INTRODUCTION:Evaluating indeterminate thyroid nodules(ITN) is challenging, especially without molecular tests. This study examines whether artificial intelligence (AI) assistance can improve ITN diagnostic accuracy and bridge expertise gaps in surgeon-performed ultrasound. METHODS:134 ultrasound clips from 67 patients with ITN were reviewed by doctors of four levels: endocrine-surgery specialist, senior residents, junior residents, and medical student. After a 2-week wash-out, they re-evaluated the clips using AI-SONIC, an AI platform analyzing ultrasound real-time to predict cancer risk. Performance was validated against final histopathology. RESULTS:Without AI, medical students, junior residents and senior residents performed significantly worse than specialists(AUROC 0.530-0.560 vs 0.771, p ​< ​0.05). AI-SONIC improved residents' and medical students' diagnostic accuracy to levels comparable with specialists(AUROC 0.733-0.751 vs 0.771). The specialists' performance remained unchanged with AI assistance. CONCLUSION:AI enhances ultrasound evaluation of ITN by junior surgeons and medical students, elevating their accuracy to expert levels, supporting clinical assessment and medical education.

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 negative impacts on quality of life. Molecular tests (MTs) have been developed to reduce unnecessary surgeries. However, well-validated, high-performance MTs are often expensive, and their cost-effectiveness has not been studied in the Asian population. This study evaluates the rate of unnecessary surgery in the setting without MT (our current practice) and the cost-effectiveness of introducing a commercially available MT for the management of cytologically indeterminate thyroid nodules in a modernized city in Asia. Methods: Management decisions and outcomes of consecutive Bethesda III or IV thyroid nodules in a tertiary endocrine surgery center in Hong Kong were evaluated. Costs of health service provided by the public health system, which covers >90% of healthcare service in the city, were retrieved. A decision tree model was developed to compare the cost-effectiveness in avoiding unnecessary surgeries of current practice versus routine MT from a public healthcare provider's perspective. In our current practice, MT was not available, and patients with indeterminate nodules received either upfront lobectomy, repeat fine needle aspiration cytology (FNAC), or active surveillance. Results: Over a 4-year period, 2157 FNACs were performed. After exclusion, 1957 FNACs were analyzed, and 18.6% were Bethesda III or IV. Thirty-six percent of these cytologically indeterminate nodules received upfront surgery, with 28% having malignancy in final pathology, that is, 72% of surgeries were unnecessary. Routine MT could reduce 82 unnecessary surgeries/year, 26% more than current practice. Routine MT resulted in an incremental cost-effectiveness ratio of Hong Kong dollar (HKD) 49,102 (US dollar [USD] 6314) per unnecessary surgery. Sensitivity analysis showed test cost of MT contributed significantly to incremental cost-effectiveness ratio. Lowering the commercial price of MT to below HKD 8044 (USD 1031) would render routine MT cost-saving. Conclusion: Currently, a high rate of unnecessary surgeries is being performed for cytologically indeterminate thyroid nodules. MT was more effective in reducing unnecessary surgeries than current practice, but at a higher cost. MT will become cost-saving if the test cost could be lowered.

The comparative efficacy of single-session radiofrequency ablation (RFA) versus microwave ablation (MWA) for benign solid thyroid nodules remains unclear because existing literature consists of heterogenous baseline and wide range of nodule volumes. This study identified the predictors of volume reduction rate (VRR) of RFA versus MWA, and compared the efficacy between the two treatments. Consecutive benign nodules ≥ 80

