Thyroid最新文献

{"title":"Hypoparathyroidism Post Thyroidectomy: Prevention, Evaluation, Management, and Application of Recent Guidelines.","authors":"Dalal S Ali, Nancy D Perrier, Aliya A Khan","doi":"10.1177/10507256261454145","DOIUrl":"10.1177/10507256261454145","url":null,"abstract":"<p><strong>Background: </strong>Postsurgical hypoparathyroidism (HypoPT) accounts for ∼75% of all HypoPT cases. It is recognized that this condition is largely preventable. Several studies have identified risk factors increasing the risk of developing postsurgical HypoPT, including patient-related factors, surgical factors, and, in some studies, presurgical factors. This narrative review highlights evidence-based guidelines for postsurgical HypoPT and provides strategies for its prevention, diagnosis, and management.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Google Scholar, and the Cochrane Library from inception through December 2025. We included studies that examined the definition, diagnosis, prevalence, risk factors, management, long-term complications, and treatment outcomes of postsurgical HypoPT.</p><p><strong>Results: </strong>This review outlines strategies for identifying individuals at risk of developing postsurgical HypoPT, with the goal of minimizing these risks and using evidence-based approaches to accurately diagnose and effectively manage these patients. Historically, management of postsurgical HypoPT beyond the first 72 hours relied on calcium supplements with active vitamin D, which remains the first-line therapy in current practice. Parathyroid hormone (PTH) replacement has emerged as an option for individuals who do not respond to conventional therapy. More recently, a long-acting PTH molecule, palopegteriparatide, has been approved by the Food and Drug Administration for the management of HypoPT. This molecule has a 60-hour half-life and has demonstrated the ability to maintain normal serum calcium levels, lower urine calcium, lower serum phosphorus, and reduce the need for calcium and active vitamin D supplements. It has also demonstrated a positive impact on quality of life. <i>Post hoc</i> data from the phase 3 trial comparing palopegteriparatide with placebo demonstrated improvements in renal function with palopegteriparatide and cessation of conventional therapy in patients with HypoPT.</p><p><strong>Conclusions: </strong>Postsurgical HypoPT remains a significant complication of thyroid surgery; however, its risk can be mitigated by careful preoperative assessment and surgical technique. While conventional therapy continues to be the mainstay of treatment, the advent of PTH replacement therapies offers promising alternatives for patients with refractory HypoPT.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"582-596"},"PeriodicalIF":6.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989249","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":"Subclinical Hyperthyroidism, Cardiovascular Disease and All-Cause Mortality: Insights from a Large Dutch Primary Care Cohort Study.","authors":"Stan R Ursem, Raymond Noordam, Jesse M van den Berg, Anita Boelen, Petra J M Elders, Wendy P J den Elzen, Annemieke C Heijboer","doi":"10.1177/10507256261449444","DOIUrl":"10.1177/10507256261449444","url":null,"abstract":"<p><strong>Background: </strong>Subclinical hyperthyroidism (SHT) has been associated with adverse cardiovascular outcomes, but the magnitude and consistency of these risks, particularly across demographic subgroups, remain unclear.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using general practitioner (GP) data from the PHARMO Data Network in the Netherlands (2012-2021). Patients with biochemically confirmed SHT (suppressed thyrotropin [TSH] with normal fT4; <i>n</i> = 11,163) were compared with a matched euthyroid reference group (<i>n</i> = 46,058) based on age, sex, and GP practice. Incidence of atherosclerotic complications, atrial fibrillation (AF), heart failure (HF), and all-cause mortality were assessed. Multivariable-adjusted Cox regression models estimated hazard ratios (HRs), adjusting for relevant confounders. Due to data limitations, information on smoking and alcohol use was not available, and medical history concerning comorbid conditions could only be assessed for the one-year period prior to cohort entry.