Special Issue "New Insights in Thyroid Diagnostics"

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging".

Deadline for manuscript submissions: closed (31 May 2020).

Special Issue Editor

Assoc. Prof. Doina Piciu
Website
Guest Editor
Prof. Dr. Ion Chiricuță Institute of Oncology, Department of Nuclear Medicine, 400015 Cluj-Napoca, Romania; Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
Interests: thyroid diagnostic; PET/CT; genetics; quality of life

Special Issue Information

Dear Colleagues, 

Thyroid pathologies are considered the most frequent endocrine disorders and thyroid carcinoma the most frequent endocrine malignant disease. The polymorphism of the symptoms in benign thyroid pathology and the dramatic increase of the incidence of thyroid nodules underline the necessity of continuous research in the field, for better and appropriate diagnosis and therapies. The era of precise medicine and personalized therapies needs new diagnostic approaches, based on the already standardized protocols, but bringing better accuracy and better pathophysiologic understandings.  This Special Issue on “New insights in Thyroid Diagnostics” will focus on novel strategies of clinical and imaging diagnostics, together with serological, histological, genetic, and molecular analysis, which tend to be more and more present in daily practice. Further, the results of studies regarding the diagnostics of modified quality of life in thyroid patients are welcome, together with papers focusing on multiple malignancies associated with thyroid disease, benign or malignant.  Researchers are encouraged to publish their work in this field, both with respect to benign thyroid diseases and thyroid carcinomas, including original articles or systematic reviews. 

Assoc. Prof. Doina Piciu
Guest Editor

Manuscript Submission Information

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Keywords

  • Thyroid benign disease;
  • PET/CT;
  • Genetic analysis;
  • Thyroid carcinoma;
  • Microcarcinoma;
  • Quality of life.

Published Papers (13 papers)

