Thyroid最新文献

{"title":"A Deep Learning-Based Artificial Intelligence Model Assisting Thyroid Nodule Diagnosis and Management: Pilot Results for Evaluating Thyroid Malignancy in Pediatric Cohorts.","authors":"Eun Ju Ha, Jeong Hoon Lee, Natalie Mak, Allison K Duh, Elizabeth Tong, Kristen W Yeom, Kara D Meister","doi":"10.1089/thy.2024.0627","DOIUrl":"https://doi.org/10.1089/thy.2024.0627","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Artificial intelligence (AI) models have shown promise in predicting malignant thyroid nodules in adults; however, research on deep learning (DL) for pediatric cases is limited. We evaluated the applicability of a DL-based model for assessing thyroid nodules in children. <b><i>Methods:</i></b> We retrospectively identified two pediatric cohorts (<i>n</i> = 128; mean age 15.5 ± 2.4 years; 103 girls) who had thyroid nodule ultrasonography (US) with histological confirmation at two institutions. The AI-Thyroid DL model, originally trained on adult data, was tested on pediatric nodules in three scenarios axial US images, longitudinal US images, and both. We conducted a subgroup analysis based on the two pediatric cohorts and age groups (≥14 years vs. < 14 years) and compared the model's performance with radiologist interpretations using the Thyroid Imaging Reporting and Data System (TIRADS). <b><i>Results:</i></b> Out of 156 nodules analyzed, 47 (30.1%) were malignant. AI-Thyroid demonstrated respective area under the receiver operating characteristic (AUROC), sensitivity, and specificity values of 0.913-0.929, 78.7-89.4%, and 79.8-91.7%, respectively. The AUROC values did not significantly differ across the image planes (all <i>p</i> > 0.05) and between the two pediatric cohorts (<i>p</i> = 0.804). No significant differences were observed between age groups in terms of sensitivity and specificity (all <i>p</i> > 0.05) while the AUROC values were higher for patients aged <14 years compared to those aged ≥14 years (all <i>p</i> < 0.01). AI-Thyroid yielded the highest AUROC values, followed by ACR-TIRADS and K-TIRADS (<i>p</i> = 0.016 and <i>p</i> < 0.001, respectively). <b><i>Conclusion:</i></b> AI-Thyroid demonstrated high performance in diagnosing pediatric thyroid cancer. Future research should focus on optimizing AI-Thyroid for pediatric use and exploring its role alongside tissue sampling in clinical practice.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200082","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":"Multi-Omics-Based Characterization of DNA Methylation Episignatures for Papillary Thyroid Cancer in a Chinese Population.","authors":"Xianhui Ruan, Feng Yang, Mengling Li, Qiman Dong, Weijing Hao, Wei Zhang, Xinwei Yun, Dapeng Li, Jingzhu Zhao, Xuan Qin, Zihan Rong, Taiyan Guo, Lei Wang, Yi Pan, Ming Gao, Minjie Zhang, Xiangqian Zheng","doi":"10.1089/thy.2024.0611","DOIUrl":"https://doi.org/10.1089/thy.2024.0611","url":null,"abstract":"<p><p><b><i>Background:</i></b> Thyroid cancer is the most common endocrine malignancy, with papillary thyroid cancer (PTC) accounting for ∼80% of all cases. DNA methylation alterations and gene expression changes in cancer, offer valuable insights into tumor biology and serve as potential clinical biomarkers. However, the functional implications of DNA methylation changes in PTC patients, particularly based on multiomics analysis in the Chinese population, remain insufficiently explored. This study aims to investigate the epigenetic signatures of thyroid cancer and identify the DNA methylation biomarkers for diagnosing PTC in Chinese patients. <b><i>Methods:</i></b> Thyroid cancer tissues (<i>n</i> = 40) and benign thyroid nodule tissues (<i>n</i> = 31) were collected from Chinese patients for global DNA methylation analysis. Gene expression profiles and H3K27ac modifications were also investigated to understand the impacts of epigenetic changes on gene expression. Genome-wide methylation profiling and machine learning methods were employed to differentiate PTC from control samples. <b><i>Results:</i></b> Genome-wide DNA methylation maps revealed significant methylome changes in Chinese PTC tissues. By integrating our data with The