Thyroid最新文献

{"title":"Free T4 Age-Specific Reference Intervals from Birth to the 10^th Decade of Life Using Direct Dialysis.","authors":"Caixia Bi, Emily I Schindler, Ethan M Li, Marjaneh Shirvani, Marco Marcelli, Edward C Wong, Nigel J Clarke, Zengru Wu","doi":"10.1177/10507256251393709","DOIUrl":"10.1177/10507256251393709","url":null,"abstract":"<p><p><b><i>Background:</i></b> Free thyroxine (FT4) reference intervals (RIs) provided by many laboratories do not adequately represent the differences in FT4 levels observed across age groups, limiting their usefulness in the diagnosis and management of disease, most particularly at the extremes of age. Interpretive criteria specific to neonates, young children, and older adults are rarely provided. This work was undertaken to develop comprehensive age-based RIs from birth to age 100 to provide clinicians with precise context for result interpretation. <b><i>Methods:</i></b> RIs were calculated through multi-modal decomposition (MMD) analysis performed on de-identified retrospective FT4 results from specimens submitted for routine testing by direct dialysis at a commercial reference laboratory. Intervals were validated using a separate data set. The study population for MMD analysis included individuals from age 0 days to 100 years who submitted specimens for FT4 testing. <b><i>Results:</i></b> A total of 1,862,273 results were included in the analysis. MMD analysis yielded 14 distinct RIs by age. FT4 intervals were broadest, with higher upper reference limit (URL) and lower reference limit (LRL) at birth, narrowing toward adult ranges throughout childhood. A mild increase in the URL was observed in older adults. <b><i>Conclusions:</i></b> The development and validation of FT4 RIs provides interpretive criteria for FT4 results for patients throughout the lifespan. By providing RIs for distinct neonatal, pediatric, and adult age groups, this work enables clinicians to evaluate FT4 results in the appropriate context, allowing more accurate classification of abnormal results.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"1453-1457"},"PeriodicalIF":6.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453392","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 Year in Thyroidology 2025-Basic Science, Clinical Science, Surgical Science.","authors":"Louise Davies, Aime T Franco, Bryan Haugen","doi":"10.1177/10507256251404831","DOIUrl":"10.1177/10507256251404831","url":null,"abstract":"","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"1353-1358"},"PeriodicalIF":6.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679051","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":"Incidence of Pediatric Graves' Disease in the United States: An Epidemiological Analysis of 2007-2022 Outpatient Insurance Claims.","authors":"Srinidhi Polkampally, Akash S Halagur, Allen Green, Eric Wei, Jason Qian, Julia Donner, Hilary Seeley, Kara D Meister","doi":"10.1177/10507256251382559","DOIUrl":"10.1177/10507256251382559","url":null,"abstract":"<p><p><b><i>Background:</i></b> Graves' disease is the leading cause of hyperthyroidism in children and adolescents, with recent studies indicating a rising incidence. Epidemiological data on trends and determinants influencing this rise remain limited. This study aims to assess the trends in incidence of pediatric Graves' disease in the United States and stratify incidence patterns based on patient sex, age, geographic region, urban vs. rural setting, and insurance plan type. <b><i>Methods:</i></b> This retrospective cohort study utilized the Merative™ Marketscan® outpatient insurance claims database from 2007 to 2022. Pediatric patients diagnosed with Graves' disease were identified using International Classification of Diseases (ICD)-9 and ICD-10 codes. Annual incidence rates were analyzed over the study period to detect temporal trends. Incidence rates were further stratified by demographic variables including sex, age, geographic region, community setting (urban vs. rural), and insurance plan. Statistical methods included chi-square, ANOVA, and linear regression models to identify