Endocrinology and Metabolism

Original Article

Radiofrequency Ablation for Papillary Thyroid Carcinoma versus Surgery and Other Thermal Ablation Techniques: A Systematic Review and Meta-Analysis of Outcomes: Eun Ju Ha, Min Kyoung Lee, Jeong Hoon Lee, Ji Ye Lee, Ji-hoon Kim; Received February 11, 2026 Accepted June 8, 2026 Published online October 6, 2026; DOI: https://doi.org/10.3803/EnM.2026.2976 [Epub ahead of print]

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Abstract PDF: Background
Radiofrequency ablation (RFA) has been proposed for selected patients with low-risk papillary thyroid carcinoma (PTC). This study compared the effectiveness, safety, and procedural characteristics of RFA with those of surgery and other thermal ablation techniques.
Methods
PubMed, Embase, Cochrane, and KoreaMed were searched for studies published between January 2000 and March 2025. Two reviewers independently extracted data in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and assessed study quality using the Risk of Bias Assessment Tool for Nonrandomized Studies, version 2. Pooled analyses were performed using random-effects models. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for dichotomous outcomes, and mean differences (MDs) were calculated for continuous outcomes.
Results
Fifteen studies including 3,612 patients with PTC were analyzed. Compared with surgery, RFA was associated with a similar disease progression rate (OR, 0.91; 95% CI, 0.55 to 1.51; P=0.683) and a lower complication rate (OR, 0.35; 95% CI, 0.20 to 0.63; P=0.003). RFA was also associated with less intraoperative blood loss (MD, −21.87 mL), shorter procedure time (MD, −68.14 minutes), and shorter hospital stay (MD, −5.75 days; all P<0.001). Compared with other thermal ablation techniques, RFA showed similar disease progression rates (OR, 1.05; 95% CI, 0.16 to 7.14), complication rates (OR, 0.88; 95% CI, 0.17 to 4.49), volume reduction rates (MD, 0.02%), and complete disappearance rates (MD, 0.96%), with no statistically significant differences across outcomes.
Conclusion
RFA may be considered as an alternative to surgery for selected patients with low-risk PTC. Randomized trials with longer follow-up are needed to confirm its oncologic durability and safety.

Review Article

Thyroid
Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers, Part II: Follow-up Surveillance after Initial Treatment 2026: Eun Kyung Lee, Seung Heon Kang, Bon Seok Koo, Mijin Kim, Min Joo Kim, Bo Hyun Kim, Ji Won Kim, Dong Gyu Na, Sohyun Park, Ji-In Bang, Kyorim Back, Youngduk Seo, Young-Ik Son, Young Shin Song, Dong Yeob Shin, Jong-hyuk Ahn, Hwa Young Ahn, So Won Oh, Ho-Ryun Won, Won Sang Yoo, Min Kyoung Lee, Sang-Woo Lee, Jeongmin Lee, Ji Ye Lee, Dong-Jun Lim, Ki-Wook Chung, Ari Chong, Jin Hyang Jung, Sun Wook Cho, Yoon Young Cho, Chae Moon Hong, Young Joo Park, Korean Thyroid Association Guideline Committee on the Management of Thyroid Nodule and Cancer; Endocrinol Metab. 2026;41(4):493-534. Published online August 31, 2026; DOI: https://doi.org/10.3803/EnM.2026.3149

