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Kjersti S Bakken Women’s Clinic, Innlandet Hospital Trust, Lillehammer, Norway
Center for International Health, University of Bergen, Bergen, Norway

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Kristina Randjelovic Nermo Center for International Health, University of Bergen, Bergen, Norway
Department of Microbiology, Innlandet Hospital Trust, Lillehammer, Norway

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Bjørn Gunnar Nedrebø Department of Medicine, Haugesund Hospital, Haugesund, Norway
Department of Clinical Science, University of Bergen, Bergen, Norway

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Tim I M Korevaar Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands

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Tor A Strand Center for International Health, University of Bergen, Bergen, Norway
Department of Research, Innlandet Hospital Trust, Lillehammer, Norway

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pregnancy, there is an increase in the size of the thyroid gland, the production of thyroid hormones, as well as iodine requirement ( 2 ). Maternal thyroid disease during pregnancy is associated with adverse outcomes depending on the type of dysfunction

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L E Zijlstra Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

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D M van Velzen Department of Internal Medicine, Section of Endocrinology, Northwest Clinics, Alkmaar, The Netherlands

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S Simsek Department of Internal Medicine, Section of Endocrinology, Northwest Clinics, Alkmaar, The Netherlands

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S P Mooijaart Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands

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M van Buren Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
Department of Internal Medicine, HagaHospital, The Hague, The Netherlands

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D J Stott Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK

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I Ford Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK

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J W Jukema Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

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S Trompet Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands

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thyroid disease and variations in the definitions of subclinical thyroid disease among different studies. In an attempt to tackle these limitations, recent large, individual participant data meta-analyses were performed and associations were found between

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Irfan Vardarli Department of Medicine I, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum, Recklinghausen, Germany

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Manuel Weber Department of Nuclear Medicine, University Hospital Essen, Essen, Germany

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Frank Weidemann Department of Medicine I, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum, Recklinghausen, Germany

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Dagmar Führer Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry – Division of Laboratory Research; Endocrine Tumor Center at WTZ/Comprehensive Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

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Ken Herrmann Department of Nuclear Medicine, University Hospital Essen, Essen, Germany

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Rainer Görges Department of Nuclear Medicine, University Hospital Essen, Essen, Germany

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and corresponds to 1–3% of all histologically proven thyroid cancers in the United States, with a prevalence of 0.1–1.4% in patients with nodular thyroid disease ( 2 , 4 ), appearing either sporadically or in a hereditary form as a component of the

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Xichang Wang Department of Endocrinology and Metabolism and The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China

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Xiaochun Teng Department of Endocrinology and Metabolism and The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China

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Chenyan Li Department of Endocrinology and Metabolism and The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China

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Yushu Li Department of Endocrinology and Metabolism and The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China

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Jing Li Department of Endocrinology and Metabolism and The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China

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Weiping Teng Department of Endocrinology and Metabolism and The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China

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Zhongyan Shan Department of Endocrinology and Metabolism and The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China

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Yaxin Lai Department of Endocrinology and Metabolism and The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China

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hyperthyroidism, the most common of which is Graves’ disease (GD); other types include toxic multinodular goiter (TMNG), toxic thyroid adenoma (TA) and Hashimoto’s hyperthyroidism. According to the findings of the Thyroid Disease, Iodine Nutrition and Disease

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Yujie Ren Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China

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Xue Han Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China

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Yujiang Li Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China

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Guofang Chen Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
Key Laboratory of TCM Syndrome and Treatment of Yingbing (Thyroid Disease) of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China

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Lin Jiang Department of Endocrinology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China

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Chao Liu Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
Key Laboratory of TCM Syndrome and Treatment of Yingbing (Thyroid Disease) of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China

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Shuhang Xu Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China

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thyroid cancer in the United States is 11.95/100,000, of which 89.1% and 35.3% are PTCs and thyroid cancers with a diameter ≤ 1 cm, respectively ( 3 ). The incidence of thyroid diseases in China has increased significantly as well. A sharp increase in the

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Signe Kirkegaard Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark

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Nanna Maria Uldall Torp Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark

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Stig Andersen Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
Department of Geriatrics, Aalborg University Hospital, Aalborg, Denmark

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Stine Linding Andersen Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark

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characteristics of the disorders, and possible mechanisms involved regarding disease outcomes. Thus, in nonpregnant as well as pregnant individuals the exact underlying mechanisms regarding adverse outcomes of thyroid disease are debated ( 3 ). Another