significant trends and differences across subgroups. <b><i>Results:</i></b> 3377 total new diagnoses of pediatric Graves' disease were identified during the 16-year study period. The average annual incidence rate was 3.33 per 100,000 (SD = 0.33), with an annual increase of 0.042 per 100,000 (<i>p</i> = 0.39). Marked differences in average annual incidence rates were observed across sex and age group; female patients exhibited greater average annual incidence rate (5.04 per 100,000) compared with male patients (1.67 per 100,000). Adolescents, patients 13-17 years of age, had the highest average annual incidence rate (5.72 per 100,000) compared with other age groups. On multivariable regression analysis, female patients had a significant increase in annual incidence by 1.69 cases per 100,000 compared with male patients [CI: 0.82-2.56]. Adolescents also saw a significant increase in adjusted annual incidence by 4.92 cases per 100,000 compared with the other age groups [CI: 3.80-6.04]. No significant change in annual incidence rate was observed across insurance plan, geographic region, or rural status. <b><i>Conclusions:</i></b> This study quantifies and delineates trends in pediatric Graves' disease incidence in the United States. The greatest average incidence rate was observed among female and adolescent patients. This study underscores the importance of monitoring Graves' disease trends to facilitate early disease detection and management. Further research is needed to elucidate the genetic and environmental factors underlying these epidemiological trends.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"1345-1349"},"PeriodicalIF":6.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114050","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":"Validation of the International Medullary Thyroid Carcinoma Grading System in Patients with Distant Metastases.","authors":"Tommaso Porcelli, Sophie Moog, Mohamed-Amine Bani, Julien Hadoux, Dario Bruzzese, Domenico Salvatore, Désirée Deandreis, Martin Schlumberger, Dana Hartl, Ingrid Breuskin, Saba Khazen Nariman, Eric Baudin, Abir Al Ghuzlan, Livia Lamartina","doi":"10.1177/10507256251388028","DOIUrl":"10.1177/10507256251388028","url":null,"abstract":"<p><p><b><i>Background:</i></b> The International Medullary Thyroid Carcinoma Grading System (IMTCGS) is a two-tier score that classifies high-grade medullary thyroid carcinoma (MTC) by the presence of at least one of the following features: mitotic index ≥5/2 mm², Ki-67 proliferation index ≥5%, or tumor necrosis. Cases lacking all three features are classified as low-grade. This study aimed to validate the prognostic role of the IMTCGS in patients with metastatic MTC. The prognostic significance of a high proliferative index (Ki-67 index ≥20%) was also investigated. <b><i>Methods:</i></b> We conducted a monocentric retrospective study of 99 metastatic MTC patients treated at Gustave Roussy between 2000 and 2024, in whom the IMTCGS was assessed on the primary tumor. <b><i>Results:</i></b> IMTCGS high-grade tumors were found in 67 patients (67.7%), who were older (<i>p</i> = 0.009) and had larger primary tumors (<i>p</i> < 0.001) compared with 32 patients with low-grade tumors. Postoperative calcitonin levels, number of metastatic sites/patient, prevalence of synchronous metastases, and <i>RET</i>-M918T mutation were similar between groups. Median overall survival (OS) was shorter in patients with IMTCGS high-grade than low-grade (4.8 vs. 13.9 years; <i>p</i> = 0.01), as was time to systemic treatment initiation (TTI) (1.0 vs. 4.8 years; <i>p</i> < 0.001). However, among the 75 patients who received systemic therapy, OS from treatment initiation was similar between the two groups (2.8 vs. 3.89 years; <i>p</i> = 0.865). <i>RET</i>-M918T mutation was not associated with worse OS. On multivariable analysis, IMTCGS high-grade and bone metastases were independently associated with both shorter OS and TTI (<i>p</i> < 0.05 for both). Patients with Ki-67 index ≥20% had worse OS (2.6 years) compared with those with Ki-67 index <5% (10.5 years; hazard ratio [HR] = 6.11; <i>p</i> < 0.001) and 5-19% (6.5 years; HR = 3.29; <i>p</i> = 0.001). <b><i>Conclusions:</i></b> The IMTCGS is a strong independent prognostic factor in patients with metastatic MTC. Patients with IMTCGS high-grade tumors and Ki-67 index ≥20% represent a high-risk subgroup with the poorest prognosis.