Advances in the application of auxiliary imaging techniques in parathyroid diseases

Hypoparathyroidism is one of the main complications after total thyroidectomy,severely affecting patients’quality of life.How to effectively protect parathyroid function after surgery and reduce the incidence of hypoparathyroidism has always been a key research area in thyroid surgery.Therefore,precise localization of parathyroid glands during surgery,effective imaging,and accurate surgical resection have become hot topics of concern for thyroid surgeons.In response to this clinical phenomenon,this study compared several different imaging methods for parathyroid surgery,including nanocarbon,indocyanine green,near-infrared imaging techniques,and technetium-99m methoxyisobutylisonitrile combined with gamma probe imaging technology.The advantages and disadvantages of each method were analyzed,providing scientific recommendations for future parathyroid imaging.In recent years,some related basic and clinical research has also been conducted in thyroid surgery.This article reviewed relevant literature and provided an overview of the practical application progress of various imaging techniques in parathyroid surgery.

MicroRNAs in thyroid cancer with focus on medullary thyroid carcinoma:potential therapeutic targets and diagnostic/prognostic markers and web based tools

This review aimed to describe the inculpation of microRNAs(miRNAs)in thyroid cancer(TC)and its subtypes,mainly medullary thyroid carcinoma(MTC),and to outline web-based tools and databases for bioinformatics analysis of miRNAs in TC.Additionally,the capacity of miRNAs to serve as therapeutic targets and biomarkers in TC management will be discussed.This review is based on a literature search of relevant articles on the role of miRNAs in TC and its subtypes,mainly MTC.Additionally,web-based tools and databases for bioinformatics analysis of miRNAs in TC were identified and described.MiRNAs can perform as oncomiRs or antioncoges,relying on the target mRNAs they regulate.MiRNA replacement therapy using miRNA mimics or antimiRs that aim to suppress the function of certain miRNAs can be applied to correct miRNAs aberrantly expressed in diseases,particularly in cancer.MiRNAs are involved in the modulation of fundamental pathways related to cancer,resembling cell cycle checkpoints and DNA repair pathways.MiRNAs are also rather stable and can reliably be detected in different types of biological materials,rendering them favorable diagnosis and prognosis biomarkers as well.MiRNAs have emerged as promising tools for evaluating medical outcomes in TC and as possible therapeutic targets.The contribution of miRNAs in thyroid cancer,particularly MTC,is an active area of research,and the utility of web applications and databases for the biological data analysis of miRNAs in TC is becoming increasingly important.

Association between lifestyle factors and thyroid function in young euthyroid adults

Purpose:The present work examines the associations of dietary habits,sedentarism,physical activity(PA)levels and sleep habits,with thyroid function in young euthyroid adults.Methods:A total of 105 young euthyroid adults participated in this cross-sectional study.Thyroid function was determined in fasting conditions(>6 h).Dietary habits were measured by a food frequency questionnaire and three non-consecutive 24 h recalls,and different dietary intake and patterns were then estimated.The time spent in sedentary,PA levels and sleep habits were objectively measured using a wrist-worn accelerometer.Results:Energy and carbohydrate intake were positively associated with thyroid stimulating hormone(TSH)(β=0.222;R^(2)=0.102;P=0.022 andβ=0.425;R^(2)=0.129;P=0.007,respectively)whereas fat intake was negatively associated with TSH(β=-0.428;R^(2)=0.137;P=0.004).Energy intake was also positively associated with free triiodothyronine(β=0.277;R^(2)=0.137;P=0.004).Further,adherence to the Mediterranean diet was negatively related to TSH and free thyroxine(FT4)(β=-0.221;R^(2)=0.113;P=0.020 andβ=-0.268;R^(2)=0.071;P=0.007,respectively).Vigorous-intensity and overall PA were negatively associated with FT4(β=-0.227;R^(2)=0.052;P=0.022 andβ=-0.204;R^(2)=0.042;P=0.041,respectively).In contrast,no associations were found between sleep parameters and thyroid function.Conclusions:Lifestyle factors such as dietary intake and PA levels seems to be related to thyroid function even in young euthyroid adults.

