Thyroid cancer - clinical

You are looking at 1 - 10 of 56 items

Arnoldo Piccardo S.C. di Medicina Nucleare, Galliera Hospital, Genoa, Italy
Centro della Tiroide, “Galliera Hospital”, Genoa, Italy

Search for other papers by Arnoldo Piccardo in
Google Scholar
PubMed
Close
,
Francesco Fiz S.C. di Medicina Nucleare, Galliera Hospital, Genoa, Italy
Centro della Tiroide, “Galliera Hospital”, Genoa, Italy

Search for other papers by Francesco Fiz in
Google Scholar
PubMed
Close
,
Sergio Righi S.S.D. Fisica Medica, Galliera Hospital, Genoa, Italy

Search for other papers by Sergio Righi in
Google Scholar
PubMed
Close
,
Stefano Raffa Department of Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy

Search for other papers by Stefano Raffa in
Google Scholar
PubMed
Close
,
Mattia Riondato Department of Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy

Search for other papers by Mattia Riondato in
Google Scholar
PubMed
Close
,
Gianluca Bottoni S.C. di Medicina Nucleare, Galliera Hospital, Genoa, Italy
Centro della Tiroide, “Galliera Hospital”, Genoa, Italy

Search for other papers by Gianluca Bottoni in
Google Scholar
PubMed
Close
,
Matteo Bauckneht Department of Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy
Department of Health Sciences, University of Genoa, Italy

Search for other papers by Matteo Bauckneht in
Google Scholar
PubMed
Close
,
Michela Massollo S.C. di Medicina Nucleare, Galliera Hospital, Genoa, Italy
Centro della Tiroide, “Galliera Hospital”, Genoa, Italy

Search for other papers by Michela Massollo in
Google Scholar
PubMed
Close
,
Alessio Rizzo Department of Nuclear Medicine, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy

Search for other papers by Alessio Rizzo in
Google Scholar
PubMed
Close
,
Mehrdad Shoushtari Zadeh Naseri S.C. di Medicina Nucleare, Galliera Hospital, Genoa, Italy
Centro della Tiroide, “Galliera Hospital”, Genoa, Italy

Search for other papers by Mehrdad Shoushtari Zadeh Naseri in
Google Scholar
PubMed
Close
,
Pierpaolo Trimboli Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

Search for other papers by Pierpaolo Trimboli in
Google Scholar
PubMed
Close
, and
Giorgio Treglia Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

Search for other papers by Giorgio Treglia in
Google Scholar
PubMed
Close

Background

In relapsing differentiated thyroid cancer (DTC), the in vivo evaluation of natrium–iodide symporter (NIS) expression is pivotal in the therapeutic planning and is achieved by 131/123Iodine (131/123I) whole body scan. However, these approaches have low sensitivity due to the low resolution of SPECT. 18F-Tetrafluoroborate (TFB) has been proposed as a viable alternative, which could outperform 131/123I scans owing to the superior PET resolution. We have reviewed the literature to collect the available data on TFB diagnostic performance and compare it with the standard methods.

Methods

Two authors searched PubMed, CENTRAL, Scopus, Web of Science and the web for studies evaluating the biodistribution and dosimetry of TFB in patients with DTC. General characteristics, technical parameters, procedures’ sensitivities and standards of reference were extracted from the selected studies. The risk of bias was evaluated with the QUADAS-2 scoring system.

Results

Five studies were included in the review. Two analysed TFB’s biodistribution and dosimetry, while the other three assessed its diagnostic performance. The diagnostic comparators were 18F-FDG PET/CT (all cases), 124I-PET/CT (one study) and diagnostic/therapeutic 131I-SPECT/CT (one study each). TFB performed better than 131I; the TFB and 18F-FDG PET/CT combination achieved the best sensitivity. TFB delivered significantly less dose than the other NIS tracers.