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"1268-1276"},"PeriodicalIF":6.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145393189","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":"Prognostic Thresholds for Lymph Node Metastasis in Medullary Thyroid Cancer: A Restricted Cubic Splines Analysis.","authors":"Christina V Lindsay, Frances Wang, Samantha M Thomas, Todd Frieze, Nicholas Frisco, Randall P Scheri, Hadiza S Kazaure","doi":"10.1177/10507256251388406","DOIUrl":"10.1177/10507256251388406","url":null,"abstract":"<p><p><b><i>Objectives:</i></b> The current American Joint Committee on Cancer medullary thyroid cancer (MTC) staging system qualitatively stratifies lymph node (LN) status based on involved LN compartments; however, American Thyroid Association guidelines note that quantitative assessment of LN metastases \"should be incorporated.\" Several studies have proposed LN ratio (LNR) and number of positive LNs as prognostic parameters. We (1) assess whether there are prognostically significant LN thresholds, (2) estimate their association with MTC-specific mortality, and (3) appraise the identified thresholds using an institutional database. <b><i>Methods:</i></b> In this retrospective cohort analysis, MTC patients were abstracted from the Surveillance, Epidemiology, and End Results database (2004-20). Cox models with restricted cubic splines assessed the functional relationship of LNR and positive LN count with MTC-specific mortality. Thresholds were estimated using Markov Chain Monte Carlo and bootstrapping. Multivariable models estimated the association of the thresholds with mortality. The testing cohort comprised 149 patients with MTC at a single institution (1996-2025). <b><i>Results:</i></b> There were 2709 patients in the derivation cohort; 2098 (77.4%) had LNs examined. Mean patient age was 54.1 years, 59.1% were female, and 69.6% were non-Hispanic White. Mean tumor size was 23.5 mm; 52.7% of patients with LNs examined had ≥1 positive LN. The 5-year MTC-specific survival was 93.3%. Threshold values of 7.8 positive LNs and a LNR of 13.8% were identified (nonlinearity <i>p</i> < 0.001 for both). Adjusted analyses revealed that ≥8 positive LNs were associated with a significantly increased hazard of MTC-specific mortality (hazard ratio [HR] 1.54, confidence interval [CI]: 1.09-2.17, <i>p</i> = 0.014, model area under the curve [AUC] 86.7%); a LNR ≥14% was associated with a significantly increased mortality hazard (HR: 3.308, CI: 2.096-5.222, <i>p</i> < 0.001, model AUC: 87.9%). The thresholds were significantly associated with recurrence-free survival in the testing cohort: 5-year recurrence-free survival was 56.5% (CI: 39.5 - 70.4) for patients with ≥8 positive LNs and 90.5% (CI: 82.5 - 94.9) for <8 (log-rank <i>p</i> < 0.001); it was 67.9% (CI: 55 - 77.9) for patients with LNR ≥14% and 92.8% (CI: 83.6 - 97) for LNR <14 (log-rank <i>p</i> < 0.001). <b><i>Conclusions:</i></b> Using population-level data, we identified robust LN thresholds associated with MTC-specific mortality. Compared with a threshold of 8 positive LNs, a LNR threshold ≥14% was associated with a greater increase in hazard of MTC-specific mortality.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"1297-1310"},"PeriodicalIF":6.