Endocrinology and Metabolism

Original Articles

Thyroid Thyroid Cancer Screening
Cost-Utility Analysis of Early Detection with Ultrasonography of Differentiated Thyroid Cancer: A Retrospective Study on a Korean Population: Han-Sang Baek, Jeonghoon Ha, Kwangsoon Kim, Ja Seong Bae, Jeong Soo Kim, Sungju Kim, Dong-Jun Lim, Chul-Min Kim; Endocrinol Metab. 2024;39(2):310-323. Published online April 9, 2024; DOI: https://doi.org/10.3803/EnM.2023.1870

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Abstract PDF Supplementary Material PubReader ePub: Background
There is debate about ultrasonography screening for thyroid cancer and its cost-effectiveness. This study aimed to evaluate the cost-effectiveness of early screening (ES) versus symptomatic detection (SD) for differentiated thyroid cancer (DTC) in Korea.
Methods
A Markov decision analysis model was constructed to compare the cost-effectiveness of ES and SD. The model considered direct medical costs, health outcomes, and different diagnostic and treatment pathways. Input data were derived from literature and Korean population studies. Incremental cost-effectiveness ratio (ICER) was calculated. Willingness-to-pay (WTP) threshold was set at USD 100,000 or 20,000 per quality-adjusted life year (QALY) gained. Sensitivity analyses were conducted to address uncertainties of the model’s variables.
Results
In a base case scenario with 50 years of follow-up, ES was found to be cost-effective compared to SD, with an ICER of $2,852 per QALY. With WTP set at $100,000, in the case with follow-up less than 10 years, the SD was cost-effective. Sensitivity analysis showed that variables such as lobectomy probability, age, mortality, and utility scores significantly influenced the ICER. Despite variations in costs and other factors, all ICER values remained below the WTP threshold.
Conclusion
Findings of this study indicate that ES is a cost-effective strategy for DTC screening in the Korean medical system. Early detection and subsequent lobectomy contribute to the cost-effectiveness of ES, while SD at an advanced stage makes ES more cost-effective. Expected follow-up duration should be considered to determine an optimal strategy for DTC screening.

Thyroid
Active Surveillance for Low-Risk Papillary Thyroid Carcinoma as an Acceptable Management Option with Additional Benefits: A Comprehensive Systematic Review: Jee Hee Yoon, Wonsuk Choi, Ji Yong Park, A Ram Hong, Hee Kyung Kim, Ho-Cheol Kang; Endocrinol Metab. 2024;39(1):152-163. Published online January 22, 2024; DOI: https://doi.org/10.3803/EnM.2023.1794

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Background
Active surveillance (AS) has been introduced as a management strategy for low-risk papillary thyroid carcinoma (PTC) due to its typically indolent nature. Despite this, the widespread adoption of AS has encountered several challenges. The aim of this systematic review was to evaluate the safety of AS related to disease progression and its benefits compared with immediate surgery (IS).
Methods
Studies related to AS in patients with low-risk PTC were searched through the Ovid MEDLINE, Embase, Cochrane Library, and KoreaMed databases. Studies on disease progression, surgical complication, quality of life (QoL), and cost-effectiveness were separately analyzed and narratively synthesized.
Results
In the evaluation of disease progression, the proportions of cases with tumor growth ≥3 mm and a volume increase >50% were 2.2%–10.8% and 16.0%–25.5%, respectively. Newly detected lymph node metastasis was identified in 0.0%–1.4% of patients. No significant difference was found between IS and delayed surgery in surgical complications, including vocal cord paralysis and postoperative hypoparathyroidism. AS was associated with better QoL than IS. Studies on the cost-effectiveness of AS reported inconsistent data, but AS was more cost-effective when quality-adjusted life years were considered.
Conclusion
AS is an acceptable management option for patients with low-risk PTC based on the low rate of disease progression and the absence of an increased mortality risk. AS has additional benefits, including improved QoL and greater QoL-based cost-effectiveness.

