Papillary thyroid carcinoma (PTC) is the most prevalent thyroid malignancy and its incidence continues to rise. Although prognosis is generally favorable, overdiagnosis, overtreatment, and occasional lethal complications persist. To clarify the micro-environmental basis of PTC metastasis, we integrated single-cell RNA-seq from tumor (T), peritumoral thyroid (PT) and lymph-node (LN) tissues with bulk transcriptomes. Metastatic (M) and non-metastatic (NM) cases were compared, and machine-learning models were built to predict lymph-node status and outcome. Our atlas delineates highly heterogeneous ecosystems across T, PT and LN samples. Within T/NK lymphocytes, both immune-activating and immune-suppressive subsets coexist; NK and CD4+TNFRSF4 cells were selectively enriched in M tumors, implying heterogeneous anti-tumor responses. Among myeloid cells, a Mac-APOC1 subset displayed tumor-associated macrophage/M2 features, consistent with immune escape and dissemination. Dendritic cells differed markedly in antigen presentation and chemotaxis, while RGS5+ myCAFs, markedly expanded in M samples from T and LN, up-regulated metabolic and ribosomal pathways. Trajectory analysis uncovered dynamic CAF state transitions. Tumor epithelial cells followed multiple developmental branches, with those linked to LN invasion predicting poorer survival. A random-forest classifier achieved 0.98 accuracy for N-stage, and a lasso-Cox signature (C-index > 0.9) robustly stratified survival, underscoring the clinical relevance of the identified genes. Collectively, this work reveals the cellular and functional heterogeneity that drives PTC progression, identifies metastasis-associated subpopulations, and demonstrates the utility of machine learning for precise prediction of lymph-node metastasis and patient prognosis, offering a foundation for tailored therapeutic strategies.

The specific role of minimal extrathyroidal extension (mETE)-particularly the differences between anterior mETE (ant-mETE) and posterior mETE (post-mETE)-in relation to Central lymph node metastasis (CLNM) for papillary thyroid carcinoma (PTC) remains uncertain. This study aimed to examine the effects of ant-mETE and post-mETE on CLNM and to construct a preoperative risk-stratification nomogram for CLNM to guide central lymph node dissection (CLND). This retrospective study analyzed 1694 consecutive clinically node-negative (cN0) PTC cases treated between 2017 and 2024. Univariate and multivariate analyses were performed to identify clinicopathological predictors of CLNM. Subsequently, a predictive nomogram incorporating significant variables was developed and internally validated. Among 1694 cN0 PTC cases analyzed, 833 (49.2%) demonstrated pathologic CLNM, and post-mETE was significantly associated with higher CLNM rates compared to ant-mETE (p < 0.001). Multivariable analysis identified seven independent CLNM predictors: age > 55 years (OR 0.466), male gender (OR 2.479), tumor size > 1 cm (OR 3.290), bilateral involvement (OR 1.335), multifocality (OR 1.420), lower pole location (OR 1.710), and mETE presence (ant-mETE OR = 2.47, post-mETE OR = 3.492). The developed nomogram demonstrated excellent discriminative ability (AUC = 0.774) and clinical utility. Both ant-mETE and post-mETE were independently associated with CLNM, with post-mETE demonstrating significantly higher metastatic propensity. The predictive nomogram developed in this study demonstrated moderate discriminative accuracy for CLNM, which could help identify occult metastases, thereby facilitating prophylactic CLND and reducing reoperation rates in patients.

BACKGROUND:The treatment of unifocal papillary thyroid microcarcinoma (PTMC) remains controversial. The study analyzed preoperative clinical characteristics and postoperative pathologic features of unifocal PTMC to provide new insights into whether prophylactic central neck dissection (pCND) should be performed in PTMC. METHODS:A total of 1475 patients with clinical lymph node-negative (cN0) unifocal PTMC who underwent thyroid lobectomy and pCND were retrospectively analyzed. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors of central lymph node metastasis (CLNM). The decision tree model was used to identify the risk for CLNM in PTMC patients and indications for pCND. RESULTS:Age, gender, tumor size and location were risk factors for CLNM in cN0 unifocal PTMC patients. The root node of the decision tree model revealed location was the main factor affecting CLNM, and the potential risk of CLNM was the lowest in the intraglandular lesion regardless of gender, age, and tumor size. If lesions located in subcapsular/isthmus lesion, the potential risk was higher and was associated with age, gender, and tumor size. CONCLUSION:For patients with cN0 unifocal PTMC, regardless of gender, age, or tumor size, the risk of CLNM is the lowest when the lesion is located within the gland. In contrast, the potential risk of CLNM is higher when the lesion is subcapsular or located in the isthmus. In such cases, the decision to perform pCND should be made by integrating the patient's gender, age, and tumor size.

