Thyroid最新文献

{"title":"Preview of the 93rd American Thyroid Association Annual Meeting.","authors":"Meredith D Hartley, Whitney S Goldner","doi":"10.1089/thy.2024.0185","DOIUrl":"10.1089/thy.2024.0185","url":null,"abstract":"","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"807-809"},"PeriodicalIF":5.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868226","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":"Anatomical Patterns of Nodal Spread in Unilateral Papillary and Medullary Thyroid Cancer.","authors":"Andreas Machens, Kerstin Lorenz, Frank Weber, Henning Dralle","doi":"10.1089/thy.2024.0076","DOIUrl":"10.1089/thy.2024.0076","url":null,"abstract":"<p><p><b><i>Background:</i></b> Skip metastases, node metastases in the lateral neck sparing the ipsilateral central neck, challenge the current concept of central-to-lateral lymphatic spread. This study sought to delineate patterns of central and lateral neck involvement in unilateral papillary thyroid cancer (PTC) and medullary thyroid cancer (MTC). <b><i>Methods:</i></b> This was a retrospective correlative analysis of nodal patterns in surgical specimens from patients with unilateral PTC or MTC who had undergone thyroidectomy with at least ipsilateral central neck dissection between November 1994 and January 2024 at a tertiary referral center. <b><i>Results:</i></b> Included were 833 patients with unilateral PTC and 640 patients with unilateral MTC. Simultaneous presence or absence of node metastases was noted in ipsilateral central and lateral neck compartments in 76.6-78.1% of patients with PTC (both node positive in 27.0-54.7% and both node negative in 23.4-49.6%) and 77.3-80.0% of patients with MTC (both node positive in 26.6-33.2% and both node negative in 44.1-53.4%). Only one ipsilateral neck compartment was node positive in 21.9-23.4% of patients with PTC and 20.0-22.7% of patients with MTC. The ipsilateral central, but not the ipsilateral lateral compartment, was node positive in 8.8-16.9% with PTC and 8.6-8.8% of patients with MTC, whereas the ipsilateral lateral, but not the ipsilateral central compartment, was node positive in 6.5-13.1% with PTC and 11.3-14.1% with MTC. Ipsilateral lateral neck involvement sparing the ipsilateral central neck was 1.5-2 times more frequent in patients with node positive MTC than patients with node positive PTC (24.2-25.2% vs. 12.9-17.1%). Greater numbers of node metastases in the ipsilateral central neck compartment were associated with more frequent involvement of the ipsilateral lateral, contralateral central, and contralateral lateral neck compartments. Thyroid tumor diameter intensified nodal spread without changing nodal spread patterns. <b><i>Conclusions:</i></b> These histopathological findings, which need to be interpreted in light of the respective tumor biology, offer an unprecedented glimpse at the metastatic patterns of unilateral PTC and MTC. Customizing neck dissection to the patterns of nodal spread, considering operative status (initial vs. reoperative surgery) and experience with neck dissection, may require more frequent concomitant dissections of ipsilateral central and ipsilateral lateral neck compartments.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"871-879"},"PeriodicalIF":5.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140892447","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 Missense Variant in the NKX2-1 <i>Homeodomain</i> Prevents Transcriptional Rescue by TAZ.","authors":"Beatriz Villafuerte, Carlos Carrasco-López, Amanda Herranz, Lucía Garzón, Rogelio Simón, Daniel Natera-de-Benito, Pouya Alikhani, Jair Tenorio, Fe García-Santiago, Mario Solis, Ángela Del-Pozo, Pablo Lapunzina, Juan Darío Ortigoza-Escobar, Pilar Santisteban, José C Moreno","doi":"10.1089/thy.2023.0593","DOIUrl":"10.1089/thy.2023.0593","url":null,"abstract":"<p><p><b><i>Background:</i></b> Brain-lung-thyroid syndrome (BLTS) is caused by <i>NKX2-1</i> haploinsufficiency, resulting in chorea/choreoathetosis, respiratory problems, and hypothyroidism. Genes interacting with NKX2-1 mutants influence its phenotypic variability. We report a novel <i>NKX2-1</i> missense variant and the modifier function of TAZ/WWTR1 in BLTS. <b><i>Methods:</i></b> A child with BLTS underwent next-generation sequencing panel testing for thyroid disorders. His family was genotyped for <i>NKX2-1</i> variants and screened for germline mosaicism. Mutant <i>NKX2-1</i> was generated, and transactivation assays were performed on three NKX2-1 target gene promoters. DNA binding capacity and protein-protein interaction were analyzed. <b><i>Results:</i></b> The patient had severe BLTS and carried a novel missense variant c.632A>G (p.N211S) in <i>NKX2-1</i>, which failed to bind to specific DNA promoters, reducing their transactivation. <i>TAZ</i> cotransfection did not significantly increase transcription of these genes, although the variant retained its ability to bind to TAZ. <b><i>Conclusions:</i></b> We identify a novel pathogenic <i>NKX2-1</i> variant that causes severe BLTS and is inherited through germline mosaicism. The mutant lacks DNA-binding capacity, impairing transactivation and suggesting that NKX2-1 binding to DNA is essential for TAZ-mediated transcriptional rescue.