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145422834","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":"Do Prognostic Differences Exist Among High-Risk <i>RET</i> Mutations? A Comparison of Outcomes Between the <i>RET</i> C634R and Other C634 Mutations in Hereditary Medullary Thyroid Carcinoma.","authors":"Jie Zhang, Luciana Audi Castroneves, Susan C Lindsey, Rulai Han, Ziyuan Liu, Yue Li, Jing Xie, Wei Zhou, Qi Song, Cleber P Camacho, Yu Zhao, Xiaoyan Xie, Yulin Zhou, Jiqi Yan, Guang Ning, Weiqing Wang, Rui M B Maciel, Ana O Hoff, Lei Ye","doi":"10.1177/10507256251372196","DOIUrl":"10.1177/10507256251372196","url":null,"abstract":"<p><p><b><i>Background:</i></b> The American Thyroid Association has stratified <i>RET</i> C634 mutations as high risk. The association between <i>RET</i> C634R mutation and a more aggressive medullary thyroid carcinoma (MTC) behavior compared with other C634 mutations remains inconclusive, possibly due to the lack of large cohorts and long-term outcome data. This study aimed to evaluate the aggressiveness and long-term outcomes of hereditary MTC in patients with different <i>RET</i> codon 634 mutations. <b><i>Methods:</i></b> This study is an international, multicenter, retrospective cohort study. Data from patients with hereditary MTC carrying <i>RET</i> codon 634 mutations treated at three tertiary medical centers were retrospectively analyzed. Clinicopathological features and long-term outcomes were compared between patients with the C634R and those with other C634 mutations (C634F/G/S/W/Y). <b><i>Results:</i></b> The study cohort included 317 patients (C634R: 133; C634F/G/S/W/Y: 184) from 137 families with a median follow-up of 10.6 years (4.9-16.6 years). Patients with the C634R mutation were slightly younger at the time of initial surgery (27.8 ± 12.1 vs. 31.3 ± 14.9, <i>p</i> = 0.025). Meanwhile, the C634R group showed larger primary tumors (1.9 ± 1.2 vs. 1.5 ± 1.1, <i>p</i> = 0.006). Kaplan-Meier analysis revealed significantly higher cumulative rates and earlier occurrence of lymph node metastases (<i>p</i> = 0.0003) and extrathyroidal extension (ETE; <i>p</i> < 0.0001) in the C634R group. The C634R mutation was significantly associated with distant metastases (hazard ratio [HR]: 2.545 [confidence interval (CI) 1.134-5.713]; <i>p</i> = 0.024). Moreover, multivariable analysis identified <i>RET</i> C634R genotype (HR: 6.488 [CI 1.364-30.862]; <i>p</i> = 0.019), increasing age (HR: 1.082 [CI 1.023-1.144]; <i>p</i> = 0.006), and ETE (HR: 9.695 [CI 2.344-40.105]; <i>p</i> = 0.002) to be significantly associated with worse disease-specific survival. <b><i>Conclusions:</i></b> Prognosis varied in hereditary MTC patients with <i>RET</i> C634 mutations. Our data highlight that the <i>RET</i> C634R mutation was associated with greater tumor aggressiveness in MTC and a poorer disease-specific survival.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"1259-1267"},"PeriodicalIF":6.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970238","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":"Executive Summary of the 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer.","authors":"Stephanie Smooke Praw, Benjamin J Gigliotti, Alex Tessnow, Hyunseok Kang, Debra J Margulies","doi":"10.1177/10507256251390877","DOIUrl":"10.1177/10507256251390877","url":null,"abstract":"<p><p><b><i>Background:</i></b> Developed by members of the American Thyroid Association (ATA) Clinical Affairs Committee, this executive summary of the 2025 ATA guidelines for adult patients with differentiated thyroid cancer provides a summary of key points and recommendations with an emphasis on notable differences between the 2025 and 2015 guidelines. <b><i>Summary:</i></b> The updated guidelines emphasize individualized care through the DATA framework (Diagnosis, risk/benefit Assessment, Treatment decisions, and response Assessment) with the goal of enhancing shared decision-making and personalized care. Highlights include expanded role of molecular diagnostics, refined risk stratification, greater emphasis on active surveillance and lobectomy, inclusion of ablative procedures, and selective use of external beam radiation therapy and chemoradiotherapy. De-escalation of surveillance for low-risk patients and introduction of the concept of complete remission are also new. <b><i>Conclusions:</i></b> This executive summary aims to provide a summary of key points and recommendations with an emphasis on notable differences between the 2025 and 2015 guidelines.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"1214-1220"},"PeriodicalIF":6.