Cancer Genome Atlas thyroid cancer methylation profiles, we identified unique hypomethylation patterns associated with thyroid hormone synthesis specifically in Chinese PTC patients. RNA sequencing and H3K27ac modification analysis, along with functional assays, showed that the dysregulated genes in PTC patients are critical for the proliferation, migration, and invasion of thyroid cancer. <b><i>Conclusions:</i></b> Our study provides a comprehensive view of the multi-omics-based, function-guided DNA methylation landscape for Chinese PTC patients. We identified seven functional differentially methylated regions with high sensitivity and specificity for diagnosing thyroid cancer in Chinese patients. Additionally, <i>DHRS3</i> is highlighted as a key player in PTC pathogenesis and shows promise as a valuable biomarker for predicting patient outcomes. This research advances our understanding of DNA methylation in thyroid cancer and underscores the importance of developing population-specific diagnostic tools to improve patient outcomes. However, further validation in larger, independent cohorts is needed to confirm their diagnostic value.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181238","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":"Regional Differences in the Management of Thyroid Eye Disease: Results from an International Clinical Practice Survey of Endocrinologists.","authors":"Danilo Villagelin, David S Cooper, Henry B Burch","doi":"10.1089/thy.2024.0759","DOIUrl":"https://doi.org/10.1089/thy.2024.0759","url":null,"abstract":"<p><p><b><i>Background:</i></b> Over the past several decades, there have been indications of potential shifts in the diagnostic strategies and treatment of patients with Graves' disease (GD) and thyroid eye disease (TED). The objective of this study was to evaluate current practices in managing GD when complicated by moderate-to-severe TED worldwide. <b><i>Methods:</i></b> We recently reported results from a global online survey of endocrinologists comparing the management of GD in different scenarios. The current analysis focuses on regional differences in the diagnosis and treatment of GD when complicated by TED. <b><i>Results:</i></b> A total of 1252 respondents from 85 countries completed the survey. Regarding the initial diagnostic and treatment measures, there were no differences among the various geographical regions. Regarding the treatment of moderate-to-severe TED, the use of sodium selenite was higher in Europe (66.5%) and Oceania (60%) compared to other regions (<i>p</i> < 0.001). North American respondents were more likely to recommend teprotumumab and less likely to use glucocorticoids (<i>p</i> < 0.001). When comparing the treatment options for GD in patients with TED, although prolonged use of antithyroid drugs (ATD) remained the first choice in all regions, respondents from Europe, North America, and Oceania were more likely to recommend thyroidectomy than those from other regions (<i>p</i> < 0.001). Ophthalmologists, rather than endocrinologists, would more often be responsible for prescribing advanced medical therapy for TED in North America, Oceania, and Africa, while endocrinologists would have primary responsibility in other regions of the globe. <b><i>Conclusions:</i></b> Although there are regional differences, respondents generally employ the recommended diagnostic tools, treatments, and a multidisciplinary approach suggested by current clinical practice guidelines. However, there were examples of deviations from current guidance from professional societies.