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Trends in Survival and Factors Associated with Survival in Primary Thyroid Lymphoma: A SEER-Based Analysis (1975-2021). 原发性甲状腺淋巴瘤的生存趋势和相关生存因素:基于seer的分析(1975-2021)。
IF 6.7 1区 医学
Thyroid Pub Date : 2025-09-01 Epub Date: 2025-07-30 DOI: 10.1177/10507256251363141
Freddy J K Toloza, Sriram Gubbi, Joanna Klubo-Gwiezdzinska
{"title":"Trends in Survival and Factors Associated with Survival in Primary Thyroid Lymphoma: A SEER-Based Analysis (1975-2021).","authors":"Freddy J K Toloza, Sriram Gubbi, Joanna Klubo-Gwiezdzinska","doi":"10.1177/10507256251363141","DOIUrl":"10.1177/10507256251363141","url":null,"abstract":"<p><p><b><i>Background:</i></b> Primary thyroid lymphoma (PTL) is a rare malignancy, comprising less than 5% of all thyroid cancers and about 2.5% of lymphomas. Historically, treatment with surgery and radiation yielded poor outcomes. The advent of combined chemotherapy and radiation has improved survival, but long-term trends and prognostic factors remain underexplored. This study aimed to characterize the clinical and demographic features of PTL, evaluate changes in survival over time, and identify factors independently associated with survival. <b><i>Methods:</i></b> A retrospective cohort study was conducted using Surveillance, Epidemiology, and End Results data from PTL patients aged ≥20 years, diagnosed between 1975 and 2021. Variables analyzed included age, sex, race/ethnicity, lymphoma subtype, stage, and treatment modality. Survival outcomes were estimated using Kaplan-Meier curves, and Cox proportional hazards models were used to identify factors associated with survival. Treatment was categorized as chemotherapy plus radiation (with or without surgery), chemotherapy alone, radiation alone, or no treatment. <b><i>Results:</i></b> A total of 2465 patients were included; 76% (<i>n</i> = 1,874) were diagnosed from 2001 to 2021. Median age at diagnosis was 67 years (interquartile range [IQR]: 56-77); 69.9% (<i>n</i> = 1723) were female, and 88.8% (<i>n</i> = 2189) were White. The most common subtype was diffuse large B-cell lymphoma (62.5%, <i>n</i> = 1540). Median follow-up was 83 months (IQR: 24-156). Median overall survival (OS) was 150 months, with 1-, 5-, and 10-year OS rates of 84.9%, 72.9%, and 57.7%, respectively. Disease-specific survival (DSS) rates at the same time points were 89.1%, 83.7%, and 80.5%. Survival significantly improved for patients diagnosed after 2000 (<i>p</i> < 0.001). Variables associated with poorer DSS survival included age ≥70 years (hazard ratio [HR] = 5.77; confidence interval [CI] 2.71-12.32, <i>p</i> < 0.001), regional metastatic disease (HR = 1.45; CI 1.04-2.02; <i>p</i> = 0.03) and distant metastatic disease (HR = 1.53; CI 1.17-1.99; <i>p</i> = 0.002). The highest 10-year DSS (86.6%) was seen in those receiving combined chemotherapy and radiation, outperforming chemotherapy alone (77.2%), radiation alone (77.0%), and no treatment (68.2%). <b><i>Conclusion:</i></b> PTL survival has significantly improved in recent decades, which may reflect both advances in treatment, particularly the combined use of chemotherapy and radiation, and shifts in disease presentation, including earlier diagnosis and changes in stage distribution.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"1074-1082"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754370","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}
引用次数: 0
Thyroid Hormone Analogs: Recent Developments. 甲状腺激素类似物:最新进展。
IF 6.7 1区 医学
Thyroid Pub Date : 2025-09-01 Epub Date: 2025-07-14 DOI: 10.1089/thy.2025.0245
Matthijs E T Freund, Floor van der Most, Stefan Groeneweg, Ferdy S van Geest, W Edward Visser
