Thyroid最新文献

{"title":"Teprotumumab-Associated Hyperglycemia: A Large-Scale Multinational Cohort Study.","authors":"Natan Lishinsky-Fischer, Rena Pollack, Zvi Gur","doi":"10.1177/10507256261442501","DOIUrl":"https://doi.org/10.1177/10507256261442501","url":null,"abstract":"<p><strong>Objective: </strong>Teprotumumab, a monoclonal antibody targeting the insulin-like growth factor-1 receptor, represents the first Food and Drug Administration (FDA)-approved treatment for thyroid eye disease (TED). However, hyperglycemia has emerged as a significant adverse event, with limited real-world data on its incidence and clinical impact. This study aimed to evaluate the risk of glycemic abnormalities associated with teprotumumab treatment using a large, multinational electronic health records database.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, which includes data from more than 165 health care organizations worldwide. Patients with TED treated with teprotumumab were matched 11 to TED patients who did not receive teprotumumab using propensity score matching (PSM). The primary outcomes were incident prediabetes, diabetes, hyperglycemia defined by a random blood glucose level ≥200 mg/dL, and initiation of antidiabetes medications during follow-up ranging from 6 months to 5 years. Time-to-event analyses were performed using Kaplan-Meier survival curves to estimate cumulative incidence over time.</p><p><strong>Results: </strong>After PSM, 792 teprotumumab-treated patients were compared with 792 matched controls over a follow-up period of up to 5 years. Teprotumumab treatment was associated with a significantly increased risk of prediabetes at 5 years (HR: 2.03, CI: 1.51-2.72), affecting 24% of treated patients compared with 10% of controls. The risk of incident diabetes at 5 years was also significantly higher in the teprotumumab-treated patients (HR: 2.23, CI: 1.46-3.43). Teprotumumab-treated patients were more likely to require the addition of antidiabetes medications at 5 years (HR: 1.68, CI: 1.27-2.22).</p><p><strong>Conclusions: </strong>In this large-scale cohort study, teprotumumab treatment was associated with an increased risk of dysglycemia. Although this risk was observed across several glycemic outcomes, the absolute risk increase was modest. These findings support routine glucose monitoring and proactive glycemic management, while emphasizing the importance of individualized risk-benefit assessment when considering teprotumumab therapy in patients with TED.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261442501"},"PeriodicalIF":6.7,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640036","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":"In Memoriam: Lawrence Crane Wood (1935-2026).","authors":"David S Cooper, Alan P Farwell","doi":"10.1177/10507256261440399","DOIUrl":"https://doi.org/10.1177/10507256261440399","url":null,"abstract":"","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261440399"},"PeriodicalIF":6.7,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639982","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":"CT-Free Quantitative Thyroid SPECT Based on Artificial Intelligence: A Prospective Multicenter Noninferiority Clinical Trial.","authors":"Hyun Woo Chung, Sang-Geon Cho, Dongkyu Oh, Kyounghyoun Kwon, Ji Hye Kim, Young So, Jae Hoon Moon, Soyeon Ahn, Won Woo Lee","doi":"10.1177/10507256261440401","DOIUrl":"10.1177/10507256261440401","url":null,"abstract":"<p><strong>Background: </strong>Hybrid single-photon emission computed tomography (SPECT)/computed tomography (CT) is used for the differential diagnosis of thyrotoxicosis, but its dependence on CT and complex analysis remains debated. This study evaluated whether CT-free thyroid SPECT using artificial intelligence (AI) could substitute for conventional SPECT/CT.</p><p><strong>Methods: </strong>This prospective multicenter noninferiority clinical trial (KCT0008387) included 152 patients with thyrotoxicosis from three tertiary referral hospitals. A pretrained AI model generated technetium thyroid uptake (TcTU) values using SPECT images without CT. These values were compared with TcTU derived from conventional SPECT/CT. The primary endpoint was diagnostic accuracy for Graves' disease. Noninferiority was defined as a lower confidence interval (CI) limit greater than -10%. Secondary endpoints included diagnostic accuracy for destructive thyroiditis and prediction of antithyroid drug (ATD) prescription within one month.