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161108","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":"Metabolic and Functional Cross Talk Between the Thyroid and Liver.","authors":"Chiaw-Ling Chng, George Boon Bee Goh, Paul Michael Yen","doi":"10.1089/thy.2025.0178","DOIUrl":"https://doi.org/10.1089/thy.2025.0178","url":null,"abstract":"<p><p><b><i>Background:</i></b> The liver and thyroid have complicated effects on each other's functions and metabolic homeostasis in the body. Both hypo- and hyperthyroidism influence hepatic carbohydrate and fat metabolism to regulate circulating glucose, cholesterol, and triglyceride levels. Hypothyroidism and \"intrahepatic\" hypothyroidism also contribute to the development of hypercholesterolemia and metabolic dysfunction-associated steatotic liver disease (MASLD). Likewise, hepatic dysfunction can modulate thyroid function by reducing thyroid hormone (TH) concentrations and their effects on peripheral tissues. <b><i>Summary:</i></b> In this review, we examine the impact of thyroid disorders and their treatment on hepatic physiology, metabolism, and pathology, as well as the influence of liver disease on thyroid function. We also describe the clinical and experimental evidence for THs playing significant roles in metabolic conditions such as metabolic syndrome, hyperlipidemia, and MASLD. Additionally, we summarize the current literature on the use of thyromimetics for the treatment of metabolic diseases. <b><i>Conclusions:</i></b> Recognizing the effects of the thyroid and THs on hepatic metabolism and fuel utilization, and the liver's role in modulating systemic TH action, is important for optimal clinical management of patients with thyroid and/or liver diseases. New emerging concepts on TH actions in the liver and the efficacy of thyromimetics for the treatment of MASLD have reshaped our understanding of the thyroid-liver relationship and the roles of THs in the pathogenesis and treatment of metabolic diseases.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151824","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":"Management of Adverse Events During Treatment for Advanced Thyroid Cancer.","authors":"Thomas J Roberts, Lori J Wirth","doi":"10.1089/thy.2024.0755","DOIUrl":"https://doi.org/10.1089/thy.2024.0755","url":null,"abstract":"<p><p><b><i>Background:</i></b> The management of advanced thyroid cancer has rapidly evolved as several multikinase, and gene-specific inhibitors have substantially improved survival for patients with most types of thyroid cancer. Optimizing management of the treatment-related adverse events (TRAEs) from these medications is important to improve quality of life and outcomes for patients with thyroid cancer. This narrative review discusses common and clinically significant TRAEs of treatments for thyroid cancer and effective management approaches. <b><i>Summary:</i></b> Published literature was reviewed to summarize available information on the incidence of TRAEs with medications used to treat thyroid cancer and management approaches for these TRAEs. There are common TRAEs across many treatments for advanced thyroid cancer including fatigue, hypertension, gastrointestinal toxicities, rashes, and hand-foot syndrome. Additionally, several other TRAEs with thyroid cancer treatments are significant because of their frequency with specific medications (e.g., pyrexia syndrome) or their severity (e.g., thromboembolic events and cardiac impairment). Data from clinical trials and real-world data along with expert guidelines and insights from experienced clinicians can guide management approaches for many of these TRAEs. <b><i>Conclusions:</i></b> The toxicity profiles are well established for treatments for advanced thyroid cancer, there are evidence-based management approaches for many commonly encountered scenarios. Following these approaches to optimizing management of TRAEs can improve the quality of life and outcomes for patients with thyroid cancer.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120611","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":"The Natural Course of Low-Risk Papillary Thyroid Microcarcinoma During Pregnancy: A Prospective Active Surveillance Study.","authors":"Wen Liu, Zhizhong Dong, Weihan Cao, Haifei Jin, Yuting Li, Ping Lei, Xuejing Yan, Ruochuan Cheng","doi":"10.1089/thy.2024.0702","DOIUrl":"https://doi.org/10.1089/thy.2024.0702","url":null,"abstract":"<p><p><b><i>Background:</i></b> Active surveillance (AS) has emerged as an established management strategy for patients with low-risk papillary thyroid microcarcinoma (PTMC). However, prior studies have suggested accelerated tumor growth during pregnancy, which raises concerns about the suitability of AS for reproductive-age