BACKGROUND:This study aimed to evaluate whether the extent of thyroidectomy is associated with long-term prognosis in patients with unilateral papillary thyroid carcinoma (PTC) and high-volume (n ≥ 5) central lymph node metastases (CLNM). METHODS:This study retrospectively analyzed the clinicopathological data of patients with unilateral PTC and high-volume (n ≥ 5) CLNM who underwent thyroidectomy between January 2013 and December 2019. Patients were divided into the thyroid lobectomy (TL) group and the total thyroidectomy (TT) group based on the extent of thyroidectomy. The primary outcome was recurrence-free survival (RFS), and the secondary outcome was the incidence of postoperative complications. RESULTS:A total of 192 patients were included in this study. Among them, 101 patients underwent TL, whereas 91 patients underwent TT. The median follow-up duration was 60 months. During the follow-up period, 5 cases of local recurrence were observed among 192 patients. The 5-year RFS was 97.1% in the TL group and 98.8% in the TT group. The log-rank test showed no significant difference in RFS between the two groups (p = 0.672). However, the TT group had higher rates of transient hypoparathyroidism. CONCLUSION:TL does not impact the long-term prognosis in unilateral PTC patients with high-volume (n ≥ 5) CLNM. Age ≥ 55 is associated with a higher risk of structure recurrence. For these patients who initially undergo TL, immediate completion thyroidectomy may not be necessary.

BackgroundExtrathyroidal extension (ETE) is a risk factor for lateral lymph node metastasis (LLNM) in patients with papillary thyroid carcinoma (PTC). However, the different effects of posterior minimal extrathyroidal extension (post-mETE) and anterior minimal extrathyroidal extension (ant-mETE) on LLNM remain unclear. This research aimed to investigate the influence of post-mETE and ant-mETE on LLNM and develop a nomogram to guide perioperative management in PTC patients at high risk for LLNM.MethodsThis retrospective study included consecutive PTC patients treated from December 2017 to March 2025. The identification of clinical and pathological predictive factors for LLNM was conducted using both univariate and multivariate analytical methods, and statistically significant variables were included to construct a predictive nomogram, followed by internal validation.ResultsAmong 1798 patients with PTC, 391 cases (21.75%) were pathologically confirmed to have LLNM. Compared to ant-mETE, post-mETE was significantly associated with a higher incidence of LLNM (p<0.001). The results of the multivariate analysis showed that there were 6 independent predictive factors for LLNM: maximum tumor diameter >1 cm (OR = 3.022), bilateral thyroid involvement (OR = 2.198), multifocality of the tumor (OR = 1.374), number of central lymph node metastases ≥2 (OR = 8.083), tumor located at the upper pole (OR = 2.679), and post-mETE (OR = 2.036). The nomogram constructed in this study demonstrated good discrimination performance (AUC = 0.850) and clinical applicability.ConclusionCompared to ant-mETE, PTC patients with post-mETE were more likely to develop LLNM. The predictive nomogram demonstrated high accuracy in forecasting LLNM and facilitated the identification of occult lymph node metastases. This capability assisted in determining the need for adjuvant radioactive iodine therapy or stricter follow-up management.

