Avoidable biopsies? Validating artificial intelligence-based decision support software in indeterminate thyroid nodules.

Background: Multiple artificial intelligence (AI) systems have been approved to risk-stratify thyroid nodules through sonographic characterization. We sought to validate the ability of one such AI system, Koios DS (Koios Medical, Chicago, IL), to aid in improving risk stratification of indeterminate thyroid nodules.

Methods: A retrospective single-institution dataset was compiled of 28 cytologically indeterminate thyroid nodules having undergone molecular testing and surgical resection, with surgical pathology categorized as malignant or benign.

Risk of malignancy in cytologically indeterminate thyroid nodules harboring thyroid stimulating hormone receptor mutations.

Objectives: To evaluate the frequency and risk of malignancy of TSHRpI568T mutations discovered in indeterminate thyroid nodules (ITN) within the Veracyte CLIA laboratory undergoing Afirma Genomic Sequencing Classifier (GSC) testing, and to evaluate a broader cohort of TSHR variants and their categorization as Afirma GSC benign (GSC-B) or suspicious (GSC-S). Finally, we seek to assess the risk of malignancy (ROM) of this group of TSHR mutated ITN in the GSC-S category.

Methods: ITN submitted to Veracyte for Afirma GSC testing between October 2017 and February 2022 were analyzed for TSHR variants and rates of GSC-B and GSC-S were calculated based upon BIII or IV cytology, by TSHR variant codon amino acid (AA) substitution, age, and gender.

Thyroid Carcinoma, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology.

Differentiated thyroid carcinomas is associated with an excellent prognosis. The treatment of choice for differentiated thyroid carcinoma is surgery, followed by radioactive iodine ablation (iodine-131) in select patients and thyroxine therapy in most patients. Surgery is also the main treatment for medullary thyroid carcinoma, and kinase inhibitors may be appropriate for select patients with recurrent or persistent disease that is not resectable.

Long-Term Outcomes of Thyroid Nodule AFIRMA GEC Testing and Literature Review: An Institutional Experience.

Objective: To assess outcomes of thyroid nodules analyzed with the AFIRMA gene expression classifier (GEC) and to perform a comprehensive literature review.

Study Design: Retrospective analysis of patients with thyroid nodules who underwent AFIRMA GEC testing at our institution.

Settings: A tertiary care academic institution.

Rapid Relief: Thyroidectomy is a Quicker Cure than Radioactive Iodine Ablation (RAI) in Patients with Hyperthyroidism.

Background: Time to hormonal control after definitive management of hyperthyroidism is unknown but may influence patient and physician decision making when choosing between treatment options. The hypothesis is that the euthyroid state is achieved faster after thyroidectomy than RAI ablation.

Methods: A retrospective review of all patients undergoing definitive therapy for hyperthyroidism was performed.

Glucocorticoid-responsive lymphocytic parathyroiditis and hypocalciuric hypercalcemia due to autoantibodies against the calcium-sensing receptor: a case report and literature review.

Objective: Autoimmune lymphocytic parathyroiditis and acquired hypocalciuric hypercalcemia associated with autoantibodies against the calcium-sensing receptor (anti-CaSR) are rare and poorly understood conditions. Here, we describe a patient with acquired parathyroid hormone (PTH)-dependent hypercalcemia with associated hypocalciuria, found to have true lymphocytic parathyroiditis on histopathology, and circulating anti-CaSR antibodies in serum.

Design And Methods: A 64-year-old woman was referred to our clinic for persistent hypercalcemia after a subtotal parathyroidectomy.

Early endocrine attending surgeon presence increases operating room efficiency.

Background: Preincision operating room (OR) preparation varies greatly. Cases requiring exacting preoperative setup may be more sensitive to inconsistent team members and trainees. Leadership and oversight by the surgeon may facilitate a timely start.

Contralateral adrenal abnormalities in Conn's syndrome.

Background: During the course of evaluation for primary hyperaldosteronism, cross-sectional imaging is obtained in efforts to identify patients with an aldosterone producing adenoma (APA). A subset of these patients will have a synchronous, contralateral adrenal abnormality. Adrenal vein sampling (AVS) further guides clinical decision making by identifying unilateral (APA) versus bilateral hypersecretion.

