iakovou, Arild Andre Østhus, Eva Gamper, Eva Hammerlid, Laura Deborah Locati, Ricardo Ribeiro Gama, Giuseppe Fanetti, Naomi Kiyota, Juan Ignacio Arraras, Johanna Inhestern, Georgios Ioannidis, Rita Canotilho, Olga Husson, Guy Andry, Harald Rimmele, Matthias Buettner, Katherine J Taylor, Susanne Singer","doi":"10.1177/10507256261442504","DOIUrl":"https://doi.org/10.1177/10507256261442504","url":null,"abstract":"<p><strong>Background: </strong>The health-related quality of life (HRQoL) of patients with differentiated thyroid carcinoma (DTC), especially their mental health, can be compromised by various factors beyond disease prognosis and treatment stage. However, predictors of poor emotional functioning (EF) in DTC patients have not been thoroughly studied. To inform targeted interventions that could improve or preserve HRQoL in patients with DTC, this study aimed to identify predictors of impaired EF, and particularly modifiable factors.</p><p><strong>Methods: </strong>Data analyzed were from the phase IV international validation study of the European Organization for Research and Treatment of Cancer thyroid cancer-specific HRQoL questionnaire (QLQ-THY34). Patients (<i>n</i> = 196) were assessed at three timepoints before treatment (t1), 6 weeks after the start of treatment (t2), and 6 months after t2 (t3). Multilevel, multivariable logistic regression models were used to assess the likelihood of impaired EF at t3 according to predefined potential predictors at t1 and t2.</p><p><strong>Results: </strong>Impaired EF at t1 or t2 predicted impaired EF at t3. Exhaustion, head and neck discomfort and body image issues were significantly associated with poor EF at t3. More specifically, temporal changes of these three variables from t1 to t2 were independent predictors of poor EF at t3 with an odds ratio of 1.04 (<i>p</i> < 0.001), 1.01 (<i>p</i> = 0.04), and 1.01 (<i>p</i> = 0.001) per score point, respectively. There was no evidence that worry about important others, lacking social support, sex, stage, or Karnofsky performance score are associated with EF at t3.</p><p><strong>Conclusions: </strong>Exhaustion, head and neck discomfort, and body image concerns emerged as modifiable factors that predict future impaired EF in patients with DTC undergoing treatment. These factors could be targeted in prehabilitation, rehabilitation or other interventional programs to potentially improve or preserve patients' EF.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261442504"},"PeriodicalIF":6.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Efficacy and Safety of Lenvatinib and Sorafenib in Thyroid Cancer: A Retrospective, Propensity-Score-Matched Study.","authors":"Max Kappenstein, Viktoria Florentine Koehler, Nadia Ninosu, Christine Koch, Michael Christoph Kreissl, Jörg Bojunga, Daniel Groener, Nikolas von Bubnoff","doi":"10.1177/10507256261442836","DOIUrl":"https://doi.org/10.1177/10507256261442836","url":null,"abstract":"<p><strong>Background: </strong>Lenvatinib and sorafenib are multitargeted tyrosine kinase inhibitors (mTKIs) approved for the treatment of radioiodine-refractory thyroid cancer (TC). In the absence of direct comparative clinical trials, we leveraged real-world TriNetX data to compare their effectiveness and tolerability in progressive TC. TriNetX is a federated international electronic medical record research network that aggregates anonymized data from multiple health care organizations.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients with TC initiating lenvatinib or sorafenib. Patients with other malignancies treated with these agents or exposure to the alternative mTKI were excluded. Propensity score matching was performed to balance demographic characteristics, tumor burden, and comorbidities. The primary outcome was overall survival (OS) at 1 and 3 years. Secondary outcomes included all-cause hospitalization, emergency care utilization, and selected treatment-emergent adverse events. Exploratory subgroup analyses were performed across demographic, disease-related, and comorbidity strata.</p><p><strong>Results: </strong>With matched cohorts of 214 patients in each arm, lenvatinib was associated with significantly improved OS compared with sorafenib at both 1 year (78.5% vs. 64.5%; hazard ratio [HR] with confidence interval [CI] 0.538 [0.373-0.775]) and 3 years ([62.1% vs. 45.8%; HR with CI 0.590 [0.444-0.784]). All-cause hospitalization and emergency care admission rates were comparable. Hematological adverse events occurred more frequently with sorafenib, while renal and cardiovascular events trended higher with lenvatinib. Survival benefits with lenvatinib were consistent across subgroups and appeared especially pronounced in patients with high tumor burden.</p><p><strong>Conclusions: </strong>Lenvatinib was associated with improved OS compared with sorafenib in patients with TC, with broadly comparable safety profiles. These findings, based on retrospective real-world data, support the use of lenvatinib as a preferred first-line mTKI in line with current treatment paradigms.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261442836"},"PeriodicalIF":6.