Effectiveness and safety of electroacupuncture analgesia in controlling intraoperative pain and hemodynamics during total thyroidectomy:A randomized controlled trial

Objective:To evaluate the effectiveness and safety of electroacupuncture in conjunction with additional medications in providing analgesia and stabilizing hemodynamic parameters during total thyroidectomy.Methods:This randomized controlled trial included 100 patients who underwent a total thyroidectomy between October 2022 and October 2023 at the Vietnam National Hospital of Acupuncture.The patients were randomized into two groups.The electroacupuncture analgesia(EA)group received EA stimulation at five acupuncture points:Hegu(LI 4),Neiguan(PC 6),Shuitu(ST 10),Quepen(ST 12),and Yifeng(SJ 17),while the control group received a bilateral superficial cervical plexus block.Primary outcomes included the level of analgesia and perioperative vital signs in both groups.Additionally,pain thresholds and serum b-endorphin levels were measured before and after electroacupuncture in the EA group.Results:Complete analgesia(Level A)was attained in 86%and 76%of the patients in the EA and control groups,respectively,with no significant difference between the two groups(P=1.00).In the EA group,the mean pain threshold after receiving EA doubled(648.7(77.4)g/s vs.305.3(45.3)g/s,P<.001),and the mean serum b-endorphin level increased by approximately 13.5 pg/mL(P<.001).All patients remained hemodynamically stable throughout the surgery.Conclusion:EA,in conjunction with additional medications that stimulate five acupuncture points,LI 4,PC 6,ST 10,ST 12,and SJ 17,was well tolerated and effectively maintained a suitable level of analgesia and hemodynamic stability during total thyroidectomy.

Association between sensitivity to thyroid hormones and non-highdensity lipoprotein cholesterol levels in patients with type 2 diabetes mellitus

BACKGROUND Dyslipidemia and type 2 diabetes mellitus(T2DM)are chronic conditions with substantial public health implications.Effective management of lipid metabolism in patients with T2DM is critical.However,there has been insufficient attention given to the relationship between thyroid hormone sensitivity and dyslipidemia in the T2DM population,particularly concerning non-high-density lipoprotein cholesterol(non-HDL-C).AIM To clarify the association between thyroid hormone sensitivity and dyslipidemia in patients with T2DM.METHODS In this cross-sectional study,thyroid hormone sensitivity indices,the thyroid feedback quantile-based index(TFQI),the thyroid-stimulating hormone index(TSHI),the thyrotrophic T4 resistance index(TT4RI),and the free triiodothyronine(FT3)/free thyroxine(FT4)ratio were calculated.Logistic regression analysis was performed to determine the associations between those composite indices and non-HDL-C levels.Random forest variable importance and Shapley Additive Explanations(SHAP)summary plots were used to identify the strength and direction of the association between hyper-non-HDL-C and its major predictor.RESULTS Among the 994 participants,389(39.13%)had high non-HDL-C levels.Logistic regression analysis revealed that the risk of hyper-non-HDL-C was positively correlated with the TFQI(OR:1.584;95%CI:1.088-2.304;P=0.016),TSHI(OR:1.238;95%CI:1.034-1.482;P=0.02),and TT4RI(OR:1.075;95%CI:1.006-1.149;P=0.032)but was not significantly correlated with the FT3/FT4 ratio.The relationships between composite indices of the thyroid system and non-HDL-C levels differed according to sex.An increased risk of hyper-non-HDL-C was associated with elevated TSHI levels in men(OR:1.331;95%CI:1.003-1.766;P=0.048)but elevated TFQI levels in women(OR:2.337;95%CI:1.4-3.901;P=0.001).Among the analyzed variables,the average SHAP values were highest for TSHI,followed by TT4RI.CONCLUSION Impaired sensitivity to thyroid hormones was associated with high non-HDL-C levels in patients with T2DM.

An overview of the contemporary diagnosis and management approaches for anaplastic thyroid carcinoma

Thyroid carcinoma is a complex disease with several types,the most common being well-differentiated and undifferentiated.The latter,“undifferentiated carcinoma”,also known as anaplastic thyroid carcinoma(ATC),is a highly aggr-essive malignant tumor accounting for less than 0.2%of all thyroid carcinomas and carries a poor prognosis with a median survival of 5 months.BRAF gene mutations are the most common molecular factor associated with this type of thyroid carcinoma.Recent advances in targeted biological agents,immuno-therapy,stem cell therapy,nanotechnology,the dabrafenib/trametinib com-bination therapy,immune checkpoint inhibitors(ICI)and artificial intelligence offer novel treatment options.The combination therapy of dabrafenib and tra-metinib is the current standard treatment for patients with BRAF-V600E gene mutations.Besides,the dabrafenib/trametinib combination therapy,ICI,used alone or in combination with targeted therapies have raised some hopes for improving the prognosis of this deadly disease.Younger age,earlier tumor stage and radiotherapy are all prognostic factors for improved outcomes.Ultimately,therapeutic regimens should be tailored to the individual patient based on surveillance and epidemiological data,and a multidisciplinary approach is ess-ential.