Conclusion

TFB is a promising tracer in relapsing DTC, showing higher sensitivity and less radiation exposure than the standard methods. The TFB and 18F-FDG combination appears particularly intriguing, especially when disease heterogeneity is suspected. However, data are still sparse and need to be confirmed by further investigations.

Open access
Tommaso Porcelli Department of Public Health, University of Naples “Federico II”, Naples, Italy

Search for other papers by Tommaso Porcelli in
Google Scholar
PubMed
Close
,
Cristina Luongo Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy

Search for other papers by Cristina Luongo in
Google Scholar
PubMed
Close
,
Anna Cerbone Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy

Search for other papers by Anna Cerbone in
Google Scholar
PubMed
Close
,
Carmine Di Luccio Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy

Search for other papers by Carmine Di Luccio in
Google Scholar
PubMed
Close
,
Mariantonia Nacchio Department of Public Health, University of Naples “Federico II”, Naples, Italy

Search for other papers by Mariantonia Nacchio in
Google Scholar
PubMed
Close
,
Maria Angela De Stefano Department of Public Health, University of Naples “Federico II”, Naples, Italy

Search for other papers by Maria Angela De Stefano in
Google Scholar
PubMed
Close
,
Martin Schlumberger Department of Endocrine Oncology, Gustave Roussy Cancer Centre and University Paris-Saclay, Villejuif, France

Search for other papers by Martin Schlumberger in
Google Scholar
PubMed
Close
, and
Domenico Salvatore Department of Public Health, University of Naples “Federico II”, Naples, Italy

Search for other papers by Domenico Salvatore in
Google Scholar
PubMed
Close

Objective

To analyse at our institution the criteria for selecting a first-line therapy for patients with advanced radioiodine-refractory thyroid cancer and their clinical responses, safety and survival outcomes.

Patients and methods

We extracted data from 69 consecutive patients referred to Federico II University Hospital from September 2016 to September 2024, among whom 44 patients were treated with TKIs as first-line treatment and outside any clinical trial, and form the basis of this report.

Results

Thirty-one (71%) patients were treated with the antiangiogenesis inhibitor lenvatinib and 13 (29%) were treated with selective tyrosine kinase inhibitors (s-TKIs). Among the latter, eight patients were treated with dabrafenib + trametinib (DT), two patients were treated with selpercatinib because of contraindications to lenvatinib, and three patients received DT as redifferentiation therapy. A RECIST partial response was observed in 28% of patients treated with lenvatinib, in 63% of those treated with DT and in one of the two patients treated with selpercatinib. Grade ≥3 adverse events occurred in 13 (42%) patients treated with lenvatinib and only in 1 (9%) patient treated with DT. Progression-free survival (PFS) and overall survival rates at 1 year were 72% and 83% in lenvatinib-treated patients and 69% and 83% in DT-treated patients, respectively. In both selpercatinib-treated patients, the PFS at data cut-off was 10 months. No treatment-related deaths were observed.

Conclusion

S-TKIs permitted tailoring systemic treatment based on disease location, tumour volume and patient comorbidities, achieving satisfactory tolerance and outcomes in selected patients with an actionable driver mutation and with contraindications to angiogenesis inhibitors or candidates for redifferentiation therapy.

Open access
Laura Croce Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia, Italy

Search for other papers by Laura Croce in
Google Scholar
PubMed
Close
,
Rosaria Maddalena Ruggeri Department of Human Pathology and Childhood “G. Barresi” (DETEV), University of Messina, Messina, Italy

Search for other papers by Rosaria Maddalena Ruggeri in
Google Scholar
PubMed
Close
,
Camilla Virili Endocrinology Section, Department of Medico-Surgical Sciences and Biotechnologies, “Sapienza” University of Rome, Latina, Italy

Search for other papers by Camilla Virili in
Google Scholar
PubMed
Close
,
Carlo Cappelli Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy

Search for other papers by Carlo Cappelli in
Google Scholar
PubMed
Close
,
Marsida Teliti Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia, Italy

