Showing papers in "Thyroid in 2020"
China Medical University (PRC)1, Chinese PLA General Hospital2, Third Military Medical University3, Dalian Medical University4, Nanchang University5, Harbin Medical University6, Central South University7, Nanjing University of Chinese Medicine8, Fujian Medical University9, Zhengzhou University10, Guangxi Medical University11, Xi'an Jiaotong University12, Huazhong University of Science and Technology13, Lanzhou University14, Sichuan University15, Jilin University16, Shanghai University17, Anhui Medical University18, Sun Yat-sen University19, Shanxi Medical University20, Centers for Disease Control and Prevention21, Guiyang Medical University22, Hebei Medical University23, First Affiliated Hospital of Xinjiang Medical University24, Tianjin Medical University General Hospital25, Shanghai Jiao Tong University26, Shandong University27
TL;DR: The long-term mandatory USI program with timely adjustments is successful in preventing iodine deficiency disorders and it appears to be safe, and the benefits outweigh the risks in a population with a stable median iodine intake level of up to 300 µg/L.
Abstract: Background: Mandatory universal salt iodization (USI) has been implemented in China for 20 years. Although iodine deficiency disorders are effectively controlled, the risk of excess iodine have bee...
135 citations
TL;DR: Encapsulation, margin status, percentage and size of ATC in the primary were prognostically relevant and remain the most crucial indicator of outcome in ATC.
Abstract: Background: Anaplastic thyroid carcinoma (ATC) is nearly always fatal. Large studies on ATC are exceedingly rare. We aimed to study the clinical, genotypic, and histologic characteristics of ATC in...
112 citations
TL;DR: For carefully selected low risk intrathyroidal PTMC, RFA was not oncologically inferior to open surgery, and was associated with a higher quality of life and lower overall costs.
Abstract: Background: Papillary thyroid microcarcinoma (PTMC) typically carries an excellent prognosis regardless of the treatment option pursued. Radiofrequency ablation (RFA) for thyroid disease has been u...
111 citations
TL;DR: PD-L1 inhibitors lead to immune mediated thyroiditis, the most frequent endocrine IRAE, and in most cases, management is supportive without requiring steroids or discontinuation of immunotherapy.
Abstract: Background: Thyroid immune-related adverse events (IRAEs) have been reported more frequently with programmed cell death protein-1 (PD-1) inhibitors than cytotoxic T lymphocyte antigen 4 (CTLA-4) in...
102 citations
TL;DR: All thermal ablation techniques were effective and safe for the treatment ofPTMC, however, each treatment modality had significant heterogeneity with respect to complete disappearance of PTMC.
Abstract: Background: The increased incidence of primary papillary thyroid microcarcinoma (PTMC) has led to increased research in the field of nonsurgical therapeutic options for those who refuse surgery or ...
83 citations
TL;DR: Fusion gene positive PTCs were significantly associated with the mixture of classical and follicular variant of PTC, extrathyroidal extension, higher T classification, lymph node and distant metastases, chronic lymphocytic thyroiditis and frequent occurrence of psammoma bodies than fusion gene negative P TCs.
Abstract: Background: Pediatric papillary thyroid carcinoma (PTC) is a rare malignancy, but with increasing incidence. Pediatric PTCs have distinct clinical and pathological features and even the molecular profile differs from adult PTCs. Somatic point mutations in pediatric PTCs have been previously described and studied, but complex information about fusion genes is lacking. The aim of this study was to identify different fusion genes in a large cohort of pediatric PTCs and to correlate them with clinical and pathological data of patients. Methods: The cohort consisted of 93 pediatric PTC patients (6-20 years old). DNA and RNA were extracted from fresh frozen tissue samples, followed by DNA and RNA-targeted next-generation sequencing analyses. Fusion gene-positive samples were verified by real-time polymerase chain reaction. Results: A genetic alteration was found in 72/93 (77.4%) pediatric PTC cases. In 52/93 (55.9%) pediatric PTC patients, a fusion gene was detected. Twenty different types of RET, NTRK3, ALK, NTRK1, BRAF, and MET fusions were found, of which five novel, TPR/RET, IKBKG/RET, BBIP1/RET, OPTN/BRAF, and EML4/MET, rearrangements were identified and a CUL1/BRAF rearrangement that has not been previously described in thyroid cancer. Fusion gene-positive PTCs were significantly associated with the mixture of classical and follicular variants of PTC, extrathyroidal extension, higher T classification, lymph node and distant metastases, chronic lymphocytic thyroiditis, and frequent occurrence of psammoma bodies compared with fusion gene-negative PTCs. Fusion-positive patients also received more doses of radioiodine therapy. The most common fusion genes were the RET fusions, followed by NTRK3 fusions. RET fusions were associated with more frequent lymph node and distant metastases and psammoma bodies, and NTRK3 fusions were associated with the follicular variant of PTC. Conclusions: Fusion genes were the most common genetic alterations in pediatric PTCs. Fusion gene-positive PTCs were associated with more aggressive disease than fusion gene-negative PTCs.
