Clinical Thyroidology for the Public summarizes selected research studies discussed in the previous month’s issue of Clinical Thyroidology, an official publication of the American Thyroid Association. Editor-in-chief, Alan Farwell, MD, FACE
Volume 17 Issue 8
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Clinical Thyroidology for the Public Volume 17 Issue 8 (PDF file, 3.34 MB)
TABLE OF CONTENTS – Web Format
THYROID NODULES
Molecular tests for thyroid nodules: unintended consequences
Despite their relatively high cost, molecular markers have been found to be cost-effective by virtue of ~50% decrease in thyroid surgery for indeterminate nodules. Molecular markers are now covered by most insurers in the United States and are widely used. In this study, the authors examined how these tests have changed clinical practices in real life.
Stillman MD et al. Molecular testing for Bethesda III thyroid nodules: Trends in implementation, cytopathology call rates, surgery rates, and malignancy yield at a single institution. Thyroid 2024;34(4):460-466; doi: 10.1089/thy.2023.0664. PMID: 38468547.
THYROID CANCER
When is it time to stop my thyroid cancer surveillance?
The excellent prognosis and low death rate of thyroid cancer results in many years of follow up visits, labs, and ultrasounds for the patients. Discharging thyroid cancer patients who are low risk of recurrence and many years after their initial thyroidectomy might be beneficial to reduce the financial burden on patients and the patient volume on the hospital systems. The purpose of the study is to identify risk factors and frequency of true recurrences of thyroid cancer in patients whose disease is characterized as low risk of recurrence.
Pałyga I etg al. The frequency of differentiated thyroid cancer recurrence in 2302 patients with excellent response to primary therapy. J Clin Endocrinol Metab 2024;109(2):e569-e578. doi:10.1210/clinem/dgad571.
THYROID NODULES
Are some indeterminate nodules candidates for active surveillance?
In up to 25% of thyroid biopsies, the results are indeterminate, meaning that the cells cannot be clearly identified as either normal or abnormal. These biopsies are usually then analyzed for any gene mutations. While the decision to send the patient to surgery if any mutation is present is the usual practice, there is a wide range of cancer risk depending on what mutation is identified. This study studied the growth rate of RAS+ indeterminate nodules that are currently undergoing active surveillance and compare them with RAS+ indeterminate nodules that go immediately to surgery.
Sfreddo HJ, Koh ES, Zhao K, et al. RAS-mutated cytologically indeterminate thyroid nodules: Prevalence of malignancy and behavior under active surveillance. Thyroid. Epub 2024 Mar 28.
THYROID CANCER
Radioiodine therapy does not impact survival in Tall-Cell subtype of Papillary Thyroid Cancer
Tall-cell papillary thyroid cancer is a rare subtype of thyroid cancer that displays a more aggressive behavior compared to the classical papillary thyroid cancer. While radioactive iodine therapy is recommended byt hew ATA guidelines, 90% of patients with tall-cell papillary thyroid cancer have a BRAF gene mutation, which is known to decrease the cancer responsiveness to radioactive iodine therapy. The goal of this study is to evaluate the impact of the radioactive iodine therapy on cancer-specific survival in patients with tall-cell papillary thyroid cancer, using the SEER database.
Dai P et al. Effect of radioactive iodine therapy on cancer-specific survival of papillary thyroid cancer tall cell variant. J Clin Endocrinol Metab 2024;109(3):e1260-e1266; doi: 10.1210/ clinem/dgad580. PMID: 37804527.
HYPOTHYROIDISM
High mortality of myxedema coma in the United States
Myxedema coma is an extreme, life-threatening form of hypothyroidism. Death from Myxedema coma is high, about 25-50%. Fortunately, Myxedema coma is rare. The authors of this study wanted to find out what are the characteristics of patients admitted to the hospital with Myxedema coma and what happens to them.
Chen DH et al. Clinical features and outcomes of myxedema coma in patients hospitalized for hypothyroidism: analysis of the United States National Inpatient Sample. Thyroid. Epub 2024 Jan 27. doi: 10.1089/thy.2023.0559. PMID: 38279788
THYROID AND KIDNEY DISEASE
Impact of thyroid disease on kidney function and chronic kidney disease
Both thyroid disease and chronic kidney disease (CKD) are common conditions with significant clinical effects. Previous studies have identified a relationship between these 2 diseases. In this study, the authors investigate whether hypothyroidism and hyperthyroidism are associated with higher CKD occurrence and progression.
You AS et al. Impact of thyroid status on incident kidney dysfunction and chronic kidney disease progression in a nationally representative cohort. Mayo Clin Proc 2024:39-56; doi: 10.1016/j.mayocp.2023.08.028. PMID: 38176833.
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