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In patients with differentiated thyroid cancer, initial recurrence-risk stratification based on clinical, histopathological, and perioperative findings remains central to management during the first 1–2 years after initial treatment. Ongoing risk stratification (ORS) complements this initial assessment by continuously integrating longitudinal clinical data and treatment response, thereby refining long-term prognostic assessment and supporting individualized risk-adapted management. Building on the 2024 Korean Thyroid Association (KTA) guidelines, the 2026 KTA guideline incorporates new evidence from large Korean multicenter cohorts and comprehensive systematic reviews. The updated recommendations reinforce the continued application of ORS and provide more specific guidance on risk-adapted thyroid-stimulating hormone (TSH) targets, surveillance strategies for recurrence detection, and long-term follow-up tailored to individual recurrence risk and treatment response. Consistent with the evolving paradigm toward risk-adapted and individualized management, this revision updates recommendations regarding target serum TSH levels, serum thyroglobulin thresholds for response assessment and long-term surveillance, and follow-up intervals based on both initial-risk category and the ORS response category. These evidence-based recommendations aim to minimize unnecessary treatment and excessive surveillance in the majority of patients who have an excellent prognosis after initial therapy while ensuring individualized long-term management for patients who require closer surveillance or additional therapeutic intervention.

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Postoperative Surveillance in Differentiated Thyroid Cancer: Response-Adapted De-Escalation in the 2025 American Thyroid Association and 2026 Korean Thyroid Association Guidelines
Sun Wook Cho
Endocrinology and Metabolism.2026; 41(4): 535. CrossRef

Original Article

Thyroid
BRAF Mutation and Tumor Growth Kinetics during Active Surveillance of Papillary Thyroid Microcarcinoma: A Single-Center Retrospective Study: Jinyoung Kim, Min Kyoung Lee, Tae-Jung Kim, Dong-Jun Lim, Ki-Hyun Baek; Endocrinol Metab. 2026;41(3):461-469. Published online June 9, 2026; DOI: https://doi.org/10.3803/EnM.2025.2821

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Abstract PDF Supplementary Material PubReader ePub: Background
We investigated tumor volume doubling time (TVDT) during active surveillance of papillary thyroid microcarcinoma (PTMC) and reviewed clinical factors including BRAF mutation associated with tumor progression.
Methods
Patients with PTMC who deferred surgery for more than 1 year after diagnosis between 2014 and 2021 and were followed until 2023 were enrolled. Inclusion criteria were papillary thyroid carcinoma confirmed by fine needle aspiration cytology (Bethesda categories V–VI), maximal tumor diameter ≤1 cm, and available BRAF mutation testing.
Results
A total of 85 patients were included. The median age was 49 years, and 63 patients (74%) were female. The positivity rate for BRAF mutation was 51% in the study cohort, and 16 patients (19%) showed rapid-growing disease, defined by a TVDT of less than 5 years. The median follow-up duration was 4.4 years, and 23 patients (27%) underwent surgery after a median of 3.2 years. When TVDT groups were analyzed using logistic regression, sonographic features with microcalcification were associated with tumor growth in binary regression (odds ratio for the group combining slowly and rapid-growing disease was 4.34; 95% confidence interval [CI], 1.41 to 13.35; P=0.010), and BRAF mutation was associated with rapid-growing disease in multinomial regression (odds ratio for rapid-growing disease was 4.48; 95% CI, 1.08 to 18.51; P=0.038).
Conclusion
BRAF mutation is presumed to be associated with tumor progression and may predict growth of PTMC. Genetic testing including BRAF testing may help distinguishing rapid-growing thyroid cancer.

Review Article

Thyroid
2025 Korean Thyroid Association Clinical Management Guideline on Active Surveillance for Low-Risk Papillary Thyroid Carcinoma: Eun Kyung Lee, Min Joo Kim, Seung Heon Kang, Bon Seok Koo, Kyungsik Kim, Mijin Kim, Bo Hyun Kim, Ji-hoon Kim, Shinje Moon, Kyorim Back, Young Shin Song, Jong-hyuk Ahn, Hwa Young Ahn, Ho-Ryun Won, Won Sang Yoo, Min Kyoung Lee, Jeongmin Lee, Ji Ye Lee, Kyong Yeun Jung, Chan Kwon Jung, Yoon Young Cho, Dong-Jun Lim, Sun Wook Kim, Young Joo Park, Dong Gyu Na, Jee Soo Kim; Endocrinol Metab. 2025;40(3):307-341. Published online June 24, 2025; DOI: https://doi.org/10.3803/EnM.2025.2461