</p><p><strong>Results: </strong>SHT was associated with a significantly increased risk of AF (HR: 1.37, 95% CI: 1.22-1.55), particularly in those with TSH < 0.1 mU/L (HR: 1.60, 1.32-1.94) and in individuals aged 30-49 years (HR 1.88, 1.05-3.36). HF risk was modestly elevated overall (HR: 1.21, 1.04-1.40), with stronger effects in individuals aged 30-49 years (HR: 3.74, 1.52-9.24) and women (HR: 1.31, 1.10-1.56). All-cause mortality was higher in the SHT group (HR: 1.51, 1.38-1.64), especially in men (HR: 1.75, 1.50-2.05) and individuals aged 30-49 years (HR: 2.95, 1.73-5.04). The association with atherosclerotic complications was weak-to-modest (HR: 1.12, 1.00-1.24).</p><p><strong>Conclusions: </strong>SHT is linked to increased risks of AF, HF, and all-cause mortality, with higher relative risks in younger patients. These findings challenge the traditional focus on older populations and underscore the need for individualized risk assessment in SHT.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"674-681"},"PeriodicalIF":6.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843179","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":"Survival Outcomes Associated with Hypothyroidism Following Cancer Therapies.","authors":"Harry D Momo, Megan R Haymart, Xu Shi, Alison M Mondul","doi":"10.1177/10507256261449473","DOIUrl":"10.1177/10507256261449473","url":null,"abstract":"<p><strong>Background: </strong>Hypothyroidism is a recognized adverse effect of cancer therapies such as immune checkpoint inhibitors (ICI), tyrosine kinase inhibitors (TKI), and radiotherapy. Although proposed as an indicator of treatment response, its prognostic significance across cancer types and therapies remains underexplored. This study evaluated survival outcomes associated with treatment-induced hypothyroidism.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using de-identified electronic health record data from the University of Michigan (2006-2023). Adults (≥18 years) receiving ICIs, TKIs, or radiotherapy, without prior thyroid disease or malignancy, were included. We defined hypothyroidism by institutional laboratory criteria or thyroid hormone initiation. Time-dependent Cox models estimated hazard ratios (HRs) and 95% confidence intervals for overall and cancer-specific survival, adjusting for demographic, clinical, and lifestyle factors. Analyses were stratified by treatment class and cancer sites; sensitivity analyses assessed robustness.</p><p><strong>Results: </strong>Among 9909 patients (57,772 person-years; median follow-up 4.64 years), 2177 (22.0%) developed hypothyroidism (median onset time: 5.04 months). Treatment-induced hypothyroidism was associated with improved overall (HR = 0.86 [0.79-0.93], <i>p</i> < 0.001) and cancer-specific survival (HR = 0.76 [0.70-0.84], <i>p</i> < 0.001). Stratified analyses showed significant survival benefits with hypothyroidism following ICI (overall HR = 0.75 [0.61-0.92], <i>p</i> = 0.014; cancer-specific HR = 0.75 [0.66-0.94], <i>p</i> = 0.012) and radiotherapy (overall HR = 0.88 [0.81-0.96], <i>p</i> = 0.011; cancer-specific HR = 0.76 [0.68-0.84], <i>p</i> < 0.001), but not for TKI. Site-specific survival benefits were observed in brain/central nervous system (HR = 0.39 [0.26-0.61], <i>p</i> < 0.001), lip/oral cavity/pharyngeal (HR = 0.77 [0.61-0.97], <i>p</i> = 0.032), and lung/bronchus cancers (HR = 0.80 [0.66-0.97], <i>p</i> = 0.034) but higher mortality in colon cancer (HR = 1.82 [1.10-3.02], <i>p</i> = 0.021). Results were consistent across sensitivity analyses.</p><p><strong>Conclusions: </strong>Hypothyroidism after ICI and radiotherapy was associated with improved survival, supporting its potential as a prognostic biomarker of therapeutic benefit. Future studies should investigate the underlying mechanisms and clinical implications.