BACKGROUND:This study aimed to evaluate the prognostic outcomes of thyroidectomy extent in unilateral TNM T1 or T2 papillary thyroid carcinoma with lateral lymph node metastasis. METHODS:Retrospective data were collected from unilateral papillary thyroid carcinoma patients with unilateral lymph node metastasis who underwent surgery at Qilu Hospital of Shandong University from 2011 to 2022. Patients were categorized into 2 groups based on the extent of the thyroidectomy (total thyroidectomy versus lobectomy). The primary endpoint was recurrence-free survival. The secondary endpoint was the incidence of complications. The Cox proportional hazards model was used to explore independent risk factors for structural recurrence. RESULTS:A total of 372 patients with unilateral TNM T1 or T2 papillary thyroid carcinoma and unilateral lymph node metastasis were followed for a median of 55 months. Among them, 119 patients underwent lobectomy, whereas 253 patients underwent total thyroidectomy. During the follow-up period, 11 patients experienced structural recurrence. Kaplan-Meier analysis found no significant difference in recurrence-free survival between the groups (P > .05). However, the total thyroidectomy group had higher rates of both transient and permanent hypoparathyroidism, as well as transient recurrent laryngeal nerve injury (P < .05). Multivariate analysis identified minor extrathyroidal extension and lymph nodes ratio >0.49 as independent risk factors for structural recurrence, whereas the extent of thyroidectomy was not. CONCLUSION:This study suggests that lobectomy does not impact the prognosis in unilateral TNM T1 and T2 papillary thyroid carcinoma patients with unilateral lymph node metastasis. Minor extrathyroidal extension and lymph nodes ratio >0.49 are identified as independent risk factors for structure recurrence, and patients exhibiting these risk factors should be subjected to vigilant postoperative monitoring.

BackgroundThyroid cancer, the most prevalent endocrine malignancy, poses significant therapeutic challenges due to its heterogeneous biological behavior. Growth differentiation factor 15 (GDF15), a stress-responsive cytokine, is implicated in tumor progression and senescence regulation in various cancers. However, its role in thyroid cancer, particularly its interaction with the p53 signaling pathway, remains poorly understood. This study aimed to investigate the functional contribution of GDF15 to thyroid cancer progression and its regulatory mechanism in cancer cell senescence.MethodsPublic datasets and clinical specimens were analyzed to evaluate GDF15 expression patterns and their clinical significance. In vitro models were established using human thyroid cancer cell lines. GDF15 expression was modulated through siRNA-mediated silencing. RT-qPCR and Western blotting were employed to evaluate the expression levels of target molecules. Functional assays were conducted to assess proliferation (CCK-8, colony formation) and migration/invasion (transwell, cell scratch assay). Cellular senescence was evaluated by measuring β-galactosidase activity, γ-H2AX expression, and senescence-associated secretory phenotype factors. The dependency on p53 was elucidated through siRNA-mediated knockdown of p53. Mechanistic investigations were performed using RNA sequencing and Western blotting.ResultsCompared with adjacent normal tissues, GDF15 was significantly upregulated in thyroid cancer tissues and correlated with lymph node metastasis status. Knockdown of GDF15 suppressed proliferation, migration, and invasion while inducing cellular senescence. RNA sequencing revealed that GDF15 silencing activated the p53 signaling pathway and upregulated p53 expression. Rescue experiments utilizing p53 siRNA partially reversed GDF15-mediated senescence.ConclusionsGDF15 is implicated in the progression of thyroid cancer and potentially modulates cellular senescence through a p53-dependent mechanism, underscoring its dual functionality as both a pro-tumorigenic driver and a senescence regulator. These findings establish the potential of GDF15 as a therapeutic target and prognostic biomarker in thyroid cancer, providing novel insights developing senescence-centered therapeutic strategies.

BACKGROUND AND OBJECTIVE:Medullary thyroid carcinoma (MTC) is an aggressive malignancy driven predominantly by activating mutations in the RET proto-oncogene. Conventional genotyping using polymerase chain reaction (PCR) or next-generation sequencing (NGS) is often hampered by burdensome costs and prolonged turnaround times, hindering timely clinical decision-making. METHODS:We developed a rapid, cost-effective, multimodal deep-learning framework to predict RET mutations from standard H&E-stained slides. Our approach leverages hyperspectral imaging and integrates a 1D-CNN-LSTM network for spectral analysis with a Swin Transformer for spatial feature extraction. A cross-modal attention mechanism effectively fuses these representations. The model was trained and validated on 82 MTC cases from Qilu Hospital and externally tested on independent cohorts from two additional centers (n = 60). RESULTS:The proposed framework achieved an overall accuracy of 89.5 %, with a sensitivity of 90.2 % and specificity of 88.6 % for RET mutation classification. External validation confirmed robust generalizability, with performance surpassing single-modality benchmarks by 7.0-19.5 %. CONCLUSIONS:This study presents a non-invasive and efficient alternative for predicting RET mutations in MTC, demonstrating the potential of hyperspectral imaging and integrated deep learning to advance precision oncology.

