BACKGROUND:The relationship between thyroid hormone sensitivity and the risk of recurrence in patients with papillary thyroid carcinoma (PTC) has not been thoroughly investigated, and it remains unclear whether factors such as thyroid-stimulating hormone suppression efficacy or underlying autoimmune mechanisms mediate this association. The primary objective of the present study was to examine the complex interrelationships among thyroid hormone sensitivity indices and their collective utility as biomarkers for predicting recurrence. METHODS:This study retrospectively analyzed a cohort of 196 patients who underwent initial surgical resection and received a pathological confirmation of PTC between January 2015 and July 2016. Logistic regression analysis was employed to evaluate the potential association of thyroid hormone sensitivity indices-specifically, the thyrotropin index (TSHI) and thyrotroph T4 resistance index (TT4RI)-with PTC recurrence, as well as to assess their predictive utility. RESULTS:In patients with PTC, multivariate logistic regression identified both TSHI ≥ 3.6 and TT4RI ≥ 54.2 as independent prognostic factors associated with reduced recurrence risk (TSHI: OR = 0.107, 95% CI: 0.012-0.948, P = .045; TT4RI: OR = 0.158, 95% CI: 0.026-0.529, P = .005). Furthermore, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) analyses revealed that the inclusion of thyroid hormone sensitivity indices significantly enhanced the predictive accuracy for recurrence events (TSHI: NRI = 0.292, 95% CI: -0.001-0.602, P = .064; IDI = 0.032, 95% CI: 0.013-0.051, P = .001; TT4RI: NRI = 0.663, 95% CI: 0.376-0.951, P < .001; IDI = 0.053, 95% CI: 0.025-0.082, P < .001). Finally, receiver operating characteristic curve analysis demonstrated that the combination of TSHI and TT4RI yielded superior predictive performance, with an area under the curve of 0.790 (P < .001), significantly outperforming either index alone. CONCLUSION:In conclusion, thyroid hormone resistance, indicated by elevated TSHI and TT4RI, represents an independent protective factor against recurrence in PTC. The integration of these indices significantly improves recurrence prediction, with their combination offering superior discriminative ability, highlighting their collective utility as clinically relevant biomarkers for optimizing postoperative surveillance and management strategies in PTC.

ObjectiveThis study aimed to evaluate the clinical value of repeat fine-needle aspiration biopsy (rFNAB) for thyroid nodules initially classified as Bethesda Category III, to explore the optimal timing for repeat biopsy, and to optimize the biopsy strategy by integrating ultrasonographic characteristics.MethodsWe retrospectively analyzed the clinical data of 109 patients (114 nodules) who underwent rFNAB at our hospital from December 2020 to December 2025, including 87 females and 22 males. Based on rFNAB results, the nodules were divided into a definitive diagnosis group (93 nodules) and a non-definitive diagnosis group (21 nodules). The definitive diagnosis group was further subdivided into a malignant group (62 nodules, Bethesda V/VI) and a benign group (31 nodules, Bethesda II). We recorded biopsy results, intervals between biopsies, postoperative pathological findings, and ultrasonographic features. Statistical differences between groups were analyzed. Statistical methods included the χ² test, Fisher’s exact test, binary logistic regression analysis, and ROC curve analysis.ResultsAmong the 114 Bethesda Category III nodules, 93 (81.6%) obtained a definitive diagnosis through rFNAB, including 62 malignant (66.7%) and 31 benign (33.3%) nodules; 21 nodules (18.4%) remained non-diagnostic. Forty-seven patients with malignant rFNAB results underwent surgical treatment, including 9 (19.1%) in the <3-month interval group and 38 (80.9%) in the ≥3-month interval group. No significant differences were observed in lymph node metastasis rates or recurrence risk stratification between the two groups. Among the ultrasonographic characteristics of the malignant, benign, and non-diagnostic groups, only calcification type showed a statistically significant difference (P < 0.05). Additionally, ROC curve analysis confirmed the diagnostic efficacy of the TI-RADS score for Bethesda Category III nodules (AUC = 0.746). The maximum Youden index (0.403) was achieved at a cut-off value of 8 points (specificity 83.9%, sensitivity 56.5%).ConclusionRepeat fine-needle aspiration biopsy (rFNAB) significantly improves the diagnostic rate for thyroid nodules initially diagnosed as Bethesda Category III, and the time interval between the two biopsies does not affect diagnostic performance. For the follow-up of nodules with an initial Bethesda Category III FNAB result, rFNAB is recommended when the TI-RADS score is ≥8, especially if suspicious ultrasonographic signs such as new or persistent microcalcifications are present. During the procedure, multi-point sampling should target non-calcified areas at the nodule periphery to improve the accuracy and reliability of rFNAB.

