Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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The vast majority of thyroid cancers of follicular origin (TC) have a very favourable outcome, but 5–10% of cases will develop metastatic disease. Around 60–70% of this subset, hence less than 5% of all patients with TC, will become radioiodine refractory (RAI-R), with a significant negative impact on prognosis and a mean life expectancy of 3–5 years. Since no European expert consensus or guidance for this challenging condition is currently available, a task force of TC experts was nominated by the European Thyroid Association (ETA) to prepare this document based on the principles of clinical evidence. The task force started to work in September 2018 and after several revision rounds, prepared a list of recommendations to support the treatment and follow-up of patients with advanced TC. Criteria for advanced RAI-R TC were proposed, and the most appropriate diagnostic tools and the local, systemic and palliative treatments are described. Systemic therapy with multikinase inhibitors is fully discussed, including recommendations on how to start it and at which dosage, on the duration of treatment, and on the management of side effects. The appropriate relationship between the specialist and the patient/family as well as ethical issues are covered. Based on the available studies and on personal experience, the experts provided 39 recommendations aimed to improve the management of advanced RAI-R TCs. Above all of them is the indication to treat and follow these patients in a specialized setting which allows the interaction between several specialists in a multidisciplinary team.
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
The National Task Force in Hyperthyroidism, Swedish National System for Knowledge-Driven Management, Umeå, Sweden
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Department of Endocrinology and Diabetes, Örebro University Hospital, Örebro, Sweden
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Thyroid Federation International, Kungsbacka, Sweden
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Swedish Thyroid Association, Stockholm, Sweden
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Swedish Thyroid Association, Stockholm, Sweden
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Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
The National Task Force in Hyperthyroidism, Swedish National System for Knowledge-Driven Management, Umeå, Sweden
Sweden and Wallenberg Center for Molecular and Translational Medicine, Västra Götaland Region, Göteborg, Sweden
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support are most relevant ( 28 ). The lack of mental energy and endurance over time reduces the ability to cope with rehabilitation, to spend time with family and friends, and to be involved in society in terms of both work and leisure ( 29 ). In burn
Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Wallenberg’s Centre of Molecular and Translational Medicine, Region Västra Götaland, Sweden
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Department of Pedagogical, Curricular and Professional Studies, Faculty of Education, University of Gothenburg, Gothenburg, Sweden
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Wallenberg’s Centre of Molecular and Translational Medicine, Region Västra Götaland, Sweden
Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
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the intention to elucidate factors that are not primary targets in the treatment of GD and which need to be addressed during rehabilitation. The following three hypotheses have received support: (i) mental fatigue, depression, anxiety, and cognitive
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ointments) should be implemented. Occasionally, objectively mild GO has a profound impact on QoL: these cases may be considered as moderate-to-severe GO and offered immunosuppressive treatment or rehabilitative surgery (see the following two sections) [ 1
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are in the end unhappy with the treatment outcome [ 2 ]. After medical treatment, many patients require some kind of rehabilitative surgery (orbital decompression, squint surgery, eyelid surgery) to correct residual manifestations. The reasons for this
Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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Introduction
Given the high prevalence of thyroid nodules and the potential for malignancy, it is imperative to understand the various factors that contribute to their development. This study aimed to explore the relationship between metabolic syndrome, lifestyle, and thyroid nodules in adult men in southern China.
Methods
This study enrolled a total of 183,990 subjects at a medical examination center in a general hospital in southern China between January 1, 2015, and December 31, 2020. Multivariate logistic regression analysis was utilized to evaluate the relationship between metabolic syndrome, lifestyle factors, and thyroid nodules. Furthermore, structural equation modeling elucidated the intricate relationships among these variables.
Results
The prevalence of thyroid nodules among Chinese adult males was 14.9%. Several factors were identified as risk factors for thyroid nodules, including advanced age, irregular meal time, smoking or quitting smoking, quitting drinking, heavy manual labor, hypertension, diabetes, dyslipidemia and centripetal obesity, and those belonging to ethnic minorities and drinking alcohol were found to be protective factors against thyroid nodules. Structural equation modeling highlighted metabolic syndrome's mediating role amidst lifestyle influences on thyroid nodules.