Core needle biopsy for thyroid nodules assessment-a new horizon?

Ultrasound-guided fine-needle aspiration is the standard for evaluating thyroid nodules with a high safety profile and a relatively low number of non-diagnostic cytological findings.Nevertheless,this diagnostic method traditionally has its weak points.Several diagnostic categories such as BethesdaⅠ,ⅢandⅣare not reliable for thyroid carcinoma risk assessment.Recent advancements in a core needle biopsy made it possible to use this tool as a new method for thyroid nodules evaluation.The main feature of this method is the use of thin needles(18-21G)and guns with an automatic trigger mechanism.The histological material collected with the use of a core needle biopsy is usually superior to cytological.Therefore,the core needle biopsy can be used as a complementary technique to a standard fine needle aspiration in difficult and dubious cases of thyroid neoplasia with uncertain malignant potential.

Reference Interval of Thyroidal Function of Women in the Early,Middle and Late Pregnancy in Jingzhou City,Hubei Province

[Objectives]To study the reference value of thyroid function in healthy women of childbearing age during different pregnancies(early,middle and late pregnancy)in Jingzhou City.[Methods]362 healthy women of childbearing age during different pregnancies(early,middle and late pregnancy)were selected as the study group,and 360 non-pregnant women were selected as the control group.Serum thyroid hormone levels in the two groups were detected,and the reference value was expressed as the median(M)and 95%confidence interval(CI).On this basis,the chart of changing trend of thyroid hormone in the early,middle and late pregnancy were plotted.[Results]Compared with the control group,FT3,TT4,TT3,FT4and TSH in the early,middle and late pregnancy were significantly different in the study group(P<0.05).In the study group,there were significant differences in the early,middle and late pregnancy(P<0.05).[Conclusions]This trend chart has certain reference value in the screening,diagnosis and treatment of thyroid diseases in healthy women of childbearing age during different pregnancies(early,middle and late pregnancy)in Jingzhou City of Hubei Province.

Childhood Papillary Thyroid Carcinoma: A Case Report

Background: Thyroid cancer is a rare disease yet the most common endocrine malignancy in pediatrics. Unlike adult patients, children with thyroid nodules typically don’t complain of pain, soreness, or difficulty swallowing. Additionally, using the recommended therapy for adults to treat paediatrics is not appropriate. There is an unmet need for updated unique guidelines for the management of papillary thyroid carcinoma (PTC) in paediatrics and adolescents. Case Report: A 12-year-old girl had an atypical presentation of metastatic PTC in lymph nodes. She was treated initially with hemi-thyroidectomy, followed by total thyroidectomy. A multidisciplinary team followed her up till successful results were found. Conclusion: Due to the difference in pathophysiology between thyroid tumors in children and adults, a unique approach to PTC management is to be implemented. Further trials are required for a better understanding of risk factors, the likelihood of recurrence, and the long-term side effects of the chosen management plan.

Vitamin D,selenium,and antidiabetic drugs in the treatment of type 2 diabetes mellitus with Hashimoto's thyroiditis