74 citations
TL;DR: Both thermal ablation techniques result in a clinically significant and long-lasting volume reduction of benign thyroid nodules and the risk of regrowth and needing retreatment was lower after RFA.
Abstract: Background: Radiofrequency ablation (RFA) and laser ablation (LA) are effective treatments for benign thyroid nodules Due to their relatively recent introduction into clinical practice, there are
66 citations
TL;DR: It is suggested that thyroid cancer incidence trends have been shaped in large part, but not completely, by changes in professional guidelines' recommendations.
Abstract: Background: Overdiagnosis is the leading factor contributing to the rapid increase in thyroid cancer incidence of the last decades. During this period, however, thyroid cancer incidence has not been increasing at a constant pace. We hypothesized that changes in the slope of the incidence trends curve, called joinpoints, could be associated with changes in clinical practice guideline recommendations. Methods: Data were obtained from the initial nine registries of the Surveillance, Epidemiology, and End Results (SEER) Program. Thyroid cancer incidence was analyzed from 1975 to 2016. Joinpoints in thyroid cancer incidence trends and clinical variables were correlated with significant changes in clinical practice recommendations. Results: Incidence rate trends of medullary and anaplastic thyroid cancer were constant during the study period. Among papillary thyroid cancers (PTCs), three main joinpoints were identified, mainly driven by changes in incidence trends of smaller cancers. First, acceleration followed by two deceleration periods in thyroid cancer incidence coincident in time with the release of American Thyroid Association guidelines in 1996, 2009, and 2015. In 1996, the use of thyroid ultrasound and fine needle aspiration biopsy for the evaluation of thyroid nodules was described; and in 2009 and 2015, higher size thresholds for the biopsy of thyroid nodules were set. For the follicular variant of PTC, a joinpoint was observed around 1988, when the histological diagnosis of this entity was revised in the World Health Organization classification; and another one in 2015 coinciding with the proposal to remove the term carcinoma from noninvasive follicular-pattern tumors with papillary-like nuclear features which contributed to drive down the overall thyroid cancer incidence. Follicular thyroid cancer incidence was affected as well by changes in the guidelines, but to a lesser extent, and it was fairly stable during the study period. Conclusions: This study suggests that thyroid cancer incidence trends have been shaped, in large part, but not completely, by changes in professional guideline recommendations.
65 citations
TL;DR: The purpose of this study was to evaluate the long-term efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) for low-risk papillary thyroid microcarcinoma (PTMC) over a follow-up period of more than 5 years.
Abstract: Background: Despite reports describing favorable short-term results for thermal ablation of thyroid cancer, there remains a need to evaluate long-term results because of its indolent characteristics. The purpose of this study was to evaluate the long-term efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) for low-risk papillary thyroid microcarcinoma (PTMC) over a follow-up period of more than five years. Methods: From a cohort of patients under surveillance after US-guided RFA for primary low-risk PTMC, those with a record of follow-up data of more than five years were selected for this study. Before RFA, all patients underwent US and computed tomography to evaluate the PTMC and the presence of neck metastasis. RFA was performed using thyroid-dedicated electrodes. Follow-up US was performed 6 and 12 months after initial RFA, and then every 12 months. The status of ablated tumors was evaluated according to volume reduction, local tumor progression, newly developed cancers, lymph node (LN) or distant metastasis, and delayed surgery during follow-up. Complications during the procedure and follow-up period were evaluated. Results: A total of 84 nodules from 74 patients were included in this study. All patients tolerated RFA, and the mean follow-up duration was 72 months. After RFA, complete disappearance rates of 98.8% and 100% were achieved at 24 and 60-month follow-up, respectively. Additional ablations were performed in 13 of 84 tumors. The mean number of RFA sessions was 1.2. There were four newly developed cancers in three patients, and these were also treated with RFA and completely disappeared. During the follow-up period, there was no local tumor progression, no LN or distant metastasis, and no patients underwent delayed surgery. The major complication rate was 1.4% (1/74), and there was no delayed complication or procedure-related death. Conclusions: RFA is effective for treating low-risk PTMC patients, without occurrence of local tumor progression, LN or distant metastasis, delayed complications, procedure-related death, or delayed surgery over more than five years of follow-up.