BACKGROUND:Intraglandular dissemination (ID) is an important clinicopathological feature, but the statistical evidence of its relationship with lymph node metastasis (LNM) and the prognosis of papillary thyroid carcinoma (PTC) has not been widely reported in the literature. The purpose of this study was to investigate the potential correlation between ID, LNM, and prognosis in PTC patients. METHODS:Patients with PTC were retrospectively collected from Qilu Hospital of Shandong University from 2017 to 2019 and categorized into two groups based on postoperative routine pathology: intraglandular dissemination group (ID group) and the non-intraglandular dissemination group (NID group). The propensity score matching (PSM) was used to analyze and compare the differences in LNM and prognosis between groups. RESULTS:Among the 2845 patients included in the study, 6.85% had ID. After PSM matching, ID was associated with an increased risk of LNM (OR: 2.143, 95% CI: 1.279-3.591, p = 0.004) and recurrence in PTC patients (HR: 6.585, 95% CI: 1.782-24.335, p = 0.005). Kaplan-Meier curves showed that the recurrence-free survival (RFS) of the ID group before and after PSM was worse than that of the NID group (95.3% vs. 99.0%, p < 0.001; 95.0% vs. 99.0%, p = 0.011). CONCLUSION:ID is an independent risk factor for LNM (includes microscopic metastasis) and postoperative recurrence in PTC patients. The recurrence rate of ID-PTC patients with markers of aggressive disease is higher than that of ID-PTC patients alone. Patients with ID-PTC require more intensive follow-up to monitor for recurrence. The necessity of more extensive lymph node dissection for these patients may need to be validated by future multi-center, prospective studies.

Pleomorphic rhabdomyosarcoma (PRMS) is a highly malignant soft tissue sarcoma that typically occurs in the soft tissues of the extremities. PRMS arising in the thyroid is extremely uncommon and can be difficult to distinguish from sarcomatoid transformation of anaplastic thyroid carcinoma. A 58-year-old male presented with a rapidly enlarging left thyroid mass accompanied by dysphagia, dyspnea, and hoarseness. Imaging revealed a 7.0 cm cystic-solid mass invading the esophagus and cervical lymphadenopathy. Core needle biopsy (CNB) confirmed pleomorphic rhabdomyosarcoma through immunohistochemical staining (desmin+/myoD1+/myogenin+) and exclusion of epithelial 24 markers (TTF-1−/CK−). Genetic analysis identified the TP53 mutation, without BRAF V600E or 25 RET/PTC rearrangements. The tumor was surgically resected via total thyroidectomy and central lymph node dissection, followed by adjuvant radiotherapy and chemotherapy per soft tissue sarcoma treatment guidelines. The disease recurred at 24 months postoperatively, leading to loss of follow-up. Under specific circumstances, CNB can provide an effective diagnostic approach for thyroid tumors. Moreover, in this case, we identified a novel TP53 intronic mutation that may drive the development of thyroid PRMS.

BackgroundConventional open thyroidectomy (COT) results in visible neck scarring. Transaxillary endoscopic thyroidectomy (TET) comprises gasless (suspension-assisted) and gas-inflated approaches, both of which offer superior scar concealment. This study aimed to compare the efficacy and safety of these two endoscopic techniques for treating papillary thyroid carcinoma (PTC).MethodsA total of 471 patients were stratified into three groups: gasless transaxillary endoscopic thyroidectomy (GTET), gas-inflated transaxillary endoscopic thyroidectomy (GITET), and COT. Comparative analyses included perioperative outcomes, complication rates, cosmetic satisfaction and others. The cumulative sum (CUSUM) curve was applied to evaluate the learning curves of GTET and GITET.ResultsPatients in the TET groups were younger and included a higher proportion of females compared to COT. The COT group demonstrated advantages in operation time, postoperative drainage volume, and the number of retrieved central lymph nodes over TET groups. No significant differences were observed among the three groups in postoperative complication rates or sensory abnormalities. However, the COT group had higher swallowing-discomfort incidence. In terms of cosmetic outcomes, GITET surpassed GTET, with lower postoperative pain scores. The learning curves for both GTET and GITET were biphasic, achieving mastery after 42 and 67 cases respectively. No significant difference was found in the efficacy of central lymph node dissection between the two endoscopic approaches.ConclusionBoth GTET and GITET were reliable and safe surgical approaches, with reduced postoperative swallowing discomfort compared to COT. While GITET offered superior cosmetic outcomes and lower postoperative pain scores than GTET, achieving technical proficiency required more cases.