BACKGROUND Diabetes and thyroiditis are closely related.They occur in combination and cause significant damage to the body.There is no clear treatment for type-2 diabetes mellitus(T2DM)with Hashimoto's thyroiditis(HT).While single symptomatic drug treatment of the two diseases is less effective,combined drug treatment may improve efficacy.AIM To investigate the effect of a combination of vitamin D,selenium,and hypoglycemic agents in T2DM with HT.METHODS This retrospective study included 150 patients with T2DM and HT treated at The Central Hospital of Shaoyang from March 2020 to February 2023.Fifty patients were assigned to the control group,test group A,and test group B according to different treatment methods.The control group received low-iodine diet guidance and hypoglycemic drug treatment.Test group A received the control treatment plus vitamin D treatment.Test group B received the group A treatment plus selenium.Blood levels of markers of thyroid function[free T3(FT3),thyroid stimulating hormone(TSH),free T4(FT4)],autoantibodies[thyroid peroxidase antibody(TPOAB)and thyroid globulin antibody(TGAB)],blood lipid index[low-density lipoprotein cholesterol(LDL-C),total cholesterol(TC),triacylglycerol(TG)],blood glucose index[fasting blood glucose(FBG),and hemoglobin A1c(HbA1c)]were measured pre-treatment and 3 and 6 months after treatment.The relationships between serum 25-hydroxyvitamin D3[25(OH)D3]level and each of these indices were analyzed.RESULTS The levels of 25(OH)D3,FT3,FT4,and LDL-C increased in the order of the control group,test group A,and test group B(all P<0.05).The TPOAB,TGAB,TC,TG,FBG,HbA1c,and TSH levels increased in the order of test groups B,A,and the control group(all P<0.05).All the above indices were compared after 3 and 6 months of treatment.Pre-treatment,there was no divergence in serum 25(OH)D3 level,thyroid function-related indexes,autoantibodies level,blood glucose,and blood lipid index between the control group,test groups A and B(all P>0.05).The 25(OH)D3 levels in test groups A and B were negatively correlated with FT4 and TGAB(all P<0.05).CONCLUSION The combination drug treatment for T2DM with HT significantly improved thyroid function,autoantibody,and blood glucose and lipid levels.

Risk stratification for radioactive iodine refractoriness using molecular alterations in distant metastatic differentiated thyroid cancer

Objective: Patients with radioactive iodine-refractory differentiated thyroid cancer(RAIR-DTC) are often diagnosed with delay and constrained to limited treatment options. The correlation between RAI refractoriness and the underlying genetic characteristics has not been extensively studied.Methods: Adult patients with distant metastatic DTC were enrolled and assigned to undergo next-generation sequencing of a customized 26-gene panel(Thyro Lead). Patients were classified into RAIR-DTC or non-RAIR groups to determine the differences in clinicopathological and molecular characteristics. Molecular risk stratification(MRS) was constructed based on the association between molecular alterations identified and RAI refractoriness, and the results were classified as high, intermediate or low MRS.Results: A total of 220 patients with distant metastases were included, 63.2% of whom were identified as RAIRDTC. Genetic alterations were identified in 90% of all the patients, with BRAF(59.7% vs. 17.3%), TERT promoter(43.9% vs. 7.4%), and TP53 mutations(11.5% vs. 3.7%) being more prevalent in the RAIR-DTC group than in the non-RAIR group, except for RET fusions(15.8% vs. 39.5%), which had the opposite pattern. BRAF and TERT promoter are independent predictors of RAIR-DTC, accounting for 67.6% of patients with RAIR-DTC. MRS was strongly associated with RAI refractoriness(P<0.001), with an odds ratio(OR) of high to low MRS of 7.52 [95%confidence interval(95% CI), 3.96-14.28;P<0.001] and an OR of intermediate to low MRS of 3.20(95% CI,1.01-10.14;P=0.041).Conclusions: Molecular alterations were associated with RAI refractoriness, with BRAF and TERT promoter mutations being the predominant contributors, followed by TP53 and DICER1 mutations. MRS might serve as a valuable tool for both prognosticating clinical outcomes and directing precision-based therapeutic interventions.

Correlation analysis of serum thyroglobulin,thyroid-stimulating hormone levels,and thyroid-cancer risk in thyroid nodule surgery

BACKGROUND Thyroglobulin(Tg)is one of the markers of thyroid cancer,and its concentration may be elevated in patients with malignant thyroid tumors.Thyroid-stimulating hormone(TSH)is secreted by the pituitary gland,which has a significant impact on thyroid gland function.Excessively high or low TSH levels may be associated with an increased risk of thyroid cancer.Thus,in-depth studies on the association of serum Tg and TSH levels with thyroid cancer risk in patients with thyroid nodules are warranted.This can help determine whether Tg and TSH levels can predict the degree of malignancy of thyroid nodules,which can in turn guide doctors in making accurate diagnoses and treatment decisions.Furthermore,such studies can provide more accurate diagnostic methods for thyroid nodules and help patients become aware of the presence of thyroid cancer as early as possible,thereby improving the success rate of treatment and prognosis.AIM To investigate the association of serum Tg and TSH levels with the risk of thyroid cancer in patients undergoing thyroid nodule surgery.METHODS The clinical data and laboratory examination results of 130 patients who underwent thyroid nodule surgery were retrospectively analyzed.Furthermore,their preoperative serum Tg and TSH levels were recorded.Histopathological examination conducted during follow-up revealed the presence of thyroid cancer.Correlation analysis were used to analyze the association of Tg and TSH levels with the risk of thyroid cancer.RESULTS Of the 130 patients,60 were diagnosed with thyroid cancer.Statistical analysis revealed a significant positive correlation between serum Tg levels and the risk of thyroid cancer(P<0.05).This suggests that high serum Tg levels are associated with an increased risk of thyroid cancer.However,no significant correlation was observed between serum TSH levels and the risk of thyroid cancer(P>0.05).CONCLUSION In patients who underwent thyroid nodule surgery,serum Tg levels exhibited a significant correlation with the risk of thyroid cancer but serum TSH levels did not.These findings suggest that serum Tg can serve as an important biomarker for assessing the risk of thyroid cancer in these patients.

