Journal of Clinical Endocrinology & Metabolism最新文献

{"title":"Long-Term Non-skeletal Complications in Patients with Thyroid Cancer and Hypoparathyroidism Post-total Thyroidectomy.","authors":"Eu Jeong Ku, Jooyoung Lee, Won Sang Yoo, Janghyeon Bae, Eun Kyung Lee, Hwa Young Ahn","doi":"10.1210/clinem/dgaf213","DOIUrl":"https://doi.org/10.1210/clinem/dgaf213","url":null,"abstract":"<p><strong>Background: </strong>Thyroid cancer (TC) is a prevalent endocrine malignancy with rising incidence attributed to advancements in diagnostic technology. Despite its generally favorable prognosis, post-surgical complications, including hypoparathyroidism, can cause long-term health challenges. This study evaluated the risk of non-skeletal complications in TC patients with hypoparathyroidism.</p><p><strong>Materials and methods: </strong>A retrospective cohort study was conducted using the National Health Insurance Service-National Sample Cohort (2002-2019), including TC patients diagnosed between 2006 and 2019. Participants were categorized into TC with hypoparathyroidism (TC with hypoP), TC without hypoparathyroidism (TC without hypoP), and matched controls. Propensity score matching and Cox proportional-hazards models evaluated the incidence and risk of non-skeletal complications, including diabetes mellitus, dyslipidemia, cardiovascular and renal outcomes, and cataracts.</p><p><strong>Results: </strong>This study included 430 and 850 patients in the TC with hypoP and TC without hypoP groups, respectively, and their matched controls. The TC with hypoP group showed significantly higher risks of diabetes mellitus (HR 1.31, 95% CI: 1.01-1.68), dyslipidemia (HR 1.29, 95% CI: 1.06-1.57), urinary stones (HR 1.61, 95% CI: 1.00-2.57), and cataracts (HR 1.50, 95% CI: 1.15-1.95), compared to controls (all P<0.05). Hypertension risk was higher in the TC with hypoP group versus the TC without hypoP group (HR 1.39, 95% CI: 1.00-1.93, P=0.048). Women had higher urinary stone risk, while cataract risk increased in patients aged over 50.</p><p><strong>Conclusion: </strong>TC patients with hypoparathyroidism are at an increased risk for specific non-skeletal complications, particularly older adults and women. These findings underscore the need for targeted monitoring and management strategies in this population. Further prospective studies are warranted to validate these associations and elucidate the underlying mechanisms.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assisted Reproduction Technology Treatment Outcomes in Female Carriers of 21-Hydroxylase Deficiency.","authors":"Arthur C Arcaz, Carlos Hernandez-Nieto, Joseph A Lee, Teresa A Cacchione, Tanmoy Mukherjee, Alan B Copperman","doi":"10.1210/clinem/dgaf198","DOIUrl":"https://doi.org/10.1210/clinem/dgaf198","url":null,"abstract":"<p><strong>Context: </strong>Carriers of a CYP21A2 pathogenic variant exhibit distinct hormonal differences, yet their impact on assisted reproductive technology outcomes remains unknown.</p><p><strong>Objective: </strong>To evaluate whether carriers of a CYP21A2 pathogenic variant exhibit differences in ovarian stimulation response and in vitro fertilization outcomes compared with non-carriers.</p><p><strong>Design: </strong>A retrospective cohort study at a single private-academic center.</p><p><strong>Subjects: </strong>A total of 1284 subjects undergoing 1556 in vitro fertilization cycles were ultimately included in the analysis, comprising of 244 carriers and 1040 non-carrier controls.</p><p><strong>Exposure: </strong>Female monoallelic CYP21A2 mutation carrier status.</p><p><strong>Main outcome measures: </strong>Live birth rates following frozen single euploid embryo transfer (SEET). Secondary outcomes included ovarian stimulation parameters, embryological development (fertilization and euploidy rates) and post-transfer outcomes (implantation, clinical pregnancy and pregnancy loss rates).</p><p><strong>Results: </strong>Baseline characteristics and ovarian stimulation parameters were similar between pathogenic CYP21A2 variant carriers and non-carriers. No significant differences were observed in live birth (50.7% vs. 51.1%, p = 0.87), implantation (75.4% vs. 73.4%, p = 0.99), clinical pregnancy (63.3% vs. 62.7%, p = 0.73) rates between carriers and non-carriers, respectively. Although a univariate analysis of fertilization rates (81.7% vs. 83.3%, p = 0.008) showed a significance difference, this difference was not observed after adjusting for confounding variables in a multivariate analysis (adjusted odds ratio of 1.05, 95% CI 0.93-1.18).