BACKGROUND:Radiofrequency ablation is an effective treatment for benign thyroid nodules. For large nodules ≥20 mL, retreatment within 6 months would lead to a higher volume reduction rate at 12 months than a single treatment. However, the optimal timing of retreatment within the 6-month period has not been determined. This prospective study compared sequential versus interval retreatment with radiofrequency ablation for predominantly solid, large benign thyroid nodules ≥20 mL and identified factors associated with a better volume reduction rate. METHODS:Consecutive patients with predominantly (>80%) solid, cytologically benign large thyroid nodules (≥20 mL) that were undergoing radiofrequency ablation at a tertiary endocrine surgery center were recruited for a planned, 2-session radiofrequency ablation treatment. Group I received sequential retreatment in <1 month, whereas group II received interval retreatment in 4-6 months. For each session, the entire nodule was ablated until it was fully covered with echogenic bubbles. The primary outcome was 18-month volume reduction rate = (baseline volume - 18-month volume)/baseline volume × 100%. Complications, compressive symptoms, and cosmetic symptoms were compared. RESULTS:From 2022 to 2023, 31 nodules (group I: 15, group II: 16) from 30 patients were recruited for a total of 62 ablation sessions. Baseline characteristics including nodule volumes (33.5 [25-40] vs 37.2 [23.9-56.1] mL) and symptoms were comparable (P < .05). The overall 12-month and 18-month volume reduction rates were 75.7% (60.4%-80.9%) and 82.7% (64.7%-87.6%). No significant difference in 18-month volume reduction rate was observed between groups (group I: 84.1% [68.1%-88.3%] vs group II: 79.4% [64.7%-87.6%], P = .608). Both groups had significant further nodule shrinkage from 12 months to 18 months (P < .05), at comparable rates (P > .05), and significant improvement in cosmetic and compressive symptoms (P < .001). A higher energy per unit volume delivered at the second ablation session was the only factor associated with an 18-month volume reduction rate of ≥80% (P = .038, odds ratio: 88.3 [1.47-532]). No vocal cord palsy or hematoma occurred, and all patients were discharged on the same day after each treatment session. CONCLUSION:Continued shrinkage beyond 12 months was observed in large, predominantly solid benign thyroid nodules that received 2-session radiofrequency ablation within 6 months. Varying the time interval to retreatment within 6 months did not affect treatment efficacy. A higher energy per unit volume delivered at the second ablation session was associated with greater volume reduction.

Both glucagon-like peptide 1 receptor agonist (GLP1RA) and pioglitazone are associated with cardiovascular and hepatic benefits in patients with type 2 diabetes (T2D). However, studies that directly compare their cardio-hepatic effects are lacking. We emulated a target trial to compare their effects on adverse liver and cardiovascular outcomes in T2D patients. We adopted an “active comparator, new user” design involving T2D patients newly prescribed GLP1RA or pioglitazone between January 2008 and December 2022. The primary outcomes were major adverse liver outcomes (MALO) and cardiovascular events (MACE), with their individual outcomes and heart failure (HF) as secondary outcomes. Cox proportional hazards models were used to estimate hazard ratios (HRs) via intention-to-treat (ITT) and per-protocol (PP) analyses. A total of 8922 patients (N = 4461 each group) were included. Compared to pioglitazone users, GLP1RA users had comparable risks of incident MALO (ITT: HR 0.94, 95

INTRODUCTION:Conventional intraoperative neuromonitoring during thyroid surgery commonly uses electromyography electrodes embedded in endotracheal tubes. Adhesive transcutaneous electrodes may be a novel, noninvasive and low-cost alternative, but its accuracy and limitations remain less known. This prospective study compared the accuracy of adhesive transcutaneous electrodes placed under laryngeal ultrasound guidance to that of conventional endotracheal tube electrodes and assessed the factors associated with success in adhesive transcutaneous electrodes intraoperative neuromonitoring. METHODS:Consecutive patients undergoing open thyroid and neck surgery in a tertiary endocrine surgery unit were prospectively recruited. Before skin incision, the position of vocal cords relative to the thyroid cartilage was marked with laryngeal ultrasonography, and a pair of adhesive transcutaneous electrodes was placed on the overlying skin. Endotracheal tube electrode was used simultaneously. Standardized vagus and recurrent laryngeal nerve stimulation protocol was followed. On each stimulation, electromyography signals were simultaneously recorded by adhesive transcutaneous electrodes and endotracheal tube electrodes and later verified by postoperative flexible laryngoscopy. RESULTS:From 2023 to 2024, 300 nerves at risk from 216 patients were analyzed. Median age was 59 (50-70) years; 72.7% were female. Adhesive transcutaneous electrode electromyography had lower amplitudes for both recurrent laryngeal nerve and vagus nerve (P < .001). All 4 vocal cord vocal cord paresis (1.33%, transient and unilateral) were detected by adhesive transcutaneous electrodes and endotracheal tube electrodes, that is, 100% sensitivity and negative predictive value for vocal cord vocal cord paresis. Adhesive transcutaneous electrodes had slightly lower specificity (91.6% vs 96.5%) and accuracy (91.8% vs 96.6%), and lower positive predictive value (14.3% vs 28.6%). Signal interference in adhesive transcutaneous electrodes occurred in 6 patients (2.8%). Higher body mass index (BMI) was the only factor associated with false results from adhesive transcutaneous electrodes (P = .002, odds ratio 1.176, 95% confidence interval 1.060-1.305). Accuracy of adhesive transcutaneous electrodes (94.6%) became comparable to endotracheal tube electrodes in patients with body mass index <25. Adhesive transcutaneous electrodes cost less than endotracheal tube electrodes (32 vs 427 US dollars) for each surgery. Two patients with misplaced endotracheal tube electrodes (false endotracheal tube electrodes signal loss) had normal recurrent laryngeal nerve function correctly predicted by adhesive transcutaneous electrodes. CONCLUSION:Laryngeal ultrasound-guided adhesive transcutaneous electrode intraoperative neuromonitoring has comparable sensitivity and negative predictive value to endotracheal tube electrodes and may resolve false endotracheal tube electrodes signal loss. Lower body mass index was associated with improved and comparable accuracy to endotracheal tube electrodes. Adhesive transcutaneous electrodes may be a reliable, low-cost replacement to endotracheal tube electrodes in patients with body mass index <25.

