Endocrinology and Metabolism

Original Article

Diabetes, obesity and metabolism
Triglyceride-Glucose Index Predicts Future Atherosclerotic Cardiovascular Diseases: A 16-Year Follow-up in a Prospective, Community-Dwelling Cohort Study: Joon Ho Moon, Yongkang Kim, Tae Jung Oh, Jae Hoon Moon, Soo Heon Kwak, Kyong Soo Park, Hak Chul Jang, Sung Hee Choi, Nam H. Cho; Endocrinol Metab. 2023;38(4):406-417. Published online August 3, 2023; DOI: https://doi.org/10.3803/EnM.2023.1703

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Background
While the triglyceride-glucose (TyG) index is a measure of insulin resistance, its association with cardiovascular disease (CVD) has not been well elucidated. We evaluated the TyG index for prediction of CVDs in a prospective large communitybased cohort.
Methods
Individuals 40 to 70 years old were prospectively followed for a median 15.6 years. The TyG index was calculated as the Ln [fasting triglycerides (mg/dL)×fasting glucose (mg/dL)/2]. CVDs included any acute myocardial infarction, coronary artery disease or cerebrovascular disease. We used a Cox proportional hazards model to estimate CVD risks according to quartiles of the TyG index and plotted the receiver operating characteristics curve for the incident CVD.
Results
Among 8,511 subjects (age 51.9±8.8 years; 47.5% males), 931 (10.9%) had incident CVDs during the follow-up. After adjustment for age, sex, body mass index, diabetes mellitus, hypertension, total cholesterol, smoking, alcohol, exercise, and C-reactive protein, subjects in the highest TyG quartile had 36% increased risk of incident CVD compared with the lowest TyG quartile (hazard ratio, 1.36; 95% confidence interval, 1.10 to 1.68). Carotid plaque, assessed by ultrasonography was more frequent in subjects in the higher quartile of TyG index (P for trend=0.049 in men and P for trend <0.001 in women). The TyG index had a higher predictive power for CVDs than the homeostasis model assessment of insulin resistance (HOMA-IR) (area under the curve, 0.578 for TyG and 0.543 for HOMA-IR). Adding TyG index on diabetes or hypertension alone gave sounder predictability for CVDs.
Conclusion
The TyG index is independently associated with future CVDs in 16 years of follow-up in large, prospective Korean cohort.

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Evaluation of the novel three lipid indices for predicting five- and ten-year incidence of cardiovascular disease: findings from Kerman coronary artery disease risk factors study (KERCADRS)
Alireza Jafari, Hamid Najafipour, Mitra Shadkam, Sina Aminizadeh
Lipids in Health and Disease.2023;[Epub] CrossRef
Construction and validation of a nomogram for predicting diabetes remission at 3 months after bariatric surgery in patients with obesity combined with type 2 diabetes mellitus
Kaisheng Yuan, Bing Wu, Ruiqi Zeng, Fuqing Zhou, Ruixiang Hu, Cunchuan Wang
Diabetes, Obesity and Metabolism.2023;[Epub] CrossRef

Corrigendum

Miscellaneous
Corrigendum: Correction of Acknowledgments. 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; Endocrinol Metab. 2022;37(1):181-182. Published online February 28, 2022; DOI: https://doi.org/10.3803/EnM.2022.104; Corrects: Endocrinol Metab 2021;36(2):359

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Risk of thyroid cancer associated with glucagon‐like peptide‐1 receptor agonists and dipeptidyl peptidase‐4 inhibitors in patients with type 2 diabetes: A population‐based cohort study
Sungho Bea, Heejun Son, Jae Hyun Bae, Sun Wook Cho, Ju‐Young Shin, Young Min Cho
Diabetes, Obesity and Metabolism.2023;[Epub] CrossRef

Original Articles

Thyroid
Association between Thyroid Function and Heart Rate Monitored by Wearable Devices in Patients with Hypothyroidism: Ki-Hun Kim, Juhui Lee, Chang Ho Ahn, Hyeong Won Yu, June Young Choi, Ho-Young Lee, Won Woo Lee, Jae Hoon Moon; Endocrinol Metab. 2021;36(5):1121-1130. Published online October 21, 2021; DOI: https://doi.org/10.3803/EnM.2021.1216