</p><p><strong>Results: </strong>Among 152 patients, 84 had Graves' disease, 45 had indeterminate disease, and 23 had thyroiditis. For Graves' disease, CT-free SPECT demonstrated 86.2% accuracy compared with 85.5% for conventional SPECT/CT. The lower bound of the CI of the accuracy difference was -3.0%, meeting the prespecified noninferiority margin. For thyroiditis and ATD prescription, the lower bounds were -7.4% and -3.2%, respectively. Omission of CT resulted in a 33.5% reduction of radiation exposure from 3.34 mSv to 2.22 mSv, and CT-free SPECT automatically generated TcTU values more quickly than SPECT/CT (40 minutes vs. 4 minutes).</p><p><strong>Conclusions: </strong>CT-free SPECT using AI demonstrated noninferior diagnostic performance for thyrotoxicosis compared with conventional hybrid imaging while reducing radiation exposure and analysis time.</p><p><strong>Trial registration: </strong>https://cris.nih.go.kr (KCT0008387).</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261440401"},"PeriodicalIF":6.7,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628436","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":"Counseling Female Thyroid Cancer Patients on Radioactive Iodine and Fertility.","authors":"Angela M Leung, Gregory A Brent, Steven M Larson, Joseph R Osborne, Robert R Flavell, Matthew D Ringel, Julie Ann Sosa","doi":"10.1177/10507256261440390","DOIUrl":"https://doi.org/10.1177/10507256261440390","url":null,"abstract":"","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261440390"},"PeriodicalIF":6.7,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623673","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 Hormone Synthesis Without Thyroglobulin.","authors":"Crystal Young, Xiaohan Zhang, Aaron P Kellogg, Tatiana L Fonseca, Kevin Pena, Alisa Beyzin, Xiao-Hui Liao, Annunziata G Cicatiello, Hao Zhang, Antonio C Bianco, Samuel Refetoff, Peter Arvan","doi":"10.1177/10507256261429120","DOIUrl":"10.1177/10507256261429120","url":null,"abstract":"<p><strong>Background: </strong>Heterozygosity of genetically encoded misfolded mutant thyroglobulin (TG, the thyroid hormone protein precursor) occurs with a frequency estimated at 1-in-217 people worldwide, resulting in subclinical hypothyroidism that largely escapes medical detection. However, patients carrying biallelic <i>TG</i> mutation, when untreated, are frankly hypothyroid unless and until they develop a massive goiter. To date, TG is the only proven endogenous precursor protein for thyroid hormone synthesis in vertebrates. Our objective was to understand how homozygous expression of mutant TG protein that cannot undergo secretion to the iodination site in the thyroid follicle lumen can be compatible with patients or animal models ultimately achieving normal/near-normal circulating T4 and T3 levels. Notably, in both monoallelic and biallelic disease, dead thyrocytes have been reported in the lumen of thyroid follicles.</p><p><strong>Methods: </strong>We recently engineered mice with homozygous <i>Tg-KO</i>, making it possible to study circulating T4 and T3 in the complete absence of TG protein expression. We also employed immunoblotting methods to test for the presence of thyroidal T4-containing and T3-containing protein.</p><p><strong>Results: </strong>We found that, concomitant with goiter growth, animals completely lacking TG (like patients or animals with biallelic <i>TG</i> defect) are able to eventually normalize circulating T4 levels when their goiter has sufficiently enlarged, while maintaining serum T3 at ∼two-thirds normal levels throughout life. Very little T3-containing protein is synthesized in the thyroid glands of <i>Tg-KO</i> mice; however, T4-containing protein is synthesized on the ghosts of dead thyrocytes, with T3 generated from circulating T4 deiodination. Albeit inefficient, thyroidal T4-containing protein content is not appreciably different in the presence of homozygous mutant TG or in the complete absence of TG.