Publications by authors named "Laszlo Hegedus"

Concerns have been raised that glucagon-like peptide 1 receptor agonists (GLP1-RAs) may increase the risk of thyroid cancer, but evidence remains conflicting. We therefore investigated if GLP1-RA use, compared with use of dipeptidyl peptidase-4 inhibitors (DPP-4is), was associated with thyroid cancer risk in patients with type 2 diabetes. This multisite cohort study with subsequent meta-analysis included six population-based databases from Canada (Ontario), Denmark, Norway, South Korea, Sweden, and Taiwan.

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Objective: The ultrasound evaluation of thyroid nodules (TNs) in patient selection for fine needle aspiration (FNA) requires both uniformly accepted definitions of each nodule characteristic and extensive experience from the examiner. We hypothesized that nodule echogenicity alone may provide comparable performance to more complex approaches in patient selection for FNA.

Patients And Methods: Seven highly experienced investigators from four countries evaluated, online, the ultrasound (US) video recordings of 123 histologically verified TN by answering 17 nodule characteristics-related questions.

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Article Synopsis
  • An online survey of European thyroid specialists revealed that 28% believe thyroid hormone (TH) treatment may be appropriate for euthyroid patients with growing simple goiters, despite guidelines against this practice.
  • There were significant regional differences in support for TH treatment, with only 7% in The Netherlands compared to 78% in the Czech Republic.
  • Factors influencing the likelihood of recommending TH included the specialist's age and the historical iodine insufficiency of their region, while gender, country, and economic factors showed weak associations.
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Persistent symptoms are common in the general population and even more so in people with hypothyroidism. When symptoms are unexplained and brought to medical attention, they can be referred to as medically not yet explained symptoms (MNYES), a term preferred to other descriptors by patients, care-givers and experts. MNYES might be neglected by endocrinologists or misattributed to hypothyroidism.

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Article Synopsis
  • - The study aimed to assess how European thyroid specialists view levothyroxine (LT4) treatment for euthyroid women with positive thyroid peroxidase antibodies (TPOAb) to improve fertility, as current evidence does not support this practice.
  • - An international survey (THESIS) revealed that 42.8% of over 2,316 respondents believe LT4 might be indicated for these patients, with significant variation across countries, highlighting a range from 22.9% to 83.7% of positive responses.
  • - Factors such as gender, age, and clinical experience influenced opinions; younger specialists and those who treat more thyroid patients were more likely to consider LT4, raising concerns about potential overtreatment risks in
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Context: Between 10% and 15% of people with hypothyroidism experience persistent symptoms, despite achieving biochemical euthyroidism. The underlying causes are unclear. Type D personality (a vulnerability factor for general psychological distress) is associated with poor health status and symptom burden but has not been studied in people with hypothyroidism.

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Objective: Hypothyroidism is a common endocrine condition usually managed with levothyroxine (LT4). However, controversy remains around the use of liothyronine (LT3). We aimed to investigate the practices of Australian endocrinologists when managing patients with hypothyroidism, their use of LT3 + LT4 combination therapy and use of thyroid hormones in euthyroid patients.

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Hypothyroidism is common, however, aspects of its treatment remain controversial. Our survey aimed at documenting treatment choices of European thyroid specialists and exploring how patients' persistent symptoms, clinician demographics, and geo-economic factors relate to treatment choices. Seventeen thousand two hundred forty-seven thyroid specialists from 28 countries were invited to participate in an online questionnaire survey.

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  • Researchers wanted to see if taking selenium would help improve the quality of life for people with autoimmune thyroiditis.
  • They studied 412 patients over 12 months by giving some of them selenium and others a placebo (fake pill), but found that both groups felt similarly about their quality of life after a year.
  • Even though selenium lowered certain antibody levels in the blood, it didn't change how much medication the patients needed or make them feel any better than those who didn’t take it.
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Introduction: Thyroid specialists influence how hypothyroid patients are treated, including patients managed in primary care. Given that physician characteristics influence patient care, this study aimed to explore thyroid specialist profiles and associations with geo-economic factors.

Methods: Thyroid specialists from 28 countries were invited to respond to a questionnaire, Treatment of Hypothyroidism in Europe by Specialists: an International Survey (THESIS).

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Objective: To determine the impact of thyroid eye disease (TED) on patients in various stages of the disease.

Background: TED is a debilitating and potentially sight-threatening inflammatory autoimmune disease that is frequently misdiagnosed. Challenging quality-of-life (QoL) issues can persist long after the active phase of disease has subsided.

