An increased calcitonin serum level is suggestive of a medullary thyroid cancer (MTC), but is not pathognomonic. The possibility of false positives or other calcitonin-secreting neuroendocrine neoplasms (NENs) should be considered. Serum calcitonin levels are generally assessed by immunoradiometric and chemiluminescent assays with high sensitivity and specificity; however, slightly moderately elevated levels could be attributable to various confounding factors. Calcitonin values >100 pg/mL are strongly suspicious of malignancy, whereas in patients with moderately elevated values (10-100 pg/mL) a stimulation test may be applied to improve diagnostic accuracy. Although the standard protocol and the best gender-specific cut-offs for calcium-stimulated calcitonin are still controversial, the fold of the calcitonin increase after stimulation seems to be more reliable. Patients with MTC show stimulated calcitonin values at least three to four times higher than the basal values, whereas calcitonin-secreting NENs can be distinguished from a C-cell disease by the absence of or
3.
Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment.
Singh Ospina, N, Iñiguez-Ariza, NM, Castro, MR
BMJ (Clinical research ed.). 2020;:l6670
Abstract
Thyroid nodules are extremely common and can be detected by sensitive imaging in more than 60% of the general population. They are often identified in patients without symptoms who are undergoing evaluation for other medical complaints. Indiscriminate evaluation of thyroid nodules with thyroid biopsy could cause a harmful epidemic of diagnoses of thyroid cancer, but inadequate selection of thyroid nodules for biopsy can lead to missed diagnoses of clinically relevant thyroid cancer. Recent clinical guidelines advocate a more conservative approach in the evaluation of thyroid nodules based on risk assessment for thyroid cancer, as determined by clinical and ultrasound features to guide the need for biopsy. Moreover, newer evidence suggests that for patients with indeterminate thyroid biopsy results, a combined assessment including the initial ultrasound risk stratification or other ancillary testing (molecular markers, second opinion on thyroid cytology) can further clarify the risk of thyroid cancer and the management strategies. This review summarizes the clinical importance of adequate evaluation of thyroid nodules, focuses on the clinical evidence for diagnostic tests that can clarify the risk of thyroid cancer, and highlights the importance of considering the patient's values and preferences when deciding on management strategies in the setting of uncertainty about the risk of thyroid cancer.
4.
[Progress of risk factors for thyroid tumors].
Liu, S, Song, JY, Zhang, JQ
Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine]. 2020;(8):897-901
Abstract
In recent years, both benign and malignant thyroid tumors have grown rapidly in the world, and have become one of the most common tumors in the endocrine system. At present, the pathogenesis of thyroid tumor is still unclear, but more and more studies have found that certain factors are related to the occurrence and development of thyroid tumors. It is of great significance to summarize and analyze these risk factors. This article reviews the research progress of its risk factors reported in recent years, so as to provide a basis for the accuracy and scientific prevention and control of thyroid tumors.
5.
Review of Factors Contributing to Nodular Goiter and Thyroid Carcinoma.
Yildirim Simsir, I, Cetinkalp, S, Kabalak, T
Medical principles and practice : international journal of the Kuwait University, Health Science Centre. 2020;(1):1-5
Abstract
There is an increased incidence of thyroid nodules and cancer. In this article, the reasons for this increase are evaluated and discussed. The factors causing increases in the incidence of nodules are the same as those causing increases in thyroid cancer. There are publications from all over the world regarding the rising incidence of thyroid cancer; it is especially associated with papillary cancer. The literature was reviewed and evaluated with regard to this significant phenomenon. Thyroid-stimulating hormone (TSH) is the main mitotic factor. Any agent that elevates TSH will stimulate nodule formation. Therefore, the incidence of thyroid nodules is high in endemic goiter regions due to iodine deficiency. This paper has described many of the factors causing this higher incidence. Of note, metabolic syndrome and insulin resistance are important factors associated with the increased incidence of nodular goiter and papillary thyroid cancer today. However, these data must be confirmed by other studies in the future.
6.
Circular RNAs: New players in thyroid cancer.
Borran, S, Ahmadi, G, Rezaei, S, Anari, MM, Modabberi, M, Azarash, Z, Razaviyan, J, Derakhshan, M, Akhbari, M, Mirzaei, H
Pathology, research and practice. 2020;(10):153217
Abstract
The prevalence of thyroid cancer the most frequent endocrine malignancy, is rapidly increasing. Most of thyroid cancers are relatively indolent, however, some cases still possess a risk of developing into lethal types of thyroid cancer. Regarding its multistep tumorigenesis, the determination of the underlying mechanisms is a vital issue for thyroid cancer therapy. Circular RNAs (circRNAs) are a type of non-coding RNAs with a closed loop structure. Numerous circRNAs have been identified in cancerous tissues. Mounting data recommends that the biological activities of circRNAs, such as serving as microRNA or ceRNAs sponges, interacting with proteins, modulating gene translation and transcription, suggesting that circRNAs will be potential targets as well as agents for the prognosis and diagnosis of diseases, including cancer. Given that circular RNAs acts as oncogenes or tumor suppressors in the thyroid cancer. Several studies documented that circular RNAs via microRNA and protein sponges could regulate a sequences of cellular and molecular mechanisms e.g., apoptosis, angiogenesis, tumor growth, and invasion that are involved in thyroid cancer pathogenesis. Herein, we summarized the role of circular RNAs as therapeutic and diagnostic biomarkers in the thyroid cancer. Moreover, we highlighted the role of these molecules in the pathogenesis of various cancers.
7.
Redifferentiation of radioiodine-refractory thyroid cancers.