Search for other papers by Marsida Teliti in
Google Scholar
PubMed
Close
,
Pietro Costa Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy

Search for other papers by Pietro Costa in
Google Scholar
PubMed
Close
,
Spyridon Chytiris Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia, Italy

Search for other papers by Spyridon Chytiris in
Google Scholar
PubMed
Close
,
Antonio Nicocia Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy

Search for other papers by Antonio Nicocia in
Google Scholar
PubMed
Close
,
Francesca Coperchini Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy

Search for other papers by Francesca Coperchini in
Google Scholar
PubMed
Close
,
Maria Flavia Bagaglini Endocrinology Section, Department of Medico-Surgical Sciences and Biotechnologies, “Sapienza” University of Rome, Latina, Italy

Search for other papers by Maria Flavia Bagaglini in
Google Scholar
PubMed
Close
,
Flavia Magri Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia, Italy

Search for other papers by Flavia Magri in
Google Scholar
PubMed
Close
,
Alfredo Campennì Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy

Search for other papers by Alfredo Campennì in
Google Scholar
PubMed
Close
, and
Mario Rotondi Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia, Italy

Search for other papers by Mario Rotondi in
Google Scholar
PubMed
Close

Graphical Abstract

Abstract

Objective

The prevalence of thyroid cancer (TC) has increased worldwide, and an association with metabolic and cardiovascular disorders has been reported. Moreover, an increasing percentage of patients are currently diagnosed incidentally through non-thyroid-related imaging for other clinical conditions. Our aim was to assess the prevalence of thyroid-related disease (TD) versus incidental diagnosis (ID) pre-surgery reasons leading to TC diagnosis and to compare the two groups in terms of clinical characteristics, size and severity of TC at presentation and rate of non-thyroid cancers and cardiovascular/metabolic comorbidities.

Design

We performed a retrospective cohort study in three high-volume hospital-based centers for thyroid diseases (Pavia, Latina and Messina) in Italy.

Patients

Consecutive patients with TC were included.

Measurements

Data on pre-surgery reasons leading to TC diagnosis, age, sex, BMI, presence of cardiometabolic comorbidities and non-thyroid cancer were collected.

Results

Among the 327 enrolled subjects, the diagnosis of TC was prompted by thyroid-related reasons in 262 (80.1%, TD group) and incidental in 65 (19.9%, ID group). The ID group patients were more frequently males, significantly older and with a higher BMI than the TD group ones; they had a higher rate of non-thyroidal cancers and cardiovascular/metabolic comorbidities. No significant differences could be observed in terms of TC histotype, cancer size, extrathyroidal extension, lymph node metastases, AJCC staging or American Thyroid Association (ATA) risk stratification.

Conclusions

Biological features of TC are similar in the TD and ID groups, but patients in the two groups display significant differences regarding their clinical features.

Open access
Min Joo Kim Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

Search for other papers by Min Joo Kim in
Google Scholar
PubMed
Close
,
Jae Hoon Moon Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

Search for other papers by Jae Hoon Moon in
Google Scholar
PubMed
Close
,
Eun Kyung Lee Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea

Search for other papers by Eun Kyung Lee in
Google Scholar
PubMed
Close
,
Young Shin Song Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea

Search for other papers by Young Shin Song in
Google Scholar
PubMed
Close
,
Kyong Yeun Jung Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea

Search for other papers by Kyong Yeun Jung in
Google Scholar
PubMed
Close
,
Ji Ye Lee Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
Deparment of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea

Search for other papers by Ji Ye Lee in
Google Scholar
PubMed
Close
,
Ji-hoon Kim Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
Deparment of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea

Search for other papers by Ji-hoon Kim in
Google Scholar
PubMed
Close
,
Woojin Lim Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea

Search for other papers by Woojin Lim in
Google Scholar
PubMed
Close
,
Kyungsik Kim Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea

Search for other papers by Kyungsik Kim in
Google Scholar
PubMed
Close
,
Sue K. Park Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, Republic of Korea

Search for other papers by Sue K. Park in
Google Scholar
PubMed
Close
, and
Young Joo Park Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea

Search for other papers by Young Joo Park in
Google Scholar
PubMed
Close

Objective

Active surveillance (AS) has emerged as a viable alternative to immediate surgery for low-risk thyroid cancer. However, several barriers still hinder its widespread adoption and implementation by physicians.

