Nuevas perspectivas en el tratamiento del cáncer de tiroides de bajo riesgo. Experiencia con la lobectomía tiroidea en una cohorte de 114 pacientes / New perspectives in the management of low-risk thyroid cancer. Experience with thyroid lobectomy in a cohort of 114 patients

RESUMEN Antecedentes: el tratamiento del carcinoma diferenciado de tiroides (CDT) de bajo riesgo es aún motivo de discusión. En las últimas décadas se observó una migración hacia tratamientos personalizados acordes con las características de cada paciente y de cada tumor. Las guías de práctica vigentes habilitan la lobectomía en pacientes seleccionados, con bajo riesgo de recurrencia. Objetivo: describir los resultados en una cohorte de pacientes con CDT de bajo riesgo de recurrencia tratados con lobectomía tiroidea. Material y métodos: estudio observacional descriptivo de una revisión retrospectiva de historias clínicas de 114 pacientes con CDT tratados con lobectomía tiroidea entre enero de 2015 y abril de 2023. Resultados: fueron operados 114 pacientes, con media de edad de 44 años ± 12; 90 (79%) fueron mujeres. La mediana del tamaño tumoral fue de 9,4 mm, RIC (rango intercuartílico 25-75% 7-13 mm), y 103 de los nódulos (90%) fueron ecográficamente sólidos. Solo 2 pacientes con invasión vascular mayor de 4 vasos requirieron completar la tiroidectomía total. No se registraron complicaciones de importancia, salvo una parálisis recurrencial transitoria. Con un seguimiento promedio de 33,4 meses, no se observaron recurrencias locorregionales ni a distancia en la población analizada. Conclusión: la lobectomía tiroidea en el tratamiento del CDT de bajo riesgo tuvo una baja morbilidad sin recurrencias en la serie presentada. La selección rigurosa de los pacientes y la interacción de un equipo multidisciplinario se consideran esenciales para la implementación exitosa de esta metodología terapéutica.

ABSTRACT Background: The treatment of low-risk differentiated thyroid cancer (DTC) is still a matter of debate. Over the past few decades, there has been a shift towards a more personalized approach, tailored to the individual risks of each patient and tumor. The current practice guidelines recommend lobectomy in selected patients, with low risk of recurrence. Objective: To describe the results of thyroid lobectomy in a cohort of patients with DTC with low risk of recurrence. Material and methods: We conducted a descriptive and observational study. The medical records of patients with DTC who underwent thyroid lobectomy between January 2015 and April 2023 were retrospectively reviewed. Results: A total of 114 patients were operated on; mean age was 44 ± 12 years and 90 (79%) were women. The median tumor size was 9.4 mm (IQR 25-75% 7-13 mm), and 103 nodules (90%) were solid on ultrasound. Only 2 patients with vascular invasion involving > 4 vessels required completion thyroidectomy. There were no major complications and only one patient developed temporary recurrent laryngeal palsy. There were no locoregional or distant recurrences during mean follow-up of 33.4 months. Conclusion: Thyroid lobectomy for low-risk DTC had low morbidity and no recurrences in the series presented. The rigorous selection of patients and the interaction of a multidisciplinary team are considered essential for the successful implementation of this therapeutic approach.

Marcadores de cáncer stem cells y transición epitelio mesenquimal como factores de agresividad y progresión en pacientes jóvenes con cáncer de tiroides

El cáncer de tiroides (CT) es el primer tumor maligno en glándulas endocrinas, y se estima que al 2030 estará en el top cinco de cáncer a nivel mundial. En Chile, el CT fue incluido, recientemente, como la patología N° 82 con Garantías Explícitas de Salud, lo que implica destinar importantes recursos públicos y privados al tratamiento de pacientes con un cáncer que va en aumento en el mundo. Existen grupos de pacientes jóvenes con tumores pequeños que presentan un comportamiento clínico más agresivo desde el inicio, donde se podría adelantar la toma de decisiones. Específicamente, destaca un grupo de pacientes menores de 55 años con tumores pequeños menores de 2 cm, pero con metástasis regionales, que quedan fuera de la indicación de radioyodoterapia y podrían requerir tratamiento complementario o presentar peor evolución. Las herramientas clínicas y moleculares para guiar el tratamiento adecuado en pacientes con metástasis linfonodales son limitadas y no han sido actualizadas hasta el momento. Existen factores de tumorigenicidad y pronóstico, tales como los marcadores de Transición Epitelio-Mesenquimal (TEM) y Cáncer Stem Cells (CSC) que se han incorporado al estudio de otros tumores y recientemente en cáncer de tiroides. Actualmente estudios que relacionan TEM y CSC con CT apuntan a la descripción molecular y genética, con escasos reportes que correlacionen, clínicamente, estos hallazgos, (particularmente en subgrupos con características particulares de agresividad) y que los propongan como marcadores de tumorigenicidad y pronóstico. La descripción de estos biomarcadores en la población descrita podría facilitar la toma de decisiones en cuanto a seguimiento, terapia quirúrgica y radioyodoterapia.

Thyroid cancer (TC) is the first malignant tumor in endocrine glands, and it is estimated that by 2030 it will be in the top five cancers worldwide. In Chile, TC was recently included as pathology No. 82 with Explicit Health Guarantees, which implies allocating significant public and private resources to the treatment of patients with a cancer that is on the rise. There are groups of young patients with small tumors that present a more aggressive clinical behavior, where decision-making could be advanced. Specifically, a group of patients under 55 years of age with tumors less than 2 cm in size but with regional metastases, that lack indication for radioiodine therapy and could require complementary treatment or present a worse evolution. Clinical and molecular tools to guide appropriate treatment in patients with lymph node metastases are limited and have not been updated. There are tumorigenicity and prognostic factors, such as EpithelialMesenchymal Transition (EMT) and Cancer Stem Cells (CSC) markers that have been incorporated into the study of other tumors and recently in thyroid cancer. Studies linking EMT and CSC with TC currently point to molecular and genetic description, with few reports clinically correlating these findings (particularly in subgroups with particular characteristics of aggressiveness) and proposing them as tumorigenicity and prognosis markers. The description of these biomarkers in the described population could facilitate decision-making regarding follow-up, surgical therapy, and radioiodine therapy.