Citations

Citations to this article as recorded by

It Is Time to Understand the Additional Benefits of Active Surveillance for Low-Risk Papillary Thyroid Carcinoma
Kyeong Jin Kim
Endocrinology and Metabolism.2024; 39(1): 95. CrossRef

Thyroid
Quality of Life of Survivors of Thyroid Cancer Is Not Inferior to That in Subjects without Cancer: Long-Term after Over 5 Years: Jeongmin Lee, Youn-Ju Lee, Dong-Jun Lim, Jung-Min Lee, Sang-Ah Chang, Min-Hee Kim; Endocrinol Metab. 2022;37(4):664-673. Published online August 29, 2022; DOI: https://doi.org/10.3803/EnM.2022.1499

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Background
Patients with thyroid cancer undergo less extensive surgery and additional therapies compared to those with other cancers. We aimed to compare the quality of life (QoL) between patients with thyroid cancer and healthy subjects using representative data from Korea. Differences in QoL of thyroid cancer survivors according to the duration after cancer diagnosis was also evaluated.
Methods
This population-based cohort study included 50,278 subjects who participated in the Korea National Health and Nutrition Examination Survey between 2007 and 2017. QoL was compared between patients with thyroid cancer and healthy subjects using self-reported data from the EuroQoL (EQ)-5 dimension (5D) and EQ-visual analog scale (VAS). Propensity score matching was used to match thyroid cancer survivors to healthy subjects (1:5 matching).
Results
Linear regression with univariate analysis showed that the presence of thyroid cancer was positively correlated with better EQ-5D index scores (β-coefficient=0.010, p=0.046). After adjusting for multiple covariables, statistical significance was maintained. EQ-VAS fails to demonstrate any significant correlation. Among the EQ-5D categories, patients with thyroid cancer showed better self-care than healthy subjects. Thyroid cancer duration did not correlate with the EQ-5D index score. In subgroup analyses, compared to patients with thyroid cancer duration of <5 years, no significant difference was observed in the correlation between the EQ-5D index score and survival duration in those with thyroid cancer duration of 5 to 9 years and ≥10 years.
Conclusion
Using a large-scale nationwide population-based database, our study demonstrated better QoL, especially in terms of self-care, among thyroid cancer survivors than among healthy subjects without cancer.

Citations

Citations to this article as recorded by

Quality of Life Considerations in Patients Treated for Differentiated Thyroid Cancer
Jie Liu
Clinical Thyroidology.2023; 35(4): 160. CrossRef
The psychosocial impact of thyroid cancer
Parker Haymart, Nina Jackson Levin, Megan R. Haymart
Current Opinion in Endocrinology, Diabetes & Obesity.2023; 30(5): 252. CrossRef
Longitudinal Changes in Quality of Life Before and After Thyroidectomy in Patients With Differentiated Thyroid Cancer
Byung Hun Kim, Soo Rack Ryu, Jin Won Lee, Chang Myeon Song, Yong Bae Ji, Seok Hyun Cho, Seung Hwan Lee, Kyung Tae
The Journal of Clinical Endocrinology & Metabolism.2023;[Epub] CrossRef

Review Article

Miscellanenous
Cushing Syndrome Associated Myopathy: It Is Time for a Change: Martin Reincke; Endocrinol Metab. 2021;36(3):564-571. Published online June 18, 2021; DOI: https://doi.org/10.3803/EnM.2021.1069

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Cushing syndrome is the result of excessive levels of glucocorticoids. Endogenous Cushing syndrome is rare with an incidence of two to three cases per million per year. Clinically, the presentation consists of a characteristic phenotype including skin symptoms and metabolic manifestations. A frequent co-morbidity with high impact on quality of life is Cushing syndrome associated myopathy. It characteristically affects the proximal myopathy, impairing stair climbing and straightening up. The pathophysiology is complex and involves protein degradation via the forkhead box O3 (FOXO3) pathway, intramuscular fat accumulation, and inactivity-associated muscle atrophy. Surgical remission of Cushing syndrome is the most important step for recovery of muscle function. Restoration depends on age, co-morbidities and postoperative insulin-like growth factor concentrations. At average, functionality remains impaired during the long-term compared to age and sex matched control persons. Growth hormone therapy in individuals with impaired growth hormone secretion could be an option but has not been proved in a randomized trial.