Methods

In 2024, an email survey was conducted among members of the Korea Thyroid Association to assess their perspectives on AS. The survey comprised questions about clinical case scenarios, perceptions of the benefits and risks associated with AS, factors influencing the consideration of AS and unmet needs for the implementation of AS.

Results

Among the 287 physicians surveyed, 40.8% were endocrinologists, followed by general surgeons at 20.9% and otolaryngologists at 19.9%. The majority worked in tertiary hospitals and had over 10 years of experience. Regarding a 65-year-old man with a 0.7 cm low-risk thyroid cancer, 74.6% of the respondents considered AS. Endocrinologists and physicians with higher self-assessment and experience explaining AS to patients were more inclined to consider AS. Although the respondents recognized the benefits of AS, such as avoiding surgery and reducing surgical complications, they expressed concerns about potential risks, including the possibility of patient lawsuits due to disease progression and patient worry and anxiety about the disease. Challenges in screening candidates for AS were highlighted, especially in detecting recurrent laryngeal nerve involvement and lymph node metastases. Additionally, physicians noted unmet needs in AS implementation, specifically regarding psychological support for patients and reimbursement for long-term follow-up costs.

Conclusions

The survey underscored the need for further research and initiatives to overcome the barriers and implement AS for the management of low-risk thyroid cancer.

Open access
Mengyue Liu Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Search for other papers by Mengyue Liu in
Google Scholar
PubMed
Close
,
Juan Tang Department of Pathology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Search for other papers by Juan Tang in
Google Scholar
PubMed
Close
,
Nan Sun Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Search for other papers by Nan Sun in
Google Scholar
PubMed
Close
,
Chuang Xi Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Search for other papers by Chuang Xi in
Google Scholar
PubMed
Close
,
Chentian Shen Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Search for other papers by Chentian Shen in
Google Scholar
PubMed
Close
,
Song Hongjun Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Search for other papers by Song Hongjun in
Google Scholar
PubMed
Close
,
Quanyong Luo Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Search for other papers by Quanyong Luo in
Google Scholar
PubMed
Close
,
Xianzhao Deng Department of General Surgery, Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Search for other papers by Xianzhao Deng in
Google Scholar
PubMed
Close
, and
Zhongling Qiu Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Search for other papers by Zhongling Qiu in
Google Scholar
PubMed
Close

Objective

Pleural metastasis (PM) is rare in patients with differentiated thyroid cancer (DTC). Radioiodine (131I) therapy has been the main treatment for postoperative metastasis and recurrence of DTC. However, clinical data on PM from DTC are limited. This study investigated the clinicopathological characteristics of patients with PM from DTC that were treated surgically and with 131I therapy and evaluated their long-term prognosis and prognostic factors.

Methods

A review of the Shanghai Sixth People’s Hospital medical records from 2010 to 2023 identified PM in 27 of 14,473 patients with DTC. Overall survival (OS) was assessed by the Kaplan–Meier method.

Results

The prevalence of PM in DTC was 1.87‰ (27/14,473). The median age at the time of initial diagnosis of PM was 59 years (range: 34–79). At the end of follow-up, eight patients (29.63%) had disease progression (PD), four (14.81%) had a partial response, and the remainder had stable disease; no patient achieved complete response. Twelve patients (44.44%) died, and 15 (55.56%) survived. Thirteen patients (48.15%) did not show 131I avidity, and 16 (59.26%) had radioiodine-refractory DTC (RR-DTC). Twenty patients (74.07%) had malignant pleural effusion (MPE), which was large in 11 cases (40.74%) and moderate in two. More-than-moderate MPE (P = 0.031), lack of 131I avidity (P = 0.041) and RR-DTC (P = 0.030) were significantly associated with worse 5-year OS in patients with PM of DTC.