Resposta Vascular da Triiodotironina sobre Anéis de Aortas Isoladas: Contribuição de Mecanismos Redox / Vascular Response of Triiodothyronine on Isolated Aortic Rings: Contribution of Redox Mechanisms

Resumo Fundamento A disfunção vascular constitui a etiologia de diversas doenças, incluindo infarto do miocárdio e hipertensão, diante da ruptura da homeostase oxi-redutiva ("redox"), desempenhando um papel no desequilíbrio do mecanismo de controle vasomotor. Nosso grupo demonstrou anteriormente que os hormônios tireoidianos melhoram a sinalização da angiogênese, exercendo efeitos protetores sobre o tecido aórtico de ratos infartados. Objetivos Investigar o papel da triiodotironina (T3) na resposta vascular, explorando seus efeitos em aortas isoladas e a presença de mecanismos redox vasculares. Métodos Anéis aórticos isolados (endotélio intacto e desnudado) pré-contraídos com fenilefrina foram incubados com T3 (10-8, 10-7, 10-6, 10-5 e 10-4 M) e a tensão foi registrada usando um transdutor de deslocamento de força acoplado a um sistema de coleta. Para avaliar o envolvimento do estresse oxidativo, os anéis aórticos foram pré-incubados com T3 e posteriormente submetidos a um sistema de geração de espécies reativas de oxigênio (ROS) in vitro. O nível de significância adotado na análise estatística foi de 5%. Resultados A T3 (10-4 M) promoveu o vasorrelaxamento dos anéis aórticos pré-contraídos com fenilefrina em endotélio intacto e desnudado. Os anéis aórticos pré-incubados na presença de T3 (10-4 M) também mostraram diminuição da vasoconstrição provocada pela fenilefrina (1 µM) em preparações de endotélio intacto. Além disso, o efeito vasorrelaxante da T3 (10-4 M) persistiu em anéis aórticos pré-incubados com éster metílico de NG-nitro-L-arginina (L-NAME, 10 µM), um inibidor inespecífico da NO sintase (NOS). Por fim, a T3 (10-4 M) exibiu, in vitro, um papel antioxidante ao reduzir a atividade da NADPH oxidase e aumentar a atividade da SOD nos homogenatos aórticos. Conclusão A T3 exerce efeitos dependentes e independentes de endotélio, o que pode estar relacionado ao seu papel na manutenção da homeostase redox.

Abstract Background Vascular dysfunction constitutes the etiology of many diseases, such as myocardial infarction and hypertension, with the disruption of redox homeostasis playing a role in the imbalance of the vasomotor control mechanism. Our group previously has shown that thyroid hormones exert protective effects on the aortic tissue of infarcted rats by improving angiogenesis signaling. Objective Investigate the role of triiodothyronine (T3) on vascular response, exploring its effects on isolated aortas and whether there is an involvement of vascular redox mechanisms. Methods Isolated aortic rings (intact- and denuded-endothelium) precontracted with phenylephrine were incubated with T3 (10-8, 10-7, 10-6, 10-5, and 10-4 M), and tension was recorded using a force-displacement transducer coupled with an acquisition system. To assess the involvement of oxidative stress, aortic rings were preincubated with T3 and subsequently submitted to an in vitro reactive oxygen species (ROS) generation system. The level of significance adopted in the statistical analysis was 5%. Results T3 (10-4 M) promoted vasorelaxation of phenylephrine precontracted aortic rings in both intact- and denuded-endothelium conditions. Aortic rings preincubated in the presence of T3 (10-4 M) also showed decreased vasoconstriction elicited by phenylephrine (1 µM) in intact-endothelium preparations. Moreover, T3 (10-4 M) vasorelaxation effect persisted in aortic rings preincubated with NG-nitro-L-arginine methylester (L-NAME, 10 µM), a nonspecific NO synthase (NOS) inhibitor. Finally, T3 (10-4 M) exhibited, in vitro, an antioxidant role by reducing NADPH oxidase activity and increasing SOD activity in the aorta's homogenates. Conclusion T3 exerts dependent- and independent-endothelium vasodilation effects, which may be related to its role in maintaining redox homeostasis.

Gasto energético en reposo y concentración sérica de lipoproteínas de baja densidad en adultos con hipotiroidismo subclínico leve

La alta prevalencia de hipotiroidismo subclínico en Chile puede deberse a que el límite superior normal de la hormona estimulante del tiroides (TSH) sérica es bajo. Personas con TSH levemente mayor al límite superior pueden ser metabólicamente similares a personas sanas. Se compararon marcadores de acción tiroidea (gasto energético en reposo [GER] y lipoproteína de baja densidad [LDL]) en adultos con hipotiroidismo subclínico leve y con función tiroidea normal con o sin tratamiento con levotiroxina. Se midió GER, perfil lipídico y tiroideo en personas sanas con función tiroidea normal (TSH ≥0,4-<4,5 µUI/ml; n=91); con hipotiroidismo subclínico leve (TSH ≥4,5-≤6,5 µUI/ml; n=5); y con hipotiroidismo clínico tratado con levotiroxina y TSH normal (n=13). Se analizó la LDL en 838 personas sanas con función tiroidea normal y 89 con hipotiroidismo subclínico leve de la Encuesta Nacional de Salud 2016/17 (ENS). El GER, ajustado por peso, sexo y edad, fue similar entre grupos (p=0,71). La LDL fue similar entre personas con función tiroidea normal e hipotiroidismo subclínico leve (91±24 vs. 101±17 mg/dl; p=0,67), y menor en hipotiroidismo tratado (64±22 mg/dl; p<0,01). La LDL no se asoció con TSH pero si inversamente con T4L en mujeres (r=-0,33; p=0,02; n=53). En la ENS, ambos grupos tuvieron similar LDL (p=0,34), la que se asoció inversamente con T4L en mujeres (r=-0,12; p=0,01; n=569) pero no con TSH. Personas sanas con función tiroidea normal y con hipotiroidismo subclínico leve tienen similar GER y LDL. Esto apoya la idea de redefinir el límite superior normal de TSH.