</p><p><strong>Conclusion: </strong>Female patients who carry a pathogenic CYP21A2 variant achieve in vitro fertilization outcomes comparable to non-carriers. These findings support maintaining standard assisted reproductive treatment protocols for carriers and help provide personalized counseling for carriers identified through genetic screening.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Initial eGFR and Albuminuria Changes on Clinical Outcomes in People With Diabetes Receiving SGLT2 Inhibitors.","authors":"Birdie Huang, Yi-Wei Kao, Kun-Chi Yen, Shao-Wei Chen, Tze-Fan Chao, Yi-Hsin Chan","doi":"10.1210/clinem/dgaf133","DOIUrl":"https://doi.org/10.1210/clinem/dgaf133","url":null,"abstract":"<p><strong>Context: </strong>The relationship between initial changes in estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (UACR), and their independent association with clinical outcomes in type 2 diabetes (T2D) patients receiving sodium-glucose cotransporter 2 inhibitors (SGLT2is), remains unclear.</p><p><strong>Objective: </strong>This study aimed to investigate the association between initial changes in eGFR and UACR with consequent cardiovascular and kidney outcomes in an Asian population with T2D following SGLT2i treatment in a real-world setting.</p><p><strong>Methods: </strong>Using a large multicenter medical database in Taiwan, we analyzed 8222 T2D patients with baseline and 3-month follow-up eGFR and UACR measurements, receiving SGLT2is between June 1, 2016, and December 31, 2021. We assessed risks of major adverse renal events (MARE), major adverse cardiovascular events (MACE), hospitalization for heart failure (HHF), and all-cause mortality using a Cox proportional hazards model.</p><p><strong>Results: </strong>After 3 months of SGLT2i treatment, patients were categorized based on early changes in eGFR (no decline, 0%-10% decline, > 10% decline) and UACR (no reduction, 0%-30% reduction, > 30% reduction). Among those with no initial eGFR decline (40.9%), 19.8% had no initial UACR reduction, 8.4% had 0% to 30% reduction, and 12.7% had greater than 30% reduction. For those with greater than 10% initial eGFR decline (21.5%), 6.5% had no UACR reduction, 4.3% had 0% to 30% reduction, and 10.7% had greater than 30% reduction. Patients with greater than 10% initial eGFR decline but no UACR reduction showed higher risks of MARE (adjusted HR [aHR]: 2.34; 95% CI, 1.32-4.15), MACE (aHR: 1.83; 95% CI, 1.01-3.29), and HHF/cardiovascular death (aHR: 1.93; 95% CI, 1.05-3.55) compared to those with modest early eGFR decline and UACR reduction.</p><p><strong>Conclusion: </strong>T2D patients experiencing profound early eGFR decline without concordant UACR reduction while on SGLT2is represent a high-risk subgroup with worse clinical outcomes. These findings suggest the need for closer monitoring and potentially more aggressive therapeutic strategies for this patient population.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of One-Month Very-Low-Calorie Ketogenic Diet on 24 h Energy Metabolism and Body Composition in Women with Obesity.","authors":"Alessio Basolo, Paolo Piaggi, Valentina Angeli, Paola Fierabracci, Chiara Bologna, Edda Vignali, Daniela Troiani, Roberta Jaccheri, Caterina Pelosini, Melania Paoli, Guido Salvetti, Luca Chiovato, Jonathan Krakoff, Alberto Landi, Ferruccio Santini","doi":"10.1210/clinem/dgaf196","DOIUrl":"https://doi.org/10.1210/clinem/dgaf196","url":null,"abstract":"<p><strong>Context: </strong>Very-low-calorie ketogenic diet (VLCKD) is used for weight loss and management of obesity-related comorbidities.</p><p><strong>Objective: </strong>We aimed at evaluating the effects of VLCKD on body composition and energy metabolism.</p><p><strong>Methods: </strong>This prospective outpatient study included 17 women with obesity (mean age 41.6 yrs; BMI 37.5 kg/m2) who followed a 1-month VLCKD (700-800 kcal/day, CHO 11%, fat 46%, protein 43%) at the University Hospital of Pisa. Measurements of 24-hour energy expenditure (24hEE) and substrate oxidation were conducted in a metabolic chamber at day 1 (V1), day 8 (V2), and day 29 (V3). Body composition was assessed by DXA. Twenty-two women with obesity fed a balanced isocaloric diet served as controls.