</p><p><strong>Conclusions: </strong>Our data suggest that in biallelic TG mutation, thyroid stimulating hormone (TSH)-driven iodination underlies inefficient T4 formation derived from the iodoproteome of dead thyrocytes. In the presence of homozygous mutant TG or in the complete absence of TG, normalizing circulating T4 requires massive goiter growth to generate sufficient cells to sustain this inefficient hormonogenesis mechanism.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"441-450"},"PeriodicalIF":6.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147390941","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":"Outcomes of Patients with <i>RAS</i>-Positive Bethesda III and IV Cytology Thyroid Nodules.","authors":"Jiahui Wu, Caitlin Yeo, Jackson Qi, Sana Ghaznavi, Moosa Khalil, Erik Nohr, Adrian Box, Markus Eszlinger, Ralf Paschke","doi":"10.1177/10507256261429119","DOIUrl":"10.1177/10507256261429119","url":null,"abstract":"<p><strong>Background: </strong>Routine resection of all <i>RAS</i>-positive nodules may result in overtreatment for up to 50% of patients. We evaluated the management strategy and outcomes of <i>RAS</i>-positive nodules.</p><p><strong>Methods: </strong>Following implementation of reflexive ThyroSPEC^TM molecular testing (MT) for all Bethesda III and IV thyroid nodules in July 2020, we identified patients with isolated <i>RAS</i> mutations between July 30, 2020, and September 30, 2024, using an institutional prospective thyroid nodule database. Patients were categorized by management strategy: surgery versus surveillance. Exclusion criteria included: absence of ultrasound (US) within 12 months prior to MT, incomplete post-MT management data, comutations with <i>RAS</i>, initial lobectomy before MT, concomitant fine-needle aspiration-proven papillary thyroid carcinomas or metastatic lymph nodes, and presence of contralateral high-risk nodules. This study represents a retrospective analysis of institutional registry data from a single health care region.</p><p><strong>Results: </strong>Among 203 patients with <i>RAS</i>-positive nodules (175 Bethesda III, 28 Bethesda IV), 126 (62%) underwent surgery and 77 (38%) were under surveillance (median follow-up: 24 months, interquartile range 14-37). Final pathology in surgery group revealed malignancy in 43 (34%), with 8 (19%) 2025 American Thyroid Association (ATA) intermediate-high or high risk, 57 (45%) benign lesions, and 26 (21%) neoplasms of uncertain or very low malignant potential. Surgical patients were younger (45 vs. 53 years, <i>p</i> = 0.001) with larger nodules (maximum diameter 2.9 vs. 2.5 cm, volume 6.2 vs. 3.8 cm³, <i>p</i> < 0.05 for both). Bethesda III nodules were more frequently managed with surveillance than surgery (95% vs. 81%, <i>p</i> = 0.010). Nuclear atypia was more frequent in malignant versus benign resected nodules (70% vs. 40%, <i>p</i> = 0.007). Seven patients crossed over to surgery during surveillance due to patient preference, nodule growth, or symptoms; two had malignant pathology (both ATA low-intermediate risk). Nodule stability was evaluated in 48 surveillance patients with at least one post-MT US and minimum 1-year follow-up. Using a threshold of 50%, 3/48 (6%) exhibited growth, with a 2% cumulative incidence of growth at 2 years.</p><p><strong>Conclusions: </strong>Isolated <i>RAS</i> mutation alone may not uniformly mandate surgery. Active surveillance represents a viable and safe alternative to surgery in appropriately selected patients with <i>RAS</i>-positive nodules, though further long-term data are needed.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"363-372"},"PeriodicalIF":6.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147366328","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":"Temporal Glycemic Patterns During IGF-1R Inhibitor Therapy for Thyroid Eye Disease: A Pooled Analysis of Two Clinical Trials.","authors":"Wei Zhao, Tianyuan Li, Junjie Deng, Yihua Xu, Xiuying Zhang, Xianqun Fan, Linong Ji","doi":"10.1177/10507256261431846","DOIUrl":"10.1177/10507256261431846","url":null,"abstract":"","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"463-466"},"PeriodicalIF":6.