patients. This study evaluates the longitudinal impact of pregnancy on tumor dynamics and validates the safety of AS management in this population. <b><i>Methods:</i></b> From February 2020 to October 2024, a single-institution prospective AS cohort enrolled 260 female patients diagnosed with low-risk PTMC. Eighteen female patients (21 pregnancy events) with complete series of ultrasound documentation underwent longitudinal analysis of changes in tumor size and growth velocity, with time-stratified comparisons before pregnancy, during pregnancy, and after delivery. Tumor doubling rate (TDR) was calculated to quantify tumor growth or shrinkage patterns across these periods. An increase in tumor size of 3 mm or more was defined as substantial enlargement. <b><i>Results:</i></b> Over a median follow-up of 59.0 (interquartile range 38.5, 72.0) months, tumor enlargement (>3 mm) was observed in 19.0% (4/21) of the PTMC cases by the last follow-up. During pregnancy, 76.2% (16/21) of tumors exhibited accelerated growth (TDR >0.5/year) or moderate growth (TDR 0.1-0.5/year), whereas postpartum stabilization (TDR -0.1 to 0.1/year) or regression (TDR <-0.1/year) occurred in 71.4% (15/21). The TDR peaked during pregnancy and decreased after delivery (0.39/year vs. -0.01/year, <i>p</i> = 0.006). Delayed surgery was required in only two patients and no instances of expanded surgical scope, T-stage progression, or tumor recurrence were observed. <b><i>Conclusion:</i></b> While pregnancy may transiently accelerate tumor growth in low-risk PTMC, most gestational changes are self-limited, with stabilization or regression commonly observed postpartum. AS remains a safe and effective strategy for reproductive-age patients, balancing oncologic safety with fertility preservation. Confirmatory studies incorporating extended follow-up and advanced imaging modalities are essential to further validate these findings and optimize clinical frameworks.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128804","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":"Reproductive Concern, Fertility Intention, and Pregnancy Outcomes in Young Women with Thyroid Cancer after Thyroid Surgery: A Prospective Cohort Study.","authors":"Fenghua Lai, Wanna Chen, Jiayuan Zhang, Wenxin Chen, Wenke Chen, Yuanyuan Zheng, Yuting Hong, Yufei He, Xuyang Li, Yu Yang, Tianyi Xu, Yingtong Hou, Xinwen Chen, Jianyan Long, Bin Li, Bo Lin, Sui Peng, Rebecca Bahn, Haixia Guan, Weiming Lv, Yihao Liu","doi":"10.1089/thy.2024.0660","DOIUrl":"https://doi.org/10.1089/thy.2024.0660","url":null,"abstract":"<p><p><b><i>Background:</i></b> Factors contributing to the development of reproductive concern, fertility intention and pregnancy outcomes in young women following thyroidectomy are unclear. This study aimed to compare the reproductive concern, fertility intentions and pregnancy outcomes between young women who had either thyroid cancer (TC) or benign thyroid disease and were treated with total thyroidectomy (TT) or thyroid lobectomy (TL). <b><i>Methods:</i></b> This prospective cohort study enrolled women aged 20-40 and scheduled for thyroid surgery at a tertiary hospital in China from November 2019 to October 2021 (ChiCTR1900027205). Reproductive concern and intention were evaluated preoperatively and at 1, 3, 6, 12, 18, and 24 months postoperatively using Reproductive Concerns After Cancer (RCAC) and Fertility Intention Scale (FIS), respectively. Pregnancy outcomes were monitored. <b><i>Results:</i></b> Of the 482 eligible women, 402 women had TC (157 [39.1%] underwent TT), and 80 had benign thyroid disease (10 [12.5%] underwent TT). Compared with the benign group, the TC group had significantly higher RCAC scores from 3 months to 2 years postoperatively (all <i>p</i> < 0.05). The TC group had significantly lower postoperative FIS scores from 3 to 12 months after surgery than the benign group (all <i>p</i> < 0.05). Women with TC in the TT group had significantly higher RCAC scores than TL group at time points from 1 months to 2 years postoperatively, and had significantly lower postoperative FIS scores from 1 to 18 months after surgery (all <i>p</i> < 0.05). During the 2-year