bluuebunny/crossref_metadata_2025_split huggingface dataset:
THU677 Performance Of American Thyroid Association And American College Of Radiology Scoring Systems In The Evaluation Of Pediatric Thyroid Nodules
Authors: Garabet Diramerian Linda , Douek Michael , Tse Gary , Iskander Paul , Li Shanpeng , Yeh Michael W , Livhits Masha J , Leung Angela M , Chiu Harvey K , Wu James X 
Published: October 2023

Abstract
Disclosure: L. Garabet Diramerian: None. M. Douek: None. G. Tse: None. P. Iskander: None. S. Li: None. M.W. Yeh: None. M.J. Livhits: None. A.M. Leung: None. H.K. Chiu: None. J.X. Wu: None.
Background: The underlying malignancy rate of thyroid nodules is higher in pediatric patients compared to adults. Ultrasound scoring systems developed for adult thyroid nodules may not be applicable to pediatric populations. Objective: To evaluate the performance characteristics of adult American Thyroid Association (ATA) and American College of Radiology Thyroid Imaging and Reporting Data System (TIRADS) scoring systems in risk-stratifying pediatric thyroid nodules. Methods: This was a retrospective chart review of pediatric patients aged ≤18 years with thyroid nodules at UCLA Health from 2002-2022. Patients with no available ultrasound images or cytopathology results (fine needle aspiration [FNA] or surgical pathology) were excluded. Each thyroid nodule was scored according to the ATA and TIRADS systems through independent, blinded review by two study radiologists; discordances were arbitrated by a third. For patients who did not undergo thyroid surgery, we considered thyroid nodules benign if their size was stable on repeat ultrasound or if a repeat FNA was benign. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each system. Sensitivity analyses were performed to determine the optimal size cut-off to recommend FNA biopsy while maintaining a sensitivity equivalent to that of adults. Results: There were 77 patients (median age, 15 years [range 2-18]); 71.4% female) with 115 thyroid nodules. The underlying malignancy rate was 27.8%. Using adult-size cut-offs for FNA biopsy, the ATA scoring system would have failed to recommend biopsy for 11 of 32 malignant nodules, and had the following performance: sensitivity 66%, specificity 55%, NPV 81%, and PPV 36%. The TIRADS scoring system would have failed to recommend biopsy for 15 of 32 malignant nodules and had the following performance: sensitivity 53%, specificity 87%, NPV 83%, and PPV 61%. In sensitivity analyses, the optimal size cut-offs for FNA using the ATA scoring system were: 2 cm for very low risk, 1 cm for low risk, and 0.5 cm for intermediate and high risk categories (sensitivity 94%; specificity 33%). The optimal size cut-offs for FNA using TIRADS were: 3 cm for TIRADS-2, 0.8 cm for TIRADS-3 and TIRADS-4, and 0.5 cm for TIRADS-5 (sensitivity 91%; specificity 59%). Conclusion: The adult ATA and TIRADS ultrasound scoring systems have low sensitivity for thyroid cancer in pediatric thyroid nodules. Lowering the size cutoffs for recommending thyroid FNA biopsy increases sensitivity to &gt;90% for both ATA and ACR TIRADS scoring systems.
Presentation: Thursday, June 15, 2023
THU682 Long-term Outcomes Of Prophylactic Lateral Neck Dissection In Papillary Thyroid Carcinoma
Authors: Matsui Ai , Kuga Yoko , Saito Yoshiyuki , Yoshioka Kana , Masaki Chie , Akaishi Junko , Yamada Hames Kiyomi , Tomoda Chisato , Suzuki Akifumi , Matsuzu Kenichi , Kitagawa Wataru , Sugino Kiminori , Ito Koichi 
Published: October 2023

Abstract
Disclosure: A. Matsui: None. Y. Kuga: None. Y. Saito: None. K. Yoshioka: None. C. Masaki: None. J. Akaishi: None. K.Y. Hames: None. C. Tomoda: None. A. Suzuki: None. K. Matsuzu: None. W. Kitagawa: None. K. Sugino: None. K. Ito: None.