</p><p><strong>Results: </strong>Compared to controls, carbohydrate oxidation (CarbOx) was lower, whereas fat oxidation (FatOx) and protein oxidation (ProtOx) were higher in the VLCKD group at V1. CarbOx decreased by 65%, while FatOx increased by 11% at V3. The rate of protein oxidation was already higher than in controls at V1 and remained stable throughout the study. After 1 month, body weight decreased by 7%, reflecting an 8.8% reduction in fat mass (FM) and a 5.6% reduction in lean soft tissue (LST). A 10% decrease in 24hEE and 24 h sleeping metabolic rate was observed at V3 compared to V1.</p><p><strong>Conclusion: </strong>VLCKD promotes weight loss in women with obesity. Our findings highlight the shift in energy metabolism towards increased fat oxidation accompanied by a modest increase in protein oxidation, a decrease in LST and a reduction in EE.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in A1C versus GMI Across Glycemic Categories in Clinical Trials of Type 1 Diabetes.","authors":"Eslam Montaser, Sebastián E Abad, Viral N Shah","doi":"10.1210/clinem/dgaf211","DOIUrl":"https://doi.org/10.1210/clinem/dgaf211","url":null,"abstract":"<p><strong>Context: </strong>The glucose management indicator (GMI) is an estimated A1C derived from sensor glucose. Though it is being used to approximate A1C in clinical trials, there is no data on direction and magnitude of change in GMI vs A1C after an intervention.</p><p><strong>Objective: </strong>To evaluate the magnitude and direction of changes in A1C compared to GMI across different baseline glycemic categories in type 1 diabetes (T1D) clinical trials.</p><p><strong>Methods: </strong>Baseline and 3-month central lab measured A1C and estimated GMI from sensor glucose were collected from T1D clinical trials (DCLP3, DCLP5, and WISDM), encompassing children, adolescents, adults, and older adults. Magnitude and direction of changes (baseline- 3 months) in A1C versus GMI were compared overall across the studies and by stratified baseline A1C (<7%, 7-9%, >9%).</p><p><strong>Results: </strong>A modest correlation was found between changes in A1C and GMI (r = 0.34). Participants with baseline A1C >9% had larger reductions in A1C compared to GMI [-1.2 (-2.1 to -0.6) vs. -0.6 (-0.94 to 0), p<0.01]. Those with baseline A1C between 7-9% showed a greater decline in A1C than GMI [-0.4 (-0.9 to -0.1) vs. -0.12 (-0.49 to 0.21), p<0.01]. No significant difference was observed for baseline A1C <7%.</p><p><strong>Conclusions: </strong>Change in GMI is influenced by the baseline A1C of the participants and it underestimates the true change in A1C. Use of GMI as an endpoint in clinical trials may not reliably capture efficacy of an intervention in T1D trials or real-world studies.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing Screening Programs for Presymptomatic Type 1 Diabetes: Practical Guidance for Diabetes Care Providers.","authors":"Steven B Leichter, Jamie L Felton, Cristy Geno Rasmussen, Patrick Rizzuto, Natalie Bellini, Osagie Ebekozien, Rifka Schulman-Rosenbaum","doi":"10.1210/clinem/dgaf194","DOIUrl":"https://doi.org/10.1210/clinem/dgaf194","url":null,"abstract":"<p><p>Type 1 diabetes (T1D) is an autoimmune disease with two presymptomatic stages (stages 1 and 2) that precede its clinical onset (stage 3). The presymptomatic stages of T1D are characterized by circulating autoantibodies that can be reliably detected by autoantibody screening panels. Identifying people in the presymptomatic stages of T1D can allow for monitoring and prevention of diabetic ketoacidosis. A disease-modifying therapy that has been shown to delay onset of stage 3 T1D is now also available for individuals with stage 2 disease, highlighting the importance of early detection. This intervention may delay the onset of stage 3 T1D. Updated guidance and protocols are needed to integrate autoantibody screening into standard practice. This report provides guidance for endocrinology providers on establishing clinical autoantibody screening programs within their practices, institutions, healthcare