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Article Synopsis
  • Autoimmune thyroid disease (AITD) includes Graves disease (GD) and Hashimoto disease (HD), with genetic factors contributing significantly to their development, while epigenetics like DNA methylation also plays a role.
  • The study aimed to identify differences in DNA methylation patterns between patients with GD and those with HD using blood samples from Australian and Danish cohorts.
  • Findings revealed specific DNA methylation differences, including 2 significant differentially methylated positions and a differentially methylated region, which could help explain the varying development of GD and HD and suggest the influence of environmental factors.
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  • Various US-based risk stratification systems for thyroid nodules are used globally, but inconsistent definitions and malignancy ratings create confusion and complicate comparisons between studies.
  • Interobserver variability in identifying ultrasound characteristics also hinders the consistent application of these systems.
  • In 2018, an international group of 19 experts formed the International Thyroid Nodule Ultrasound Working Group to develop the International Thyroid Imaging Reporting and Data System (I-TIRADS), starting with a lexicon and atlas of ultrasound descriptors for thyroid nodules.
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  • The study investigates the link between hypothyroidism and oxidative stress, focusing on biomarkers 8-oxoGuo and 8-oxodG, which indicate RNA and DNA oxidation, respectively.
  • 45 Danish women with newly diagnosed hypothyroidism were compared before and after treatment with levothyroxine, along with healthy control subjects to assess changes in these biomarkers.
  • Results showed no significant changes in oxidative stress markers after initiating treatment in patients, although hypothyroid women had higher levels of 8-oxoGuo and 8-oxodG compared to the control group.
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Purpose: Inconsistencies in the medical management of hypothyroidism have been reported between endocrinologists in different countries. This study aimed to identify the attitudes of Latin America thyroid specialists towards the use of thyroid hormones.

Methods: Online survey of members of the Latin America Thyroid Society.

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Purpose: We investigated the association between health-related quality of life (HRQL) and the severity of hypothyroidism at diagnosis in patients referred to a secondary hospital clinic.

Methods: Sixty-seven adult patients referred from primary care were enrolled. All patients had newly diagnosed hypothyroidism due to autoimmune thyroiditis and were treated with levothyroxine (LT4).

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  • Widespread use of sensitive imaging techniques has led to the detection of many thyroid nodules, most of which are benign and don’t require treatment.
  • When cancer is diagnosed, it is often in the form of small, low-risk tumors that can be managed conservatively.
  • New guidelines have been created to help doctors approach the assessment and management of thyroid nodules in adults while considering patient preferences and building on previous research.
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Between 10% and 15% of hypothyroid patients experience persistent symptoms despite achieving biochemical euthyroidism. Unexplained persistent symptoms can be a sign of somatization. This is associated with distress and high health care resource use and can be classified as somatic symptom disorder (SSD).

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Progress in the management of thyroid eye disease (TED) has been slow for many decades. The recent introduction of teprotumumab (TEP) in the therapeutic arena for TED has had a major impact in view of its efficacy, particularly with respect to its ability to reduce proptosis. However, the high cost of TEP, limited availability to patients outside the USA, and the lack of data on cost-effectiveness are significant barriers to improving the care of patients with TED globally.

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Article Synopsis
  • The study aimed to create a glossary of terms for better communication in the development of clinical practice guidelines (CPGs) to prevent misunderstandings.
  • Researchers conducted a literature review and collaborated with experts to gather and define relevant terms in two rounds of Delphi surveys.
  • The final glossary, which reached consensus on 37 terms, is intended to enhance collaboration among organizations, improve communication, and streamline the guideline development process.
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Diethyl α-benzylamino- and α-amino-benzylphosphonates obtained by the Kabachnik-Fields reaction were useful intermediates in the synthesis of other derivatives. Acylation of α-aminophosphonates with acyl chlorides led to the corresponding -acyl species existing under a dynamic equilibrium of two conformers. Judging from the broad NMR signals, the sterically most crowded -benzoyl--benzyl derivative suffered a hindered rotation around the N-C axis to the acyl carbon atom at 26 °C.

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Objective: Thyroid nodule ultrasound characteristics are used as an indication for fine-needle aspiration cytology, usually as the basis for Thyroid Imaging Reporting and Data System (TIRADS) score calculation. Few studies on interobserver variation are available, all of which are based on analysis of preselected still ultrasound images and often lack surgical confirmation.

Methods: After the blinded online evaluation of video recordings of the ultrasound examinations of 47 consecutive malignant and 76 consecutive benign thyroid lesions, 7 experts from 7 thyroid centers answered 17 TIRADS-related questions.

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