Thyroid最新文献

{"title":"TSH Stimulation Methods are Associated with Comparable Outcomes in Radioiodine-Avid Metastatic Differentiated Thyroid Cancer: Single Center Retrospective Observational Study.","authors":"Aleksandra Ledwon, Ewa Paliczka-Cieślik, Aleksandra Kropińska, Aleksandra Blewąska, Agnieszka Czarniecka, Ewa Chmielik, Jolanta Krajewska, Paweł Cieślik, Barbara Jarząb, Daria Handkiewicz-Junak","doi":"10.1177/10507256261448724","DOIUrl":"10.1177/10507256261448724","url":null,"abstract":"<p><strong>Background: </strong>To enhance sodium-iodide symporter expression and, thereby, radiopharmaceutical uptake/retention in differentiated thyroid carcinoma (DTC) metastases, radioiodine therapy (RAIT) can be stimulated by recombinant human TSH (rhTSH) or thyroid hormone withdrawal (THW). We investigated the association of thyrotropin (TSH) stimulation methodology with treatment outcomes in patients with radioiodine-avid distantly metastatic DTC.</p><p><strong>Methods: </strong>Single-center retrospective cohort study involving 189 consecutive eligible patients initiating RAIT from 2005 to 2015, a period allowing sufficient follow-up to adequately assess long-term outcomes. Patients were dichotomized into \"rhTSH only\" or \"mixed stimulation\" subgroups (respectively, all RAIT activities prepared by rhTSH or ≥1 activity prepared using THW; <i>n</i> = 81, <i>n</i> = 108). Patients given only THW (<i>n</i> = 5) were excluded due to low numbers for statistical analysis. Endpoints comprised radiological/biochemical response and time-to-progression (TTP) and overall survival (OS) estimated via the Kaplan-Meier method. Unadjusted inter-subgroup differences underwent log-rank testing; multivariable Cox modeling assessed independent associations with TTP and OS of disease/treatment characteristics, including stimulation methodology. Propensity score matching was performed to reduce baseline differences between the stimulation groups.</p><p><strong>Results: </strong>Median (minimum-maximum) follow-up was 123 (3-182) months. The best radiologic response consisted predominantly of stable disease (49%), with complete and partial responses observed in 23% and 18% of patients, respectively, and progressive disease in 10%, without significant differences between the TSH stimulation subgroups. Unadjusted analyses favored the mixed subgroup regarding TTP (141 vs. 42 months; <i>p</i> < 0.05) and OS (116 vs. 68 months; <i>p</i> < 0.01). However, after adjustment, TSH stimulation method was not independently associated with these outcomes; metastatic burden (macrometastasis) and age at DTC diagnosis were the strongest independent predictors. Consistent results were observed in the propensity score-matched cohort, with no significant differences in TTP or OS between stimulation groups.</p><p><strong>Conclusions: </strong>In radioiodine-avid metastatic DTC, rhTSH or mixed rhTSH/THW preparation is associated with comparable adjusted outcomes. Prognosis appears to be chiefly driven by metastatic burden and age.</p><p><strong>Clinical implications: </strong>In patients with radioiodine-avid metastatic DTC, the choice between rhTSH and THW should be individualized based on comorbidities, logistics, and patient preference rather than an assumed difference in oncologic efficacy.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"641-653"},"PeriodicalIF":6.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943116","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":"First Clinical Series of Patients Undergoing Nanosecond Pulsed Field Ablation for Symptomatic Benign Thyroid Nodules in a Clinic Setting.","authors":"Isabella C Ihrig, Camila Mancera, Maria Moreno, Tonya S King, Ralph P Tufano","doi":"10.1177/10507256261443630","DOIUrl":"10.1177/10507256261443630","url":null,"abstract":"<p><strong>Background: </strong>The nPulse^™ Vybrance^™ Percutaneous Electrode System delivers nanosecond pulsed field ablation (nsPFA), a nonthermal technology that permeabilizes cell membranes while preserving surrounding structures. As a novel therapeutic approach in the United States, nsPFA may offer a nonsurgical alternative for symptomatic benign thyroid nodules (BTNs). This study evaluates the short-term clinical outcomes and safety of nsPFA treatment performed in a clinic setting, focusing on changes in nodule volume and treatment-related complications.