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Research

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Open AccessArticle
False-Positive Malignant Diagnosis of Nodule Mimicking Lesions by Computer-Aided Thyroid Nodule Analysis in Clinical Ultrasonography Practice
Diagnostics 2020, 10(6), 378; https://doi.org/10.3390/diagnostics10060378 - 06 Jun 2020
Abstract
This study aims to test computer-aided diagnosis (CAD) for thyroid nodules in clinical ultrasonography (US) practice with a focus towards identifying thyroid entities associated with CAD system misdiagnoses. Two-hundred patients referred to thyroid US were prospectively enrolled. An experienced radiologist evaluated the thyroid [...] Read more.
This study aims to test computer-aided diagnosis (CAD) for thyroid nodules in clinical ultrasonography (US) practice with a focus towards identifying thyroid entities associated with CAD system misdiagnoses. Two-hundred patients referred to thyroid US were prospectively enrolled. An experienced radiologist evaluated the thyroid nodules and saved axial images for further offline blinded analysis using a commercially available CAD system. To represent clinical practice, not only true nodules, but mimicking lesions were also included. Fine needle aspiration biopsy (FNAB) was performed according to present guidelines. US features and thyroid entities significantly associated with CAD system misdiagnosis were identified along with the diagnostic accuracy of the radiologist and the CAD system. Diagnostic specificity regarding the radiologist was significantly (p < 0.05) higher than when compared with the CAD system (88.1% vs. 40.5%) while no significant difference was found in the sensitivity (88.6% vs. 80%). Focal inhomogeneities and true nodules in thyroiditis, nodules with coarse calcification and inspissated colloid cystic nodules were significantly (p < 0.05) associated with CAD system misdiagnosis as false-positives. The commercially available CAD system is promising when used to exclude thyroid malignancies, however, it currently may not be able to reduce unnecessary FNABs, mainly due to the false-positive diagnoses of nodule mimicking lesions. Full article
(This article belongs to the Special Issue New Insights in Thyroid Diagnostics)
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Open AccessArticle
Loss of Integrase Interactor 1 (INI1) Expression in a Subset of Differentiated Thyroid Cancer
Diagnostics 2020, 10(5), 280; https://doi.org/10.3390/diagnostics10050280 - 05 May 2020
Abstract
Alterations in the switching defective/sucrose non-fermenting (SWI/SNF) chromatin-remodeling complex are enriched in advanced thyroid cancer. Integrase interactor 1 (INI1), encoded by the SMARCB1 gene on the long arm of chromosome 22, is one of the core subunits of the SWI/SNF complex. INI1 immunohistochemistry [...] Read more.
Alterations in the switching defective/sucrose non-fermenting (SWI/SNF) chromatin-remodeling complex are enriched in advanced thyroid cancer. Integrase interactor 1 (INI1), encoded by the SMARCB1 gene on the long arm of chromosome 22, is one of the core subunits of the SWI/SNF complex. INI1 immunohistochemistry is frequently used for the diagnosis of malignant rhabdoid neoplasms. In the present study, we found normal and benign thyroid tissues generally had diffusely intense nuclear immunostaining. Loss of INI1 immunohistochemical expression was observed in 8% of papillary thyroid cancer and 30% of follicular thyroid cancer. Furthermore, loss of INI1 expression was associated with extrathyroidal extension (p < 0.001) and lymph node metastasis (p = 0.038). Analysis of The Cancer Genome Atlas database revealed that SMARCB1 underexpression was associated with the follicular variant subtype and aneuploidy in papillary thyroid cancer. We speculate that SMARCB1 is an important effector in addition to NF2 and CHEK2 inactivation among thyroid cancers with chromosome 22q loss. Full article
(This article belongs to the Special Issue New Insights in Thyroid Diagnostics)
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Open AccessArticle
Thyroid Pathology in End-Stage Renal Disease Patients on Hemodialysis
Diagnostics 2020, 10(4), 245; https://doi.org/10.3390/diagnostics10040245 - 23 Apr 2020
Abstract
Objectives: Chronic kidney disease is a rising cause of morbidity and mortality in developed countries, including end-stage renal disease (ESRD). The prevalence of thyroid comorbidities in persons with chronic kidney disease is documented higher than in normal population. The study aims to investigate [...] Read more.
Objectives: Chronic kidney disease is a rising cause of morbidity and mortality in developed countries, including end-stage renal disease (ESRD). The prevalence of thyroid comorbidities in persons with chronic kidney disease is documented higher than in normal population. The study aims to investigate the prevalence of morphological and functional thyroid disorders in patients with chronic kidney disease, with renal replacement therapy (hemodialysis). Methods: A cross-sectional study was performed on 123 consecutive patients with chronic kidney disease stage 5, on hemodialysis during a period of one month (May 2019–June 2020). All patients were enrolled for maintenance hemodialysis in B Braun Hemodialysis Center Timisoara and were examined on conventional 2B ultrasound. Thyroid blood tests were done, including serum free thyroxin (FT4), free triiodothyronine (FT3) and thyroid-stimulating hormone (TSH) at the time of starting hemodialysis. Results: We evaluated 123 patients (male to female ratio 70/53) mean age 62.2 ± 11.01, mostly above 65 years old, enrolled in the end-stage renal disease program, on renal replacement therapy. From the cohort, 76/123 