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Thyroid Disease: Updates from Diagnosis to Treatment: 2nd Edition
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Thyroid Disease: Updates from Diagnosis to Treatment: 2nd Edition

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Endocrinology & Metabolism".

Deadline for manuscript submissions: 15 September 2026 | Viewed by 5618

Special Issue Editors

Dr. Luca Giovanella

E-Mail Website
Guest Editor
1. Nuclear Medicine and Thyroid Diseases, University Hospital of Zurich, Zurich, Switzerland
2. Nuclear Medicine and Thyroid Diseases, Gruppo Ospedaliero Moncucco, Lugano, Switzerland
Interests: clinical thyroidology; parathyroid imaging; laboratory medicine; molecular imaging; PET/CT; thyroid cancer; thyroid diseases; molecular endocrinology
Special Issues, Collections and Topics in MDPI journals
Dr. Petra Petranović Ovčariček

E-Mail Website
Guest Editor
Department of Oncology and Nuclear Medicine, University Hospital Center “Sestre milosrdnice”, Zagreb, Croatia
Interests: thyroid
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

It is my pleasure to invite you to contribute to the Special Issue entitled “Thyroid Disease: Updates from Diagnosis to Treatment: 2nd Edition”. This is one new volume, we published 8 papers in the first volume. For more details, please visit: https://www.mdpi.com/journal/jcm/special_issues/1716S77H3Z.

Thyroid disorders are frequently encountered in clinical daily life and their diagnosis and therapy may involve different specialists using different methods. Laboratory tests and imaging procedures are integral to the diagnosis and management of thyroid disease. The appropriate integration of laboratory, imaging, and (cyto)pathology data is pivotal to refine diagnosis and select patients for different available therapies. Radioiodine (i.e., I-131) therapy constituted the first application of the theranostic approach in clinical practice and is widely used in patients with differentiated thyroid cancer, hyperthyroidism, and non-toxic compressive goiter since 1940s. Accordingly, thyroid diseases represent an ideal platform for developing and evaluating integrated diagnostics and theranostics strategies. The present Issue aims to provide relevant information on different diagnostic methods actionable in thyroid patients and their rational integration (i.e., integrated diagnostics). Furthermore, surgical, pharmacologic, and theragnostic applications for patients with either benign and malignant thyroid diseases will also be illustrated. We invite specialists in clinical thyroidology, endocrine surgery, imaging and theranostics, laboratory research, and (cyto)pathology to share their experience and contribute with original research and reviews to our present Issue.

Dr. Luca Giovanella
Dr. Petra Petranović Ovčariček
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • autoimmune thyroid diseases
  • thyroiditis
  • thyroid cancers
  • PET/CT
  • hyperthyroidism

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Related Special Issue

Published Papers (5 papers)