OBJECTIVES:Conventional definitive treatments of relapsed Graves' disease (GD) include surgery and radioiodine therapy (RAI). Recently, radiofrequency ablation (RFA) has emerged as a potential novel treatment option. This study compared the health-related quality of life (HRQOL) at 2 years after treatment of relapsed GD with RFA, surgery, and RAI. METHODS:Patients with persistent/relapsed GD who underwent RFA, surgery (total thyroidectomy), or RAI at the same tertiary endocrine surgery unit from 2020 to 2022 were recruited to complete the disease-specific (ThyPRO-39) and generic (SF-12V2, SF-6D and EQ-5D-5L) HRQOL questionnaires at two years after each of the above respective treatments. Composite and domain specific scores were compared after propensity score matching for baseline age, sex, thyroid function, and comorbidities. Patients with moderate to severe Graves ophthalmopathy were excluded. RESULTS:Eighty-five patients completed the questionnaires. In the matched cohort, 45 patients (RFA: 15, Surgery: 15, RAI: 15) were analyzed. Their median age was 34 (30 - 44), and majority were female patients (91%). For the thyroid disease-specific ThyPRO-39 questionnaire, the RFA group had significantly lower (better) scores for depressive symptoms than the RAI and surgery groups (p = 0.046 and 0.009, respectively). The RFA group also had lower (better) scores for anxiety symptoms, hypothyroid symptoms, tiredness, overall quality of life impact scale, and composite scale, albeit differences being not statistically significant. In generic questionnaires, comparable composite scores were observed. These include the physical component score and mental component score in SF-12v2, the SF-6D utility score, EQ-5D-5L utility score, and EQ-VAS score. Sensitivity analysis with inverse probability of treatment weighting yielded consistent results. CONCLUSION:At 2 years after treatment of relapsed GD, single-session RFA achieved significantly better outcomes in terms of less depressive symptoms and at least comparable outcomes in most HRQOL domains when compared to surgery and RAI, when a disease-specific questionnaire (ThyPRO-39) was used. Comparable outcomes from generic HRQOL questionnaires were noted across RFA, surgery, and RAI.