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445178","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":"DNA Hypermethylation Suppresses Thyroid Peroxidase Expression and May Be a Promising Diagnostic Marker for Thyroid Cancer.","authors":"Lefan Zhu, Ke Jiang, Jiayong Huang, Qi Zhang, Yulu Chen, Guanghui Hu, Bo Lin, Weiming Lv, Pinning Feng, Rengyun Liu","doi":"10.1177/10507256261427034","DOIUrl":"10.1177/10507256261427034","url":null,"abstract":"<p><strong>Background: </strong>Decreased expression of thyroid peroxidase (TPO) is frequently observed in thyroid cancer, but the underlying regulatory mechanism remains largely unknown. This study aimed to elucidate the epigenetic basis of TPO silencing and assess its potential value for the diagnosis of thyroid cancer.</p><p><strong>Methods: </strong>DNA methylation and expression levels of <i>TPO</i> were analyzed using the Infinium HumanMethylation450 array and transcriptome data from The Cancer Genome Atlas thyroid cancer dataset and validated in clinical tissue samples by bisulfite sequencing polymerase chain reaction (PCR) and quantitative PCR (qPCR). Thyroid cancer cell lines MDA-T41, KTC-1, CAL62, and TTA1 were treated with the demethylating drug decitabine and subjected to DNA methylation and mRNA expression analyses. Potential regulatory proteins were identified through DNA pull-down coupled with LC-MS/MS and validated by chromatin immunoprecipitation, luciferase reporter assay, and qPCR. A pyrosequencing assay was designed to quantify the methylation level of <i>TPO</i>.</p><p><strong>Results: </strong>TPO expression was markedly downregulated in thyroid cancer and showed a strong inverse correlation with DNA methylation level at <i>TPO</i> differentially methylated region (DMR). Treatment of thyroid cancer cells with decitabine induced significantly decreased methylation level of <i>TPO</i> DMR and increased expression of TPO. Mechanistic analyses demonstrated that DNA hypermethylation suppressed TPO expression by recruiting methyl-CpG binding domain protein 2 (MBD2). Moreover, a pyrosequencing-based method for quantifying <i>TPO</i> methylation level was developed, and a remarkable difference between malignant and benign thyroid nodules (BTNs) was observed. Two CpG sites within <i>TPO</i> DMR achieved diagnostic performance with areas under the receiver operating characteristic curves of 0.927 (95% confidence interval [CI]: 0.864-0.989) and 0.916 (95% CI: 0.846-0.987), respectively.</p><p><strong>Conclusions: </strong>DNA hypermethylation suppresses TPO transcription by recruiting MBD2 in thyroid cancer. Quantitative assessment of <i>TPO</i> methylation by pyrosequencing offers a promising molecular diagnostic approach to distinguish malignant cancer from BTN. Further studies are warranted to ascertain the clinical diagnostic utility of these findings.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"373-384"},"PeriodicalIF":6.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349032","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":"MarginView3D: Extending Novel 3D Surgical Pathology Reporting for Use in Invasive pT4 Thyroid Cancer and Other Surgical Oncologic Procedures.","authors":"Sabrina R Comess, Jacob E Kapustin, Margaret Nurimba, Ike Kwon, Margaret Brandwein-Weber, Michael Karasick, Mark L Urken","doi":"10.1177/10507256261431842","DOIUrl":"10.1177/10507256261431842","url":null,"abstract":"<p><strong>Background: </strong>The American Thyroid Association's most recent clinical practice guidelines include margin status as a key factor to estimate risk of recurrence. Unlike most thyroid cancers, the successful resection of invasive pT4 thyroid cancers necessitates the use of frozen section analysis (FSA). There is no standardized method for intraoperative surgical margin assessment. We developed a novel intraoperative workflow and software platform, MarginView3D^TM (MV3D), to enhance the precision of FSA and improve surgical pathology reporting in head and neck cancer. Here, we demonstrate its use in invasive thyroid cancer.</p><p><strong>Methods: </strong>We describe the MV3D^TM surgical pathology reporting software and detail our surgical workflow, which incorporates 3D scanning technology and standardized \"timeouts\" to facilitate intraoperative communication and pathologic documentation. This approach was utilized in five invasive pT4 thyroid cancer cases.