Thyroid最新文献

{"title":"Functional Characterization of a Novel Variant of the Thyroid Hormone Receptor Alpha in a Child with Developmental Delay and Abnormal Thyroid Function.","authors":"Véronique Caron, Katherine Bonnycastle, Agathe Rio, Lyne Chiniara, Mélanie Henderson, Guy Van Vliet, André Tremblay, Fabien Magne","doi":"10.1177/10507256261490862","DOIUrl":"10.1177/10507256261490862","url":null,"abstract":"<p><strong>Background: </strong>Resistance to thyroid hormone α (RTHα) is a rare disorder caused by pathogenic <i>THRA</i> variants. We investigated the molecular basis of RTHα in a child with developmental delay, dysmorphic features, and a suggestive biochemical profile.</p><p><strong>Methods: </strong>Whole-exome sequencing identified a <i>de novo THRA</i> variant. Cell-based transcriptional assays assessed thyroid hormone responsiveness, coactivator dependence, and dominant-negative activity.</p><p><strong>Results: </strong>A novel heterozygous frameshift variant, c.1125_1132dup (p.Gly378Alafs*2), truncating the ligand-binding domain, was identified. The mutant receptor showed markedly impaired responses to triiodothyronine (T3) and TRIAC. CBP/p300 and PGC1α failed to activate the variant, supporting loss of function. Co-expression studies demonstrated strong inhibition of wild-type <i>THRA</i> activity that was not rescued by high T3 concentrations, indicating a potent dominant-negative effect. Disruption of DNA binding abolished this interference, showing that DNA occupancy is required.</p><p><strong>Conclusions: </strong>These findings expand the spectrum of pathogenic <i>THRA</i> variants and provide new insight into transcriptional repression in RTHα.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"1267-1274"},"PeriodicalIF":6.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012833","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":"Smartphone-Based Deep Learning Exophthalmometry in Thyroid Eye Disease: A Multicenter, Multiethnic Validation Study.","authors":"Jae Hoon Moon, Joonhyeon Park, Min Joo Kim, Jongchan Kim, Kyubo Shin, Jaemin Park, Jin Sook Yoon, Won Sang Yoo, Raquel Monge Carmona, Marina Soto-Sierra, Luz Valverde, Tomás Martín-Hernández, Mariola Méndez-Muros, Antonio Manuel Garrido-Hermosilla, Namju Kim, JaeSang Ko","doi":"10.1177/10507256261495636","DOIUrl":"10.1177/10507256261495636","url":null,"abstract":"<p><strong>Background: </strong>Proptosis is the principal quantitative measure of disease severity in thyroid eye disease (TED), but Hertel exophthalmometry has substantial interobserver variability and requires in-person specialist visits. Existing deep learning (DL) proptosis-from-photograph models require studio-acquired images. We aimed to validate, in a multicenter multiethnic study, a DL model fine-tuned to estimate proptosis (mm) from nonstudio facial photographs-smartphone selfies or clinician-taken photographs.</p><p><strong>Methods: </strong>This validation study included 361 patients with confirmed or suspected TED at three institutions. Data were collected prospectively at two Korean sites-Severance Hospital (SH; 203 patients/3654 facial images; internal validation) and Seoul National University Bundang Hospital (SNUBH; 79/933; same-ethnicity external validation)-and retrospectively, from routine-care images, at one Spanish site, Virgen Macarena University Hospital (HUVM; 79/336; different-ethnicity external validation). Korean patients self-acquired selfies on six smartphone models per site using a capture-guidance application; Spanish images were clinician-acquired during routine care without such guidance. The model-a dual-stream ResNet-18 jointly processing a facial image and a per-pixel depth map (ZoeDepth)-outputs a proptosis estimate (mm) per eye from one photograph and was fine-tuned, from a previously published model trained on studio digital single-lens reflex photographs, for these nonstudio acquisitions. Hertel measurements by oculoplastic specialists served as the reference standard.</p><p><strong>Results: </strong>On single-image analysis, the mean absolute error (MAE) versus Hertel measurement was 1.14 mm (Pearson correlation coefficient [PCC] 0.83) in SH, 1.44 mm (PCC 0.85) in SNUBH, and 1.58 mm (PCC 0.77) in HUVM, with predictions within 2 mm of Hertel in 83.6%, 71.3%, and 69.7% of images, respectively. Performance was consistent across 12 smartphone models (per-device MAE 1.11-1.54 mm). For detecting severe proptosis (Hertel ≥21 mm), the area under the receiver operating characteristic curve was 0.94 (confidence interval 0.93-0.96), 0.91 (0.89-0.92), and 0.86 (0.82-0.91) in SH, SNUBH, and HUVM, respectively. Bland-Altman analysis revealed underestimation at the upper extreme.