Importance:Primary hyperparathyroidism (PHPT) is linked to insulin resistance, glucose intolerance, and diabetes. Whether parathyroidectomy is associated with lower risk of diabetes has not been evaluated in a large cohort. Objective:To examine the independent association between parathyroidectomy and the risk of incident diabetes in patients with PHPT. Design, Setting, and Participants:Patients diagnosed with PHPT between January 2006 and December 2023 were identified from a territorywide electronic health database in Hong Kong and classified into surgical and nonsurgical groups based on presence of subsequent parathyroidectomy. They were followed up with from the index date (first diagnosis of PHPT), until the outcome of interest (incident diabetes), death, or end of the study period (December 2023), whichever came first. Exposure:Parathyroidectomy vs nonsurgical management. Main Outcomes and Measures:The primary outcome of this study was incident diabetes. Inverse probability of treatment weighting was used to balance all baseline characteristics. Cox proportional hazards regression was used to evaluate the hazard of incident diabetes associated with parathyroidectomy. Results:A total of 3135 patients with PHPT were included (596 [19.0%] surgical and 2539 [81.0%] nonsurgical). The mean (SD) age was 67.5 (14.2) years, and 2211 (70.5%) individuals were female. A total of 518 patients in the nonsurgical group developed incident diabetes during a median (IQR) follow-up of 2.2 (0.9-4.3) years, compared to 156 patients in the surgical group during a median (IQR) follow-up of 5.5 (3.3-8.0) years. Parathyroidectomy was associated with lower risk of incident diabetes (hazard ratio [HR], 0.68 [95% CI, 0.65-0.71]; P < .001). Results were consistent across multiple sensitivity analyses. Subgroup analyses revealed more prominent protective associations among younger patients (age ≤65 years vs >65 years: HR, 0.64 [95% CI, 0.60-0.68] vs HR, 0.68 [95% CI, 0.63-0.72]; interaction P < .001) and those with more severe PHPT (parathyroid hormone [PTH] > twice the upper limit of normal vs PTH ≤ twice the upper limit of normal: HR, 0.58 [95% CI, 0.53-0.63] vs HR, 0.73 [95% CI, 0.69-0.77]; calcium > 2.8 vs calcium ≤ 2.8 mmol/L : HR, 0.58 [95%CI, 0.54-0.63] vs HR, 0.69 [95%CI, 0.66-0.73]; interaction P < .001). Conclusions and Relevance:In this cohort of patients with PHPT, parathyroidectomy was associated with a lower risk of incident diabetes. The association was more prominent in younger patients and those with more severe PHPT. These results may suggest potential additional metabolic benefits of parathyroidectomy in PHPT.

INTRODUCTION:Radiofrequency ablation (RFA) is an effective nonsurgical treatment for symptomatic benign thyroid nodules. Large-volume nodules (≥20-mL) often require 2 or more radiofrequency ablation sessions to achieve desirable shrinkage but the optimal interval between sessions remains unknown. We hypothesized that early (within 6 months) retreatment could improve nodule shrinkage. This study compared the 12-month volume reduction rate (VRR) and complications between single-session radiofrequency ablation and 2-session radiofrequency ablation within 6 months for large benign thyroid nodules. METHODS:Consecutive patients with cytologically proven benign thyroid nodules ≥20 mL undergoing radiofrequency ablation were prospectively assigned to undergo either single-session (group 1) or 2-session radiofrequency ablation within 6 months (group 2). All were followed up for at least 12 months after the initial radiofrequency ablation. Volume reduction rate was calculated as (baseline - current volume)/baseline volume × 100%. Complications were documented. RESULTS:Out of 67 nodules ≥20 mL that underwent radiofrequency ablation, 43 nodules (group 1: n = 23, group 2: n = 20) from 42 patients were analyzed. Both groups had comparable baseline nodule volumes (33.2 ± 14.9 mL vs 34.3 ± 12.5 mL) and clinical parameters (P > .05). The 6-month volume reduction rate was comparable (65.7 ± 13.2% vs 68.6 ± 13.3%, P = .264) but the 12-month volume reduction rate was significantly greater in group 2 (65.9 ± 17.1% vs 75.6 ± 11.5%, P = .019). Group 2 nodules continued to shrink from 6 to 12 months (P = .012), whereas group 1 nodules did not (P = .503). Two-session radiofrequency ablation within 6 months was the only significant factor associated with a 12-month volume reduction rate of ≥75% (odds ratio 4.375, 95% confidence interval 1.210-15.812, P = .024). No vocal cord paresis or hematoma requiring reoperation occurred. CONCLUSION:Early retreatment with 2-session radiofrequency ablation within 6 months was safe and led to significantly greater nodule shrinkage at 12 months than single-session radiofrequency ablation.

Background: Despite being minimally invasive, thermal ablation (TA) of thyroid nodules may still cause significant pain during and shortly afterwards. Conventional analgesia relies on perithyroidal local anesthesia (PLA) with or without sedation. The use of cervical plexus block (CPB) has been extensively studied in thyroidectomy, but never studied in TA of the thyroid gland. This study examined whether adding ultrasound-guided CPB to PLA and sedation could further reduce post-operative pain in unilateral TA of thyroid nodules. Methods: Consecutive patients aged >= 18 years undergoing unilateral radiofrequency ablation (RFA) or microwave ablation (MWA) of thyroid nodules were reviewed. Group I patients did not receive CPB, and Group II patients received CPB by bupivacaine injection between the sternocleidomastoid muscle (SCM) and prevertebral fascia on the treatment side. Pain was charted immediately and 4 hours after ablation using a numeric rating scale (NRS) of 0-10. The Quality-of-Recovery-9 (QoR9) questionnaire was completed. Results: Over an 18-month period, 100 patients underwent unilateral thyroid ablation (Group I, n=50; Group II, n=50). Comparable baseline patient demographics, nodule characteristics, ablation parameters were noted (P>0.05). Significantly lower immediate NRS {1 [0-3] vs. 4 [1.3-6], P<0.001}, 4-hour NRS {1 [0-3] vs. 2 [0-4], P=0.04}, and more zero immediate NRS (44% vs. 14%, P=0.001) was observed in Group II. Total QoR9 scores were comparable {16 [12-17] vs. 15 [12-17], P=0.72}. No adverse events occurred. All patients were discharged within the same day. Conclusions: Adding ultrasound-guided CPB further enhanced pain control following unilateral TA of thyroid nodules, without compromising quality of recovery or same-day discharge.