OBJECTIVE:To characterize the patterns, mechanisms, and outcomes of vagus nerve (VN) injury associated with continuous intraoperative neuromonitoring (CIONM) during total thyroidectomy and to outline prevention strategies. DATA SOURCES:A prospectively maintained thyroidectomy database (2014-2024), operative records, anesthesia charts, intraoperative electromyography (EMG) data, and standardized postoperative laryngoscopy. REVIEW METHODS:Retrospective identification of all postoperative VN injuries following total thyroidectomy with CIONM. VN injury was defined as new ipsilateral vocal fold palsy with abrupt or marked VN EMG loss not attributable to recurrent laryngeal nerve (RLN) trauma, confirmed by absent proximal and preserved distal stimulation. Variables included demographics, surgical approach, device type, VN topography, timing and mechanism of injury, EMG pattern, and recovery to 180 days. Incidence was calculated per nerve at risk. Analyses were descriptive. RESULTS:Among 1060 thyroidectomies (2120 nerves at risk), nine VN injuries occurred (0.42%). Eight were transient and one permanent. Most injuries (89%) arose during initial carotid sheath dissection or probe application, particularly in posterior VN positions or short, thick necks. Older circumferential probes were more often involved. All lesions were segmental with preserved RLN EMG. No global VN damage, macroscopic disruption, thermal injury, or intraoperative hemodynamic instability was observed. Complete EMG loss predicted the only permanent palsy; partial amplitude/latency changes resolved. Early recognition, stopping manipulation, and timely voice therapy supported recovery. CONCLUSION:CIONM-related VN injury rate is low (0.4%), and most cases recovered in approximately 4 months. CIONM-related VN injury is usually related to nerve exposure rather than probe handling.

BackgroundPost-thyroidectomy voice change is common, but early postoperative objective voice-change patterns and their short-term clinical relevance remain insufficiently characterized.MethodsIn this single-center prospective cohort study, patients undergoing thyroid surgery were screened consecutively from October 2025 to November 2025. Standardized voice recordings were obtained at baseline and postoperative day 2 (POD2), and clinical voice outcomes were assessed at postoperative day 7 (POD7). Five POD2 spectral change features relative to baseline were used to derive phenotypes through a prespecified two-stage unsupervised clustering workflow based on partitioning around medoids, Manhattan distance, and silhouette-based cluster-number selection. Clinical validation used change in Voice Handicap Index-30 (VHI-30), the prespecified VHI-30 responder definition (Delta VHI-30 ≥ 13), and change in Grade within the Grade, Roughness, Breathiness, Asthenia, Strain scale. Robustness was evaluated using consensus clustering, proportion of ambiguous clustering, sample-level stability, and resampling-based adjusted Rand index reproducibility. Sensitivity analyses compared the primary workflow with one-step k = 3 and k = 4 clustering alternatives, and exploratory analyses evaluated operative and demographic factors in relation to POD7 outcomes.ResultsOf 401 screened patients, 245 were included in the final analytic cohort. The final phenotypes were A/B/C = 59/56/130. All five spectral clustering features differed significantly across phenotypes (all P < 0.001). At POD7, phenotypes differed significantly in VHI-30 change (epsilon-squared = 0.641), VHI-30 responder rate (Cramér’s V = 0.639), and Grade change (epsilon-squared = 0.203) (all P < 0.001). Phenotype B showed the greatest short-term burden, including a responder rate of 53.6% (30/56; exact 95% confidence interval, 39.7%–67.0%), compared with 1.7% (1/59; exact 95% confidence interval, 0.0%–9.1%) in phenotype A and 1.5% (2/130; exact 95% confidence interval, 0.2%–5.4%) in phenotype C. Sensitivity analyses did not support replacing the prespecified two-stage workflow with one-step k = 3 or k = 4 alternatives. Exploratory analyses suggested that the clinical profile of phenotype B was not simply explained by thyroidectomy extent, surgical approach, lateral neck dissection, or operative time.ConclusionsEarly postoperative objective voice changes after thyroid surgery can be organized into clinically interpretable short-term phenotypes associated with patient-reported and supportive perceptual outcomes. These phenotypes should be interpreted as early postoperative voice-change patterns rather than as nerve-injury phenotypes or persistent long-term voice categories.