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Background
Heart rate (HR) monitored by a wearable device (WD) has demonstrated its clinical feasibility for thyrotoxicosis subjects. However, the association of HR monitored by wearables with hypothyroidism has not been examined. We assessed the association between serum thyroid hormone concentration and three WD-HR parameters in hypothyroid subjects.
Methods
Forty-four subjects scheduled for radioactive iodine therapy (RAI Tx) after thyroid cancer surgery were included. Thirty subjects were prepared for RAI Tx by thyroid hormone withdrawal (hypothyroidism group) and 14 subjects by recombinant human thyrotropin (control group). Three WD-HR parameters were calculated from the HR data collected during rest, during sleep, and from 2:00 AM to 6:00 AM, respectively. We analyzed the changes in conventionally measured resting HR (On-site rHR) and WDHR parameters relative to thyroid hormone levels.
Results
Serum free thyroxine (T4) levels, On-site rHR, and WD-HR parameters were lower in the hypothyroid group than in the control group at the time of RAI Tx. WD-HR parameters also reflected minute changes in free T4 levels. A decrease in On-site rHR and WD-HR parameters by one standard deviation (On-site rHR, approximately 12 bpm; WD-HR parameters, approximately 8 bpm) was associated with a 0.2 ng/dL decrease in free T4 levels (P<0.01) and a 2-fold increase of the odds ratio of hypothyroidism (P<0.01). WD-HR parameters displayed a better goodness-of-fit measure (lower quasi-information criterion value) than On-site rHR in predicting the hypothyroidism.
Conclusion
This study identified WD-HR parameters as informative and easy-to-measure biomarkers to predict hypothyroidism.

Citations

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Thyroid hormone action during GABAergic neuron maturation: The quest for mechanisms
Sabine Richard, Juan Ren, Frédéric Flamant
Frontiers in Endocrinology.2023;[Epub] CrossRef
A machine learning-assisted system to predict thyrotoxicosis using patients’ heart rate monitoring data: a retrospective cohort study
Kyubo Shin, Jongchan Kim, Jaemin Park, Tae Jung Oh, Sung Hye Kong, Chang Ho Ahn, Joon Ho Moon, Min Joo Kim, Jae Hoon Moon
Scientific Reports.2023;[Epub] CrossRef

Clinical Study
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; Endocrinol Metab. 2021;36(2):359-364. Published online March 23, 2021; DOI: https://doi.org/10.3803/EnM.2020.890; Correction in: Endocrinol Metab 2022;37(1):181

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Background
A Korean Multicenter Prospective cohort study of Active Surveillance or Surgery (KoMPASS) for papillary thyroid microcarcinomas (PTMCs) has been initiated. The aim is to compare clinical outcomes between active surveillance (AS) and an immediate lobectomy for low-risk PTMCs. We here outline the detailed protocol for this study.
Methods
Adult patients with a cytopathologically confirmed PTMC sized 6.0 to 10.0 mm by ultrasound (US) will be included. Patients will be excluded if they have a suspicious extra-thyroidal extension or metastasis of a PTMC or multiple thyroid nodules or other thyroid diseases which require a total thyroidectomy. Printed material describing the prognosis of PTMCs, and the pros and cons of each management option, will be provided to eligible patients to select their preferred intervention. For the AS group, thyroid US, thyroid function, and quality of life (QoL) parameters will be monitored every 6 months during the first year, and then annually thereafter. Disease progression will be defined as a ≥3 mm increase in maximal diameter of a PTMC, or the development of new thyroid cancers or metastases. If progression is detected, patients should undergo appropriate surgery. For the lobectomy group, a lobectomy with prophylactic central neck dissection will be done within 6 months. After initial surgery, thyroid US, thyroid function, serum thyroglobulin (Tg), anti-Tg antibody, and QoL parameters will be monitored every 6 months during the first year and annually thereafter. Disease progression will be defined in these cases as the development of new thyroid cancers or metastases.
Conclusion
KoMPASS findings will help to confirm the role of AS, and develop individualized management strategies, for low-risk PTMCs.