65 citations
TL;DR: It is confirmed that the risk for recurrence of DTC is higher in men than in women, and although men tend to present with more advanced stage disease, the difference in recurrence risk persists when adjusted for stage of presentation.
Abstract: Background: Well-differentiated thyroid cancer (DTC) presents at a more advanced stage in men than in women, and the mortality in men is higher than that in women. However, it is not clear whether ...
63 citations
TL;DR: ATD therapy was the most common Graves' disease therapy and demonstrated the lowest efficacy and infrequent significant adverse effect profile.
Abstract: Background: Considerable uncertainty remains about the pattern of use of treatment options for Graves' disease (GD) and their comparative effectiveness and safety. Methods: Between 2005 and 2013, w...
TL;DR: Thyroid hormones levels, and in particular fT4 levels, seem to have stronger associations with clinical parameters than do TSH levels, which warrants reconsideration.
Abstract: Background: Though the functional states of other endocrine systems are not defined on the basis of levels of controlling hormones, the assessment of thyroid function is based on levels of the cont...
TL;DR: The presented radiomics nomogram, which is based on the SWE radiomics signature, shows favorable predictive value for LN staging in patients with PTC and showed favorable discriminatory efficacy in the US-reported LN negative (cN0) subgroup.
Abstract: Background: Accurate preoperative prediction of cervical lymph node (LN) metastasis in patients with papillary thyroid carcinoma (PTC) provides a basis for surgical decision-making and the extent o...
TL;DR: 4 cases of thyroid cancer patients treated with selective BRAF inhibitors who developed a RAS mutation in addition to the BRAFV600E mutation at progression are presented.
Abstract: Background: The BRAFV600E mutation is the most common driver mutation in papillary thyroid cancer (PTC) and anaplastic thyroid cancer (ATC). This mutation is considered actionable and, for BRAFV600E-mutated ATC, a BRAF inhibitor (dabrafenib) in combination with an MEK inhibitor (trametinib) is FDA approved. BRAF inhibitors have also shown efficacy in BRAFV600E-mutated PTC. However, as with all targeted therapies, resistance to these drugs eventually develops. It is essential that we understand the mechanisms of resistance to the BRAF inhibitors in thyroid cancer to develop future strategies to effectively treat these patients and improve survival. Patients: Herein, we describe four patients with thyroid cancer treated with selective BRAF inhibitors, who developed a RAS mutation in addition to the BRAFV600E mutation at progression. Results: Patients 1 and 3 acquired a KRASG12V mutation in the progressive tumor, patient 2 acquired a NRASQ61K mutation in a progressive lymph node, and patient 4 acquired NRASG13D mutation on liquid biopsy performed at the time of radiographic disease progression. Conclusion: Similar to the melanoma experience, the emergence of RAS mutations appears to act as a mechanism of resistance to BRAF inhibitors in thyroid cancers.
TL;DR: An unified lexicon of thyroid US features, a simplified method of classification, and a dedicated training in the description of thyroidUS findings may increase the observers' agreement and the predictive value of US classification systems in real world practice.