</p><p><strong>Conclusions: </strong>An artificial intelligence model fine-tuned for nonstudio facial photographs achieved Hertel-level agreement and reliable severity discrimination across 2 ethnicities and 12 smartphones, both for patient self-acquired smartphone selfies and for clinician-acquired routine clinic photographs, providing a scalable approach for patient-facing and clinic-based monitoring of TED severity, pending further longitudinal validation.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"1247-1257"},"PeriodicalIF":6.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128150","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":"Association Between Household Iodized Salt Trajectory and High Milk-Enriched Diet with Thyroid Nodules and Goiter in Children: A Prospective Cohort Study.","authors":"Mao Liu, Ziyi Xiao, Peihua Wang, Yunjie Ye, Li Shang, Yuting Xia, Yang Wang, Haiyan Chu, Yan Xu, Zhen Ding","doi":"10.1177/10507256261499154","DOIUrl":"https://doi.org/10.1177/10507256261499154","url":null,"abstract":"<p><strong>Background: </strong>Universal salt iodization (USI) policies have achieved remarkable results in preventing iodine deficiency disorders globally. However, concerns regarding its safety have emerged along with rising detection rates of thyroid disorders and shifts in dietary structures. The association between iodized salt consumption and thyroid nodule development remains unclear, and the modifying role of dietary structures is not well understood. This study aimed to examine associations between iodized salt consumption and the incidence of thyroid nodules and goiter, accounting for dietary structures.</p><p><strong>Methods: </strong>This prospective cohort study enrolled 8464 school-aged children across 79 schools from 2021 to 2023. Salt exposure and dietary structures were assessed via household sampling and questionnaires. Thyroid nodules and goiter were identified through ultrasonography. Latent class trajectory modeling identified iodized and noniodized salt trajectories, alongside high milk-enriched and low milk-enriched dietary structures. Cox proportional hazards model and logistic regression model were applied to analyze the associations between salt trajectories and dietary structures with thyroid nodules and goiter separately.</p><p><strong>Results: </strong>Two thousand seven hundred and seven (32.0%) participants developed thyroid nodules and 164 (1.9%) had goiter. Two salt trajectories were identified: iodized (7892; 93.2%) and noniodized (572; 6.8%). Iodized salt was associated with lower risks of nodules (hazard ratio [HR], 0.806 [confidence interval or CI: 0.659-0.986]) and goiter (odds ratio, 0.458 [CI: 0.299-0.669]). However, the association with nodules did not persist in region-stratified analyses (HR, 1.114 [CI: 0.745-1.667]). A high milk-enriched diet was consistently associated with reduced nodule risk (HR, 0.867 [CI: 0.787-0.956]) and remained significant in all sensitivity analyses. A significant interaction was observed between dietary structure and salt trajectory (adjusted <i>p</i> for interaction = 0.024). A U-shaped relationship was observed between salt iodine concentration and nodule risk, with an inflection point at 21.3 mg/kg.</p><p><strong>Conclusions: </strong>Iodized salt was associated with lower goiter risk, but its inverse association with thyroid nodules was not observed after region restriction. A high milk-enriched diet was inversely associated with thyroid nodules. These findings support continued USI for goiter prevention and highlight the importance of regional iodine status and dietary patterns when interpreting household salt use and thyroid outcomes in children.