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145422820","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 Potential Association Between Exposure to Estriol-Containing Skincare Cosmetics Sold in China and Autoimmune Thyroid Disease.","authors":"Lanchun Liu, Chunhu Li, Chang Liu, Tingting Qian, Miao Jing, Yunyan Gao, Rong Sun, Meng Zhao, Wenjing Che, Xin Hou, Honglei Xie, Peng Liu","doi":"10.1177/10507256251382545","DOIUrl":"10.1177/10507256251382545","url":null,"abstract":"<p><p><b><i>Background:</i></b> Estrogen may contribute to a higher prevalence of autoimmune thyroid disease (AITD) in women. However, it is unknown whether estrogen-containing cosmetics may be associated with AITD. This study aimed to (1) measure the estrogen concentration in skincare cosmetics sold in China, (2) examine the thyroid autoantibody levels in nude mice after dermal estrogen application, and (3) explore the relationship between skincare cosmetic use and AITD in the Chinese population in a population-based cross-sectional study and hospital-based case-control study. <b><i>Methods:</i></b> Skincare cosmetics of variable type and price were collected from various Chinese retail merchants and online shopping platforms to measure the respective estrogen concentrations in the products. Nude mice were smeared with estrogen on the skin to assess their effects on the thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) levels. A cross-sectional study was conducted in four districts or counties to compare differences in serum TPOAb, TgAb, and thyroid function between cosmetic users and nonusers. A case-control study was conducted in four district hospitals and two city hospitals to explore the association between cosmetic use and AITD. <b><i>Results:</i></b> Estriol was detected in 73 of 240 skincare cosmetic products, with a median concentration of 34.58 µg/g. In animal experiments, serum thyroid autoantibodies were significantly increased in mice smeared with (low or high) estriol-containing creams compared with controls (TPOAb, 31.07 ± 6.89 ng/L or 32.22 ± 8.92 ng/L vs. 21.27 ± 6.32 ng/L, <i>p</i> < 0.05; TgAb, 20.94 ± 6.12 ng/L or 19.56 ± 8.35 ng/L vs. 11.28 ± 1.43 ng/L, <i>p</i> < 0.05). In a cross-sectional study, no difference was found in TPOAb, TgAb, and thyroid function between skincare cosmetic users and nonusers (<i>p</i> > 0.05). However, the case-control study revealed a significant association between skincare cosmetics use and the presence of AITD (odds ratio = 1.577, confidence intervals 1.037-2.400, <i>p</i> = 0.033) after adjusting for other related variables. <b><i>Conclusions:</i></b> Estriol was found in some skincare cosmetics sold in China. Dermal estriol application could induce thyroid autoimmune reactions in nude mice. Preliminary population-based study data suggest that skincare cosmetic use may be associated with AITD. Prospective cohort studies or randomized controlled trials are needed in the future to confirm a potential association between estriol in skincare cosmetic use and AITD.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"1331-1344"},"PeriodicalIF":6.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453353","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 Association of Number of Retrieved Lymph Nodes with Oncologic Outcomes in Patients with Papillary Thyroid Cancer with Lateral Cervical Nodal Metastasis.","authors":"Hye In Kim, Jung Hee Shin, Boram Kim, Mihyeon Jin, Nak Gyeong Ko, Jung Hwan Cho, Ji Min Han, Sunghwan Suh, Ji Cheol Bae, Jung-Han Kim, Sun Wook Kim, Jae Hoon Chung, Tae Hyuk Kim, Jee Soo Kim","doi":"10.1177/10507256251388093","DOIUrl":"10.1177/10507256251388093","url":null,"abstract":"<p><p><b><i>Background:</i></b> The number of retrieved lymph nodes (rLN) is an important surgical metric associated with survival in cancer. However, its association with oncological outcomes in patients with papillary thyroid cancer (PTC) with lateral lymph node (LN) metastasis (N1b disease) has not been investigated. <b><i>Methods:</i></b> This retrospective cohort study included patients with PTC and N1b disease (<i>N</i> = 1003) who underwent lateral neck dissection and