Abstract: Background: Single-center trials demonstrated moderate-substantial level of interobserver agreement in the evaluation of ultrasound (US) features of thyroid nodules. Multicenter studies on US agreement, however, are scanty, and data on intraobserver agreement are poor. Aim of the study was to assess inter- and intraobserver agreement between different thyroid centers and different specialists. Methods: A blinded analysis of 100 electronically recorded thyroid nodule US images was conducted in three large-volume thyroid centers by seven radiologists and endocrinologists. The evaluation was repeated after randomization 4 months later. The following US characteristics were evaluated: composition, echogenicity, margins, intranodular echogenic spots, vascularity, and shape. Thyroid nodules were also classified according to AACE/ACE/AME, EU-TIRADS, ATA, and ACR-TIRADS US classifications. Intra- and interobserver agreement was calculated using cross-tabulation expressed as mean Cohen's Kappa. Results: Interobserver agreement for US features: K-coefficient was 0.53 for composition, 0.47 for echogenicity, 0.46 for intranodular vascularity, and 0.33 for margins of the nodules. For echogenic foci, the K-coefficient was 0.47 for microcalcifications, 0.38 for macrocalcifications, 0.11 for the subcategory comet-tail artifacts, and 0.42 for shape. Operators resulted uncertain on hyperechoic foci definition in 16% of cases and described them as "hyperechoic foci of uncertain significance." Interobserver Cohen-K for US classification systems was 0.44 for AACE, 0.42 for ACR-TIRADS, 0.39 EU-TIRADS, and 0.34 for ATA. Intraobserver agreement: the K-coefficient for nodule US features was 0.62 for intranodular vascularity, 0.58 for composition, 0.60 for echogenicity, 0.54 for macrocalcifications, 0.55 for microcalcifications, 0.47 for comet tails, 0.39 for margins, and 0.35 for shape. Intraobserver Cohen-K for US classification systems was 0.54 for AACE, 0.49 for ACR-TIRADS, 0.38 for ATA, and 0.33 for EU-TIRADS. Conclusions: Intraobserver reproducibility for thyroid nodule US reporting and US classification systems appears fairly adequate, while the interobserver agreement between different centers is lower than that assessed in single-center trials. Reporting and rating ability of thyroid US examiners still appear not consistent. An unified lexicon of thyroid US features, a simplified method of classification, and a dedicated training in the description of thyroid US findings may increase the observers' agreement and the predictive value of US classification systems in real world practice.
TL;DR: Acquired overt thyroid toxicity and above median ATAb levels during anti-PD-1 treatment are associated with improved PFS and OS, and the results suggest that AtAb levels at baseline are of clinical relevance for P FS and OS.
Abstract: Background: Thyroid dysfunction is among the most common adverse effects during anti-programmed cell death 1 (PD-1) immunotherapy, and alongside correlations with elevated anti-thyroid antibodies (ATAb), studies have found correlations with survival. However, the exact relations remain to be clarified. We, therefore, aimed at clarifying the relationship between thyroid dysfunction, ATAbs, and survival in anti-PD-1 treated cancer patients. Methods: We included 168 patients with nonsmall-cell lung carcinoma, renal cell carcinoma, and metastatic melanoma treated with nivolumab or pembrolizumab. Thyrotropin and free T4 (fT4) levels were measured before each anti-PD-1 infusion. ATAb levels (anti-thyroid peroxidase [TPO] and anti-thyroglobulin [Tg]) were measured at baseline and after two months of treatment. Although the vast majority of patients had detectable levels of ATABs, only a few patients had positive ATAbs when using conventional cut-offs. To study the consequences of detectable ATABs, the cut-off levels were a priori set at the median concentrations at baseline in the study population. Tumor progression was classified according to RECIST v1.1. Results: Patients who acquired overt thyroid dysfunction during treatment had significantly higher overall survival (OS) (hazard ratio [HR] = 0.18 confidence interval [CI: 0.04-0.76]; p = 0.020) and progression-free survival (PFS) (HR = 0.39 [0.15-0.998]; p = 0.050) than patients without thyroid dysfunction with 1-year OS rates of 94% vs. 59% and 1-year PFS rates of 64% vs. 34%. During treatment, patients with ATAb levels above the median had a higher OS (HR = 0.39 [0.21-0.72]; p = 0.003) and PFS (HR = 0.52 [0.33-0.81]; p = 0.004) than patients with ATAb levels below the median, with 1-year OS rates of 83% vs. 49% and PFS rates of 54% vs. 20%, respectively. When analyzing ATAb levels over time, patients with a persistent ATAb level above the median had a higher OS (HR = 0.41 [0.19-0.89], p = 0.025) and PFS (HR = 0.54 [0.31-0.95], p = 0.032) compared with patients with a persistent ATAb level below the median. Patients whose ATAb levels increased above the median during treatment had an improved OS (HR = 0.27 [0.06-1.22], p = 0.088) and PFS (HR = 0.24 [0.07-0.77], p = 0.017) compared with patients whose ATAb levels decreased below the median. Conclusions: Acquired overt thyroid toxicity and above median ATAb levels during anti-PD-1 treatment are associated with improved PFS and OS. In addition, our results suggest that ATAb levels at baseline are of clinical relevance for PFS and OS.