Objectives: Graves' disease (GD) is the most common cause of hyperthyroidism. Antithyroid drugs (ATDs) are the first-line treatment, but when discontinued, >50% of patients experience relapses. Conventional definitive treatment options include surgery and radioiodine therapy (RAI), each with its own disadvantages. Radiofrequency ablation (RFA) achieved promising short-term remission rates in a previous pilot study. The current study reports our experience of using RFA to treat relapsed GD in the largest cohort of patients with a longer follow-up period. Methods: This single-arm prospective study recruited consecutive patients aged >= 18 with persistent/relapsed GD requiring ATD from two tertiary endocrine surgery centers. Those with compressive goiter, suspected thyroid malignancy, moderate-to-severe Graves' ophthalmopathy, preference for surgery/RAI, or pregnancy were excluded. Eligible patients received ultrasound-guided RFA to the entire bulk of the thyroid gland. ATDs were discontinued afterward, and thyroid function tests were monitored bimonthly. The primary outcome was the disease remission rate at 24 months follow-up after single-session RFA, defined as being biochemically euthyroid or hypothyroid without ATD. Secondary outcomes were complication rates. Results: Of the 100 patients considered, 30 (30.0%) patients were eligible and received RFA. Most were female patients (93.3%). The median total thyroid volume was 23 mL (15.9-34.5). All completed 24 months follow-up. After single-session RFA, disease remission rates were 60.0% at 12 months and 56.7% at 24 months. Among the 13 patients with relapse after RFA, 9 (69%) required a lower ATD dose than before RFA; 2 received surgery without complications. Total thyroid volume was the only significant factor associated with relapse after RFA (odds ratio 1.054, confidence interval 1.012-1.099, p = 0.012). At 24 months, RFA led to disease remission in 100% of the 9 patients with a total thyroid volume <20 mL and 35% of patients with a total thyroid volume >= 20 mL (p = 0.007). There was no vocal cord palsy, skin burn, hematoma, or thyroid storm after RFA. Conclusions: In a highly selected group of patients with relapsed GD and predominantly small thyroid glands, single-session RFA may achieve disease remission. Smaller total thyroid volume may be a favorable factor associated with disease remission after RFA. The results of this study need to be confirmed with a long-term clinical trial. Clinical Trial Registration: This study is registered at www.clinicaltrial.gov with identifier NCT06418919.

Abstract Background High levels of high-density lipoprotein cholesterol (HDL-C) are previously considered protective against cardiovascular diseases (CVD), but recent studies suggest an increased risk of adverse events at very high HDL-C levels in the general population. It remains to be elucidated such a relationship in diabetes, a condition with high cardiovascular risks. We examined the association of HDL-C levels with the risk of major adverse cardiovascular events (MACE) and mortality in type 2 diabetes. Methods This retrospective cohort study identified individuals with type 2 diabetes who had HDL-C records (2008–2020) from the electronic health record database of the Hong Kong Hospital Authority. They were classified into three groups based on their first-recorded HDL-C levels following diabetes diagnosis: low (≤ 40 mg/dL), medium (> 40 and ≤ 80 mg/dL) and high HDL-C (> 80 mg/dL) groups. The primary outcome was incident MACE (composite of myocardial infarction, stroke, heart failure, and cardiovascular mortality). Cox regression model and restricted cubic spline analysis were employed to assess the relationship between HDL-C and adverse outcomes. Results Among 596,943 individuals with type 2 diabetes included, 168,931 (28.30%), 412,863 (69.16%), and 15,149 (2.54%) were classified as low HDL-C, medium HDL-C, and high HDL-C groups, respectively. Over a median follow-up of 79.5 months, both low and high HDL-C groups had higher risk of incident MACE compared to the medium HDL-C group (HR 1.24, 95% CI 1.23–1.26, P < 0.001; HR 1.09, 95% CI 1.04–1.13, P < 0.001). The spline curves revealed a U-shaped association between HDL-C levels and incident MACE (non-linear p < 0.001). Similar U-shaped relationship was observed for all-cause and non-cardiovascular mortality. Conclusions Our study demonstrated a U-shaped association between HDL-C levels and incident MACEs and all-cause and non-cardiovascular mortality in individuals with type 2 diabetes, highlighting the need for mechanistic studies on the adverse outcomes seen at high HDL-C levels in type 2 diabetes.