Background: Prophylactic lateral neck dissection for papillary thyroid carcinoma is no longer recommended in guidelines of each country. Since 2010, it is not employed at our hospital as well. Thereafter, however, no long-term study has been conducted to investigate the differences in postoperative lymph node recurrence rate between patients who underwent prophylactic lateral neck dissection and those who did not; in this study, we have re-examined these differences. Object and Methods: There were 1732 cases of papillary thyroid carcinoma with no distant metastasis operated between January 2010 and December 2011. Among them, 1542 cases, excluding the cases with clinical lateral neck lymph node metastasis, were included in this study. Lymph node metastases were confirmed based on the diagnosis via cytological or histopathological examination. No exclusion criteria were established for the extent of thyroidectomy, and cases with lobectomy and total or subtotal thyroidectomy were included. Of the 1542 cases, 140 cases had lateral neck dissection (Group A) and 1402 cases did not have prophylactic lateral neck dissection (Group B), and both were compared. The study design was a retrospective study, comparing each group using the Kaplan-Meier method with lymph node recurrence as the endpoint. Results: Comparing the backgrounds of Group A and Group B, respectively, significant differences for age (49.2 years vs. 52.9 years, P = 0.003), macroscopic tumor invasion into the perithyroidal soft tissues (13 [9.3%] vs. 27 [1.9%], P &lt; 0.001), and tumor size (24.8 mm vs. 13.1 mm, P &lt; 0.001), were observed. And significant differences were observed in the 10-year postoperative lymph node recurrence-free rates (92.6% vs. 96.6%, P = 0.012) in Group A and Group B, respectively. When the backgrounds were matched by age, sex, macroscopic tumor invasion into the perithyroidal soft tissues, and tumor size using propensity score matching (138 matched pairs), no significant differences were observed in the 10-year recurrence-free rates (92.5% vs. 95. P = 0.208) in both groups. Conclusions: The results of this study showed no significant difference in postoperative lymph node recurrence rates between the two groups, suggesting that the presence or absence of prophylactic lateral neck dissection does not affect postoperative lymph node recurrence during the long-term observation period.
Presentation: Thursday, June 15, 2023
THU683 TERT Promoter Mutations, But Not BRAFV600EMutation, Correlate With The American Thyroid Association And TNM Staging Systems And Predict Outcome Of Differentiated Thyroid Cancer
Authors: Mukhtar Noha , Alhamoudi Kheloud , Alswailem Meshael , Al-Hindi Hindi , Murugan Avaniyapuram K , Alghamdi Balgees , Saeed Alzahrani Ali 
Published: October 2023

Abstract
Disclosure: N. Mukhtar: None. K. Alhamoudi: None. M. Alswailem: None. H. Al-Hindi: None. A.K. Murugan: None. B. Alghamdi: None. A.S. Alzahrani: None.
Context: The American Thyroid Association risk stratification (ATA) and the American Joint Committee on Cancer Tumor Node Metastases (TNM) predict recurrence and mortality of differentiated thyroid cancer (DTC). BRAFV600E and TERT promoter mutations have been shown to predict DTC outcome. Our objectives were to study these molecular markers in terms of their interaction and potential incremental prognostic values over the ATA and TNM staging systems. Patients and Methods: We studied 315 non-selected patients, 229 females, 86 males with a median age of 36 years (IQR 24-49). Data were extracted from medical records. BRAFV600E and TERT promoter mutations were tested by PCR-based Sanger sequencing. Persistent disease (PD) included all patients in structurally or biochemically incomplete and indeterminate response as defined by the 2015 ATA guidelines. Data were analysed using Chi-Square and Fisher Exact test and Kaplan Meier analysis. Results: Of 315 patients tested, 138 (43.8%) had BRAFV600E-positive tumors and 77 (24.5%) were positive for TERT promoter mutations. The BRAFV600E mutation did not correlate with the ATA and TNM staging, being non-significantly different in various stages of these systems and did not predict the development of PD (P 0.11). Unlike BRAFV600E, TERT promoter mutations were more frequent in the ATA high-risk than in intermediate- or low-risk tumors (P 0.01) and in TNM stages III and IV than in lower stages (P &lt;0.001). TERT promoter mutations also predicted the outcome being present in 36.4% of patients with PD compared to only 15.6% in those without evidence of disease (P &lt;0.0001). The same pattern was also seen when BRAFV600E and TERT promoter mutations were combined. TERT promoter mutations alone or TERT promoter + BRAFV600E mutations predicted the development of PD in 100% of patients in TNM stage IV or high-risk ATA stage. Conclusions:TERT promoter mutations alone or in combination with BRAFV600E mutation, but not BRAFV600E mutation alone, correlated well with the ATA and TNM staging and predicted development of PD, especially in higher stages of these systems. The combination of high-risk ATA or TNM stage IV with TERT promoter mutations is highly predictive of development of PD predicting PD in 100% of cases with these combinations.