TL;DR: The impact of USI on IDDs has significantly reduced the number of newborns affected by IDDs, and 720 million cases of clinical IDDs have been prevented by USI, mainly in low- and middle-income countries.
Abstract: Background: There has been tremendous progress over the past 25 years to control iodine deficiency disorders (IDDs) through universal salt iodization (USI). In 2019, using the median urinary iodine concentration (MUIC), only 19 countries in the world are classified as iodine deficient; in contrast in 1993, using the total goiter rate (TGR), 113 countries were classified as iodine deficient. However, few analyses have tried to quantify the global health and economic benefits of USI programs, and the shift from TGR to MUIC as the main indicator of IDDs complicates assessment of progress. Methods: We used a novel approach to estimate the impact of USI on IDDs, applying a regression model derived from observational data on the relationship between the TGR and the MUIC from 24 countries. The model was used to generate hypothetical national TGR values for 2019 based on current MUIC data. TGR in 1993 and modeled TGR in 2019 were then compared for 139 countries, and using consequence modeling, the potential health and economic benefits realized between 1993 and 2019 were estimated. Results: Based on this approach, the global prevalence of clinical IDDs (as assessed by the TGR) fell from 13.1% to 3.2%, and 720 million cases of clinical IDDs have been prevented by USI (a reduction of 75.9%). USI has significantly reduced the number of newborns affected by IDDs, with 20.5 million cases prevented annually. The resulting improvement in cognitive development and future earnings suggest a potential global economic benefit of nearly $33 billion. However, 4.8 million newborns will be affected by IDDs in 2019, who will experience life-long productivity losses totaling a net present value of $12.5 billion. Conclusions: The global improvements in iodine status over the past 25 years have resulted in major health and economic benefits, mainly in low- and middle-income countries. Efforts should now focus on sustaining this achievement and expanding USI to reach the continuing large number of infants who remain unprotected from IDDs.
TL;DR: Surgeons' and endocrinologists' attitudes and beliefs about overtreatment focus on the automaticity of over diagnosis, and most providers felt it is easier to prevent overdiagnosis than overtreatment.
Abstract: Introduction: The optimal management for patients with small, low-risk thyroid cancer is often debated. We aimed to characterize the attitudes and beliefs of providers and patients about management...
TL;DR: Using image similarity AI model, this work was able to create an explainable AI model which increases physician's confidence in the predictions and can decrease subjectivity and decrease the number of unnecessary biopsies.
Abstract: Background: Current classification systems for thyroid nodules are very subjective. Artificial intelligence (AI) algorithms have been used to decrease subjectivity in medical image interpretation. One out of 2 women over the age of 50 years may have a thyroid nodule and at present the only way to exclude malignancy is through invasive procedures for those that are suspicious on ultrasonography. Hence, there exists a need for noninvasive objective classification of thyroid nodules. Some cancers have benign appearance on ultrasonogram. Hence, we decided to create an image similarity algorithm rather than image classification algorithm. Materials and Methods: Ultrasound images of thyroid nodules from patients who underwent either biopsy or thyroid surgery from February 2012 to February 2017 in our institution were used to create AI models. Nodules were excluded if there was no definitive diagnosis of it being benign or malignant. A total of 482 nodules met the inclusion criteria and all available images from these nodules were used to create the AI models. Later, these AI models were used to test 103 thyroid nodules that underwent biopsy or surgery from March 2017 to July 2018. Results: Negative predictive value (NPV) of the image similarity model was 93.2%. Sensitivity, specificity, positive predictive value (PPV), and accuracy of the model were 87.8%, 78.5%, 65.9%, and 81.5%, respectively. Conclusions: When compared with published results of ultrasound thyroid cancer risk stratification systems, our image similarity model had comparable NPV with better sensitivity, specificity, and PPV. By using image similarity AI models, we can decrease subjectivity and decrease the number of unnecessary biopsies. Using image similarity AI model, we were able to create an explainable AI model that increases physician's confidence in the predictions.