follow-up, 78 women became pregnant and 13 (16.7%) suffered pregnancy loss. No significant differences in adverse pregnancy outcomes were found between the TC group and benign thyroid disease group, or those between the TT group and the TL group of women with TC. Women with planned pregnancy and preconception counseling had significantly lower rates of pregnancy loss than those with unplanned pregnancy and no preconception counseling (4.0% vs. 22.6% and 11.7% vs. 33.3%, both <i>p</i> < 0.05). <b><i>Conclusions:</i></b> It is important to address reproductive concern and fertility intention postoperatively in young women with TC. Preconception counseling and planned pregnancy may be associated with a reduced risk of pregnancy loss after thyroid surgery.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128727","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":"Comparison of Progression-Free Survival in Familial Non-Medullary Thyroid Cancer and Sporadic Differentiated Thyroid Cancer Patients.","authors":"Elias Chuki, Noha Behairy, Sungyoung Auh, Andrew Makarewicz, Chandra Nayan Uttarkar Vikram, Sonam Kumari, Padmasree Veeraraghavan, Craig Cochran, Sriram Gubbi, Joanna Klubo-Gwiezdzinska","doi":"10.1089/thy.2024.0588","DOIUrl":"https://doi.org/10.1089/thy.2024.0588","url":null,"abstract":"<p><p><b><i>Background:</i></b> Familial non-medullary thyroid carcinoma (FNMTC) accounts for approximately 9% of differentiated thyroid cancer (DTC). There is conflicting data on the FNMTC aggressiveness compared with sporadic DTC (sDTC), leading to usually more extensive therapy applied for FNMTC, given its autosomal dominant genetic background. This study aimed to compare the progression-free survival (PFS) in patients with FNMTC and sDTC treated with standard therapy. <b><i>Methods:</i></b> This longitudinal retrospective cohort study included patients with FNMTC, defined as at least two first-degree relatives affected by DTC. FNMTC patients were matched with sDTC in a 1:3 ratio based on age, sex, American Thyroid Association recurrence risk stratification (ATA-R), extent of initial surgery, and diagnosis date. The primary outcome was PFS. Kaplan-Meier curves were used to compare PFS between the groups, and the Cox proportional hazards model was used to assess confounders. <b><i>Results:</i></b> From 95 affected FNMTC patients, 30 were excluded due to lack of follow-up data. The study population consisted of 65 FNMTC and 170 sDTC patients, with a median follow-up of 4.73 (2.87-10.27) years for FNMTC and 5.83 (2.33-10.79) years for sDTC (<i>p</i> = 0.76). There was 100% matching for ATA-R, sex, surgery type, and year of surgery and a satisfactory matching for age (43.12 ± 15.11 vs. 42.76 ± 12.46 years, <i>p</i> = 0.85). FNMTC exhibited a smaller tumor size (1.20 ± 0.96 vs. 1.89 ± 1.51 cm, <i>p</i> < 0.01) and fewer positive lymph nodes (range 0-13 vs. 0-38, <i>p</i> = 0.009) at presentation. The rate of repeated neck surgeries for persistent/recurrent disease was comparable between the groups: 13.8% (9/65) for FNMTC vs. 17.7% (30/170) for sDTC (<i>p</i> = 0.48). There was no difference in radioactive iodine (RAI) therapy dosage between the groups (104 [100-149] vs. 106 [76-160] mCi<i>, p =</i> 0.82). During follow-up, 15.4% of FNMTC and 18.2% of sDTC patients experienced disease progression (<i>p</i> = 0.61). PFS was non-different between groups (<i>p</i> = 0.56) and was associated with ATA-R (high vs. low hazard ratio [HR]: 9.2, confidence interval [CI]: 2.67-31.85, <i>p</i> < 0.001) and sex (male vs. female, HR: 2.5, CI: 1.11-5.6, <i>p</i> = 0.026). <b><i>Conclusions:</i></b> No difference in PFS between FNMTC and sDTC patients suggests comparable responsiveness to standard therapy. Therefore, the management of FNMTC should align with the standard of care for DTC to avoid overtreatment of FNMTC.