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Research

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10 pages, 417 KB  
Article
Thyroid Hormone Replacement Dose Is Not Associated with Anti-TPO and Anti-TG Antibody Titers in Hashimoto’s Disease
by Małgorzata Szczuko, Olimpia Szmigiel, Urszula Szczuko, Leon Rudak, Karolina Wrońska, Lidia Kwiatkowska, Małgorzata Tomasik, Anhelli Syrenicz and Jakub Pobłocki
J. Clin. Med. 2026, 15(3), 970; https://doi.org/10.3390/jcm15030970 - 25 Jan 2026
Viewed by 1190
Abstract
Background: Hashimoto’s thyroiditis (HT) is the result of a complex interplay between genetic, environmental, and epigenetic factors. The role of cellular and humoral immunity in the pathogenesis of the disease is well-established. Inflammatory infiltration of T and B lymphocytes is a key [...] Read more.
Background: Hashimoto’s thyroiditis (HT) is the result of a complex interplay between genetic, environmental, and epigenetic factors. The role of cellular and humoral immunity in the pathogenesis of the disease is well-established. Inflammatory infiltration of T and B lymphocytes is a key feature identified on ultrasound examination. The lack of data on the effect of L-thyroxine (LT-4) doses on the level of anti-TPO and anti-TG antibodies in Hashimoto’s thyroiditis and the relationship with anthropometric measurements resulted in the desire to fill this niche. Methods: A total of 70 Caucasian patients diagnosed with Hashimoto’s thyroiditis within the past two years were examined. The participants were divided into three groups based on their L-thyroxine dosage (≤50, 50–100, >100 μg). Results: The results revealed no correlation between the dosage of L-thyroxine and anthropometric measurements (age, height, body weight, and body fat content). No correlation was identified between the levels of anti-TPO and anti-TG and the dose of L-thyroxine in patients with Hashimoto’s thyroiditis. Conclusions: The mechanism regulating the levels of anti-TPO and anti-TG appears to be associated with a more advanced thyroid inflammation and disease process. Long-term observation of patients would be advisable. We present evidence of no effect of hormone dose on antibody levels in Hashimoto’s thyroiditis. Regardless of disease severity, immune regulation remains outside the scope of hormonal regulation. Full article
(This article belongs to the Special Issue Thyroid Disease: Updates from Diagnosis to Treatment: 2nd Edition)
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9 pages, 784 KB  
Article
A TRAb-First Diagnostic Strategy for Overt Hyperthyroidism: Diagnostic Performance and Implications for Reflex Testing
by Petra Petranović Ovčariček, Alfredo Campennì, Federica D’Aurizio, Rosaria Maddalena Ruggeri and Luca Giovanella
J. Clin. Med. 2026, 15(2), 445; https://doi.org/10.3390/jcm15020445 - 6 Jan 2026
Viewed by 752
Abstract
Background/Objectives: To evaluate whether a TSH-receptor antibody (TRAb)-first, one-sample diagnostic strategy improves etiologic classification of overt hyperthyroidism compared with conventional pathways, and to assess its implications for imaging use, diagnostic accuracy, and cost efficiency. Methods: In this multicentre retrospective study, 274 [...] Read more.
Background/Objectives: To evaluate whether a TSH-receptor antibody (TRAb)-first, one-sample diagnostic strategy improves etiologic classification of overt hyperthyroidism compared with conventional pathways, and to assess its implications for imaging use, diagnostic accuracy, and cost efficiency. Methods: In this multicentre retrospective study, 274 adults with newly diagnosed overt hyperthyroidism underwent TRAb measurement, thyroid ultrasound, and scintigraphy during a single clinical encounter. Scintigraphy served as the functional reference standard. We compared the diagnostic performance of TRAb and ultrasound, modeled TRAb-first diagnostic algorithms, and estimated the potential impact of reflex TRAb testing on diagnostic workflow and resource use. Results: Graves’ disease (GD) accounted for 65% of cases. TRAb showed excellent diagnostic accuracy for GD (sensitivity 92.0%, specificity 96.0%; κ = 0.86) and markedly outperformed ultrasound (sensitivity 66.9%, specificity 62.5%; κ = 0.43). A TRAb-first pathway in which TRAb-positive patients are directly classified as GD and TRAb-negative patients undergo scintigraphy achieved 100% sensitivity, 95.8% specificity, and the lowest overall misclassification rate. Replacing scintigraphy with ultrasound in TRAb-negative patients substantially reduced specificity (~60%) and yielded significant overdiagnosis of GD. Ultrasound identified numerous nodules but detected only one low-risk carcinoma (malignancy rate: 1.2%), suggesting limited oncologic yield. A TRAb-first strategy would have avoided two-thirds of scintigraphies and minimized unnecessary imaging. Conclusions: A TRAb-first diagnostic approach offers the most accurate, efficient, and clinically appropriate pathway for etiologic assessment of overt hyperthyroidism. Scintigraphy should be reserved for TRAb-negative patients, while ultrasound should be used selectively for structural evaluation rather than as part of routine etiologic work-up. Reflex TRAb testing may further streamline care by enabling rapid, one-sample etiologic diagnosis and reducing resource use. Full article
