Thyroid最新文献

{"title":"Development of a Nomogram to Integrate Molecular Testing and Clinical Variables to Improve Malignancy Risk Assessment Among Cytologically Indeterminate Thyroid Nodules.","authors":"Jiahui Wu, Paul Stewardson, Markus Eszlinger, Moosa Khalil, Sana Ghaznavi, Erik Nohr, Adrian Box, Ralf Paschke","doi":"10.1089/thy.2024.0481","DOIUrl":"https://doi.org/10.1089/thy.2024.0481","url":null,"abstract":"<p><p><b><i>Background:</i></b> The introduction of molecular testing (MT) of cytologically indeterminate thyroid nodules (ITNs) alone has not impacted thyroidectomy rates. Due to this, we evaluated the incremental diagnostic value of various clinical variables in addition to MT results, in predicting the risk of malignancy (ROM) among ITNs. <b><i>Methods:</i></b> This prospective observational study included 1024 consecutive ITNs that underwent reflexive ThyroSPEC MT between Jul 30, 2020, and Oct 30, 2023. A multivariable logistic regression model was built to assess the relationship between histology outcomes and clinical variables, including nodule discovery by palpation, ultrasound risk categories, maximum nodule size, Bethesda category, Bethesda atypia, and ThyroSPEC categories. A total of 332 out of 1024 patients who underwent surgery and had complete data for all variables were included in the model. A nomogram was subsequently developed based on the model. <b><i>Results:</i></b> The model achieved a cross-validated AUC of 0.831 (95% confidence intervals: 0.787-0.874). Patients with high-risk mutations or malignant molecular markers exhibited significantly higher odds (152.79 times) of malignancy compared to those with mutation-negative or benign molecular marker results. Patients with maximum nodule size >5 cm have 4.34 times higher odds of malignancy than those 0-2 cm. The presence of nuclear atypia increased the odds of malignancy by 4.26 times, while ultrasound malignancy risk category 5 increased the odds of malignancy by 2.89 times compared to categories 1-3. Positive palpation discovery increased the odds by 1.83 times. The integrated ROM estimated from the regression model is significantly associated with the surgery type (<i>p</i> < 0.001). In the low (0-30%) and intermediate ROM (31-70%) categories, lobectomy alone is the most common surgery (61% and 70%, respectively), while in the high ROM (>70%) category, total thyroidectomy dominates (62%). <b><i>Conclusions:</i></b> Although MT alone played an important role in decision-making regarding surveillance versus surgery in our study population, integrating MT results with additional clinical variables improved the malignancy risk prediction for ITNs. Our results highlight the importance of contextualizing MT results within an integrated interdisciplinary thyroid nodule diagnostic pathway.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557359","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":"Radiofrequency Ablation for Solitary Autonomously Functioning Thyroid Nodules: Multicenter Study from Latin America.","authors":"Juan Pablo Dueñas, Nathalia Buitrago-Gómez, Antonio Rahal, Jose Higinio Steck, Cristhian García, Rafael De Cicco, Leonardo G Rangel, Ana Voogd, Lorena Savluk, Erivelto Martinho Volpi","doi":"10.1089/thy.2024.0338","DOIUrl":"10.1089/thy.2024.0338","url":null,"abstract":"<p><p><b><i>Background:</i></b> Autonomously functioning thyroid nodules (AFTNs) represent ∼5% of all thyroid nodules and often necessitate definitive treatments such as surgery or radioiodine (¹³¹I), both of which have inherent risks. Radiofrequency ablation (RFA) has emerged as an effective and safe therapeutic option for managing AFTNs. This study aims to assess the effectiveness and safety of RFA for solitary AFTNs in various countries across Latin America. <b><i>Methods:</i></b> This retrospective, observational, multicenter cohort study included patients with a solitary AFTN that was histologically confirmed as benign and treated with a single session of RFA. The study included an analysis of patient demographics, sonographic characteristics of the nodules, thyroid profile assessment at each follow-up visit, evaluation of clinical symptoms to determine the achievement of a euthyroid state, and the measurement of nodule volume reduction. In addition, a bivariate analysis was conducted to identify associations between these variables and the resolution of hyperthyroidism. <b><i>Results:</i></b> Our study enrolled 81 patients with a solitary, benign AFTN. The volume reduction ratio (VRR) consistently increased over the follow-up period, with medians of -50%, -74.9%, -78.4%, and -90.2% at 1, 3, 6, and 12 months, respectively. The rate of resolution of hyperthyroidism was 93.8% (76/81). Following