Conclusions

PM is rare in DTC. Lack of 131I avidity, RR-DTC and more-than-moderate MPE are associated with poor OS in patients with DTC and PM.

Open access
Karoly Rucz Department of Endocrinology, Siofok Hospital, Siofok, Hungary

Search for other papers by Karoly Rucz in
Google Scholar
PubMed
Close
,
Laszlo Hegedűs Department of Endocrinology, Odense University Hospital, Odense, Denmark

Search for other papers by Laszlo Hegedűs in
Google Scholar
PubMed
Close
,
Steen Joop Bonnema Department of Endocrinology, Odense University Hospital, Odense, Denmark

Search for other papers by Steen Joop Bonnema in
Google Scholar
PubMed
Close
,
Andrea Frasoldati Endocrinology Unit of Arcispedale S. Maria Nuova, Reggio Emilia, Italy

Search for other papers by Andrea Frasoldati in
Google Scholar
PubMed
Close
,
Laszlo Jambor Institute of Medical Imaging, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

Search for other papers by Laszlo Jambor in
Google Scholar
PubMed
Close
,
Gabor Laszlo Kovacs 1st Department of Medicine, Flohr Ferenc Hospital, Kistarcsa, Hungary

Search for other papers by Gabor Laszlo Kovacs in
Google Scholar
PubMed
Close
,
Enrico Papini Regina Apostolorum Hospital in Albano, Rome, Italy

Search for other papers by Enrico Papini in
Google Scholar
PubMed
Close
,
Gilles Russ Unité Thyroïde et Tumeurs Endocrines - Pr Leenhardt Hôpital La Pitie Salpetriere, Sorbonne Université, Paris, France

Search for other papers by Gilles Russ in
Google Scholar
PubMed
Close
,
Zsolt Karanyi Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

Search for other papers by Zsolt Karanyi in
Google Scholar
PubMed
Close
,
Endre V Nagy Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

Search for other papers by Endre V Nagy in
Google Scholar
PubMed
Close
, and
Tamas Solymosi Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

Search for other papers by Tamas Solymosi in
Google Scholar
PubMed
Close

Objective

The ultrasound evaluation of thyroid nodules (TNs) in patient selection for fine needle aspiration (FNA) requires both uniformly accepted definitions of each nodule characteristic and extensive experience from the examiner. We hypothesized that nodule echogenicity alone may provide comparable performance to more complex approaches in patient selection for FNA.

Patients and methods

Seven highly experienced investigators from four countries evaluated, online, the ultrasound (US) video recordings of 123 histologically verified TN by answering 17 nodule characteristics-related questions. The diagnostic performances of five TN image reporting and data systems (TIRADS) were compared to making decisions based solely on the echogenicity of the nodule for indicating FNA in 110 nodules ≥10 mm.

Results

In the 10–20 mm size range, the sensitivities and specificities of the five TIRADS systems in identifying malignant nodules were 80.5–91.0% and 31.4–50.9%, respectively. Had FNA been recommended for all hypoechoic nodules, disregarding other US characteristics, comparable sensitivity and specificity (87.5% and 43.4%, respectively) were obtained. Compared to nodules >20 mm, a higher proportion of cancers were hypoechoic in the 10–20 mm size range (87.2% vs 77.8%, P = 0.05). In the 10–20 mm size range, compared to hypoechoic nodules, a significantly lower proportion of isoechoic nodules demonstrated suspicious findings (70.7% vs 30.0%, P < 0.05).

Conclusion

In contrast to >20 mm diameter nodules, the recommendation of FNA may rely on a single US feature, echogenicity, in the 10–20 mm size range. If independently confirmed in larger cohorts, this may simplify nodule evaluation in this size range.