categorized them by total number of rLNs. We investigated the association of the categories with recurrence or cancer-specific mortality (CSM) using multivariable Cox proportional hazard models. The optimal number of rLNs associated with low recurrence rate or CSM were identified using restricted cubic spline analysis. Survival analyses across subgroups were performed according to adequate (the estimated total number of rLN at which CSM appeared to be lowest) and inadequate groups. <b><i>Results:</i></b> At initial surgery, the median total number of rLNs and positive number of LNs was 36.0 (25.0-49.0) and 9.0 (5.0-14.0), respectively. During a median follow-up of 90.0 (73.0-129.0) months, recurrence and CSM were detected in 165 and 30 patients, respectively. A higher total number of rLNs was inversely associated with the adjusted hazard ratio (aHR) for recurrence (0.50, 0.51, 0.33, and 0.28; <i>p</i> for trend = 0.001) and CSM (0.33, 0.13, 0.02, and 0.04; <i>p</i> for trend 0.002). The estimated total number of rLNs associated with the lowest recurrence rate and CSM were 32 and 33, respectively. Compared with the inadequate rLNs group, the adequate rLNs group (≥33 total rLNs) showed better prognosis in the entire group (aHR 0.51 [0.35-0.73], <i>p</i> < 0.001; recurrence) (aHR 0.14 [0.04-0.47], <i>p</i> = 0.001; CSM) and various subgroups. <b><i>Conclusions:</i></b> rLNs are associated with recurrence and CSM in patients with PTC and N1b disease, with outcomes appearing to improve at approximately 32-33. This finding suggests that rLNs may serve as a potential quality indicator for neck dissection in PTC. Our finding is mostly applicable to more aggressive disease, and further prospective confirmatory research is warranted.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":" ","pages":"1311-1321"},"PeriodicalIF":6.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12852175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410127","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":"Scholarly Dialogue on Risk to the Recurrent Laryngeal Nerve with Thermal Ablation Procedures: A Reflection on Empirical Practices.","authors":"Marika Russell, Che-Wei Wu, Tzu-Yen Huang, R Michael Tuttle, Peter A Kopp, Jung Hwan Baek, Lisa A Orloff, Julia Noel, Joseph Scharpf, Peter Angelos, Kyung Tae, Jeong Seon Park, Elizabeth Cottrill, Victoria Banuchi, MaryBeth Cunnane, Maurilio Deandrea, Whitney Liddy, Neil Tolley, Erivelto M Volpi, Mark L Urken, Ronald B Kuppersmith, Amr H Abdelhamid Ahmed, Gregory W Randolph","doi":"10.1177/10507256251390376","DOIUrl":"https://doi.org/10.1177/10507256251390376","url":null,"abstract":"<p><p><b><i>Background:</i></b> Radiofrequency and other ablative treatments for thyroid nodules and thyroid malignancies are increasingly being adopted into clinical practice. The safety of these procedures with respect to the recurrent laryngeal nerve (RLN) is not well-characterized. <b><i>Summary:</i></b> Our current understanding of RLN injury with thermal ablation procedures is nascent. Review of surgical literature and practices offers a framework for voice and laryngeal evaluation and reveals important features of RLN injury. At present, current strategies to mitigate and manage RLN injury in thyroid ablation procedures are offered by physicians of varying specialties and are empirical. An in-depth understanding of lessons learned from surgical management of the thyroid and RLN should optimize the safety of thermal ablation procedures. Critically examining commonly recommended ablation techniques through a surgical framework may provide practical insights that can be used to minimize the risk of RLN injury. <b><i>Conclusions:</i></b> Further work is needed to characterize the risk of thermal injury to the RLN in ablation procedures. Research should address the safety and efficacy of hydrodissection and cold irrigation techniques.</p>","PeriodicalId":23016,"journal":{"name":"Thyroid","volume":"35 11","pages":"1221-1229"},"PeriodicalIF":6.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145542338","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}