bluuebunny/crossref_metadata_2025_split huggingface dataset:
6621 Iodine Nutritional Status in Different Trimesters of Pregnancy: A Prospective Observational Study in Taiwan
Authors: Pan Li-Hsin , Yeh Chang-Ching , Yang Chen-Chang , Hwu Chii-Min , Chen Harn-Shen , Wang Fan-Fen , Huang Chun Jui 
Published: October 2024

Abstract
Disclosure: L. Pan: None. C. Yeh: None. C. Yang: None. C. Hwu: None. H. Chen: None. F. Wang: None. C. Huang: None.
Pregnant women are susceptible to iodine deficiency. Iodine nutritional studies in pregnant women were mostly cross sectional evaluations of iodine status. This prospective observational study was designed to longitudinally follow the iodine status of pregnant women in different trimesters of pregnancy and to assess the clinical parameters and dietary influences on iodine status. A total of 209 pregnant women in their first trimester were enrolled in Taipei Veterans General Hospital, Taiwan from March 2019 to March 2023. Subjects provided a spot urine sample and completed a food frequency questionnaire at each trimester. Urinary iodine concentration (UIC) was measured by inductively coupled plasma mass spectrometry. The median UIC for the first, second and third trimester was 156.3 μg/L (Interquartile range [IQR]: 100.7-241.1), 146.2 μg/L (84.6-224.4), and 169.9 μg/L (94.4-283.5), respectively. Mild iodine deficiency was observed in the second trimester despite adequate iodine status in the first and third trimesters. Compared to the first trimester, intake of seaweed (p = 0.004, p &lt; 0.001, respectively), fish (p &lt; 0.001, p &lt; 0.001, respectively), and prenatal multivitamins (p &lt; 0.001, p &lt; 0.001, respectively) increased in the second and third trimesters. A gradual increment in dairy product intake was also noted between each trimesters through pregnancy (p &lt; 0.001, p = 0.004, respectively). Multivariate analysis indicated a positive association between multiparity and increased UIC in the second trimesters (multiparity vs. uniparity; adjusted odds ratio [OR]: 2.273, 95% confidence interval [CI]: 1.202-4.310). Additionally, increased prenatal multivitamin intake elevated the odds of adequate UIC in the third trimester (≥ 3 days/week vs. ≤ 1 day/week; adjusted OR: 2.890, 95% CI: 1.351-6.173). This study revealed the longitudinal changes in iodine status during pregnancy and suggested that women who regularly took prenatal multivitamins and were multiparous were more likely to have adequate iodine nutrition.
Presentation: 6/2/2024
12398 Isolated Thyroid Gland Langerhans Cell Histiocytosis In A Patient With Simple Goiter
Authors: Ziganshina Anna P , Callender Glenda G , Coppola Kristen , Druar Nicholas M , Jacob Jack 
Published: October 2024

Abstract
Disclosure: A.P. Ziganshina: None. G.G. Callender: None. K. Coppola: None. N.M. Druar: None. J. Jacob: None.
Background: Langerhans cell histiocytosis (LHC) is an overproduction of white blood cells - histocytes (Langerhans cells) - that accumulate in various organs, forming granulomas and affecting their function. It is a rare entity that can be systemic or confined to an isolated organ only. The thyroid gland is very infrequently a site for isolated LHC penetrance or part of multisystemic disease. Here we present a case of an incidental finding of an isolated LCH of the thyroid gland in a patient with simple goiter. Case presentation: This is a 42-year-old woman who is a chronic smoker with a history of primary hypothyroidism on thyroid replacement therapy, infertility, antiphospholipid antibody syndrome, MTFHR-mutated homocystinemia. She had a long-standing history of intermittent dysphagia and neck discomfort and was noted to have simple goiter measuring 8.9 x 2.8 x 2.8 cm in the right lobe and 7.3 x 2.6 x 2.2 cm in the left lobe. The patient was referred for a total thyroidectomy to relieve compressive symptoms. She had an uncomplicated operation; intraoperatively she was noted to have no suspicious central neck lymphadenopathy or other unexpected findings. The final pathology report demonstrated aggregates of Langerhans cells and eosinophils in a background of lymphocytic thyroiditis. Follow-up cytogenetics performed on the thyroid tissue found an activating (gain of function) mutation in MAP2K1 at codon 57, exon 2, with 7% allele frequency (MAP2K1 K57E). These findings support the diagnosis of LCH. There are no other sites of LCH on PET full body imaging. The patient continues on thyroid replacement therapy and will be closely monitored for PET evidence of systemic involvement of LCH. Conclusion: This clinical case raises awareness of the entity of LCH of the thyroid gland in patients presenting with simple goiter. It is important to differentiate LCH from a simple goiter because it can recur and requires prolonged follow up. Additionally, isolated thyroid LCH can precede or reveal disseminated disease; thus, whole-body surveillance is needed.
Presentation: 6/1/2024
7647 Myxedema Coma- A Rare and Fatal Manifestation of Severe Hypothyroidism
Authors: Ray B K , Kaur R , Kaur L , Thakur M 
Published: October 2024

