Background/Objectives: We investigated the association between leisure-time physical activity (LTPA) and liver fibrosis, and whether this relationship differs by obesity and diabetes status. Methods: We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) 2017-March 2020 cycle. LTPA was assessed using the Global Physical Activity Questionnaire (GPAQ) and classified as physically active if engaging in ≥600 metabolic equivalent (MET)-minutes per week of moderate-to-vigorous activity, or inactive. Clinically significant liver fibrosis was defined as liver stiffness measurement (LSM) ≥ 8.0 kPa on transient elastography. Multivariable logistic and linear regression models estimated adjusted odds ratios (ORs) for significant liver fibrosis, with additional subgroup analyses according to obesity and diabetes status. Results: In 7662 U.S. adults, physically active participants (n = 2721) had a lower prevalence of significant fibrosis than inactive individuals (5.4% vs. 11.4%, p < 0.001). In multivariable analysis, Participants who were physically active were associated with 42% lower odds of having fibrosis (OR 0.58, 95% confidence interval [CI] 0.41-0.82; p = 0.004). This association remained consistent in subgroup analyses stratified by obesity and diabetes status, even in the non-obese subgroup with body mass index (BMI) < 30 kg/m2 (OR 0.54, 95% CI 0.32-0.91; p = 0.022) and the non-diabetic subgroup (OR 0.59, 95% CI 0.39-0.90; p = 0.016). Conclusions: Regular moderate-to-vigorous LTPA was independently associated with lower likelihood of clinically significant liver fibrosis. This beneficial association was significant regardless of obesity or diabetes status, suggesting that LTPA may play a clinically meaningful role in populations at high risk for progressive liver disease.

Salivary gland dysfunction is a common but underexplored complication of menopause that contributes to oral dryness, dysphagia, and increased risk of infection. Although ferroptosis, a form of regulated necrotic cell death driven by iron-dependent lipid peroxidation, has recently been implicated in postmenopausal tissue degeneration, its regulatory mechanisms in salivary glands remain unclear. In this study, we investigated the roles of mitochondrial dysfunction and mitophagy in driving ferroptosis-induced salivary gland injury in an ovariectomized (OVX) rat model of estrogen deficiency. OVX rats exhibited elevated markers of oxidative stress, lipid accumulation, and iron overload, and suppression of GPX4 activity in the salivary glands, consistent with ferroptotic activation. These changes were accompanied by impaired mitochondrial dynamics (MFN1 and OPA1), decreased expression of mitochondrial antioxidant regulators (PGC-1α, SOD, and catalase), and upregulation of mitophagy-related genes (PINK1, ULK1, Rab9, and LC3B), as well as LAMP, a lysosomal marker involved in autophagosome–lysosome fusion, while ferritinophagy (NCOA4) remained unchanged. Early administration of ferrostatin-1 effectively suppressed these pathological changes, preserving both glandular structure and function, as evidenced by the restored AQP5 and AMY2A expression. Collectively, our findings reveal that ferroptosis in estrogen-deficient salivary glands is regulated by mitochondrial instability and aberrant mitophagy, and ferrostatin-1 mitigates this cascade through multi-level mitochondrial protection. These results highlight ferrostatin-1 as a promising preventive agent against menopause-associated salivary gland dysfunction, with broader implications for organ-specific ferroptosis modulation.