Open access
Ruiguo Zhang Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China

Search for other papers by Ruiguo Zhang in
Google Scholar
PubMed
Close
,
Weijian Li Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China

Search for other papers by Weijian Li in
Google Scholar
PubMed
Close
,
Hui Wang Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China

Search for other papers by Hui Wang in
Google Scholar
PubMed
Close
,
Wenxin Zhang Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
Department of Nuclear Medicine, West China Hospital, Chengdu, China

Search for other papers by Wenxin Zhang in
Google Scholar
PubMed
Close
,
Jinyan Chai Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China

Search for other papers by Jinyan Chai in
Google Scholar
PubMed
Close
,
Pengpeng Chang Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China

Search for other papers by Pengpeng Chang in
Google Scholar
PubMed
Close
,
Qiang Jia Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China

Search for other papers by Qiang Jia in
Google Scholar
PubMed
Close
, and
Wei Zheng Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China

Search for other papers by Wei Zheng in
Google Scholar
PubMed
Close

Graphical Abstract

Abstract

Background

Population-based estimates of brain metastases in follicular thyroid cancer (FTC) patients with or without distant metastases (DMs) at diagnosis are lacking.

Objective

To study the prevalence of brain metastases in FTC patients and compare gender disparity.

Methods

DMs are defined as bone, lung and brain metastases. Using the SEER database, we identified 5116 patients diagnosed with FTC between 2010 and 2019. The incidences of brain metastases were calculated for the entire cohort and among patients with bone/lung metastases. Cohorts were stratified by gender and age.

Results

4.8% (245) had DMs at diagnosis, primarily in the form of bone metastases (3.6%), followed by lung metastases (2.4%). The incidence of brain metastases at initial diagnosis was only 0.37% (17 females and 2 males) but occurred in 8.2 and 6.1% of patients with bone metastases and lung metastases, respectively. Median survival for patients with brain metastases was only 8.0 months (95% CI: 4.1–11.9). Interestingly, female patients with bone metastases exhibited a significantly higher incidence of brain metastases compared to males (12.0 vs 1.5%), with a notable odds ratio (OR) of 8.971 (95% CI: 1.152–69.835) in univariate analysis. Multivariate logistic regression analysis confirmed that being female (OR: 10.08, 95% CI: 1.243–81.748) was the sole statistically significant risk factor for brain metastases in FTC patients with bone metastases at diagnosis.

Conclusion

An incidence of brain metastases is observed in newly diagnosed FTC patients with DMs, especially in females with bone involvement. Our findings advocate for the early detection of brain metastases in female FTC patients with concurrent bone metastases at diagnosis.

Open access
Bernard Goichot Department of Endocrinology, Diabetology and Nutrition, Strasbourg University Hospital, France
FMTS, Université de Strasbourg, Faculté de Médecine, France

Search for other papers by Bernard Goichot in
Google Scholar
PubMed
Close
,
François Lefebvre GMRC, Public Health Department, Strasbourg University Hospital, France

Search for other papers by François Lefebvre in
Google Scholar
PubMed
Close
,
Stéphane Vinzio Department of Internal Medicine, Groupe Hospitalier Mutualiste, Grenoble, France

Search for other papers by Stéphane Vinzio in
Google Scholar
PubMed
Close
,
Anne Cailleux Department of Endocrinology, INSERM CIC-CRB, Rouen University Hospital, Rouen, France

Search for other papers by Anne Cailleux in
Google Scholar
PubMed
Close
,
Jean-Marc Kuhn Department of Endocrinology, INSERM CIC-CRB, Rouen University Hospital, Rouen, France

Search for other papers by Jean-Marc Kuhn in
Google Scholar
PubMed
Close
,
Olivier Schneegans Department of Nuclear Medicine, ICANS, Strasbourg Cedex, France

Search for other papers by Olivier Schneegans in
Google Scholar
PubMed
Close
,
Bodgan Catargi Endocrinology-Metabolic Diseases, Hôpital Saint-André, Bordeaux University, Bordeaux, France