(This article belongs to the Special Issue Thyroid Disease: Updates from Diagnosis to Treatment: 2nd Edition)
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17 pages, 1817 KB  
Article
Prolonged Normal Thyroid Function After 131I Radioiodine Therapy Using a Minute LT3 Suppression Test (LT3s-RIT) in Patients with Thyroid Unifocal Autonomy and Baseline Detectable TSH
by Jérôme Clerc, Paul Bodin-Cufi, Louise Giraud, Aurélie Forbes, Emmanuelle Laroche-Masse, Lionel Groussin Rouiller, Louis Schubert, Yvan Mouraeff, Kawtar Hilmy, Anne-Ségolène Cottereau and Eve Piekarski
J. Clin. Med. 2025, 14(21), 7871; https://doi.org/10.3390/jcm14217871 - 6 Nov 2025
Viewed by 1598
Abstract
Background: Subclinical hyperthyroidism grade 1 (SCH G1, TSH > 0.1 mU/L) is common in patients with thyroid unifocal autonomy (UFA) and associated with cardiovascular risks and increased mortality. While 131I radioiodine therapy (131I-RIT) effectively treats UFA, it frequently induces [...] Read more.
Background: Subclinical hyperthyroidism grade 1 (SCH G1, TSH > 0.1 mU/L) is common in patients with thyroid unifocal autonomy (UFA) and associated with cardiovascular risks and increased mortality. While 131I radioiodine therapy (131I-RIT) effectively treats UFA, it frequently induces hypothyroidism, partly due to extra-nodular absorbed dose (AD) enhanced by residual TSH stimulation. Objective: We hypothesized that short-term LT3-induced TSH suppression at the time of RIT would promote long-term euthyroidism. Patients and Methods: A retrospective study was conducted on 95 UFA patients with SCH G1 (2001–2024). Patients underwent baseline and post-LT3 thyroid scintigraphy, and then received 131I-RIT with individualized dosimetry. Long-term bioclinical follow-up was achieved. Results: Short-term low-dose LT3 suppression caused no adverse events and significantly reduced TSH (0.45 to 0.047 mU/L). Whole-gland 123I uptake decreased moderately (11.0 to 8.4%), while extra-nodular lobe uptake dropped markedly (1.77 to 0.73%) (all p < 0.0001). This focused activity on the UFA (2.5-fold increase), maintaining mean UFA AD (about 260 Gy) but reducing extra-nodular AD (61 to 37 Gy, p < 0.0001). Despite low 131I doses (mean 181 MBq), a dose–response relationship was observed: higher AD correlated with greater nodular lobe volume reduction (p < 0.033). At the 88-month follow-up, 93% of patients achieved normal thyroid function; one had persistent SCH G1, two were borderline hypothyroid, and two required LT4. Conclusions: 131I-RIT under brief LT3-induced TSH suppression induces sustained euthyroidism in SCH G1 with UFA. This simple, low-risk strategy reduces radioprotection concerns and is under evaluation to determine cardiovascular benefits. Full article
(This article belongs to the Special Issue Thyroid Disease: Updates from Diagnosis to Treatment: 2nd Edition)
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10 pages, 466 KB  
Article
Thyroid Nodule Surveillance in Transfusion-Dependent Thalassemia: A Comparative Ultrasonographic Study
by Maddalena Casale, Martina Errico, Raffaella Origa, Paolo Mureddu, Francesca Allosso, Lucia Digitale Selvaggio, Graziella Grande, Claudia Di Ludovico, Raffaele Navarra, Domenico Roberti, Maria Chiara Capellupo, Silverio Perrotta and Daniela Pasquali
J. Clin. Med. 2025, 14(20), 7265; https://doi.org/10.3390/jcm14207265 - 15 Oct 2025
Viewed by 838
Abstract
Background: Thyroid nodules are common in the general population, and up to 15% may be malignant. Patients with transfusion-dependent thalassemia (TDT) are predisposed to endocrine complications, raising concern for thyroid malignancy. This study compared surveillance strategies between TDT patients and healthy controls (HCs). [...] Read more.
Background: Thyroid nodules are common in the general population, and up to 15% may be malignant. Patients with transfusion-dependent thalassemia (TDT) are predisposed to endocrine complications, raising concern for thyroid malignancy. This study compared surveillance strategies between TDT patients and healthy controls (HCs). Methods: This cross-sectional study used thyroid ultrasonography (US) to identify and characterize thyroid nodules in patients with TDT and HCs. Nodule assessment was performed using the Thyroid Imaging Reporting and Data System and the Italian Consensus for the Classification and Reporting of Thyroid Cytology for FNAs. Rates of indicated but unperformed FNAs and confirmed thyroid cancer cases were recorded. Statistical comparisons were performed using Fisher’s exact and chi-squared tests. Results: A total of 156 TDT and 101 HCs underwent thyroid US. Nodules were detected in 35.2% of TDT patients and 34.6% of HCs, with no difference in prevalence. Nodules were smaller in TDT patients, but suspicious ultrasound features and cancer prevalence were similar. Furthermore, 33.3% of TDT patients vs. 4.5% of HCs did not undergo indicated FNA (p = 0.021). Conclusions: Thyroid nodule prevalence and malignancy risk were comparable in TDT patients and HCs. A higher proportion of TDT patients missed indicated FNA procedures, revealing a critical gap in surveillance. Enhanced adherence to guideline-based follow-up is needed in thalassemia care. Full article
(This article belongs to the Special Issue Thyroid Disease: Updates from Diagnosis to Treatment: 2nd Edition)
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Other