PURPOSE:Radioactive iodine therapy (RAI) ≥100 mCi (3.7 GBq) is commonly recommended for papillary thyroid cancer (PTC) patients with extranodal extension (ENE). However, no study has evaluated whether RAI ≥100 mCi is effective in reducing the recurrence of PTC with ENE. METHODS:This retrospective cohort study enrolled 191 PTC patients with ENE who underwent total thyroidectomy and RAI. Recurrence according to RAI activity (<100 vs. ≥100 mCi) was compared before and after propensity score matching (PSM) (1:2) using Kaplan-Meier curves and Cox proportional hazards regression models. Subgroup analyses according to mass size (<4 and ≥4 cm), gender, blood vessel invasion, lymph node (LN) number (≤5 and >5), and stimulated Tg (sTg) level (<10 and ≥10 ng/mL) before and after PSM were performed. RESULTS:During about 116 months, 5 (12.5%) and 19 (12.6%) before PSM, five (12.5%) and 3 (3.8%) after PSM recorded recurrence in <100 and ≥100 mCi groups, respectively. The impact of RAI ≥100 mCi on reducing recurrence was not significant before [log-rank P = 0.915, adjusted hazard ratio (HR) 0.49 (0.12-1.85); P = 0.294) and after PSM (log-rank P = 0.077). Subgroup analysis after PSM demonstrated the impact of RAI ≥100 mCi on lowering recurrence only in ENE patients with mass size ≥4 cm (log-rank P = 0.008), LN >5 (log-rank P = 0.007), and sTg ≥10 ng/mL (log-rank P = 0.039). CONCLUSIONS:In PTC patients with ENE, mass size ≥4 cm, LN >5, or sTg ≥10 ng/mL had a benefit from RAI ≥100 mCi compared with RAI <100 mCi.

Background/Objectives: Iodine intake influences thyroid-related and metabolic diseases that have important public health implications. However, longitudinal evidence of the association between iodine intake and mortality remains scarce and limited to Western populations. Given the markedly high iodine intake among Asians and possible ethnic or regional differences in iodine sensitivity, population-based data from Asian cohorts are needed. Methods: We analyzed 5497 adults from the Korean National Health and Nutrition Examination Survey (2013-2015) linked with mortality follow-up through 2021. Urinary iodine concentration (UIC) was quantified from spot urine samples using inductively coupled plasma mass spectrometry. Iodine intake was estimated from UIC and categorized into four groups: below the estimated average requirement, low-normal, high-normal, and above the tolerable upper level (UL). The primary outcome was all-cause mortality. Cardiovascular disease-specific and cancer-specific mortality were also assessed. Multivariable Cox proportional hazards models accounting for the complex survey design were used to estimate hazard ratios and 95% confidence intervals. Sensitivity analysis excluded participants with thyroid disease or early death, and subgroup analyses by age and sex were also conducted. Results: During a median 8.4-year follow-up, 139 deaths occurred. Compared with the low-normal intake group, excessive iodine intake (above UL) was not associated with all-cause mortality (HR 1.09, 95% CI 0.36-3.27), cardiovascular mortality (HR 1.27, 95% CI 0.21-7.61), or cancer mortality (HR 1.71, 95% CI 0.40-7.29). No significant trends were observed across intake categories (p > 0.2), and similar findings were obtained when UIC levels were analyzed. Excluding participants with thyroid disease or early death did not change the results, and no significant interaction was observed by age or sex. Conclusions: In this first population-based Asian study on iodine intake to mortality, neither estimated iodine intake nor UIC was associated with all-cause mortality. These results suggest that the relationship between iodine exposure and mortality may differ across populations, underscoring the need for further large-scale studies.