The high prevalence of subclinical hypothyroidism in Chile may be due to the low normal upper limit of serum thyroid-stimulating hormone (TSH). People with TSH slightly higher than the upper limit may be metabolically similar to healthy people. Thyroid action markers (resting energy expenditure [REE] and low-density lipoprotein [LDL]) were compared in adults with mild subclinical hypothyroidism and with normal thyroid function with or without levothyroxine treatment. REE, lipid and thyroid profile were measured in healthy people with normal thyroid function (TSH ≥0,4-<4,5 µUI/ml (n=91); with mild subclinical hypothyroidism (TSH ≥4,5-≤6 µUI/ml; n=5); and with clinical hypothyroidism treated with levothyroxine and normal TSH (n=13). LDL was analyzed in 838 healthy people with normal thyroid function and 89 with mild subclinical hypothyroidism from the 2016/17 National Health Survey (NHS). REE, adjusted for weight, sex and age, was similar between the groups (p=0,71). LDL was similar between people with normal thyroid function and mild subclinical hypothyroidism (91±24 vs. 101±17 mg/dl; p=0,67), and lower in treated hypothyroidism (64±22 mg/dl; p<0,01). LDL was not associated with TSH but was inversely with FT4 in women (r=-0,33; p=0,02; n=53). In the NHS, both groups had similar serum LDL (p=0,34), which was inversely associated with FT4 in women (r=-0,12; p=0,01; n=569), but not with TSH. Healthy people with normal thyroid function and mild subclinical hypothyroidism have similar REE and LDL. These results support the idea of redefining the normal upper limit of TSH.

Guía de práctica clínica para el tratamiento y seguimiento de personas con cáncer diferenciado de tiroides. Parte I: Vigilancia activa

Introducción: El cáncer de tiroides es una enfermedad frecuente en el mundo, con mayor prevalencia del tipo diferenciado. El diagnóstico temprano y manejo pertinente, individualizado y adaptable puede mejorar su pronóstico. Objetivo: Generar recomendaciones basadas en evidencia sobre el tratamiento y seguimiento de personas adultas con cáncer diferenciado de tiroides (CDT). Metodología: Guía de práctica clínica (GPC) a partir de revisión sistemática de literatura (RSL) y consenso de expertos clínicos. El grupo desarrollador definió el alcance y cuatro preguntas que se resolvieron a través de revisión de evidencia de GPC existentes, RSL, estudios primarios publicadas en español o inglés en diferentes fuentes de información desde 2013. Las preguntas de investigación fueron: 1. ¿Cuáles son las indicaciones de la vigilancia activa?, ¿cómo realizarla?, ¿cuándo y con que periodicidad realizarla? 2. ¿Cuál es el tratamiento y su indicación en pacientes con nódulos tiroideos sospechosos de cáncer? 3. ¿Cómo y cuándo realizar seguimiento de pacientes con CDT de acuerdo con el riesgo dinámico? 4. ¿Cuál es el manejo actual de los pacientes iodo refractarios? Se propusieron recomendaciones basadas en la evidencia, y analizadas y discutidas por el colectivo experto en sesiones asincrónicas. Se evalúo la calidad de la evidencia y las recomendaciones fueron gradadas en fuerte o condicional y a favor o en contra a partir del análisis de la calidad de la evidencia, contexto de implementación (disponibilidad e implementación) y la experticia clínica. En el presente documento se desarrollada la primera pregunta, referente a vigilancia activa. Resultados: 86 recomendaciones fueron propuestas y acordadas por el grupo desarrollador, categorizadas en tratamiento y seguimiento para resolver las preguntas planteadas. 10 de las recomendaciones corresponden a vigilancia activa y se incluyen en el presente documento. Recomendaciones claves incluyen, brindar información completa y oportuna a pacientes, conformación de equipos multidisciplinarios, análisis individualizado del paciente para la decisión de tratamiento, estadificación rutinaria de riesgo dinámico para evaluar la respuesta al tratamiento y ajustarlo, minimización de procedimientos fútiles o que aportan poco a la supervivencia y calidad de vida de los pacientes. Conclusión: Se presentan recomendaciones que esperan incidir en la estandarización de la práctica clínica cotidiana de pacientes con CDT y mejores resultados en salud.

Introduction: Thyroid cancer is a common disease in the world, with a higher prevalence of the differentiated type. Early diagnosis individualized and adaptive management can improve prognosis. Objective: Generate evidence-based recommendations on the treatment and follow-up of adults with differentiated thyroid carcinoma (DTC). Methodology: Clinical practice guideline (CPG) based on systematic literature review (RSL) and consensus of clinical experts. The development group defined the range and four questions that were resolved through a review of evidence from existing CPGs, RSLs, primary studies published in Spanish or English in various sources of information since 2013. The research questions were: 1. What are the indications for active surveillance? How to carry it out? When and how often to carry it out? 2. What is the treatment and its indication in patients with thyroid nodules suspicious for cancer? 3. How and when to follow up patients with CDT according to dynamic risk? 4. What is the current management of iodine refractory patients? Evidence-based recommendations analyzed and discussed by the expert group in asynchronous sessions were proposed. The quality of the evidence was evaluated, and the recommendations were graded as strong or conditional and in favor or against based on the analysis of the quality of the evidence, implementation context (availability and implementation) and clinical expertise. In this document, is developed the first question, referring to active surveillance. Results: 86 recommendations were proposed and agreed upon by the development group, categorized into treatment and follow-up to solve the questions raised. 10 of the recommendations correspond to active surveillance and are included in this document. Key recommendations include providing complete and timely information to patients, develop of multidisciplinary teams, individualized patient analysis for treatment decisions, routine dynamic risk staging to evaluate response to treatment and adjust it, minimization of futile procedures or that contribute little to the survival and quality of life of patients. Conclusion: Recommendations are presented that longs to influence the standardization of the daily clinical practice of patients with DTC and better health outcomes.

Clinical Effect Observation of Apatinib Combined with 131I for Radioiodine-Refractory Differentiated Thyroid Cancer and Prognostic Significance Analysis of Macrophage Inflammatory Protein-1alpha After Treatment: A Cell Regulation Study / Observación del Efecto Clínico de Apatinib Combinado con 131I para el Cáncer de Tiroides Diferenciado Resistente al Yodo Radiactivo y Análisis de Importancia Pronóstica de la Proteína Inflamatoria 1alfa de Macrófagos Después del Tratamiento: Un Estudio de Regulación Celular

SUMMARY: The objective of this study was to observe the clinical efficacy of apatinib (AP) combined with 131I in the treatment of radioiodine-refractory differentiated thyroid cancer (RAIR-DTC) and the prognostic significance of MIP-1α after treatment, and to provide reference and guidance for future treatment and disease assessment of RAIR-DTC. One hundred and six patients with RAIR- DTC admitted to our hospital from January 2019 to October 2020 were selected for the study. All the patients were treated with TC surgery with 131I at our hospital, and 58 of them were subsequently transferred to AP treatment, which was considered as the research group; the other 48 patients were transferred to thyroid stimulating hormone (TSH) suppression treatment, which was considered as the control group. The clinical efficacy of the research group was better than that of the control group (P 0.05). After treatment, Tg, TL, maximum diameter of C/B lymph nodes, number of lymph nodes and number of calcified spots were lower in the research group than in the control group (P < 0.05). ROC analysis revealed that the predictive sensitivity of MIP-1α for prognosis of 3-year RAIR-DTC death in the research group of patients was 84.63 % and the specificity was 72.16 %. AP combined with 131I is effective in the treatment of RAIR-DTC and is worth using in the clinical practice. In addition, elevated levels of MIP-1α predicted a poor prognosis for patients with RAIR-DTC.

