Current Issue : October-December Volume : 2025 Issue Number : 4 Articles : 5 Articles
Background and Clinical Significance: The concurrent presence of a thyrotropinsecreting hypophyseal adenoma (TSHoma) with a thyroid malignancy, such as papillary thyroid carcinoma (PTC), is exceptionally rare and significantly complicates clinical diagnosis and management. This rare combination raises difficult decisions regarding the treatment sequence and carries the risk of exacerbating either or both conditions. Case report: We present the case of a 59-year-old female patient exhibiting persistent hyperthyroid symptoms with unusually normal TSH levels despite elevated thyroid hormone concentrations. Initial diagnostic imaging revealed a hypophyseal macroadenoma and a diffuse nodular goiter. After the macroadenoma diagnosis, the patient initially refused surgical intervention, and subsequent dopamine agonist therapy proved ineffective. Eight years later, during a routine follow-up, a thyroid ultrasound revealed a diffuse nodular goiter classified as EU-TIRADS 5, and papillary thyroid carcinoma was confirmed through fine needle aspiration biopsy. A total thyroidectomy and subsequent radioactive iodine therapy were performed. However, persistently elevated postoperative TSH levels remained despite high-dose levothyroxine therapy. Due to the increased risk of malignancy recurrence associated with elevated TSH levels, the patient consented to macroadenoma surgery. A successful transsphenoidal macroadenomectomy stabilized the patient’s condition, allowing for the normalization of TSH levels. Conclusions: This case underscores the importance of accurate differential diagnosis and highlights the challenges in managing TSH levels in patients with coexisting thyroid malignancies. With there being no clear guidelines for managing the combination of these conditions, decisions regarding treatment priority should consider the patient’s preferences, the risk of malignancy recurrence or progression, neurological symptoms, and the aggressiveness of the thyroid tumor....
Background: Microvascular complications in type 2 diabetes (T2D) and cancer share biological pathways, including chronic inflammation, dysregulated angiogenesis, and endothelial dysfunction, yet their impact on cancer risk and mortality remains unclear. This study evaluated whether T2D patients with microvascular complications face increased cancer incidence or cancer-related mortality. Methods: Using the Taiwan National Health Insurance Research Database, we identified individuals newly diagnosed with T2D (2008–2021) and assessed the outcomes with multivariable Cox proportional hazards models. Results: Our findings indicate that T2D patients with diabetic neuropathy, retinopathy, or chronic kidney disease do not have a significantly increased risk of major cancers, including those of the oral cavity, thyroid, breast, respiratory tract, digestive system, or lymphoid tissues. Similarly, microvascular complications were not associated with higher cancer-related mortality. However, microvascular complications significantly increased all-cause mortality in a dose-dependent manner: adjusted hazard ratio (aHR) 1.16 [95% CI: 1.15–1.17] for one complication, aHR 1.42 [1.38–1.45] for two, and aHR 1.71 [1.60–1.83] for three. Conclusions: In this nationwide cohort study, we demonstrate that while microvascular complications are associated with increased all-cause mortality in T2D, they do not appear to elevate cancer risk or cancer-specific mortality. These findings provide crucial epidemiological insights into the relationship between diabetes complications and cancer....
Congenital hypothyroidism (CH) is a critical condition in infancy where early detection is vital for optimal development. This study aimed to evaluate the sensitivity of Aotearoa New Zealand’s Newborn Metabolic Screening “Low BirthWeight” protocol for detecting CH in preterm infants. A 10-year audit was conducted on 2935 preterm infants (<2000 g or ≤34 weeks gestation) screened within NICUs or SCBUs in the Auckland region. The study assessed both screen-detected and clinically detected cases of CH. Data were collected from screening and clinical records to evaluate the sensitivity and reliability of the current protocol. The audit identified 19 cases of primary CH, with a 1:154 incidence. Thirteen cases met the criteria for inclusion in the audit. Just over half of the eligible cases (7/13) were screen-detected, while the remaining were detected clinically, suggesting limitations in screening sensitivity. The analysis revealed that the protocol missed permanent as well as transient cases, and that biochemical severity was not predictive of permanence. A revised screening protocol was developed and commenced in July 2024....
Objectives: The current standard of care for endocrine tumors includes a personalized diagnostic and therapeutic approach aimed at the early detection of tumor recurrence after radical surgery. Assessment of tumor-associated biological factors in serum may be useful in patient management. The aim of this study is to determine whether any of the selected growth factors (VEGF, FGF), lectins (Galectin-1, Galectin-3), proteins (Fascin), or TNF-α measured in serum may serve as a potential marker of recurrence. Methods: A total of 68 cases, including 43 patients with disseminated endocrine neoplasm (neuroendocrine tumor (NET) 30 cases, medullary thyroid cancer (MTC) 6 cases, adrenal neoplasm 7 cases) and 25 healthy participants, were included in the analysis. Serum concentrations of TNF-α, Fascin, VEGF, Galectin-1, Galectin-3, and FGF were determined in all cases. The results were compared between groups. Results: A comparison between all patients and controls revealed differences in TNF-α concentrations (2.88 vs. 0.93 (ng/mL), p = 0.008). When comparing the concentrations of the measured factors between the subgroups (classified by tumor type) and the control group, differences were found for TNF-α (p = 0.007) and Fascin (p = 0.035). In the case of Fascin, differences were found for MTC and adrenal neoplasm patients (0.52 vs. 5.28 (ng/mL), p = 0.048), as well as MTC and NET patients (0.52 vs. 5.59 (ng/mL), p = 0.007), while the differences between NET patients and controls were close to significance (5.59 vs. 3.67 (ng/mL), p = 0.076). For TNF-α, significant differences were found between NET patients and controls (2.88 vs. 0.03 (ng/mL), p = 0.005) as well as between MTC patients and controls (2.77 vs. 0.93 (ng/mL), p = 0.004). Conclusions: Serum concentrations of selected proteins and growth factors (Fascin, TNF-α) are significantly higher in those with disseminated endocrine tumors compared to healthy controls. More studies are needed to determine the role of these selected proteins and growth factors in the early detection of NET/MTC recurrence....
Thyroid ultrasonography (US) usage has risen significantly over the past two decades, with annual increases of up to 21% in some healthcare systems. This review examines patterns in thyroid US usage, factors driving potential misuse, and strategies to mitigate overuse. While thyroid US provides valuable information on thyroid morphology and structure without radiation exposure, inappropriate use—estimated at 10–50% of exams—leads to adverse consequences, including patient anxiety, unnecessary procedures, and potential overdiagnosis of thyroid cancer. The widespread adoption of US has coincided with increased thyroid cancer diagnoses, yet mortality rates remain unchanged, suggesting overdiagnosis rather than actual disease increase. Clinical guidelines consistently recommend selective US use not for routine evaluation of thyroid dysfunction (hyper/hypothyroidism) without palpable abnormalities, but for the anatomical assessment of palpable nodules. For thyroid incidentalomas (ITNs), evidence suggests negligible malignancy risk for nodules < 1 cm, arguing against further investigation. The paper proposes a rational approach to thyroid US, emphasizing that patients with thyroid dysfunction without palpable abnormalities, euthyroid patients without palpable nodules, and patients with subcentimetric ITNs should not undergo thyroid US. Addressing this overutilization requires a better understanding of contributing factors and targeted interventions. By restricting US to appropriate clinical scenarios, healthcare resources can be optimized without compromising patient outcomes, ensuring that rare cases of clinically significant thyroid cancer receive proper diagnosis and treatment....
Loading....