the RFA procedure, 58.02% of patients (47/81) normalized their thyrotropin levels within 1 month of follow-up, and by 3 months, an additional 33.3% had achieved normalization (27/81). Notably, a baseline volume ≥10, 20, or 30 mL did not affect the achievement of clinical success. In bivariate analyses, a VRR ≥50% at the 6-month follow-up was associated with the resolution of hyperthyroidism. Overall complications occurred in 6.2% of patients (5/81), including 1.2% (1/81) of a major complication (transient Horner syndrome), 3.7% cases of transient dysphonia (3/81), and 1.2% (1/81) of hypothyroidism requiring low-dose levothyroxine replacement. <b><i>Conclusions:</i></b> The results of this multicenter study suggest that RFA is a promising treatment option for patients with solitary AFTN, regardless of their baseline characteristics, including volume, age, or composition. The clinical success of the intervention may be related to the VRR at 6 months.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"283-290"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855449","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":"<i>Letter to the Editor:</i> Does Thermal Ablation of Thyroid Nodules Increase the Complexity of Subsequent Thyroidectomy?","authors":"Xinxin Zhao, Ye Yang","doi":"10.1089/thy.2025.0002","DOIUrl":"10.1089/thy.2025.0002","url":null,"abstract":"","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"338-339"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190715","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":"Controversies Surrounding IGF-I Receptor Involvement in Thyroid-Associated Ophthalmopathy.","authors":"Terry J Smith","doi":"10.1089/thy.2024.0606","DOIUrl":"10.1089/thy.2024.0606","url":null,"abstract":"<p><p><b><i>Background:</i></b> Thyroid-associated ophthalmopathy (TAO, aka thyroid eye disease [TED], Graves' orbitopathy) remains poorly understood and inadequately treated since its initial description. It is disfiguring, can threaten vision, and represents an autoimmune process closely associated with thyroid disease. Unambiguous connections linking TAO to the glandular maladies of Graves' disease (GD) remain incompletely clarified. Detecting the thyrotropin receptor (TSHR) in periocular tissues suggests that this cell-surface protein represents a shared autoantigen with the thyroid gland, but we now know that its expression is ubiquitous. Most patients with TAO have relatively high circulating levels of activating anti-TSHR autoantibodies. Emerging more recently is the importance of insulin-like growth factor I receptor (IGF-IR) in the pathogenesis of TAO. The TSHR/IGF-IR signaling complex apparently drives circulating fibrocytes and the unique phenotypes of fibroblasts inhabiting the TAO orbit (GD-OF). <b><i>Methods:</i></b> The PubMed database was scanned for articles dating back to the earliest time periods covered. Keywords used for primary searches included thyroid-associated ophthalmopathy, Graves' orbitopathy, TED, orbit, TSH receptor, IGF-I receptor, and autoimmune thyroid disease. Secondary searches used numerous other search terms. <b><i>Results:</i></b> GD-OF have been characterized extensively as being particularly responsive to the immunological factors and key effectors in TAO pathogenesis. Both TSHR and IGF-IR are overexpressed by GD-OF and CD34⁺ fibrocytes and form a signaling complex. They are activated through this TSHR/IGF-IR complex to produce large amounts of hyaluronan and express multiple cytokines. This complex mediates cellular responses to pathogenic IgGs in TAO. CD34⁺ fibrocytes and CD34⁺ OF also express relatively high levels of multiple thyroid autoantigens. Identifying IGF-IR as a key component of a receptor complex and its intertwining signaling activities with those of TSHR has led to a targeted medical therapy for TAO. This therapy involves the selective systemic inhibition of IGF-IR. <b><i>Conclusions:</i></b> Much has been learned over the preceding decades about the pathogenesis of TAO. Among these is the identification of IGF-IR as a pivotal component underpinning the disease. This has led directly to development of an effective targeted therapy. Important gaps in our understanding persist, and current therapies have limitations. Thus, despite these advancements, considerably more remains to be achieved.