presented thyroid disease, including autoimmune hypothyroidism, nodular goiter or thyroid cancer. Among them, 63 patients presented nodular goiter, including 3 thyroid cancers, confirmed by surgery and histopathological result, 22 patients had thyroid autoimmune disease. The serum thyroid-stimulating hormone levels found in the cohort was 3.36 ± 2.313 mUI/mL, which was in the normal laboratory reference range. The thyroid volume was 13 ± 7.18 mL. A single patient in the cohort presented Graves Basedow disease, under treatment and three patients present subclinical hyperthyroidism. We have found that thyroid disease risk is increased by 3.4-fold for the female gender and also the increase of body mass index (BMI) with one unit raises the risk of developing thyroid disease with 1.083 times (p = 0.018). Conclusion: To conclude, this study aimed to quantify the prevalence of thyroid disease in end-stage kidney disease population, especially nodular goiter, important for differential diagnosis in cases with secondary hyperparathyroidism. Thyroid autoimmune disease can be prevalent among these patients, as symptoms can overlap those of chronic disease and decrease the quality of life. We have found that thyroid disease has a high prevalence among patients with end-stage renal disease on hemodialysis. Thyroid goiter and nodules in ESRD patients were more prevalent than in the general population. Clinical surveillance and routine screening for thyroid disorders can improve the quality of life in these patients. Full article
(This article belongs to the Special Issue New Insights in Thyroid Diagnostics)
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Open AccessArticle
Post-Treatment Thyroid Diseases in Children with Brain Tumors: A Single-Center Experience at “Prof. Dr. Ion Chiricuță” Institute of Oncology, Cluj-Napoca
Diagnostics 2020, 10(3), 142; https://doi.org/10.3390/diagnostics10030142 - 05 Mar 2020
Abstract
Aim of study: The purpose of the study was to evaluate the association of thyroid dysfunction occurring in pediatric patients treated for brain tumors. Patients and methods: A total of 255 patients with brain tumors were treated between 2001 and 2018 at the [...] Read more.
Aim of study: The purpose of the study was to evaluate the association of thyroid dysfunction occurring in pediatric patients treated for brain tumors. Patients and methods: A total of 255 patients with brain tumors were treated between 2001 and 2018 at the “Prof. Dr. Ion Chiricuță” Institute of Oncology, Cluj-Napoca. Due to a minimum follow-up of 4 years, we studied 184 out of the 255 patients. The cohort included 69 girls (37.5%) and 109 boys (62.5%), with a median age of 8.4 years. The evaluated tumors included medulloblastomas (47 patients), astrocytomas (44 patients), ependymomas (22 patients), gliomas (20 patients), germ cell tumors (12 patients), primitive neuroectodermal tumors (4 patients), as well as other types of tumors (15 patients); in 20 of the cases, biopsy could not be performed. Results: There was a 60% overall survival rate; among the 120 surviving patients, 11 (9.1%) were diagnosed with iatrogenic thyroid disease. We observed an important number of iatrogenic thyroid disease cases in this group of patients, thus revealing the importance of long-term thyroid function evaluation in all children who finalized their treatment for brain tumors. Through this study, we aimed to provide an accurate image of the methodology of monitoring for thyroid dysfunction in childhood brain tumor survivors. Conclusion: Given the fact that the probability of developing thyroid dysfunction in the pediatric population treated for brain tumors is not rare, we recommend that childhood brain tumor survivors be monitored for iatrogenic thyroid disease, in order to provide early diagnosis and treatment. Full article
(This article belongs to the Special Issue New Insights in Thyroid Diagnostics)
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Open AccessArticle
Analysis of Let-7 Family miRNA in Plasma as Potential Predictive Biomarkers of Diagnosis for Papillary Thyroid Cancer
Diagnostics 2020, 10(3), 130; https://doi.org/10.3390/diagnostics10030130 - 28 Feb 2020
Cited by 1
Abstract
The most common histological type of thyroid cancer is papillary thyroid carcinoma (PTC). Radical resection of the thyroid gland is currently the recommended method of treatment. Almost 75% of thyroidectomies performed just for diagnostic purposes are benign. Thus, the confirmation of innovative and [...] Read more.
The most common histological type of thyroid cancer is papillary thyroid carcinoma (PTC). Radical resection of the thyroid gland is currently the recommended method of treatment. Almost 75% of thyroidectomies performed just for diagnostic purposes are benign. Thus, the confirmation of innovative and more precise noninvasive biomarkers holds promise for the detection of PTC, which may decrease the number of unnecessary thyroid lobectomies. In this work, using the droplet digital PCR (ddPCR) method, we have analyzed the level of five miRNAs (let-7a, let-7c, let-7d, let-7f, and let-7i) in the plasma of patients with PTC and compared them with those of a healthy control group to investigate whether miRNAs also have value in the management of PTC. Levels of four miRNAs, namely let-7a, let-7c, let-7d, and let-7f, were significantly higher in PTC patients than healthy controls. Thus, the analysis of circulating let-7 can be a useful tool and support the currently used methods for PTC diagnosis. However, our observation requires further research on a larger patient group. Full article
(This article belongs to the Special Issue New Insights in Thyroid Diagnostics)
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Review