El objetivo de este estudio fue observar la eficacia clínica de apatinib (AP) combinado con 131I en el tratamiento del cáncer de tiroides diferenciado refractario al yodo radiactivo (RAIR-DTC) y la importancia pronóstica de MIP-1α después del tratamiento, y proporcionar referencia y orientación para futuros tratamientos y enfermedades. Evaluación de RAIR- DTC. Se seleccionaron para el estudio 106 pacientes con RAIR- DTC ingresados en nuestro hospital desde enero de 2019 hasta octubre de 2020. Todos los pacientes fueron tratados con cirugía CT con 131I, y 58 de ellos fueron trasladados posteriormente a tratamiento AP, los que fueron considerados como grupo de investigación; los otros 48 pacientes fueron transferidos a tratamiento de supresión de la hormona estimulante de la tiroides (TSH), que se consideró como grupo de control. La eficacia clínica del grupo de investigación fue mejor que la del grupo de control (P 0,05). Después del tratamiento, Tg, TL, diámetro máximo de los linfonodos C/B, número linfonodos y número de manchas calcificadas fueron menores en el grupo de investigación que en el grupo de control (P <0,05). El análisis ROC reveló que la sensibilidad predictiva de MIP-1α para el pronóstico de muerte por RAIR-DTC a 3 años en el grupo de pacientes de investigación fue del 84,63 % y la especificidad fue del 72,16 %. AP combinado con 131I es eficaz en el tratamiento del RAIR-DTC y vale la pena utilizarlo en la práctica clínica. Además, los niveles elevados de MIP-1α predijeron un mal pronóstico para los pacientes con RAIR- DTC.

Ablación por radiofrecuencia de nódulos tiroideos; a propósito de un caso exitoso en un hospital público en Perú / Radiofrequency ablation of thyroid nodules: a successful case in a public hospital in Perú

RESUMEN Se expone los resultados que sugieren la viabilidad de la ablación con radiofrecuencia (ARF) como una posible estrategia terapéutica efectiva en el caso de una mujer de 56 años con un nódulo tiroideo benigno en lugar de la cirugía tradicional en un Hospital Público del Perú. El seguimiento a los 6 meses reveló una reducción significativa en el tamaño del nódulo y reducción del 70% del volumen; además de mejorar la calidad de vida, mejora en los síntomas y función tiroidea normal. Este caso destaca la evolución en el tratamiento de nódulos tiroideos benignos, con la ARF como una posible opción mínimamente invasiva y segura, la cual se ofrece una alternativa prometedora a las intervenciones quirúrgicas convencionales para el manejo de nódulos tiroideos, marcando un cambio significativo en la práctica clínica, ya que es el primer hospital del MINSA (Ministerio de Salud) en realizar este tipo de procedimientos y que ofrece múltiples enfoques de tratamiento de nódulos tiroideos: ARF, tiroidectomía endoscópica transoral, tiroidectomía convencional y vigilancia activa.

ABSTRACT The results are presented, suggesting the viability of radiofrequency ablation (RFA) as an effective therapeutic strategy in the case of a 56-year-old woman with a benign thyroid nodule instead of traditional surgery at a Public Hospital in Peru. The 6-month follow-up revealed a significant reduction in the size of the nodule and a 70% reduction in volume; in addition to improved quality of life, symptom improvement, and normal thyroid function. This case highlights the evolution in the treatment of benign thyroid nodules, with RFA as a possible minimally invasive and safe option, offering a promising alternative to conventional surgical interventions for the management of thyroid nodules, marking a significant change in clinical practice. This is because it is the first hospital of the MINSA (Ministry of Health) to perform such procedures, offering multiple treatment approaches for thyroid nodules: RFA, transoral endoscopic thyroidectomy, conventional thyroidectomy, and active surveillance.

Correlation of acoustic voice analysis and Voice Handicap Index in patients with postoperative unilateral vocal cord paralysis after thyroid surgery

Unilateral vocal cord paralysis is frequently observed in patients who undergo thyroid surgery. This study explored the correlation between acoustic voice analysis (objective measure) and Voice Handicap Index (VHI, a self-assessment tool). One hundred and forty patients who had thyroid surgery with or without postoperative unilateral vocal cord paralysis (PVCP and NPVCP) were included. The patients were evaluated by the VHI and Dysphonia Severity Index (DSI) tools. VHI scores were significantly higher in PVCP patients than in NPVCP patients. Jitter (%) and shimmer (%) were significantly increased, whereas DSI was significantly decreased in PVCP patients. Receiver operating characteristics curve revealed that VHI scores were associated with the diagnosis of PVCP, of which VHI total score yielded an area under the curve (AUC) of 0.81. Among acoustic parameters, DSI was highly associated to PVCP (AUC=0.82, 95%CI=0.75 to 0.89). Moreover, we found a correlation between VHI scores and voice acoustic parameters. Among them, DSI had a moderate correlation with functional and VHI scores, as suggested by an R value of 0.41 and 0.49, respectively. VHI scores and acoustic parameters were associated with the diagnosis of PVCP.