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"597-608"},"PeriodicalIF":6.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Temporal Analysis of Surgical Management and Outcomes Following ATA Guideline Updates in Papillary Thyroid Carcinoma: A Real-World Cohort Study of 31,861 Patients in South Korea.","authors":"Jae Sang Ryu, Eun Jin Kim, In A Lee, Dong Wook Kim, Ji An Lee, Dong Hyun Seo, Ji Ahn Park, Sunmi Park, Sungkeun Kang, Sang Wook Kang, Jong Ju Jeong, Kee Hyun Nam, Woong Youn Chung, Young Suk Jo, Jandee Lee","doi":"10.1177/10507256261442841","DOIUrl":"10.1177/10507256261442841","url":null,"abstract":"<p><strong>Background: </strong>The American Thyroid Association (ATA) guideline revisions in 2009 and 2015 encouraged a shift toward less extensive surgery and reduced use of radioactive iodine (RAI) in the management of patients with low-risk papillary thyroid carcinoma (PTC). The aim of this study was to evaluate the real-world impact of these guideline changes on treatment patterns, complications, and oncologic outcomes.</p><p><strong>Methods: </strong>In this retrospective cohort study conducted at a high-volume tertiary center in South Korea, we analyzed 31,861 patients treated for PTCs measuring ≤4 cm during 2004-2020. Patients were stratified into three temporal cohorts (triad 0 2004-2009; triad 1: 2010-2015; and triad 2: 2016-2020), and exact matching was performed to balance clinicopathologic characteristics across the groups. Segmented regression analysis was used to identify treatment pattern shifts. Postoperative complications and disease-free survival (DFS) were compared across the matched cohorts by using conditional logistic and stratified Cox regression analyses. Five-year restricted mean survival time (RMST) analysis was performed to adjust for follow-up variation.</p><p><strong>Results: </strong>After guideline implementation, total thyroidectomies and RAI use significantly declined. Permanent hypocalcemia decreased from 2.7% to 0.2% (<i>p</i> < 0.001) while transient complications remained stable. Although recurrence rates were lowest in the most recent era (1.3%), DFS analysis revealed higher hazard ratios for recurrence in triad 2 versus earlier cohorts (triad 2 vs. 0 hazard ratio: 1.520, confidence interval: 1.160-1.980). However, 5-year DFS and RMST comparisons revealed no significant differences.</p><p><strong>Conclusions: </strong>ATA guideline-driven de-escalation strategies were successfully implemented in real-world practice in this study, reducing overtreatment and surgical morbidity without compromising short-term oncologic outcomes.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"609-619"},"PeriodicalIF":6.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639933","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":"Real-World Efficacy and Safety of Lenvatinib and Sorafenib in Thyroid Cancer: A Retrospective, Propensity-Score-Matched Study.","authors":"Max Kappenstein, Viktoria Florentine Koehler, Nadia Ninosu, Christine Koch, Michael Christoph Kreissl, Jörg Bojunga, Daniel Groener, Nikolas von Bubnoff","doi":"10.1177/10507256261442836","DOIUrl":"10.1177/10507256261442836","url":null,"abstract":"<p><strong>Background: </strong>Lenvatinib and sorafenib are multitargeted tyrosine kinase inhibitors (mTKIs) approved for the treatment of radioiodine-refractory thyroid cancer (TC). In the absence of direct comparative clinical trials, we leveraged real-world TriNetX data to compare their effectiveness and tolerability in progressive TC. TriNetX is a federated international electronic medical record research network that aggregates anonymized data from multiple health care organizations.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients with TC initiating lenvatinib or sorafenib. Patients with other malignancies treated with these agents or exposure to the alternative mTKI were excluded. Propensity score matching was performed to balance demographic characteristics, tumor burden, and comorbidities. The primary outcome was overall survival (OS) at 1 and 3 years. Secondary outcomes included all-cause hospitalization, emergency care utilization, and selected treatment-emergent adverse events. Exploratory subgroup analyses were performed across demographic, disease-related, and comorbidity strata.