Endocrine Practice, Journal Year: 2024, Volume and Issue: unknown
Published: June 1, 2024
Language: Английский
Thyroid, Journal Year: 2025, Volume and Issue: unknown
Published: Jan. 21, 2025
Objectives: Cytologically indeterminate thyroid nodules (Bethesda class III or IV) carry a 10-40% risk of malignancy. Diagnostic lobectomies are frequently performed but negative surgeries incur unnecessary costs on the healthcare system, potential complications, and impacts quality life. Molecular tests (MTs) have been developed to reduce surgeries. However, well-validated, high-performance MTs often expensive, their cost-effectiveness has not studied in Asian population. This study evaluates rate surgery setting without MT (our current practice) introducing commercially available for management cytologically modernized city Asia. Methods: Management decisions outcomes consecutive Bethesda IV tertiary endocrine center Hong Kong were evaluated. Costs health service provided by public which covers >90% city, retrieved. A decision tree model was compare avoiding practice versus routine from provider's perspective. In our practice, available, patients with received either upfront lobectomy, repeat fine needle aspiration cytology (FNAC), active surveillance. Results: Over 4-year period, 2157 FNACs performed. After exclusion, 1957 analyzed, 18.6% IV. Thirty-six percent these surgery, 28% having malignancy final pathology, that is, 72% unnecessary. Routine could 82 surgeries/year, 26% more than practice. resulted an incremental ratio dollar (HKD) 49,102 (US [USD] 6314) per surgery. Sensitivity analysis showed test cost contributed significantly ratio. Lowering commercial price below HKD 8044 (USD 1031) would render cost-saving. Conclusion: Currently, high is being nodules. effective reducing at higher cost. will become cost-saving if be lowered.
Language: Английский
Citations
3
Pituitary, Journal Year: 2023, Volume and Issue: 26(4), P. 319 - 332
Published: May 20, 2023
Diagnostic delay is high in acromegaly and leads to increased morbidity mortality. The aim of this study systematically assess the most prevalent clinical signs, symptoms comorbidities at time diagnosis.A literature search (in PubMed, Embase Web Science) was performed on November 18, 2021, collaboration with a medical information specialist.Prevalence data (presenting) diagnosis were extracted synthesized as weighted mean prevalence. risk bias assessed for each included using Joanna Briggs Institute Critical Appraisal Checklist Studies Reporting Prevalence Data.Risk heterogeneity 124 articles. Clinical signs highest prevalence were: acral enlargement (90%), facial features (65%), oral changes (62%), headache (59%), fatigue/tiredness (53%; including daytime sleepiness: 48%), hyperhidrosis (47%), snoring (46%), skin (including oily skin: 37% thicker 35%), weight gain (36%) arthralgia (34%). Concerning comorbidities, patients more frequently had hypertension, left ventricle hypertrophy, dia/systolic dysfunction, cardiac arrhythmias, (pre)diabetes, dyslipidemia intestinal polyps- malignancy than age- sex matched controls. Noteworthy, cardiovascular comorbidity lower recent studies. Features that often led typical physical (acral enlargement, prognatism), local tumor effects (headache visual defect), diabetes, thyroid cancer menstrual disorders.Acromegaly manifests itself but also wide variety common emphasizing recognition combination these key establishing diagnosis.
Language: Английский
Citations
26
Nature Reviews Endocrinology, Journal Year: 2024, Volume and Issue: 20(12), P. 715 - 728
Published: Aug. 16, 2024
Language: Английский
Citations
9
Frontiers in Endocrinology, Journal Year: 2023, Volume and Issue: 14
Published: Aug. 11, 2023
Background Published data on the relationship between polycystic ovary syndrome (PCOS) and thyroid dysfunction are sparse confusing. Objective To comprehensively review available in literature regarding PCOS function, its abnormalities. Methods Nine main areas of interest were identified analyzed according to evidence: 1) Evaluation function for diagnosis; 2) Epidemiology function/disorders patients with PCOS, vice versa; 3) Experimental supporting PCOS; 4) Effects features, 5) Effect alterations cardiometabolic risk women 6) abnormalities reproductive outcomes 7) Relationship function/abnormalities who undergoing fertility treatment; 8) treatments diseases 9) function. An extensive search specific keywords was performed articles published from 1970 March 2023 using PubMed Web Science. Data reported a narrative fashion. Results is diagnosis exclusion which possible only after excluding disorders that mimic phenotype, including dysfunctions. However, tests cutoff values used this not specified. Many experimental clinical suggest perturbations PCOS. Direct unequivocal evidence effects features lacking. High thyroid-stimulating hormone levels subclinical hypothyroidism may be associated significant worsening several intermediate endpoints Thyroid worsen outcomes, especially treatment. date, there no demonstrating efficacy medications Lifestyle modification changes, metformin, vitamin D seem improve general population. Conclusion closely related, their coexistence identify higher metabolic risk. Regular screening thyroid-specific autoantibodies particularly before during pregnancy, highly recommended.
Language: Английский
Citations
21
EDPACS, Journal Year: 2024, Volume and Issue: 69(10), P. 1 - 29
Published: Aug. 2, 2024
This study presents a comprehensive bibliometric and content analysis of scholarly articles exploring the intersection information systems marketing strategy. Leveraging Web Science Core Collection database, research employed rigorous search strategy using key terms such as "information systems" "marketing strategy." After initially identifying over 2,000 sources, final dataset 124 peer-reviewed studies from management business domains was meticulously selected for analysis. The identifies seven trends within strategy, with particular focus on evolving impact remote work. Special attention is dedicated to authentic applications in shaping dynamics. study's novelty lies its extensive examination, offering fresh insights guiding future directions. By significantly contributing understanding advancement this field, underscores complex interplay between contemporary organizational contexts.