</p><p><strong>Methods: </strong>A retrospective chart review was conducted of 38 patients (48 symptomatic BTNs) treated with nsPFA. Benign cytology was confirmed via fine-needle aspiration biopsy. Since some patients underwent nsPFA of multiple BTNs, analysis of volume reduction was performed at the nodule level using a repeated measures approach, which accounts for within-patient correlation when estimating average changes over time.</p><p><strong>Results: </strong>Average nodule volume reduction at 1, 3, 6, and 12 months was 49.0% [confidence interval (CI) 42.5-55.4], 53.5% [CI 48.6-58.4], 51.8% [CI 45.2-58.5], and 50.2% [CI 34.9-65.5], respectively. Primary nodules received a median of 37 low-voltage and 24 default-voltage cycles, with additional nodules requiring fewer total cycles. No procedural or post-procedural complications were observed. All patients reported symptomatic improvement, often as early as 2 weeks following treatment. Three patients with toxic nodules and one with a nontoxic nodule were initially on antithyroid medication; all successfully discontinued antithyroid medication within 1 month of nsPFA. Subsequent thyroid function monitoring showed no abnormalities across patients with toxic and nontoxic nodules.</p><p><strong>Conclusions: </strong>This study represents the first reported clinical series of nsPFA outcomes for thyroid nodules in North America and the first in the world in a clinic setting. Early findings suggest that nsPFA is a promising, minimally invasive alternative to surgery for symptomatic BTNs, offering significant volume reduction and an excellent safety profile. The rapid symptomatic improvement and durable volume reductions during limited follow-up support further investigation. The modest sample size, retrospective design, and loss to follow-up at later time points may affect the interpretation of sustained effectiveness. Larger, prospective studies with extended follow-up are warranted to validate these results, assess long-term outcomes, and compare procedural environments.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"688-692"},"PeriodicalIF":6.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Memoriam: Lawrence Crane Wood (1935-2026).","authors":"David S Cooper, Alan P Farwell","doi":"10.1177/10507256261440399","DOIUrl":"https://doi.org/10.1177/10507256261440399","url":null,"abstract":"","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":"36 5","pages":"549-550"},"PeriodicalIF":6.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Counseling Female Thyroid Cancer Patients on Radioactive Iodine and Fertility.","authors":"Angela M Leung, Gregory A Brent, Steven M Larson, Joseph R Osborne, Robert R Flavell, Matthew D Ringel, Julie Ann Sosa","doi":"10.1177/10507256261440390","DOIUrl":"10.1177/10507256261440390","url":null,"abstract":"","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"547-548"},"PeriodicalIF":6.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radioactive Iodine and Female Fertility: Are We Underestimating the Risk?","authors":"Panagiotis Anagnostis, Julia K Bosdou","doi":"10.1177/10507256261430251","DOIUrl":"10.1177/10507256261430251","url":null,"abstract":"","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"545-546"},"PeriodicalIF":6.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147390758","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":"American Thyroid Association 2026 Guidelines for Thyroid Disease in Preconception, Pregnancy, and Postpartum.","authors":"Tim I M Korevaar, Angela M Leung, Erik K Alexander, Sofie Bliddal, Kristien Boelaert, Gabriela Brenta, Roger Chou, Rima Dhillon-Smith, Chrysoula Dosiou, Jennifer L Eaton, Haixia Guan, Sarah J Kilpatrick, Bente J Lasserre, Sun Y Lee, Spyridoula Maraka, Kara D Meister, Lilah F Morris-Wiseman, Caroline T Nguyen, Elizabeth N Pearce, Zhongyan Shan","doi":"10.1177/10507256261445624","DOIUrl":"10.1177/10507256261445624","url":null,"abstract":"<p><strong>Background: </strong>Thyroid disease in pregnancy, preconception, and postpartum is a common and clinically relevant problem. Since the publication of the American Thyroid Association (ATA) guidelines in 2017, substantial new clinical and scientific evidence has become available. The aim of these guidelines is to provide clinicians, patients, researchers, and policymakers with evidence-based recommendations on the care of women with thyroid disease before, during, and after pregnancy.