Background: Recent studies have suggested that pathogenic variants of the DICER1 gene could be a driver of alterations in some pediatric thyroid nodules, but data are still limited. The aim of this study was to detect variants in the DICER1 gene in a large cohort of pediatric thyroid nodules and then correlate them with clinicopathological data, with a focus on the disease prognosis in patients with thyroid carcinoma. Methods: This retrospective cohort study consisted of 350 pediatric and young adult patients (aged 2-21 years) with thyroid nodules, from whom 275 fresh-frozen thyroid nodule samples and 92 fine-needle aspiration biopsy (FNAB) samples were collected. After an analysis of variants in major genetic alterations of thyroid tumors, variants in the DICER1 gene were identified using next-generation sequencing and multiplex ligation-dependent probe amplification methods. Peripheral blood was analyzed from patients with DICER1-positive tumors. The results of genetic analysis were then correlated with clinicopathological data. Results: Variants in the DICER1 gene were detected in a total of 24/350 (6.9%; 95%CI [4.4;10.0]) pediatric and young adult patients, respectively, in 10/119 (8.4%; [4.1;14.9]) patients with benign fresh-frozen tissue, in 8/141 (5.7%; [1.9;9.5]) with papillary thyroid carcinoma (PTC) and in 6/86 (7.0%; [4.1;14.6]) patients with FNAB. No other gene alteration was found in DICER1-positive samples. Germline DICER1 variants were identified in 11/24 (45.8%; [25.6;67.2]) patients. Two somatic (biallelic) variants in the DICER1 gene were found in 9/24 (37.5%; [18.8;59.4]) thyroid nodules. Somatic deletions of at least 3 Mbp long were revealed in 2/24 (8.3%; [1.0;27.0]) cases. DICER1-positive PTCs were significantly associated with the follicular subtype of PTC (p = 0.001), encapsulation (p = 0.006) and were larger in size (p = 0.035), but with no extrathyroidal extension (p = 0.039), and less frequent lymph node metastases (p = 0.003) compared with DICER1-negative PTCs. Patients with DICER1-positive PTC had an excellent response to treatment in 75% of cases. Conclusions: Variants of the DICER1 gene are frequently found in the thyroid nodules of pediatric and young adult patients. In our patients, DICER1-positive PTCs showed low invasiveness. Our findings support considering more conservative management for DICER1-positive low-risk PTCs.

• Klíčová slova
• DICER1 gene, DICER1 syndrome, papillary thyroid carcinoma, pediatric, thyroid nodules,
• MeSH
• DEAD-box RNA-helikasy * genetika   MeSH
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• nádory štítné žlázy * genetika   patologie   MeSH
• papilární karcinom štítné žlázy genetika   patologie   MeSH
• předškolní dítě MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• ribonukleasa III * genetika   MeSH
• tenkojehlová biopsie MeSH
• uzly štítné žlázy * genetika   patologie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• DEAD-box RNA-helikasy * MeSH
• DICER1 protein, human MeSH Prohlížeč
• ribonukleasa III * MeSH

Thyroid nodules are common finding. Most of them are of benign origin without thyroid dysfunction. Diagnosis is based on evaluation of thyroid function by assessment of serum thyroid stimulating hormone, and ultrasound for the purpose to identify the nodules which should be referred to fine needle aspiration biopsy (FNAB). The nodule size, ultrasound pattern and clinical risk factors should be considered before the FNAB is performed. The FNAB results should be categorized based on the risk of malignancy to improving a standardization of the patients management and minimizing number of false negative and false positive FNAB results. The most appropriate categorizing system seems to be Bethesda classification, although it is not completely optimal mainly because of controversial Bethesda III category.

• Klíčová slova
• fine needle aspiration biopsy Bethesda classification., thyroid cancer, thyroid nodule, ultrasound,
• MeSH
• lidé MeSH
• nádory štítné žlázy * terapie   MeSH
• retrospektivní studie MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• uzly štítné žlázy * terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH
• Spojené státy americké MeSH

Some medical definitions remain the same for many years, others change due to the progress in the diagnostic tools, which are able to distinguish markers and symptoms until then undetectable. Occult thyroid carcinoma is a general term indicating clinically different situations, whereas the incidentally detected papillary thyroid microcarcinoma is the most important from the clinical point of view. It is fundamental, for therapeutic management, to determine biological parameters which would define a small group of papillary thyroid microcarcinomas with aggressive biological behaviour. The most promising genetic and molecular markers for papillary thyroid carcinoma risk stratification are discussed in this review. Preoperative evaluation of these markers, obtained through analysis of ultrasonography-guided fine needle biopsy specimens of papillary thyroid microcarcinoma, could be very valuable in guiding treatment of this type of cancer.