Language: Английский
Citations
7
The Journal of Clinical Endocrinology & Metabolism, Journal Year: 2023, Volume and Issue: 108(11), P. 2759 - 2771
Published: May 18, 2023
Abstract Over the past 3 decades, advances in molecular genetics of thyroid cancer (TC) have been translated into diagnostic tests, prognostic markers, and therapeutic agents. The main drivers differentiated TC pathogenesis are single-point mutations gene fusions components Mitogen-activated protein kinase (MAPK) phosphoinositide-3-kinase-protein B/Akt (PI3K/Akt) pathways. Other important genetic alterations more advanced types include TERT promoter, TP53, EIF1AX, epigenetic alterations. Using this knowledge, several tests developed for cytologically indeterminate nodules. Currently, commercially available use including a DNA/RNA-based test (ThyroSeq v.3), an RNA-based (Afirma Gene Sequencing Classifier), hybrid DNA/miRNA test, ThyGeNEXT/ThyraMIR. These mostly used to rule out malignancy Bethesda III IV nodules because they all high sensitivities negative predictive values. Their common use, predominantly United States, has resulted significant reduction unnecessary surgeries benign Some these also provide information on underlying TC; may support decision making initial management planning, although practice not yet widely adopted. More importantly, testing is essential patients with disease before using specific mono-kinase inhibitors (eg, selpercatinib RET-altered TC) drugs ineffective absence target. This mini-review discusses utilization data clinical different situations.
Language: Английский
Citations
12
Folia Medica, Journal Year: 2025, Volume and Issue: 67(2)
Published: March 20, 2025
The prevalence of thyroid nodules in the population ranges from 24.83% to 44.4%, with a notable increase observed patients over 80 years age, reaching up 79.8%. In 0.7% 1.59% cases, presenting spontaneous cysts or node hemorrhage require surgical intervention. present report details case 37-year-old woman who was admitted hospital complaints cervical pain on left side neck, weakness, and palpable mass anterolateral surface lower third neck left. required aspiration hemithyroidectomy. demonstrates efficacy point-of-care ultrasonography (USG) cyst as initial steps process decompression. However, it is imperative exercise caution meticulous monitoring patient, necessity for urgent elective intervention remains possibility. Furthermore, perform surgery, histological examination glands post-hemorrhage reveals malignancy 5.1-66.7% cases.
Language: Английский
Citations
0
Aesthetic Plastic Surgery, Journal Year: 2025, Volume and Issue: unknown
Published: April 28, 2025
Language: Английский
Citations
0
Life, Journal Year: 2023, Volume and Issue: 13(6), P. 1292 - 1292
Published: May 31, 2023
A widely discussed topic in the pathophysiology of thyroid nodules is role obesity, a state that leads to increased systemic inflammatory markers. Leptin plays vital forming and cancer through several mechanisms. Together with chronic inflammation, there an augmentation secretion tumor necrosis factor (TNF) cytokine interleukin 6 (IL-6), which contributed development, progression metastasis. In addition, leptin exerts modulatory action growth, proliferation invasion carcinoma cell lines via activating various signal pathways, such as Janus kinase/signal transducer activator transcription, mitogen-activated protein kinase (MAPK) and/or phosphoinositide 3-kinase (PI3K)/protein B (Akt). Through proposed mechanisms, aberrant endogenous estrogen levels have been suggested play development both benign malignant nodules. Metabolic syndrome triggers by stimulating angiogenesis due hyperinsulinemia, hyperglycemia dyslipidemia. Insulin resistance influences distribution structure blood vessels. growth 1 (IGF-1) insulin affect regulation expression genes differentiation cells. TSH can promote pre-adipocytes mature adipocytes but also, presence insulin, possesses mitogenic properties. This review aims summarize underlying mechanisms explaining obesity discuss potential clinical implications.
Language: Английский
Citations
10
PeerJ, Journal Year: 2025, Volume and Issue: 13, P. e18801 - e18801
Published: Jan. 20, 2025
Background The differential diagnosis between benign and malignant thyroid nodules continues to be a major challenge in clinical practice. rising incidence of neoplasm the low aggressive carcinoma, urges exploration strategies improve diagnostic accuracy pre-surgical phase, particularly for indeterminate nodules, prevent unnecessary surgeries. Only 2022, 5th WHO Classification Endocrine Neuroendocrine Tumors, 2023, 3rd Bethesda System Reporting Thyroid Cytopathology European Association included biomarkers their guidelines. In this review, we discuss integration within routine practice cancer. Methodology literature search review was performed through Pub Med, Science Direct, Google Scholar. We selected 156 publications with significant contributions topic, majority (86, or 55.1%) published January 2019 March 2024, including some from our group during those periods. inclusion criteria were based on articles recognized scientific journals high proposed topic. excluded not emphasizing molecular refine nodules. Results explored genetic biomarkers, considering division into BRAF -like tumor RAS tumor. specificity mutation papillary carcinoma (PTC) is nearly 100% but its sensitivity below 35%. mutations are found broad spectrum neoplasm, follicular-patterned tumors, do increase ability distinguish lesions. overexpression miRNAs correlated aggressiveness, node metastasis (TMN) stage, recurrence, representing real signature cancer, PTC. addition, associations expression levels presence specific have been related aggressiveness worse prognosis. Conclusions knowledge has achieved level complexity, difficulties applicability determine that implementation yet reality. More studies larger series needed optimize use Additionally, improvement new techniques, such as liquid biopsy and/or artificial intelligence, may future better understanding nodular disease.
Language: Английский
Citations
0