Thyroid Research最新文献

Establishment of trimester-specific reference intervals (RIs) for thyroid hormones is essential to avoid misdiagnosis and misinterpretation in pregnant women. This systematic review comprehensively analysed gestational age-specific reference intervals in different populations. The electronic databases such as Medline, Embase, Scopus, and Google Scholar were searched to identify relevant articles. The reference population, consisting of healthy pregnant women in the first, second, and third trimesters of pregnancy, meeting eligibility, such as the absence of thyroid disease, a negative thyroid peroxidase (TPO) antibody test, and sufficient urinary iodine concentration (UIC), was selected for the present study. Of the 1,160 studies identified in the databases, 48 were eligible for the systematic review. Data on trimester-specific RIs, established from a 95% confidence interval (CI) between the 2.5th percentile (lower limit) and the 97.5th percentile (upper limit) of thyroid hormones, were extracted. In most studies, the upper limit of TSH in healthy pregnant women during the first (85.4%), second (94.1%), and third trimesters (72%) was determined to be 2.15-4.51 mIU/L, 2.73-4.84 mIU/L, and 2.90-4.91 mIU/L, respectively. Furthermore, the lower and upper limits of FT4 during the first (80.5% and 87.8%), second (83.3% and 90%), and third trimesters (82.1% and 96.4%) have been reported as being between 10.17 and 14.16 pmol/L and 15.22-23.94 pmol/L, 8.31-11.71 pmol/L and 15.47-20.59 pmol/L, and 7.39-9.78 pmol/L and 12.03-19.82 pmol/L, respectively. The study results showed that reference value for thyroid hormones vary within the same population and also between different populations, particularly for TSH. Given this high variability, even within the Indian population, it is imperative to establish population-specific reference values.

Background: The aim of this novel study was to explore the possibility of the development of a machine learning (ML) model that can predict early response to radioactive iodine (RAI) therapy in patients with hyperthyroidism on the basis of demographic, clinical, laboratory, and imaging features.

Methods: A total of 914 patients who received RAI for the treatment of hyperthyroidism between January 2000 and December 2023 were included in the study. The early positive response, defined as an accomplishment of hypothyroidism (thyroid-stimulating hormone (TSH) > 4 mIU/L) in the 6-month period following RAI therapy, was accomplished in 336 patients (36.76%) (hypothyroidism group), whereas hypothyroidism was not accomplished in 578 patients (63.24%) (control group). The training data consisted of 90% of the sample (822 patients), whereas the test set contained 92 patients. Multiple ML models, including k-nearest neighbors, random forest, various gradient boosting algorithms, and neural networks, were trained via AutoGluon.

Results: The neural network model performed the best, with a balanced accuracy of 68.81%, sensitivity of 61.76%, specificity of 75.86%, PPV of 60.0%, NPV of 77.19%, and F1 score of 60.87%, with the area under the curve (AUC) of 0.706 (95% confidence interval [CI]: 0.593-0.809; receiver operating characteristic [ROC] curve analysis). In the development of the top-performing model, baseline TSH, age, 24-h radioactive iodine uptake, dose, and duration of previous treatment with antithyroid drugs (ATDs) were the most important features.

Conclusions: We developed models for the prediction of the response to RAI in patients with hyperthyroidism. However, these models require further development before they can be applied in clinical practice. By introducing more variables and increasing the sample size, the model performance can increase further.

Background: Hashimoto's thyroiditis (HT) is a prevalent autoimmune thyroid disease (AITD) closely linked to genetic predisposition and environmental factors. Gut microbiota dysbiosis has recently been implicated as a critical contributor to AITDs' pathogenesis. Our study aims to systematically investigate the dynamic alterations in gut microbial communities under varying thyroid functional statuses and elucidate their underlying mechanisms.

Methods: 67 HT patients with varying thyroid functional statuses and 23 healthy controls were enrolled. Fecal 16 S rDNA sequencing and analyses (alpha diversity, LEfSe, correlation, functional pathways) assessed microbiota-thyroid function links.

Results: HT patients with hypo/hyperthyroidism had lower gut microbiota richness than euthyroid patients (more reduced in hyperthyroidism). The hyperthyroid group exhibited enrichment of Fusobacterium, the hypothyroid group was dominated by Clostridium sensu stricto_1, and the euthyroid group showed a predominance of short-chain fatty acid (SCFA)-producing bacteria (e.g., Lactobacillus). Clostridium sensu stricto_1 positively correlated with TPO-Ab levels but negatively correlated with FT3.Pro-inflammatory genera(e.g., Escherichia-Shigella, Streptococcus) demonstrated negative correlations with FT3.Functional prediction analysis revealed potential associations with L-tyrosine degradation in the hyperthyroid group, reduced proportions of bile acid metabolism pathways in the hypothyroid group, and enriched proportions of fatty acid metabolism pathways in the euthyroid group.