Alcune definizione mediche restano invaiate nel tempo, mentre altre si modificano seguendo i progressi che consentono in campo diagnostico di definire markers e sintomi fino a quel momento non valutabili. Il carcinoma occulto della tiroide è un termine generico che indica differenti situazioni cliniche, mentre il microcarcinoma papillifero della tiroide diagnosticato incidentalmente resta l’entità clinica maggiormente significativa. È fondamentale ai fini della programmazione terapeutica la possibilità di identificare dei parametri biologici in grado di differenziare i microcarcinomi papilliferi sulla base della loro aggressività. In questa review sono stati rivisti i markers genetici e molecolari del microcarcinoma papillifero della tiroide più significativi ai fini di una loro possibile stratificazione. La valutazione pre-operatoria di questi markers, ottenuti attraverso l’analisi di agobiopsie ecoguidate di microcarcinomi papilliferi, potrebbe essere utile per la pianificazione terapeutica di questo tipo di carcinoma.

• Klíčová slova
• Molecular markers, Occult carcinoma, Papillary microcarcinoma, Therapeutic strategy, Thyroid,
• MeSH
• choristom komplikace   patologie   MeSH
• karcinom patologie   MeSH
• lidé MeSH
• nádory neznámé primární lokalizace * klasifikace   patologie   MeSH
• nádory štítné žlázy * klasifikace   komplikace   patologie   MeSH
• náhodný nález MeSH
• papilární karcinom štítné žlázy MeSH
• papilární karcinom MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

INTRODUCTION: The relationship between Hashimoto's thyroiditis (HT) and thyroid cancer (TC) is controversial. While most surgical studies report a high incidence of malignancy among patients with HT, cytological studies do not. The role of autoantibodies in the incidence of malignancy is unclear. MATERIAL AND METHODS: A single-centre retrospective observational study was conducted in patients evaluated for thyroid nodules by US-guided fine-needle aspiration cytology (FNAC) and, if indicated, by surgery. The levels of thyroid-stimulating hormone (TSH) and anti-thyroid antibodies were measured at the time of FNAC. RESULTS: Of 4947 patients, 599 (12.1%) were diagnosed with HT. A malignant/suspicious cytological result was found in 14.2% of the patients with HT and in 15.2% of the others. The odds ratio (OR) for malignancy in HT was 0.921 (0.716-1.183, p = 0.51). Of 1603 patients who underwent surgery, differentiated thyroid carcinoma was found in 29.5% of the HT patients and in 15.2% of the others (OR 2.33, 95% confidence interval CI, 1.403-3.854, p < 0,001). Low TSH (< 0.4 mIU/L) decreased the malignancy rate in the entire patient population, both when considering the cytological results and the surgical results. This was not confirmed in the subgroup diagnosed with HT. No relationship was observed between autoantibodies against thyroid peroxidase (ATP) or thyroglobulin (ATG) and malignancy rate. CONCLUSIONS: No association between HT and thyroid cancer was observed cytologically; a positive relationship in histological series was caused by selection bias. Low TSH levels decreased the risk of TC in patients with nodular goitre, but this has not been proven in patients with HT.

• Klíčová slova
• biopsy, fine-needle biopsy, thyroid cancer, thyroid nodule, thyroiditis,
• MeSH
• autoantigeny imunologie   MeSH
• autoprotilátky krev   MeSH
• Hashimotova nemoc * MeSH
• incidence MeSH
• jodidperoxidasa imunologie   MeSH
• lidé MeSH
• nádory štítné žlázy krev   epidemiologie   MeSH
• proteiny vázající železo imunologie   MeSH
• retrospektivní studie MeSH
• štítná žláza imunologie   metabolismus   MeSH
• thyreoglobulin imunologie   MeSH
• thyreotropin krev   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• autoantigeny MeSH
• autoprotilátky MeSH
• jodidperoxidasa MeSH
• proteiny vázající železo MeSH
• thyreoglobulin MeSH
• thyreotropin MeSH
• TPO protein, human MeSH Prohlížeč