Thyroid cancer is the most common malignant tumor of the endocrine system, and Papillary Thyroid Cancer (PTC) is the most common. For differentiated thyroid cancer (DTC), surgery is the most important treatment modality, which is most widely used in clinical practice, and 131I therapy and thyroid stimulating hormone (TSH) suppression therapy also play an important role in the comprehensive treatment of DTC. However, for advanced disease states, particularly radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC) and Anaplastic Thyroid Cancer (ATC), which is characterized by rapid progression and extremely poor prognosis, conventional therapeutic strategies have shown limited efficacy. Therefore, there is an urgent need to develop more precise and effective treatment approaches, especially for ATC. In recent years, novel therapeutic strategies based on nanomaterials have demonstrated groundbreaking potential in cancer treatment through photothermal therapy, photodynamic therapy, targeted delivery drug, and multimodal combined therapy. In this review, we comprehensively summarize the latest advances in nanomaterial-mediated optical therapy for thyroid cancer, with a particular focus on ATC, and discuss their potential in precision treatment as well as the current challenges and future perspectives for clinical translation.

Postoperative hypoparathyroidism is a common complication of thyroid surgery, mainly due to inadvertent injury or removal of the parathyroid glands. The small size, anatomical variability, and subtle appearance of the parathyroid glands make their intraoperative identification and preservation challenging. In recent years, carbon nanoparticle suspensions (CNS) have shown promise in improving the accuracy of parathyroid preservation during thyroidectomy. This narrative review aims to summarise current evidence on the use of CNS in thyroid surgery, focusing on their mechanism of action, clinical efficacy, safety profile, and limitations. We conducted a narrative review of the literature addressing CNS use for parathyroid preservation in thyroid surgery. Outcomes of interest included rates of accidental parathyroidectomy, transient and permanent hypoparathyroidism, lymph node yield, and surgical complications. Carbon nanoparticles are selectively taken up by lymphoid and thyroid tissue but not by the parathyroid glands, creating a clear visual contrast that facilitates rapid intraoperative identification. Clinical studies and meta-analyses have shown that CNS use is associated with lower rates of accidental parathyroidectomy and transient hypoparathyroidism, along with increased lymph node retrieval. The safety profile is favorable, with adverse events being rare and mild. However, uncertainties remain regarding optimal administration protocols, long-term outcomes, and integration with other intraoperative tools. Carbon nanoparticle technology represents a promising adjunct for improving parathyroid preservation during thyroidectomy. While current evidence supports its clinical value, further research is needed to refine application techniques and establish standardized guidelines for broader use.

Objective:Direct anastomosis (DA) is the standard approach after recurrent laryngeal nerve (RLN) transection but is often not feasible due to excessive tension. This experimental study evaluated a novel intraoperative neuromonitoring (IONM)-guided selective vagus-recurrent laryngeal nerve anastomosis (SVRA) technique and compared its immediate electrophysiologic performance with DA in a porcine thyroid surgery model. Methods:18 transected nerves from 9 pigs were randomized to DA or SVRA (9 nerves per group). In the SVRA group, low-current IONM was used to map vagus nerve (VN) motor fibers innervating laryngeal musculature; these fibers were selectively dissected and anastomosed to the transected RLN. In the DA group, end-to-end RLN neurorrhaphy was performed under microscopy. Electromyography (EMG) amplitudes and latencies were recorded at baseline and serially up to 2 hours after anastomosis; hemodynamic parameters were monitored to assess the safety of VN manipulation. Results:VN motor fibers innervating the laryngeal muscles were predominantly localized to the lateral VN and were mostly concentrated in a single strand. After anastomosis, both techniques yielded early EMG recovery, with post-anastomotic amplitudes often exceeding 50% of baseline. A cross-innervation model (left VN to right RLN) produced immediate EMG responses approaching baseline and bilateral vocal fold activation. Moreover, when the anastomosed nerve was pulled, the EMG amplitude varied with the alteration of the relative position of the fiber components at the two severed ends. VN dissection did not cause clinically relevant changes in blood pressure or oxygen saturation, and only minor, non-significant heart rate increases were observed. Conclusion:IONM-guided SVRA enables selective recruitment of VN motor fibers for targeted RLN reconstruction while largely preserving VN trunk integrity. These findings support SVRA as a physiologically grounded and technically feasible reconstructive option that can achieve acute electrophysiological recovery when tension precludes DA during thyroid surgery-related RLN transection, although long-term functional reinnervation remains to be established.

