bluuebunny/crossref_metadata_2025_split huggingface dataset:
THU680 Cytologic And Molecular Assessment Of Isthmus Thyroid Nodules
Authors: Jasim Sina , Chen Yang , Jiang Rouchen , Hao Yangyang , Huang Jing , Klopper Joshua P , Kloos Richard T , Brown Taylor C 
Published: October 2023

Abstract
Disclosure: S. Jasim: None. Y. Chen: Employee; Self; Veracyte, Inc. Stock Owner; Self; Veracyte, Inc. R. Jiang: Employee; Self; Veracyte, Inc. Stock Owner; Self; Veracyte, Inc. Y. Hao: Employee; Self; Veracyte, Inc. Stock Owner; Self; Veracyte, Inc. J. Huang: Employee; Self; Veracyte, Inc. Stock Owner; Self; Veracyte, Inc. J.P. Klopper: Employee; Self; Veracyte, Inc. Stock Owner; Self; Veracyte, Inc. R.T. Kloos: Employee; Self; Veracyte, Inc. Stock Owner; Self; Veracyte, Inc. T.C. Brown: None.
Thyroid nodules arising in the isthmus are more likely to be malignant and demonstrate more aggressive behavior relative to thyroid nodules from either thyroid lobe. Preliminary studies of papillary thyroid cancers (PTC) studied in The Cancer Genome Atlas (TCGA) indicate molecular profiles that may explain the more aggressive phenotype of isthmic PTC, including an increased ERK signaling molecular profile. The goal of this study was to interrogate the Veracyte Afirma thyroid nodule database and assess cytologic and molecular differences of thyroid aspirates sent for Afirma Genomic Sequencing (GSC) testing from isthmus nodules relative to lobar nodules. Samples from isthmus nodules represented 4.8% of all samples. Most Afirma nodules had indeterminate cytology (ITN, Bethesda III or IV) and there were more ITN samples from the thyroid lobes (95.7%) compared to the isthmus (91.8%). For Bethesda V or VI nodules, the proportion from the isthmus was almost double that from the lobes (8.2% vs 4.3%). There were no significant differences observed in the Afirma benign or suspicious result of ITN samples comparing isthmus versus lobar location. Analysis of molecular alterations in Afirma suspicious nodules from ITN and Bethesda V-VI nodules showed that isthmus nodules had twice the frequency of BRAFV600E mutations compared to lobar nodules (21% vs 10%), an increased frequency of ALK/NTRK/RET fusions (4.6% vs 2.5%), and a lower frequency of NRAS (7.7% vs 13%) and HRAS (4.5% vs 8.2%) variants (all comparisons significant (p &lt; 0.001)). Additionally, isthmus nodules had significantly higher BRAF-like signature, ERK signaling, and follicular-mesenchymal transition scores compared to lobar nodules (p &lt; 0.01). In summary, thyroid nodules sent for Afirma molecular testing arising from the isthmus are more likely to have Bethesda V and VI cytology and, amongst Afirma suspicious ITN and Bethesda V and VI lesions, have higher levels of molecular markers of aggressiveness relative to lobar nodules. This study expands upon the data seen in PTCs from the TCGA as most thyroid tumors referred for molecular testing have Bethesda III and IV cytology and thus are enriched for follicular lesions including follicular variants of PTC and follicular carcinomas. Future studies should investigate the final histopathology of these molecularly tested isthmus nodules as well as oncologic outcomes.
Presentation: Thursday, June 15, 2023
FRI481 Clinical Characteristics Of Neutropenic Patients Under Anti-thyroid Drug: A Retrospective Cohort Study In Taiwan
Authors: Tseng Chih-Hsueh , Tseng Chi-Lung , Chen Harn-Shen , Chen Pei-Lung , Jui Huang Chun 
Published: October 2023

Abstract
Disclosure: C. Tseng: None. C. Tseng: None. H. Chen: None. P. Chen: None. C. Huang: None.