</p><p><strong>Methods: </strong>The clinical questions addressed were informed by prior ATA guidelines, stakeholder feedback, a global needs assessment, and input from the multidisciplinary task force. Systematic literature searches were conducted with the support from a medical librarian and evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Recommendations were formulated based on the quality of evidence, balance of benefits and harms, patient values, feasibility, and equity. Where data were limited, Good Practice Statements were formulated. The task force included representatives from 10 international societies as well as patient advocacy groups and a methodologist.</p><p><strong>Results: </strong>The updated guidelines include recommendations on thyroid function testing, iodine supplementation, thyroid autoimmunity, hypothyroidism, hypothyroxinemia, hyperthyroidism and Graves' disease, thyroid nodules and cancer, and postpartum thyroid dysfunction for women with infertility, pregnant women, and women during postpartum and/or lactation. Recommendations are presented using recommendation tables, additional practical considerations are highlighted in boxes, and background information is provided in the text, tables, and figures per disease entity and chronological subset.</p><p><strong>Conclusions: </strong>These 2026 ATA guidelines provide updated, evidence-based recommendations for the diagnosis and management of thyroid disease in women during preconception, pregnancy, and postpartum. While acknowledging that much of the evidence remains of low-to-moderate quality, these guidelines represent current best practices and consensus among international experts from different fields, offering an optimized framework for individualized patient care.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":"36 5","pages":"481-544"},"PeriodicalIF":6.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Memoriam: Lawrence Crane Wood (1935-2026).","authors":"David S Cooper, Alan P Farwell","doi":"10.1177/10507256261440399","DOIUrl":"https://doi.org/10.1177/10507256261440399","url":null,"abstract":"","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"10507256261440399"},"PeriodicalIF":6.7,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Glycemic Patterns During IGF-1R Inhibitor Therapy for Thyroid Eye Disease: A Pooled Analysis of Two Clinical Trials.","authors":"Wei Zhao, Tianyuan Li, Junjie Deng, Yihua Xu, Xiuying Zhang, Xianqun Fan, Linong Ji","doi":"10.1177/10507256261431846","DOIUrl":"10.1177/10507256261431846","url":null,"abstract":"","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"463-466"},"PeriodicalIF":6.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Patients with <i>RAS</i>-Positive Bethesda III and IV Cytology Thyroid Nodules.","authors":"Jiahui Wu, Caitlin Yeo, Jackson Qi, Sana Ghaznavi, Moosa Khalil, Erik Nohr, Adrian Box, Markus Eszlinger, Ralf Paschke","doi":"10.1177/10507256261429119","DOIUrl":"10.1177/10507256261429119","url":null,"abstract":"<p><strong>Background: </strong>Routine resection of all <i>RAS</i>-positive nodules may result in overtreatment for up to 50% of patients. We evaluated the management strategy and outcomes of <i>RAS</i>-positive nodules.</p><p><strong>Methods: </strong>Following implementation of reflexive ThyroSPEC^TM molecular testing (MT) for all Bethesda III and IV thyroid nodules in July 2020, we identified patients with isolated <i>RAS</i> mutations between July 30, 2020, and September 30, 2024, using an institutional prospective thyroid nodule database. Patients were categorized by management strategy: surgery versus surveillance. Exclusion criteria included: absence of ultrasound (US) within 12 months prior to MT, incomplete post-MT management data, comutations with <i>RAS</i>, initial lobectomy before MT, concomitant fine-needle aspiration-proven papillary thyroid carcinomas or metastatic lymph nodes, and presence of contralateral high-risk nodules. This study represents a retrospective analysis of institutional registry data from a single health care region.