Abstract
Disclosure: B.K. Ray: None. R. Kaur: None. L. Kaur: None. M. Thakur: None.
Introduction: Myxedema coma is a severe and life-threatening form of hypothyroidism. It is a rare occurrence with an incidence of 0.22 per million per year, associated with a high mortality rate ranging from 30 to 60% even with early diagnosis and treatment. This condition arises when the body's response to hypothyroidism is overwhelmed by factors like infection, surgery, and medication noncompliance. The definitive management is with thyroid hormones but supportive measures and identification and treatment of the precipitating factors is also vital. The case discussed concerns an elderly woman with myxedema coma due to noncompliance to Levothyroxine. This case stresses the importance of consistent medical follow-ups. Case Presentation: A 73 year old female presented to the hospital with altered mental status for about 32 hours. Vital signs at presentation showed hypotension (80/50 mmHg), bradycardia (54 beats per minute), tachypnea (32 breaths per minute) and hypothermia (33.2 °C). A computed tomography scan of the brain and Computed tomography angiography of the head/neck showed no stenosis or large vessel occlusion of the vasculature. Initial pertinent laboratory test results revealed a white blood cell count of 6.1 (3.7–11.0×103/uL), hemoglobin level of 14.3 (11.5–16.0 g/dL), sodium level of 131 (136–145 mmol/L), glucose level of 142 (65–125 mg/dL). Troponin, lactate and procalcitonin were normal. She was intubated and transferred to the Intensive care unit. Thyroid function tests revealed a markedly elevated TSH of 37.9 (0.4 to 4.0 mIU/L) and a decreased T4 of 0.3 (0.9-1.7 ng/dL). She was immediately started on hydrocortisone 100 mg Three times daily and initiated on intravenous levothyroxine monotherapy with a loading dose of 200 mcg followed by 100 mcg daily. Her T4 level was trended daily and she demonstrated gradual improvement. She was successfully extubated. On discussion she reported noncompliance with her medications. Hydrocortisone was tapered and she was started on her home dose of oral Levothyroxine (200 mcg) after four days of Intravenous levothyroxine. She was counselled on medication compliance and discharged to home. Conclusion: Myxedema, an extreme form of hypothyroidism, is life-threatening and requires immediate admission to intensive care. Symptoms are usually vague, and require a high degree of suspicion. Treatments include thyroid hormone supplementation, steroid replacement and supportive care. Early detection and quick intervention are crucial for survival. Patient education on medication compliance, regular testing, and reporting new medication to prevent interference with thyroid metabolism is crucial.
Presentation: 6/1/2024
7708 Navigating Thyroid Cancer With Differences in Thyroglobulin Assessment Techniques
Authors: Singh Shah Mahabir , Humayon Salman , Mungo Nicolas A 
Published: October 2024