Post-translational modifications (PTMs) are pivotal in tumor biology, yet their role in papillary thyroid cancer (PTC) remains unclear. We integrated bulk and single-cell transcriptomes with clinical data from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases to analyze 17 PTMs and construct a prognostic model using 12 machine learning algorithms for predicting the thyroid cancer-free interval (TCFi). Enrichment analysis, single-cell analysis, and immune-related analysis were performed to elucidate the biological role of PTMs. Therapeutic responses of PTC patients were predicted based on the model. We validated the expression of model genes and identified the key signature associated with the malignant phenotypes of PTC. We filtered out 12 genes to construct a post-translational modification index (PTMI) and identified three molecular clusters of PTC. Shapley additive explanations (SHAP) and nomogram models confirmed the predictive efficacy of PTMI. Integrated analyses revealed significant associations between PTMI and immune features. High-PTMI patients showed sensitivity to FDA-approved drugs and chemotherapeutics but resistance to radioactive iodine therapy. Notably, we identified TYMS as a key functional PTMI signature. The PTMI proposed in this study holds strong potential as a prognostic biomarker and therapeutic predictor, offering valuable insights for personalized management of PTC patients.

Background:With the development and new technological knowledge, such as surgical techniques that accompany the consolidated open surgical procedures, minimally invasive strategies have also emerged for thyroid surgery. Among these, we can cite the transoral endoscopic vestibular approach known as TOETVA. Recurrences and metastases of differentiated thyroid cancer frequently manifest in the lymph nodes, lungs, bones, and liver. Although the primary implantation of cancer cells causing these recurrences and metastases is considered an uncommon event, it can nonetheless occur in specific instances. This can be a serious complication for patients, as these recurrences and metastases can be difficult to detect and treat effectively. Early identification and appropriate management of these cases are crucial for improving patient outcomes. Case Description:We present a case of a 55-year-old male patient with recurring muscular and subcutaneous recurrence that developed five years after the initial left thyroidectomy performed via a TOETVA. The patient therefore required a second surgical procedure of completion thyroidectomy, central lymph node dissection (level 6 and 7), and removal of nodes in subcutaneous tissue and muscle. Conclusions:Tumor biology, local environment, technical issues, surgical skills, and the correct management and handling of neoplastic nodules represent crucial clinical pitfalls and important factors that can contribute to local recurrence and malignant cellular implantation following a TOETVA for thyroid surgery.

OBJECTIVE:To investigate the linear and nonlinear relationships between the triglyceride-glucose body mass index (TyG-BMI) and aggressiveness and risk of recurrence in papillary thyroid carcinoma (PTC). METHODS:This retrospective single-center cohort study included 11 317 patients with PTC. The associations between the TyG-BMI and PTC aggressiveness as well as moderate-to-high recurrence risk were analyzed with binary logistic regression and odds ratios (ORs). Linear and nonlinear relationships between the TyG-BMI and these outcomes were evaluated with restricted cubic spline and smoothed curve-fitted logistic risk regression models. Key factors contributing to TyG-BMI prediction outcomes were weighted with machine learning algorithms. RESULTS:After adjusting for confounding factors, higher TyG-BMI was associated with a significantly increased risk for tumors with a maximum diameter of >1 cm (OR adjust = 1.35, P < 0.001), multifocality (OR adjust = 1.42, P < 0.001), and extrathyroidal extension (OR adjust = 1.53, P < 0.001). Conversely, higher TyG-BMI was associated with a significantly decreased risk for positive lymph nodes with a maximum diameter of >0.2 cm (OR adjust = 0.36, P < 0.001) and intermediate-to-high risk of PTC recurrence (OR adjust = 0.68, P < 0.001). TyG-BMI exhibited a linear relationship with the risk of tumors with a maximum diameter of >1 cm and multifocality, but a nonlinear relationship with extrathyroidal extension and intermediate-to-high recurrence risk of PTC. TyG-BMI showed a positive linear correlation with free triiodothyronine (FT3) and thyroglobulin (Tg); a negative linear correlation with free thyroxine (FT4), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb); and no linear relationship with thyroid-stimulating hormone (TSH). Among the components of the TyG-BMI and potential confounding factors, machine learning algorithms consistently identified triglyceride (TG) level as the primary contributor when predicting PTC aggressiveness and intermediate-to-high risk of PTC recurrence. CONCLUSION:This study reveals complex relationships, both linear and nonlinear, between the TyG-BMI, PTC aggressiveness and intermediate-to-high risk of PTC recurrence, with TG playing a pivotal role within the TyG-BMI. There were linear correlations between the TyG-BMI and thyroid function.