Cáncer en quiste tirogloso, con tiroides agenésica y nódulo ectópico. Caso clínico

Introducción: La glándula tiroides tiene su origen embriológico en la base de la lengua, desde donde desciende al cuello. Este proceso migratorio puede detenerse o continuar más allá, dando diferentes cuadros de tiroides ectópica. El quiste tirogloso es la alteración embriológica más frecuente en el cuello, pudiendo desarrollar cáncer como una complicación rara. Caso clínico: Paciente de 21 años con aumento de volumen cervical, se diagnostica quiste tirogloso, la biopsia identifica cáncer papilar en el quiste. Se decide completar tiroidectomía, se objetiva agenesia de glándula. Ante respuesta bioquímica incompleta se realiza cintigrama que identifica nódulo retrolingual, el cual es resecado. Discusión: La resección del quiste tirogloso se debe realizar según la descripción de Sistrunk para evitar recidivas. La historia natural del cáncer en quiste tirogloso es bastante menos conocida y podría tener un peor pronóstico que el cáncer tiroideo habitual. Existen grupos que defienden la necesidad de completar tiroidectomía y, eventualmente, realizar disecciones cervicales como parte de su manejo. Conclusión: El cáncer de quiste tirogloso es una patología infrecuente, Existen diferentes lineas de manejo que se discuten en la literatura. Aún el análisis individualizado de los pacientes en comités multidisciplinario de expertos es la conducta sugerida.

Introduction: The thyroid gland has its embryological origin from the base of the tongue, where it descends to the neck. This migratory process can stop early or continue beyond, giving rise to differents cases of ectopic thyroid. The thyroglossal cyst is the most frequent embryological alteration in the neck, and it can develop cancer as a rare complication. Clinical case: A 21 year old patient with a cervical volume increase is diagnosed a thyroglossal cyst. Biopsy identifies papilary cancer in the cyst. It is decided to complete de thyroidectomy, and agenesis of the gland is observed. Due to incomplete biochemical response, a scintigram is performed, wich identifies a retrolingual nodule that is resected. Discussion: The resection of the thyroglossus cyst should be performed according to the description of Sistrunk to avoid recurrence. The natural history of cancer in the thyroglossal cyst is much less known and could have a worst prognosis than usual thyroid cancer. Some groups advocate for the need to complete a thyroidectomy and eventually perform cervical dissections as part of its management. Conclusion: The cancer on a thyroglossal cyst is a rare pathology. There are diferents management approaches that are discussed in the literature. However, an individualized analysis of patients in multidisciplinary expert committees it still the suggested aproach.

Synergy between isobavachalcone and doxorubicin suppressed the progression of anaplastic thyroid cancer through ferroptosis activation

The objective of this study was to explore the effects and mechanisms of the combination of isobavachalcone (IBC) and doxorubicin (DOX) on the progression of anaplastic thyroid cancer (ATC). Cell viability of 8505C and CAL62 cells was observed by CCK-8 assay. Kits were used to detect the presence of reactive oxygen species (ROS), glutathione (GSH), malondialdehyde (MDA), and cellular iron. Protein expression of solute carrier family 7 member 11 (SLC7A11) and glutathione peroxidase 4 (GPX4) was detected using western blot, and CD31 was detected through immunofluorescence. Tumor xenograft models of 8505C cells were constructed to observe the effect of IBC and DOX on ATC growth in vivo. The co-administration of IBC and DOX exhibited a synergistic effect of suppressing the growth of 8505C and CAL62 cells. The concurrent use of IBC and DOX resulted in elevated iron, ROS, and MDA levels, while reducing GSH levels and protein expression of SLC7A11 and GPX4. However, the Fer-1 ferroptosis inhibitor effectively counteracted this effect. In vitro and in vivo, the inhibitory effect on ATC cell proliferation and tumor growth was significantly enhanced by the combination of IBC and DOX. The combination of IBC and DOX can inhibit the growth of ATC by activating ferroptosis, and might prove to be a potent chemotherapy protocol for addressing ATC.

Evaluación de la agudeza diagnóstica de la Ecografía Translaríngea Transcutánea (ETLTC) en la valoración de la movilidad de las cuerdas vocales en cirugía de tiroides y paratiroides / Evaluation of the diagnostic acuity of the Transcutaneous Translaryngeal Ultrasound (TCTLUS) in the assessment of the vocal cords mobility in thyroid and parathyroid surgery

Introducción. La evaluación de la movilidad de las cuerdas vocales en cirugía de tiroides y paratiroides hace parte de la adecuada valoración integral. Aunque la laringoscopia directa es prueba de referencia, su uso real no es rutinario por lo que se propone la ecografía translaríngea como alternativa de evaluación. Métodos. Estudio prospectivo de evaluación de una prueba diagnóstica de la movilidad de las cuerdas vocales pre y posoperatoria, comparando la ecografía translaríngea con la video laringoscopia, en pacientes con cirugía de tiroides y paratiroides, de febrero 1° a noviembre 30 de 2022. Se describieron las variables usando frecuencias absolutas y relativas. En el análisis univariado se calcularon Chi cuadrado y T de Student y en el bivariado, regresión logística binaria. La agudeza diagnóstica se determinó con sensibilidad, especificidad y valores predictivos; se consideró la significancia estadística con p < 0,05. Resultados. Se incluyeron 267 pacientes, 219 mujeres y 48 hombres; 196 pacientes (73,4%) tenían malignidad. Se encontró en el preoperatorio, sensibilidad 100 %, especificidad 99,6 %, VPP 83,3 %, VPN 100 %, odds de probabilidad positiva 83 % y Odds de probabilidad negativa 0,004 %. En el posoperatorio, sensibilidad 82,8 %, especificidad 99,2 %, VPP 92,3 % VPN 97,9 %, odds de probabilidad positiva 92 % y odds de probabilidad negativa 0,2 %. Conclusiones. La ecografía translaríngea en nuestro medio tiene alta agudeza diagnóstica. Podría ser usada en el abordaje inicial de la evaluación de la movilidad de las cuerdas vocales y reemplazar la laringoscopia directa, dejando ésta para cuando la visualización ecográfica no sea adecuada, o en casos de afectación o sospecha de invasión, para su confirmación.