Conclusions: This study revealed that gut microbiota dysbiosis is closely associated with thyroid functional statuses in HT. Specific bacterial genera, such as Clostridium sensu stricto_1 and Fusobacterium, may contribute to immune regulation and disease progression. The dynamic alterations in gut microbial profiles provide potential biomarkers for precision diagnosis and treatment of HT.

Background: Ultrasound (US) is the most accurate tool for the assessment of thyroid nodules (TNs). Despite the subcapsular position of TNs may represent a game changer for clinical practice in selecting cases for biopsy or surgery, this parameter is not included in US-based risk stratification systems. The present study evaluated the agreement of endocrinologists using US in clinical practice with the experts' results employed as reference standard.

Methods: A sub-series of TNs for which the agreement between US expert endocrinologists and radiologists was perfect was assumed as reference. Participants of the 2025 Thyroid Update of Associazione Medici Endocrinologi (AME) were asked to assess TNs in a 3-choice answer: subcapsular, non-subcapsular, or uncertain. The agreement was determined according to majority consensus (i.e., ratings > 50% = final consensus outcome) and Fleiss κ (from 0.1 to 1.0).

Results: The series included 13 TNs (6/13 cancer, 7/13 echographically at high risk) whose median distance from the anterior and posterior thyroid capsule was 0 and 1.5 mm, respectively. One hundred and six endocrinologists (females, 62%; age, < 40 years 33%; specialized professionals, 81%) participated as raters. The TNs assessed by experts as subcapsular were judged as subcapsular in 90% to 97% of votes. The TNs assessed as non-subcapsular by experts were classified as non-subcapsular by 3% to 48% of votes. The majority consensus fully matched the experts' assessment (κ = 1.0, p = 0.0003). The distance from the anterior thyroid capsule was an independent factor of assessment (p = 0.005, R² = 0.86).

Conclusions: Clinical endocrinologists largely agree with experts' assessment in subcapsular cases where experts had perfect concordance while uncertainty is present for non-subcapsular nodules. Future studies should establish a standardized definition of subcapsular TN.

Background: Thyroid cancer (TC) is one of the most rapidly increasing endocrine malignancies worldwide, yet its long-term epidemiologic trends remain incompletely understood. We aimed to evaluate the global, regional, and national burden of TC from 1990 to 2021 and project its incidence and mortality to 2035 based on data from the Global Burden of Disease (GBD) Study.

Methods: The Global Burden of Disease database was used to collect age-standardized incidence rates (ASIR), age-standardized death rates (ASDR) and disability-adjusted life years (DALYs) for TC. Age-standardized rates (ASRs) were employed as indicators for these measurements. We calculated the estimated annual percent change (EAPC) and measured the mean change in ASRs. Additionally, we assessed TC-attributable risk factors and trends across different regions and age groups worldwide. The Bayesian age-period-cohort model was applied to predict future trends until 2035.

Results: In 2021, the worldwide TC age-standardized incidence rates (ASIR), age-standardized death rates (ASDR), and age-standardized DALY rates (ASDALYR) per 100,000 population were 2.91 (95% uncertainty interval (UI), 2.61-3.21), 0.53 (95% UI, 0.47-0.57), and 14.57 (95% UI, 12.78-16.11), respectively. Compared with 1990, the EAPC was 1.25 (95% UI, 1.13-1.37) for ASIR, -0.24 (95% UI, -0.27 to 0.21) for ASDR, and -0.14 (95% UI, -0.17 to 0.11) for ASDALY, respectively. As individuals age, the disease burden of TC increases, and there are significant variations across different regions worldwide. Elevated body mass index is a major risk factor for TC-related deaths and DALYs. From 2022 to 2035, the global ASIR is expected to rise slightly from 3.00 (95% UI, 2.92-3.08) in 2022 to 3.62 (95% UI, 3.26-3.97) in 2035, while ASDR and ASDALYR are anticipated to remain relatively stable with just marginal variations.The global ASIR of TC experienced an upward trend from 1990 to 2021; however, ASDR and ASDALY slightly decreased. Projections from 2022 to 2035 indicate a slight increase in ASIR, with ASDR and ASDALY remaining stable.

Conclusion: The global burden of thyroid cancer remains substantial and is projected to continue increasing through 2035. Public health strategies should be strengthened to address modifiable risk factors, particularly reducing obesity rates and optimize comprehensive cancer control for TC, with targeted approaches to early diagnosis in high-risk populations rather than population-wide screening.