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"232-244"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256671","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":"Thyroid Nodules with Indeterminate Cytology and Negative Molecular Profile: Prevalence of Malignancy and Practice Paradigms for Surveillance.","authors":"Sapir Nachum, Isabella Tondi Resta, Zubair Baloch, Susan J Mandel","doi":"10.1089/thy.2024.0455","DOIUrl":"10.1089/thy.2024.0455","url":null,"abstract":"<p><p><b><i>Background:</i></b> In the era of molecular testing, thyroid nodules with indeterminate cytology are increasingly being managed nonoperatively. The false-negative rates of these molecular tests, and therefore missed malignancies, are not well defined in real-world clinical practice. <b><i>Methods:</i></b> This retrospective study of patients undergoing fine needle aspiration (FNA) biopsy at our health system between November 2017 and March 2022 included nodules with The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) III and IV cytology and negative, currently negative, or negative but limited ThyroSeq version 3 (TSv3) results. Surgical pathology of resected nodules, as well as details of ultrasound (US) surveillance practices, was recorded. A range of prevalence of malignancy (PoM) estimates were calculated based on all nodules (PoM low) and surgically resected nodules (PoM high). <b><i>Results:</i></b> The study cohort consisted of 556 nodules. TSv3 results were distributed as 443 (80%) negative, 85 (15%) currently negative, and 28 (5%) negative but limited. Overall, 75 nodules were resected: 54 nodules (9.7%) had immediate surgery, and 21 nodules (3.8%) had delayed surgery after surveillance imaging. Currently negative and negative but limited nodules were more likely to undergo immediate surgical resection compared with negative nodules (20%, 18%, and 7%, respectively, <i>p</i> < 0.001). The PoM in molecularly benign TBSRTC III and IV thyroid nodules ranged between 3% and 23% depending on the inclusion of all versus resected nodules. TBSRTC IV molecularly benign nodules had a higher PoM than TBSRTC III (PoM low 7.3% vs. 1.6%, <i>p</i> < 0.001; PoM high 48% vs. 13%, <i>p</i> = 0.0013). In the 90% of nodules that were managed nonoperatively, 63% had at least one surveillance US. Timing of initial surveillance US ranged from 3 to 60 months (median 13 months, interquartile [IQR] 11-19 months). Median follow-up duration was 25 months (IQR 17-34 months). Nodule growth occurred in 24% of nodules; only a minority (7%) underwent repeat FNA. <b><i>Conclusions:</i></b> Negative subtype of TSv3 should be considered in clinical management recommendations. For negative but limited samples, repeat FNA should be performed. Optimal surveillance strategy for nonresected negative and currently negative nodules remains unknown. Until further real-world data are available, surveillance ultrasonography is recommended for TSN and TSCN nodules, similar to the ATA guidelines for TBSRTC II nodules.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"265-273"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060730","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 Epidemiological Landscape of Thyroid Cancer and Estimates of Overdiagnosis in China: A Population-Based Study.","authors":"Qixun Zhu, Junli Liu, Junrong Hu, Yanting Zhang","doi":"10.1089/thy.2024.0583","DOIUrl":"10.1089/thy.2024.0583","url":null,"abstract":"<p><p><b><i>Background:</i></b> In China, thyroid cancer (TC) is the most common cancer in females and the fifth most common cancer in males. TC overdiagnosis leads to overtreatment, lifelong medical care, and side effects. This study systematically quantifies the epidemiological profile of TC incidence in China, as well as estimating TC incidence attributable to overdiagnosis. <b><i>Methods:</i></b> Data were derived from the Cancer Incidence in Five Continents databases. Age-standardized incidence rates (ASIRs) per 100,000 person-years were calculated using the world standard population. Joinpoint regression and age-period-cohort models were conducted to examine temporal ASIR trends and period effects, respectively. We estimated TC incidence attributable to overdiagnosis among patients aged 15-84 years by comparing shapes of age-specific curves with those observed before diagnostic practices. <b><i>Results:</i></b> In 2013-2017, there were 37,862 and 117,979 new TC cases in males and females in China, respectively, with ASIRs of 6.9/100,000 and 21.1/100,000. Significant upward trends were observed from 1993 to 2017, with average annual percent changes being 14.7% for males and 16.2% for females. Incidence rate ratios of period effects markedly increased from 1.0 to 61.8 for males and from 1.0 to 42.9 for females from 1993 to 2017. Overdiagnosis accounted for 83.5% (31,455/37,685) and 88.7% (104,222/117,509) of cases in males and females in 2013-2017, respectively, yielding ASIRs of 5.9/100,000 and 19.1/100,000. ASIRs attributable to overdiagnosis in urban populations (6.9/100,000 for males and 21.7/100,000 for females) were significantly higher than in