Presentation: Thursday, June 15, 2023
FRI474 Panhypopituitarism And Central Hypothyroidism Presenting As Myoclonus And Hyperreflexia, An Unusual Presentation Likely Related To Thyrotropin-releasing Hormone
Authors: Nadeem Ifrah , Khan Wahab J , Thapa Sudan 
Published: October 2023

Abstract
Disclosure: I. Nadeem: None. W.J. Khan: None. S. Thapa: None.
Introduction: Panhypopituitarism may present with symptoms of predominantly one or more hormonal deficiencies. The thyrotropin-releasing hormone has been described as causing neuromuscular hyperexcitability via its modifying role in synaptic functions in addition to its effect on the pituitary. We present a panhypopituitarism due to macroadenoma presenting with weakness, tongue fasciculation, hyperreflexia, and myoclonic jerks. Case Presentation: A 78-year-old woman with a medical history of essential hypertension came to ER with generalized weakness, twitching of her tongue, and involuntary jerking movements of her lower limbs for the past month. On admission, vital signs were normal. Neurological examination revealed tongue fasciculation and bilateral lower extremity myoclonus. Her visual field testing was normal. CT scan of the head showed an apparent seller mass but ruled out any acute pathology. Further neurologic, infectious, and rheumatologic work-up revealed negative results. In addition, an MRI of the cervical, thoracic, and lumbar spine was negative for any mass effect. The pituitary showed a 2.0 x 1.5 x 2.3 cm sellar mass, deforming the optic chiasm and deviating the infundibular stalk to the right side. Laboratory work-up revealed secondary adrenal insufficiency, central hypothyroidism, hypogonadotropic hypogonadism, and hyperprolactinemia. The patient was diagnosed with non-functioning pituitary macro adenoma. Myoclonus significantly improved after initiating the hormone replacement with levothyroxine and a stress hydrocortisone dose, gradually tapered to a physiological dose, and cabergoline. Repeat MRI after three months showed a stable 1.5 x 2.0 x 2.3 cm sellar mass. Surgery was not recommended due to no visual compromise. Instead, she will be followed in the clinic with a 6-month head imaging and hormone testing. Discussion: Usual clinical manifestations of hypothyroidism are the same regardless of etiology. However, there may be additional findings related to hypothalamic or pituitary dysfunction in the case of secondary or tertiary hypothyroidism due to non-thyroidal illness. Muscle fasciculations are common with hypothyroidism. But myoclonus and hyperreflexia are the findings in hyperthyroidism except for one hypothyroid state, i.e., Hashimoto encephalopathy (HE). TRH plays an important role in the pathophysiology of myoclonus and hyperreflexia in patients with HE and without HE. Our patient had tertiary hypothyroidism with likely elevated TRH in the presence of low FT4 and TSH. Therefore, we propose a high level of TRH in central hypothyroidism as the reason for her hyperreflexia and myoclonus.
Presentation: Friday, June 16, 2023
FRI486 Overactive Thyroid And Overactive Mind - An Intervened Relationship
Authors: Bilichodu Rangappa Sushma , Avula Sreekant , Anderson Zachary A , Kumar Ameya 
Published: October 2023

Abstract
Disclosure: S. Bilichodu Rangappa: None. S. Avula: None. Z.A. Anderson: None. A. Kumar: None.
Introduction: Traditionally, psychiatric symptoms were thought to be common manifestation of hypothyroidism. However, in the recent times the trend has changed. Various studies have shown a strong association of hyperthyroidism and psychosis. Thyrotoxicosis is associated with various psychiatric symptoms such as anxiety, restlessness, emotional liability, depression, mania, and rarely acute psychosis. Association between thyroid and mental health is a long-known entity but poorly understood pathophysiology. Here we present a case of graves disease presenting as acute psychosis as initial presentation. Clinical Case: A 45-year-old male with no significant past medical history was brought to emergency department (ED) by police after he was found to be walking in front of a shopping mall and was severely agitated. On arrival to ED, he was found to be very restless, irritable, and aggressive. Patient was found to have persecutory delusions and auditory hallucinations. His blood pressure was elevated, and he had tachycardia. He was given Haloperidol to calm down. Patient was evaluated with blood work and urine toxicology. Blood work up showed thyroid stimulating hormone (TSH) of &lt;0.01m IU/L, Free T4 of 4 ng/dl and Total T3 of 380 ng/dl. Patient was started on Methimazole and propranolol. On further work up for thyrotoxicosis there was elevated thyroid stimulating immunoglobulin (TSI) which was consistent with Grave’s disease. Ultrasound thyroid revealed diffuse enlarged thyroid with increased vascularity. Once the patient was stable, he was further interviewed, he gave a history of palpitations, increased anxiety, and weight loss for two months, but he didn’t seek any medical attention. By the time of discharge, he symptomatically improved and his Free T4 and total T3 trended down. Patient was discharged on methimazole 10 mg daily along with propranolol. Conclusion: Graves’s disease can mimic psychosis. Psychosis may develop in the wake of thyroid hormone excess. Future research is warranted to find out the relation between psychotic disorders and excess thyroid hormone and the pathological process involved. It also helps in having clear treatment guidelines which will reduce the morbidity and improves the quality of life. Identifying somatic causes for psychiatric issues will help in treating them and might lead to complete recovery and not needing any further psychiatric medications.