Background: Thionamide-induced agranulocytosis (TiA), is a rare adverse event with a reported incidence of around 0.1-1.75%. To reduce mortality, prompt recognition is critical but the differential diagnosis of TiA cases from non-TiA neutropenia can be challenging as other causes of neutropenia, such as concomitant chemotherapy, liver dysfunction or infection, may simultaneously exist. The present study aimed at investigating the possible factors associated with the development of TiA. Method: This is a retrospective cohort study of patients treated with anti-thyroid drugs (ATDs) in Taipei Veterans General Hospital from 2006-2018. Patients who developed a neutropenic event under treatment of ATDs were identified from the medical records. TiA was defined as (1) development of neutropenia under treatment or within 7 days of previous exposure to the same ATDs; (2) total recovery of neutropenia within one month after discontinuation of the culprit drug with absolute neutrophil count &gt; 1500/μL; (3) exclusion of other causes for neutropenia. The incidence and risk factors for developing TiA were analyzed and compared to those with non-TiA neutropenia. Results: Among 6644 patients treated with ATDs, 66 (mean age, 53±15 years; 16.2% men) developed a neutropenic event and 20 were diagnosed with TiA (incidence: 0.3%). In univariate analysis, TiA was associated with shorter treatment duration, lesser cumulative ATD dosage, higher ATDs dosage, higher absolute neutrophil count and higher free T4 level at the time of the neutropenic event, compared to non-TiA neutropenia. After accounting for age, gender and time to neutropenia, ATDs dosage at the time of neutropenic event [odds ratio (OR) and 95% confident intervals (CIs): 635.47, 1.88-214562.36], free T4 level (OR and 95% CIs: 17.23, 1.02-290.58), and absolute neutrophil count (OR and 95% CIs: 1.00, 1.00-1.01) were still independently associated with TiA in multivariable logistic regression. Conclusions: TiA patients were more likely to have higher free T4 level, higher absolute neutrophil count at the time of neutropenic event and had received higher dosage of ATDs, compared to non-TiA cases.
Presentation: Friday, June 16, 2023
FRI491 The Impact Of Insulin Resistance On Thyroid Function In Pregnancy
Authors: Trofimiuk-Muldner Malgorzata , Jerzy Nowak Andrzej , Podlewski Jacek , Hubalewska-Dydejczyk Alicja 
Published: October 2023

Abstract
Disclosure: M. Trofimiuk-Muldner: None. A.J. Nowak: None. J. Podlewski: None. A. Hubalewska-Dydejczyk: None.
The influence of hyperinsulinemia on thyroid function is debatable. Insulin as an anabolic hormone may be responsible for thyroid hypertrophy and nodular development. The interplay between insulin and the function of the pituitary-thyroid axis may influence thyroid tests’ results and their interpretation. This study evaluated the association between thyroid hormones and insulin resistance in pregnant women. The study group was recruited from the Polish National Program for Elimination of Iodine Deficiency, conducted between 2007-2017. We assessed the fasting glucose, insulin levels, thyroid hormones (TSH, FT4, FT3), and ATPO antibodies in 1069 pregnant women (median age 29 years, IQR 6 years). Based on calculated HOMA-IR, participants were stratified into three subgroups HOMA1 (324 women with HOMA-IR &lt; 1), HOMA 2 (570 women with HOMA-IR ≥1& &lt;2.5) and HOMA3 (175 women with HOMA-IR ≥ 2.5). Results: Median (IQR) TSH concentrations were 1.42 (1.33) mIU/L, 1.65 (1.31) mIU/L, and 1.77 (1.29) mIU/L in HOMA1, HOMA2, and HOMA3 subgroups, respectively. Median (IQR) FT4 concentrations were 12.9 (3.0) pmol/L, 12.48 (2.85) pmol/L, and 11.38 (2.8) pmol/L in HOMA1, HOMA2, and HOMA3 subgroups, respectively. Median (IQR) FT3 concentrations were 4.79 (1.75) pmol/L, 4.6 (1.02) pmol/L, and 4.47 (0.88) pmol/L in HOMA1, HOMA2, and HOMA3 subgroups, respectively. Median (IQR) aTPO concentrations were 10 (11.34) IU/L, 11.59 (8.54) IU/L, and 10.15 (7.5) mIU/L in HOMA1, HOMA2, and HOMA3 subgroups, respectively. HOMA1 and HOMA2 subgroups differed significantly in TSH (p=0.026) and FT3concentrations (p=0.001). HOMA2 and HOMA3 subgroups differed significantly in FT4 (p&lt;0.001) and aTPO concentrations (p=0.045). HOMA1 and HOMA3 patients differed in TSH (p=0.001), FT4 (p&lt;0.001), and FT3 (p=0.001) concentrations. aTPO-positivity was not related to HOMA-IR values (mean HOMA-IR in aTPO-positive andaTPO-negative women were 1.63 and 1.80 respectively, p=0.32). Conclusions: Insulin resistance may impact thyroid function in pregnancy independently of thyroid autoimmunity, with higher TSH and lower thyroid hormones concentrations in pregnant women with higher HOMA-IR indices.