Background: The number of retrieved lymph nodes (rLN) is an important surgical metric associated with survival in cancer. However, its association with oncological outcomes in patients with papillary thyroid cancer (PTC) with lateral lymph node (LN) metastasis (N1b disease) has not been investigated. Methods: This retrospective cohort study included patients with PTC and N1b disease (N = 1003) who underwent lateral neck dissection and categorized them by total number of rLNs. We investigated the association of the categories with recurrence or cancer-specific mortality (CSM) using multivariable Cox proportional hazard models. The optimal number of rLNs associated with low recurrence rate or CSM were identified using restricted cubic spline analysis. Survival analyses across subgroups were performed according to adequate (the estimated total number of rLN at which CSM appeared to be lowest) and inadequate groups. Results: At initial surgery, the median total number of rLNs and positive number of LNs was 36.0 (25.0-49.0) and 9.0 (5.0-14.0), respectively. During a median follow-up of 90.0 (73.0-129.0) months, recurrence and CSM were detected in 165 and 30 patients, respectively. A higher total number of rLNs was inversely associated with the adjusted hazard ratio (aHR) for recurrence (0.50, 0.51, 0.33, and 0.28; p for trend = 0.001) and CSM (0.33, 0.13, 0.02, and 0.04; p for trend 0.002). The estimated total number of rLNs associated with the lowest recurrence rate and CSM were 32 and 33, respectively. Compared with the inadequate rLNs group, the adequate rLNs group (≥33 total rLNs) showed better prognosis in the entire group (aHR 0.51 [0.35-0.73], p < 0.001; recurrence) (aHR 0.14 [0.04-0.47], p = 0.001; CSM) and various subgroups. Conclusions: rLNs are associated with recurrence and CSM in patients with PTC and N1b disease, with outcomes appearing to improve at approximately 32-33. This finding suggests that rLNs may serve as a potential quality indicator for neck dissection in PTC. Our finding is mostly applicable to more aggressive disease, and further prospective confirmatory research is warranted.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a hepatic manifestation of metabolic syndrome. This study investigated the association between newly developed nomenclature MASLD and the risk of thyroid cancer in the Korean population. Methods: After excluding individuals with a history of liver disease or malignancy, we analyzed a cohort of 214,502 Korean adults aged 40 years and above who participated in the National Health Screening Program from 2009 to 2010. Participants were categorized into four groups: no steatotic liver disease (SLD) without a cardiometabolic risk factor (CMRF), no SLD with at least one CMRF, MASLD, and metabolic and alcohol-related/associated liver disease (MetALD). SLD was diagnosed using a fatty liver index threshold of ≥30. The primary outcome was the diagnosis of new thyroid cancer during the follow-up period. We examined the relationship between CMRF/SLD and thyroid cancer incidence using the multivariable-adjusted Cox proportional hazards model. Results: A total of 2761 participants (1.3%) were newly diagnosed with thyroid cancer over an average follow-up of 9.61 years. Compared with participants without CMRF and SLD, those with CMRF (hazard ratio [HR] 1.33, confidence interval [CI] 1.16-1.52), those with MASLD (HR 1.36, CI 1.17-1.58), and the MetALD group (HR 1.40, CI 1.04-1.88) exhibited a significantly higher risk of thyroid cancer. In addition, MetALD is significantly associated with thyroid cancer incidence solely in men. Conclusions: In addition to CMRF, MASLD and MetALD were associated with a higher incidence of thyroid cancer in the Korean population. This study is the first to demonstrate the association between thyroid cancer and the CMRF-MASLD-MetALD continuum.

This study aimed to investigate the association between the intensity of statin therapy and the development of cardiovascular disease (CVD) and diabetes in individuals without prior diabetes who were being treated for dyslipidemia with statins for the primary prevention of CVD, using the National Health Insurance Service-Health Screening database. The database is a longitudinal cohort study of Korean men and women 40 years of age or older who underwent comprehensive biannual screening health examinations by Korean National Health Insurance Service from January 1, 2002, to December 31, 2015. We included patients in the health screening checkup cohort who underwent health checkups in 2009 and 2010.The primary outcome was the occurrence of a first major cardiovascular or cerebrovascular event, new-onset diabetes. A total of 20,322 participants without prior diabetes at baseline from 2009 to 2015 were followed up for a mean duration of 81.2 ± 6.6 months. The mean age of all participants at baseline was 59.2 ± 8.4 years and 43.0% of them were male. Their index low lipoprotein cholesterol level was 130.4 ± mg/dL, the mean duration of taking statins was 337.4 ± 52.3 days, and 93.9% of them had been taking moderate-intensity statins. At that time, a total of 641 diabetes cases occurred, 41 from using low-intensity statins, 588 from moderate-intensity statins, and 11 from high-intensity statins. The results indicated no significant differences in the incidence of death, CVD death, or CVD among those in the strong statin group compared with the reference groups. While statin treatment for the primary prevention of CVD in patients with dyslipidemia showed a subtle difference in the incidence of diabetes, there was no difference in the occurrence of CVD or CVD death according to statin intensity.