</p><p><strong>Results: </strong>Among 203 patients with <i>RAS</i>-positive nodules (175 Bethesda III, 28 Bethesda IV), 126 (62%) underwent surgery and 77 (38%) were under surveillance (median follow-up: 24 months, interquartile range 14-37). Final pathology in surgery group revealed malignancy in 43 (34%), with 8 (19%) 2025 American Thyroid Association (ATA) intermediate-high or high risk, 57 (45%) benign lesions, and 26 (21%) neoplasms of uncertain or very low malignant potential. Surgical patients were younger (45 vs. 53 years, <i>p</i> = 0.001) with larger nodules (maximum diameter 2.9 vs. 2.5 cm, volume 6.2 vs. 3.8 cm³, <i>p</i> < 0.05 for both). Bethesda III nodules were more frequently managed with surveillance than surgery (95% vs. 81%, <i>p</i> = 0.010). Nuclear atypia was more frequent in malignant versus benign resected nodules (70% vs. 40%, <i>p</i> = 0.007). Seven patients crossed over to surgery during surveillance due to patient preference, nodule growth, or symptoms; two had malignant pathology (both ATA low-intermediate risk). Nodule stability was evaluated in 48 surveillance patients with at least one post-MT US and minimum 1-year follow-up. Using a threshold of 50%, 3/48 (6%) exhibited growth, with a 2% cumulative incidence of growth at 2 years.</p><p><strong>Conclusions: </strong>Isolated <i>RAS</i> mutation alone may not uniformly mandate surgery. Active surveillance represents a viable and safe alternative to surgery in appropriately selected patients with <i>RAS</i>-positive nodules, though further long-term data are needed.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"363-372"},"PeriodicalIF":6.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147366328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroid Hormone Synthesis Without Thyroglobulin.","authors":"Crystal Young, Xiaohan Zhang, Aaron P Kellogg, Tatiana L Fonseca, Kevin Pena, Alisa Beyzin, Xiao-Hui Liao, Annunziata G Cicatiello, Hao Zhang, Antonio C Bianco, Samuel Refetoff, Peter Arvan","doi":"10.1177/10507256261429120","DOIUrl":"10.1177/10507256261429120","url":null,"abstract":"<p><strong>Background: </strong>Heterozygosity of genetically encoded misfolded mutant thyroglobulin (TG, the thyroid hormone protein precursor) occurs with a frequency estimated at 1-in-217 people worldwide, resulting in subclinical hypothyroidism that largely escapes medical detection. However, patients carrying biallelic <i>TG</i> mutation, when untreated, are frankly hypothyroid unless and until they develop a massive goiter. To date, TG is the only proven endogenous precursor protein for thyroid hormone synthesis in vertebrates. Our objective was to understand how homozygous expression of mutant TG protein that cannot undergo secretion to the iodination site in the thyroid follicle lumen can be compatible with patients or animal models ultimately achieving normal/near-normal circulating T4 and T3 levels. Notably, in both monoallelic and biallelic disease, dead thyrocytes have been reported in the lumen of thyroid follicles.</p><p><strong>Methods: </strong>We recently engineered mice with homozygous <i>Tg-KO</i>, making it possible to study circulating T4 and T3 in the complete absence of TG protein expression. We also employed immunoblotting methods to test for the presence of thyroidal T4-containing and T3-containing protein.</p><p><strong>Results: </strong>We found that, concomitant with goiter growth, animals completely lacking TG (like patients or animals with biallelic <i>TG</i> defect) are able to eventually normalize circulating T4 levels when their goiter has sufficiently enlarged, while maintaining serum T3 at ∼two-thirds normal levels throughout life. Very little T3-containing protein is synthesized in the thyroid glands of <i>Tg-KO</i> mice; however, T4-containing protein is synthesized on the ghosts of dead thyrocytes, with T3 generated from circulating T4 deiodination. Albeit inefficient, thyroidal T4-containing protein content is not appreciably different in the presence of homozygous mutant TG or in the complete absence of TG.</p><p><strong>Conclusions: </strong>Our data suggest that in biallelic TG mutation, thyroid stimulating hormone (TSH)-driven iodination underlies inefficient T4 formation derived from the iodoproteome of dead thyrocytes. In the presence of homozygous mutant TG or in the complete absence of TG, normalizing circulating T4 requires massive goiter growth to generate sufficient cells to sustain this inefficient hormonogenesis mechanism.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"441-450"},"PeriodicalIF":6.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13184668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147390941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}