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261499154"},"PeriodicalIF":6.6,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149273256","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":"Paternally Inherited <i>DIO3</i> Loss and Infantile-Onset Central Hypothyroidism: Human Evidence for a Novel Mechanism of Hypothalamic-Pituitary-Thyroid Axis Dysregulation.","authors":"Tomohiro Hori, Hiroshi Ito, Tatsuya Sakashita, Toshinari Koyama, Masahiro Shimozawa, Mai Mori, Saori Kadowaki, Hideki Matsumoto, Hideo Sasai, Fumiaki Sakura, Yutaka Yamamoto, Satoshi Okada, Hidenori Ohnishi","doi":"10.1177/10507256261500920","DOIUrl":"https://doi.org/10.1177/10507256261500920","url":null,"abstract":"<p><strong>Background: </strong><i>DIO3</i> encodes type 3 iodothyronine deiodinase, the major thyroid hormone-inactivating enzyme, and is an imprinted gene with preferential paternal-allele expression demonstrated in human neonatal skin. <i>Dio3</i>-deficient mice develop neonatal thyrotoxicosis followed by central hypothyroidism, but human evidence has been lacking.</p><p><strong>Patient findings: </strong>On newborn screening, thyrotropin (TSH) and free thyroxine (fT4) did not meet repeat-testing criteria, while T-cell lymphopenia was detected neonatally. From 5 months onward, fT4 progressively declined without compensatory TSH elevation. Chromosomal microarray identified a derivative chromosome 14 with a 14q32.31-q32.33 deletion encompassing <i>DIO3</i> and <i>TRAF3</i>. The deletion originated from a paternal balanced 4p/14q translocation.</p><p><strong>Summary: </strong>In this patient, delayed-onset central hypothyroidism was most consistent with paternal <i>DIO3</i> loss, whereas the accompanying T-cell lymphopenia was consistent with <i>TRAF3</i> haploinsufficiency.</p><p><strong>Conclusions: </strong>This case provides the first human evidence linking paternal <i>DIO3</i> loss to delayed-onset central hypothyroidism, supporting a novel developmental mechanism that may alter hypothalamic-pituitary-thyroid axis programming.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261500920"},"PeriodicalIF":6.6,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149273244","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>PDE8B</i> rs4704397 Modifies the Association Between Iodine Status and Serum TSH in Pregnant Women.","authors":"Cui Yao, Yongze Li, Chenyan Li, Weiwei Wang, Xiaochen Xie, Chenling Fan, Weiping Teng, Zhongyan Shan, Jinyuan Mao","doi":"10.1177/10507256261500925","DOIUrl":"https://doi.org/10.1177/10507256261500925","url":null,"abstract":"<p><strong>Background: </strong>Maternal thyroid function is essential for a healthy pregnancy, and elevated thyrotropin (TSH) is the hallmark of subclinical hypothyroidism (SCH). Previous studies have shown that both genetic factors, particularly the <i>PDE8B</i> rs4704397 polymorphism, and iodine intake influence TSH levels. However, whether iodine-related changes in TSH vary by genetic background remains unclear. This study aimed to investigate the association between iodine status and TSH levels across different genetic backgrounds in early pregnancy.</p><p><strong>Methods: </strong>We performed a retrospective analysis of prospectively collected data from the subclinical hypothyroid in early pregnancy (SHEP) prospective cohort, using a nested case-control design. The analysis included 728 pregnant women with SCH and 968 age- and body mass index-matched euthyroid controls. Participants were genotyped for <i>PDE8B</i> rs4704397 using matrix-assisted laser desorption ionization-time-of-flight mass spectrometry. The urinary iodine-to-creatinine ratio (UIC/Cr) was used to assess iodine status. Restricted cubic spline (RCS), linear, and logistic regression models were applied to evaluate the associations of UIC/Cr with TSH, free thyroxine (fT4), and SCH, stratified by <i>PDE8B</i> genotype.</p><p><strong>Results: </strong>The distribution of the AA genotype did not differ between case and control groups. In the overall population, the AA genotype accounted for 70% of participants. RCS analyses showed a positive linear association between UIC/Cr and serum TSH concentrations in both the overall population and individuals with the AA genotype, but not in those with the GA + GG genotypes. A nonlinear inverse association between UIC/Cr and fT4 levels was observed across all genotypes. Among individuals with the AA genotype, each standard deviation increase in UIC/Cr was associated with higher serum TSH levels (adjusted β = 0.16, confidence interval [CI]: 0.08-0.24) and an increased risk of SCH (OR = 1.22, CI: 1.08-1.39), but not among those with the GA + GG genotypes (<i>p</i> for genotype × UIC/Cr interaction = 0.09 for both outcomes). In contrast, fT4 levels decreased with increasing UIC/Cr across all genotypes <i>(p</i> for genotype × UIC/Cr interaction = 0.48).