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12 pages, 1409 KB  
Case Report
From Cytology to Frozen Section: Diagnostic Challenges in Riedel’s Thyroiditis—A Case Report and Brief Literature Review
by Diana-Raluca Streinu, Andreea Bena, Ion Icma, Ivan Codrut, Călin Muntean, Iuliana-Anamaria Trăilă and Dana Liana Stoian
J. Clin. Med. 2026, 15(7), 2529; https://doi.org/10.3390/jcm15072529 - 26 Mar 2026
Viewed by 480
Abstract
Background: Riedel’s thyroiditis is a rare fibrosing thyroid disorder that remains one of the most difficult to diagnose, often being initially interpreted as malignant due to its clinical, radiological, and histopathological similarities with anaplastic carcinoma or other infiltrative thyroid diseases. Preoperative investigations, [...] Read more.
Background: Riedel’s thyroiditis is a rare fibrosing thyroid disorder that remains one of the most difficult to diagnose, often being initially interpreted as malignant due to its clinical, radiological, and histopathological similarities with anaplastic carcinoma or other infiltrative thyroid diseases. Preoperative investigations, including fine-needle aspiration cytology (FNAC), may be misleading and contribute to an erroneous diagnosis of cancer. Methods: We report the case of a 44-year-old woman presenting with a rapidly enlarging, hard goiter associated with compressive symptoms and cytological findings suspicious for papillary thyroid carcinoma (Bethesda V). Based on these findings and the multidisciplinary team’s assessment, surgical intervention was undertaken. Intraoperatively, the thyroid gland was densely fibrotic and adherent to adjacent structures, prompting frozen-section analysis that revealed a benign fibroinflammatory process consistent with Riedel’s thyroiditis. This intraoperative finding guided the surgical team toward a near-total thyroidectomy, preventing unnecessary radical excision. Results: The paraffin-embedded section confirmed the diagnosis. Postoperative recovery was favorable, with complete resolution of compressive symptoms. Conclusions: This case highlights the persistent diagnostic challenges of Riedel’s thyroiditis and illustrates how intraoperative frozen-section examination can contribute to differentiating it from malignancy when preoperative findings remain inconclusive. A multidisciplinary approach and surgical expertise are essential in tailoring the extent of resection, preventing complications, and achieving both diagnostic confirmation and symptom relief. Full article
(This article belongs to the Special Issue Thyroid Disease: Updates from Diagnosis to Treatment: 2nd Edition)
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