networks, and/or communities. Key steps include nominating a champion for the program, building a team to implement screening, and motivating other providers to participate. Implementation of screening requires standardizing several steps in the screening process, including communicating with individuals at risk, integrating screening into existing workflows, and streamlining logistics such as ordering and coding for autoantibody panels. Providers must have a plan to interpret and communicate results and to ensure that individuals may be appropriately followed in the future. Here, common barriers to screening are addressed, and practical solutions to facilitate the adoption and success of screening initiatives are offered.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes risk in young survivors of childhood cancer: a need for prevention and survivor-specific treatment strategies.","authors":"Stephanie B Dixon","doi":"10.1210/clinem/dgaf202","DOIUrl":"https://doi.org/10.1210/clinem/dgaf202","url":null,"abstract":"","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adrenal Vein Sampling in Primary Aldosteronism - Is the Gold Standard Losing its Luster?","authors":"Jaap Deinum, Adina F Turcu","doi":"10.1210/clinem/dgaf204","DOIUrl":"https://doi.org/10.1210/clinem/dgaf204","url":null,"abstract":"<p><p>The first primary aldosteronism (PA) case, documented in 1954, was attributed to a sizable aldosterone-producing adenoma (APA), which was palpable during exploratory surgery. By the 1960s, expected APAs in several other, equally severe PA cases escaped localization with ether radiographic modalities available at the time (aortography and retroperitoneal pneumography) or during intraoperative exploration. Adrenal vein sampling (AVS) was, hence, introduced in an effort to accurately guide adrenalectomy. Computed tomography eventually became available in the 1970s, albeit with limited initial performance. Over the following decades, cross-sectional imaging underwent major advancements in spatial resolution, scanning time, and manufacturing capacity, broadening its use at a global scale. Nevertheless, AVS has remained the most trusted modality for identifying PA cases that could benefit from surgery. This clinical practice standard has been anchored in two major arguments: 1) a rising detection of nonfunctional incidentalomas, and 2) histological documentation of millimetric sources of clinically overt PA. Numerous limitations of AVS (an invasive, costly, and technically challenging procedure, with scarce availability) have driven efforts to develop alternative modalities to localize PA sources. In addition, growing understanding of PA pathophysiology has challenged the gold-standard status of AVS for PA subtyping. This perspective discusses the evolving role of AVS in contemporary PA management.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of Pasireotide in Insulinoma-associated hypoglycemia: a Systematic Review.","authors":"Arturo Vega-Beyhart, Betina Biagetti, Mónica Marazuela, Manel Puig-Domingo, Marta Araujo-Castro","doi":"10.1210/clinem/dgaf195","DOIUrl":"https://doi.org/10.1210/clinem/dgaf195","url":null,"abstract":"<p><strong>Background: </strong>Persistent hypoglycemia is a life-threatening complication in insulinoma patients. When tumor excision is not possible, medical treatments are the main option. Pasireotide has shown promise in managing refractory hypoglycemia, but its use has only been reported in case series and reports.</p><p><strong>Objective: </strong>To assess the efficacy and safety of Pasireotide in treating insulinoma-associated hypoglycemia.</p><p><strong>Methods: </strong>We conducted a systematic review on using Pasireotide to treat insulinoma-associated hypoglycemia, following a pre-developed protocol. We searched MEDLINE, Scopus, Google Scholar, and references forward and backward from database inception to March 30, 2024.