</p><p><strong>Results: </strong>With matched cohorts of 214 patients in each arm, lenvatinib was associated with significantly improved OS compared with sorafenib at both 1 year (78.5% vs. 64.5%; hazard ratio [HR] with confidence interval [CI] 0.538 [0.373-0.775]) and 3 years ([62.1% vs. 45.8%; HR with CI 0.590 [0.444-0.784]). All-cause hospitalization and emergency care admission rates were comparable. Hematological adverse events occurred more frequently with sorafenib, while renal and cardiovascular events trended higher with lenvatinib. Survival benefits with lenvatinib were consistent across subgroups and appeared especially pronounced in patients with high tumor burden.</p><p><strong>Conclusions: </strong>Lenvatinib was associated with improved OS compared with sorafenib in patients with TC, with broadly comparable safety profiles. These findings, based on retrospective real-world data, support the use of lenvatinib as a preferred first-line mTKI in line with current treatment paradigms.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"620-629"},"PeriodicalIF":6.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676714","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 Novel Approach to Targeting DLL3 with Tarlatamab in a Patient with Medullary Thyroid Carcinoma after Progression on Selpercatinib.","authors":"Thomas J Roberts, Catherine B Meador, Alexander D Fuld, Aubrey Lasko, Matthew Frigault, Katherine M Hangar, Kerry Reynolds, Peter M Sadow, Lori J Wirth","doi":"10.1177/10507256261448706","DOIUrl":"10.1177/10507256261448706","url":null,"abstract":"<p><strong>Background: </strong>After progression on selpercatinib, patients with <i>RET-</i>altered medullary thyroid carcinoma (MTC) face a poor prognosis. Tarlatamab-a Delta-like ligand 3-targeted bispecific T-cell engager-is a promising therapeutic option for patients with MTC, but a prior case series raised safety concerns in this population.</p><p><strong>Methods: </strong>A patient with <i>RET-</i>altered MTC who progressed on selpercatinib received tarlatamab using a three-step step-up dosing regimen with modified protocols for monitoring and managing cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).</p><p><strong>Results: </strong>This patient experienced grade 2 CRS and grade 2 ICANS after cycle 1, day 1. He did not experience any grade ≥3 treatment-related adverse events. The patient had rapid improvement of the disease-associated symptoms. After 8 weeks of treatment, the patient experienced a biochemical and radiographic complete response that is ongoing.</p><p><strong>Conclusions: </strong>A modified dosing and monitoring protocol may improve the safety of tarlatamab in patients with MTC while maintaining efficacy. Further research is needed to evaluate the role of tarlatamab in MTC.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"682-687"},"PeriodicalIF":6.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875863","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":"Tocilizumab in Active, Moderate-to-Severe, Glucocorticoid-Resistant Thyroid Eye Disease: An Open-Label Prospective Study in Two Independent Cohorts.","authors":"Joanna Rymuza, Aleksander Kuś, Biljana Nedeljković Beleslin, Miroslav Knežević, Dorota Białas-Niedziela, Monika Turczyńska, Mirjana Stojković, Bojan Marković, Dariusz Kęcik, Miloš Žarković, Tomasz Bednarczuk","doi":"10.1177/10507256261450089","DOIUrl":"10.1177/10507256261450089","url":null,"abstract":"<p><strong>Background: </strong>Treatment of active, moderate-to-severe thyroid eye disease (TED) remains a challenge. Up to 55% of patients show an incomplete response to intravenous (IV) glucocorticoids (GCs), and relapses are common. Tocilizumab (TCZ), a monoclonal antibody against the interleukin-6 receptor, has been proposed as a second-line therapy for GC-resistant TED.