Citations

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Thyroid-Stimulating Hormone, Age, and Tumor Size are Risk Factors for Progression During Active Surveillance of Low-Risk Papillary Thyroid Microcarcinoma in Adults
Yasuhiro Ito, Akira Miyauchi, Makoto Fujishima, Takuya Noda, Tsutomu Sano, Takahiro Sasaki, Taketoshi Kishi, Tomohiko Nakamura
World Journal of Surgery.2023; 47(2): 392. CrossRef
Thyroid FNA cytology: The Eastern versus Western perspectives
Mitsuyoshi Hirokawa, Manon Auger, Chan Kwon Jung, Fabiano Mesquita Callegari
Cancer Cytopathology.2023; 131(7): 415. CrossRef
To Screen or Not to Screen?
Do Joon Park
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Lower Thyroid Cancer Mortality in Patients Detected by Screening: A Meta-Analysis
Shinje Moon, Young Shin Song, Kyong Yeun Jung, Eun Kyung Lee, Young Joo Park
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Long-Term Outcomes of Active Surveillance and Immediate Surgery for Adult Patients with Low-Risk Papillary Thyroid Microcarcinoma: 30-Year Experience
Akira Miyauchi, Yasuhiro Ito, Makoto Fujishima, Akihiro Miya, Naoyoshi Onoda, Minoru Kihara, Takuya Higashiyama, Hiroo Masuoka, Shiori Kawano, Takahiro Sasaki, Mitsushige Nishikawa, Shuji Fukata, Takashi Akamizu, Mitsuru Ito, Eijun Nishihara, Mako Hisakad
Thyroid®.2023; 33(7): 817. CrossRef
Active Surveillance Outcomes of Patients with Low-Risk Papillary Thyroid Microcarcinoma According to Levothyroxine Treatment Status
Masashi Yamamoto, Akira Miyauchi, Yasuhiro Ito, Makoto Fujishima, Takahiro Sasaki, Takumi Kudo
Thyroid®.2023; 33(10): 1182. CrossRef
Cost-Effectiveness of Active Surveillance Compared to Early Surgery of Small Papillary Thyroid Cancer: A Retrospective Study on a Korean Population
Han-Sang Baek, Jeonghoon Ha, Kwangsoon Kim, Jaseong Bae, Jeong Soo Kim, Sungju Kim, Dong-Jun Lim, Chulmin Kim
Journal of Korean Medical Science.2023;[Epub] CrossRef
Optimal Cutoff Values of the Contact Angle of Tumor on Sonography System for Predicting Extrathyroidal Extension of Papillary Thyroid Carcinoma by Tumor Location
Ik Beom Shin, Do Hoon Koo, Dong Sik Bae
Clinical Medicine Insights: Oncology.2023;[Epub] CrossRef
Thermal ablation for papillary thyroid microcarcinoma located in the isthmus: a study with 3 years of follow-up
Lin Zheng, Fang-yi Liu, Jie Yu, Zhi-gang Cheng, Xiao-ling Yu, Xiao-cong Dong, Zhi-yu Han, Ping Liang
Future Oncology.2022; 18(4): 471. CrossRef
Trends in the Management of Localized Papillary Thyroid Carcinoma in the United States (2000–2018)
Elisa Pasqual, Julie Ann Sosa, Yingxi Chen, Sara J. Schonfeld, Amy Berrington de González, Cari M. Kitahara
Thyroid.2022; 32(4): 397. CrossRef
Management of Low-Risk Thyroid Cancers: Is Active Surveillance a Valid Option? A Systematic Review of the Literature
Renato Patrone, Nunzio Velotti, Stefania Masone, Alessandra Conzo, Luigi Flagiello, Chiara Cacciatore, Marco Filardo, Vincenza Granata, Francesco Izzo, Domenico Testa, Stefano Avenia, Alessandro Sanguinetti, Andrea Polistena, Giovanni Conzo
Journal of Clinical Medicine.2021; 10(16): 3569. CrossRef
Cost-Effectiveness Analysis of Active Surveillance Compared to Early Surgery in Small Papillary Thyroid Cancer: A Systemic Review
Han-sang Baek, Chai-ho Jeong, Jeonghoon Ha, Ja-Seong Bae, Jeong-soo Kim, Dong-Jun Lim, Chul-Min Kim
Cancer Management and Research.2021; Volume 13: 6721. CrossRef
Active Surveillance as an Effective Management Option for Low-Risk Papillary Thyroid Microcarcinoma
Min Ji Jeon, Won Gu Kim, Tae Yong Kim, Young Kee Shong, Won Bae Kim
Endocrinology and Metabolism.2021; 36(4): 717. CrossRef

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
Subclinical Hypothyroidism Affects the Long-Term Outcomes of Patients Who Undergo Coronary Artery Bypass Grafting Surgery but Not Heart Valve Surgery: Hana Kim, Sung Hye Kong, Jae Hoon Moon, Sang Yoon Kim, Kay-Hyun Park, Jun Sung Kim, Joong Haeng Choh, Young Joo Park, Cheong Lim; Endocrinol Metab. 2020;35(2):308-318. Published online June 24, 2020; DOI: https://doi.org/10.3803/EnM.2020.35.2.308

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Background
The aim of this study was to determine the associations between subclinical hypothyroidism (SCH) and long-term cardiovascular outcomes after coronary artery bypass grafting (CABG) or heart valve surgery (HVS).
Methods
We retrospectively reviewed and compared all-cause mortality, cardiovascular mortality, and cardiovascular events in 461 patients who underwent CABG and 104 patients who underwent HVS.
Results
During a mean±standard deviation follow-up duration of 7.6±3.8 years, there were 187 all-cause deaths, 97 cardiovascular deaths, 127 major adverse cardiovascular events (MACE), 11 myocardial infarctions, one unstable angina, 70 strokes, 30 hospitalizations due to heart failure, 101 atrial fibrillation, and 33 coronary revascularizations. The incidence of all-cause mortality after CABG was significantly higher in patients with SCH (n=36, 55.4%) than in euthyroid patients (n=120, 30.3%), with a hazard ratio of 1.70 (95% confidence interval, 1.10 to 2.63; P=0.018) after adjustment for age, sex, current smoking status, body mass index, underlying diseases, left ventricular dysfunction, and emergency operation. Interestingly, low total triiodothyronine (T3) levels in euthyroid patients who underwent CABG were significantly associated with increased risks of all-cause mortality, cardiovascular mortality, and MACE, but those associations were not observed in HVS patients. Both free thyroxine and thyroid-stimulating hormone levels in euthyroid patients were not related with any cardiovascular outcomes in either the CABG or HVS group.
Conclusion
SCH or low total T3 might be associated with a poor prognosis after CABG, but not after HVS, implying that preoperative thyroid hormonal status may be important in ischemic heart disease patients.