Background:The survey aimed to elucidate the complete range of national practices, including all technical and non-technical aspects, as well as surgical stratification and maturation, of the use of intraoperative neuromonitoring (IONM) during thyroid surgery in China.Materials and methods:Six national questionnaires, developed by the Chinese Neural Monitoring Study Group (CNMSG) between 2015 and 2023, were used to collect and analyze data regarding the clinical application, education, and scientific research related to IONM in Chinese medical institutions.Results:Among the surveyed hospitals, 45% reported an average annual surgical volume exceeding 3000 cases, with 82.5% performing more than 80% of the surgeries for malignant thyroid tumors. Additionally, 97.5% of the hospitals reported a less than 3% incidence of postoperative hoarseness with IONM. Statistical analysis from 2011 to 2015 found that the incidence of postoperative hoarseness decreased by 30% in 2013 compared with 2011, when the technology was introduced. Preoperative and postoperative laryngoscopies were routinely performed by 82.5% and 15% of the hospitals, respectively. For 65% of the hospitals, the publication of the Chinese edition of neuromonitoring guidelines in 2013 prompted the utilization of IONM technology. An average annual number of IONM applications exceeding 500 cases (18.5% the average volume) was reported by 80% of the hospitals, while 62.5% reported a cumulative number of applications greater than 5000 cases (47.1% the average cumulative volume). Regarding technical parameters, 75% of the hospitals reported an intraoperative V1 amplitude of greater than 500 mu V, and 70% reported an intraoperative loss of signal (LOS) rate of less than 3%. 92.5% of the surveyed hospitals believed that IONM could help identify dissociated nerves, and 95% of the surveyed hospitals believed that IONM could reduce nerve damage. However, 72.5% of the respondents thought that cost was the main limitation. Furthermore, 67.5% of the hospitals reported that half of their thyroid surgical team members were trained in IONM, with 17.5% reporting that all team members were trained. Areas for reinforced training included IONM research methods and directions (72.5%) and analysis and treatment of abnormal EMG signals (72.5%). Research projects related to IONM were conducted by 42.5% of the hospitals, while 52.5% had published papers on neuromonitoring.Conclusions:IONM was independently and incrementally associated with the annual surgical volume. This survey emphasized the importance of national collaboration and/or a registry for the uptake, consolidation, and development of CNMSG consensus.

BACKGROUND:The effect of topical intraoperative corticosteroid application on voice quality in thyroid surgery with preserved RLN remains unclear. This randomized controlled trial aimed to evaluate the efficacy and safety of this intervention. METHODS:Between January 2023 and June 2024, 134 patients scheduled for thyroid surgery were screened for eligibility. Patients who developed loss of signal (LOS) during surgery or who had postoperative impaired vocal cord motility on laryngoscopy were not included in the final analysis. Fourteen patients were excluded (six for previous thyroid/parathyroid surgery, four for preoperative vocal cord paralysis, and four for corticosteroid allergy), leaving 120 patients who were randomized equally to receive either topical intraoperative corticosteroids (n = 60) or standard treatment (n = 60). Baseline demographic and clinical data were comparable between the groups. Dynamic function of the larynx was monitored intraoperatively using electromyography (EMG), and vocal outcomes were assessed 1 week postoperatively using the Voice Handicap Index (VHI) and voice-related quality of life (V-RQOL). Laryngeal findings and adverse events were also recorded. RESULTS:No EMG signal was recognized in any patient. The EMG amplitudes and latencies of the vagus nerve (V1 and V2) did not differ significantly between the groups. EMG signal changes between V1 and V2 were observed in 16% of RLNs in the control group and in 18% in the corticosteroid group, but these were not associated with clinically significant decreases in amplitude or increases in latency. Postoperatively, the corticosteroid group had significantly lower (better) mean VHI scores (12.4 ± 3.2 vs. 19.6 ± 4.7; p < 0.01) and higher V-RQOL scores (88.3 ± 6.1 vs. 77.5 ± 8.8; p = 0.02) than the control group. The subgroup analysis of patients with EMG changes showed similar trends. Vocal fold edema occurred in 2 patients in the corticosteroid group and 5 in the control group, with complete resolution of stroboscopic abnormalities in all patients after 4 weeks. No local or systemic complications related to the use of corticosteroids were observed, and the postoperative courses were uneventful in both groups. CONCLUSIONS:Topical intraoperative use of corticosteroids in thyroid surgery with preserved RLN is safe and associated with improved early postoperative voice outcomes. No significant adverse events were observed, and RLN function was preserved in all cases. Further studies are needed to assess the long-term clinical relevance of these results.