Introduction. The evaluation of the mobility of the vocal cords in thyroid and parathyroid surgery is part of the adequate comprehensive assessment. Altough, direct laryngoscopy is the gold standard, its real use is not routine, so translaryngeal ultrasound approach is proposed as an alternative. Methods. A prospective diagnostic test study was carried out to evaluate the translaryngeal ultrasound compared with video laryngoscopy in visualizing vocal mobility in patients with thyroid and parathyroid surgery from February 1 to November 30, 2022. Patients were described using absolute and relative frequencies. Univariate statistical analysis with Chi-square and Student's t tests. T. Bivariate analysis using binary logistic regression. Diagnostic acuity was calculated with sensitivity, specificity, PPV, NPV. Statistical significance with p< 0.05, 95% confidence interval. Results. 267 patients undergoing thyroid or parathyroid surgery were included, 219 women and 48 men. Malignant: thyroid neoplasm 196 patients (73.4%). The findings were for the preoperative period, 100% sensitivity, 99.6% specificity, PPV 83.33%, NPV 100%, 83% positive probability odds, and 0.004% negative probability odds. For the postoperative period, 82.8% sensitivity, 99.2% specificity, 92.3% PPV, 97.9% NPV, 92% positive probability odds, and 0.2% negative probability odds were found.Conclusions. Translaryngeal ultrasound in our series has high diagnostic acuity. It could be used as the initial approach to evaluate vocal mobility and might replace direct laryngoscopy, leaving it when its visualization is not adequate or in cases of involvement or suspected invasion for confirmation.

Utilidad diagnóstica de citopatología para diagnóstico de nódulos tiroideos malignos en un hospital peruano / Diagnostic utility of cytopathology for the diagnosis of malignant thyroid nodules in a Peruvian hospital

RESUMEN Objetivos: determinar el rendimiento diagnóstico de la biopsia por punción aspiración con aguja fina (PAAF) para el diagnóstico de nódulos tiroideos malignos. Materiales y métodos: estudio retrospectivo que evaluó las PAAF de tiroides realizadas en el Hospital Nacional Guillermo Almenara Irigoyen en Lima, Perú, durante un período de tres años. Se categorizó el diagnóstico citopatológico de las biopsias usando el sistema de Bethesda, se consideró las categorías V y VI como malignas y la categoría II como benigna. Se obtuvo solo una biopsia por paciente y se consideró el resultado con la categoría de Bethesda más alta. Todos los pacientes fueron sometidos a tiroidectomía y los resultados histopatológicos se categorizaron como malignos o benignos. Resultados: se incluyó a 173 pacientes con resultados citopatológicos de Bethesda II al VI. El diagnóstico citológico mostró que el 47,4% de los pacientes tenían Bethesda VI. El 59,5% de los nódulos tiroideos fueron malignos en la histopatología, siendo el carcinoma papilar el tipo más frecuente. El rendimiento diagnóstico de la PAAF fue alta cuando considera Bethesda V y VI como malignos, con una sensibilidad 91,92%, especificidad 71,67%, valor predictivo positivo 84,26%, valor predictivo negativo 84,31% y precisión de 84,28%, razón de verosimilitud positiva 3,39; pero mejoró significativamente cuando se consideró solo Bethesda VI como maligno, con sensibilidad del 90,7%, especificidad del 89,58%, precisión 90,3% y razón de verosimilitud positiva 8,71. Conclusiones : la PAAF tiene buen rendimiento. Este estudio demostró ser de gran utilidad en nuestro centro de salud para detectar errores y promover mejoras, así también como modelo para próximas investigaciones en diferentes establecimientos de salud.

ABSTRACT Objectives: To determine the diagnostic performance of fine needle aspiration biopsy (FNAB) for diagnosing malignant thyroid nodules. Methods: This is a retrospective study that assessed thyroid FNABs in Guillermo Almenara-Irigoyen National Hospital in Lima, Peru, during a three-year period. Cytopathologic diagnosis of biopsies was categorized using the Bethesda System, considering categories V and VI as malignant, and category II as benign. A single biopsy per patient was obtained, and results with the highest value in the Bethesda System were considered. All patients underwent thyroidectomy and histopathological results were characterized as malignant or benign. Results: One hundred and seventy-three patients were included in the study. Their cytopathology results were Bethesda II to VI. Cytological diagnosis showed that 47.4% of all patients were Bethesda VI. Nearly sixty percent (59.5%) of thyroid nodules were malignant in histopathology, and papillary carcinoma was the most frequent neoplasm. Diagnostic performance of FNAB was high when considering Bethesda V and VI as malignant, with 91.92% sensitivity, 71.67% specificity, 84.26 positive predictive value, 84.31% negative predictive value, and 84.28% precision. Positive verisimilitude rate was 3.39; but this significantly improved when only Bethesda VI was considered as malignant, with 90.7% sensitivity, 89.58% specificity, 90.3% precision, and 8.71 positive verisimilitude rate. Conclusion: FNAB showed good performance. This study proved to be quite useful in our healthcare facility for detecting errors and promote improvement, as well as a model for future research in different healthcare instances.

Advances and Reflections on Neoadjuvant Therapy for Locally Advanced Thyroid Cancer / 肿瘤防治研究

The vast majority of thyroid cancers show a good prognosis. However, the treatment of locally advanced thyroid cancer presents a huge problem. The wide application of targeted and immunotherapy in neoadjuvant therapy for locally advanced thyroid cancer has become a new therapeutic direction. This article summarizes the research on neoadjuvant chemotherapy, radiotherapy, and targeted therapy and immunotherapy related to various pathological types of thyroid cancer, with a focus on the recent advancements and thoughts on the application of targeted and immunotherapeutic drugs in neoadjuvant therapy. The results provide additional options for the clinical treatment of locally advanced thyroid cancer.

Influencing factors on thyroid volume in school-age children aged 8-10 years in Tianjin / 公共卫生与预防医学

Objective To investigate the status and the influencing factors of thyroid volume of children aged 8-10 years in Tianjin. Methods Among the 1-2 primary schools were randomly selected from 12 districts in Tianjin. A total of 1 090 children were selected by class cluster sampling method (half male and half female, with a balanced age distribution). A questionnaire survey was conducted. Children’s height, weight and thyroid volume were measured, and their salt iodine content and urinary iodine content were detected. Results I n this study, the median urinary iodine in children was 161.35 µg/L, the mean thyroid volume was 2.56 mL, and the goiter rate was 3.58%. Univariate analysis showed that age, BSA, salt iodine content, urinary iodine content, eating habits, food taste, eating lunch at school, father's work, anxiety and depression, pressure, and different regional grouping were the influencing factors of thyroid volume (P<0.05). Multivariate linear regression showed that BSA, age, food taste, and urinary iodine content had significant independent effects on thyroid volume (P<0.05). Conclusion In Tianjin, the iodine nutrition level of children aged 8-10 years is at an appropriate level. When evaluating the thyroid volume of children, in addition to age factors, other factors such as physical development level and iodine intake should also be considered.