Colonoscopy-based screening provides protection against colorectal cancer (CRC), but the optimal starting age and time intervals of screening colonoscopies are unknown. We aimed to determine an optimal screening schedule for the US population and its dependencies on the objective of screening (life years gained or incidence, mortality, or cost reduction) and the setting in which screening is performed. We used our established open-source microsimulation model CMOST to calculate optimized colonoscopy schedules with one, two, three or four screening colonoscopies between 20 and 90 years of age. A single screening colonoscopy was most effective in reducing life years lost from CRC when performed at 55 years of age. Two, three and four screening colonoscopy schedules saved a maximum number of life years when performed between 49-64 years; 44-69 years; and 40-72 years; respectively. However, for maximum incidence and mortality reduction, screening colonoscopies needed to be scheduled 4-8 years later in life. The optimum was also influenced by adenoma detection efficiency with lower values for these parameters favoring a later starting age of screening. Low adherence to screening consistently favored a later start and an earlier end of screening. In a personalized approach, optimal screening would start earlier for high-risk patients and later for low-risk individuals. In conclusion, our microsimulation-based approach supports colonoscopy screening schedule between 45 and 75 years of age but the precise timing depends on the objective of screening, as well as assumptions regarding individual CRC risk, efficiency of adenoma detection during colonoscopy and adherence to screening.

Objectives This network meta-analysis aimed to evaluate the association of anti-thyroid drugs (ATD), radioactive iodine (RAI), and thyroidectomy with subsequent outcomes in patients with newly-diagnosed hyperthyroidism.Methods The Ovid Medline, Ovid Embase, and Cochrane Library databases were searched for observational studies and randomized controlled trials. Included studies were published on or before 1st May 2022 involving at least two of the treatments among ATD, RAI, and thyroidectomy for hyperthyroidism. Pairwise comparisons and Bayesian network meta-analysis were used to estimate hazard ratios (HRs) and their credible interval (CrI) of outcomes, including cardiovascular disease (CVD), cancer, overall mortality, and Graves' ophthalmopathy (GO).Results A total of 22 cohort studies with 131,297 hyperthyroidism patients were included. Thyroidectomy was associated with lower risks of mortality and GO than ATD (HR = 0.54, 95% CrI: 0.31, 0.96; HR = 0.31, 95% CrI: 0.12, 0.64) and RAI (HR = 0.62, 95% CrI: 0.41, 0.95; HR = 0.18, 95% CrI: 0.07, 0.35). RAI had a higher risk of GO (HR = 1.70, 95% CrI: 1.02, 2.99) than ATD treatment.Conclusions This Bayesian network meta-analysis indicated that thyroidectomy was associated with lower risks of mortality and GO in newly-diagnosed hyperthyroid patients compared to ATD and RAI. Relative to ATD, RAI therapy increased the risk of GO.