</p><p><strong>Conclusions: </strong>Higher iodine status was associated with higher TSH levels and an increased risk of SCH only among pregnant women with the <i>PDE8B</i> rs4704397 AA genotype, suggesting that the effect of iodine on thyroid function is modified by genotype.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261500925"},"PeriodicalIF":6.6,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149273192","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":"Factors Associated with Adverse Effects of Postoperative TSH-Directed Levothyroxine Therapy in Adults with Differentiated Thyroid Cancer: A Scoping Review.","authors":"Mohammad Jay, Fadi Esttaifo, Grace Reszetnik, Cristina Goens, Emma Wilson, Lorraine L Lipscombe, Antoine Eskander","doi":"10.1177/10507256261499041","DOIUrl":"https://doi.org/10.1177/10507256261499041","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Postoperative thyrotropin (TSH)-directed levothyroxine is used to reduce recurrence risk in selected patients with differentiated thyroid cancer (DTC), but treatment-related adverse effects may vary based on patient susceptibility and treatment exposure. Contemporary guidelines increasingly require balancing anticipated oncologic benefit against potential harm. This scoping review synthesizes patient-, treatment-, and disease-related factors associated with adverse effects of postoperative TSH-directed levothyroxine therapy in adults with DTC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This scoping review was reported following PRISMA-ScR guidelines and prospectively registered on the Open Science Framework. MEDLINE, Embase, and Cochrane CENTRAL were searched from January 1, 2011, to February 24, 2026. Eligible studies reported associations between patient-, treatment-, or disease-related factors and adverse effects among adults with DTC receiving postoperative TSH-directed levothyroxine therapy. Data were summarized descriptively and synthesized narratively, with stratification according to TSH exposure definition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 7361 records screened, 35 studies including 11,819 patients were included. Skeletal outcomes were most frequently reported (51.4%), followed by cardiometabolic (40.0%), neuropsychological (11.4%), reproductive (2.9%), and muscular outcomes (2.9%). TSH exposure definitions varied substantially: 18 studies evaluated subnormal TSH, 2 low-normal TSH, 8 mixed categories spanning subnormal and low-normal TSH, 4 continuous biochemical/treatment measures, and 3 unclear exposures. Greater suppression intensity was the most consistently reported treatment-related factor associated with adverse skeletal outcomes, particularly in studies evaluating subnormal TSH. Longer treatment duration was associated with skeletal harm in selected studies. Postmenopausal status emerged as a relatively consistent patient-level factor, whereas associations with age and body mass index were variable. Evidence for cardiometabolic, neuropsychological, reproductive, and muscular outcomes was less extensive and less consistent, and disease-related factors were infrequently examined. Only two studies conducted prediction/discrimination analyses, both involving skeletal outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Evidence on adverse effects associated with TSH-directed levothyroxine therapy in DTC is most consistent for skeletal outcomes and predominantly derives from studies evaluating subnormal TSH exposure. The available literature provides limited evidence for clinically applicable prediction of toxicity or cumulative treatment burden. Future longitudinal studies should better characterize the intensity and persistence of biochemical exposure and develop outcome-specific prediction models integrating baseline susceptibility, organ vulnerability, and longitudinal treatment exposure to support individualized T","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261499041"},"PeriodicalIF":6.6,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149239520","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":"Precision Thyroid Oncology Using Genetic-Based Therapies: A Narrative Review.","authors":"Vincenzo Marotta, Mingzhao Xing, Mario Vitale","doi":"10.1177/10507256261497620","DOIUrl":"https://doi.org/10.1177/10507256261497620","url":null,"abstract":"<p><strong>Background: </strong>Most thyroid malignancies harbor a limited set of well-characterized mutations driving tumor initiation and determining phenotype. This relatively direct genotype-phenotype association, bringing insights into molecular mechanisms of progression and drug resistance, makes advanced thyroid cancers suitable for genetic-based therapies. Personalized cancer treatment by targeting actionable tumor mutations represents one of the most innovative frontiers in oncology.