Search for other papers by Bodgan Catargi in
Google Scholar
PubMed
Close
,
Olivier Gilly Department of Endocrinology, CHU de Nîmes, Nîmes, France

Search for other papers by Olivier Gilly in
Google Scholar
PubMed
Close
,
Philippe Baltzinger Department of Endocrinology, Diabetology and Nutrition, Strasbourg University Hospital, France

Search for other papers by Philippe Baltzinger in
Google Scholar
PubMed
Close
,
Nicolas Meyer GMRC, Public Health Department, Strasbourg University Hospital, France
iCUBE, CNRS UMR, Illkrich, France

Search for other papers by Nicolas Meyer in
Google Scholar
PubMed
Close
,
Philippe Caron Department of Endocrinology, Metabolic diseases and Nutrition, Pôle Cardio-vasculaire et Métabolique, CHU Larrey, Toulouse
Université Paul Sabatier, Inserm, Toulouse, France

Search for other papers by Philippe Caron in
Google Scholar
PubMed
Close
, and
the investigators of the Pirahtes study †
Search for other papers by the investigators of the Pirahtes study † in
Google Scholar
PubMed
Close
the investigators of the Pirahtes study

Objective

Subclinical hyperthyroidism (SCH) is common and associated with atrial fibrillation (AF) risk in the elderly. Current guidelines rely on a low level of evidence.

Methods

Randomized clinical trial including patients 50 years and older, with thyroid-stimulating hormone (TSH) <0.4 mU/L and normal thyroid hormone concentrations. All patients showed autonomy on thyroid scan. They were randomized either to receive radioiodine (I-131) or to be monitored and treated only if they underwent AF or evolved toward overt hyperthyroidism. Primary outcome was the onset of new AF. Secondary outcomes were treatment-induced hypothyroidism rate and health-related quality of life.

Results

One hundred forty-four patients (mean age: 65.3 ± 8.9 years, 76% females) were randomized, 74 to surveillance and 70 to treatment. Four patients in the surveillance group and one in the treatment group developed AF (P = 0.238). However, the patient who developed AF in the treatment group maintained TSH <0.4 mU/L at AF onset. A post-hoc analysis was carried out and showed that when normalization of TSH was considered, the risk of AF was significantly reduced (P = 0.0003). In the surveillance group, several patients showed no classical characteristics associated with AF risk, including age >65 years or TSH < 0.1mU/L. Of 94 patients treated using radioiodine, 25% developed hypothyroidism during follow-up.

Conclusion

Due to recruitment difficulties, this study failed to demonstrate that SCH treatment can significantly reduce the incidence of AF in patients older than 50 years with thyroid autonomy even if all the patients who developed AF maintained TSH <0.4 mU/L. This result must be balanced with the increased risk of radioiodine-induced hypothyroidism.

Open access
Hyunju Park Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea

Search for other papers by Hyunju Park in
Google Scholar
PubMed
Close
,
Jung Heo Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang-si, Gyeonggi-do, Korea

Search for other papers by Jung Heo in
Google Scholar
PubMed
Close
,
Hyun Jin Ryu Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Search for other papers by Hyun Jin Ryu in
Google Scholar
PubMed
Close
,
Min-Ji Kim Statistics and Data Center, Samsung Medical Center, Research Institute for Future Medicine

Search for other papers by Min-Ji Kim in
Google Scholar
PubMed
Close
,
Young Lyun Oh Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Search for other papers by Young Lyun Oh in
Google Scholar
PubMed
Close
,
Tae Hyuk Kim Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Search for other papers by Tae Hyuk Kim in
Google Scholar
PubMed
Close
,
Sun Wook Kim Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Search for other papers by Sun Wook Kim in
Google Scholar
PubMed
Close
, and
Jae Hoon Chung Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Search for other papers by Jae Hoon Chung in
Google Scholar
PubMed
Close

Objective

Previous reports suggest that a high body mass index (BMI) increases the risk of thyroid carcinoma. However, it remains unclear whether a high BMI is associated with the risk of the BRAFV600E mutation. We aimed to assess whether a high BMI is associated with an increased risk of the BRAFV600E mutation.