Background: Brain metastases (BM) from differentiated thyroid cancer are rare. Stereotactic radiosurgery (SRS) is commonly used for the treatment of BMs; however, the experience with SRS for thyroid cancer BMs remains limited. The goal of this international, multi-centered study was to evaluate the efficacy and safety of SRS for thyroid cancer BMs. Methods: From 10 institutions participating in the International Radiosurgery Research Foundation, we pooled patients with established papillary or follicular thyroid cancer diagnosis who underwent SRS for histologically confirmed or radiologically suspected BMs. We investigated patient overall survival (OS), local tumor control, and adverse radiation events (AREs). Results: We studied 42 (52% men) patients who underwent SRS for 122 papillary (83%) or follicular (17%) thyroid cancer BMs. The mean age at SRS was 59.86 ± 12.69 years. The mean latency from thyroid cancer diagnosis to SRS for BMs was 89.05 ± 105.49 months. The median number of BMs per patient was 2 (range: 1-10 BMs). The median SRS treatment volume was 0.79 cm3 (range: 0.003-38.18 cm3), and the median SRS prescription dose was 20 Gy (range: 8-24 Gy). The median survival after SRS for BMs was 14 months (range: 3-58 months). The OS was significantly shorter in patients harboring ≥2 BMs, when compared with patients with one BM (Log-rank = 5.452, p = 0.02). Two or more BMs (odds ratio [OR] = 3.688; confidence interval [CI]: 1.143-11.904; p = 0.03) and lower Karnofsky performance score at the time of SRS (OR = 0.807; CI: 0.689-0.945; p = 0.008) were associated with shorter OS. During post-SRS imaging follow-up of 25.21 ± 30.49 months, local failure (progression and/or radiation necrosis) of BMs treated with SRS was documented in five (4%) BMs at 7.2 ± 7.3 months after the SRS. At the last imaging follow-up, the majority of patients with available imaging data had stable intracranial disease (33%) or achieved complete (26%) or partial (24%) response. There were no clinical AREs. Post-SRS peritumoral T2/fluid attenuated inversion recovery signal hyperintensity was noted in 7% BMs. Conclusion: The SRS allows durable local control of papillary and follicular thyroid cancer BMs in the vast majority of patients. Higher number of BMs and worse functional status at the time of SRS are associated with shorter OS in patients with thyroid cancer BMs. The SRS is safe and is associated with a low risk of AREs.

• Klíčová slova
• brain metastases, local control, stereotactic radiosurgery, survival, thyroid cancer,
• MeSH
• analýza přežití MeSH
• doba přežití bez progrese choroby MeSH
• dospělí MeSH
• folikulární adenokarcinom sekundární   chirurgie   MeSH
• Karnofského skóre MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• nádory mozku sekundární   chirurgie   MeSH
• nádory štítné žlázy patologie   MeSH
• následné studie MeSH
• papilární karcinom sekundární   chirurgie   MeSH
• radiochirurgie škodlivé účinky   metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

The double innervation of the thyroid comes from the sympathetic and parasympathetic nervous system. Injury rates during surgery are at 30% but can be minimized by upwardly preparing the thyroid vessels at the level of thyroid capsule. Several factors have been accused of increasing the risk of injury including age and tumor size. Our aim was to investigate of there is indeed any possible correlations between these factors and a possible increase in injury rates following thyroidectomy. Seven studies were included in the meta-analysis. Statistical correlation was observed for a positive relationship between injury of the sympathetic nerve and thyroid malignancy surgery (p 2 = 74%) No statistical correlations were observed for a negative or positive relationship between injury of the sympathetic nerve and tumor size. There was also no statistically significant value observed for the correlation of the patients' age with the risk of sympathetic nerve injury (p = 0.388). Lack of significant correlation reported could be due to the small number of studies and great heterogeneity between them.

• Klíčová slova
• sympathetic innervation, thyroid neoplasm, thyroidectomy,
• MeSH
• lidé MeSH
• nádory štítné žlázy patologie   chirurgie   MeSH
• peroperační komplikace * etiologie   prevence a kontrola   MeSH
• poranění periferního nervu * etiologie   prevence a kontrola   MeSH
• štítná žláza inervace   MeSH
• sympatický nervový systém zranění   MeSH
• tyreoidektomie škodlivé účinky   metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Thyroid hormones are crucial for the growth and maturation of many target tissues, especially the brain and skeleton. During critical periods in the first trimester of pregnancy, maternal thyroxine is essential for fetal development as it supplies thyroid hormone-dependent tissues. The ontogeny of mature thyroid function involves organogenesis, and maturation of the hypothalamus, pituitary and the thyroid gland; and it is almost complete by the 12th-14th gestational week. In case of maternal hypothyroidism, substitution with levothyroxine must be started in early pregnancy. After the 14th gestational week, fetal brain development may already be irreversibly affected by lack of thyroid hormones. The prevalence of manifest hypothyroidism in pregnancy is about 0.3-0.5%. The prevalence of subclinical hypothyroidism varies between 4 and 17%, strongly depending on the definition of the upper TSH cutoff limit. Hyperthyroidism occurs in 0.1-1% of all pregnancies. Positivity for antibodies against thyroid peroxidase (TPOAb) is common in women of childbearing age with an incidence rate of 5.1-12.4%. TPOAb-positivity may be regarded as a manifestation of a general autoimmune state which may alter the fertilization and implantation processes or cause early missed abortions. Women positive for TPOAb are at a significant risk of developing hypothyroidism during pregnancy and postpartum. Laboratory diagnosis of thyroid dysfunction during pregnancy is based upon serum TSH concentration. TSH in pregnancy is physiologically lower than the non-pregnant population. Results of multiple international studies point toward creation of trimester-specific reference intervals for TSH in pregnancy. Screening for hypothyroidism in pregnancy is controversial and its implementation varies from country to country. Currently, the case-finding approach of screening high-risk women is preferred in most countries to universal screening. However, numerous studies have shown that one-third to one-half of women with thyroid disorders escape the case-finding approach. Moreover, the universal screening has been shown to be more cost-effective. Screening for thyroid disorders in pregnancy should include assessment of both TSH and TPOAb, regardless of the screening approach. This review summarizes the current knowledge on physiology of thyroid hormones in pregnancy, causes of maternal thyroid dysfunction and its effects on pregnancy course and fetal development. We discuss the question of case-finding versus universal screening strategies and we display an overview of the analytical methods and their reference intervals in the assessment of thyroid function and thyroid autoimmunity in pregnancy. Finally, we present our results supporting the implementation of universal screening.