{"title":"Thyroid Hormone Analogs: Recent Developments.","authors":"Matthijs E T Freund, Floor van der Most, Stefan Groeneweg, Ferdy S van Geest, W Edward Visser","doi":"10.1089/thy.2025.0245","DOIUrl":"10.1089/thy.2025.0245","url":null,"abstract":"<p><p><b><i>Background:</i></b> Thyroid hormone exerts its function on virtually all tissues in the human body through binding to the thyroid hormone receptor (TR), making it an interesting vehicle for therapeutic intervention in nonthyroid conditions with metabolic consequences, as well as genetic thyroid hormone signaling disorders. Since the 1990s, several thyroid hormone analogs have been developed that have tissue specificity. Given the recent approval of two thyroid hormone analogs, the aim of this review is to give an update on developments in the field since 2020. <b><i>Summary:</i></b> Although initial therapeutic use of thyroid hormone analogs for nonthyroid conditions with metabolic consequences focused on cardiovascular disease and dyslipidemia, nowadays the primary focus is on the treatment of metabolic dysfunction-associated steatohepatitis (MASH). Clinical trials with MGL-3196 (resmetirom) showed significant improvement on hepatic steatosis, fibrosis, and lipids, which led to approval by the U.S. Food and Drug Administration in 2024 for the treatment of MASH. Results are currently awaited for prodrug VK2809, exerting organ specificity through prodrug conversion in the liver, ultimately targeting MASH. For the treatment of genetic thyroid hormone signaling disorders (resistance to thyroid hormone β [RTHβ] and monocarboxylate transporter 8 [MCT8] deficiency), different thyroid hormone analogs have been tested. 3,5,3'-triiodothyroacetic acid (Triac), an endogenous thyroid hormone analog, has been prescribed on a compassionate use basis for RTHβ. In MCT8 deficiency, 3,5-diiodothyropropionic acid has been explored in patients, and Sob-AM2, a prodrug of which the active compound accumulates in the brain, has been investigated in preclinical studies. Recently, the European Medicines Agency has granted market authorization for Triac, being the first approved medicine for this rare disease. <b><i>Conclusions:</i></b> Ongoing strategies to enhance organ specificity of thyroid hormone analogs should include not only TR specificity but also other determinants of tissue selectivity, such as tissue-specific transporters or enzymes that activate the prodrug. This, together with the recent approval of two thyroid hormone analogs, may ensure a promising future for the development and application of thyroid hormone analogs.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"990-1002"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627143","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}
引用次数: 0
The Point Scale for Thyroid Storm-32 Years and (Still) Counting. 甲状腺风暴的分值量表-32年和(仍在)计数。
IF 6.7 1区 医学
Thyroid Pub Date : 2025-09-01 Epub Date: 2025-08-06 DOI: 10.1177/10507256251367267
Henry B Burch
{"title":"The Point Scale for Thyroid Storm-32 Years and (Still) Counting.","authors":"Henry B Burch","doi":"10.1177/10507256251367267","DOIUrl":"10.1177/10507256251367267","url":null,"abstract":"","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"987-989"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790047","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}
引用次数: 0
Letter: Prolonged Treatment with Sirolimus (Rapamycin) for Graves' Orbitopathy. 信:西罗莫司(雷帕霉素)长期治疗Graves眼病。
IF 6.7 1区 医学
Thyroid Pub Date : 2025-09-01 Epub Date: 2025-07-29 DOI: 10.1177/10507256251363145
Dalì Antonia Ciampa, Simone Comi, Giada Cosentino, Francesca Menconi, Michele Marinò
{"title":"<i>Letter:</i> Prolonged Treatment with Sirolimus (Rapamycin) for Graves' Orbitopathy.","authors":"Dalì Antonia Ciampa, Simone Comi, Giada Cosentino, Francesca Menconi, Michele Marinò","doi":"10.1177/10507256251363145","DOIUrl":"10.1177/10507256251363145","url":null,"abstract":"","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"1095-1096"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733416","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}
引用次数: 0
Thyroid Cancer Survivors Experience Persistent Symptoms and Health-Related Quality-of-Life Deficits 12 Months Following Surgery. 甲状腺癌幸存者在手术后12个月经历持续的症状和健康相关的生活质量缺陷。
IF 6.7 1区 医学
Thyroid Pub Date : 2025-09-01 Epub Date: 2025-07-10 DOI: 10.1089/thy.2025.0149
Christine J O'Neill, Christopher W Rowe, Harriet Morris-Baguley, Melissa A Carlson, Sarah Leask, Tara Clinton-McHarg, Elizabeth Holliday, Elizabeth A Fradgley, Christine L Paul