Presentation: Friday, June 16, 2023
FRI495 Analytical Validation Of An Inductively Coupled Plasma Mass Spectrometry Method For Measuring Iodine Content In Breast Milk
Authors: Li Jia-Zhen , Lee Lin-Hsuan , Wang Fan-Fen , Yang Chen-Chang , Jui Huang Chun 
Published: October 2023

Abstract
Disclosure: J. Li: None. L. Lee: None. F. Wang: None. C. Yang: None. C. Huang: None.
Background: Adequate iodine status in lactating women is defined by a maternal median urinary iodine concentration above 100 μg/L. However, the current standard does not account for the secretion of iodine into breastmilk and could not truly reflect the amount of iodine delivered to the infants. Measuring breastmilk median iodine concentration (BMIC) is of crucial importance but the method to measure BMIC has not been developed and validated in Taiwan. Method: We adopted the ammonia dilution method without prior sample digestion to measure BMIC by inductively coupled plasma mass spectrometry (ICP-MS). Samples and iodine calibrators were prepared into an aqueous solution containing Triton X-100, 0.5% ammonia solution and tellurium (128Te) as the internal standard. Precision, accuracy, serial dilution, and recovery tests were performed for method validation. Results: The intra-assay and inter-assay coefﬁcient of variation for the four human breast milk samples with different iodine concentrations ranged from 3.2% to 4.7% and 2.3% to 5.5%, respectively. The standard NIST 1549 milk powder was prepared into three different concentrations of 50 μg/L, 100 μg/L and 200 μg/L to assess accuracy and the biases were &lt;5%. A recovery of 95-105% was achieved for four human breast milk samples spiked with sodium iodide solution. The serial dilution test confirmed linearity up to 500 μg/L. The limit for detection and quantification was 0.73 μg/L and 2.19 μg/L, respectively. Conclusion: The results of the current study conﬁrmed that this ICP-MS method is accurate and reliable in measuring BMIC.
Presentation: Friday, June 16, 2023
FRI548 A Case Of Periureteric Myxedema
Authors: Ferris Jaclyn M , Merrimen Jennifer , Kaiser Stephanie M 
Published: October 2023

Abstract
Disclosure: J.M. Ferris: None. J. Merrimen: None. S.M. Kaiser: Advisory Board Member; Self; Amgen Inc. Speaker; Self; Amgen Inc.
Background: Graves’ disease is the most common cause of hyperthyroidism. Classic extrathyroidal manifestations include Graves orbitopathy and pretibial myxedema (also known as thyroid dermopathy). Both involve cytokine-induced hyaluronic acid secretion by fibroblasts, likely related to TSH-receptor antibodies. Pretibial myxedema is now rare, but nearly always coexists with orbitopathy. It classically involves the shins, but has been described in other locations. Here we present a case of myxedema changes affecting the periureteric soft tissue of a patient with Graves’ disease. Case: A 46-year-old male was seen by endocrinology for symptomatic hyperthyroidism. His clinical presentation was consistent with Graves’ disease and the diagnosis was confirmed with a strongly positive TSH receptor antibody of 25 IU/L (normal &lt;1 IU/L). He had findings of moderate thyroid eye disease and had bilateral skin changes suspicious for pretibial myxedema. The skin findings preceded his hyperthyroidism by a few years. Dermatology was consulted and a skin biopsy confirmed pretibial myxedema, which was treated with triamcinolone injections with good effect. His thyroid function normalized with methimazole. Coincidentally, while being treated for Graves’ disease he altruistically donated a kidney to a transplant recipient. During the nephrectomy, it was noted that part of the periureteric tissue appeared thickened and firm, and further dissection revealed a soft tissue, lipoma-like mass surrounding the ureter. A frozen section sent from the operating room was found to contain myxomatous adipose tissue with very little cellularity. The final pathology reported adipose tissue with myxoid degeneration and reactive lymphoid aggregates. The histomorphology was consistent with a reactive process and there was no evidence of malignancy. In the context of the patient’s history the findings were concluded to be related to his Graves’ disease. Discussion: While pretibial myxedema most commonly affects the shins, it has also been described at other dermatologic sites, often associated with areas of trauma. Our patient, who had biopsy proven thyroid dermopathy, was also found to have myxedema affecting the ureter. To our knowledge this is only the third reported case of ureteral myxedema, and the first in a kidney donor. The patient’s renal function before surgery was normal, and post-nephrectomy his eGFR is mildly decreased, but stable. His thyroid function remains normal on methimazole.
