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Appel K Grabe HJ . Diagnosed thyroid disorders are associated with depression and anxiety . Social Psychiatry and Psychiatric Epidemiology 2015 50 1417 – 1425 . ( https://doi.org/10.1007/s00127-015-1043-0 ) 8 Gulseren S Gulseren L Hekimsoy
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Pediatric Endocrinology Unit, Department of Women's and Children's Health, Padua University Hospital, Padova, Italy
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females than in males if compared to GD and its incidence rises with age, in particular from 60 years of age ( 7 ). It is well known that iodine viability influences the epidemiology of thyroid diseases, with hypothyroidism dominating in areas of high
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Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Emma Children’s Hospital, Amsterdam UMC, Department of Pediatrics, Amsterdam, The Netherlands
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University Hospital Würzburg, Department of Nuclear Medicine, Würzburg, Germany
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Background
Childhood cancer survivors (CCS) who received radiation therapy exposing the thyroid gland are at increased risk of developing differentiated thyroid cancer (DTC). Therefore, the International Guideline Harmonization Group (IGHG) on late effects of childhood cancer therefore recommends surveillance. It is unclear whether surveillance reduces mortality.
Aim
The aim of this study was to compare four strategies for DTC surveillance in CCS with the aim of reducing mortality: Strategy-1, no surveillance; Strategy-2, ultrasound alone; Strategy-3, ultrasound followed by fine-needle biopsy (FNB); Strategy-4, palpation followed by ultrasound and FNB.
Materials and methods
A decision tree was formulated with 10-year thyroid cancer-specific survival as the endpoint, based on data extracted from literature.
Results
It was calculated that 12.6% of CCS will develop DTC. Using Strategy-1, all CCS with DTC would erroneously not be operated upon, but no CCS would have unnecessary surgery. With Strategy-2, all CCS with and 55.6% of CCS without DTC would be operated. Using Strategy-3, 11.1% of CCS with DTC would be correctly operated upon, 11.2% without DTC would be operated upon and 1.5% with DTC would not be operated upon. With Strategy-4, these percentages would be 6.8, 3.9 and 5.8%, respectively. Median 10-year survival rates would be equal across strategies (0.997).
Conclusion
Different surveillance strategies for DTC in CCS all result in the same high DTC survival. Therefore, the indication for surveillance may lie in a reduction of surgery-related morbidity rather than DTC-related mortality. In accordance with the IGHG guidelines, the precise strategy should be decided upon in a process of shared decision-making.
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Division of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
Division of Clinical Studies, Institute of Cancer Research, London, UK
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Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
Department of Biomedical Sciences and Humanitas Clinical and Research Centre, Department of Nuclear Medicine, Humanitas University, Milan, Italy
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Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
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Objective
This study assessed the health-related quality of life (HRQoL) in patients undergoing 2-[18F]fluoro-2-deoxy-D-glucose (FDG)-PET/CT for an indeterminate (Bethesda III/IV) thyroid nodule. FDG-PET/CT accurately rules out malignancy and prevents 40% of futile diagnostic surgeries in these nodules.
Design
Secondary analyses of HRQoL data from a randomised controlled multicentre trial (NCT02208544) in 126 patients from 15 hospitals in the Netherlands were done.
Methods
Longitudinal HRQoL assessment was performed using the EuroQol 5-dimension 5-level (EQ-5D-5L), the RAND 36-item Health Survey v2.0 (RAND-36), and the Thyroid Patient-Reported Outcome (ThyPRO) questionnaire on baseline, 3, 6, and 12 months, relative to the date of the FDG-PET/CT scan.
Results
Patients who were randomised to active surveillance following an FDG-negative nodule instead of diagnostic surgery reported stable HRQoL scores throughout the year. Univariate analysis indicated better HRQoL for patients undergoing surveillance than surgical patients with benign histopathology on multiple physical and psychosocial domains. Univariate within-group analysis suggested both temporary and continued HRQoL deteriorations in patients with benign histopathology over time. Multivariate within-group analysis demonstrated no significant longitudinal HRQoL changes in patients undergoing active surveillance. In contrast, in patients with benign histopathology, worse HRQoL was observed with regard to ThyPRO cognitive impairment (P = 0.01) and cosmetic complaints (P = 0.02), whereas goitre symptoms (P < 0.001) and anxiety (P = 0.04) improved over time. In patients with malignant histopathology, anxiety also decreased (P = 0.05).
Conclusions
The reassurance of a negative FDG-PET/CT resulted in sustained HRQoL throughout the first year of active surveillance. Diagnostic surgery for a nodule with benign histopathology resulted in more cognitive impairment and physical problems including cosmetic complaints, but improved goitre symptoms and anxiety. Anxiety was also reduced in patients with malignant histopathology.
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Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Université Libre de Bruxelles, Bruxelles, Belgium
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School of Medicine, Zagreb, Croatia
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Department of Clinical Nutrition, Landspitali-National University Hospital, Reykjavik, Iceland
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Goldman School of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel
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Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Universitat Autònoma de Barcelona, Barcelona, Spain
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Frölunda Specialist Hospital, Västra Frölunda, Sweden
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Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Wallenberg Centre of Molecular and Translational Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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countries, European registers can potentially represent valuable and efficient data sources for evaluating differences in thyroid outcomes across the countries/regions. Iodine intake in a population is a main factor behind thyroid disease epidemiology
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Hsiao A Kurokawa K . Translation, adaptation, and validation of the SF-36 health survey for use in Japan . Journal of Clinical Epidemiology 1998 51 1037 – 1044 . ( https://doi.org/10.1016/s0895-4356(98)00095-x ) 21 Fukuhara S Ware Jr JE
Department of Hematology, University of Groningen, University Medical Center Groningen, The Netherlands
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. International Journal of Epidemiology 2015 44 1172 – 1180 . ( https://doi.org/10.1093/ije/dyu229 ) 18 Stolk RP Rosmalen JG Postma DS de Boer RA Navis G Slaets JP Ormel J & Wolffenbuttel BH . Universal risk factors for multifactorial diseases
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.0000000000001474 ) 3 Li N Du XL Reitzel LR Xu L & Sturgis EM . Impact of enhanced detection on the increase in thyroid cancer incidence in the United States: review of incidence trends by socioeconomic status within the surveillance, epidemiology, and end
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has been used widely in epidemiology studies that have associated hypothyroidism during pregnancy with adverse maternal and neonatal outcomes (see below). A 2021 guideline for the management of thyroid disorders in women undergoing assisted
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Martino MC , et al. Global epidemiology of acromegaly: a systematic review and meta-analysis . European Journal of Endocrinology 2021 185 251 – 263 . ( https://doi.org/10.1530/EJE-21-0216 ) 2 Holdaway IM Bolland MJ & Gamble GD . A meta
