CONTEXT: Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced as a new entity replacing the diagnosis of noninvasive encapsulated follicular variant of papillary thyroid carcinoma (PTC). Significant variability in the incidence of NIFTP diagnosed in different world regions has been reported. OBJECTIVE: To investigate the rate of adoption of NIFTP, change in practice patterns, and uniformity in applying diagnostic criteria among pathologists practicing in different regions. METHODS: Two surveys distributed to pathologists of the International Endocrine Pathology Discussion Group with multiple-choice questions on NIFTP adoption into pathology practice and whole slide images of 5 tumors to collect information on nuclear score and diagnosis. Forty-eight endocrine pathologists, including 24 from North America, 8 from Europe, and 16 from Asia/Oceania completed the first survey and 38 the second survey. RESULTS: A 94% adoption rate of NIFTP by the pathologists was found. Yet, the frequency of rendering NIFTP diagnosis was significantly higher in North America than in other regions (P = .009). While the highest concordance was found in diagnosing lesions with mildly or well-developed PTC-like nuclei, there was significant variability in nuclear scoring and diagnosing NIFTP for tumors with moderate nuclear changes (nuclear score 2) (case 2, P < .05). Pathologists practicing in North America and Europe showed a tendency for lower thresholds for PTC-like nuclei and NIFTP than those practicing in Asia/Oceania. CONCLUSION: Despite a high adoption rate of NIFTP across geographic regions, NIFTP is diagnosed more often by pathologists in North America. Significant differences remain in diagnosing intermediate PTC-like nuclei and respectively NIFTP, with more conservative nuclear scoring in Asia/Oceania, which may explain the geographic differences in NIFTP incidence.

• MeSH
• buněčné jádro patologie   MeSH
• folikulární adenokarcinom * patologie   epidemiologie   diagnóza   MeSH
• lékařská praxe - způsoby provádění statistika a číselné údaje   MeSH
• lidé MeSH
• nádory štítné žlázy * epidemiologie   patologie   diagnóza   MeSH
• papilární karcinom štítné žlázy epidemiologie   patologie   diagnóza   MeSH
• papilární karcinom patologie   epidemiologie   diagnóza   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Asie MeSH
• Evropa MeSH
• Oceánie MeSH
• Severní Amerika MeSH

OBJECTIVES: We analyze survival in thyroid cancer from Denmark (DK), Finland (FI), Norway (NO), and Sweden (SE) over a 50-year period (1971-2020), and additionally consider concomitant changes in incidence and mortality. DESIGN: Population-based survival study. METHODS: Relative 1-, 5/1 (conditional)-, and 5-year survival data were obtained from the NORDCAN database for years 1971-2020. Incidence and mortality rates were also assessed. RESULTS: A novel consistent observation was that 1-year survival was worse than 5/1-year survival but the difference between these decreased with time. Relative 1-year survival in thyroid cancer (mean for the 4 countries) reached 92.7% for men and 95.6% for women; 5-year survival reached 88.0% for men and 93.7% for women. Survival increased most for DK which started at a low level and reached the best survival at the end. Male and female incidence rates for thyroid cancer increased 3- and 4-fold, respectively. In the same time, mortality halved for men and for women, it decreased by 2/3. CONCLUSIONS: We documented worse relative survival in the first year than in the 4 subsequent years, most likely because of rare anaplastic cancer. Overall survival in thyroid cancer patients increased in the Nordic countries in the course of 50 years; 5-year survival was close to 90% for men and close to 95% for women. Even though overdiagnosis may explain some of 5-year survival increase, it is unlikely to influence the substantial increase in 1-year survival. The unmet need is to increase 1-year survival by diagnosing and treating aggressive tumors before metastatic spread.

• MeSH
• databáze faktografické MeSH
• lidé MeSH
• nádory štítné žlázy * diagnóza   epidemiologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Finsko MeSH
• Norsko MeSH

BACKGROUND: Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. METHODS: In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. FINDINGS: Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039). INTERPRETATION: Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation. FUNDING: None.