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Hiba Masri-Iraqi, Yaron Rudman, Carmel Friedrich Dubinchik, Idit Dotan, Talia Diker-Cohen, Liat Sasson, Tzipora Shochat, Ilan Shimon, Eyal Robenshtok, Amit Akirov
Endocrine Research.2023; 48(2-3): 68. CrossRef
Mid-term outcomes of patients with subclinical hypothyroidism after coronary bypass surgery
Dong Zhao, Wei Zhao, Chuangshi Wang, Fei Xu, Wei Zhao, Xieraili Tiemuerniyazi, Hao Ma, Wei Feng
Interdisciplinary CardioVascular and Thoracic Surgery.2023;[Epub] CrossRef
Thyroid Pathology in High-Risk Cardiac Surgery Patients with Coronary Artery Disease
Olena K. Gogayeva, Anatoliy V. Rudenko, Vasyl V. Lazoryshynets, Serhii A. Rudenko, Tetiana A. Andrushchenko
Ukrainian Journal of Cardiovascular Surgery.2022; 30(1 (46)): 9. CrossRef
High-TSH Subclinical Hypothyroidism Is Associated With Postoperative Mortality in Acute Type A Aortic Dissection
Shi-Pan Wang, Yuan Xue, Hai-Yang Li, Wen-Jian Jiang, Hong-Jia Zhang
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Triiodothyronine improves contractile recovery of human atrial trabeculae after hypoxia/reoxygenation
Petra Kleinbongard, Philipp Kuthan, Chantal Eickelmann, Philipp Jakobs, Joachim Altschmied, Judith Haendeler, Arjang Ruhparwar, Matthias Thielmann, Gerd Heusch
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Jiun-Yu Lin, Pei-Chi Kao, Yi-Ting Tsai, Chi-Hsiang Chung, Wu-Chien Chien, Chih-Yuan Lin, Chieh-Hua Lu, Chien-Sung Tsai
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Minor perturbations of thyroid homeostasis and major cardiovascular endpoints—Physiological mechanisms and clinical evidence
Patrick Müller, Melvin Khee-Shing Leow, Johannes W. Dietrich
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Subclinical Hypothyroidism: Prevalence, Health Impact, and Treatment Landscape
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Review Article

Thyroid
Digital Medicine in Thyroidology: A New Era of Managing Thyroid Disease: Jae Hoon Moon, Steven R. Steinhubl; Endocrinol Metab. 2019;34(2):124-131. Published online June 24, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.2.124

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Digital medicine has the capacity to affect all aspects of medicine, including disease prediction, prevention, diagnosis, treatment, and post-treatment management. In the field of thyroidology, researchers are also investigating potential applications of digital technology for the thyroid disease. Recent studies using artificial intelligence (AI)/machine learning (ML) have reported reasonable performance for the classification of thyroid nodules based on ultrasonographic (US) images. AI/ML-based methods have also shown good diagnostic accuracy for distinguishing between benign and malignant thyroid lesions based on cytopathologic findings. Assistance from AI/ML methods could overcome the limitations of conventional thyroid US and fine-needle aspiration cytology. A web-based database has been developed for thyroid cancer care. In addition to its role as a nationwide registry of thyroid cancer, it is expected to serve as a clinical platform to facilitate better thyroid cancer care and as a research platform providing comprehensive disease-specific big data. Evidence has been found that biosignal monitoring with wearable devices may predict thyroid dysfunction. This real-world thyroid function monitoring could aid in the management and early detection of thyroid dysfunction. In the thyroidology field, research involving the range of digital medicine technologies and their clinical applications is expected to be even more active in the future.