Citations

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Long-Term Consequences of Cushing Syndrome: A Systematic Literature Review
Soraya Puglisi, Anna Maria Elena Perini, Cristina Botto, Francesco Oliva, Massimo Terzolo
The Journal of Clinical Endocrinology & Metabolism.2024; 109(3): e901. CrossRef
The Link between Mitochondrial Dysfunction and Sarcopenia: An Update Focusing on the Role of Pyruvate Dehydrogenase Kinase 4
Min-Ji Kim, Ibotombi Singh Sinam, Zerwa Siddique, Jae-Han Jeon, In-Kyu Lee
Diabetes & Metabolism Journal.2023; 47(2): 153. CrossRef
Intelligent Systems for Muscle Tracking: A Review on Sensor‐Algorithm Synergy
Arjun Putcha, Tien Nguyen, Regina Smith, Rachel Choffin, Wubin Bai
Advanced Intelligent Systems.2023;[Epub] CrossRef
Sarcopenia in youth
Han Na Jung, Chang Hee Jung, You-Cheol Hwang
Metabolism.2023; 144: 155557. CrossRef
Cushing Syndrome
Martin Reincke, Maria Fleseriu
JAMA.2023; 330(2): 170. CrossRef
Musculoskeletal complications of Cushing syndrome
Dorota Leszczyńska, Alicja Szatko, Lucyna Papierska, Wojciech Zgliczyński, Piotr Glinicki
Rheumatology.2023; 61(4): 271. CrossRef
Circulating myomiRNAs as biomarkers in patients with Cushing’s syndrome
C. Pivonello, R. Patalano, C. Simeoli, T. Montò, M. Negri, F. Amatrudo, N. Di Paola, A. Larocca, E. M. Crescenzo, R. Pirchio, D. Solari, C. de Angelis, R. S. Auriemma, L. M. Cavallo, A. Colao, R. Pivonello
Journal of Endocrinological Investigation.2023; 47(3): 655. CrossRef
Low-grade inflammation during the glucocorticoid withdrawal phase in patients with Cushing's syndrome
Frederick Vogel, Leah Braun, Stephanie Zopp, Elisabeth Nowak, Jochen Schreiner, Irina Benz, German Rubinstein, Heike Künzel, Katrin Ritzel, Matthias Kroiss, Jürgen Honegger, Felix Beuschlein, Katharina Schilbach, Daniel Teupser, Martin Bidlingmaier, Marti
European Journal of Endocrinology.2023; 188(4): 375. CrossRef
An odd case of immune-mediated necrotizing myopathy, complicated with sagittal, transverse and sigmoid sinus thrombosis
Andreea Trandafir, Violeta Claudia Bonjincă, Delia Tulba, Gelu Onose
Balneo and PRM Research Journal.2023; 14(Vol.14, no): 630. CrossRef
Morbidität und Mortalität beim Cushing-Syndrom
Frederick Vogel, Leah Braun, Martin Reincke
Der Internist.2022; 63(1): 34. CrossRef
Pathophysiology of Mild Hypercortisolism: From the Bench to the Bedside
Vittoria Favero, Arianna Cremaschi, Chiara Parazzoli, Alberto Falchetti, Agostino Gaudio, Luigi Gennari, Alfredo Scillitani, Fabio Vescini, Valentina Morelli, Carmen Aresta, Iacopo Chiodini
International Journal of Molecular Sciences.2022; 23(2): 673. CrossRef
Long‐term morbidity and mortality in patients with Cushing's syndrome
Leah T. Braun, Frederick Vogel, Martin Reincke
Journal of Neuroendocrinology.2022;[Epub] CrossRef
Clinical presentation and etiology of Cushing's syndrome: Data from ERCUSYN
Elena Valassi
Journal of Neuroendocrinology.2022;[Epub] CrossRef
Pyruvate dehydrogenase kinase 4 promotes ubiquitin–proteasome system‐dependent muscle atrophy
Ibotombi Singh Sinam, Dipanjan Chanda, Themis Thoudam, Min‐Ji Kim, Byung‐Gyu Kim, Hyeon‐Ji Kang, Jung Yi Lee, Seung‐Hoon Baek, Shin‐Yoon Kim, Bum Jin Shim, Dongryeol Ryu, Jae‐Han Jeon, In‐Kyu Lee
Journal of Cachexia, Sarcopenia and Muscle.2022; 13(6): 3122. CrossRef
Consensus on diagnosis and management of Cushing's disease: a guideline update
Maria Fleseriu, Richard Auchus, Irina Bancos, Anat Ben-Shlomo, Jerome Bertherat, Nienke R Biermasz, Cesar L Boguszewski, Marcello D Bronstein, Michael Buchfelder, John D Carmichael, Felipe F Casanueva, Frederic Castinetti, Philippe Chanson, James Findling
The Lancet Diabetes & Endocrinology.2021; 9(12): 847. CrossRef