rural populations (1.3/100,000 and 6.4/100,000). Among the 25 included provinces, ASIRs attributable to overdiagnosis ranged from 0.3/100,000 in Sichuan to 18.5/100,000 in Shanghai in males and from 0.1/100,000 in Shanxi to 49.4/100,000 in Shanghai in females. The national ASIRs attributable to overdiagnosis increased from 2.6/100,000 in 2008-2012 to 5.9/100,000 in 2013-2017 for males and from 9.2/100,000 to 19.1/100,000 for females. <b><i>Conclusions:</i></b> The incidence rates of TC have considerably increased over the past 25 years in China. Rapidly increasing trends and considerable geographic variations in TC incidence attributable to overdiagnosis highlight the need to adjust TC screening strategies and clinical practices, optimize healthcare resource allocation, and monitor the impacts of TC overdiagnosis on population-level health.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"307-320"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459587","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 Report Examining Efficacy and Safety of Radiofrequency Ablation for the Treatment of Skin-Involving Recurrent Thyroid Cancer.","authors":"Hye Hyeon Moon, Jung Hwan Baek, Sae Rom Chung, Young Jun Choi, Ki-Wook Chung, Tae Yong Kim, Jeong Hyun Lee","doi":"10.1089/thy.2024.0339","DOIUrl":"10.1089/thy.2024.0339","url":null,"abstract":"<p><p><b><i>Background:</i></b> This study assessed the efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) for treatment of skin-involving recurrent thyroid cancer. <b><i>Methods:</i></b> In this retrospective case series study, 43 patients (mean age: 67.9 ± 14.4 years; 31 females) with skin-involving recurrent thyroid cancer were treated with RFA for a total of 50 tumors between May 2008 and March 2023. The location of the tumor was classified into epidermis, dermis, or hypodermis on the basis of the involved skin layer. After RFA, the technique efficacy (absence of detectable vasculature and volume reduction at 12 months), clinical success (resolution of symptoms or cosmetic problems), volume reduction ratio (VRR), complete disappearance of tumor, and complications were assessed. <b><i>Results:</i></b> Of the 50 recurrent tumors, 9 involved the epidermis, 10 involved the dermis, and 31 involved the hypodermis. A total of 88 RFA sessions (mean, 1.8; range: 1-6) were performed. The technique efficacy at 1 year was 72% (36/50 [confidence interval or CI: 59.6-84.4%]). At the last follow-up (median [interquartile range]: 2.7 [1.1-4.5] years), the clinical success rate was 86% (44/50), the complete disappearance rate 54% (27/50), and the mean VRR 77.3% ± 44.2%. In a subgroup analysis comparing epidermis/dermis vs. hypodermis, there was no statistical difference in technique efficacy (57.9% [11/19] vs. 80.6% [25/31], <i>p</i> = 0.085), clinical success rate (78.9% [15/19] vs. 90.3% [28/31], <i>p</i> = 0.265), complete disappearance rate (42.1% [8/19] vs. 51.6% [16/31], <i>p</i> = 0.541), or mean VRR (65.5% vs. 84.6%, <i>p</i> = 0.141). Skin burns were observed in 4.9% per treatment session (2/41 [CI: 0-11.3%]) of epidermis/dermis-involving tumor procedures and none of the hypodermal tumor procedures. No patients experienced life-threatening or major complications. <b><i>Conclusions:</i></b> RFA might serve as a promising approach for managing skin-involving recurrent thyroid cancer, with no major complications reported in this preliminary study. Recurrent tumors involving the epidermis/dermis may pose a higher risk of skin burns than tumors involving the hypodermis. Early intervention with RFA before the tumor extends to the epidermis/dermis may thus be preferable.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"274-282"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839757","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":"Biphasic Effect of Thyroid Hormone on Megakaryopoiesis and Platelet Production.","authors":"Baichuan Xu, Xianpeng Ye, Zhaoyang Wen, Jun Chen, Mo Chen, Mingqiang Shen, Yang Xu, Junping Wang, Shilei Chen","doi":"10.1089/thy.2024.0361","DOIUrl":"10.1089/thy.2024.0361","url":null,"abstract":"<p><p><b><i>Background:</i></b> Abnormal platelet counts are frequently observed in patients with thyroid dysfunction; however, the direct impact of thyroid hormones on thrombopoiesis remains largely undefined. <b><i>Methods:</i></b> This study elucidates the dose-response effect of the thyroid hormone triiodothyronine (T₃) on megakaryocyte (MK) development and thrombopoiesis using both a murine model of hyperthyroidism/hypothyroidism and <i>in vitro</i> cultures of human cord blood CD34⁺ cell-derived MKs. After the application of inhibitors to MKs, the examination of total and phosphorylated protein levels of