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Systems.2023; 11(10): 519. CrossRef
Empirical Method for Thyroid Disease Classification Using a Machine Learning Approach
Tahir Alyas, Muhammad Hamid, Khalid Alissa, Tauqeer Faiz, Nadia Tabassum, Aqeel Ahmad, Gulnaz Afzal
BioMed Research International.2022; 2022: 1. CrossRef
Deep Learning Based Classification of Wrist Cracks from X-ray Imaging
Jahangir Jabbar, Muzammil Hussain, Hassaan Malik, Abdullah Gani, Ali Haider Khan, Muhammad Shiraz
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Diagnostic Performance of Kwak, EU, ACR, and Korean TIRADS as Well as ATA Guidelines for the Ultrasound Risk Stratification of Non-Autonomously Functioning Thyroid Nodules in a Region with Long History of Iodine Deficiency: A German Multicenter Trial
Philipp Seifert, Simone Schenke, Michael Zimny, Alexander Stahl, Michael Grunert, Burkhard Klemenz, Martin Freesmeyer, Michael C. Kreissl, Ken Herrmann, Rainer Görges
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Association between Thyroid Function and Heart Rate Monitored by Wearable Devices in Patients with Hypothyroidism
Ki-Hun Kim, Juhui Lee, Chang Ho Ahn, Hyeong Won Yu, June Young Choi, Ho-Young Lee, Won Woo Lee, Jae Hoon Moon
Endocrinology and Metabolism.2021; 36(5): 1121. CrossRef
Ultrasound risk stratification systems for thyroid nodule: between lights and shadows, we are moving towards a new era
Pierpaolo Trimboli, Cosimo Durante
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Associations of Thyroid Hormones and Resting Heart Rate in Patients Referred to Coronary Angiography
Eva Steinberger, Stefan Pilz, Christian Trummer, Verena Theiler-Schwetz, Markus Reichhartinger, Thomas Benninger, Marlene Pandis, Oliver Malle, Martin H. Keppel, Nicolas Verheyen, Martin R. Grübler, Jakob Voelkl, Andreas Meinitzer, Winfried März
Hormone and Metabolic Research.2020; 52(12): 850. CrossRef

Corrigendum

Miscellaneous
Corrigendum: Author's Name Correction. Study Protocol of Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro): Jae Hoon Moon, Ji-hoon Kim, Eun Kyung Lee, Kyu Eun Lee, Sung Hye Kong, Yeo Koon Kim, Woo-Jin Jeong, Chang Yoon Lee, Roh-Eul Yoo, Yul Hwangbo, Young Shin Song, Min Joo Kim, Sun Wook Cho, Su-jin Kim, Eun-Jae Chung, June Young Choi, Chang Hwan Ryu, You Jin Lee, Jeong Hun Hah, Yuh-Seog Jung, Junsun Ryu, Yunji Hwang, Sue K. Park, Ho Kyung Sung, Ka Hee Yi, Do Joon Park, Young Joo Park; Endocrinol Metab. 2018;33(3):427. Published online August 14, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.3.427

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Invasiveness and Metastatic Aggressiveness in Small Differentiated Thyroid Cancers: Demography of Small Papillary Thyroid Carcinomas in the Swedish Population
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Clinical and pathologic predictors of lymph node metastasis in papillary thyroid microcarcinomas
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Annals of Diagnostic Pathology.2020; 49: 151647. CrossRef

Original Articles

Thyroid
Study Protocol of Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro): Jae Hoon Moon, Ji-hoon Kim, Eun Kyung Lee, Kyu Eun Lee, Sung Hye Kong, Yeo Koon Kim, Woo-jin Jung, Chang Yoon Lee, Roh-Eul Yoo, Yul Hwangbo, Young Shin Song, Min Joo Kim, Sun Wook Cho, Su-jin Kim, Eun Jae Jung, June Young Choi, Chang Hwan Ryu, You Jin Lee, Jeong Hun Hah, Yuh-Seog Jung, Junsun Ryu, Yunji Hwang, Sue K. Park, Ho Kyung Sung, Ka Hee Yi, Do Joon Park, Young Joo Park; Endocrinol Metab. 2018;33(2):278-286. Published online June 21, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.2.278

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Background

The ongoing Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) aims to observe the natural course of papillary thyroid microcarcinoma (PTMC), develop a protocol for active surveillance (AS), and compare the long-term prognosis, quality of life, and medical costs between the AS and immediate surgery groups.

Methods

This multicenter prospective cohort study of PTMC started in June 2016. The inclusion criteria were suspicious of malignancy or malignancy based on fine needle aspiration or core needle biopsy, age of ≥18 years, and a maximum diameter of ≤1 cm. If there was no major organ involvement, no lymph node/distant metastasis, and no variants with poor prognosis, the patients were explained of the pros and cons of immediate surgery and AS before selecting AS or immediate surgery. Follow-up visits (physical examination, ultrasonography, thyroid function, and questionnaires) are scheduled every 6 months during the first 2 years, and then every 1 year thereafter. Progression was defined as a maximum diameter increase of ≥3, ≥2 mm in two dimensions, suspected organ involvement, or lymph node/distant metastasis.

Results

Among 439 enrolled patients, 290 patients (66.1%) chose AS and 149 patients (33.9%) chose immediate surgery. The median follow-up was 6.7 months (range, 0.2 to 11.9). The immediate surgery group had a larger maximum tumor diameter, compared to the AS group (7.1±1.9 mm vs. 6.6±2.0 mm, respectively; P=0.014).

Conclusion

The results will be useful for developing an appropriate PTMC treatment policy based on its natural course and risk factors for progression.