Original Articles

Clinical Study
A Phase II Multi-Center, Non-Randomized, Parallel Group, Non-Inferiority Study to Compare the Efficacy of No Radioactive Iodine Remnant Ablation to Remnant Ablation Treatment in Low- to Intermediate-Risk of Papillary Thyroid Cancer: The MOREthyroid Trial Protocol: Eun Kyung Lee, You Jin Lee, Young Joo Park, Jae Hoon Moon, Ka Hee Yi, Koon Soon Kim, Joo Hee Lee, Sun Wook Cho, Jungnam Joo, Yul Hwangbo, Sujeong Go, Do Joon Park; Endocrinol Metab. 2020;35(3):571-577. Published online September 22, 2020; DOI: https://doi.org/10.3803/EnM.2020.681

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Abstract PDF Supplementary Material PubReader ePub: Background
Radioactive iodine (RAI) remnant ablation is recommended in patients with papillary thyroid cancer (PTC) and extrathyroidal extension or central lymph node metastasis. However, there exists little evidence about the necessity of remnant ablation in PTC patients with low- to intermediate-risk, those have been increasing in recent decades.
Methods
This multicenter, prospective, non-randomized, parallel group clinical trial will enroll 310 eligible patients with low- to intermediate-risk of thyroid cancer. Inclusion criteria are patients who recently underwent total thyroidectomy for PTC with 3 or less tumors of size 1≤ to ≤2 cm with no microscopic extension and N0/x, or size ≤2 cm with microscopic extension and/or N1a (number of lymph node ≤3, size of tumor foci ≤0.2 cm, and lymph node ratio <0.4). Patients choose to undergo RAI ablation (¹³¹I, dose 1.1 GBq) or diagnostic whole-body scan (DxWBS) (¹³¹I or ¹²³I, dose 0.074 to 0.222 GBq), followed by subsequent measurement of stimulated thyroglobulin (sTg) within 1 year. Survey for quality of life (QOL) will be performed at baseline and at 1 year after follow-up. The total enrollment period is 5 years, and patients will be followed up for 1 year. The primary endpoint is the non-inferiority of surgery alone to surgery with ablation in terms of biochemical remission (BCR) rate (sTg ≤2 ng/mL) without evidence of structural recurrence. The secondary endpoint was the difference of QOL.
Conclusion
This study will evaluate whether surgery alone achieves similar BCR and improved QOL compared to RAI ablation in patients with low- to intermediate-risk PTC within 1 year.

Clinical Study
Quality of Life in Patients with Papillary Thyroid Microcarcinoma According to Treatment: Total Thyroidectomy with or without Radioactive Iodine Ablation: Jonghwa Ahn, Min Ji Jeon, Eyun Song, Tae Yong Kim, Won Bae Kim, Young Kee Shong, Won Gu Kim; Endocrinol Metab. 2020;35(1):115-121. Published online March 19, 2020; DOI: https://doi.org/10.3803/EnM.2020.35.1.115

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Background

Recently, there has been some controversy regarding the role of radioactive iodine (RAI) ablation in the treatment of low-risk differentiated thyroid carcinoma (DTC), especially papillary thyroid microcarcinoma (PTMC). This study aimed to compare quality of life (QoL) parameters between patients with PTMC who underwent total thyroidectomy (TT) alone and those who underwent TT with RAI ablation.