The larynx of children and adolescents is still in the developmental phase and the anatomical structure is still very small and sensitive. The higher malignancy and faster progression of some paediatric thyroid cancers make surgery more difficult. Intraoperative neuromonitoring (IONM) is frequently used in thyroid surgery as an effective means of securing the recurrent laryngeal nerve (RLN). Little information is available on the clinical efficacy of IONM in paediatric surgery. In addition, classic IONM techniques such as reinforced tracheal tube models with integrated surface electrodes are not standardised for children and adolescents. The use of innovative devices such as laryngeal masks with surface electrodes and thyroid cartilage receiving electrodes could replace monitoring tubes as a new form of IONM. Tracheal intubation in children needs to be performed by a highly experienced anaesthetist. The continued maturation of AI technology could be attempted in the future in conjunction with IONM to further reduce RLN injuries in children and adolescents. This article describes the anatomical features of the paediatric larynx, which differ from those of adults, and the advantages and shortcomings of IONM techniques for thyroid surgery in this population. The use of IONM in paediatric surgery is a complex technique and should be performed by experienced thyroid surgeons with in-depth IONM training. The use of IONM should be standardised within the clinical parameters of children.

Medullary thyroid carcinoma (MTC) is a rare neuroendocrine neoplasm derived from parafollicular C cells of the thyroid gland, primarily driven by alterations in the rearranged during transfection (RET) oncogene. This review focuses on the current advances in treatment modalities for MTCs, encompassing surgical interventions, targeted therapy, postoperative surveillance, and future challenges. Total thyroidectomy is the primary curative approach for MTCs. However, the extent of lymph node dissection, particularly lateral neck dissection, remains controversial. Postoperative surveillance involves monitoring serum calcitonin and carcinoembryonic antigen levels, imaging assessments, and dynamic risk stratification to detect recurrence. Drug therapy offers an alternative approach in cases of challenging surgical scenarios or advanced MTCs. Multi-kinase inhibitors (e.g. vandetanib and cabozantinib) have shown increased survival outcomes for metastatic MTCs and are approved as effective treatment options. More recently, selective rearranged during transfection inhibitors like selpercatinib and pralsetinib have demonstrated higher efficacy and better tolerability. Despite these advances, challenges persist in managing MTCs, including addressing biochemical recurrence, determining surgical scope, considering immunotherapy, and treating advanced cases. Personalized medicine approaches, incorporating genetic screening, and innovative therapies, are essential for improving survival and quality of life in MTC patients.

BACKGROUND:Patients with medium and high-risk papillary thyroid carcinoma (PTC) demonstrate significantly poorer clinical outcomes compared to their low-risk counterparts. However, current prognostic stratification for this patient population remains suboptimal due to the absence of reliable biomarkers. This investigation aims to evaluate the clinical utility and prognostic potential of three hematological inflammatory indices: the platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) in medium and high-risk PTC cases. METHODS:This study analyzed 1070 PTC patients from the "DTCC study" (2014-2016), a multicenter prospective cohort investigating the initial management of differentiated thyroid cancer (DTC) in China. Preoperative hematological parameters (including PLR, NLR, and SII) and baseline clinical characteristics were evaluated to assess their prognostic significance. RESULTS:In medium and high-risk PTC patients, PLR ≤ 115.6 predicted increased recurrence risk (OR = 4.579, 95% CI: 1.863-11.255, p = 0.001) and worse disease-free survival (DFS; p = 0.001). Multivariate Cox regression confirmed PLR ≤ 115.6 as an independent prognostic factor for reduced DFS (HR = 3.080, 95% CI: 1.115-8.507, p = 0.030). Notably, this association persisted in intermediate-risk patients. Among high-risk PTC patients, however, SII ≤ 360.9 (rather than PLR) demonstrated stronger predictive value for recurrence (OR = 15.154, 95% CI: 1.873-122.640, p = 0.011). Consistently, multivariate analysis identified SII ≤ 360.9 as an independent risk factor for shorter DFS (HR = 14.399, 95% CI: 1.823-113.730, p = 0.011). CONCLUSION:Our findings demonstrate that PLR and SII emerged as risk stratification-specific prognostic biomarkers: PLR independently predicted prognosis in intermediate-risk cases, while SII showed superior predictive value for prognosis in high-risk patients. The differential utility of these indices-PLR for intermediate-risk stratification patients and SII for high-risk stratification patients-highlights their complementary roles in clinical decision-making. As routinely available, cost-effective inflammatory markers, PLR and SII may enhance risk-adapted surveillance strategies, though further validation is warranted to standardize cutoff values and integrate them into existing clinical management systems. TRIAL REGISTRATION:The trial was registered at ClinicalTrials. gov under the identifier NCT02638077.