Background Identifying risk factors for adverse pathologic features in low-risk papillary thyroid microcarcinoma (PTMC) can provide valuable insights into the necessity of surgical or non-surgical treatment. This study aims to develop a nomogram for predicting the probability of adverse pathologic features in low-risk PTMC patients. Methods A total of 662 patients with low-risk PTMC who underwent thyroid surgery were retrospectively analyzed in Qilu Hospital of Shandong University from May 2019 to December 2021. Logistic regression analysis was used to determine the risk factors for adverse pathologic features, and a nomogram was constructed based on these factors. Results Most PTMC patients with these adverse pathologic features had tumor diameters greater than 0.6 cm ( p < 0.05). Other factors (age, gender, family history of thyroid cancer, history of autoimmune thyroiditis, and BRAF V600E mutation) had no significant correlation with adverse pathologic features ( p > 0.05 each). The nomogram was drawn to provide a quantitative and convenient tool for predicting the risk of adverse pathologic features based on age, gender, family history of thyroid cancer, autoimmune thyroiditis, tumor size, and BRAF V600E mutation in low-risk PTMC patients. The areas under curves (AUC) were 0.645 (95% CI 0.580–0.702). Additionally, decision curve analysis (DCA) and calibration curves were used to evaluate the clinical benefits of this nomogram, presenting a high net benefit. Conclusion Tumor size > 0.60 cm was identified as an independent risk factor for adverse pathologic features in low-risk PTMC patients. The nomogram had a high predictive value and consistency based on these factors.

Ectopic parathyroid adenoma, though rare, is one of the causes of persistent hyperparathyroidism and recurrence of hyperparathyroidism. Ectopic parathyroid glands can be seen in thymus, thyroid, and mediastinum. However, ectopic parathyroid adenoma occurred in the posterior superior mediastinum is extremely rare. Here, we report a case of primary hyperparathyroidism caused by ectopic parathyroid adenoma located in the posterior superior mediastinum. Serum parathyroid hormone, calcium, and vitamin D levels of the patient was followed up for one year.

Background: Multiple targeted therapeutics are available for radioiodine-refractory differentiated thyroid cancer (RAIR-DTC), but it remains unclear which treatment is optimal to achieve long-term survival.Methods: A systematic search of the PubMed, Embase, and ClinicalTrials.gov databases was conducted to identify eligible randomized controlled trials (RCTs) comparing the efficacy and safety of targeted treatments for patients with RAIR-DTC from inception to April, 2022. Data were extracted by following the recommendations of the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. We calculated the odds ratio (OR) or hazard ratio (HR), its corresponding 95% credible intervals (CrI), and the surface under the cumulative ranking curve (SUCRA) to indicate ranking probability using Bayesian network meta-analyses. The primary outcome was progression-free survival (PFS). The secondary outcomes were overall survival (OS), objective response rate (ORR), disease control rate (DCR), and grade 3 or higher adverse events.Results: A total of 12 eligible RCTs involved 1,959 patients and 13 treatments: apatinib, cabozantinib, anlotinib, nintedanib, lenvatinib, lenvatinib with low dose (LD), sorafenib, sorafenib plus everolimus, donafenib (200 mg), donafenib (300 mg), pazopanib (continuous), pazopanib (intermittent), and vandetanib. Pooled analyses indicated that targeted therapeutics significantly prolonged PFS and OS in patients with RAIR-DTC (0.31, 0.21–0.41; 0.69, 0.53–0.85, respectively) compared with placebo. Network meta-analyses indicated that lenvatinib showed the most favorable PFS, with significant differences versus sorafenib (0.33, 0.23-0.48), vandetanib (0.31, 0.20–0.49), nintedanib (0.30, 0.15–0.60), and placebo (0.19, 0.15–0.25), while apatinib was most likely to be ranked first for prolonging OS with a SUCRA of 0.90. Lenvatinib showed the highest ORR (66%, 61%–70%), followed by anlotinib (59%, 48%–70%) and apatinib (54%, 40%–69%). Lenvatinib caused the most adverse events of grade 3 or higher, followed by lenvatinib (LD) and apatinib. Different toxicity profiles of individual treatment were also revealed.Conclusion: This network meta-analysis suggests that lenvatinib and apatinib were associated with the best progression-free survival and overall survival benefits, respectively, for patients with RAIR-DTC, compared with other targeted therapeutics. Patients who received lenvatinib or apatinib also had more grade 3 or higher adverse events.Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=302249], identifier [CRD42022302249].