Glucocorticoids provide a potent therapeutic response and are widely used to treat a variety of diseases, including coronavirus disease 2019 (COVID-19) infection. However, the issue of glucocorticoid-induced hyperglycemia (GIH), which is observed in over one-third of patients treated with glucocorticoids, is often neglected. To improve the clinical course and prognosis of diseases that necessitate glucocorticoid therapy, proper management of GIH is essential. The key pathophysiology of GIH includes systemic insulin resistance, which exacerbates hepatic steatosis and visceral obesity, as well as proteolysis and lipolysis of muscle and adipose tissue, coupled with β-cell dysfunction. For patients on glucocorticoid therapy, risk stratification should be conducted through a detailed baseline evaluation, and frequent glucose monitoring is recommended to detect the onset of GIH, particularly in high-risk individuals. Patients with confirmed GIH who require treatment should follow an insulin-centered regimen that varies depending on whether they are inpatients or outpatients, as well as the type and dosage of glucocorticoid used. The ideal strategy to maintain normoglycemia while preventing hypoglycemia is to combine basal-bolus insulin and correction doses with a continuous glucose monitoring system. This review focuses on the current understanding and latest evidence concerning GIH, incorporating insights gained from the COVID-19 pandemic.

Objective: To assess the metabolic effects of adrenalectomy in patients with mild autonomous cortisol secretion (MACS). Background: Despite retrospective studies showing the association of adrenalectomy for MACS with beneficial metabolic effects, there have been only 2 randomized prospective studies with some limitations to date. Methods: A prospective, multicenter study randomized 132 patients with adrenal incidentaloma without any features of Cushing syndrome but with serum cortisol >50 nmol/L after a 1 mg overnight dexamethasone suppression test into an adrenalectomy group (n = 66) or control group (n = 66). The primary outcomes were changes in body weight, glucose, and blood pressure (BP). Results: Among the 118 participants who completed the study with a median follow-up duration of 48 months (range: 3-66), the adrenalectomy group (n = 46) exhibited a significantly higher frequency of improved weight control, glucose control, and BP control (32.6%, 45.7%, and 45.7%, respectively) compared with the control group (n = 46; 6.5%, P = 0.002; 15.2%, P = 0.002; and 23.9%, P = 0.029, respectively) after matching for age and sex. Adrenalectomy [odds ratio (OR) = 10.38, 95% CI = 2.09-51.52, P = 0.004], body mass index (OR = 1.39, 95% CI = 1.08-1.79, P = 0.010), and cortisol after a 1 mg overnight dexamethasone suppression test levels (OR = 92.21, 95% CI = 5.30-1604.07, P = 0.002) were identified as independent factors associated with improved weight control. Adrenalectomy (OR = 5.30, 95% CI = 1.63-17.25, P = 0.006) and diabetes (OR = 8.05, 95% CI = 2.34-27.65, P = 0.001) were independently associated with improved glucose control. Adrenalectomy (OR = 2.27, 95% CI = 0.87-5.94, P = 0.095) and hypertension (OR = 10.77, 95% CI = 3.65-31.81, P < 0.001) demonstrated associations with improved BP control. Conclusions: adrenalectomy improved weight, glucose, and BP control in patients with MACS.

This study compares the efficacy and safety of a tubeless, on-body automated insulin delivery (AID) system with that of a tubeless, on-body sensor-augmented pump (SAP). This multicentre, parallel-group, RCT was conducted at 13 tertiary medical centres in South Korea. Adults aged 19–69 years with type 1 diabetes who had HbA1c levels of <85.8 mmol/mol (<10.0