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary Evidence of Microplastics in the Human Thyroid and Their Potential Association with Autoimmune Thyroiditis.","authors":"Shi-Tong Yu, Jinrong Fu, Zihao Fan, Qiting Ye, Shili Zhang, Haixia Guan","doi":"10.1177/10507256261442506","DOIUrl":"https://doi.org/10.1177/10507256261442506","url":null,"abstract":"<p><strong>Background: </strong>Microplastics (MPs) have been identified in multiple human tissues and are increasingly implicated in systemic health risks. Their presence in the thyroid gland, however, remains unexamined. Autoimmune thyroiditis (AIT) is the most frequent autoimmune thyroid disorder and the leading cause of hypothyroidism. This study aims to detect the presence of MPs in the thyroid and their potential relevance to AIT.</p><p><strong>Methods: </strong>In this case-control study, thyroid tissues were obtained from 29 patients with histologically confirmed AIT and 29 age- and sex-matched non-AIT controls who underwent thyroidectomy due to thyroid nodules. MP burden was quantified by pyrolysis-gas chromatography-mass spectrometry (Py-GC/MS). Particle-level polymer identity and particle characteristics, including size, shape, and color, were assessed using micro-Raman spectroscopy, whereas scanning electron microscopy (SEM) was employed for morphological observation.</p><p><strong>Results: </strong>MPs were detected in thyroid tissues from both groups. Py-GC/MS revealed significantly higher total MP concentrations in the AIT group compared to controls (median: 19.9 vs. 1.9 μg/g; p=0.012). This elevation was primarily driven by polyvinyl chloride (PVC), which was significantly higher in AIT patients. Micro-Raman spectroscopy identified particles ranging from 33.9 to 1467 µm. The AIT group contained significantly increased MPs abundance compared with the non-AIT control group (172 vs. 50.2 items/g, p=0.037). Morphological profiling revealed no significant differences in the size, shape and color of MPs between groups.</p><p><strong>Conclusion: </strong>An increased MPs burden with the particular enrichment of PVC was observed in patients with AIT, suggesting a potential association between environmental MPs exposure and thyroid autoimmunity. Further mechanistic and epidemiological studies to clarify the impacts of chronic MPs exposure are needed.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261442506"},"PeriodicalIF":6.7,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Temporal Analysis of Surgical Management and Outcomes Following ATA Guideline Updates in Papillary Thyroid Carcinoma: A Real-World Cohort Study of 31,861 Patients in South Korea.","authors":"Jae Sang Ryu, Eun Jin Kim, In A Lee, Dong Wook Kim, Ji An Lee, Dong Hyun Seo, Ji Ahn Park, Sunmi Park, Sungkeun Kang, Sang Wook Kang, Jong Ju Jeong, Kee Hyun Nam, Woong Youn Chung, Young Suk Jo, Jandee Lee","doi":"10.1177/10507256261442841","DOIUrl":"https://doi.org/10.1177/10507256261442841","url":null,"abstract":"<p><strong>Background: </strong>The American Thyroid Association (ATA) guideline revisions in 2009 and 2015 encouraged a shift toward less extensive surgery and reduced use of radioactive iodine (RAI) in the management of patients with low-risk papillary thyroid carcinoma (PTC). The aim of this study was to evaluate the real-world impact of these guideline changes on treatment patterns, complications, and oncologic outcomes.</p><p><strong>Methods: </strong>In this retrospective cohort study conducted at a high-volume tertiary center in South Korea, we analyzed 31,861 patients treated for PTCs measuring ≤4 cm during 2004-2020. Patients were stratified into three temporal cohorts (triad 0 2004-2009; triad 1: 2010-2015; and triad 2: 2016-2020), and exact matching was performed to balance clinicopathologic characteristics across the groups. Segmented regression analysis was used to identify treatment pattern shifts. Postoperative complications and disease-free survival (DFS) were compared across the matched cohorts by using conditional logistic and stratified Cox regression analyses. Five-year restricted mean survival time (RMST) analysis was performed to adjust for follow-up variation.</p><p><strong>Results: </strong>After guideline implementation, total thyroidectomies and RAI use significantly declined. Permanent hypocalcemia decreased from 2.7% to 0.2% (<i>p</i> < 0.001) while transient complications remained stable. Although recurrence rates were lowest in the most recent era (1.3%), DFS analysis revealed higher hazard ratios for recurrence in triad 2 versus earlier cohorts (triad 2 vs. 0 hazard ratio: 1.520, confidence interval: 1.160-1.980). However, 5-year DFS and RMST comparisons revealed no significant differences.</p><p><strong>Conclusions: </strong>ATA guideline-driven de-escalation strategies were successfully implemented in real-world practice in this study, reducing overtreatment and surgical morbidity without compromising short-term oncologic outcomes.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261442841"},"PeriodicalIF":6.7,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}