{"title":"Thyroid Cancer Survivors Experience Persistent Symptoms and Health-Related Quality-of-Life Deficits 12 Months Following Surgery.","authors":"Christine J O'Neill, Christopher W Rowe, Harriet Morris-Baguley, Melissa A Carlson, Sarah Leask, Tara Clinton-McHarg, Elizabeth Holliday, Elizabeth A Fradgley, Christine L Paul","doi":"10.1089/thy.2025.0149","DOIUrl":"10.1089/thy.2025.0149","url":null,"abstract":"<p><p><b><i>Background:</i></b> Thyroid cancer survivors may experience significant health-related quality-of-life (HRQoL) detriments. Currently available HRQoL survey tools, used in isolation, can be insensitive to change over time and may incompletely assess thyroid cancer-specific symptoms and fear of cancer recurrence. This study aimed to measure the trajectory of HRQoL changes in thyroid cancer survivors using repeated measures, comparing commonly used surveys, over the first 12-18 months following diagnosis. <b><i>Methods:</i></b> A prospective longitudinal cohort study recruited all patients with newly diagnosed thyroid cancer (excluding low-risk papillary thyroid microcarcinoma and anaplastic thyroid cancer) from a mixed metropolitan and regional health district (public and private). Patients were invited to complete Short Form-12 (SF-12), EORTC-QLQ-C30, Thyroid Cancer Quality of Life (ThyCaQoL) Survey, City of Hope-Thyroid Version, and Assessment of Survivor Concerns surveys postoperatively, and at 3, 6, and 12 months. Responses were assessed for changes over time, and multivariable analysis was used to identify variables associated with outcomes at follow-up. <b><i>Results:</i></b> Between January 2021 and June 2023, 111 patients completed surveys at a minimum of one time point (response rate 59%). Most were female (72%), mean age 55 years, 56% metropolitan, 56% privately insured, 55% American Thyroid Association low-risk differentiated thyroid cancer. Treatment included surgery (total thyroidectomy 49%, two-stage thyroidectomy 24%, lobectomy 25%, active surveillance 2%); 58% received radioactive iodine ablation. At the completion of the study, 82% were euthyroid and 92% disease-free. At all time points, SF-12 physical and mental component scores (PCS and MCS), remained below normative population values (>12 months; mean PCS = 39.4, mean MCS = 46.7, normative = 50). MCS showed more consistent improvement over the first year following thyroid cancer diagnosis (global <i>p</i> = 0.03). ThyCaQoL surveys identified improvement in voice and scar symptoms (<i>p</i> < 0.01 each), but distress regarding neuromuscular (<i>p</i> < 0.01), sensory symptoms (<i>p</i> = 0.01), and weight gain (<i>p</i> = 0.04) worsened over the course of the study. Fear of cancer recurrence was common and persisted over time. <b><i>Conclusion:</i></b> A year after diagnosis, thyroid cancer survivors have persisting HRQoL deficits with some symptoms worsening over time. As part of follow-up care, clinicians should specifically inquire about persistent symptoms that could affect HRQoL. Supportive care interventions for those with persistent HRQoL deficits are required.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"1039-1051"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601694","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}
引用次数: 0
Clinical and Pathological Factors Associated with Disease Persistence in Pediatric Patients with Differentiated Thyroid Carcinoma. 小儿分化型甲状腺癌患者疾病持续性的临床及病理因素
IF 6.7 1区 医学
Thyroid Pub Date : 2025-09-01 Epub Date: 2025-07-30 DOI: 10.1177/10507256251363978
Simone De Leo, Valeria Bottici, Gabriella Pellegriti, Marco Russo, Caterina Mian, Federica Vianello, Barbara Puligheddu, Gerdi Tuli, Rita Ortolano, Maria Grazia Castagna, Carlotta Pozza, Malgorzata Gabriela Wasniewska, Manlio Cabria, Vincenzo Rochira, Giulia Brigante, Francesco Felicetti, Maria Cristina Vigone, Maria Chiara Zatelli, Gerardo Esposito, Alessia Dolci, Emanuela Arvat, Francesco Giorgino, Marcello Giachetti, Maria Laura Tanda, Laura Fugazzola, Rossella Elisei
{"title":"Clinical and Pathological Factors Associated with Disease Persistence in Pediatric Patients with Differentiated Thyroid Carcinoma.","authors":"Simone De Leo, Valeria Bottici, Gabriella Pellegriti, Marco Russo, Caterina Mian, Federica Vianello, Barbara Puligheddu, Gerdi Tuli, Rita Ortolano, Maria Grazia Castagna, Carlotta Pozza, Malgorzata Gabriela Wasniewska, Manlio Cabria, Vincenzo Rochira, Giulia Brigante, Francesco Felicetti, Maria Cristina Vigone, Maria Chiara Zatelli, Gerardo Esposito, Alessia Dolci, Emanuela Arvat, Francesco Giorgino, Marcello Giachetti, Maria Laura Tanda, Laura Fugazzola, Rossella Elisei","doi":"10.1177/10507256251363978","DOIUrl":"10.1177/10507256251363978","url":null,"abstract":"<p><p><b><i>Background:</i></b> Differentiated thyroid carcinoma (DTC) in pediatric patients has specific clinical, pathological, and molecular characteristics, making its management different from that of adults. Our study aimed to evaluate the outcome and factors associated with persistent disease in a large cohort of pediatric patients. <b><i>Methods:</i></b> We performed a multicenter retrospective cohort study, including patients aged ≤18 years, diagnosed with a DTC, since January 2000. Both biochemical (BIR) and structural (SIR) incomplete responses were evaluated. <b><i>Results:</i></b> We included 538 patients, 401/538 (74.5%) females, with a median age of 15 years (interquartile range [IQR] 13-17 years). Papillary thyroid cancer was the most prevalent histotype and 277/530 (52.3%) had lymph node metastases at diagnosis. Vascular invasion and gross extrathyroidal extension (ETE) were reported in 133/326 (40.8%) and 91/533 (17.1%) of patients, respectively. T4 tumors represented 5% of the entire cohort. Radioactive iodine treatment (RAIT) was administered to 493/533 (92.5%) patients, and among them 138/493 (28%) received more than one RAIT cycle. After a median follow-up of 85 months (IQR 42-126 months), 414/538 patients (77%) had no evidence of disease and 124/538 patients (23.0%) a disease persistence: BIR in 68/538 patients (12.6%) and SIR in 56/538 patients (10.4%). In a multivariable analysis, the features significantly associated with persistent disease (BIR or SIR) were gross ETE (odds ratio [OR] 2.81, confidence interval [CI] 1.49-5.32, <i>p</i> = 0.0015) and lymph node uptake at whole-body scan (WBS) after the first RAIT (OR 3.31, CI 1.77-6.19, <i>p</i> = 0.0002). Multivariable analysis showed that the features significantly associated with SIR were T4 tumor (OR 4.3, CI 1.38-13.44, <i>p</i> = 0.01) and lymph node uptake at WBS after the first RAIT (OR 3.39, CI 1.5-7.67, <i>p</i> = 0.003). <b><i>Conclusions:</i></b> Our study of a very large series of pediatric DTC with long follow-up provides valuable insights into the clinical and pathological features associated with disease persistence. We identified T4 tumor, lymph node uptake on WBS, and gross ETE as independent factors associated with persistent disease. These findings emphasize the importance of careful risk stratification in pediatric DTC, allowing for more individualized treatment approaches.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"1013-1023"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754369","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}
引用次数: 0
First-in-Human Clinical Feasibility Study of Ablation of Benign Thyroid Nodules Using Nanosecond Pulsed Field Ablation. 应用纳秒脉冲场消融治疗良性甲状腺结节的首次人体临床可行性研究。
IF 6.7 1区 医学
Thyroid Pub Date : 2025-09-01 Epub Date: 2025-08-21 DOI: 10.1177/10507256251372166
Stefano Spiezia, Chiara Offi, Claudia Misso, Giovanni Antonelli, Richard Nuccitelli, Ralph P Tufano, William A Knape
{"title":"First-in-Human Clinical Feasibility Study of Ablation of Benign Thyroid Nodules Using Nanosecond Pulsed Field Ablation.","authors":"Stefano Spiezia, Chiara Offi, Claudia Misso, Giovanni Antonelli, Richard Nuccitelli, Ralph P Tufano, William A Knape","doi":"10.1177/10507256251372166","DOIUrl":"10.1177/10507256251372166","url":null,"abstract":"<p><p><b><i>Background:</i></b> Thyroid nodules are common in the general population, and most are benign. Thyroidectomy remains the most common treatment for symptomatic benign thyroid nodular disease. The objective of this study is to determine if a novel, cell-specific, nonthermal modality called nanosecond pulsed field ablation (nsPFA) can provide a safe and effective treatment for symptomatic thyroid nodules. <b><i>Methods:</i></b> In this clinical feasibility trial (NCT06117085), an nsPFA percutaneous electrode was used to ablate benign thyroid nodules under ultrasound guidance. In Cohort 1 (5 patients), ablations were created during a thyroidectomy procedure (treat-and-resect), so that initial ablation zone characterization could be assessed histologically. In Cohort 2 (20 patients), up to 4 isolated ablations were created in the <i>in situ</i> thyroid for dose-ranging and to allow for estimation of ablation zone volume. In Cohort 3 (5 patients), the entire nodule was ablated with therapeutic intent using multiple, overlapping ablations for resolution of symptoms. <b><i>Results:</i></b> For Cohort 1, the mean ablation zone measured 1.7 cm long by 0.7 cm wide post-ablation. For Cohort 2, the mean ablation zone was estimated to be 2.7 cc in volume at 90 days post-ablation (based on nodule size reduction from baseline). Transient dysphonia (<24 hours) was seen in two patients treated at the highest ablation setting (93 mJ/mm<sup>2</sup>). For Cohort 3, treated nodules had a mean volume reduction of 48.2% as early as 2 weeks, and 71.1% at 1 month and 85.8% at 1 year. Patients could typically resume normal activities on the same day. There was no transient dysphonia in this group. Noticeable volume reduction and relief of symptoms were seen as early as 2 weeks post-treatment. No fibrosis or scars were seen on follow-up ultrasounds. No serious adverse events were reported for any cohorts. <b><i>Conclusions:</i></b> This first-in-human study supports the initial safety/efficacy profile of the nsPFA electrode system in treating benign thyroid nodules. The minimally invasive and nonthermal nature of nsPFA energy has the potential to reduce risk of major complications in treatment of benign thyroid nodules as compared with thyroidectomy or thermal ablation and to improve healing through rapid reduction ofablated areas and lack of postprocedural scarring.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"1024-1029"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970197","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}
引用次数: 0
Variable Diagnoses in Cases Referred for Discordant Thyroid Function Tests: Focus on Lymphoproliferative Disorders. 不一致甲状腺功能检查病例的可变诊断:关注淋巴增生性疾病。
IF 6.7 1区 医学
Thyroid Pub Date : 2025-09-01 Epub Date: 2025-07-30 DOI: 10.1177/10507256251364557
Antonio Musolino, Giacomo Fabio Antonio Grifoni, Simone Rodolfi, Massimiliano Andreasi, Ilaria Bulgarelli, Flaminia Fanelli, Valentina Morelli, Luca Persani, Irene Campi
{"title":"Variable Diagnoses in Cases Referred for Discordant Thyroid Function Tests: Focus on Lymphoproliferative Disorders.","authors":"Antonio Musolino, Giacomo Fabio Antonio Grifoni, Simone Rodolfi, Massimiliano Andreasi, Ilaria Bulgarelli, Flaminia Fanelli, Valentina Morelli, Luca Persani, Irene Campi","doi":"10.1177/10507256251364557","DOIUrl":"10.1177/10507256251364557","url":null,"abstract":"<p><p><b><i>Background:</i></b> Careful consideration of the differential diagnosis of discordant thyroid function tests (TFTs) is fundamental to prevent mismanagement, waste of resources, uncover rare thyroid disorders, or other underlying critical conditions in patients referred for the evaluation of this issue. Here, we describe the frequency of underlying diagnoses and focus on cases in which the identification of analytical interferences led to the discovery of lymphoproliferative disorders. <b><i>Methods:</i></b> This is a retrospective cross-sectional study including all consecutive patients referred to the Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, for suspected central hyperthyroidism between January 2017 and February 2025. Inclusion criteria were based on laboratory findings of (1) elevated or inappropriately normal thyrotropin (TSH) with high FT4 and/or FT3, (2) elevated TSH with FT4 in the upper reference range, and (3) failure of TSH to normalize despite levothyroxine therapy, along with rising FT4 levels. The differential diagnosis was made by (1) reassessment of discrepant results in the hormone panel by different analytical methods or tandem mass spectrometry; (2) serum serial dilution or polyethylene glycol precipitation; (3) evaluation of rheumatoid factor, serum protein electrophoresis (SPEP), and cryoglobulins; and (4) deep clinical phenotyping and/or confirmatory genetic testing, as appropriate. <b><i>Results:</i></b> Among 144 patients referred for discordant TFTs mimicking central hyperthyroidism, 44% were genuine rare thyroid disorders-32% with resistance to thyroid hormone beta (RTHβ), 7% with TSH-secreting adenomas, and 5% other diagnosis-and 56% had assay interference. In this latter group, interfering clonal paraproteins were detected in 6/81 cases. One patient was ultimately diagnosed with multiple myeloma, another one with type 1 cryoglobulinemia due to indolent marginal zone B non-Hodgkin lymphoma, and the remaining four cases were found to have monoclonal gammopathy of uncertain significance. The clonal paraprotein was an IgM kappa/lambda in five cases and IgG kappa or IgA kappa in one case, respectively. <b><i>Conclusions:</i></b> In patients referred for discordant TFTs, RTHβ is the most prevalent thyroid disorder, but variable assay interferences represent the most frequent condition. In these cases, SPEP and hematological investigations are highly recommended.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"1003-1012"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754371","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}
引用次数: 0
Mortality Risks Associated with Antithyroid Drugs, Radioactive Iodine, and Surgery for Hyperthyroidism: A Systematic Review and Network Meta-Analysis. 抗甲状腺药物、放射性碘和甲状腺功能亢进手术相关的死亡率风险:系统综述和网络荟萃分析。
IF 6.7 1区 医学
Thyroid Pub Date : 2025-09-01 DOI: 10.1177/10507256251372193
Carol Chiung-Hui Peng, Brianna R Spiegel, David Flynn, Huei-Kai Huang, Ching-Hui Loh, Peter Pin-Sung Liu, Elizabeth N Pearce
{"title":"Mortality Risks Associated with Antithyroid Drugs, Radioactive Iodine, and Surgery for Hyperthyroidism: A Systematic Review and Network Meta-Analysis.","authors":"Carol Chiung-Hui Peng, Brianna R Spiegel, David Flynn, Huei-Kai Huang, Ching-Hui Loh, Peter Pin-Sung Liu, Elizabeth N Pearce","doi":"10.1177/10507256251372193","DOIUrl":"https://doi.org/10.1177/10507256251372193","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Hyperthyroidism can be treated with antithyroid drugs (ATD), radioactive iodine (RAI), or surgery. We aimed to evaluate the long-term outcomes of these treatments through a systematic review and network meta-analysis (NMA). <b><i>Methods:</i></b> A systematic literature search of PubMed, EMBASE, Web of Science, and the Cochrane Library (from inception to March 7, 2025) was conducted to identify studies comparing the risks of all-cause mortality, cardiovascular mortality, major adverse cardiovascular events (MACE), and cancer mortality among patients with hyperthyroidism treated with ATD, RAI, or surgery. Pooled effect estimates were expressed as hazard ratios (HR) with confidence intervals (CI) using a random-effects model. The study was registered with PROSPERO (CRD420250543380) and adhered to the PRISMA-NMA guidelines. <b><i>Results:</i></b> Of the 8163 studies screened, 12 observational studies with an overall moderate risk of bias, comprising 192,208 patients were included in this NMA. Most patients received ATD (<i>n</i> = 142,622), followed by RAI (<i>n</i> = 19,303) and surgery (<i>n</i> = 10,360). Surgery was associated with decreased risks of all-cause mortality and cardiovascular mortality compared with both ATD and RAI. For all-cause mortality, the pooled HRs (CI, <i>p</i>-values) were 0.58 (0.45-0.75, <i>p</i> < 0.0001) for surgery versus ATD and 0.68 (0.56-0.84, <i>p</i> = 0.0004) for surgery versus RAI. For cardiovascular mortality, the pooled HR (CI, <i>p</i>-values) were 0.43 (0.19-0.98, <i>p</i> = 0.0445) for surgery versus ATD and 0.55 (0.33-0.93, <i>p</i> = 0.0269) for surgery versus RAI. No significant differences were observed in MACE or cancer mortality across the treatment groups. <b><i>Conclusions:</i></b> In patients with hyperthyroidism, surgery was associated with significantly decreased risks of all-cause mortality and cardiovascular mortality compared with ATD and RAI. Risks of MACE and cancer mortality did not differ by type of hyperthyroidism treatment. However, these findings should be interpreted with caution due to inherent methodological limitations of observational studies, including, but not limited to heterogeneity and potential selection bias.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970229","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}
引用次数: 0
Corrigendum to: 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. 2016年美国甲状腺协会甲状腺功能亢进和甲状腺毒症其他原因诊断和治疗指南的勘误表。
IF 6.7 1区 医学
Thyroid Pub Date : 2025-09-01 Epub Date: 2025-08-06 DOI: 10.1089/thy.2016.0229.correx2
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引用次数: 0
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