Methods

In this cross-sectional study, patients with PTMC who underwent TT with/without RAI remnant ablation were prospectively enrolled between June 2016 and October 2017. All patients completed three questionnaires: the 12-item short-form health survey (SF-12), thyroid cancer-specific quality of life (THYCA-QoL) questionnaire, and fear of progression (FoP) questionnaire.

Results

The TT and TT with RAI groups comprised 107 and 182 patients, respectively. The TT with RAI group had significantly lower serum thyrotropin (TSH) levels than the TT group. However, after matching for TSH levels between the groups (n=100 in both groups), there were no significant differences in baseline characteristics. According to the SF-12, the score for general health was significantly lower in the TT with RAI group than in the TT group (P=0.047). The THYCA-QoL also showed a significant difference in the “felt chilly” score between groups (P=0.023). No significant differences in FoP scores were observed between the groups.

Conclusion

Patients with PTMC who underwent TT with RAI ablation experienced more health-related problems than those managed with TT alone. These findings support the idea that RAI ablation should be carefully considered in patients with low-risk DTCs.

Citations

Citations to this article as recorded by

Quality of life of patients with thyroid cancer in Colombia
Oscar Gómez, Alvaro Sanabria
Endocrinología, Diabetes y Nutrición.2024; 71(2): 61. CrossRef
Quality of life of patients with thyroid cancer in Colombia
Oscar Gómez, Alvaro Sanabria
Endocrinología, Diabetes y Nutrición (English ed.).2024; 71(2): 61. CrossRef
Fear of Cancer Recurrence in Differentiated Thyroid Cancer Survivors: A Systematic Review
Jacob Hampton, Ahmad Alam, Nicholas Zdenkowski, Christopher Rowe, Elizabeth Fradgley, Christine J. O'Neill
Thyroid®.2024;[Epub] CrossRef
Review: Improving quality of life in patients with differentiated thyroid cancer
Pia Pace-Asciak, Jonathon O. Russell, Ralph P. Tufano
Frontiers in Oncology.2023;[Epub] CrossRef
Health-Related Quality of Life and Thyroid Cancer-Specific Symptoms in Patients Treated for Differentiated Thyroid Cancer: A Single-Center Cross-Sectional Survey from Mainland China
Changlian Chen, Jiayan Cao, Yueyang Wang, Xuya Han, Yaju Zhang, Shumei Zhuang
Thyroid.2023; 33(4): 474. CrossRef
The "not so good" thyroid cancer: a scoping review on risk factors associated with anxiety, depression and quality of life
Kyle Alexander, Sum-Yu Christina Lee, Stelios Georgiades, Constantina Constantinou
Journal of Medicine and Life.2023; 16(3): 348. CrossRef
Comparison of health‐related quality of life and cosmetic outcome between traditional gasless trans‐axillary endoscopic thyroidectomy and modified gasless trans‐axillary endoscopic thyroidectomy for patients with papillary thyroid microcarcinoma
Deenraj Kush Dhoomun, HuiLan Cai, Ning Li, YanHuan Qiu, XingRui Li, XiaoPeng Hu, WenZhuang Shen
Cancer Medicine.2023; 12(15): 16604. CrossRef
Risk of Adverse Pregnancy Outcomes in Young Women with Thyroid Cancer: A Systematic Review and Meta-Analysis
Shinje Moon, Ka Hee Yi, Young Joo Park
Cancers.2022; 14(10): 2382. CrossRef
Health-related quality of life following FDG-PET/CT for cytological indeterminate thyroid nodules
Elizabeth J de Koster, Olga Husson, Eveline W C M van Dam, G Sophie Mijnhout, Romana T Netea-Maier, Wim J G Oyen, Marieke Snel, Lioe-Fee de Geus-Oei, Dennis Vriens, _ _
Endocrine Connections.2022;[Epub] CrossRef
Is a four-week hormone suspension necessary for thyroid remnant ablation in low and intermediate risk patients? A pilot study with quality-of-life assessment
Poliane A.L. Santos, Maria E.D.M. Flamini, Felipe A. Mourato, Fernando R.A. Lima, Joelan A.L. Santos, Fabiana F. Lima, Estelita T.B. Albuquerque, Alexandra C. De Freitas, Simone C.S. Brandão
Brazilian Journal of Radiation Sciences.2022; 10(4): 1. CrossRef
Health-related quality of life after transoral robotic thyroidectomy in papillary thyroid carcinoma
Chang Myeon Song, Hyang Sook Bang, Hyung Gu Kim, Hae Jin Park, Kyung Tae
Surgery.2021; 170(1): 99. CrossRef
Protocol for a Korean Multicenter Prospective Cohort Study of Active Surveillance or Surgery (KoMPASS) in Papillary Thyroid Microcarcinoma
Min Ji Jeon, Yea Eun Kang, Jae Hoon Moon, Dong Jun Lim, Chang Yoon Lee, Yong Sang Lee, Sun Wook Kim, Min-Hee Kim, Bo Hyun Kim, Ho-Cheol Kang, Minho Shong, Sun Wook Cho, Won Bae Kim
Endocrinology and Metabolism.2021; 36(2): 359. CrossRef