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Dongyan Han Department of Pathology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China

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Min Ding Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Rongli Xie Department of General Surgery, RuiJin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China

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Zhengshi Wang Thyroid Center, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
Shanghai Center of Thyroid Diseases, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China

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Guohui Xiao Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Xiaohong Wang Shanghai Rigen Biotechnology Co., Ltd. Shanghai, China

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Lei Dong Department of Pathology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Zhiqiang Yin Thyroid Center, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
Shanghai Center of Thyroid Diseases, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China

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Jian Fei Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Research Institute of Pancreatic Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Shanghai Jiao Tong University, Shanghai, China
Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China

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unrelated to thyroid disease (‘incidentalomas’) ( 1 , 2 ). In a retrospective study investigating the prevalence of thyroid nodules in the healthy Chinese population, the overall prevalence was 36.9% ( 3 ). Most thyroid nodules (about 90%) are benign and

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Navid Tabriz University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Carl von Ossietzky University, Oldenburg, Germany

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Kilian Gloy University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Carl von Ossietzky University, Oldenburg, Germany

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Astrid Schantzen University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Carl von Ossietzky University, Oldenburg, Germany

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Dennis Fried University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Carl von Ossietzky University, Oldenburg, Germany

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Dirk Weyhe University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Carl von Ossietzky University, Oldenburg, Germany

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Verena Uslar University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Carl von Ossietzky University, Oldenburg, Germany

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(PRO) are often being used. For an accurate assessment of HRQL, the combination of generic and disease-specific questionnaires is recommended ( 1 , 2 ). Thyroid diseases are very common worldwide, and as depicted by the Papillon study, every third

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Ya Zhang Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China

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Xiaoqiu Chu Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China

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Yuling Liu Department of Endocrinology, Zaozhuang Municipal Hospital, Zaozhuang, China

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Yueting Zhao Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China

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Xue Han Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China

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Xin Hu Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China

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Pingping Xiang Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
Key Laboratory of TCM Syndrome and Treatment of Yingbing (Thyroid Disease) of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China

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Guofang Chen Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
Key Laboratory of TCM Syndrome and Treatment of Yingbing (Thyroid Disease) of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China

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Chao Liu Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
Key Laboratory of TCM Syndrome and Treatment of Yingbing (Thyroid Disease) of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China

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Shuhang Xu Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China

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Objective

To compare the efficacy and safety of ethanol ablation (EA) and microwave ablation (MWA) in the treatment of cystic or predominantly cystic thyroid nodules.

Methods

Patients with cystic or predominantly cystic thyroid nodules intervened with EA or MWA were retrospectively enrolled and divided into EA group (n  = 30) and MWA group (n  = 31). The volume and volume reduction rate (VRR) of thyroid nodules before ablation, and at 3 and 12 months after ablation were compared between the two groups. The effective rate (ER) and incidence of adverse events in both groups were recorded.

Results

The median VRR and ER at 3 months after ablation were significantly higher in EA group than in MWA group (81.30% vs 75.76%, P = 0.011; 76.67% (23/30) vs 51.61% (16/31), P = 0.040), while no significant difference was detected at 12 months (93.39% vs 88.78%, P = 0.141; 86.67% (26/30) vs 87.10% (27/31), P = 0.960). The median VRR of small nodules in EA group was significantly higher than that in MWA group (81.30% vs 71.18%, P = 0.006; 93.40% vs 83.14%, P = 0.032). There was no significant difference of median VRR in medium nodules at final follow-up between MWA and EA group (93.01% vs 89.68%, P = 0.482). Serious adverse events were not reported in both groups.

Conclusion

EA and MWA are both effective and safe in the treatment of cystic or predominantly cystic thyroid nodules. EA is more cost-effective and effective than MWA for small nodules, but it requires more cycles of treatment and may pose a higher risk of postoperative pain compared with MWA.

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Elena Izkhakov Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel

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Joseph Meyerovitch Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Community Division, Clalit Health Services, Tel Aviv, Israel
The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel

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Micha Barchana School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel

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Yacov Shacham Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

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Naftali Stern Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

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Lital Keinan-Boker School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
National Cancer Registry, Israel Center for Disease Control, Ministry of Health, Israel, Ramat Gan, Israel

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incidence of atherosclerotic CaV and CeV morbidity in Israeli TC survivors compared to a sex- and age-matched control group with no thyroid disease, while controlling for cardiovascular risk factors and previous CaV&CeV morbidity. The second objective was to

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