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Open AccessReview
The Influence of Thyroid Pathology on Osteoporosis and Fracture Risk: A Review
Diagnostics 2020, 10(3), 149; https://doi.org/10.3390/diagnostics10030149 - 07 Mar 2020
Abstract
Thyroid hormones are important factors that regulate metabolism and cell differentiation throughout the human body. A complication of thyroid pathology is represented by an alteration of the bone metabolism which can lead to osteoporosis and fragility fractures, known to have a high mortality [...] Read more.
Thyroid hormones are important factors that regulate metabolism and cell differentiation throughout the human body. A complication of thyroid pathology is represented by an alteration of the bone metabolism which can lead to osteoporosis and fragility fractures, known to have a high mortality rate. Although there is a consensus on the negative impact of hyperthyroidism on bone metabolism, when referring to hypothyroidism, subclinical hypothyroidism, or subclinical hyperthyroidism, there is no general agreement. The aim of our review was to update clinicians and researchers about the current data regarding the bone health in hypothyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism patients. Thyroid disorders have an important impact on bone metabolism and fracture risk, such that hyperthyroidism, hypothyroidism, and subclinical hyperthyroidism are associated with a decreased bone mineral density (BMD) and increased risk of fracture. Subclinical hypothyroidism, on the other hand, is not associated with osteoporosis or fragility fractures, and subclinical hyperthyroidism treatment with radioiodine could improve bone health. Full article
(This article belongs to the Special Issue New Insights in Thyroid Diagnostics)
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Open AccessReview
Pediatric Thyroid Cancer in Europe: An Overdiagnosed Condition? A Literature Review
Diagnostics 2020, 10(2), 112; https://doi.org/10.3390/diagnostics10020112 - 19 Feb 2020
Abstract
Thyroid neoplastic pathology is the most common form of cancer associated with radiation exposure. The most common histopathological type of thyroid carcinoma is the differentiated thyroid cancer (these include papillary and follicular type), which represents over 90% of all cases, especially affecting girls [...] Read more.
Thyroid neoplastic pathology is the most common form of cancer associated with radiation exposure. The most common histopathological type of thyroid carcinoma is the differentiated thyroid cancer (these include papillary and follicular type), which represents over 90% of all cases, especially affecting girls rather than boys. Although patients are diagnosed in advanced stages as compared to adults, the prognosis of the disease is very good, with a 30-year survival rate of over 95% but post-therapeutic morbidity remains quite high. The treatment is based in particular on the therapeutic guidelines for adults, but as children have some histopathological and genetic characteristics of thyroid cancer, as well as different initial clinical presentations, we decided to review the literature on this pathology among the pediatric population, focusing on cases in Europe. The major interest is the impact of the Chernobyl accident. Full article
(This article belongs to the Special Issue New Insights in Thyroid Diagnostics)
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Open AccessReview
Skeletal Muscle Metastasis in Papillary Thyroid Microcarcinoma Evaluated by F18-FDG PET/CT
Diagnostics 2020, 10(2), 100; https://doi.org/10.3390/diagnostics10020100 - 12 Feb 2020
Cited by 1
Abstract
Papillary thyroid cancer (PTC) is the most common type of thyroid malignancy and is characterized by slow growth and an indolent biological behavior. Papillary thyroid microcarcinoma is the PTC with the maximum size of the tumor <1cm, considered the most indolent form of [...] Read more.
Papillary thyroid cancer (PTC) is the most common type of thyroid malignancy and is characterized by slow growth and an indolent biological behavior. Papillary thyroid microcarcinoma is the PTC with the maximum size of the tumor <1cm, considered the most indolent form of thyroid cancer. PTC is usually metastasizes in cervical lymph nodes, lungs and bones and, less commonly, in brain or liver. Skeletal muscle metastases from PTC are extremely rare, a retrospective review of the literature revealed only 13 case reports. Among them, six cases are solitary skeletal muscle metastases, and seven are multiple metastases, most of them being associated with lung lesions. It seems that PTC is prone to metastasizing to the erector spinae and thigh muscles groups with unique cases located in trapezoid, biceps, deltoid, gastrocnemius and rectus abdominis muscles. Although extremely rare, one must bear in mind the fact that muscle metastasis from PTC is possible, and that is the reason we would like to discuss the existing clinical cases and to add a unique case of solitary skeletal muscle metastasis from papillary microcarcinoma. Full article
(This article belongs to the Special Issue New Insights in Thyroid Diagnostics)
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Other