</p><p><strong>Summary: </strong>The present narrative review focuses on actionable mutations occurring in thyroid cancers and provides a state-of-the-art overview of genetic-based treatments that have received regulatory approval worldwide. These include two selective RET inhibitors (sRET-Is) (selpercatinib and pralsetinib), three NTRK inhibitors (NTRK-Is) (larotrectinib, entrectinib, and repotrectinib), and two dual BRAF/MEK inhibitor regimens (dabrafenib plus trametinib and encorafenib plus binimetinib). The most significant impact has been observed in the management of <i>RET</i>-mutant medullary thyroid cancer. Selpercatinib, available in many countries, demonstrated superiority over standard multikinase inhibitors (MKIs) in a head-to-head comparison. It currently represents the best first-line treatment option. In BRAF^V600E-positive anaplastic thyroid cancer, both dabrafenib plus trametinib and encorafenib plus binimetinib showed efficacy that appeared to exceed that historically observed with standard approaches. However, their approval is currently limited to a few countries. In radioiodine-refractory differentiated thyroid cancer (DTC), sRET-Is and NTRK-Is are effective in molecularly selected patients and are approved in many countries. However, their applicability is limited by the low prevalence of the corresponding actionable alterations. In BRAF^V600E-positive radioiodine-refractory DTC, dabrafenib plus trametinib has emerged as a useful option after MKI failure, although a tumor-specific approval has been granted only in Europe.</p><p><strong>Conclusions: </strong>Precision oncology is increasingly being integrated into the management of advanced thyroid cancer. However, its impact varies widely across different tumor settings, and its real-world use is strongly influenced by country-specific drug regulations.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261497620"},"PeriodicalIF":6.6,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224894","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:</i> The Iatrogenic Delay Paradox: A Call for Contextual Adaptation of the 2026 ATA Guidelines.","authors":"Laura Sterian Ward, Cleo Otaviano Mesa Junior, Rosiane Mattar, Sara Toassa Gomes Solha","doi":"10.1177/10507256261499156","DOIUrl":"https://doi.org/10.1177/10507256261499156","url":null,"abstract":"","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261499156"},"PeriodicalIF":6.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196535","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 of Calcified Papillary Thyroid Microcarcinoma: Long-Term Imaging Evolution and Clinical Outcomes.","authors":"So Yeong Jeong, Sun Mi Baek, Suyoung Shin, Hyunsoo Kim, Young Hwa Suh, Jung Hwan Baek","doi":"10.1177/10507256261494905","DOIUrl":"https://doi.org/10.1177/10507256261494905","url":null,"abstract":"<p><strong>Background: </strong>Radiofrequency ablation (RFA) is a minimally invasive treatment for low-risk papillary thyroid microcarcinoma (PTMC). Although intratumoral calcification is a common feature of papillary thyroid carcinoma (PTC), its impact on RFA efficacy remains unclear. We aimed to evaluate the technical feasibility, clinical outcomes, and pattern-specific course of calcification resolution with RFA for PTMC.</p><p><strong>Methods: </strong>This retrospective study included 258 consecutive patients with low-risk, unifocal PTMC who underwent RFA between November 2017 and August 2022. Intratumoral calcification was classified on ultrasonography as microcalcification, macrocalcification, rim calcification, or mixed calcification. The primary outcomes were technical success and calcification disappearance rates by calcification pattern. Secondary outcomes included serial volume reduction ratio (VRR), cumulative disease progression, local tumor recurrence, and complications.