With the increasing of thyroid cancer worldwide, there urgently demands new mild theranostic strategies for treatment of recurrence of thyroid cancer to overcome the side-effects of the clinical practices (131I). In this work, photodynamic therapy (PDT) was first explored for treatment of thyroid cancer by incorporating iodomethane choline onto the phthalocyanine through either axial or peripheral substitution. Due to the extraordinary nonaggregation properties in aqueous solution, the axial choline substituted SiPc 1 shows much higher singlet oxygen generation and fluorescence emission than ZnPc 2 and 3 with peripheral substituted cholines. Their photodynamic activities in different type of thyroid cancer cells were clearly compared, disclosing that SiPc 1 is the most promising candidate for PDT of thyroid cancer.

Background: This study aimed to clarify whether the extent of thyroidectomy (total thyroidectomy vs thyroid lobectomy) influences survival in adults with localized medullary thyroid cancer.Methods: Patients with localized medullary thyroid cancer were identified using the Surveillance, Epidemiology, and End Results database (2000-2018). An independent cohort of patients with localized medullary thyroid cancer were retrospectively reviewed from three medical centers in China from 2010 to 2020. The patients were grouped by the extent of surgery (total thyroidectomy vs thyroid lobectomy). Primary end points were overall survival and disease-specific survival.Results: From 1,686 patients with medullary thyroid cancer identified in SEER, 1,122 patients met inclusion for matching, with a median follow-up of 99 months. After propensity score matching, 122 patients underwent a total thyroidectomy and 122 patients underwent a thyroid lobectomy. The 10-year overall survival was 85.2% (77.9%-90.7%) and 83.1% (75.5%-90.7%) in total thyroidectomy group and in thyroid lobectomy group, respectively. The 10-year disease-specific survival was 100% and 96.8% (93.1%-100%) in total thyroidectomy group and in thyroid lobectomy group, respectively. There was no sta-tistically significant difference in overall survival or disease-specific survival in patients with localized medullary thyroid cancer undergoing total thyroidectomy or thyroid lobectomy (hazard ratio = 0.83, 95% confidence interval 0.44-1.57, P = .57 and hazard ratio = 0.49, 95% confidence interval 0.10-2.41, P = .39, respectively). Forty-seven patients with localized medullary thyroid cancer were identified in an inde-pendent Chinese cohort (n = 29 in total thyroidectomy group vs n = 18 in thyroid lobectomy group). After a median follow-up of 47 months, there was no mortality observed in either group.Conclusion: This study suggests that the extent of thyroidectomy does not influence survival for patients with early-stage localized medullary thyroid cancer and that thyroid lobectomy might be adequate in this patient population.(c) 2022 Elsevier Inc. All rights reserved.

The clinical presentation of primary hyperparathyroidism (PHPT) differs between patients from developed and developing countries. In China, the clinical pattern has changed over the past few decades. Our aim was to elucidate general changes in the clinical characteristics of PHPT from 2010 to 2021. We enrolled 343 patients with PHPT at the Qilu Hospital of Shandong University, Jinan, China, from January 2010 to May 2021, including both surgical and non-surgical patients. Patients were divided into two subgroups, 2010-2016 (group A, n = 152) and 2017-2021 (group B, n = 191), based on the time span. We compared clinical manifestations and laboratory result data between these two groups. The mean patient age was 52.59 ± 13.55 years, and the male-to-female ratio was 1:2.54. Of the 343 patients, 183 (53.35%) had symptomatic PHPT; bone pain, urolithiasis, and fatigue were the most common symptoms. Post-operative pathology showed that 96.20% of the patients had parathyroid adenoma, whereas 2.41% had parathyroid carcinoma. Great changes occurred between 2010 and 2021; the percentage of patients with asymptomatic PHPT (aPHPT) increased from 36.18% in group A to 54.97% in group B. Moreover, patients in group B showed significantly lower serum calcium, alkaline phosphatase, parathyroid hormone, and urinary phosphate levels but higher serum 25-hydroxyvitamin D levels than those in group A. Clinical presentations in group B were also milder. In conclusion, the clinical characteristics of Chinese PHPT patients changed dramatically from 2010 to 2021, with asymptomatic PHPT (aPHPT becoming the predominant type over the last 3 years.