Clinicopathological features of radioactive iodine-refractory differentiated thyroid cancer / 重庆医学

Objective To investigate the clinicopathological characteristics of radioactive Iodine-refrac-tory differentiated thyroid cancer(RAIR-DTC)to provide a clinical evidence for early prediction of the thyroid cancer patients with radioactive Iodine-refractory(RAIR).Methods The data of 84 patients with undergoing thyroidectomy and 131I therapy in PLA 960 hospital from January 2010 to December 2019 were retrospectively analyzed.Thirty-nine patients with diagnosed RAIR-DTC served as the study group and 45 cases of radioactive iodine-avid differentiated thyroid cancer(RAIA-DTC)served as the control group.The clinicopathological characteristics were compared between the two groups.The logistic regression was used to analyze the inde-pendent risk factors of RAIR-DTC,and the RAIR-DTC prediction model was established.Results Compared with the RAIA-DTC group,the RAIR-DTC group had more iodine treatment times,the proportions of the pa-tients with age ≥55 years old,total iodine therapeutic dose,distant metastasis,TNM stage Ⅳ,high-risk sub-types and focal calcification were higher,the tumor maximum diameter was greater,the number of lymph node metastases was more and the probability of Ⅱ,Ⅰ+Ⅱ and non-central lymph node metastases was higher(P＞0.05).The progression-free survival rate had statistical difference between the two groups(P＜0.05).The total survival rate had no statistical difference between the two groups(P＞0.05).The binary logistic re-gression analysis results showed that the distant metastasis,high-risk histological subtype and maximum tumor diameter ≥10.5 mm were the independent risk factors for RAIR-DTC.The obtained fitting equation logit(P)=-2.259+3.330X1+2.287X2+1.606X3,the ROC curve was used to calculate the truncation val-ue of the fitted equation as-0.312 5,when logit(P)＞-0.312 5,it might develop into RAIR-DTC.Conclusion The clinicopathological characteristics of the patients with differentiated thyroid cancer could ef-fectively predict RAIR.

Clinical value of serum TgAb and TPOAb in diagnosis and treatment of papillary thyroid microcarcinoma / 重庆医学

Objective To investigate the clinical value of thyroid globulin antibody(TgAb)and thyroid peroxidase antibody(TPOAb)in the diagnosis and treatment of papillary thyroid microcarcinoma(PTMC).Methods A total of 346 patients with thyroid nodules who underwent surgical treatment in the hospital from August 2012 to October 2021 were selected as the research objects.According to the postoperative pathologi-cal results,the patients were divided into the benign nodule group,PTMC group and non-micro papillary thy-roid carcinoma(PTC)group.The general data of the patients and thyroid function indexes[free triiodothyro-nine(FT3),free tetraiodothyronine(FT4),thyroid stimulating hormone(TSH),TgAb and TPOAb]before and after operation were collected,the tumor recurrence or lymph node metastasis after operation were ob-served,and the relationship between serum TgAb and TPOAb and the risk and prognosis of PTMC was ana-lyzed.Results The positivity rate of TgAb in the PTMC and non-micro PTC groups was significantly higher than that in the benign nodule group(P<0.05).The TPOAb positivity rate was not significantly different among the three groups(P>0.05).Only the TSH level in the PTMC group was higher than that in the non-micro PTC group(P<0.05).Multivariate logistic analysis showed that younger age,higher TSH and positive TgAb were independent risk factors for PTMC and non-micro PTC(P<0.05).However,the risk of PTC didn't increase with increasing TgAb titres.The positivity rate of TgAb in the PTMC and non-micro PTC groups didn't change significantly within one month after operation,but decreased in one year after operation(P<0.05).The TPOAb positivity rate decreased after operation,but the difference was not statistically sig-nificant(P>0.05).In the PTMC group,four cases had tumor recurrence or lymph node metastasis,and the TgAb level increased by 88.4%,49.5%,5.7%and 84.0%respectively when the tumor recurred or metasta-sized.Among them,the TPOAb level increased by 51.6%,30.0%and 2.9%respectively in three cases and decreased by 53.9%in one case.In the PTMC group,there were 11 patients with cervical lymph node enlarge-ment,and there was no statistical difference in TgAb and TPOAb levels when the condition changed(P>0.05).Conclusion TgAb is a risk factor for PTMC,and can be followed up regularly during the diagnosis and treatment of PTMC.The specificity of TPOAb is not as good as that of TgAb,and appropriate follow-up can be chosen during the course of the disease.

Clinical value of serum calcitonin in the diagnosis,preoperative evaluation and postoperative follow-up of medullary thyroid cancer / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the diagnostic efficacy of serum calcitonin(Ctn)in medullary thyroid cancer(MTC),the correlation between preoperative serum Ctn and clinicopathological features,and the risk factors affecting the progression of MTC disease during follow-up.METHODS The clinical data of 50 patients admitted to the Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine from 2011 to 2022 were systematically reviewed,the ROC curve calculated the diagnostic efficacy of Ctn and CEA levels on MTC,and the risk factors for lymph node metastasis in the central region of MTC were analyzed in univariate and multivariate,and the survival curve without disease progression was drawn to predict risk factors.RESULTS The ROC curve yields the preoperative cut-off value of Ctn was 23.81 pg/ml and the cut-off value of CEA was 3.035 ng/ml for the diagnosis of MTC.The age of disease,tumor diameter,and preoperative serum Ctn and CEA levels in MTC patients were higher than those in non-MTC patients.Ctn≥289.62 pg/ml was an independent risk factor for central lymph node metastasis in MTC.The survival curve showed that invasion of the capsule,central region metastasis,and TNM stage above T2 were risk factors for predicting disease progression(P<0.05).Patients with MTC who have disease progression have higher preoperative Ctn.CONCLUSION Serum Ctn has important clinical value in the differential diagnosis,preoperative evaluation and postoperative follow-up of MTC.