Medullary thyroid carcinoma (MTC) accounts for only 3% of all thyroid carcinomas: 75% as sporadic MTC (sMTC) and 25% as hereditary MTC (hMTC) in the context of multiple endocrine neoplasia type 2 (MEN2). Early diagnosis is possible by determining the tumour marker calcitonin (Ctn) when clarifying nodular goitre and by detecting the mutation in the proto-oncogene RET in the MEN2 families. If the Ctn level is only slightly elevated, up to 30 pg/ml in women and up to 60 pg/ml in men, follow-up checks are advisable. At higher levels, surgery should be considered; at a level of > 100 pg/ml, surgery is always advisable. The treatment of choice is total thyroidectomy, possibly with central lymphadenectomy. In the early stage, cure is possible with adequate surgery; in the late stage, treatment with tyrosine kinase inhibitors is an option. RET A mutation analysis should be performed on all patients with MTC. During follow-up, a biochemical distinction is made between: healed (Ctn not measurably low), biochemically incomplete (Ctn increased without tumour detection) and structural tumour detection (metastases on imaging). After MTC surgery, the following results should be available for classification in follow-up care: (i) histology, Ctn immunohistology if necessary, (ii) classification according to the pTNM scheme, (iii) the result of the RET analysis for categorisation into the hereditary or sporadic variant and (iiii) the postoperative Ctn value. Tumour progression is determined by assessing the Ctn doubling time and the RECIST criteria on imaging. In most cases, “active surveillance” is possible. In the case of progression and symptoms, the following applies: local (palliative surgery, radiotherapy) before systemic (tyrosine kinase inhibitors).

ObjectiveThis study aimed to evaluate the effectiveness and safety of carbon nanoparticles-guided lymph node dissection during thyroidectomy in patients with papillary thyroid cancer(PTC).MethodsClinical trials consisted of two subgroups: unilateral lobectomy (UL; n=283) and total thyroidectomy (TT; n=286). From each subgroup, the patients were randomly assigned to two groups: the carbon nanoparticle group and control group. Primary endpoints included parathyroid hormone (PTH) levels, number of lymph nodes (LNs) detected, number of tiny lymph nodes detected, and recognition and retention of the parathyroid glands. Secondary endpoint was recognition and protection of the recurrent laryngeal nerve.ResultsA total of 569 patients with PTC were recruited. There were no statistically significant differences in demographics between the carbon nanoparticles and control groups (P > 0.05). In the UL subgroup, there were no significant differences in PTH levels between the two groups at preoperative, intraoperative, and postoperative day one, and postoperative month one (P>0.05). There was no significant difference in the serum Ca2+ levels between the two groups preoperatively and at postoperative month one (P>0.05). The number of lymph nodes dissected in the carbon nanoparticles group was significantly higher than that in the control group (P<0.0001). The detection rate of tiny lymph nodes in the carbon nanoparticles group was higher than that in the control group (P=0.0268). In the TT subgroup, there was no significant difference in PTH levels between the two groups at preoperative, intraoperative, and postoperative day one (P>0.05). However, the mean PTH level in the carbon nanoparticles group was significantly higher than that of the control group at postoperative month one (P=0.0368). There was no significant difference in the serum Ca2+ levels between the two groups preoperatively and at postoperative month one (P>0.05). There were no significant differences between the two groups in the number of dissected LNs (P>0.05) or the detection rate of tiny lymph nodes (P>0.05). No drug-related AE and complications due to the injection of carbon nanoparticles were recorded in this study. There were no significant differences between the two groups in terms of parathyroid preserved in situ and recurrent laryngeal nerve injury in the UL and TT subgroups.ConclusionsCarbon nanoparticles demonstrated efficacy and safety in thyroidectomy. The application of carbon nanoparticles could significantly facilitate the identification and clearance of LNs and the optimum preservation of parathyroid function.Clinical trial registrationhttps://www.chictr.org.cn/, identifier ChiCTR2300068502.