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Psychological adjustment to initial treatment for low‐risk thyroid cancer: Preliminary study
Gabriella T. Seo, Mark L. Urken, Lauren E. Wein, Michael P. Saturno, Danielle Kapustin, Monica H. Xing, Lauren E. Yue, Eric M. Dowling, Tracey A. Revenson, Katherine J. Roberts, Robert Michael Tuttle
Head & Neck.2023; 45(2): 439. CrossRef
Response to Letter to the Editor on Surgical Outcomes in Patients With Low-Risk Papillary Thyroid Microcarcinoma From MAeSTro Study: Immediate Operation Versus Delayed Operation Following Active Surveillance: A Multicenter Prospective Cohort Study
Hyeonuk Hwang, June Young Choi, Jae Hoon Moon, Eun Kyung Lee, Young Joo Park, Su-jin Kim, Yuh-Seog Jung
Annals of Surgery Open.2023; 4(3): e311. CrossRef
Lower Thyroid Cancer Mortality in Patients Detected by Screening: A Meta-Analysis
Shinje Moon, Young Shin Song, Kyong Yeun Jung, Eun Kyung Lee, Young Joo Park
Endocrinology and Metabolism.2023; 38(1): 93. CrossRef
To Screen or Not to Screen?
Do Joon Park
Endocrinology and Metabolism.2023; 38(1): 69. CrossRef
Surgical Outcomes in Patients With Low-risk Papillary Thyroid Microcarcinoma From MAeSTro Study
Hyeonuk Hwang, June Young Choi, Hyeong Won Yu, Jae Hoon Moon, Ji-hoon Kim, Eun Kyung Lee, Yeo Koon Kim, Chang Yoon Lee, Sun Wook Cho, Eun-Jae Chung, Chang Hwan Ryu, Junsun Ryu, Ka Hee Yi, Do Joon Park, Kyu Eun Lee, Young Joo Park, Su-jin Kim, Yuh-Seog Jun
Annals of Surgery.2023; 278(5): e1087. CrossRef
US Predictors of Papillary Thyroid Microcarcinoma Progression at Active Surveillance
Ji Ye Lee, Ji-hoon Kim, Yeo Koon Kim, Chang Yoon Lee, Eun Kyung Lee, Jae Hoon Moon, Hoon Sung Choi, Hwangbo Yul, Sun Wook Cho, Su-jin Kim, Kyu Eun Lee, Do Joon Park, Young Joo Park
Radiology.2023;[Epub] CrossRef
Active Surveillance of Thyroid Microcarcinomas: a Critical View
Claudio R. Cernea, Leandro Luongo Matos, Cecília Eugênio, Giovanna Mattos Ferreira, Yasmin Sa Cerqueira, Ana Kober N. Leite, Felipe A. B. Vanderlei, Dorival de Carlucci, Renato N. Gotoda, Flávio C. Hojaij, Vergilius J. F. Araújo-Filho
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Jolanta Krajewska, Aleksandra Kukulska, Malgorzata Oczko-Wojciechowska, Agnieszka Kotecka-Blicharz, Katarzyna Drosik-Rutowicz, Malgorzata Haras-Gil, Barbara Jarzab, Daria Handkiewicz-Junak
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Thyroid
Star-Shaped Intense Uptake of ¹³¹I on Whole Body Scans Can Reflect Good Therapeutic Effects of Low-Dose Radioactive Iodine Treatment of 1.1 GBq: Sung Hye Kong, Jung Ah Lim, Young Shin Song, Shinje Moon, Ye An Kim, Min Joo Kim, Sun Wook Cho, Jae Hoon Moon, Ka Hee Yi, Do Joon Park, Bo Youn Cho, Young Joo Park; Endocrinol Metab. 2018;33(2):228-235. Published online May 4, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.2.228

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Background

After initial radioactive iodine (RAI) treatment in differentiated thyroid cancer patients, we sometimes observe a star-shaped region of intense uptake of ¹³¹I on whole body scans (WBSs), called a ‘star artifact.’ We evaluated the clinical implications of star artifacts on the success rate of remnant ablation and long-term prognosis.

Methods

Total 636 patients who received ¹³¹I dose of 1.1 GBq for the initial RAI therapy and who did not show distant metastasis at the time of diagnosis were retrospectively evaluated. A negative second WBS was used for evaluating the ablation efficacy of the RAI therapy. Among them, 235 patients (36.9%) showed a star artifact on their first WBS.

Results

In patients with first stimulated thyroglobulin (sTg) levels ≤2 ng/mL, patients with star artifacts had a higher rate of negative second WBS compared with those without star artifacts (77.8% vs. 63.9%, P=0.044), and showed significantly higher recurrence-free survival (P=0.043) during the median 8.0 years (range, 1.0 to 10.0) of follow-up. The 5- and 10-year recurrence rates (5YRR, 10YRR) were also significantly lower in patients with star artifacts compared with those without (0% vs. 4.9%, respectively, P=0.006 for 5YRR; 0% vs. 6.4%, respectively, P=0.005 for 10YRR). However, ablation success rate or recurrence-free survival was not different among patients whose first sTg levels >2 ng/mL regardless of star artifacts.