Background Recurrent laryngeal nerve injury (RLNI) still occurs in total endoscopic thyroidectomy (TET) by using intraoperative neuromonitoring (IONM). As the region where most injuries occur, more attention should be paid to RLNI near the nerve entry point (NEP) in TET. Materials and Methods This cohort study collected retrospectively data from 415 patients who underwent TET between February 2012 and December 2019. The functions of the recurrent laryngeal nerve (RLN) in TET were recorded by IONM. The patients with RLNI near the NEP were followed up by laryngoscopies. The demographic and clinical characteristics, the mechanisms of RLNI, and the outcomes of RLNI were recorded and analyzed. Results There were a total of 444 at-risk nerves in 405 patients were analyzed. The incidence of RLNI near the NEP was 7.9%. RLNs with extralaryngeal branches were more likely to be injured near the NEP (P = 0.037). The incidences of different types of RLNI, in order of frequency, were 68.8% for thermal injury (n = 22), 28.1% for traction/compression injury (n = 9), and 3.1% for transverse injury (n = 1). A total of 93.8% (n = 30) of RLNI patients had complete recovery of vocal cord activity function. Conclusion The extralaryngeal branch was a risk factor for RLNI near the NEP in TET. Thermal injury caused by an ultrasonic scalpel was the most common cause of RLNI near the NEP. Most RLNIs near the NEP would eventually recover.

The main objective of the current study was to examine the anticancer effects of naturally occurring Hirsutenone in human thyroid cancer cells along with investigating its effects on cell migration and invasion, apoptosis and Wnt/Beta-catenin signalling pathway. MTT assay and clonogenic assay were used to study effects on cell viability and cancer colony formation. Fluorescence microscopy along with flow cytometry was used to study apoptotic effects induced by Hirsutenone. Effects on Wnt/Beta-catenin signalling pathway were examined by western blot assay. Results indicated that Hirsutenone led to potent cell proliferation inhibition along with reducing cancer colony formation in a dose-dependent manner. Hirsutenone induced apoptotic effects as indicated by acridine orange/ethidium bromide staining assay as well as annexin-V FITC assay. The percentage of both early and late apoptotic cells increased significantly with increasing doses of Hirsutenone. Hirsutenone also caused activation of CASPASE-3, CASPASE-9, and BAX while as it led to downregulation of BCL-2. Hirsutenone also caused the inhibition of cell migration and cell invasion along with causing suppression of Wnt/beta-catenin signalling pathway. In conclusion, Hirsutenone exhibits strong anticancer properties in human thyroid cancer cells mediated via apoptosis, cell migration and invasion inhibition and suppression of Wnt/beta-catenin signalling pathway.

BACKGROUND:Multiple studies have reported the increased incidence of thyroid cancer in patients with primary hyperparathyroidism (PHPT). However, the underlying risk factors of concomitant thyroid cancer in patients with PHPT remain unknown. The primary aim of this study was to examine the records of patients with PHPT to identify characteristics that correlated with the presence of coexisting thyroid nodules, and which may have an implication for the prediction of thyroid cancer. METHODS:Medical records of consecutive patients with PHPT (n = 318) were reviewed from January 2010 to September 2020 in two tertiary medical centers in China. Patient clinicopathological and biological data were collected and analyzed. RESULTS:Of a total of 318 patients with PHPT, 105 (33.0%) patients had thyroid nodules and 26 (8.2%) patients were concomitant with thyroid cancer. A total of 38 thyroid nodules taken from 26 patients were pathologically assessed to be well-differentiated papillary thyroid carcinoma (PTC), with 81% being papillary thyroid microcarcinoma (PTMC). In 79% (30/38) of these cancers, thyroid nodules were considered suspicious following preoperative ultrasound. Multinomial logistic regression analysis revealed that female gender was associated with increased risk of thyroid nodules (OR = 2.13, 95% CI: 1.13-3.99, P = 0.019), while lower log-transformed parathyroid hormone levels were an independent predictor of thyroid cancer in patients with PHPT (OR = 0.50, 95% CI: 0.26-0.93, P = 0.028). CONCLUSION:In conclusion, we observed a relatively high prevalence of thyroid cancer in our cohort of Chinese patients with PHPT. Evaluation of thyroid nodules by preoperative ultrasound may be advisable in patients with PHPT, particularly for females and patients with modestly elevated serum parathyroid hormone levels.