Abstract
Disclosure: M.S. Shah: None. S. Humayon: None. N.A. Mungo: None.
This case report delves into the diagnostic journey of a patient with papillary thyroid carcinoma, emphasizing the importance of precise thyroglobulin measurement methods. The case highlights the differences between immunoassay and mass spectrometry in monitoring disease progression and treatment response.A 42-year-old female with a family history of thyroid-related issues, was found to have a thyroid nodule on physical exam. She underwent fine-needle aspiration (FNA) revealing papillary thyroid carcinoma, Bethesda category VI. Lymphatic invasion was present necessitating total thyroidectomy and lymph node dissection. Left level 3 and 4 lymph node excision showing 2 of 15 positive for metastatic papillary thyroid carcinoma without extranodal extension. Left superficial jugular lymph node excision showing 1 of 3 lymph node being positive for metastatic thyroid carcinoma without extranodal extension. RAI therapy and post-ablative scan showed focal moderate increased activity adjacent to the left hyoid bone. CT scan of the neck later showed stable appearance of the thyroidectomy bed with no new suspicious soft tissue mass. A small crescentic focus of enhancing soft tissue medial to the left common carotid artery is favored to represent residual thyroid tissue. Multiple small enhancing lymph node in the left neck at level llB and junction of levels ll and lll. Several of these are new or increased in size from prior examination and somewhat acidly enhanced. Although these are within normal limits by size criteria, recurrent diseases cannot be excluded. She underwent another surgical neck dissection with no cancer found. Given the negative findings, a shift from checking thyroglobulin (TG) from immunoassay to mass spectrometry was ideal.Patient was found to have persistent thyroglobulin elevation with Immunoassay, thyroglobulin level (60.5 ng/mL, n&lt;35 ng/ml), without the presence of TG antibodies, whereas liquid chromatography-tandem mass spectrometry (LC-MS/MS) showing (&lt;0.5 ng/mL), highlighting the methodological divergence. To date she has no imaging concerns and repeat testing from different labs similarly demonstrated undetectably Tg by LC-MS/MS and varying levels when tested by Immunoassay. Her levels by Immunoassay have trended down to her most recent level of (38 ng/ml).This case emphasizes the critical role of accurate thyroglobulin assessment in thyroid carcinoma follow-up. Immunoassay and mass spectrometry present divergent results, with LC-MS/MS proving more reliable in monitoring disease progression but more expensive and time consuming. Clinicians should consider the implications of methodological choices on patient management, particularly in cases of persistent elevation despite treatment. The potential discrepancies between these methods should be emphasized considering the impact on treatment decisions.
Presentation: 6/1/2024
6492 Novel compound heterozygous mutations in the SBP2 gene
Authors: Ahn Jungmin , Jeong Hwalrim 
Published: October 2024

Abstract
Disclosure: H. Jeong: None.
Mutations in the selenocysteine insertion sequence binding protein 2 gene (SECISBP2 also known as SBP2) result in a multisystemic disorder. A 4-year-old Korean girl presented with atypical thyroid function test result, characterized by normal TSH 2.13 μIU/mL, decreased T3 0.51 ng/mL, free T3(FT3) 1.71 (pg/mL), and elevated free thyroxine (FT4) 4.28 ng/dL. Additionally, she exhibited short stature below 2 standard deviations and delayed bone age. She has not yet begun speaking, and her waking ability commenced only recently. She conceived twins through natural pregnancy, but tragically, her twin sibling passed away in utero at 8 weeks of gestation.A targeted next-generation sequencing panel revealed compound heterozygous mutation in SBP2 gene (p.Arg120Ter/p.Arg672Ter) and in TPO gene (p.Glu413Gln).Her serum selenium level was relatively low,, easuring at 6.94 ng/dL. She underwent T3 supplementation and received a daily selenium supplement of 20mcg. Subsequently, her thyroid function tests normalized.
Presentation: 6/2/2024
6802 NRAS-Mutated Malignant Struma Ovarii with Papillary and Solid Histologic Variants
Authors: Wagle Sneha , Lomo Lesley , Dood Robert L , Chadwick Barbara , Abraham Devaprabu 
Published: October 2024

Abstract
Disclosure: S. Wagle: None. L. Lomo: None. R.L. Dood: None. B. Chadwick: None. D. Abraham: None.
Introduction: Struma ovarii is a mono-dermal teratoma of the ovary that is composed of more than &gt;50% of mature thyroid tissue. It accounts for 5% of ovarian teratomas and 1% of ovarian tumors. Although rare, it is seen in women between 40-60 years of age. Most of these tumors are found incidentally. Malignant struma ovarii is even rarer and the mutational profile of these tumors is neither well studied nor understood. We present an uncommon case of malignant struma with NRAS p.Q61R mutation yet with papillary and solid histologic patterns. Case Description: A 53-year-old female with no significant medical or family history presented with acute worsening of chronic lower abdominal pain and irregular menstruation. Her symptoms developed gradually over 6 months. A pelvic and abdominal CT identified a 9.7 cm cystic left ovarian mass without evidence of ascites or peritoneal masses. She underwent laparoscopic left salpingo-oophorectomy. Histopathology examination of the ovarian tumor revealed classical type, well-differentiated papillary, and solid patterns of thyroid carcinoma. The cells revealed nuclear enlargement, irregular nuclei, finely dispersed chromatin, distinct nucleoli, and nuclear grooves. Due to the histologic pattern of classical papillary thyroid cancer, BRAF V600E pyrosequencing was conducted, which revealed wild-type BRAF. This was followed by NGS when NRAS p.Q61R pathogenic variant was identified. Her thyroid ultrasound did not reveal actionable nodules. A TSH (2.17mU/ml) and thyroglobulin (7.6 ng/ml, TG ab neg) levels are consistent with a normal functioning thyroid gland. This patient's tumor findings are unique in that papillary thyroid carcinoma (PTC) and solid growth patterns are typically associated with the BRAF V600E mutation but rarely seen in the context of an RAS mutation. Discussion: Typically, thyroid cancers with papillary and solid variant features are associated with the BRAF V600E mutation. RAS-type tumors have follicular histologic architecture. BRAF and RAS mutations are mutually exclusive in tumors. Our patient’s malignant struma is unique in that it contained a wild-type BRAF and was positive for NRAS p.Q61R mutation. However, the histology was that of papillary and solid patterns. NRAS mutation with papillary histology combination is rare and is seen in 12% of thyroid cancers. The mutational profile of malignant struma ovarii has not been fully understood or studied due to their rarity.
Presentation: 6/3/2024
7290 Hippo Signaling Regulates Zona Glomerulosa Cell Fate In The Adrenal Cortex Of Mice
Authors: Nader N Abou , Jakuc N , Meinsohn M C , Charrier L , Paquet M , St-Jean G , Brind’Amour J , Boerboom D , Mao J , Pepin D , Zamberlam G , Breault D T , Boyer A 
Published: October 2024