</p><p><strong>Results: </strong>Among 258 PTMCs, 94 had calcifications (68 microcalcifications, 12 macrocalcifications, 14 rim calcifications) and 164 had none. Mean follow-up was 53.5 ± 16.7 months. Technical success was achieved in all patients in both groups. By 18 months, mean VRR exceeded 90% in both groups, and all tumors achieved 100% VRR at the final follow-up (≥36 months). Cumulative disease progression occurred in one patient (0.4%, lymph node metastases at ipsilateral neck level IV and VI), and 15 patients (5.8%) developed new PTC in the remaining thyroid; the rates did not differ between groups. Among PTMCs with calcifications, complete disappearance of calcification occurred in 90 cases (90/94, 95.7%) after 14.2 ± 12.3 months. Disappearance rates were highest for microcalcifications (100%), followed by rim calcifications (92.9%) and macrocalcifications (75.0%). Microcalcifications were resolved significantly faster (mean, 12.0 months), whereas rim calcifications were resolved the slowest (mean, 24.8 months; <i>p</i> < 0.001). The solid component and calcification resolved concurrently in 75.5% of tumors. One minor complication (transient hoarseness, 0.4%) occurred, and no major or delayed complications were observed.</p><p><strong>Conclusions: </strong>In this retrospective cohort, RFA achieved complete resolution of the viable soft-tissue component with a low complication rate in low-risk PTMC, both with and without intratumoral calcification. Technical success was achieved in 100% of tumors regardless of calcification status, and no significant difference in outcomes was observed between the calcified and noncalcified groups. These findings suggest that intratumoral calcification does not preclude effective ablation.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261494905"},"PeriodicalIF":6.6,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148649","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":"Changes in Multisystem Morbidity in Thyroid Cancer after the 2015 ATA Guideline: A Nationwide Population-Based Retrospective Cohort Study.","authors":"Seong Hee Ahn, Dong Wook Kim, Jinyoung Kim, Kyoung Jin Kim, Jeonghoon Ha, Mihye Seo, Beom-Jun Kim, Hun-Sung Kim, Eun-Gyoung Hong","doi":"10.1177/10507256261495805","DOIUrl":"https://doi.org/10.1177/10507256261495805","url":null,"abstract":"<p><strong>Background: </strong>As survivorship has become increasingly important in differentiated thyroid cancer (DTC), the 2015 American Thyroid Association (ATA) guideline introduced a more risk-adapted and less intensive approach to management. However, evidence regarding the association between guideline-driven de-intensification and non-cancer-specific multisystem morbidity remains limited.</p><p><strong>Methods: </strong>We conducted a nationwide population-based retrospective cohort study using Korean national claims data and compared patients who underwent total thyroidectomy before (2009-2014, <i>n</i> = 96,776) and after (2016-2021, <i>n</i> = 29,408) the 2015 ATA guideline. Outcome-specific 1:1 propensity score-matched analytic sets were constructed. The primary outcomes were composite cardiovascular/cerebrovascular, composite skeletal, and composite neurocognitive/psychiatric outcomes, as well as all-cause mortality. Secondary analyses examined the individual components of each composite outcome. Time-to-event analyses were performed using multivariable Cox proportional hazards models.</p><p><strong>Results: </strong>After matching and adjustment, the postguideline period demonstrated lower risks of composite skeletal outcomes (hazard ratio [HR] = 0.83; confidence interval [CI] 0.69-0.99) and composite neurocognitive/psychiatric outcomes (HR = 0.73; CI 0.69-0.77). Composite cardiovascular/cerebrovascular outcomes did not differ significantly between periods; however, secondary analyses showed lower risks of atrial fibrillation (HR = 0.62; CI 0.50-0.76), myocardial infarction (HR = 0.81; CI 0.66-0.99), and stroke (HR = 0.56; CI 0.49-0.63). All-cause mortality was similar between periods.</p><p><strong>Conclusions: </strong>During the post-2015 ATA guideline period, there was a lower burden of non-cancer-specific multisystem morbidity among patients undergoing total thyroidectomy for thyroid cancer. These findings support the relevance of guideline-recommended, risk-adapted de-intensification strategies for improving long-term survivorship outcomes in DTC.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261495805"},"PeriodicalIF":6.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128204","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}