</p><p><strong>Methods: </strong>We performed an open-label, prospective study at two tertiary TED referral centers (Warsaw, Poland; Belgrade, Serbia) from May 2022 to May 2025. Adults with active, moderate-to-severe, GC-resistant TED received TCZ 8 mg/kg IV every 4 weeks for four cycles and were followed for 24 weeks. Primary endpoints were (1) improvement in the composite ophthalmic score and (2) improvement in disease-specific quality of life (Graves' ophthalmopathy quality of life questionnaire [GO-QoL]). Secondary endpoints included changes in clinical activity score (CAS), proptosis, eyelid aperture, diplopia, thyrotropin receptor antibody (TRAb) levels, and safety. The trial was registered at ClinicalTrials.gov (NCT06367517).</p><p><strong>Results: </strong>A total of 44 patients underwent TCZ treatment (Warsaw, <i>n</i> = 32; Belgrade, <i>n</i> = 12). Both primary endpoints were met by 20/32 (62.5%) patients at Warsaw and all 12/12 (100%) patients at Belgrade. CAS reduction by ≥2 points was observed in 24/32 (75%) and 12/12 (100%) patients, respectively. A reduction of ≥2 mm in proptosis occurred in 19/32 (59.4%) and 7/12 (58.3%). Diplopia improved by ≥1 grade in Gorman score in 7/32 (21.9%) and 6/12 (50%). Eyelid aperture decreased by ≥2 mm in 11/32 (34.4%) and 8/12 (66.7%). Median TRAb levels decreased from 7.0 to 2.1 IU/L (Warsaw) and from 4.7 to 2.0 IU/L (Belgrade). No patients experienced TED deterioration. Adverse events occurred in 18/44 (40.9%) patients (47 events, only 1 severe).</p><p><strong>Conclusions: </strong>In this prospective, real-world study conducted in two independent cohorts of patients with GC-resistant, active, moderate-to-severe TED, TCZ was associated with clinically meaningful improvements in composite ophthalmic score response, CAS, proptosis, and quality of life, with a generally acceptable safety profile. These findings support TCZ as an effective and safe second-line therapeutic option for GC-resistant TED.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"654-664"},"PeriodicalIF":6.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875884","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":"Teprotumumab-Associated Hyperglycemia: A Large-Scale Multinational Cohort Study.","authors":"Natan Lishinsky-Fischer, Rena Pollack, Zvi Gur","doi":"10.1177/10507256261442501","DOIUrl":"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":"665-673"},"PeriodicalIF":6.6,"publicationDate":"2026-06-01","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":"Preliminary Evidence of Microplastics in the Human Thyroid and Their Potential Association with Autoimmune Thyroiditis.","authors":"Shi-Tong Yu, Jinrong Fu, Zihao Fan, Qiting Ye, Shili Zhang, Haixia Guan","doi":"10.1177/10507256261442506","DOIUrl":"10.1177/10507256261442506","url":null,"abstract":"<p><strong>Background: </strong>Microplastics (MPs) have been identified in multiple human tissues and are increasingly implicated in systemic health risks. Their presence in the thyroid gland, however, remains unexamined. Autoimmune thyroiditis (AIT) is the most frequent autoimmune thyroid disorder and the leading cause of hypothyroidism. This study aims to detect the presence of MPs in the thyroid and their potential relevance to AIT.</p><p><strong>Methods: </strong>In this case-control study, thyroid tissues were obtained from 29 patients with histologically confirmed AIT and 29 age- and sex-matched non-AIT controls who underwent thyroidectomy due to thyroid nodules. MP burden was quantified by pyrolysis-gas chromatography-mass spectrometry (Py-GC/MS). Particle-level polymer identity and particle characteristics, including size, shape, and color, were assessed using micro-Raman spectroscopy, whereas scanning electron microscopy (SEM) was employed for morphological observation.