DNA Methylation of KLRC1 and KLRC3 in Autoimmune Thyroiditis:Perspective of Different Water Iodine Exposure

Objective This study aimed to identify differentially methylated genes(DMGs) associated with natural killer cells in patients with autoimmune thyroiditis(AIT), focusing on the influence of varying water iodine exposure levels.Methods Participants were divided into categories based on median water iodine(MWI)concentrations: iodine-fortified areas(IFA, MWI < 10 μg/L), iodine-adequate areas(IAA, 40 ≤ MWI ≤ 100μg/L), and iodine-excessive areas(IEA, MWI > 300 μg/L). A total of 176 matched AIT cases and controls were recruited and divided into 89, 40, and 47 pairs for IFA, IAA, and IEA, respectively. DMGs were identified using 850K Bead Chip analysis for 10/10 paired samples. Validation of DNA methylation and m RNA expression levels of the DMGs was conducted using Methyl Target^(TM) and QRT-PCR for 176/176paired samples.Results KLRC1, KLRC3, and SH2D1B were identified as significant DMGs. Validation revealed that KLRC1 was hypomethylated and highly expressed, whereas KLRC3 was hypermethylated and highly expressed in individuals with AIT. Furthermore, KLRC1 was hypomethylated and highly expressed in both IFA and IEA.Conclusion The DNA methylation status of KLRC1 and KLRC3 may play crucial roles in AIT pathogenesis. Additionally, DNA methylation of KLRC1 seems to be influenced by different iodine concentrations in water.

Exploring the relationship between Hashimoto's thyroiditis and male fertility:A meta-analytic and meta-regression perspective on hormonal and seminal factors

Objective:To explore the relationship between Hashimoto's autoimmune hypothyroidism(HT)and male fertility,focusing on hormonal and seminal factors.Methods:A systematic literature search was conducted across databases such as PubMed,Web of Science,EMBASE,Scopus,Cochrane,and Google Scholar,covering studies published from January 2000 to March 2024.Studies investigating the impact of HT on semen quality parameters and reproductive hormones were included.Pooled effect estimates were calculated using standard mean difference(SMD)and 95%confidence intervals(CI).Results:A total of 8 studies with 8965 participants were included.HT significantly affected semen quality and reproductive hormone levels.Specifically,there was a notable decrease in progressive morphology(SMD=-0.78;95%CI:-1.40 to-0.17;P=0.01)and sperm motility(SMD=-1.151;95%CI:-1.876 to-0.425;P=0.002).In addition,there were no significant changes in reproductive hormones,although there were elevated levels of luteinizing hormone(SMD=0.437;95%CI:0.000 to 0.874;P=0.050)and follicle-stimulating hormone(SMD=0.293;95%CI:-0.171 to 0.758;P=0.216),with a slight impact on testosterone levels(SMD=-1.143;95%CI:-2.487 to 0.200;P=0.095).Conclusions:This systematic review and meta-analysis provides robust evidence of the detrimental effects of HT on semen quality and reproductive hormones,underscoring the necessity for thorough evaluation and management of thyroid function in male infertility assessments.