TL;DR: While the success rate was similar in the RFA and LA groups, RFA achieved a significantly larger nodule volume reduction at six months, which was confirmed in the linear regression model adjusted for age, baseline volume, and proportion of cellular component.
Abstract: Background: No direct prospective studies comparing laser ablation (LA) and radiofrequency ablation (RFA) for debulking benign non-functioning thyroid nodules (BNTNs) exist. We aimed at comparing t...
TL;DR: ICI-induced thyroiditis is a T lymphocyte mediated process with intra-thyroidal predominance of CD8+ and CD4-CD8- T lymphocytes and HLA haplotypes may be involved.
Abstract: Background: Immune checkpoint inhibitors (ICIs) frequently cause thyroid dysfunction but their underlying mechanism remains unclear. We have previously demonstrated increased circulating natural ki...
Greifswald University Hospital1, Leibniz Association2, National Institute for Health and Welfare3, University of Gothenburg4, Sahlgrenska University Hospital5, Ljubljana University Medical Centre6, University of Málaga7, Carol Davila University of Medicine and Pharmacy8, Jagiellonian University Medical College9, ETH Zurich10, University Hospital Centre Zagreb11, Saints Cyril and Methodius University of Skopje12, Cyprus University of Technology13, University of Patras14, Ludwig Maximilian University of Munich15, Belfast Health and Social Care Trust16, University of Debrecen17, University of Latvia18, University of Niš19, Robert Koch Institute20, Dokuz Eylül University21, University of Pisa22, Queen's University Belfast23
TL;DR: It is demonstrated that iodine deficiency is still present in Europe, using standardized data from a large number of studies, which calls for action to ensure that non-iodized salt is replaced by iodized salt more often.
Abstract: Background: Knowledge about the population's iodine status is important, because it allows adjustment of iodine supply and prevention of iodine deficiency. The validity and comparability of iodine-...
TL;DR: Personal perceptions about cancer or thyroidectomy, contextual factors, family considerations, and trust in health care providers strongly influenced patients' disease management choices.
Abstract: Background: Active surveillance (AS) of small, low-risk papillary thyroid cancers (PTCs) is increasingly being considered. There is limited understanding of why individuals with low-risk PTC may ch...
TL;DR: Thyroid nodule location was an independent risk factor in predicting thyroid cancer (P= 0.005), and Isthmic nodules carry the highest risk of cancer diagnosis and lower lobe nodulescarry the lowest risk.
Abstract: Background: Thyroid nodules are routinely evaluated with ultrasound. Our aim was to determine if thyroid nodule location was a useful feature to predict thyroid cancer. Materials and Methods: Retro...
TL;DR: In this 5-year follow-up, MWA presented favourable efficacy with satisfactory safety for the treatment of PTMC and should be considered as an alternative therapy to surgery and active surveillance for solitary PTMC.
Abstract: Background: Some researchers have achieved favorable efficacy in the treatment of primary papillary thyroid microcarcinoma (PTMC) using microwave ablation (MWA). However, as PTMC is a slowly progre...
TL;DR: The age threshold adopted in the 8th edition of TNM staging system for DTC patients' prognosis identifies cases at higher risk of relapse and applying age at diagnosis above 55 years to the ATA system identified a subgroup of patients at highest risk for relapse.
Abstract: Background: The 2015 American Thyroid Association (ATA) guidelines proposed a three-category system for estimating the risk of recurrence of differentiated thyroid carcinoma (DTC). This system incl...
TL;DR: The overall diagnostic performance of the four US-based risk stratification systems were comparable and study location, proportion of female patients and malignant nodules, and study design were associated with study heterogeneity.
Abstract: Background: Several ultrasound (US)-based risk stratification systems have been increasingly used for the optimal management of thyroid nodules. However, there are considerable discrepancies across...