• MeSH
• COVID-19 * epidemiologie   MeSH
• lidé MeSH
• lymfatické metastázy MeSH
• nádory štítné žlázy * epidemiologie   chirurgie   patologie   MeSH
• pandemie MeSH
• průřezové studie MeSH
• retrospektivní studie MeSH
• uzle štítné žlázy * epidemiologie   chirurgie   diagnóza   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

• MeSH
• lidé MeSH
• nádory štítné žlázy * epidemiologie   prevence a kontrola   terapie   MeSH
• pooperační komplikace farmakoterapie   patologie   MeSH
• riziko MeSH
• terciární prevence * klasifikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Thyroid cancer is a rare type of malignancy. However, thyroid cancer constitutes more than 90 % of endocrine tumors. Metformin (N', N'-dimethybiguanide) is the most commonly prescribed drug in the world, and the annual number of prescriptions for this drug exceeds 120 million. Metformin is the first-line oral treatment for patients with type II diabetes. Metformin has recently been investigated for potential anti-cancer activity in patients with thyroid cancer by stimulating the Adenosine Mono-Phosphate-Activated Protein Kinase (AMPK) pathway in some types of tumors. In general, the anti-cancer mechanism of metformin acts directly by blocking mitochondrial oxidative phosphorylation through down-regulation of mitochondrial complex I and mitochondrial glycerophosphate dehydrogenase. This leads to a state of metabolic stress that in turn stimulates the AMPK pathway due to ATP reduction, and leads to inhibition of the mechanical (mammalian) target of the rapamycin (mTOR) pathway, which subsequently inhibits cancer cell proliferation and stimulates apoptosis and autophagy with cell cycle perturbation. Metformin also acts in an independent manner, in addition to its indirect actions that target insulin resistance. In this review, we reviewed 21 studies on the use of metformin in thyroid cancer, which showed that administration of metformin in diabetic patients is associated with a reduced incidence of thyroid cancer. On the other hand, the use of metformin enhances the response to anticancer drugs in thyroid cancer. Overall, we need further prospective studies to elucidate the synergistic mechanism of metformin when it is used to treat thyroid cancer as adjuvant therapy with anticancer drugs.

• MeSH
• diabetes mellitus 2. typu farmakoterapie   MeSH
• kinasy AMP aktivovaných proteinkinas MeSH
• lidé MeSH
• mechanistické cílové místo rapamycinového komplexu 1 MeSH
• metaanalýza jako téma MeSH
• metformin * farmakologie   metabolismus   terapeutické užití   MeSH
• mTOR inhibitory MeSH
• nádory štítné žlázy * epidemiologie   etiologie   farmakoterapie   klasifikace   MeSH
• signální transdukce MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• autoimunitní tyreoiditida diagnóza   epidemiologie   farmakoterapie   MeSH
• dítě MeSH
• Hashimotova nemoc diagnóza   epidemiologie   farmakoterapie   MeSH
• jod aplikace a dávkování   nedostatek   normy   MeSH
• kongenitální hypotyreóza diagnóza   farmakoterapie   MeSH
• lidé MeSH
• nádory štítné žlázy diagnostické zobrazování   epidemiologie   patologie   MeSH
• nemoci štítné žlázy * epidemiologie   klasifikace   krev   MeSH
• novorozenecký screening normy   MeSH
• thyreotropin krev   normy   MeSH
• thyroxin krev   normy   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH

Karcinom štítné žlázy patří k vzácným nádorům, vyskytuje se asi u 1 % populace. Léčba DTC vyžaduje multidisciplinární přístup zahrnující těsnou spolupráci endokrinologa, chirurga, patologa, specialisty pro nukleární medicínu a onkologa. DTC se léčí chirurgicky, radioaktivním jodem (RAI) a supresní hormonální léčbou levothyroxinem. Většina pacientů s DTC má velmi dobrou prognózu. Pokud se však stane DTC vůči radiojodu refrakterní, pak je prognóza špatná. V posledních letech se výrazně začaly uplatňovat poznatky z genetiky v cílené systémové léčbě v klinické praxi a možnost ovlivnit průběh nemoci u RAI-refrakterních pacientů pomocí inhibitorů tyrosinkináz (TKI): sorafenibu a lenvatinibu u DTC a kabozantinibu a vandetanibu MTC. Multidisciplinární tým řeší otázku včasného načasování zahájení léčby TKI, posuzuje rychlost progrese onemocnění a zda již nádor dosáhl inflekčního bodu: došlo ke zdvojnásobení velikosti měřeného ložiska v průběhu 1 roku, kdy je třeba již okamžitě zahájit systémovou léčbu. V současné době máme v ČR 6 center pro léčbu lokálně pokročilého nebo metastatického karcinomu štítné žlázy pomocí TKI, na která se lze obrátit k poskytnutí komplexní péče o tyto nemocné.

Thyroid cancer is a rare tumor, occurring in about 1 % of the population. DTC treatment requires a multidisciplinary approach involving close collaboration between the endocrinologist, surgeon, pathologist, nuclear medicine specialist, and oncologist. DTCs are treated with surgical, radioactive iodine (RAI) and levothyroxine suppressive hormone therapy. Most patients with DTC have a very good prognosis. However, if the DTC becomes refractory to radioiodine, then the prognosis is poor. In recent years, the knowledge of genetics has been significantly applied in targeted systemic treatment in clinical practice. We now have the opportunity to influence the course of the disease in RAI-refractory patients using tyrosine kinase inhibitors (TKIs): sorafenib and lenvatinib in DTC and cabozantinib and vandetanib MTC. The multidisciplinary team addresses the issue of early timing of initiation of TKI, assesses the rate of disease progression and whether the tumor has reached the point of inflection: the size of the lesion has doubled within 1 year, and systemic treatment should be started immediately. At present, we have in Czech Republic 6 centers for the treatment of locally advanced or metastatic thyroid carcinoma using TKI, which can be approached to provide comprehensive care for these patients.

• Klíčová slova
• refrakterní nemoci,
• MeSH
• dávka záření MeSH
• lidé MeSH
• nádory štítné žlázy * diagnóza   epidemiologie   klasifikace   radioterapie   terapie   MeSH
• prognóza MeSH
• radioizotopy jodu terapeutické užití   MeSH
• týmová péče o pacienty MeSH
• výběr pacientů MeSH
• Check Tag
• lidé MeSH

• MeSH
• buněčná diferenciace MeSH
• lidé MeSH
• lokální recidiva nádoru * diagnostické zobrazování   epidemiologie   etiologie   terapie   MeSH
• nádorové komplikace v těhotenství * diagnóza   epidemiologie   patologie   terapie   MeSH
• nádory štítné žlázy * diagnóza   epidemiologie   patologie   terapie   MeSH
• novorozenec MeSH
• papilární karcinom * diagnóza   epidemiologie   patologie   terapie   MeSH
• progrese nemoci MeSH
• rizikové faktory MeSH
• těhotenství * psychologie   MeSH
• tyreoidektomie MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství * psychologie   MeSH
• ženské pohlaví MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• dospělí MeSH
• hypertyreóza * komplikace   MeSH
• hypotyreóza * komplikace   MeSH
• incidence MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory štítné žlázy * epidemiologie   etiologie   MeSH
• registrace MeSH
• riziko MeSH
• senioři MeSH
• sexuální faktory MeSH
• tyreoiditida * komplikace   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• souhrny MeSH
• Geografické názvy
• Dánsko MeSH

• MeSH
• anamnéza * MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• medulární karcinom MeSH
• nádory štítné žlázy * diagnóza   epidemiologie   klasifikace   patologie   MeSH
• nemoci štítné žlázy * diagnóza   MeSH
• papilární karcinom štítné žlázy MeSH
• progrese nemoci MeSH
• tenkojehlová biopsie * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• souhrny MeSH