Deep learning-based automatic pipeline system for predicting lateral cervical lymph node metastasis in patients with papillary thyroid carcinoma using computed tomography:A multi-center study

Objective:The assessment of lateral lymph node metastasis(LLNM)in patients with papillary thyroid carcinoma(PTC)holds great significance.This study aims to develop and evaluate a deep learning-based automatic pipeline system(DLAPS)for diagnosing LLNM in PTC using computed tomography(CT).Methods:A total of 1,266 lateral lymph nodes(LLNs)from 519 PTC patients who underwent CT examinations from January 2019 to November 2022 were included and divided into training and validation set,internal test set,pooled external test set,and prospective test set.The DLAPS consists of an auto-segmentation network based on RefineNet model and a classification network based on ensemble model(ResNet,Xception,and DenseNet).The performance of the DLAPS was compared with that of manually segmented DL models,the clinical model,and Node Reporting and Data System(Node-RADS).The improvement of radiologists’diagnostic performance under the DLAPS-assisted strategy was explored.In addition,bulk RNA-sequencing was conducted based on 12 LLNs to reveal the underlying biological basis of the DLAPS.Results:The DLAPS yielded good performance with area under the receiver operating characteristic curve(AUC)of 0.872,0.910,and 0.822 in the internal,pooled external,and prospective test sets,respectively.The DLAPS significantly outperformed clinical models(AUC 0.731,P<0.001)and Node-RADS(AUC 0.602,P<0.001)in the internal test set.Moreover,the performance of the DLAPS was comparable to that of the manually segmented deep learning(DL)model with AUCs ranging 0.814−0.901 in three test sets.Furthermore,the DLAPSassisted strategy improved the performance of radiologists and enhanced inter-observer consistency.In clinical situations,the rate of unnecessary LLN dissection decreased from 33.33%to 7.32%.Furthermore,the DLAPS was associated with the cell-cell conjunction in the microenvironment.Conclusions:Using CT images from PTC patients,the DLAPS could effectively segment and classify LLNs non-invasively,and this system had a good generalization ability and clinical applicability.

A Study on the Explainability of Thyroid Cancer Prediction:SHAP Values and Association-Rule Based Feature Integration Framework

In the era of advanced machine learning techniques,the development of accurate predictive models for complex medical conditions,such as thyroid cancer,has shown remarkable progress.Accurate predictivemodels for thyroid cancer enhance early detection,improve resource allocation,and reduce overtreatment.However,the widespread adoption of these models in clinical practice demands predictive performance along with interpretability and transparency.This paper proposes a novel association-rule based feature-integratedmachine learning model which shows better classification and prediction accuracy than present state-of-the-artmodels.Our study also focuses on the application of SHapley Additive exPlanations(SHAP)values as a powerful tool for explaining thyroid cancer prediction models.In the proposed method,the association-rule based feature integration framework identifies frequently occurring attribute combinations in the dataset.The original dataset is used in trainingmachine learning models,and further used in generating SHAP values fromthesemodels.In the next phase,the dataset is integrated with the dominant feature sets identified through association-rule based analysis.This new integrated dataset is used in re-training the machine learning models.The new SHAP values generated from these models help in validating the contributions of feature sets in predicting malignancy.The conventional machine learning models lack interpretability,which can hinder their integration into clinical decision-making systems.In this study,the SHAP values are introduced along with association-rule based feature integration as a comprehensive framework for understanding the contributions of feature sets inmodelling the predictions.The study discusses the importance of reliable predictive models for early diagnosis of thyroid cancer,and a validation framework of explainability.The proposed model shows an accuracy of 93.48%.Performance metrics such as precision,recall,F1-score,and the area under the receiver operating characteristic(AUROC)are also higher than the baseline models.The results of the proposed model help us identify the dominant feature sets that impact thyroid cancer classification and prediction.The features{calcification}and{shape}consistently emerged as the top-ranked features associated with thyroid malignancy,in both association-rule based interestingnessmetric values and SHAPmethods.The paper highlights the potential of the rule-based integrated models with SHAP in bridging the gap between the machine learning predictions and the interpretability of this prediction which is required for real-world medical applications.

Transposition of the lingual thyroid gland to the submandibular region through a submandibular approach:A case report

BACKGROUNDEctopic thyroid at the base of the tongue is a rare congenital condition, and it iseven rarer to have clinical symptoms and require surgical intervention. Thisdisease is easily misdiagnosed preoperatively. This article reports the diagnosis,surgical treatment, and follow-up of a case of lingual thyroid.CASE SUMMARYThe patient was a 54-year-old woman who presented with laryngeal foreign bodysensation and dysphagia for 20 d. The lingual thyroid was considered for generalexamination, and surgery was performed to transpose the lingual thyroid to theright submaxillary region. Pathological analysis confirmed thyroid tissue. Thepatient experienced complete remission after surgery, but developed hypothyroidismand required thyroid hormone replacement therapy, and her thyroidfunction gradually recovered over time.CONCLUSIONWe report a rare case of lingual thyroid with marked laryngeal foreign body sensationand dysphagia. Symptoms were completely relieved by transposition surgerybut postoperative hypothyroidism developed.