Background The positive relationship between triiodothyronine (T3) and steatotic liver disease (SLD) demonstrated only in crosssectional study. We aimed to evaluated whether total T3 (TT3) is associated with the development/resolution of SLD in longitudinal design. Methods This retrospective, longitudinal, population-based cohort study included 1,665 South Korean euthyroid adults with ≥4 thyroid function test. We explored the impact of mean TT3 during follow-up on development/resolution of either SLD (diagnosed by ultrasound) or modified metabolic dysfunction-associated steatotic liver disease (MASLD) using Cox proportional hazards regression models. Results During about median 5 years follow-up, 807/1,216 (66.3%) participants among participants without SLD at baseline developed SLD, and 253/318 (79.5%) participants among participants with SLD at baseline SLD resolved fatty liver. Mean TT3 rather than thyroid stimulating hormone or mean free thyroxine was significantly related with development (adjusted hazard ratio [HR], 1.01; 95% confidence interval [CI], 1.00 to 1.02; P=0.002) and resolution (adjusted HR, 0.97; 95% CI, 0.96 to 0.99; P=0.005) of SLD. Compared with low mean TT3 group, high mean TT3 group was positively associated with development of SLD (adjusted HR, 1.20; 95% CI, 1.05 to 1.38; P=0.008) and inversely associated with resolution of SLD (adjusted HR, 0.66; 95% CI, 0.51 to 0.85; P=0.001). The statistical significance remained for development (adjusted HR, 1.29; 95% CI, 1.10 to 1.51; P=0.001) and resolution (adjusted HR, 0.71; 95% CI, 0.54 to 0.94; P=0.018) of modified MASLD. Conclusion In Korean euthyroid adults, TT3 level was associated with development and resolution of either SLD or modified MASLD.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Background: Fatty liver is associated with increased risk of developing type 2 diabetes. We aimed to evaluate whether the severity of hepatic steatosis is associated with incident diabetes.Methods: We conducted a longitudinal analysis using data from 1,798 participants who underwent a comprehensive health checkup and abdominal computed tomography (CT). We assessed the association between baseline liver attenuation value on non-contrast CT images and risk of incident diabetes. All the participants were categorized into three groups based on the baseline liver attenuation value on non-contrast CT images: without hepatic steatosis (>57 Hounsfield unit [HU]), mild hepatic steatosis (41–57 HU), and moderate to severe hepatic steatosis (≤40 HU).Results: During a median follow-up period of 5 years, 6.0% of the study participants progressed to diabetes. The incidence of diabetes was 17.3% in the moderate to severe hepatic steatosis group, 9.0% in the mild steatosis group, and 2.9% in those without hepatic steatosis. In a multivariate adjustment model, as compared with participants without hepatic steatosis, those with moderate to severe steatosis had a hazard ratio (HR) of 3.24 (95% confidence interval [CI], 1.64 to 4.2) for the development of diabetes, and those in the mild steatosis group had a HR of 2.33 (95% CI, 1.42 to 3.80). One standard deviation decrease in mean CT attenuation values of the liver was associated with a 40% increase in the development of diabetes (multivariate adjusted HR, 1.40; 95% CI, 1.2 to 1.63).Conclusion: We found a positive association between severity of hepatic steatosis and risk of incident diabetes. Greater severity of steatosis was associated with a higher risk of incident diabetes.

Diabetes mellitus (DM) is a chronic condition that is highly prevalent among the elderly, with an estimated 20% to 30% of this population believed to have DM [1].Elderly patients with DM often have additional medical conditions, such as cardiovascular disease, chronic kidney disease, or heart failure, which increases their risk of mortality and potentially imposes a significant socioeconomic burden on Korean society [2].Consequently, this study by Lee et al. [3] aims to describe the causespecific risk of death in the Korean elderly population.Additionally, it categorizes this population according to the glucose spectrum in relation to mortality risk, including normal glucose tolerance, impaired fasting glucose, newly diagnosed DM, early DM, and advanced DM.The authors analyzed 1,292,264 participants over a median follow-up period of 8.4 years.The primary outcome was death, and the authors collected data on all-cause, system-specific, and disease-specific mortality for the enrolled participants.During the follow-up period, there were 257,356 death events.Overall, elderly individuals with DM were found to have an increased risk of mortality compared to their counterparts without DM, a finding that aligns with a recent study from Hong Kong [4].When cause-specific mortality was analyzed, individuals with DM exhibited a higher hazard ratio of mortality across all system categories (circulatory, respiratory, genitourinary, neoplasm, and others).Furthermore, the risk of mortality progressively in-