Design and Methods

We screened 6558 PTC patients who had undergone BRAFV600E mutation testing between January 2009 and December 2017. After exclusion, 6438 PTC patients were enrolled. We used logistic regression, and restricted cubic spline plots of the adjusted odds ratios (ORs) were illustrated to model the relationship between BMI and the BRAFV600E mutation.

Results

Of the 6438 patients, 5102 (79.2%) had the BRAFV600E mutation, and 4954 (76.9%) were female. The median BMI was 23.8 (21.6–26.2) kg/m2. The primary tumor size was ≤1 cm in 4226 patients (65.6%) and >1 cm in 2212 patients (34.4%). The BRAFV600E mutation was significantly associated with high BMI only in patients with a primary tumor size >1 cm (OR: 1.034; 95% CI: 1.003–1.065; P = 0.029), whereas no clear association was found in patients with a primary tumor size ≤1 cm (OR: 1.007; 95% CI: 0.984–1.030; P = 0.570). Gender was not a significant factor in either group.

Conclusions

Our study found that a higher BMI was positively associated with the BRAFV600E mutation in patients with a primary tumor size >1 cm. These results suggest that the association between BMI and the BRAFV600E mutation status differs depending on primary tumor size.

Significance Statement

Obesity has been suggested as a potential risk factor for thyroid carcinoma. The aim of this study was to assess the association between BMI and the BRAFV600E mutation. In this study, the BRAFV600E mutation was significantly associated with a high BMI only in a primary tumor size >1 cm (OR: 1.034; P = 0.029). No clear association was found in patients with a primary tumor size ≤1 cm (OR: 1.007; P = 0.570). The association between BMI and the BRAFV600E mutation status differs depending on the primary tumor size.

Open access
Carla Gambale Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa, Italy

Search for other papers by Carla Gambale in
Google Scholar
PubMed
Close
,
Alessandro Prete Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa, Italy

Search for other papers by Alessandro Prete in
Google Scholar
PubMed
Close
,
Chiara Romei Department of Diagnostic Imaging, Unit of Radiology, Pisa University Hospital, Pisa, Italy

Search for other papers by Chiara Romei in
Google Scholar
PubMed
Close
,
Alessandro Celi Department of Surgery, Medicine, Molecular Biology and Critical Care, Respiratory Pathophysiology Unit, Pisa University Hospital, Pisa, Italy

Search for other papers by Alessandro Celi in
Google Scholar
PubMed
Close
,
Rossella Elisei Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa, Italy

Search for other papers by Rossella Elisei in
Google Scholar
PubMed
Close
, and
Antonio Matrone Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa, Italy

Search for other papers by Antonio Matrone in
Google Scholar
PubMed
Close

Highly selective RET inhibitor selpercatinib has demonstrated notable efficacy in advanced/progressive RET-mutant medullary thyroid cancer (MTC) patients. However, despite a more tolerable toxicity profile than multikinase inhibitors, peculiar adverse events (AEs) have been described. Obliterative bronchiolitis (OB) is a respiratory disease characterized by inflammation and fibrosis in small conducting airways. We evaluated a 70-year-old man with advanced RET-mutant MTC who developed OB during treatment with selpercatinib. Radiological features of OB occurred early and persisted during selpercatinib treatment, with a waxing and waning pattern. Notably, a partial response of MTC was achieved during the treatment, and selpercatinib was never reduced or interrupted. The almost complete absence of symptoms and the fluctuating trend, without specific treatment for OB, suggested that it is necessary to carefully evaluate the risks mediated by this AE with the risks of modifying or discontinuing the anti-cancer therapy.

Open access