Conclusion
The prevalence of thyroid nodules in Chinese adult males is relatively moderate to low. The factors identified in this study can help clinicians identify high-risk patients and develop targeted screening strategies for the timely detection of thyroid nodules. However, further mechanistic research and longitudinal studies are necessary to explore the underlying causes and establish causal relationships.
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Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Department of Clinical Sciences and Community Health, Milan, Italy
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Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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loss by introducing dietary and rehabilitative supports. The biliary enzymes, or at least γGT, should be routinely prescribed before the start and during the first 3 months of treatment, and immediately when a pronounced weight loss occurs during follow
Department of Nuclear Medicine, The Fourth hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Objective
Correct diagnosis and prognostic evaluation of medullary thyroid cancer (MTC) are crucial to treat patients. The purpose of this study was to evaluate the diagnostic and prognostic value of [18F]F-DOPA PET/CT in patients with MTC.
Methods
We reviewed MTC patients who underwent [18F]F-DOPA PET/CT from June 2008 to November 2023. Clinical characteristics, follow-up data, and the following [18F]F-DOPA PET/CT parameters were recorded: maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), and SUVmean of multiple organs. The diagnostic value of PET/CT for the detection of tumor lesions was calculated. Serum basal calcitonin (bCt) and stimulated calcitonin (sCt) were determined. Receiver operating characteristics, Kaplan–Meier, and Cox regression analyses were performed.
Results
In total, 109 patients (50 women, 59 men; average age, 55 ± 14 years) were included in the analysis. The patient-related sensitivity, specificity, and accuracy of [18F]F-DOPA PET/CT were 95%, 93%, and 94%, respectively. The lesion-related sensitivity, specificity, and accuracy were 65%, 99%, and 72%, respectively. The optimal cutoff values of bCt, sCt, and CEA to obtain positive [18F]F-DOPA PET/CT results were 64 pg/mL, 1808 pg/mL, and 4 µg/L, respectively. Patients with negative [18F]F-DOPA PET/CT had longer overall survival than patients with positive [18F]F-DOPA PET/CT results (P = 0.017). Significant positive correlations were found between bCt, sCt, and CEA with SUVmax, SUVmean, and MTV of [18F]F-DOPA PET/CT (P < 0.001). [18F]F-DOPA PET/CT results and MTV may be useful for the evaluation of the prognosis of patients with recurrent MTC, while age and MTV were independent prognostic factors in patients with primary MTC. For all patients, SUVmean of the left kidney, liver, aorta, and pancreas might be used to independently predict OS.
Conclusion
[18F]F-DOPA PET/CT had great value for diagnosis and prognostic assessment in patients with MTC. The DOPA PET/CT parameter SUVmean and MTV showed significant association with OS.
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Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Weight loss is one of the most frequent adverse events during treatment with multikinase inhibitors, but scanty data are available on its extent and characteristics. This is the first assessment of the body composition by bioelectrical impedance analysis and of circulating leptin and ghrelin levels, in patients with advanced thyroid cancer before and at regular intervals during treatment with the tyrosine kinase inhibitor lenvatinib. Body mass index (BMI) decreased in all patients, with an average ∆ reduction of –6.4, –9.8, and –15.3% at 3, 6, and 12 months of treatment, respectively. Interestingly, in most patients, after the first year of treatment, BMI remained stable. In all patients, fat mass (FM) reduced more than fat-free mass, the highest decrement being of –60 and –16%, respectively. A decrease in the body cell mass, a parameter mainly due to muscle tissue, was observed only in patients with a vast baseline muscular mass. Total body water decreased in parallel to BMI. During treatment, leptin tightly paralleled the decrease of BMI values, consistent with the decrease in FM, whereas ghrelin levels increased upon BMI decrease. The loss of the FM accounts for the largest portion of BMI reduction during lenvatinib treatment. The increase in ghrelin could account for the BMI stabilization observed after 1 year of treatment. Nevertheless, oral nutritional supplements should be given as early as possible and athletic patients should be encouraged to maintain physical activity. In some circumstances, parenteral nutrition is required for the rehabilitation of these patients.
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rehabilitative surgery (orbital decompression, strabismus surgery, and palpebral aperture narrowing) is good as assessed from pre- and postoperative scores for the same subjects [ 48 ]. TED-QoL is significantly faster to complete (1.6 min vs. GO-QoL 3.1 min vs