Conclusion

Therefore, star artifacts at initial RAI therapy imply a good ablation efficacy or a favorable long-term prognosis in patients with sTg levels ≤2 ng/mL.

Citations

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Prognostic value of star-shaped intense uptake of 131I in thyroid cancer patients
Liu Xiao, Wen Jie Zhang, Yue Qi Wang, Lin Li
Revista Española de Medicina Nuclear e Imagen Molecular (English Edition).2021; 40(1): 30. CrossRef
Valores pronósticos de la captación en estrella de 131I en pacientes con cáncer diferenciado de tiroides
L. Xiao, W.J. Zhang, Y.Q. Wang, L. Li
Revista Española de Medicina Nuclear e Imagen Molecular.2021; 40(1): 30. CrossRef
Comparison between planar and single-photon computed tomography images for radiation intensity quantification in iodine-131 scintigraphy
Yusuke Iizuka, Tomohiro Katagiri, Minoru Inoue, Kiyonao Nakamura, Takashi Mizowaki
Scientific Reports.2021;[Epub] CrossRef

Thyroid
Validity and Reliability of the Korean Version of the Hyperthyroidism Symptom Scale: Jie-Eun Lee, Dong Hwa Lee, Tae Jung Oh, Kyoung Min Kim, Sung Hee Choi, Soo Lim, Young Joo Park, Do Joon Park, Hak Chul Jang, Jae Hoon Moon; Endocrinol Metab. 2018;33(1):70-78. Published online March 21, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.1.70

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Background

Thyrotoxicosis is a common disease resulting from an excess of thyroid hormones, which affects many organ systems. The clinical symptoms and signs are relatively nonspecific and can vary depending on age, sex, comorbidities, and the duration and cause of the disease. Several symptom rating scales have been developed in an attempt to assess these symptoms objectively and have been applied to diagnosis or to evaluation of the response to treatment. The aim of this study was to assess the reliability and validity of the Korean version of the hyperthyroidism symptom scale (K-HSS).

Methods

Twenty-eight thyrotoxic patients and 10 healthy subjects completed the K-HSS at baseline and after follow-up at Seoul National University Bundang Hospital. The correlation between K-HSS scores and thyroid function was analyzed. K-HSS scores were compared between baseline and follow-up in patient and control groups. Cronbach's α coefficient was calculated to demonstrate the internal consistency of K-HSS.

Results

The mean age of the participants was 34.7±9.8 years and 13 (34.2%) were men. K-HSS scores demonstrated a significant positive correlation with serum free thyroxine concentration and decreased significantly with improved thyroid function. K-HSS scores were highest in subclinically thyrotoxic subjects, lower in patients who were euthyroid after treatment, and lowest in the control group at follow-up, but these differences were not significant. Cronbach's α coefficient for the K-HSS was 0.86.

Conclusion

The K-HSS is a reliable and valid instrument for evaluating symptoms of thyrotoxicosis in Korean patients.

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Jae Hoon Moon, Ji Won Han, Tae Jung Oh, Sung Hee Choi, Soo Lim, Ki Woong Kim, Hak Chul Jang
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Clinical Feasibility of Monitoring Resting Heart Rate Using a Wearable Activity Tracker in Patients With Thyrotoxicosis: Prospective Longitudinal Observational Study
Jie-Eun Lee, Dong Hwa Lee, Tae Jung Oh, Kyoung Min Kim, Sung Hee Choi, Soo Lim, Young Joo Park, Do Joon Park, Hak Chul Jang, Jae Hoon Moon
JMIR mHealth and uHealth.2018; 6(7): e159. CrossRef

Review Article

Endocrine Risk Factors for Cognitive Impairment: Jae Hoon Moon; Endocrinol Metab. 2016;31(2):185-192. Published online April 25, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.2.185

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Cognitive impairment, including Alzheimer's disease and other kinds of dementia, is a major health problem in older adults worldwide. Although numerous investigators have attempted to develop effective treatment modalities or drugs, there is no reasonably efficacious strategy for preventing or recovering from cognitive impairment. Therefore, modifiable risk factors for cognitive impairment have received attention, and the growing literature of metabolic risk factors for cognitive impairment has expanded from epidemiology to molecular pathogenesis and therapeutic management. This review focuses on the epidemiological evidence for the association between cognitive impairment and several endocrine risk factors, including insulin resistance, dyslipidemia, thyroid dysfunction, vitamin D deficiency, and subclinical atherosclerosis. Researches suggesting possible mechanisms for this association are reviewed. The research investigating modifiable endocrine risk factors for cognitive impairment provides clues for understanding the pathogenesis of cognitive impairment and developing novel treatment modalities. However, so far, interventional studies investigating the beneficial effect of the "modification" of these "modifiable risk factors" on cognitive impairment have reported variable results. Therefore, well-designed, randomized prospective interventional studies are needed.