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111974","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":"Considerations in the Diagnosis and Management of Thyroid Dysfunction in Older Adults.","authors":"Sina Jasim, Maria Papaleontiou","doi":"10.1089/thy.2025.0128","DOIUrl":"https://doi.org/10.1089/thy.2025.0128","url":null,"abstract":"<p><p><b><i>Background:</i></b> Thyroid dysfunction is common in older adults and poses diagnostic and management challenges for clinicians. In this narrative review, we present published data focusing on special considerations in the diagnosis and management of hypothyroidism and hyperthyroidism in older adults. <b><i>Methods:</i></b> A comprehensive literature search of the PubMed and Ovid MEDLINE databases was conducted from January 2000 to December 2024 to identify pertinent articles in English for this narrative review. <b><i>Results:</i></b> Due to significant cardiovascular risk if untreated, both overt hypothyroidism and hyperthyroidism should be treated in older adults. Findings from observational studies do not support treating older adults with subclinical hypothyroidism with a thyrotropin (TSH) <7 mIU/L. However, observational data have demonstrated an increased risk of cardiovascular mortality and stroke in older adults with subclinical hypothyroidism with TSH 7.0-9.9 mIU/L and of coronary heart disease, cardiovascular mortality, and heart failure in those with TSH ≥10 mIU/L, suggesting levothyroxine treatment in these individuals should be considered. Data from clinical trials failed to show improvement with levothyroxine in hypothyroidism symptoms or fatigue in older adults with subclinical hypothyroidism compared with placebo. Over- and under-replacement with thyroid hormone is common and should be avoided, as population-based studies have shown associations with adverse cardiovascular and skeletal events. Subclinical hyperthyroidism with a TSH <0.1 mIU/L should be treated in older individuals as it has been associated with increased cardiovascular risk and bone density loss based on observational data. Randomized controlled trials have shown that long-term low-dose methimazole is a viable alternative to radioactive iodine in older adults with hyperthyroidism. <b><i>Conclusions:</i></b> A personalized approach should be undertaken in the diagnosis and management of thyroid dysfunction in older adults. Multiple factors should be considered, including physiological age-related changes in thyroid function, comorbidities, and polypharmacy. Care should be taken to maintain euthyroidism in order to avoid adverse events.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079737","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":"First Report of SPECC1L::ALK Fusion in Medullary Thyroid Carcinoma with Remarkable Response to Alectinib.","authors":"Hervé Bischoff, Antonin Fattori, Fabien Moinard-Butot, Olivier Schneegans, Pablo Diaz, Damien Reita, Valérie Rimelen, Anne-Claire Voegeli, Laura Bender","doi":"10.1089/thy.2025.0017","DOIUrl":"https://doi.org/10.1089/thy.2025.0017","url":null,"abstract":"<p><p><b><i>Background:</i></b> Rearrangements of the <i>ALK</i> gene are rare in medullary thyroid carcinoma (MTC), with limited data on the efficacy of ALK inhibitors in this context. Novel fusions, such as SPECC1L::ALK, have not been extensively studied. <b><i>Methods:</i></b> We present a case of a 33-year-old woman with metastatic MTC, in whom molecular profiling using next-generation sequencing (Archer FusionPlex®) identified a SPECC1L::ALK gene fusion. Treatment with the ALK inhibitor alectinib was initiated at 600 mg twice daily. <b><i>Results:</i></b> The patient demonstrated a dramatic partial to near-complete response after 6 days of treatment, as shown by positron emission tomography-computed tomography. At 6 weeks, a complete response was confirmed. Treatment was generally well tolerated, aside from grade 3 myalgia with elevated creatine phosphokinase, managed with temporary cessation and dose adjustment. As of the latest follow-up (8 months), the patient remains on alectinib with sustained complete response. <b><i>Conclusions:</i></b> This is the first report of a SPECC1L::ALK fusion in MTC. The dramatic response to alectinib highlights the importance of molecular profiling and suggests that ALK inhibitors may benefit patients with rare <i>ALK</i> fusions in thyroid cancers.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079810","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}