Buffet, C, Wassermann, J, Hecht, F, Leenhardt, L, Dupuy, C, Groussin, L, Lussey-Lepoutre, C
Endocrine-related cancer. 2020;(5):R113-R132
Abstract
The management of radioiodine refractory thyroid cancers (RAIR TC) is challenging for the clinician. Tyrosine kinase inhibitors classically prescribed in this setting can fail due to primary or acquired resistance or the necessity of drug withdrawal because of serious or moderate but chronic and deleterious adverse effects. Thus, the concept of redifferentiation strategy, which involves treating patients with one or more drugs capable of restoring radioiodine sensitivity for RAIR TC, has emerged. The area of redifferentiation strategy leads to the creation of new definitions of RAIR TC including persistent non radioiodine-avid patients and 'true' RAIR TC patients. The latter group presents a restored or increased radioiodine uptake in metastatic lesions but with no radiological response on conventional imaging, that is, progression of a metastatic disease, thus proving that they are 'truly' resistant to the radiation delivered by radioiodine. Unlike these patients, metastatic TC patients with restored radioiodine uptake offer the hope of prolonged remission or even cure of the disease as for radioiodine-avid metastatic TC. Here, we review the different redifferentiation strategies based on the underlying molecular mechanism leading to the sodium iodide symporter (NIS) and radioiodine uptake reinduction, that is, by modulating signaling pathways, NIS transcription, NIS trafficking to the plasma membrane, NIS post-transcriptional regulation, by gene therapy and other potential strategies. We discuss clinical trials and promising preclinical data of potential future targets.
8.
Fathoming the link between anthropogenic chemical contamination and thyroid cancer.
Marotta, V, Malandrino, P, Russo, M, Panariello, I, Ionna, F, Chiofalo, MG, Pezzullo, L
Critical reviews in oncology/hematology. 2020;:102950
Abstract
Incidence and mortality of thyroid cancer are increasing, thus making mandatory to improve the knowledge of disease etiology. The hypothesis of a role for anthropogenic chemicals is raising wide consideration. A series of occupational studies revealed that job exposures with high risk of chemical contamination were usually more prone to thyroid cancer development. These include shoe manufacture, preserving industry, building activities, pulp/papermaker industry and the wood processing, agricultural activities, and other work categories characterized by contact with chemicals, such as chemists and pharmacists. However, such epidemiological analyses cannot define a causal relationship. Thyroid-disrupting activity has emerged for a broad set of anthropogenic chemicals, with the best evidence being gained for polychlorinated biphenyls, polybrominated diphenyl ethers, dioxins, bisphenols, phthalates, pesticides, and heavy metals. A series of case-control studies, assessing exposure to thyroid-disrupting agents, as measured on biological matrices, have been recently performed providing the following insights: a) positive relationship with thyroid cancer was found for phthalates, bisphenols, the heavy metals cadmium, copper, and lead; b) polybrominated diphenyl ethers exposure showed no relationship with thyroid cancer c) controversial results were reported for polychlorinated biphenyls and pesticides. However, such studies cannot demonstrate the causal link with disease occurrence, as exposure is assessed after tumour development. Studies with different methodological approach are therefore required for defining the role of anthropogenic environmental chemicals in thyroid carcinogenesis.
9.
Acute airway compromise after recombinant human TSH administration: A case report and review of the literature.
Dowling, E, Kasperbauer, J, Morris, J, Bayan, S
The Laryngoscope. 2020;(11):2725-2727
Abstract
Radioiodine ablation is a commonly utilized treatment for differentiated thyroid carcinoma. Uptake of radioiodine can be enhanced by pretreatment with thyroid hormone withdrawal or administration of recombinant human thyroid-stimulating hormone (rhTSH). rhTSH is generally well-tolerated with minimal adverse effects. However, in patients with extensive tumor burden in confined anatomic spaces, rapid enlargement of normal or neoplastic thyroid tissue secondary to rhTSH administration can result in significant compressive effects. In this report, we describe a case of rapid airway deterioration requiring intubation in a patient with involvement of the thyroid cartilage by papillary thyroid carcinoma. Laryngoscope, 122:0000-0000, 2019 Laryngoscope, 130:2725-2727, 2020.
10.
Trends in the epidemiology of thyroid diseases in Bulgaria since the year 2000-a review of the literature.
Boyanov, MA
Hormones (Athens, Greece). 2020;(4):477-484
Abstract
This review attempts to summarize data on the prevalence of thyroid pathology in the Bulgarian population over a period of 20 years. Thyroid dysfunction was studied in two population-based studies (2006 and 2012). In the first, hypothyroidism was found in 6.3% and hyperthyroidism in 3.7% of the participants. The second study found overt and subclinical hypothyroidism in 3.2% and 4.5%, respectively, of females, and in 1.1% and 2% of males. TPOAb levels were elevated in 23% of females and in 9.6% of males. Nodules were found using ultrasound (US) in 23.4% of the participants in the 2006 study (in 30.1% of females and 15.0% of males), while the 2012 study showed 24.4% (32.1% of females and 15.7% of males). Recent data regarding prevalence of thyroid carcinoma in the Bulgarian population are lacking. Between 4 and 6% of thyroid biopsies produce results which have markers for malignancy. Four studies were carried out to address urinary iodine excretion levels in schoolchildren and three for those in pregnant women. Although median urinary iodine was in the iodine-sufficient range, a rising proportion of women had low urinary excretion. In the studies involving schoolchildren, excessive iodine excretion was also observed. The major strength of this review is the combination of data from different publications to give an overall baseline of thyroid epidemiology in Bulgaria. Further work is needed to map the recent trends regarding thyroid pathology in Bulgaria and the complete epidemiological dataset.