Chronic infectious unilateral giant thyroid cyst related to diabetes mellitus:A case report

BACKGROUND Patients rarely develop complicated infections in thyroid cysts.Here,we describe a patient with chronic infected unilateral giant thyroid cyst related to diabetes mellitus(DM).CASE SUMMARY A 66-year-old male was admitted due to an evident neck lump for 5 d after approximately 40 years of gradually progressive neck mass and 7 years of DM.Doppler ultrasound and computed tomography scan showed a giant lump in the left thyroid gland lobe.He was diagnosed with a large thyroid nodule complicated by tracheal dislocation and had surgical indications.Surgical exploration revealed evident inflammatory edema and exudation between the left anterior neck muscles,the nodule and glandular tissue.Fortunately,inflammatory lesions did not affect major neck vessels.Finally,a left partial thyroidectomy was performed.Macroscopic observation showed that the cystic thyroid mass consisted of extensive cystic wall calcification and was rich in massive rough sand-like calculi content and purulent matter.Postoperative pathology confirmed benign thyroid cyst with chronic infection.CONCLUSION The progression of this chronic infectious unilateral giant thyroid cyst may have been related to DM,and identifying blood vessels involvement can prevent serious complications during operation.

Intra-thyroid esophageal duplication cyst:A case report

BACKGROUND Esophageal cysts are relatively rare in clinical practice,with most of the literature comprising case reports.Esophageal cysts protruding into the thyroid gland are easily misdiagnosed as thyroid tumors.No such cases have been reported so far.CASE SUMMARY This article reports the case of a 31-year-old adult male diagnosed with thyroid nodules before admission.The patient underwent left thyroidectomy and isthmusectomy.During the surgery,esophageal cysts were identified in the esophageal muscle and thyroid glands.The pathology results confirmed a nodular goiter combined with esophageal cysts.Postoperatively,the patient developed a neck infection and underwent another operation and broad-spectrum antibiotic treatment for recovery.CONCLUSION We report the first clinical case of an esophageal cyst located within the thyroid gland that was successfully treated surgically.Esophageal cyst located within the thyroid gland cause difficulties in diagnosis.In the present study,the contents of the esophageal cysts were calcified foci,and a small amount of fluid mixture,which were easily misdiagnosed as thyroid nodules and misled the surgical methods.

COL4A2 enhances thyroid cancer cell proliferation through the AKT pathway

Objectives:Thyroid cancer(THCA)is the most common malignant tumor in endocrine system and the incidence has been increasing worldwide.And the number of patients dying from THCA has also gradually risen because the incidence continues to increase,so the mechanisms related to effective targets is necessary to improve the survival.This study was to preliminarily investigate the effects of the COL4A2 gene on the regulation of thyroid cancer(THCA)cell proliferation and the associated pathways.Methods:Bioinformatics analysis revealed that COL4A2 was closely associated with cancer development.COL4A2 expression in THCA tissues was analyzed using immunohistochemistry,and survival information was determined via Kaplan-Meier curves.The expression of COL4A2 and AKT pathway-related genes were analyzed using qPCR and western blot analyses.Colony formation as well as CCK-8 assays exhibited the cell proliferation level and cell activity,respectively.Downstream of COL4A2 was identified by Gene set enrichment analysis(GSEA).The effects of the COL4A2 and AKT pathways on THCA tumor growth in vivo were determined using a mouse model.Results:Bioinformatics analysis exhibited that COL4A2 plays a significant role in cancer and that the AKT pathway is downstream of COL4A2.THCA patients with high COL4A2 expression had shorter recurrence-free survival.Upregulation of COL4A2 gene expression in 2 THCA cell lines promoted tumor cell growth and activity.The use of AKT pathway blockers also restrained the growth and activity of the 2 THCA cell lines.The use of AKT pathway blockers reduced tumor volume and mass and prolonged mouse survival.Conclusions:COL4A2 can promote the growth as well as development of THCA through the AKT pathway and COL4A2 could be used as a target for THCA.