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Original Article

Clinical Study
Characterization of Patients with Type 2 Diabetes according to Body Mass Index: Korea National Health and Nutrition Examination Survey from 2007 to 2011: Dong-Hwa Lee, Kyong Yeun Jung, Kyeong Seon Park, Kyoung Min Kim, Jae Hoon Moon, Soo Lim, Hak Chul Jang, Sung Hee Choi; Endocrinol Metab. 2015;30(4):514-521. Published online December 31, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.4.514

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Background

The present study aimed to investigate the clinical characteristics of type 2 diabetes mellitus (T2DM) in Korean adults according to body mass index (BMI) and to analyze the association with cardiovascular disease (CVD).

Methods

We conducted a cross-sectional study of data from the Korea National Health and Nutrition Examination Survey from 2007 to 2011. A total of 3,370 patients with T2DM were divided into categories according to BMI. We conducted a comparison of the T2DM patient population composition by BMI category between different countries. We investigated the prevalence of awareness, treatment, and target control of T2DM according to BMI.

Results

Patients with T2DM had a higher BMI, and were more likely to have a history of CVD than healthy controls. For Korean adults with T2DM, 8% had BMI ≥30 kg/m². By contrast, the population of patients with T2DM and BMI ≥30 kg/m² was 72% in patients in the USA and 56% in the UK. The rate of recognition, treatment, and control has worsened in parallel with increasing BMI. Even in patients with BMI 25 to 29.9 kg/m², the prevalence of CVD or high risk factors for CVD was significantly higher than in patients with BMI 18.5 to 22.9 kg/m² (odds ratio, 2.07).

Conclusion

Korean patients with T2DM had lower BMI than those in Western countries. Higher BMI was associated with lower awareness, treatment, and control of diabetes, and a positive association was observed between CVD or high risk factors for CVD and BMI, even for patients who were overweight but not obese.

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Diet Quality Scores and Asthenoteratozoospermia Risk: Finding From a Hospital-Based Case–Control Study in China
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Ildiko Lingvay, Priya Sumithran, Ricardo V Cohen, Carel W le Roux
The Lancet.2022; 399(10342): 2189. CrossRef
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Review Article

Thyroid
The Diagnosis and Management of Hyperthyroidism in Korea: Consensus Report of the Korean Thyroid Association: Jae Hoon Moon, Ka Hee Yi; Endocrinol Metab. 2013;28(4):275-279. Published online December 12, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.4.275

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Hyperthyroidism is one of the causes of thyrotoxicosis and the most common cause of hyperthyroidism in Korea is Graves disease. The diagnosis and treatment of Graves disease are different according to geographical area. Recently, the American Thyroid Association and the American Association of Clinical Endocrinologists suggested new management guidelines for hyperthyroidism. However, these guidelines are different from clinical practice in Korea and are difficult to apply. Therefore, the Korean Thyroid Association (KTA) conducted a survey of KTA members regarding the diagnosis and treatment of hyperthyroidism, and reported the consensus on the management of hyperthyroidism. In this review, we summarized the KTA report on the contemporary practice patterns in the diagnosis and management of hyperthyroidism, and compared this report with guidelines from other countries.

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Citations to this article as recorded by

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Case Report

A Case of Pheochromocytoma Presented with Cardiogenic Shock.: Mi Young Do, Hee Man Kim, Young Guk Ko, Sung Kil Lim, Jae Hun Jung, Namsik Chung, Yeon A Kim, Shin Ae Kang, Jae Hoon Moon, Jin Hyung Lee, Sang Tae Choi; J Korean Endocr Soc. 2005;20(3):283-288. Published online June 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.3.283

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Abstract PDF

A pheochromocytoma is a catecholamine secreting tumor, which is often overlooked when cardiovascular complications, such as acute heart failure, myocardial infarction, angina pectoris, arrhythmias, and dilated cardiomyopathy, presented as the initial clinical manifestations. Failure to identify a pheochromocytoma in these situations may be fatal. We report the case of 32-year-old female, who presented with cardiogenic shock. Echocardiography revealed severe global hypokinesia of the dilated left ventricle, with the exception of the apex. Computed tomography of the aorta showed a well-enhanced left adrenal mass, 3.5cm in diameter. A 24 hour urine collection study for catecholamines and a 131I-metaiodobenzylguanidine(MIBG) scan were suggestive of the diagnosis of a single adrenal pheochromocytoma. The patient stabilized after shock management, and recovered with intensive medical treatment. Follow-up echocardiography revealed normalized cardiac function and chamber dimensions. Thereafter, the adrenal mass was successfully removed using laparaoscopic surgery, without complications

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A Case of Pheochromocytoma Crisis with Acute Myocardial Infarction Induced by Glucocorticoids Administration
Woo Sun Rou, Sang Kyung Jung, Sung Yun Lee, Yun Jeong Lee, Dong Jun Kim, Young Doo Kim, Hyung Yoon Kim, Sunhee Chang, Jung Hyun Noh
Endocrinology and Metabolism.2010; 25(3): 240. CrossRef

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