Background: To explore the effect of lower baseline amplitude on its predictive accuracy of postoperative vocal cord paralysis (VCP) in monitored thyroid surgery. Materials and methods: Clinical and electrophysiological data were collected during thyroid surgeries performed between November and December 2021 at China-Japan Union Hospital. Univariate/multivariate regression analysis were applied to these data to examine a possible correlation. A receiver operating characteristic curve was used to evaluate predictive efficacy. Results: A total of 631 nerves-at-risk (NAR) were identified in 460 patients who were divided into two groups according to postoperative development of VCP. The VCP group included a higher percentage of NAR with V1<1000 (68.2 vs. 40.7%, respectively; P =0.014) and NAR with R1<1400 (77.3 vs. 47.0%, respectively; P =0.005) compared with the non-VCP group. Multivariate regression analysis further identified V1<1000 [odds ratio (OR)=2.688, P =0.038], R1<1400 (OR=3.484, P =0.018) as independent risk factors for postoperative temporary VCP. The receiver operating characteristic curve showed the AUC value of V signal decline for predicting VCP was 0.87. The diagnostic efficiency of R signal decline reached as high as 0.973. A multivariate logistic regression analysis identified independent risk factors for V1<1000 and these included: higher BMI (OR=1.072, P =0.013), hypertension (OR=1.816, P =0.015), smoking (OR=1.814, P =0.031), and male sex (OR=2.016, P =0.027). Conclusion: In our cohort, lower baseline amplitude was an independent risk factor for developing transient postoperative VCP. It also affected the predictive efficacy of intraoperative amplitude changes on VCP. Higher BMI, hypertension, smoking, and male sex may also be closely associated with lower initial amplitude. Thus, maintaining a higher initial amplitude is critical for patient safety during thyroid surgery.

INTRODUCTION:Our aim was to determine whether bacteria contamination occurred within the surgical field or on endoscopic equipment during surgery using the transoral endoscopic thyroidectomy vestibular approach (TOETVA).MATERIALS AND METHODS:Participants were recruited from patients planned for TOETVA between May 2017 and December 2019. Bacterial samples were taken before and at the conclusion of the TOETVA procedure. The preoperative and postoperative samples were taken from the endoscopic materials and inferior oral vestibulum using a sterile flocked swab.RESULTS:The study resulted in 480 samples (80 TOETVAs). No vestibular, port site, or neck infections occurred in any of the patients. Three (3.7%) out of 80 patients developed postoperative fever. Our results show different microbial communities during TOETVA. The most prevalent species detected were S treptococcus species. Multivariate logistic regression analyses revealed that the degree of contamination depended on the sampling site (inferior vestibulum > equipment) ( P =0.03). In addition, the abundance of bacteria was affected by operative time ( P =0.013). There were no significant differences observed in isolation frequencies of bacteria in malignancy ( P =0.34).CONCLUSIONS:TOETVA surgery is categorized as a "clean-contaminated" operation. A swab identified the common colonizers of oral microbiota on the endoscopic equipment and within the surgical field.

Ultrasound-guided minimally invasive thermoablative (MIT) therapies are a therapeutic option for selected patients with large, hypoenhancing, benign thyroid nodules that cause compression disorders or aesthetic discomfort. MIT, which does not require general anaesthesia, causes thermal necrosis of the treated nodule, which is reduced in size by 50 % without functional consequences, and is indicated for patients who are not too young or in the presence of anaesthesia-related risk factors or recurrence following thyroidectomy or refusal of surgery. For the above indications, MIT complements surgery but does not replace it; it must always be performed in centres and by surgeons with proven technical skills and clinical experience. Subject to appropriate informed consent, the treatment is short-duration, well-tolerated by the patient, safe, and non-invasive. It does not require anaesthesia and complications are rare and transient. MIT, and in particular laser-based procedures (TAL), can also be effective and safe for the treatment of potentially destructible papillary microcarcinoma, as shown by the limited but sufficient literature, including the most recent guidelines, which consider it to be a therapeutic alternative that requires a better understanding of its efficacy and safety.