</p><p><strong>Results: </strong>MPs were detected in thyroid tissues from both groups. Py-GC/MS revealed significantly higher total MP concentrations in the AIT group compared to controls (median: 19.9 vs. 1.9 μg/g; p=0.012). This elevation was primarily driven by polyvinyl chloride (PVC), which was significantly higher in AIT patients. Micro-Raman spectroscopy identified particles ranging from 33.9 to 1467 µm. The AIT group contained significantly increased MPs abundance compared with the non-AIT control group (172 vs. 50.2 items/g, p=0.037). Morphological profiling revealed no significant differences in the size, shape and color of MPs between groups.</p><p><strong>Conclusion: </strong>An increased MPs burden with the particular enrichment of PVC was observed in patients with AIT, suggesting a potential association between environmental MPs exposure and thyroid autoimmunity. Further mechanistic and epidemiological studies to clarify the impacts of chronic MPs exposure are needed.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"693-697"},"PeriodicalIF":6.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646407","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":"Markedly Elevated Preoperative Thyroid-Stimulating Hormone Levels and Greater Operative Difficulty in Graves' Disease: A Single-Center Cohort Study.","authors":"Takahiro Sasaki, Minoru Kihara, Makoto Fujishima, Hiroo Masuoka, Takuya Higashiyama, Yasuhiro Ito, Akihiro Miya, Akira Miyauchi, Takashi Akamizu","doi":"10.1177/10507256261449452","DOIUrl":"10.1177/10507256261449452","url":null,"abstract":"<p><strong>Background: </strong>Preoperative management of Graves' disease (GD) typically includes antithyroid drugs, β-blockers, and short-term iodine. However, intensified therapy may result in excessive elevation of thyroid-stimulating hormone (TSH). Whether a TSH threshold (≥10.0 μIU/mL) can determine greater operative difficulty in such patients is unclear. Therefore, we assessed this association in patients with GD who underwent total thyroidectomy.</p><p><strong>Methods: </strong>This retrospective cohort study included consecutive patients with GD who underwent total thyroidectomy at a single center between 2009 and 2022 (<i>n</i> = 1516). The primary analysis comprised a complete case-cohort design (<i>n</i> = 1407; TSH ≥ 10.0 group, <i>n</i> = 48; TSH < 10.0 group, <i>n</i> = 1359). Primary outcomes included intraoperative blood loss, enlargement ratio (ER; estimated preoperative thyroid weight/preadmission thyroid weight), and operative time. Secondary outcomes were perioperative complications and resected thyroid weight. Multivariable linear or logistic regression included prespecified covariates. Rare events were modeled using Firth's penalized logistic regression. For temporal context, we compared preadmission and preoperative TSH levels. Preoperative TSH was modeled as four clinically defined categories based on the institutional reference range to address heterogeneity within the TSH < 10.0 μIU/mL category.</p><p><strong>Results: </strong>Of 1407 patients, 48 (3.4%) had preoperative TSH ≥ 10.0 μIU/mL. Unadjusted analyses indicated that the TSH ≥ 10.0 group had greater blood loss (median, 52 mL vs. 34 mL; <i>p</i> < 0.001), higher ERs (1.137 vs. 1.029), longer operative times (129 minutes vs. 112 minutes), and heavier resected thyroids (131.8 g vs. 97.0 g). Adjusted models indicated that TSH ≥ 10.0 was independently associated with greater blood loss (β = 53.03 mL; <i>p</i> < 0.001) and higher ERs (β = 0.12; <i>p =</i> 0.002). Dichotomized analyses indicated that TSH ≥ 10.0 increased the odds of ER ≥ 1.1 (adjusted odds ratio [aOR] 2.60; <i>p</i> = 0.004) and operative times ≥ 120 minutes (aOR: 2.29; <i>p</i> = 0.018). Preadmission TSH ≥ 10.0 μIU/mL was more common in the TSH ≥ 10.0 group (20.8% vs. 3.2%), indicating earlier elevation.</p><p><strong>Conclusions: </strong>Preoperative TSH ≥ 10.0 μIU/mL was independently associated with greater blood loss and higher ERs in patients with GD who underwent total thyroidectomy. Avoiding iatrogenic hypothyroidism and marked TSH elevation during preoperative preparation may improve operative conditions.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"630-640"},"PeriodicalIF":6.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147933394","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}