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

During the coronavirus disease 2019 (COVID-19) pandemic, COVID-19 vaccination-induced hyperglycemia and related complications have been reported. However, there have been few reports of type 1 diabetes triggered by COVID-19 vaccines in subjects without diabetes. Here, we report the case of a 56-year-old female patient who developed hyperglycemia after the second dose of COVID-19 mRNA-based vaccination without a prior history of diabetes. She visited our hospital with uncontrolled hyperglycemia despite administration of oral hyperglycemic agents. Her initial glycated hemoglobin level was high (11.0%), and fasting serum C-peptide level was normal. The fasting serum C-peptide level decreased to 0.269 ng/mL 5 days after admission, and the anti-glutamic acid decarboxylase antibody was positive. The patient was discharged in stable condition with insulin treatment. To our knowledge, this is the first case of the development of type 1 diabetes without diabetic ketoacidosis after mRNA-based COVID-19 vaccination, and is the oldest case of type 1 diabetes development under such circumstances.

Objective: To assess the metabolic effects of adrenalectomy in patients with mild autonomous cortisol secretion (MACS). Background: Despite retrospective studies showing the association of adrenalectomy for MACS with beneficial metabolic effects, there have been only two randomized prospective studies with some limitations to date. Methods: A prospective, multicenter study randomized 132 patients with adrenal incidentaloma without any features of Cushing’s syndrome but with serum cortisol>50 nmol/L after a 1 mg overnight dexamethasone suppression test (F-1mgODST) into an adrenalectomy group (n=66) or control group (n=66). The primary outcomes were changes in body weight, glucose, and blood pressure (BP). Results: Among the 118 participants who completed the study with a median follow-up duration of 48 months (range: 3–66), the adrenalectomy group (n=46) exhibited a significantly higher frequency of improved weight control, glucose control, and BP control (32.6%, 45.7%, and 45.7%, respectively) compared to the control group (n=46; 6.5%, P=0.002; 15.2%, P=0.002; and 23.9%, P=0.029, respectively) after matching for age and sex. Adrenalectomy (odds ratio [OR]=10.38, 95% confidence interval [95% CI]=2.09–51.52, P=0.004), body mass index (OR=1.39, 95% CI=1.08–1.79, P=0.010), and F-1mgODST levels (OR=92.21, 95% CI=5.30–1604.07, P=0.002) were identified as independent factors associated with improved weight control. Adrenalectomy (OR=5.30, 95% CI=1.63–17.25, P=0.006) and diabetes (OR=8.05, 95% CI=2.34–27.65, P=0.001) were independently associated with improved glucose control. Adrenalectomy (OR=2.27, 95% CI=0.87–5.94, P=0.095) and hypertension (OR=10.77, 95% CI=3.65–31.81, P<0.001) demonstrated associations with improved BP control. Conclusions: Adrenalectomy improved weight, glucose, and BP control in patients with MACS.

Background: Despite the well-recognized health benefits of fresh fruit consumption, there is still substantial uncertainty about its potential effects on glycemic control in patients with type 2 diabetes mellitus (T2DM).Methods: We examined the association of fresh fruit consumption and glycemic control in patients with T2DM using data from the 6th Korea National Health and Nutrition Examination Survey. The study sample was divided into three groups based on weekly fruit consumption frequency for the analysis.Results: Patients with the highest fruit intake were older than those in the other two groups, and women were more likely to consume fruits in general. Being a current smoker and weekly alcohol intake also showed negative correlations according to the fruit intake tertiles. Fruit consumption was positively correlated with better hemoglobin A1c (HbA1c) levels. Moreover, patients in the highest tertile of fruit intake were 3.48 times more likely to be in good glycemic control defined as HbA1c <7%.Conclusion: We observed that fruit consumption can be helpful in glycemic control in Korean patients with T2DM.