</p><p><strong>Results: </strong>MV3D^TM was used to guide intraoperative margin assessment, communication, and pathologic documentation in four tracheal resections and one sternal mass resection. A final surgical pathology report was generated for each case, integrating 3D scans, annotated radiographs, and audiovisual summaries into a dynamic interface for multidisciplinary use. We highlight case 5, where MV3D^TM facilitated bidirectional communication between the surgeon and pathologist to guide precise harvesting of supplemental margins. The surgeon and pathologist collaborated in real time to address at-risk areas requiring immediate re-resection. An R0 resection was achieved, and all relevant details were captured within MV3D^TM.</p><p><strong>Conclusions: </strong>We have utilized our novel approach extensively in head and neck cancer. Here, we highlight it as a tool for the management of invasive pT4 thyroid cancer. As a brief summary of new and innovative research, this study introduces MV3D^TM as a novel and scalable approach to intraoperative margin assessment and documentation in advanced thyroid cancer, with the potential to inform future practice in surgical oncology.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"467-470"},"PeriodicalIF":6.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147390861","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":"Patient-Reported Outcomes Three Years After Deciding on Surgery or Active Surveillance for Small, Low-Risk Papillary Thyroid Cancer: Results of a Prospective Cohort Study.","authors":"Anna M Sawka, Sangeet Ghai, Lorne Rotstein, Jonathan C Irish, Jesse D Pasternak, Katherine Lajkosz, Wei Xu, Jennifer M Jones, Amiram Gafni, Nancy N Baxter, David P Goldstein","doi":"10.1177/10507256251408857","DOIUrl":"10.1177/10507256251408857","url":null,"abstract":"<p><strong>Background: </strong>Long-term quality of life is an important consideration of patients in deciding on disease management options for low-risk papillary thyroid cancer (PTC).</p><p><strong>Methods: </strong>We conducted a prospective cohort study of Canadian patients who were diagnosed with small (<2 cm in maximal diameter), low-risk papillary thyroid cancer (PTC) and were given the choice of active surveillance (AS) or immediate surgery. We report the results of a self-administered questionnaire on patient-reported outcomes (PROs) that was completed approximately three years after the initial disease management choice. PROs included overall and subscale scores from questionnaires, including those on quality of life (EORTC QLQ-C30, EORTC THY-34), the Assessment of Survivor Concerns, the Decision Regret Scale, and the Generalized Anxiety Disorder 7-item Scale. We compared the results according to the initial disease management choice and according to the disease management status at the time of questionnaire completion.</p><p><strong>Results: </strong>The participant response rate was 64% (120/188), including 98 individuals who chose AS and 22 who chose immediate surgery. The median duration of follow-up at the time of questionnaire completion was 42 months (interquartile range [IQR] = 39, 46). After statistical adjustment for multiple comparisons, there were no significant differences in the overall scores or subscales of any of the questionnaires between patients who chose AS and those who chose immediate surgery. However, in a secondary analysis, patients who crossed over from AS to surgery experienced greater cancer-related worry as well as overall worry (<i>p</i> = 0.021 for each) and decision regret (<i>p</i> = 0.031) as compared with patients who remained under AS and those who initially chose surgery.</p><p><strong>Conclusions: </strong>We observed that PROs do not significantly differ between patients who chose AS and those who chose immediate surgery a few years after the initial disease management choice. However, patients who crossover from AS to surgery may experience greater cancer-related worry and decision regret.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"385-396"},"PeriodicalIF":6.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435641","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}