Presentation: Friday, June 16, 2023
SAT452 Efficacy Of I-131 Treatment Dosage For Hyperthyroidism With Current Institution Formula
Authors: Salam Sanna , Nso Nso , Nassar Mahmoud , Kondaveeti Ravali , chings Scotti 
Published: October 2023

Abstract
Disclosure: S. Salam: None. N. Nso: None. M. Nassar: None. R. Kondaveeti: None. S. chings: None.
-131 (radioactive iodine) therapy effectively targets overactivity of the thyroid gland; however, literature provides conflicting outcomes regarding dosage optimization of I-131 for patients with hyperthyroidism and associated clinical complications. This retrospective study aimed to validate the therapeutic efficacy of an empirically derived I-131 institution formula in resolving hyperthyroidism by establishing a euthyroid or a hypothyroid state. Methods: This retrospective chart review was undertaken for 89 adult patients (&gt;18 years) who received I-131 therapy from 2016 to 2020 at H&H/Queens, New York. The I-131 dose range was determined in accordance with their thyroid gland weight and thyroid uptake percentages; however, the follow-up assessment was performed for the duration of 6 months. The primary endpoint (i.e., treatment success) was defined by the interim development of a euthyroid state, or hypothyroidism, or subclinical/questionable/suspected hypothyroidism, or questionable euthyroid state. The secondary endpoints included the frequency of repeat RAI doses and post-ablation thyroid function tests (TFTs). Results: The univariate and multivariate analysis of patient data indicated an 83% I-131 treatment success rate defined by the achievement of a euthyroid state and hypothyroidism in 6.7% and 70.8% of patients along with the attainment of questionable euthyroid status, questionable hypothyroidism, subclinical hypothyroidism, and suspected hypothyroidism in 1.1%, 1.1%, 2.2%, and 1.1% of patients, respectively. In addition, a low number (i.e., 9%) of patients with hyperthyroidism required repeat I-131 treatment dosages to achieve a hypothyroid or euthyroid state. The results indicated a clinically significant impact of I-131 treatment dosages on post-ablation TSH, T3, and FT4 levels. Conclusion: The results of this study testified to the therapeutic efficacy of the current institution formula for I-131 treatment dosages in treating hyperthyroidism. In addition, 83% treatment success and a low retreatment requirement strengthened current evidence favoring the optimization of RAI therapy for hyperthyroidism.
Presentation: Saturday, June 17, 2023
SAT457 Ethanol Ablation For The Treatment Of Cystic Thyroid Nodules: The First Ecuadorian Prospective Cohort
Authors: Solis Pazmiño Andrea Paola , Carrion Felipe , Mesias Joseph , Pilatuna Eduardo , Godoy Richard , Garcia Cristhian 
Published: October 2023

Abstract
Disclosure: A.P. Solis Pazmiño: None. F. Carrion: None. J. Mesias: None. E. Pilatuna: None. R. Godoy: None. C. Garcia: None.