the phosphoinositide 3-kinase (PI3K)/AKT pathway was utilized to assess the specific mechanisms of T₃ action. The use of autophagy dual-staining lentivirus and transmission electron microscopy was employed to evaluate the impact of T₃ on the autophagy flux in MKs. Mouse whole-body irradiation and bone marrow transplantation models are applied to assess the influence of T₃ on the recovery of MKs/platelets <i>in vivo</i>. <b><i>Results:</i></b> We found that physiological or slightly elevated thyroid hormone levels are essential for sustaining MK development and thrombopoiesis, primarily through the TRα-PI3K/AKT signaling pathway. In contrast, supraphysiological thyroid hormone concentrations induce MK apoptosis via excessive autophagy, thereby reducing platelet production. <b><i>Conclusions:</i></b> Here, we present evidence that the thyroid hormone influences MK development and platelet production in a concentration-dependent manner, exhibiting a dualistic role. Our discoveries shed new light on the intricate relationship between thyroid hormones and platelet formation, offering novel perspectives on the pathophysiological consequences of thyroid disorders.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"321-334"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847628","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":"Is Radioactive Iodine Contraindicated in Patients with Moderate-to-Severe and Active Graves' Orbitopathy?","authors":"Luigi Bartalena, Maria Laura Tanda","doi":"10.1089/thy.2025.0059","DOIUrl":"10.1089/thy.2025.0059","url":null,"abstract":"","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"230-231"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399864","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":"Ablative Versus Conservative Approach for Hyperthyroidism Treatment in Patients with Graves' Orbitopathy: A Retrospective Cohort Study.","authors":"Giada Cosentino, Giulia Lanzolla, Simone Comi, Maria Novella Maglionico, Chiara Posarelli, Dalì Antonia Ciampa, Francesca Menconi, Roberto Rocchi, Francesco Latrofa, Michele Figus, Ferruccio Santini, Michele Marinò","doi":"10.1089/thy.2024.0633","DOIUrl":"10.1089/thy.2024.0633","url":null,"abstract":"<p><p><b><i>Background:</i></b> Treatment for Graves' hyperthyroidism (GH) in patients with Graves' orbitopathy (GO) remains a topic of debate. This study aimed to investigate the outcome of GO following glucocorticoids, depending on the chosen thyroid treatment. <b><i>Methods:</i></b> This retrospective cohort study included 49 consecutive patients with GH and moderate-to-severe, active GO, as defined by the European Group on Graves' Orbitopathy guidelines. Twenty-four patients were treated with radioactive iodine (RAI) and 25 with methimazole (MMI). All patients were administered intravenous methylprednisolone. Follow-up visits occurred at weeks 24, 48, and 72. The primary endpoint was the overall outcome of GO at week 24. Response was defined as a change in at least two of the following eye features: reduction ≥1 point in clinical activity score; proptosis reduction ≥2 mm; eyelid aperture reduction ≥2 mm; increase in eye ductions ≥8 degrees. <b><i>Results:</i></b> Follow-up duration was 72 weeks for both groups (interquartile range 66-72 for RAI and 48-72 for MMI). The proportion of responders for week 24 overall GO outcome was greater in RAI (54.1% vs. 16%; odds ratio [OR] 6.2 [confidence interval (CI): 1.6-23.6], <i>p</i> = 0.0075), but it increased in MMI at weeks 48 and 72, with no differences between groups. There was a trend indicating a better response in RAI regarding individual eye features. Improvement in GO-specific quality of life questionnaire at week 24 was trendily more pronounced in RAI (responders 50% vs. 28% in MMI; OR = 2.5 [CI: 0.7-8.4], <i>p</i> = 0.11), although results were similar in both groups at later time points. At week 24, only one patient (4%) in RAI and three (12%) in MMI experienced worsening of GO. Fifty-nine adverse events were recorded among 36 patients, with no differences between groups, except for infections, which were more frequent in RAI (53.8% vs. 15.3% in MMI; OR = 6.41 [CI: 1.7-23.9], <i>p</i> = 0.0056). <b><i>Conclusions:</i></b> RAI appears to be associated with an earlier response of GO to intravenous glucocorticoids. In the long term, a conservative approach also seems to be effective. RAI appears to be relatively safe when patients are concurrently treated with glucocorticoids. However, randomized clinical trials are necessary to confirm these findings.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"298-306"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256668","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}