• Klíčová slova
• Autoimmune thyroid disease, anti-thyroperoxidase antibodies, pregnancy, pregnancy loss, screening, thyroid-stimulating hormone,
• MeSH
• hormony štítné žlázy MeSH
• komplikace těhotenství * MeSH
• lidé MeSH
• nemoci štítné žlázy * diagnóza   patofyziologie   MeSH
• štítná žláza fyziologie   MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Názvy látek
• hormony štítné žlázy MeSH

Sex hormone-binding globulin (SHBG) levels were followed in three groups of female subjects to evaluate interrelationships between its levels and parameters characterizing thyroid function. In the first part of the study the data from 201 patients with thyroid and other endocrine dysfunctions were grouped according to SHBG or basic laboratory parameters of thyroid function (thyrotropin, free thyroxine). Particular attention was paid to the presence of antithyroid antibodies (against thyroglobulin or thyroid peroxidase). Analysis of covariance revealed that SHBG changes were significant only in hyperthyroidism, and were not influenced by the presence of antibodies. Age was a minor factor influencing SHBG levels, in contrast to thyroid status. In a well-defined group of 16 females with severe hypothyroidism after total thyroidectomy because of thyroid cancer the low SHBG levels increased significantly to physiologic values after reaching normal thyroid function, irrespective of contraceptive use. In the final part of the study SHBG levels were correlated with the basic laboratory data, reflecting thyroid function in a sample of normal female population (129 subjects) screened for iodine deficiency in one region of the Czech Republic. After adjustment for age, the only significant positive correlation was between SHBG and free triiodothyronine.

• MeSH
• autoprotilátky krev   MeSH
• biologické markery krev   MeSH
• dítě MeSH
• dospělí MeSH
• globulin vázající pohlavní hormony metabolismus   MeSH
• hypotyreóza krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• nemoci štítné žlázy krev   MeSH
• referenční hodnoty MeSH
• senioři MeSH
• štítná žláza imunologie   MeSH
• thyreotropin krev   MeSH
• thyroxin krev   MeSH
• trijodthyronin krev   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• autoprotilátky MeSH
• biologické markery MeSH
• globulin vázající pohlavní hormony MeSH
• thyreotropin MeSH
• thyroxin MeSH
• trijodthyronin MeSH

Comprehensive information about current thyroid carcinoma treatment options depending on its histology and extent of the disease, focusing on locally advanced findings at the limit of operability. Treatment of such a heterogeneous group requires interdisciplinary cooperation. We provide 6 unique case reports including imaging scans, description of the therapy and description of development of the condition.

• Klíčová slova
• locally advanced thyroid cancer, trachea resection,
• MeSH
• lidé MeSH
• nádory štítné žlázy * chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Fine-needle aspiration biopsy (FNAB) has become an established procedure for the basic examination of thyroid nodules, which remain common in our population. The widely used Bethesda system for reporting thyroid cytopathology has undoubtedly contributed to the understanding among clinicians and cytopathologists. Since its publication in 2010, the systems overall applicability has been tested by many studies and reclassification of follicular thyroid tumours has occurred. The consensus embedded in the latest version of the WHO classification was the impetus for a revision of the very successful Bethesda 2010 system in 2017. We present a brief overview of the changes in the persistent categories of the original classification to the newly established format along with practical recommendations for routine FNAB diagnostics of thyroid lesions.

• Klíčová slova
• thyroid nodules, FNAB of thyroid gland, The Bethesda 2017 revised Classification of thyroid FNAB, The Bethesda system for reporting thyroid cytology 2010, goitre, thyroid cancer,
• MeSH
• lidé MeSH
• nádory štítné žlázy * diagnóza   MeSH
• tenkojehlová biopsie MeSH
• uzly štítné žlázy * diagnóza   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH