Thyroid最新文献

{"title":"Clinically Significant Central Lymph Node Metastasis is Not Common in Patients with Clinically N0 Papillary Thyroid Carcinoma on Both Ultrasonography and CT.","authors":"Byung-Chang Kim, Shin Jeong Pak, Douk Kwon, Won Woong Kim, Yu-Mi Lee, Tae-Yon Sung, Won Gu Kim, Won Bae Kim, Jung Hwan Baek, Jeong Hyun Lee, Young Jun Choi, Dong Eun Song, Ki-Wook Chung","doi":"10.1089/thy.2024.0484","DOIUrl":"10.1089/thy.2024.0484","url":null,"abstract":"<p><p><b><i>Background:</i></b> The necessity of prophylactic central lymph node dissection (p-CLND) in patients with clinically node-negative papillary thyroid carcinoma (PTC) is unclear. The present study evaluated the central lymph node (LN) metastases status in patients with clinically node-negative PTC on both preoperative thyroid ultrasonography (USG) and neck computed tomography (CT) who underwent p-CLND. <b><i>Methods:</i></b> This retrospective cohort study included 3002 clinically node-negative patients diagnosed with PTC who had undergone thyroidectomy with p-CLND from January 2000 to September 2022. Clinically node-negative was defined as the absence of suspicious metastatic LNs on preoperative USG and neck CT. Low-risk central LN metastases were defined as LN metastases <2 mm in size with metastatic LNs ≤5. The median follow-up duration was 4.52 (interquartile range [IQR]: 1.6-7.5) years. <b><i>Results:</i></b> Of the 3002 patients, 1194 (39.7%) had central LN metastases, whereas 1808 (60.3%) did not. The 1194 patients with central LN metastases included 507 (16.9%) with intermediate-risk metastases and 610 (20.3%) with low-risk LN metastases, with a total of 2428 (80.5%) patients having low-risk LN metastases or no central LN metastases. High-risk metastases were observed in only 77 (2.5%) patients. Of the 584 patients with intermediate-/high-risk metastases, 577 (98.8%) had central LN metastases <1 cm in size, whereas only 7 (1.2%) had central LN metastases ≥1 cm. The disease recurrence rates for the no LN metastases, low-risk LN metastases, and intermediate-/high-risk LN metastases groups were 0.4%, 1.1%, and 1.9%, respectively (<i>p</i> = 0.012). Factors independently associated with intermediate-/high-risk central LN metastases included age <55 years (odds ratio [OR] = 2.29), male sex (OR = 2.33), tumor size >1 cm on USG (OR = 1.94), and the presence of extrathyroidal extension on CT scans (OR = 1.53), with <i>p</i> < 0.001 for all factors. <b><i>Conclusions:</i></b> Most LNs confirmed after CLND in cN0 PTC patients assessed by USG and CT were either metastasis-free or classified as low-risk metastatic LNs. Furthermore, the majority of metastatic LNs were small in size, typically measuring <1 cm. p-CLND may be unnecessary if preoperative thyroid USG and neck CT show no evidence of central neck LN metastaes.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"415-423"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754439","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 Response to Intravenous Glucocorticoids in Active Moderate-to-Severe Thyroid Eye Disease.","authors":"Natalia Baczewska, Orsalia Alexopoulou, Stefan M Constantinescu, Chantal Daumerie, Maëlle Coutel, Antonella Boschi, Maria-Cristina Burlacu","doi":"10.1089/thy.2024.0629","DOIUrl":"10.1089/thy.2024.0629","url":null,"abstract":"<p><p><b><i>Background:</i></b> Intravenous glucocorticoids (IVGCs) are the first-line treatment for active moderate-to-severe thyroid eye disease (TED) in many countries worldwide, mainly because of their anti-inflammatory efficacy. <b><i>Methods:</i></b> Retrospective cohort study of 64 patients with active moderate-to-severe TED, without dysthyroid optic neuropathy, treated between 2003 and 2023 at a single tertiary centre with the 12 weeks IVGC EUGOGO (European Group on Graves Orbitopathy) protocol. All patients were evaluated for response to IVGC according to the clinical judgment (CL) and 44/64 (69%) patients were also evaluated with the EUGOGO 2021 revised composite index (CI). <b><i>Results:</i></b> The mean patients' age at IVGC initiation was 51.7 ± 11 years, 47/64 (73.5%) were women, 56/64 (87.5%) were Caucasians, and 33/64 (51.5%) were active smokers. At 6 months after IVGC, 48 out of 64 (75%) patients evaluated with CL and 32 out of 44 (73%) patients evaluated with EUGOGO CI responded to the treatment. Nonresponders tended to be older than responders (56.6 ± 10.2 vs. 50.1 ± 10.8 years, <i>p</i> = 0.040 for CL and 56.5 ± 11.9 vs. 50.3 ± 11.6 years, <i>p</i> = 0.131 for EUGOGO CI) and had higher clinical activity score (CAS) before IVGC (5.0 ± 1.1 vs.4.2 ± 1.1, <i>p</i> = 0.022 for CL and 4.7 ± 0.6 vs. 3.1 ± 0.8, <i>p</i> < 0.001 for EUGOGO CI). In patients evaluated with CL or EUGOGO CI, respectively, multivariable logistic regression identified age at IVGC initiation (odds ratio [OR] = 0.92 [95% confidence interval (CI) 0.86-0.99], <i>p</i> = 0.024 and OR = 0.88 [CI 0.77-0.99], <i>p</i> = 0.046) and CAS before IVGC (OR = 0.53 [CI 0.31-0.90], <i>p</i> = 0.021 and OR= 0.08 [CI 0.01-0.38], <i>p</i> = 0.001) but not active smoking as independent factors associated with response to IVGC. The optimal cut-off associated with poorer response to IVGC was CAS ≥4.5/7 (66.7% specificity, 56.3% sensitivity; Area Under the Curve [AUC] = 0.689 [CI 0.54-0.83], <i>p</i> = 0.010) in patients evaluated with CL and CAS ≥3.5/5 (65.6% specificity, 91.7% sensitivity; AUC = 0.910 [CI 0.80-1.01], <i>p</i> < 0.001) in patients evaluated with EUGOGO CI. <b><i>Conclusion:</i></b> Older age and higher CAS before treatment were associated with poorer response to IVGC. Patients with these characteristics could be offered other immunotherapies as a first-line treatment for active moderate-to-severe TED.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"424-432"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575992","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":"Two Different Shades of Anaplastic Thyroid Cancer.","authors":"Iñigo Landa","doi":"10.1089/thy.2025.0097","DOIUrl":"10.1089/thy.2025.0097","url":null,"abstract":"","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"344-345"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664359","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":"Composition and Priorities of Multidisciplinary Pediatric Thyroid Programs: A Consensus Statement.","authors":"Ronik Kothari, Julia R Donner, Karthik Balakrishnan, Gary Hartman, Adina Alazraki, Zoltan Antal, Andrew Bauer, Daniel Chelius, Christine Cherella, John P Dahl, Amy Dimachkieh, Larry A Fox, Sara Helmig, Wen Jiang, Ken Kazahaya, Theodore W Laetsch, Maya Lodish, Priya Mahajan, Lauren Parsons, Kara Prickett, Lourdes Quintanilla-Dieck, Jeffrey Rastatter, David H Rothstein, Jeffrey Simons, Anthony Sheyn, Amy Wagner, Steven G Waguespack, Jonathan D Wasserman, Ari J Wassner, Hilary Seeley, Kara D Meister","doi":"10.1089/thy.2024.0496","DOIUrl":"10.1089/thy.2024.0496","url":null,"abstract":"<p><p><b><i>Background:</i></b> The incidence of pediatric thyroid cancer has been increasing, and care varies due to socioeconomic disparities or differing practice patterns. Clinical guidelines call for care in multidisciplinary teams to minimize variance and provide protocols. Based on expert opinion, we hope to describe the form and function of such multidisciplinary teams for pediatric thyroid programs. <b><i>Methods:</i></b> A modified Delphi method to reach consensus statements over two rounds. Twenty-one experts with varying backgrounds responded to each statement on a 9-point Likert scale. Upon completion of the survey, the panel reviewed and shared the results and comments from participants and modified the statements accordingly. This process was repeated such that statements reached consensus, were deemed no consensus, or had no change in the mean. <b><i>Results:</i></b> There was an 88% and 83% completion rate for Rounds 1 and 2, respectively. A consensus was observed that there is a distinct definable model of care for pediatric thyroid patients. No consensus was reached for the age range of patients, but programs should care for children with medullary thyroid cancer, differentiated thyroid cancer, and patients with genetic predisposition syndromes. A comprehensive team includes, but is not limited to, a thyroid surgeon, a pediatric endocrinologist, a high-volume fine-needle aspiration (FNA) proceduralist, an oncologist, a nuclear medicine physician, a pediatric pathologist, a pediatric radiologist, and a nurse coordinator. Necessary support services involve care coordination, access to a multidisciplinary tumor board, ability to perform ultrasound-guided FNA, and access to molecular testing. The panel emphasized cross-institutional collaborative research prioritizing guidelines development, disease-specific outcomes, treatment toxicity, and the molecular landscape of thyroid cancer. <b><i>Conclusions:</i></b> These consensus statements can be beneficial in improving multidisciplinary care, by describing which elements of pediatric thyroid programs should be consistent across institutions. Overall, the panel agreed that pediatric thyroid centers should provide integrated care with defined team members, services, resources, and research priorities. This model has the potential to standardize various aspects of clinical care and enhance our ability to study patient outcomes, improve health care delivery, and increase scholarly collaboration.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"346-356"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415266","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":"A Clinical Nomogram to Predict Survival Outcomes in Patients with Well-Differentiated Thyroid Cancer.","authors":"Cristina Valero, Alana Eagan, Dauren Adilbay, Danielli Matsuura, Victoria Harries, Ashok R Shaha, Jatin P Shah, R Michael Tuttle, Darkhan Akhmedin, Renan Aguera Pinheiro, Leandro Luongo Matos, Luiz P Kowalski, Galym Adilbayev, Rabiga Kadyrbayeva, Snehal G Patel, Ian Ganly","doi":"10.1089/thy.2024.0486","DOIUrl":"10.1089/thy.2024.0486","url":null,"abstract":"<p><p><b><i>Background:</i></b> The current American Joint Committee on Cancer 8th edition staging system on thyroid cancer describes outcomes for populations of patients with well-differentiated thyroid cancer (WDTC) and not individual patients. The aim of this study was to create a clinical nomogram that can be used to predict survival in individual patients with WDTC. <b><i>Methods:</i></b> A single institutional cohort of 8535 patients with WDTC treated with primary surgery at the Memorial Sloan Kettering Cancer Center was used to create a predictive nomogram for disease-specific survival (DSS) as a retrospective cohort study. The nomogram was created using DSS as the dependent variable, and the independent variables used were sex, age, pathology subtype, and TNM stage. An external validation cohort of 519 patients from three different international centers was used to assess the accuracy and generalizability of the nomogram. <b><i>Results:</i></b> Sex, age, pathology subtype, T stage, N stage, and M stage were significant predictors of DSS on univariable analysis. The nomogram created using all these variables showed an extremely high concordance index (0.963; SE 0.012). This nomogram was validated on the external patient cohort with a high concordance index (0.810; SE: 0.070). <b><i>Conclusions:</i></b> We describe a predictive nomogram that accurately predicts DSS in individual patients with WDTC. The external validation illustrates its generalizability. This nomogram will help in counseling individual patients on prognosis and may identify patients who could benefit from more aggressive therapy.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"397-405"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416738","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 Usefulness of the International Grading System in the Management of Sporadic Medullary Thyroid Carcinoma.","authors":"Alessandro Prete, Liborio Torregrossa, Carla Gambale, Raffaele Ciampi, Teresa Ramone, Cristina Romei, Virginia Cappagli, Paolo Piaggi, Clara Ugolini, Gabriele Materazzi, Rossella Elisei, Antonio Matrone","doi":"10.1089/thy.2024.0444","DOIUrl":"10.1089/thy.2024.0444","url":null,"abstract":"<p><p><b><i>Background:</i></b> The international medullary thyroid carcinoma (MTC) grading system (IMTCGS) has been proposed as an independent tool to predict disease-specific survival (DSS), distant metastasis-free survival (DMFS), and locoregional recurrence-free survival (LRFS). We aimed to evaluate the performance of