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"942-948"},"PeriodicalIF":5.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959504","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":"Mapping Thyroid Hormone Action in the Human Brain.","authors":"Federico Salas-Lucia","doi":"10.1089/thy.2024.0120","DOIUrl":"10.1089/thy.2024.0120","url":null,"abstract":"<p><p><b><i>Background:</i></b> Normal brain development, mood, and cognitive functions depend on thyroid hormone (TH) action. However, little is known about how TH mediates its actions in the human brain. This is due to limited access to human brains deprived of TH during fetal and early postnatal life, as well as from adults with altered thyroid status. One way to partially bypass these limitations is by using magnetic resonance imaging and spectroscopy, two neuroimaging techniques that provide detailed, noninvasive information on human brain structure and function. Another way is using human-induced pluripotent stem cell (hiPSCs)-derived three-dimensional <i>in vitro</i> systems, known as brain organoids, which allow for the study of fundamental aspects of the early stages of human brain development. <b><i>Summary:</i></b> This narrative review focuses on neuroimaging and brain organoid studies. Neuroimaging of human brains performed in individuals with different thyroid conditions provides information on the volume, myelination, blood flow, neural activity, and connectivity of different areas. Such studies show that suboptimal thyroid status can impact human brain development and its normal function throughout life. This is true not only for patients with sporadic congenital hypothyroidism, during pregnancy or early after birth, but also for adult patients with hypo- or hyperthyroidism, patients carrying mutations that manifest as impaired sensitivity to TH, and even for normal individuals during aging. Studies using brain organoids generated from hiPSCs of healthy individuals or patients with thyroid genetic conditions provide insights into how TH can impact the early development of the human cerebral cortex. <b><i>Conclusions:</i></b> The developmental alterations in children born to mothers with different degrees of gestational hypothyroidism or who developed hypothyroidism early in life are remarkable, affecting multiple brain regions and pathways, including the cerebral cortex, hippocampus, cerebellum, interhemispheric and corticospinal tracts, and associative nuclei. The data connecting such changes to poor neurological outcomes in adult patients with hypothyroidism represent an objective link between thyroid-specific functional brain alterations and behavior. Growing brain organoids require TH, which is critical for human neurogenesis and oligodendrogenesis. These models have proven useful in screening drugs with potential therapeutic effects for patients with genetic thyroid diseases.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"815-826"},"PeriodicalIF":5.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11295854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959578","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":"Prevalence of Thyroid Nodules in Residents of Ukraine Exposed as Children or Adolescents to Iodine-131 from the Chornobyl Accident.","authors":"Elizabeth Khaykin Cahoon, Eric Grimm, Kiyohiko Mabuchi, Jim Zhiming Mai, Rui Zhang, Vladimir Drozdovitch, Maureen Hatch, Mark P Little, Kamau O Peters, Tetiana I Bogdanova, Evgeniy Shelkovoy, Viktor M Shpak, Galyna Terekhova, Galyna Zamotayeva, Ihor P Pasteur, Sergii V Masiuk, Mykola Chepurny, Lydia B Zablotska, Robert McConnell, Patrick O'Kane, Mykola D Tronko, Alina V Brenner","doi":"10.1089/thy.2023.0654","DOIUrl":"10.1089/thy.2023.0654","url":null,"abstract":"<p><p><b><i>Background:</i></b> Although childhood exposure to radioactive iodine-131 (I-131) is an established risk factor for thyroid cancer, evidence for an association with thyroid nodules is less clear. The objective of this study is to evaluate the association between childhood I-131 exposure and prevalence of ultrasound-detected thyroid nodules overall and by nodule histology/cytology (neoplastic/suspicious/non-neoplastic), size (<10 mm/≥10 mm), and number (single/multiple). <b><i>Methods:</i></b> This is a cross-sectional study of radiation dose (mean = 0.53 gray, range: 0.0003-31 gray) and screen-detected thyroid nodules conducted in 1998-2000 (median population age 21.5 years) in a cohort of 13,243 residents of Ukraine who were under 18 years at the time of the Chornobyl accident on April 26, 1986. Excess odds ratios per gray (excess odds ratio [EOR]/Gy) and confidence intervals (CIs) were estimated using logistic regression. <b><i>Results:</i></b> Among 13,078 eligible individuals, we identified 358 (2.7%) with at least one thyroid nodule. Significantly increased dose-response associations were found for all nodules and nodule groups with doses <5 Gy except individuals with non-neoplastic nodules. Among individuals with doses <5 Gy, the EOR/Gy for neoplastic nodules (5.35; CI: 2.19-15.5) was significantly higher than for non-neoplastic nodules (0.24; CI: 0.07-0.74), but the EOR/Gy did not vary by nodule size or number. <b><i>Conclusions:</i></b> Childhood exposure to I-131 is associated with an increased risk of thyroid nodules detected 12-14 years following exposure, and the risk for neoplastic nodules is higher than for non-neoplastic nodules. Analyses of incident thyroid nodules may help clarify dose-response patterns by nodule characteristics and provide insights into thyroid nodule etiology.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"890-898"},"PeriodicalIF":5.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11295839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959584","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":"Sex-Specific Associations between Maternal Thyroid Peroxidase Antibodies and Cognitive Development in Preschool Children: A Prospective Cohort Study.","authors":"Yuzhu Teng, Jixing Zhou, Linlin Zhu, Mengting Yang, Xue Ru, Juan Tong, Yan Han, Shuangqin Yan, Fangbiao Tao, Kun Huang","doi":"10.1089/thy.2023.0612","DOIUrl":"10.1089/thy.2023.0612","url":null,"abstract":"<p><p><b><i>Background:</i></b> An association between maternal thyroid dysfunction throughout pregnancy and the subsequent risk of neurodevelopmental abnormalities in offspring has been demonstrated. However, the potential effects of maternal thyroid autoimmunity on neurodevelopment in the absence of maternal hypothyroidism remain unclear. Therefore, in this study, we explored the association between maternal thyroid peroxidase antibody (TPOAb) positivity and cognitive development in preschool children. <b><i>Methods:</i></b> A total of 1849 mother-child pairs were recruited from the Ma'anshan Birth Cohort (MABC) Study. During the follow-up period, an electrochemiluminescence immunoassay was used to retrospectively measure serum TPOAb levels in pregnant women. The cognitive development of preschool children was evaluated by using the Chinese version of the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition (WPPSI-IV). A growth mixture model was used to fit the trajectory of TPOAb. Multiple linear regression and logistic regression models were used to explore the associations between the developmental trajectory of TPOAb-positivity at different gestational periods and the cognitive development of preschool children by sex. <b><i>Results:</i></b> A total of 1849 mother-child pairs (mean [SD] age: 26.7 [3.6] years) were enrolled in the final study. Maternal TPOAb positivity in the first trimester was associated with a risk of below-average processing speed index in girls (OR: 2.07; 95% CI 1.06 to 4.01) and below-average full-scale intelligence quotient (FSIQ) in boys (OR: 2.36; 95% CI: 1.10 to 5.05). Maternal TPOAb positivity in the third trimester (T3) was associated with below-average working memory index (WMI) (OR: 2.51; 95% CI: 1.02 to 6.20) in girls. In girls, the WMI (β = -3.17, 95% CI: -5.82 to -0.52), fluid reasoning index (FRI) (β = -4.49, 95% CI: -7.18 to -1.80), and FSIQ score (β = -2.43, 95% CI: -4.77 to -0.08) decreased, whereas in mothers, the level of log-transformed thyroid peroxidase antibody (lgTPOAb) increased during pregnancy. <b><i>Conclusions:</i></b> Positive maternal TPOAb levels during pregnancy may be associated with poorer cognitive development in preschool children. These findings require independent confirmation in other populations.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"899-911"},"PeriodicalIF":5.