Presentation: Friday, June 16, 2023
FRI517 BIUX2X2
Authors: Dash Kalpana , Ayyagari Usha 
Published: October 2023

Abstract
Disclosure: K. Dash: None. U. Ayyagari: None.
A Rare Presentation of Solitary Thyroid Nodule - Microfilaria: Case reportDash Kalpana,* Ayyagari Usha***Department of Endocrinology & Metabolism, Apollo Hospitals, Bilaspur. Chhattisgarh, India.** Smriti Speciality Klinics, Chennai, IndiaTel: +919827143474, Email: drkdash@rediffmail.com. Introduction: Filariasis is a debilitating public health problem in the tropics most commonly presenting with asymptomatic microfilaremia. Clinical manifestations include lymphangitis/lymphadenitis in lower limbs(elephantiasis), peritoneum, scrotum(hydrocele), and rarely in breast (breast lump), pleural effusion, bone marrow, and thyroid (painless nodule or thyroiditis). Diagnosis is by demonstrating microfilaria in peripheral blood or tissue biopsy or detection of filarial antigen/antibody in blood. Adult worms are found in lymphatics, subcutaneous tissue, peritoneal and pleural fluid, heart, brain, scrotum, breast, and rarely, thyroid. Filariasis may rarely present as superficial swellings at unusual sites. We present a case of filarial thyroid nodule, a rare manifestation of filarial disease. Clinical Case: Female, 72, presented with painless swelling over the thyroid for 6 months. She had no significant past medical history, was otherwise asymptomatic, clinically and biochemically euthyroid, with normal hemogram, RFT, and LFT. Clinical examination revealed a firm, non-tender nodule measuring 35x45mm, moves with deglutition. On USG of neck, a nodular hypoechoic lesion of 41x45mm was seen over right lobe of thyroid with calcification. FNAC was done for suspected carcinoma & showed histiocytes, hurthle cells, giant cells and a single viable Microfilarial form of Wuchereria bancrofti. She was treated with Diethylcarbamazine citrate & made a full recovery with resolution of the nodule. Discussion: We report a rare manifestation of filarial disease as a painless thyroid nodule. Circulating microfilaria reach the thyroid tissue, followed by rupture of vasculature causing local inflammatory reaction and subsequent nodular transformation. Diagnosis presents challenges as the endemic species in India exhibit nocturnal periodicity and it is difficult to find microfilariae in blood and fine-needle aspirates during the day. Case reports of microfilaria in thyroid aspirates from nodules or thyroiditis are rare. Clinical Lesson: The differential diagnosis for a painless thyroid nodule includes possible malignant disease, with the associated stress of further investigation and treatment. However, accurate diagnosis of filarial disease, rare as it may be, even in endemic areas, obviates the need for surgery as evidenced by the resolution of the nodule with medical treatment in our case.
Presentation: Friday, June 16, 2023
FRI520 Disparities In Available Surgeons And Specialty Physicians Providing Endocrine-related Health Care Coverage To Populations In South Texas And The Rio Grande Valley
Authors: Sampson Alia Valentine , Wong Alvarado Ed , Diaz Edward M , Reinhart Henry 
Published: October 2023

Abstract
Disclosure: V. Alia: None. E.W. Alvarado: None. E.M. Diaz: None. H. Reinhart: None.