</p><p><strong>Results: </strong>Of 490 identified studies, 137 were reviewed, and 17 cases from 13 studies met inclusion criteria. Patients' ages ranged from 52 to 71 years (nine female). Five patients (30%) underwent surgical tumor resection. Pasireotide was never the initial treatment. The most common doses were 40-60 mg/month for Pasireotide LAR and 0.6 mg/12h for short-acting Pasireotide. Six patients (35%) showed no improvement, four (23%) had partial improvement, and seven (41%) had complete resolution. Patients with aggressive insulinomas had a lower response rate, with 55% showing no improvement compared to 16% in indolent cases. Larger tumors were significantly associated with poorer response (p = 0.043). Hyperglycemia was the most common side effect (n=3).</p><p><strong>Conclusion: </strong>Pasireotide effectively restored glucose levels in insulinoma patients who failed prior treatments. However, its efficacy was lower in aggressive insulinomas, emphasizing the need for alternative or combinatory strategies in metastatic cases. Given that Pasireotide was never used as a first-line therapy in the reviewed cases, earlier administration in selected patients may improve outcomes.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Validation of ATA Risk Score for Papillary Thyroid Microcarcinoma: An ITCO Real-World Study.","authors":"Simone De Leo, Giulia Brigante, Silvia D'Elia, Simona Censi, Bruno Madeo, Silvia Morelli, Alice Nervo, Andrea Repaci, Clotilde Sparano, Ilaria Stramazzo, Camilla Virili, Francesco Bertagna, Francesco Dondi, Efisio Puxeddu, Edoardo Talpacci, Maria Chiara Zatelli, Maria Rosaria Ambrosio, Francesco Felicetti, Alessandro Piovesan, Luisa Petrone, Virginia Adornato, Matteo Trevisan, Laura Fugazzola, Chiara Mele, Marco Zavattaro, Erica Solaroli, Nicola Salituro, Mattia Rossi, Loredana Pagano, Alessandra Colapinto, Cristina Basso, Graziano Ceresini, Michela Marina, Umberto Crocetti, Michela Massa, Maurilio Deandrea, Francesca Retta, Giovanna Spiazzi, Nicoletta Rolli, Rocco Bruno, Antonella Carbone, Mario Rotondi, Flavia Magri, Poupak Fallahi, Maria Grazia Chiofalo, Maria Giulia Santaguida, Salvatore Monti, Tommaso Porcelli, Roberto Castello, Alfonso Sagnella, Cristina Clausi, Giulia Di Dalmazi, Dario Tumino, Andrea Palermo, Antonio Brunetti, Andrea Lania, Andrea Liverani, Cosimo Durante, Umberto Ferraro Petrillo, Marco Alfo', Sebastiano Filetti, Giorgio Grani","doi":"10.1210/clinem/dgaf190","DOIUrl":"https://doi.org/10.1210/clinem/dgaf190","url":null,"abstract":"<p><strong>Context: </strong>The risk of recurrence of papillary thyroid carcinoma smaller than 1 cm (microPTC) is low. Predictors of disease persistence in microPTC are still unclear.</p><p><strong>Objective: </strong>To compare the clinical and pathological characteristics of microPTCs with macrocarcinomas (PTC > 1 cm), identifying the predictors of biochemical and structural incomplete response one year after initial treatment in microPTC.</p><p><strong>Methods: </strong>We included patients consecutively enrolled in the Italian Thyroid Cancer Observatory (NCT04031339), and selected patients with a histological diagnosis of PTC for whom complete pathological, clinical, treatment information, and results at the 1-year follow-up visits were available.</p><p><strong>Results: </strong>Among 5038 patients in the cohort, 2345 (46.5%) had a microPTC. Patients with microPTCs had tumors with more indolent pathological features: only 3% of patients were classified as high risk according to the American Thyroid Association (ATA) risk stratification system for persistent or recurrent disease and 1% had distant metastases at diagnosis. MicroPTCs had a significantly better outcome: only 5% had a biochemical (BIR) and 2.3% a structural incomplete (SIR) response. Distant metastases at diagnosis were the best predictor of SIR in microPTCs (OR 5.13, 95% CI 1.11-23.73, p=0.04). In a subgroup of 925 patients treated by total thyroidectomy and radioiodine treatment, the best predictor of SIR was the ATA high risk (OR 5.47, 95% CI 1.42-21.04, p=0.01).</p><p><strong>Conclusion: </strong>Our study confirms the favorable initial outcome of microPTC in a large series. We demonstrate that the ATA risk classification is reliable in predicting biochemical and structural persistence in microPTC patients. Distant metastases, although rare, remain the best predictor of structural persistence at 1-year follow-up. These findings underscore the importance of tailored management strategies based on comprehensive risk stratification, rather than solely on tumor size.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}