TL;DR: State anxiety among patients with PTMC seemed to be a reflection of an individual's trait rather than management, which appears to be key to improve shared decision-making.
Abstract: Background: Clinical practice guidelines have endorsed both active surveillance and surgery as viable management options for papillary thyroid microcarcinoma (PTMC). However, patients' perceptions ...
TL;DR: Global long-term declines in TC mortality have been accompanied by downward trends in both period and cohort effects, and indirectly confirm the main role of overdiagnosis in the epidemic of TC incidence.
Abstract: Background: Thyroid cancer (TC) incidence rates have been increasing in many countries, predominantly due to overdiagnosis. It is, however, not yet clear whether a true increase in exposure to risk factors might have also contributed to the TC epidemic. We assessed the TC mortality trends, which should not be affected by overdiagnosis, to disentangle the specific contribution of period and cohort effects. Methods: We analyzed long-term mortality data in 24 countries from 5 continents using age-period-cohort (APC) models. Nonidentifiability of the APC models was circumvented by integrating evidence of a consistent relationship between age and TC mortality, allowing to estimate period and cohort linear effects. Results: Substantial heterogeneity existed in the historical TC mortality rates across countries, but long-term rates declined over time in most of the countries, converging around a value of 0.5/100,000. The shape of the age-specific curves was consistently similar across countries and periods, resembling straight lines on the log-log scale, with the slopes ranging between 4.0 and 6.0. Both period and cohort effects showed long-term declines in most countries for both genders. In some countries, such as the United States, Canada, and Australia, substantial long-term declines by period were visible until the 1980s and 1990s, but then stabilized or increased slightly. Declining cohort effects were also seen in almost all countries, and were particularly pronounced in women from Switzerland, whereas stable cohort effects were recorded in South Africa. Although there were some indications of possible increasing risks of deaths among the youngest generations in some countries for both men and women, changes are too recent to be treated as unequivocal and estimates suffered from large statistical variability due to small numbers of deaths. Conclusions: Global long-term declines in TC mortality have been accompanied by downward trends in both period and cohort effects. Our results suggest lack of evidence of a possible major contribution of "real" risk factors in TC mortality, and indirectly confirm the main role of overdiagnosis in the epidemic of TC incidence.
TL;DR: While patients with thyroid cancer may have clear preferences for extent of surgery, common themes moderating preferences for surgical interventions were identified in the DCE and can lead to better treatment-decision making.
Abstract: Background: Patient preferences pertaining to surgical options for thyroid cancer management are not well studied. Our aim was to conduct a discrete choice experiment (DCE) to characterize participants' views on the relative importance of various risks and benefits associated with lobectomy versus total thyroidectomy for low-risk thyroid cancer. Methods: Adult participants with low-risk thyroid cancer or a thyroid nodule requiring surgery were asked to choose between experimentally designed surgical options with varying levels of risk of nerve damage (1%, 9%, 14%), hypocalcemia (0%, 3%, 8%), risk of needing a second surgery (0%, 40%), cancer recurrence (1%, 3%, 5%), and need for daily thyroid hormone supplementation (yes, no). Their choices were analyzed using random-parameters logit regression. Results: One hundred fifty participants completed an online DCE survey. Median age was 58 years; 82% were female. Twenty-four participants (16%) had a diagnosis of thyroid cancer at the time of completing the survey, and 126 (84%) had a thyroid nodule necessitating surgery. On average, 35% of participants' choices were explained by differences in the risk of cancer recurrence; 28% by the chance of needing a second surgery; 19% by the risk of nerve damage; and 9% by differences in risks of hypocalcemia and the need for thyroid hormone supplementation. When accounting for differences in postoperative risks, the average patient favored lobectomy over total thyroidectomy as long as the chance of needing a second (i.e., completion) surgery after initial lobectomy remained below 30%. Participants would accept a 4.1% risk of cancer recurrence if the risk of a second surgery could be reduced from 40% to 10%. Conclusions: While patients with thyroid cancer may have clear preferences for extent of surgery, common themes moderating preferences for surgical interventions were identified in the DCE. Adequate preoperative evaluation to decrease the chance of a second surgery and providing patients with a good understanding of risks and benefits associated with extent of surgery can lead to better treatment decision-making.