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959507","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 Prognostication in Patients with Differentiated Thyroid Cancer and Distant Metastases: A SEER Population-Based Study.","authors":"Debbie W Chen, Grant Carr, Francis P Worden, Christine M Veenstra, Megan R Haymart, Mousumi Banerjee","doi":"10.1089/thy.2023.0709","DOIUrl":"10.1089/thy.2023.0709","url":null,"abstract":"<p><p><b><i>Background:</i></b> For patients with thyroid cancer, distant metastasis is a significant predictor of poor outcome. Since distant metastasis occurs in less than 10% of patients with differentiated thyroid cancer, correlates of survival in this vulnerable patient population remain understudied. This study aimed to identify prognostic groups among patients with differentiated thyroid cancer and distant metastases and to determine the role of, and interactions between, patient and tumor characteristics in determining survival. <b><i>Methods:</i></b> We identified adult patients diagnosed with differentiated thyroid cancer with distant metastases from the U.S. SEER-17 cancer registry (2010-2019). Analyses were performed using Cox proportional hazards regression, survival trees, and random survival forest. Relative importance of patient and tumor factors important for disease-specific and overall survival was assessed based on the random survival forest analyses. <b><i>Results:</i></b> Cohort consisted of 2411 patients with differentiated thyroid cancer with distant metastases followed for a median of 62 months. Most common histopathologic subtype (86.0%) was papillary thyroid cancer, and the most common sites of distant metastasis were the lungs (33.7%) and bone (18.9%). Cox proportional hazards model illustrated significant associations between survival and the following: patient age (<i>p</i> < 0.001), tumor size (<i>p</i> < 0.01), and site of distant metastasis (<i>p</i> < 0.05). Survival tree analyses identified three distinct prognostic groups based on disease-specific survival (DSS) (5-year survival of the prognostic groups was 92%, 64%, and 41%; <i>p</i> < 0.001) and four distinct prognostic groups based on overall survival (OS) (5-year survival of the prognostic groups was 96%, 84%, 57%, and 31%; <i>p</i> < 0.001). The first split in the survival trees for DSS and OS was by age at diagnosis (≤57 years vs. ≥58 years) with subsequent splits based on presence/absence of lung metastases, tumor size (≤4 cm vs. >4 cm), and patient age. A total of 558 patients (23.1%) died from thyroid cancer, and 757 patients (31.4%) died from all causes during the study period. <b><i>Conclusions:</i></b> This study identifies distinct prognostic groups for patients with differentiated thyroid cancer with distant metastases and highlights the importance of patient age, lung metastases, and tumor size for determining both disease-specific and overall survival. These findings inform risk stratification and treatment decision-making in this understudied patient population.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"837-845"},"PeriodicalIF":5.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11295792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959512","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":"Neoadjuvant Treatment of Locally Advanced Thyroid Cancer: A Preliminary Latin American Experience.","authors":"Fabián Pitoia, Erika Abelleira, Alejandro Román-González, Debora L S Danilovic, Rafael Selbach Scheffel, Ana Luiza Maia, Ana O Hoff, Inés Califano","doi":"10.1089/thy.2024.0090","DOIUrl":"10.1089/thy.2024.0090","url":null,"abstract":"<p><p><b><i>Background:</i></b> Surgical resection is not always achievable in thyroid cancer patients. Neoadjuvant therapy is rarely used, but recent trends favor multikinase inhibitors or selective tyrosine kinase inhibitors. These aim to reduce tumor volume, enabling previously unfeasible surgeries. <b><i>Patients and Methods:</i></b> Consecutive patients with locally advanced malignant thyroid tumors who received systemic therapies with a neoadjuvant intention were included in this retrospective multicenter case series conducted in five Latin American referral centers. Primary outcomes were pre- versus postneoadjuvant response evaluations using the Response Evaluation Criteria in Solid Tumors, feasibility of surgery, and completeness of resection. Secondary outcomes were mortality and status at the last visit. <b><i>Results:</i></b> Twenty-seven patients were included in this analysis. Patients with unresectable differentiated thyroid cancer (DTC) or poorly differentiated thyroid cancer (PDTC) received sorafenib (<i>n</i> = 6) or lenvatinib (<i>n</i> = 12), those with medullary thyroid cancer (MTC) were treated with vandetanib (<i>n</i> = 5) or selpercatinib (<i>n</i> = 1), and those with anaplastic thyroid cancer (ATC) harboring a <i>BRAF^V600E</i> mutation (<i>n</i> = 3) received dabrafenib and trametinib. The median patient age was 66 years (range 12-82), and 52% of the patients were female. In patients with PTC and PDTC, the median reduction in the diameter of the primary tumor was 