Introduction: The Rio Grande Valley and South Texas is home to some of the most medically underserved populations in the nation, with gaps in health care ranging from low rates of adequately insured individuals, to the amount of primary and specialty healthcare services available [1]. Populations living in these areas near the Texas-Mexico border have some of the highest incidence of metabolic and endocrine-related disease in the U.S., while paradoxically having a large deficit in endocrine-specialists available to meet the medical and surgical needs of the community [1,2,3]. Methodology: We analyzed data from the National Center for Health Workforce Analysis (NCHWA), as well as data from the Texas department of state health services (TDSHS) to determine current and projected endocrine-related healthcare coverage needs in South Texas and the Rio Grande Valley (RGV) between 2013 to 2025 and 2018 to 2032 respectively [2,3]. Results: Analysis of the data provided by the NCHWA revealed that by 2025 the southern region of the U.S. is projected to have the largest shortage of full-time equivalent (FTE) surgical specialty physicians in the entire country with a deficit of 10,210 [3]. ​Additionally, data displaying critical-shortages provided by the TDSHS stated that in 2018 the percent demand met (PDM) for FTE endocrinologists in South Texas was only 76.6% with a projected decline to 65.7% by 2032 [2]. Noteworthy data from the TDSHS also stated that in 2018 the RGV specifically had a significant deficit in endocrinologists with a PDM of only 53.6%, while simultaneously having a projected increase to 66.4% by 2032 [2]. The TDSHS classified specialties in South Texas to be critically short when they are projected to have a deficit of ≥100 FTEs and &lt;80% of the physician demand being met [2]. Conclusion: The collection of data analyzed led us to effectively identify significant disparities in endocrine-related healthcare coverage in the South Texas region, specifically the RGV. Additionally, new multidisciplinary healthcare institutions built in the RGV are striving to improve patient access to primary and subspecialty care by recruiting and training physicians in the area, but further action is still needed to counteract the described critical-shortages in physicians responsible for the long-term management of endocrine-related diseases.
Presentation: Friday, June 16, 2023
FRI530 Immune-Modulation By Rapamycin, Or Mycophenolic Acid, Of Th1 And Th2 Chemokines Secretion In Retro-orbital Cells Of Patients With Graves’ Ophthalmopathy
Authors: Elia Giusy , Ragusa Francesca , Rosaria Paparo Sabrina , Mazzi Valeria , Patrizio Armando , Fallahi Poupak , Antonelli Alessandro , Martina Ferrari Silvia 
Published: October 2023

Abstract
Disclosure: G. Elia: None. F. Ragusa: None. S. Paparo: None. V. Mazzi: None. A. Patrizio: None. P. Fallahi: None. A. Antonelli: None. S. Ferrari: None.
Objectives: Cytokines and chemokines contribute to the inflammation of Graves’ ophthalmopathy (GO). Indeed cytokines stimulate the T helper (Th)1 and Th2 chemokines release from orbital cells (fibroblasts, preadipocytes and myocytes).We aim to investigate the effects of rapamycin or mycophenolic acid on the secretion of these chemokines in GO orbital cells. Methods: We obtained primary cultures of fibroblasts, preadipocytes and myoblasts from the orbits of GO patients, and we tested increasing concentrations of rapamycin and/or mycophenolic acid evaluating the secretion of the prototype Th1 [chemokine (C-X-C motif) ligand 10 (CXCL10)] and Th2 [chemokine (C-C motif) ligand 2 (CCL2)] chemokines. Results: We observed that CXCL10 secretion in the retro-orbital cells of GO was undetectable in the supernatants, whereas interferon (IFN)-gamma induce its release in a dose-dependently manner. No effect was observed under the tumor necrosis factor (TNF)-alpha stimuli, while the combination of both cytokines had a significant synergistic effect on CXCL10 secretion. As regards the effect on the CCL2 secretion, it was released in low amounts in basal condition; TNF-alpha dose-dependently induced its release, whereas IFN-gamma alone had no effect. The combination of TNF-alpha plus IFN-gamma had a significant synergistic effect on CCL2 secretion. By adding mycophenolic acid, or rapamycin, (in a pharmacological range) at the time of IFN-gamma and TNF-alpha stimulation, we observed a dose-dependently inhibitory effect on the chemokines release in the retro-orbital cells of GO. Furthermore, the combination of mycophenolic acid with rapamycin, have a synergistic inhibitory effect on the release of chemokines. Conclusion: Our data showed an immune-modulating effect of mycophenolic acid or rapamycin on the Th1 and Th2 chemokines secretion, in GO orbital cells. These findings suggest the therapeutic role of these drugs that could obtained, at least in part, through this mechanism.
Presentation: Friday, June 16, 2023