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The increasing detection of papillary thyroid microcarcinoma (PTMC) has raised concerns regarding overtreatment. For low-risk PTMC, either immediate surgery or active surveillance (AS) can be considered. To facilitate the implementation of AS, the Korean Thyroid Association convened a multidisciplinary panel and developed the first Korean guideline. AS is recommended for adults with pathologically confirmed Bethesda V–VI PTMC who have no clinical evidence of lymph node or distant metastasis, gross extrathyroidal extension, invasion of the trachea or recurrent laryngeal nerve, or aggressive histology. A baseline assessment requires high-resolution neck ultrasound performed by experienced operators to exclude extrathyroidal extension, tracheal or recurrent laryngeal nerve invasion, and lymph node metastasis; contrast-enhanced neck computed tomography is optional. Patient characteristics, including age, comorbidities, and the capacity for long-term follow-up, should be thoroughly assessed. Shared decision-making should carefully weigh the benefits and risks of surgery versus AS, considering expected oncologic outcomes, potential complications, quality of life, anxiety, medical costs, and patient preference. Follow-up involves neck ultrasound and thyroid function tests every 6 months for 2 years and annually thereafter. Disease progression, defined as significant tumor growth or newly detected nodal or distant metastasis, warrants surgery. Despite remaining uncertainties, this guideline provides a structured framework to ensure oncologic safety and supports patient-centered AS.

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Current Oncology.2026; 33(2): 98. CrossRef
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The Oncologist.2026;[Epub] CrossRef
Controlled minimally invasive surgical interventions for the treatment of patients with thyroid carcinoma
David D. Dolidze, Zurab A. Bagatelia, Suren G. Laboyan, Arshak V. Vardanyan, Konstantin S. Titov, Ivan N. Lebedinsky, Georgi Genadi Melkonyan, Dmitriy V. Matveev, Nodar N. Gogitidze, Andrei Y. Lukin, Armen R. Oganyan, David G. Gogolashvili, Anastasia V. B
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Aydan Farzaliyeva, Feride Pınar Altay, Ozlem Turhan Iyidir, Neslihan Bascil Tutuncu
Medicina.2026; 62(5): 981. CrossRef
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Korean Journal of Radiology.2026; 27(9): 908. CrossRef
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World Journal of Surgical Oncology.2026;[Epub] CrossRef
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Original Articles

Thyroid Thyroid Cancer Screening
Diagnostic Performance of Ultrasound-Based Risk Stratification Systems for Thyroid Nodules: A Systematic Review and Meta-Analysis: Leehi Joo, Min Kyoung Lee, Ji Ye Lee, Eun Ju Ha, Dong Gyu Na; Endocrinol Metab. 2023;38(1):117-128. Published online February 27, 2023; DOI: https://doi.org/10.3803/EnM.2023.1670

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Background
This study investigated the diagnostic performance of biopsy criteria in four society ultrasonography risk stratification systems (RSSs) for thyroid nodules, including the 2021 Korean (K)-Thyroid Imaging Reporting and Data System (TIRADS).
Methods
The Ovid-MEDLINE, Embase, Cochrane, and KoreaMed databases were searched and a manual search was conducted to identify original articles investigating the diagnostic performance of biopsy criteria for thyroid nodules (≥1 cm) in four widely used society RSSs.
Results
Eleven articles were included. The pooled sensitivity and specificity were 82% (95% confidence interval [CI], 74% to 87%) and 60% (95% CI, 52% to 67%) for the American College of Radiology (ACR)-TIRADS, 89% (95% CI, 85% to 93%) and 34% (95% CI, 26% to 42%) for the American Thyroid Association (ATA) system, 88% (95% CI, 81% to 92%) and 42% (95% CI, 22% to 67%) for the European (EU)-TIRADS, and 96% (95% CI, 94% to 97%) and 21% (95% CI, 17% to 25%) for the 2016 K-TIRADS. The sensitivity and specificity were 76% (95% CI, 74% to 79%) and 50% (95% CI, 49% to 52%) for the 2021 K-TIRADS_1.5 (1.5-cm size cut-off for intermediate-suspicion nodules). The pooled unnecessary biopsy rates of the ACR-TIRADS, ATA system, EU-TIRADS, and 2016 K-TIRADS were 41% (95% CI, 32% to 49%), 65% (95% CI, 56% to 74%), 68% (95% CI, 60% to 75%), and 79% (95% CI, 74% to 83%), respectively. The unnecessary biopsy rate was 50% (95% CI, 47% to 53%) for the 2021 K-TIRADS_1.5.
Conclusion
The unnecessary biopsy rate of the 2021 K-TIRADS_1.5 was substantially lower than that of the 2016 K-TIRADS and comparable to that of the ACR-TIRADS. The 2021 K-TIRADS may help reduce potential harm due to unnecessary biopsies.

