Endocrines

Background: Obesity has been proposed as a risk factor for differentiated thyroid carcinoma (DTC), though findings in the literature remain conflicting. While some studies suggest an association between elevated body mass index (BMI) and thyroid malignancy, others attribute this link to diagnostic bias. The Calabria region in Southern Italy, historically affected by iodine deficiency and endemic goiter, offers a valuable population for investigating this relationship. Objective: This study aimed to evaluate the association between obesity and clinical, sonographic, and cytological characteristics of thyroid nodules in a Calabrian cohort undergoing fine-needle aspiration biopsy (FNAB). Methods: This retrospective observational study included 1192 patients evaluated at a single endocrine referral center between 2015 and 2024. Patients were stratified by BMI (<30 vs. ≥30 kg/m²). Demographic, biochemical, ultrasound, and cytological data were collected and analyzed. Cytological results were classified according to the SIAPEC 2014 system. Results: Obese patients had significantly larger thyroid nodules in terms of anteroposterior and transverse diameters, as well as overall volume (p < 0.05). However, the distribution of high-risk cytological categories (TIR 3B, TIR 4, and TIR 5) did not differ significantly between obese and non-obese patients (9.4% in both groups). Multivariate analysis confirmed that BMI was not an independent predictor of malignancy risk (OR 0.988; p = 0.723), whereas younger age was inversely associated with malignancy. Conclusions: Obesity appears to influence thyroid nodule size but does not constitute an independent risk factor for cytological malignancy. BMI should not influence indications for FNAB or subsequent treatment decisions. Thyroid nodule management should instead rely on ultrasound risk stratification and cytological findings. Special attention should be given to younger patients as they may carry a higher malignancy risk.

Background: The oral glucose tolerance test (OGTT) is the gold standard for diagnosing diabetes; however, its use is often limited by the need for laboratory infrastructure, trained personnel, and extended turnaround times. In contrast, glucometer-based OGTT offers a convenient and affordable alternative, especially in resource-limited settings. Objective: This narrative review aims to assess the diagnostic accuracy of glucometer-based OGTT compared to standard laboratory-based OGTT, while also evaluating its feasibility and potential application in diabetes screening programs. Evidence Summary: Studies consistently demonstrate a strong correlation between capillary glucose levels measured by glucometers and venous plasma glucose concentrations obtained through standard laboratory methods. Many studies reported high sensitivity and specificity, often exceeding 90%, particularly when using well-calibrated, newer-generation devices. These findings support the diagnostic utility of glucometer-based OGTT in various populations, although performance may vary by device model and clinical context. Standardization of testing protocols remains essential for consistent results. Conclusions: Glucometer-based OGTT shows promise as a reliable, rapid and cost-effective diagnostic approach, particularly in low-resource and community-based settings. While it is not a complete substitute for laboratory-based OGTT, it offers substantial advantages in accessibility, affordability, and scalability. Continued research with newer-generation glucometers and standardized testing protocols is essential to support broader clinical implementation and public health integration.

The intersection of type 2 diabetes mellitus (T2DM) and sarcopenia, often termed diabetic sarcopenia, represents a critical yet underrecognized comorbidity that significantly impacts the quality of life and functional capacity of older adults. This paper explores the complex interplay between T2DM and sarcopenia, focusing on the prevalence, risk factors, and underlying mechanisms driving muscle mass and strength decline in this population. Drawing from recent clinical studies, we highlight a prevalence of sarcopenia ranging from 15.36% to 30.2% among elderly T2DM patients, with notable gender disparities (41.3% in men versus 20.1% in women) and regional variations. Key risk factors identified include poor glycemic control (HbA1c ≥8%), longer diabetes duration (>5 years), low body mass index (BMI), and reduced levels of 25-hydroxyvitamin D and insulin-like growth factor-1 (IGF-1). We also recommend a practical screening algorithm for diabetic sarcopenia, integrating tools like the SARC-F questionnaire, dynamometry, and BMI-adjusted calf circumference to facilitate early diagnosis and staging in clinical settings. The review underscores the need for a multidisciplinary approach—encompassing pharmacological optimization, nutritional interventions with high-protein diets, and tailored physical exercise—to mitigate muscle loss and improve metabolic outcomes. Future research directions should focus on validating diagnostic protocols and diagnosis techniques and further exploring specific therapies to effectively address this dual burden.