The impact of obesity on the presentation of primary hyperparathyroidism.

Context: Obesity has been associated with elevated serum PTH (sPTH) in the general population. Obesity may also alter the clinical presentation in patients with primary hyperparathyroidism (PHPT).

Objectives: The objectives of the study were to compare the clinical presentation of obese (OB) vs nonobese (NO) PHPT patients and to assess the impact of obesity on the presentation of PHPT independent of serum calcium and PTH.

Significance of elevated parathyroid hormone after parathyroidectomy for primary hyperparathyroidism.

Objective: To provide a clinical update on persistent parathyroid hormone (PTH) elevation after surgical resection for primary hyperparathyroidism (PHPT) and to suggest a schedule for follow-up monitoring and strategies for future study.

Methods: We reviewed the literature targeting studies with detailed analysis of biochemical parameters before and after parathyroidectomy for PHPT. We focused on potential etiologies and currently available outcome data.

Effect of the Bethesda system for reporting thyroid cytopathology on thyroidectomy rates and malignancy risk in cytologically indeterminate lesions.

Background: Cytologically indeterminate thyroid nodules represent a diagnostic and therapeutic challenge. In 2007, the National Cancer Institute recommended The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) as a means of improving the accuracy of thyroid cytopathology. Our objective was to determine the effect of TBSRTC on thyroidectomy rates and malignancy risk in cytologically indeterminate lesions.

Papillary thyroid carcinoma shows elevated levels of 2-hydroxyglutarate.

Elevated levels of D: -2-hydroxyglutarate (D: -2-HG) occur in gliomas and myeloid leukemias associated with mutations of IDH1 and IDH2. L: -2-Hydroxyglutaric aciduria, an inherited metabolic disorder, predisposes to brain tumors. Therefore, we asked whether sporadic cancers, without IDH1 or IDH2 hot-spot mutations, show elevated 2-hydroxyglutarate levels.

Surgical approach and perioperative complications determine short-term outcomes in patients with insulinoma: results of a bi-institutional study.

Background: Despite advancements in radiologic imaging and minimally invasive surgery, the evaluation and management of insulinomas is institution and surgeon dependent. Therefore, the reported surgical outcomes are highly variable. We compared the surgical management and outcomes of insulinomas between two international tertiary-care surgical units to better identify the best management as determined by short-term outcomes.

"Subclinical Cushing's syndrome" is not subclinical: improvement after adrenalectomy in 9 patients.

Background: A subgroup of patients with adrenal cortisol hypersecretion fails to meet the biochemical criteria for Cushing's syndrome. Appropriate therapy for this entity, subclinical Cushing's syndrome (subclinical CS), is unclear. We examined outcomes for patients who underwent unilateral adrenalectomy for subclinical CS.

Trends in thyroid cancer demographics and surgical therapy in the United States.

Background: The incidence of thyroid cancer is increasing. Our objective was to characterize the demographic pattern of this increase and to examine trends in surgical therapy for thyroid cancer.

Methods: Analysis of the SEER and NHDS databases was performed from 1974 to 2000 and from 1979 to 2004, respectively.

Measurement of 18-hydroxycorticosterone during adrenal vein sampling for primary aldosteronism.

Context: In primary aldosteronism, elevated serum 18-hydroxycorticosterone (18OHB) suggests aldosterone-producing adenoma (APA) rather than bilateral, idiopathic hyperaldosteronism (IHA), but little is known about the relative production of 18OHB and aldosterone (A) in APAs compared with IHA.

Objectives: We measured 18OHB, A, and cortisol (F) in blood from adrenal vein sampling (AVS) studies. We compared the discriminatory power of gradients in 18OHB/A and 18OHB/F ratios with A/F ratio gradients for distinguishing APA from IHA.

Primary hyperaldosteronism: effect of adrenal vein sampling on surgical outcome.

Hypothesis: Adrenal vein sampling is superior to computed tomography for subtype differentiation of primary hyperaldosteronism.

Design: Retrospective review.

Setting: University medical center.