Abstract
Disclosure: N. Abou Nader: None. N. Jakuc: None. M. Meinsohn: None. L. Charrier: None. M. Paquet: None. G. St-Jean: None. J. Brind’Amour: None. D. Boerboom: None. J. Mao: None. D. Pepin: None. G. Zamberlam: None. D.T. Breault: None. A. Boyer: None.
The Hippo signaling is a major signaling pathway that regulates processes such as cell proliferation and differentiation during both embryogenesis and postnatal homeostatic maintenance in several tissues. Our recent findings, using the Nr5a1-cre model, have highlighted the essential role of Lats1 and Lats2 (large tumor suppressor homolog kinases 1/2), the main kinases of the Hippo signaling cascade, in maintaining proper differentiation of mouse developing adrenocortical cells by suppressing their differentiation into myofibroblast-like cells. However, since the abnormal transdifferentiation of Lats1/2-negative adrenocortical cells occurs before the establishment of zonation when using the Nr5a1-cre model, the role of Hippo signaling in zona glomerulosa (zG) cells could not be assessed with this model. To overcome this limitation, we inactivated Lats1/2 in aldosterone-producing zG cells using the zG cell-specific AS-cre strain (Lats1flox/flox; Lats2flox/flox; AScre/+). We report here that specific loss of Lats1/2 in steroidogenic zG cells results in the accumulation of an important extracellular matrix (ECM) in the zG an outer zona fasciculata (zF) by 4 weeks of age; a phenotype that does not seem to progress with aging. In addition, tracing experiments demonstrate that the inactivation of Lats1/2 leads to the ectopic transdifferentiation of the zG cells into the ECM-producing cells rather than into zF cells. We then performed RNAseq experiments on whole adrenals which further suggested that the ECM producing cells derived from zG cells share characteristics with chondroblast/osteoblast mesenchymal progenitors among other cell lineages and, that the ectopic transdifferentiation of zG cells triggers a significant inflammation/immune response in the adrenal cortex. Our study also demonstrates that the increased activity of the Hippo pathway effectors YAP (Yes-associated protein) and TAZ (transcriptional coactivator with PDZ-binding motif) is responsible for the ectopic transdifferentiation of the zG cells as their concomitant inactivation with Lats1/2 (Yapflox/flox; Tazflox/flox; Lats1flox/flox; Lats2flox/flox; AScre/+) rescues the observed phenotype. Finally, we also demonstrate that the expression of a constitutively active form of YAP (YAP5SA) in zG cells (Rosa26YAP5SA/+; AScre/+) does not alter their identity as severely as the loss of Lats1/2 but leads to adrenal hyperplasia. Together, these novel findings underscore the crucial role of Hippo signaling in maintaining the identity of zG cells in the adrenal cortex.
Presentation: 6/2/2024
7235 Papillary Thyroid Carcinoma in a Hyperfunctioning Thyroid Nodule
Authors: Yang Jungyoon , Nadkarni Prashant V 
Published: October 2024