Clinical Study
Impact of Subtotal Parathyroidectomy on Clinical Parameters and Quality of Life in Hemodialysis Patients with Secondary Hyperparathyroidism: Mohamed Mimi Abd Elgawwad El-kholey, Ghada El-said Ibrahim, Osama Ibrahim Elshahat, Ghada El-Kannishy; Endocrinol Metab. 2019;34(4):367-373. Published online December 23, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.4.367

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Background

Impairment of quality of life (QOL) is a key clinical characteristic of patients with end-stage renal disease (ESRD), and can be especially severe in the presence of secondary hyperparathyroidism (SHPT). Despite the proven success of parathyroidectomy (PTX) in controlling biochemical parameters in patients with severe SHPT, evidence is lacking regarding the effects of PTX on various clinical outcomes, including QOL.

Methods

Twenty ESRD patients on maintenance hemodialysis with SHPT who underwent subtotal PTX were included in an observational longitudinal study. All studied patients underwent history-taking, clinical examinations, and laboratory investigations, including a complete blood count and measurements of serum calcium, phosphorus, magnesium, parathyroid hormone (PTH), and albumin levels preoperatively and at 3 months postoperatively. QOL was assessed before surgery and at 3 months after surgery using the Kidney Disease Quality of Life 36-Item Short-Form instrument.

Results

After PTX, significant decreases in serum PTH and phosphorus levels were observed, as well as a significant increase in serum magnesium levels. Significant weight gain and improvements of QOL were also detected postoperatively.

Conclusion

Subtotal PTX seems to be an efficient alternative to medical management in uncontrolled cases of SHPT, as it is capable of controlling the biochemical derangements that occur in hyperparathyroidism. Furthermore, PTX had a beneficial effect on clinical outcomes, as shown by weight gain and improvements in all QOL scales.

Citations

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Abnormalities of serum magnesium levels in dialysis patients undergoing parathyroidectomy
Chi-Yu Kuo, Chung-Hsin Tsai, Jie-Jen Lee, Shih-Ping Cheng
Updates in Surgery.2024;[Epub] CrossRef
Effect of Parathyroidectomy on Quality of Life Among Patients Undergoing Dialysis
Lin Wang, Ming-Hui Xin, Yan Ma, Yu Wang, Meng-Yuan Hu, Qiang-Qiang Liu, Jin-Bor Chen
International Journal of General Medicine.2022; Volume 15: 1185. CrossRef
Paricalcitol versus Calcitriol + Cinacalcet for the Treatment of Secondary Hyperparathyroidism in Chronic Kidney Disease in China: A Cost-Effectiveness Analysis
Zhuolin Zhang, Lele Cai, Hong Wu, Xinglu Xu, Wenqing Fang, Xuan He, Xiao Wang, Xin Li
Frontiers in Public Health.2021;[Epub] CrossRef

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