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Open AccessReply
Reply to “Missing Skeletal Muscle Metastases of Papillary Thyroid Carcinoma”
Diagnostics 2020, 10(7), 458; https://doi.org/10.3390/diagnostics10070458 - 06 Jul 2020
(This article belongs to the Special Issue New Insights in Thyroid Diagnostics)
Open AccessComment
Missing Skeletal Muscle Metastases of Papillary Thyroid Carcinoma
Diagnostics 2020, 10(7), 457; https://doi.org/10.3390/diagnostics10070457 - 06 Jul 2020
Abstract
With regard to several important gaps in the work “Skeletal Muscle Metastasis in Papillary Thyroid Microcarcinoma Evaluated by F18-FDG PET/CT” [...] Full article
(This article belongs to the Special Issue New Insights in Thyroid Diagnostics)
Open AccessCase Report
Thyrotoxic Periodic Paralysis—A Misleading Challenge in the Emergency Department
Diagnostics 2020, 10(5), 316; https://doi.org/10.3390/diagnostics10050316 - 18 May 2020
Cited by 1
Abstract
Despite its’ life-threatening potential due to cardiac severe dysrhythmia in the context of severe hypokalemia, thyrotoxic periodic paralysis (TPP) often goes unrecognized. Although classically confined to young Asian men, it can occur irrespective of age, sex, and race. We report a short series [...] Read more.
Despite its’ life-threatening potential due to cardiac severe dysrhythmia in the context of severe hypokalemia, thyrotoxic periodic paralysis (TPP) often goes unrecognized. Although classically confined to young Asian men, it can occur irrespective of age, sex, and race. We report a short series of three cases of TPP as first presentation of Graves’ disease in a young Caucasian male and in two Caucasian elderly and middle-aged women, respectively. The first patient developed malignant ventricular arrhythmias due to severe hypokalemia and was defibrillated, with recovery after prompt potassium correction and administration of antithyroid agents and propranolol. The other two cases developed persistent hypokalemia despite adequate potassium chloride (KCl) repletion, with slow recovery of motor deficit and serum potassium normalization up to day 5. In the first case, long-term euthyroid state was achieved via total thyroidectomy due to the presence of a suspicious nodule that proved to be malignant. In the other two cases, medical treatment was the choice of therapy for thyrotoxicosis. None experienced recurrent TPP. Thyroid hormone evaluation is mandatory in the presence of hypokalemic paralysis, even in the absence of clinical signs of thyrotoxicosis. If TPP is confirmed, initial therapy should comprise antithyroid drugs and propranolol, besides hypokalemia correction. Full article
(This article belongs to the Special Issue New Insights in Thyroid Diagnostics)
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Open AccessCase Report
Triple Metachronous Malignancies with Thyroid Involvement: A Brief Overview of Five Case Reports over 20 Years of Institutional Experience
Diagnostics 2020, 10(3), 168; https://doi.org/10.3390/diagnostics10030168 - 20 Mar 2020
Abstract
Multiple primary malignant tumors are defined by the development of more than one malignancy in a single patient. These can be subdivided into synchronous or metachronous malignant tumors, depending on their time of appearance, relative to the first malignancy. Triple primary malignancies are [...] Read more.
Multiple primary malignant tumors are defined by the development of more than one malignancy in a single patient. These can be subdivided into synchronous or metachronous malignant tumors, depending on their time of appearance, relative to the first malignancy. Triple primary malignancies are a relatively rare occurrence in day-to-day practice and triple synchronous or metachronous carcinomas involving a thyroid localization are even less common. In this case series, we report our 20-year experience in diagnosing and managing five patients with triple malignant tumors with thyroid involvement. Full article
(This article belongs to the Special Issue New Insights in Thyroid Diagnostics)
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Open AccessCase Report
Papillary Thyroid Cancer in a Struma Ovarii in a 17-Year-Old Nulliparous Patient: A Case Report
Diagnostics 2020, 10(1), 45; https://doi.org/10.3390/diagnostics10010045 - 15 Jan 2020
Abstract
Introduction: Struma ovarii accounts for 2% of mature teratomas. Struma ovarii is diagnosed when thyroid tissue accounts for >50% of the teratoma. Malignant transformation is rare, occurring in <5% of struma ovarii cases. Case presentation: A 17-year-old patient was diagnosed with papillary thyroid [...] Read more.
Introduction: Struma ovarii accounts for 2% of mature teratomas. Struma ovarii is diagnosed when thyroid tissue accounts for >50% of the teratoma. Malignant transformation is rare, occurring in <5% of struma ovarii cases. Case presentation: A 17-year-old patient was diagnosed with papillary thyroid cancer in struma ovarii. The patient exhibited menstrual disorders. Abdominal and pelvic CT revealed a 17 cm mass in the left adnexa. Laparoscopic removal of the left adnexa with enucleation of right ovarian cysts was performed. Histopathological diagnosis was a follicular variant papillary carcinoma measuring 23 mm in diameter. Immunohistochemical positive expression of CK19, TTF-1, and thyroglobulin (Tg) confirmed the diagnosis. Molecular analysis detected the BRAF K601E mutation in ovarian tumor tissues. Preoperative serum Tg concentration was >300 ng/mL, which decreased to 38.2 ng/mL after gynecological surgery with undetectable anti-Tg antibodies. The patient underwent total thyroidectomy with no cancer detected on histopathological examination. The patient was treated with I-131 and showed no recurrence 4 years after the diagnosis. Conclusions: Malignant struma ovarii is diagnosed by surgery. Because papillary carcinoma in struma ovarii is rare and there are no guidelines regarding the management of this type of cancer, therapeutic decisions should be made individually based on clinical and pathological data. Full article
(This article belongs to the Special Issue New Insights in Thyroid Diagnostics)
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