Background We previously showed that higher SARS-CoV-2 viral load correlated with smaller thyroid volumes among COVID-19 survivors at 2 months after acute COVID-19. Our current follow-up study evaluated the evolution of thyroid volumes and thyroiditis features within the same group of patients 6 months later. Methods Adult COVID-19 survivors who underwent thyroid ultrasonography 2 months after infection (USG1) were recruited for follow-up USG 6 months later (USG2). The primary outcome was the change in thyroid volume. We also reassessed thyroiditis features on USG, thyroid function and anti-thyroid antibodies. Results Fifty-four patients were recruited (mean age 48.1 years; 63% men). The mean thyroid volume increased from USG1 to USG2 (11.9 ± 4.8 to 14.5 ± 6.2 mL, p < 0.001). Thirty-two patients (59.3%) had significant increase in thyroid volume by ≥15%, and they had a median increase of +33.3% (IQR: +20.0% to +45.0%). Multivariable logistic regression analysis showed that only higher baseline SARS-CoV-2 viral load independently correlated with significant thyroid volume increase on USG2 (p = 0.022). Among the seven patients with thyroiditis features on USG1, six (85.7%) had the features resolved on USG2. None had new thyroiditis features on USG2. All abnormal thyroid function during acute COVID-19 resolved upon USG1 and USG2. Conclusion Most COVID-19 survivors had an increase in thyroid volume from early convalescent phase to later convalescent phase. This increase correlated with high initial SARS-CoV-2 viral load. Together with the resolution of thyroiditis features, these may suggest a transient direct atrophic effect of SARS-CoV-2 on the thyroid gland with subsequent recovery of thyroid volume and thyroiditis features.

Background: The primary goal of this interdisciplinary consensus statement is to provide a framework for the safe adoption and implementation of ablation technologies for benign thyroid nodules. Summary: This consensus statement is organized around three key themes: (1) safety of ablation techniques and their implementation, (2) optimal skillset criteria for proceduralists performing ablative procedures, and (3) defining expectations of success for this treatment option given its unique risks and benefits. Ablation safety considerations in pre-procedural, peri-procedural, and post-procedural settings are discussed, including clinical factors related to patient selection and counseling, anesthetic and technical considerations to optimize patient safety, peri-procedural risk mitigation strategies, post-procedural complication management, and safe follow-up practices. Prior training, knowledge, and steps that should be considered by any physician who desires to incorporate thyroid nodule ablation into their practice are defined and discussed. Examples of successful clinical practice implementation models of this emerging technology are provided. Conclusions: Thyroid ablative procedures provide valid alternative treatment strategies to conventional surgical management for a subset of patients with symptomatic benign thyroid nodules. Careful patient and nodule selection are critical to the success of these procedures as is extensive pre-procedural patient counseling. Although these emerging technologies hold great promise, they are not without risk and require the development of a unique skillset and environment for optimal, safe performance and consistent outcomes.

Background: While the detrimental impact of negative emotions on the clinical course of inflammatory bowel disease (IBD) and quality of life has been extensively investigated, evidence for a potential impact of positive emotions is scarce. Objectives: We aim to analyse contributing factors of positive affect and their predictive value for disease course in IBD patients. Design: In this retrospective cohort study, epidemiological, psychosocial and IBD disease characteristics of Swiss IBD cohort study patients were analysed longitudinally. Methods: Epidemiological, psychosocial and disease characteristics were extracted from the database of the Swiss IBD cohort study. Participants’ positive emotions were assessed cross-sectionally with the seven-item Marburg questionnaire (range 1–6) addressing positive affect in different aspects of daily life. Predictors of positive emotions were identified by linear regression. The quantitative longitudinal impact of positive emotions on the further disease course was analysed using a multivariable Cox proportional hazards model. Results: Among 702 IBD patients, those reporting more positive emotions were found to have significantly less intense medical treatment, less pain and fewer depressive symptoms ( p < 0.05). A higher percentage of variability in positive emotions was explained by pain (36%) and depressive symptoms (13%) than by epidemiological characteristics (0.3%), or characteristics of IBD and its treatment (2.4%). Patients with higher levels of positive emotions (score > 3.5) experienced longer flare-free survival, also after adjusting for confounders (adjusted hazard ratio: 0.39, p < 0.05). Conclusions: The absence of pain and depressive symptoms were the strongest drivers for high positive affect. Higher scores of positive affect were associated with longer disease-free survival in IBD patients.

The “purity” of an organic compound typically refers, in practice, to an assignment of the mass fraction content of the primary organic component present in the material. The “purity” value of an organic primary calibrator material is the ultimate source of metrological traceability of any quantitative measurement of the content of that compound in a given matrix. The primary calibrator may consist of a Certified Reference Material (CRM) whose purity has been assigned by the CRM producer or a laboratory may choose to value-assign a material to the extent necessary for their intended application by using appropriately valid methods. This report provides an overview of the approach, performance and applicability of the principal methods used to determine organic purity including mass balance, quantitative NMR, thermal methods and direct-assay techniques. A statistical section reviews best practice for combination of data, value assignment as the upper limit values corresponding to 100 % purity are approached and how to report and propagate the standard uncertainty associated with the assigned values.