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Marcio J. Concepción-Zavaleta, Jenyfer M. Fuentes-Mendoza, Cristian A. Rojas-Hipólito, Daniela Sánchez-Mejía, Mariana A. López-Torres, Luis Concepción-Urteaga, Cristian D. Armas, José Paz-Ibarra
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THE IMPACT OF STANDARDIZATION IN ULTRASOUND DIAGNOSTICS AND THE UNIFICATION OF TI-RADS ON THE JUSTIFICATION FOR REFERRING THYROID NODULES FOR FINE-NEEDLE ASPIRATION BIOPSY
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Endocrine.2025; 88(3): 766. CrossRef
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Andrea Leoncini, Pierpaolo Trimboli
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Rasha Nadeem Ahmed, Maysaloon Shaman Saeed, Nazar M. T. Jawhar, Mohamed Tarek El-Diasty, Noha Yahia Ebaid, Mostafa Mohamad Assy
Egyptian Journal of Radiology and Nuclear Medicine.2025;[Epub] CrossRef
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European Thyroid Journal.2025;[Epub] CrossRef
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Archives of Endocrinology and Metabolism.2024;[Epub] CrossRef
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2023 Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules
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Clinical Study
Effectiveness of Injecting Cold 5% Dextrose into Patients with Nerve Damage Symptoms during Thyroid Radiofrequency Ablation: Min Kyoung Lee, Jung Hwan Baek, Sae Rom Chung, Young Jun Choi, Yu-Mi Lee, Tae Yong Kim, Jeong Hyun Lee; Endocrinol Metab. 2020;35(2):407-415. Published online June 24, 2020; DOI: https://doi.org/10.3803/EnM.2020.35.2.407

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Background
Although radiofrequency ablation (RFA) is a safe treatment for thyroid tumors, nerve damage is a frequent complication. A previous retrospective study suggested that an injection of cold 5% dextrose in water (5% DW) can reduce nerve damage during RFA. This study validated the efficacy of injecting cold 5% DW for management of nerve damage during RFA.
Methods
Between November 2017 and December 2018, 242 patients underwent 291 RFA sessions for treatment of benign thyroid nodules or recurrent thyroid cancers. Using a standardized technique, cold (0°C to 4°C) 5% DW was immediately injected around the damaged nerve into patients with any symptoms suggesting nerve damage. The incidence of nerve damage, the volume of 5% DW injected, symptom recovery time and the incidence of permanent nerve damage were evaluated.
Results
Nineteen patients experienced nerve damage symptoms related to 21 RFA sessions, including 17 patients during 19 sessions and two patients on the day after two sessions. Patients with nerve damage symptoms detected during RFA were treated by injection of a mean 41 mL (range, 3 to 260) cold 5% DW, but the two patients who experienced symptoms the next day did not receive cold 5% DW injections. Immediate recovery was observed after 15 RFA sessions in 14 patients. No patient experienced permanent nerve damage.
Conclusion
Injection of cold 5% DW is effective in managing nerve damage during RFA of thyroid lesions.

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