IMTCGS in our series of sporadic MTCs and to compare its predictive power with conventional prognostic factors. <b><i>Methods:</i></b> In a retrospective cohort study, we evaluated data from 314 patients with sporadic MTC, all managed at the Pisa University Hospital. We divided patients according to the extent of the disease at diagnosis into localized (183/314, 58.3%) (confined to the thyroid), regional (100/314, 31.8%) (limited to the neck, involving surrounding thyroid tissues and/or regional lymph nodes), and distant (31/314, 9.9%) (distant metastases) disease. Data about somatic mutations were available in 212/314 (67.5%) patients. Expert pathologists differentiated high- and low-grade tumors. <b><i>Results:</i></b> According to the IMTCGS, 115/314 (36.6%) had high- and 199/314 (63.4%) patients had low-grade tumors. Patients with high-grade tumors showed higher preoperative calcitonin levels compared with low-grade (542 vs. 76 pg/mL, <i>p</i> < 0.01) as well as larger tumor size (2.3 vs. 1.1 cm, <i>p</i> < 0.01) and more frequent multifocality (22.6 vs. 12.1%, <i>p</i> = 0.01), minimal extrathyroidal extension (30.4 vs. 9.5%, <i>p</i> < 0.01), and lymph node metastases (63.5 vs. 27.6%, <i>p</i> < 0.01). Overall, patients with high-grade showed lower DSS, LRFS, and DMFS (<i>p</i> < 0.01). Grouping the whole cohort according to different disease extent at diagnosis, only in the case of localized disease, patients with high-grade tumors had significantly lower LRFS compared with low-grade. Similarly, in the other subgroups, we did not identify any difference in DSS, LRFS, and DMFS. Moreover, in the case of <i>RET</i> aggressive mutations, no differences in DSS, LRFS, and DMFS were observed between high- and low-grade tumors. <b><i>Conclusions:</i></b> We confirmed the usefulness of IMTCGS in predicting DSS, LRFS, and DMFS. However, it finds the best utility in patients with a lower risk of recurrence and mortality, identifying those rare cases with more aggressive clinical behavior. Conversely, when laterocervical lymph nodes (N1), distant metastasis (M1), or <i>RET</i> mutations, particularly <i>M918T</i> or <i>indels</i>, are already present at diagnosis, the role of IMTCGS in predicting DSS, DMFS, and LRFS becomes less relevant.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"387-396"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reproductive Factors, Sex Hormone Levels, and Differentiated Thyroid Cancer Risk: A Mendelian Randomization Study.","authors":"See Hyun Park, Pierre-Emmanuel Sugier, Yazdan Asgari, Mojgan Karimi, Rudolf Kaaks, Renée Turzanski Fortner, Matthias Schulze, Claudia Agnoli, Fabrizio Pasanisi, Carlotta Sacerdote, Miguel Rodriguez-Barranco, Amaia Aizpurua, Natalia Cabrera Castro, Marcela Guevara, Sandar Tin Tin, Elisabete Weiderpass, Florent de Vathaire, Fabienne Lesueur, Pascal Guénel, Claire Mulot, Pierre Laurent-Puig, Evgenia Ostroumova, Anne Boland-Auge, Jean-François Deleuze, Hauke Thomsen, Asta Försti, Rosella Elisei, Federica Gemignani, Stefano Landi, Sabina Rinaldi, Alexis Elbaz, Cloé Domenighetti, Thérèse Truong","doi":"10.1089/thy.2024.0548","DOIUrl":"10.1089/thy.2024.0548","url":null,"abstract":"<p><p><b><i>Background:</i></b> Differentiated thyroid carcinoma (DTC) is occurring three times more frequently in females than in males. However, the underlying biological mechanisms driving this discrepancy remain poorly understood. To investigate the causal role of sex hormones and reproductive factors in the risk of DTC, we implemented a two-sample Mendelian randomization (MR) analysis. <b><i>Methods:</i></b> We utilized genome-wide association studies (GWAS) summary statistics to explore these associations. GWAS data on DTC were derived from a meta-analysis of six studies including 7705 cases and 963,612 controls of European ancestry. GWAS summary statistics on sex hormones, reproductive factors, and gynecological conditions were retrieved from publicly available sources. We used the inverse-variance weighted (IVW) method to estimate odds ratio (OR), with additional sensitivity analyses and conducted multivariable MR (MVMR) to account for potential confounding by body mass index (BMI) and thyrotropin (TSH). <b><i>Results:</i></b> We identified a positive association between sex hormone binding globulin (SHBG) and DTC (OR_ivw = 1.13, <i>p</i> = 0.046). After controlling for TSH and BMI in a MVMR analysis, the strength of this association remained similar but lost statistical significance. Bioavailable testosterone also showed a positive but marginally significant association with DTC after adjustment for BMI in the MVMR (OR_ivw = 1.13, <i>p</i> = 0.07). Putative causal association was observed with uterine fibroids in females under 50 years old (OR_ivw = 1.52, <i>p</i> = 0.017). Endometrial cancer was associated with DTC (OR_ivw = 1.15, <i>p</i> = 9.0 × 10^-3); however, a genetic correlation of r² = 13% suggested potential pleiotropy. No significant associations were observed for other investigated factors. <b><i>Conclusions:</i></b> Our study does not provide strong evidence for a causal role of reproductive and hormonal factors in DTC risk, despite the observed sex disparity in incidence rates. The associations observed with SHBG, bioavailable testosterone, uterine fibroids, and endometrial cancer indicate potential risk factors, but further investigation is required.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"433-443"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730646","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":"Transcriptome of Anaplastic Thyroid Cancer Reveals Two Molecular Subtypes with Distinct Tumor Microenvironment and Prognosis.","authors":"Hyunjong Byun, Han Sai Lee, Young Shin Song, Young Joo Park","doi":"10.1089/thy.2024.0266","DOIUrl":"10.1089/thy.2024.0266","url":null,"abstract":"<p><p><b><i>Background:</i></b> Although patients with anaplastic thyroid cancer (ATC) generally have a poor prognosis and there are currently no effective treatment options, survival and response to therapy vary between patients. Genomic and transcriptomic profiles of ATC have been reported; however, a comprehensive study of the tumor microenvironment (TME) of ATC is still lacking. This study aimed to elucidate the TME characteristics associated with ATC and their prognostic implications. <b><i>Methods:</i></b> We analyzed bulk RNA transcriptomic data from 1,634 samples-including 476 normal thyroid tissues, 25 benign thyroid adenomas, 340 <i>RAS</i>-like and 719 <i>BRAF</i>^V600E-like differentiated thyroid cancers (DTC-R and DTC-B, respectively), and 74 ATCs. We assessed the TME and molecular characteristics of these thyroid cancer subtypes using deconvolution analysis. <b><i>Results:</i></b> The TME of ATC was characterized by a high abundance of immune cells and fibroblasts and a low abundance of epithelial cells compared to other thyroid histologies. During its malignant evolution, ATC exhibited an ecotype more closely related to DTC-B than <i>RAS</i>-like DTC (DTC-R). Furthermore, we identified two distinct molecular subtypes within ATC with significant differences in their TMEs. We termed the subtype with increased immune cells and fibroblasts as ATC-immune-fibroblast (ATC-IF) and the subtype with elevated epithelial and endothelial cells as ATC-epithelial-endothelial (ATC-E). The ATC-IF group had worse disease-specific survival (log-rank <i>p</i> = 0.035), higher ERK scores, and lower thyroid differentiation scores than the ATC-E group. While both ATC subtypes had elevated immune cells and fibroblasts compared to DTC-R and DTC-B, this increase was more pronounced in ATC-IF, with a marked rise in myeloid lineage cells and promigratory fibroblasts. Immune checkpoint gene expression and epithelial-mesenchymal transition scores were significantly higher in the ATC-IF group than in the ATC-E group. <b><i>Conclusion:</i></b> ATC shows a TME distinct from that of DTC and can be further divided into two molecular subtypes-each with its own unique TME. The ATC-IF group, with a poorer prognosis and higher ERK score, is enriched in immune cells and fibroblasts, which may represent potential therapeutic targets.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"367-378"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047888","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":"<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}