Introduction: Percutaneous ethanol injection (PEI) has been adopted to treat benign cystic nodules in the last decade. For this study, we aimed to investigate the change in nodule volumes and cosmetic scores before and after EA in benign thyroid nodules and the effectiveness of treatment. Method: This prospective study, conducted at ITECC, included adults who underwent PEI for benign thyroid nodules (TN) with cystic content, between February 2021 and October 2022. The technique first consists of providing anesthesia using 10 ml of 2% solution. lidocaine. We then injected 75% ethanol into 1/3 of the volume of the TN. Nodule size and volume, thyroid function, and complications were evaluated before and after UPEA. Initial volume and change in TN volume were calculated with the ATA calculator and the independent-samples T-test. Results: A total of 13 patients with purely cystic single nodules with non-functioning and graded as Bethesda II were included. The mean age at the time of PEI was 52.46 years, and most of the patients were female (76.9%), euthyroid (77%), and symptomatic (69%). The median largest diameter of the thyroid cyst was 4.0 cm (interquartile range [IQR], 3.2 -4.5 cm; range, 1.7-5.9 cm); the median volume pre-PEI was 15.06 mL (IQR, 3.63-22.07 mL; range, 0.6-44.8 mL). The median amount of cystic fluid drained before PEI was 20 mL, and the median amount of ethanol administered was 3,85 mL (IQR, 3-5.25 mL; range, 1.5-6 mL). After a month’s follow-up, of 10 patients with available imaging on follow-up, 8 (80%) had a 50% or greater reduction in nodule volume. The median volume post-PEI was 1.5 (IQR, 0.6-8.1) ml decrease, 80.44% [IQR, 31.88%-95%]). We did not have any adverse effects. Prior to ablation, there were 46% of patients with cosmetic problems and symptomatic scores. At the 12-month follow-up, the overall cosmetic score improved from 2 to 0 (p&lt; 0.001), as well as the overall symptomatic score improved from 3.2 to 0.5. Conclusions: Percutaneous ethanol injection seems to be a safe and effective alternative to surgical resection for patients with purely or predominantly cystic thyroid nodules and compressive symptoms who decline surgery or are not good surgical candidates. ITECC is the first center in Ecuador to perform this procedure, having encouraging results with a considerable reduction in TN in the first month with symptomatic relief and improvement in cosmetic score.
Presentation: Saturday, June 17, 2023
SAT472 A Case of Contrast Induced Thyrotoxicosis in a Patient Newly Diagnosed with Hyperthyroidism
Authors: Askar Esraa , Reddy Bharrathi 
Published: October 2023

Abstract
Disclosure: E. Askar: None. B. Reddy: None.
Background: It is quite uncommon for thyrotoxicosis to manifest itself after the administration of iodinated contrast. Although the actual prevalence has not yet been identified, estimates showed that the prevalence in areas with iodine deficiency is 0.25 to 0.5% and 0.025% in non-iodine-deficient areas with higher risk in elderly patients. Clinical Case: A 68-year-old female presented to the emergency department for 2 weeks of intermittent substernal chest pain associated with diaphoresis. She was diagnosed with hyperthyroidism by an outside clinic approximately one week prior to her presentation and was prescribed methimazole but did not start it. Her physical examination was significant for mild exophthalmos. EKG showed ST depression in anterolateral leads. Laboratory data showed a troponin of 0.328 ng/ml (0.0.015-0.45) which trended up to 4.830 after 3 hours and TSH of &lt;0.005 mIU/L (0.358-3.74), otherwise BMP and CBC were within normal limits. Patient was started on aspirin, statin and heparin infusion along with methimazole. Patient was transferred to tertiary hospital for urgent cardiac catheterization that showed 90 % stenosis of left anterior descending artery (LAD) and 95 % stenosis in distal right coronary artery (RCA). A successful drug eluting stent was deployed in LAD with a plan of staged PCI in RCA. An hour after the procedure, Patient complained of palpitations and diaphoresis. Laboratory findings at that time revealed Free T4 of 17.5 ng/dl (0.9-1.8), Free T3 of 12.3 pg/ml (1.8-4.6) with positive Thyroperoxidase antibody, TSI and TSH Receptor Antibody. Thyroid ultrasound revealed diffusely heterogeneous thyroid gland with increased vascularity, consistent with Graves’ disease. The patient was diagnosed with thyrotoxicosis secondary to contrast administration. She was treated with methimazole 20 mg TID, metoprolol tartrate 25mg BID and hydrocortisone 25 mg BID. Decision was made to postpone the second procedure until trending down of thyroid hormones and improvement of symptoms. A successful staged RCA PCI was performed eight days later and patient did not experience any complications despite exposure to the same dose of iodinated contrast. Conclusion: Rarely, hyperthyroid patients may experience chest discomfort and EKG abnormalities that are consistent with cardiac ischemia. This usually happens in older patients with known underlying coronary artery disease in response to the rise in cardiac contractility and strain caused by thyrotoxicosis. Our case did not have any history or risk factors of coronary artery disease other than hyperthyroidism. This case highlights how recognition of hyperthyroidism may alter management, because the use of some procedures or treatments may acutely exacerbate the condition of the patient.
Presentation Date: Saturday, June 17, 2023