Abstract
Disclosure: J. Yang: None. P.V. Nadkarni: None.
Background: The prevalence of malignancy in a hyperfunctioning or hot thyroid nodule is considered to be low. According to the 2015 American Thyroid Association Guidelines, no cytologic evaluation is routinely recommended for hyperfunctioning nodules since they are rarely associated with malignancy (1). We present a case of a 71-year-old female with a hot nodule containing papillary thyroid cancer. Clinical Case: A 71-year-old female with Type 1 diabetes mellitus and coronary artery disease on dual antiplatelet therapy was found to have a 1.5 cm firm, non-tender right-sided thyroid nodule on a routine physical exam. Laboratory tests demonstrated low TSH &lt;0.01 (normal 0.36 - 3.74 m[IU]/L) and FT4 level elevated at 1.62 (normal 0.76 -1.46 ng/dL). She noticed palpitations and started on low dose Methimazole. Thyroid ultrasound results showed a 2.1 x 2.0 x 2.0 cm right inferior lobe thyroid nodule. This thyroid nodule appeared mixed cystic and solid, hypoechoic, not taller than wide, with ill-defined margins and peripheral calcifications (ACR TI-RADS risk category: TR4). Nuclear medicine thyroid uptake scan demonstrated focally increased activity in the right lower pole corresponding with her right inferior thyroid nodule seen on ultrasound. Remainder of the gland appeared suppressed. She was recommended for ultrasound-guided fine needle aspiration biopsy of her right inferior thyroid nodule, given concerning characteristics on ultrasound findings despite results consistent with a hot nodule. Timing of her antiplatelet therapy was coordinated with her cardiologist, and her biopsy procedure scheduled after she stopped dual antiplatelet therapy. Her FNA results showed clusters of follicular cells with nuclear and architectural atypia, suspicious for papillary thyroid carcinoma. She underwent right thyroid lobectomy. Surgical pathology revealed 2 foci of papillary thyroid carcinoma, follicular variant (2.0 cm, 0.1 cm) and confined to the thyroid. All regional lymph nodes were negative for tumor. Methimazole was discontinued post-operatively, and she started Levothyroxine suppression therapy. Discussion: We present a rare association of papillary thyroid carcinoma presenting as a hot thyroid nodule. Though uncommon, detection of a hyperfunctioning thyroid nodule does not exclude the possibility of thyroid carcinoma and warrants careful evaluation. Clinicians should retain a high index of suspicion particularly when ultrasonography demonstrates findings suspicious for malignancy and consider additional evaluation with fine needle aspiration. Reference: (1) Haugen BR, Alexander EK, Bible KC et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133.
Presentation: 6/2/2024
7860 Predictors of Remission in Patients with Graves' Disease Treated with Antithyroid Drugs at the University of Santo Tomas Hospital - A Retrospective Cohort Study
Authors: Sorsona F E , Cunanan E C 
Published: October 2024

Abstract
Disclosure: F.E. Sorsona: None. E.C. Cunanan: None.
This is a local study with the objective to determine the predictors of remission in Graves’ disease patients who completed 12 to 18 months of antithyroid drug therapy in University of Santo Tomas Hospital (Manila, Philippines) from 2017 to 2022. The study employed a retrospective cohort design. Patients included were all Graves’ disease patients seen at University of Santo Tomas Hospital who were treated with antithyroid drug methimazole. Data were collected via a retrospective review of medical charts. From the 203 Graves’ disease patients, a total of 59 patients met the inclusion criteria and were included in the study. Following completion of antithyroid drug therapy, patients were divided into remission and non-remission groups. Predictive factors analyzed were age, gender, smoking history, presence of orbitopathy and goiter, duration of ATD therapy, and thyroid function tests (TSH, free T3 and free T4) at time of initiation and completion of ATD. Forty-nine patients (83%) were females, and ten patients (17%) were males. The median age at the time of ATD initiation was 35 years old. The median duration of ATD therapy was 24.2 months. Following completion of ATD, 34 patients had remission with incidence of 57.63% (95% CI: 44.07-70.39%). Age, gender, smoking history, presence of goiter and orbitopathy, duration of ATD therapy, thyroid function tests at initiation, and FT3, FT4 and FT3/FT4 ratio at time of completion showed no significant differences between the two groups. After univariate and multivariate analyses, only one factor was significantly associated with 1-year remission which was the TSH at the time of ATD completion, with a median of 1.54 mIU/L, range: 0.001-7.94 mIU/L. Median TSH was significantly higher among patients who had remission than those with non-remission. Compared to patients with normal TSH at the time of ATD completion, the odds of remission was 14 times lower among patients with low TSH, and 7 times lower among patients with high TSH. A normal TSH at the time of ATD completion was associated with 1-year remission from Graves’ disease.
Presentation: 6/2/2024