25% (range 0-100%) after a median of 6 months of treatment. Surgical intervention was performed in 10 (55%) of the patients. Among these, six patients (60%) achieved R0/R1 resection status. Six patients with MTC had a median reduction in tumor diameter of 24.5% (range 1-49) after a median treatment time of 9.5 months. Only one patient receiving selpercatinib, with a tumoral reduction of 25% could undergo surgery, resulting in an R2 resection due to extensive mediastinal extension. Three patients with ATC showed a median tumor diameter reduction of 42% (range 6.7-50) after a median treatment time of 2 months. Two patients underwent surgical intervention and achieved R1 and R2 resection, respectively. <b><i>Conclusions:</i></b> While neoadjuvant therapy achieved tumoral responses, surgical resection was feasible in 55% of DTC, 33% of ATC, and 16% of MTC patients, with R0/R1 resection in 26% of the cohort, underscoring the need for patient selection and further research in this area.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"949-952"},"PeriodicalIF":5.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959582","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":"Radiation Exposure and Benign Thyroid Nodules.","authors":"Arthur B Schneider, Dan V Mihailescu","doi":"10.1089/thy.2024.0279","DOIUrl":"10.1089/thy.2024.0279","url":null,"abstract":"","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"810-811"},"PeriodicalIF":5.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155479","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 Perioperative Period of Heart Transplantation Is Affected by Thyroid Hormone Status.","authors":"Balázs Szécsi, Richárd Sinkó, Alexandra Vereb, Dmitry Khochanskiy, Kálmán Benke, Tamás Radovits, Bálint Lakatos, Andrea Kőszegi, Eszter Losoncz, Szilvia Kugler, Márk Szabó, Béla Merkely, Andrea Székely, Balázs Gereben","doi":"10.1089/thy.2023.0628","DOIUrl":"10.1089/thy.2023.0628","url":null,"abstract":"<p><p><b><i>Background:</i></b> Orthotopic heart transplantation (HTx) is a long-term surgical therapeutic approach for patients with end-stage heart failure. The objective of the present study was to uncover associations between altered thyroid hormone (TH) status and adverse outcomes after HTx. <b><i>Methods:</i></b> In this prospective, single-center cohort study, 283 patients underwent HTx between 2013 and 2020 at the Heart and Vascular Center of Semmelweis University in Hungary. We measured serum free triiodothyronine (fT3), free thyroxine (fT4), and thyrotropin (TSH) pre- and postoperatively. TaqMan qPCR was used to measure type 2 deiodinase and type 3 deiodinase mRNA (<i>Dio2</i> and <i>Dio3</i>, respectively) levels from the diseased heart bioptates. To assess the local TH action of the heart, mRNA levels of <i>Hcn2</i> and <i>Myh7</i> were measured in a subgroup of patients receiving extracorporeal membrane oxygenation (ECMO) postoperatively. Groups were compared using nonparametric tests. Cox regression analysis and logistic regression test were used to investigate the outcomes. The connection between serum TH parameters and cardiac gene expressions was assessed using linear regression. <b><i>Results:</i></b> Serum TSH (<i>p</i> = 0.009), fT3 (<i>p</i> < 0.001), and fT4 (<i>p</i> < 0.001) levels were lower after HTx than preoperatively. Levothyroxine (LT4) administered to donors was associated with better survival after 30 days (<i>p</i> = 0.049). LT4 replacement given to recipients after HTx was associated with better survival after 30 days (<i>p</i> = 0.018), 1 year (<i>p</i> = 0.002), and 2 years (<i>p</i> = 0.001). <i>Dio3</i> mRNA level was significantly increased in patients who were treated with ECMO (<i>p</i> = 0.026), left ventricular assist device (LVAD) (<i>p</i> = 0.008), and biventricular assist device (BiVAD) (<i>p</i> = 0.013) preoperatively, and ECMO (<i>p</i> = 0.042) postoperatively, compared with those who did not require any type of mechanical circulatory support (MCS). We found no significant difference in the expression of the <i>Hcn2</i> and <i>Myh7</i> marker genes between patients on postoperative ECMO and those without MCS, and neither did they correlate with serum hormone levels (<i>p</i> = 0.519 and <i>p</i> = 0.056, respectively). <b><i>Conclusions:</i></b> We conclude that TH status plays an important role in HTx patients, and monitoring of TH status in the perioperative period may contribute to improved treatment outcomes. Our findings require independent confirmation in a randomized controlled clinical trial.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"774-784"},"PeriodicalIF":5.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871280","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}