Serum metabolomic characteristics of early papillary thyroid carcinoma and association with lymph node metastasis / 中国耳鼻咽喉头颈外科

OBJECTIVE To compare the metabolomic characteristics of stage T1 papillary thyroid carcinoma(PTC)and nodular goiter(NG),and the relationship between metabolites and lymph node metastasis of PTC.METHODS Serum samples were collected from 60 patients with stage T1 PTC and 30 patients with NG who underwent thyroidectomy at the Department of Otolaryngology Head and Neck Surgery,Civil Aviation General Hospital between September 2021 and April 2022.The PTC group was divided into the N+ group with lymph node metastasis and the N-group without lymph node metastasis according to the presence or absence of lymph node metastasis.The serum metabolites of the N+ and N-groups and the PTC and NG groups were compared and analyzed using an ultra-performance liquid chromatography-mass spectrometry(UPLC-Q-Exactive-MS)coupled platform,and principal component analysis(PCA),partial least squares discriminant analysis(PLS-DA),and orthogonal partial least squares discriminant analysis(OPLS-DA)was performed using SIMCA-P 14.1 software.OPLS-DA modeling,combined with FDR-corrected Mann-Whitney-Wilcoxon test results and metabolite difference multiples in the two groups undergoing comparison,etc.to screen for potential small molecule metabolic markers,and to establish a joint diagnostic model by binary logistic regression analysis.RESULTS There were no significant differential metabolites between the N+ group with lymph node metastasis and the N-group without lymph node metastasis.Seven differential metabolites were found between PCA patients and NG patients,and the five relevant metabolic pathways were the pentose phosphate pathway,pentose and glucuronide interconversion,glycolysis/gluconeogenesis,fructose,and mannose metabolism,and fatty acid biosynthesis.The differential metabolite with an area under the ROC curve>0.9 was D-glyceraldehyde 3-phosphate,and another N-undecanoylglycine,uronic acid,and the area under the ROC curve for three metabolites,N-undecanoylglycine,uric acid,and triiodothyronine glucuronide,was>0.8.CONCLUSION PTC patients differed from NG patients mainly in glucose metabolism and lipid metabolism,and D-glyceraldehyde 3-phosphate could be distinguished from NG patients with the aid of N-undecanoylglycine,uric acid,and triiodothyronine glucuronide,combined with imaging findings.Also,no significant differences in serum metabolites were found in the N+ group compared with the N-group,and the presence or absence of lymph node metastases did not affect serum metabolites in patients with stage T1 PTC.

Correlation between serum HbA1c,LAG-3 and thyroid nodules in patients with type 2 diabetes mellitus / 国际检验医学杂志

Objective To explore the correlation between serum glycosylated hemoglobin(HbA1c),lym-phocyte activation gene-3(LAG-3)and thyroid nodules in patients with type 2 diabetes mellitus(T2DM).Methods A total of 120 T2DM patients with thyroid nodules admitted to the Third Hospital of Hebei Medi-cal University from July 2021 to July 2022 were included as the study group,and 100 simple T2DM patients(without thyroid nodules)were included as the control group during the same period.According to the patho-logical examination results of thyroid nodules,the study group was grouped into a benign nodule group(85 ca-ses)and a malignant nodule group(35 cases).Enzyme linked immunosorbent assay was applied to detect the serum LAG-3 level of all study subjects.Fully automated glycated hemoglobin analyzer was applied to detect HbA1c level in all study subjects.Spearman method was applied to analyze the correlation between serum HbA1c,LAG-3,and thyroid imaging report and data system(TI-RADS)scores in patients with T2DM and thyroid nodules.Multivariate Logistic regression was applied to analyze the influencing factors of T2DM with thyroid nodules.Receiver operating characteristic(ROC)curve was applied to analyze the diagnostic value of HbA1c and LAG-3 levels in T2DM with thyroid nodules.Results Compared with the control group,the level of HbA1c in the study group was obviously higher(P<0.05),while the level of LAG-3 was obviously lower(P<0.05).Compared with the benign nodule group,the serum LAG-3 level in the malignant nodule group was obviously lower(P<0.05),while the level of LAG-3 was obviously lower(P<0.05).Spearman analysis showed a positive correlation between HbA1c level and TI-RADS score in T2DM patients with thyroid nod-ules(r=0.378,P<0.001),while the serum LAG-3 level was negatively correlated with TI-RADS score(r=-0.472,P<0.001).The results of multivariate Logistic regression analysis showed that HbA1c was a risk factor for the occurrence of thyroid nodules in T2DM patients(P<0.05),and LAG-3 was a protective factor for the occurrence of thyroid nodules in T2DM patients(P<0.05).The combination of HbA1c and LAG-3 in the diagnosis of T2DM with thyroid nodules was superior to their individual diagnosis(Zcombination-HbA1c=2.542,P=0.011;Zcombination-LAG-3=3.098,P=0.002).Conclusion Patients with T2DM combined with thyroid nodules have obviously lower serum LAG-3 level and higher HbA1c level,and the two are related to the malignancy of thyroid nodules.

Value of serum Irisin and TPOAb in the diagnosis of hypothyroidism during pregnancy / 国际检验医学杂志

Objective To explore the value of serum Irisin and thyroid peroxidase antibody(TPOAb)in the diagnosis of hypothyroidism during pregnancy.Methods A total of 107 pregnant women with hypothy-roidism during pregnancy who were diagnosed and treated in the hospital from October 2020 to October 2022 were regarded as the study group,another 107 healthy pregnant women who were examined in the hospital at the same time and whose general data matched with cases of hypothyroidism during pregnancy and 107 non pregnant healthy women were taken as the control group and health group.Pearson method was applied to an-alyze the correlation between the levels of serum Irisin and TPOAb in pregnant women with hypothyroidism during pregnancy.Logistic regression was applied to analyze the related factors affecting the occurrence of hy-pothyroidism during pregnancy.The diagnostic value of serum Irisin and TPOAb levels for hypothyroidism during pregnancy was analyzed by the receiver operating characteristic(ROC)curve.Results The levels of serum Irisin and TPOAb in the study group were significantly higher than those in the health group and con-trol group(P<0.05).The levels of serum Irisin and TPOAb in pregnant women with hypothyroidism during pregnancy were positively correlated(r=0.641,P<0.05).The proportions of pregnant women with BMI<20 kg/m2 and iodine deficiency before pregnancy in the study group were obviously higher than those in the control group(P<0.05).BMI<20 kg/m2 before pregnancy,iodine deficiency,increased levels of Irisin and TPOAb were all risk factors for hypothyroidism during pregnancy(P<0.05).The area under the curve(AUC)of serum Irisin and TPOAb in the diagnosis of hypothyroidism during pregnancy was 0.765 and 0.835,respectively,while the AUC of the combined diagnosis of the two was 0.926,the combined diagnosis of the two was better than that of serum Irisin and TPOAb alone(Zcombination-Irisin=6.105,Zcombination-TPOAb=4.951,P<0.001).Conclusion The increased levels of serum Irisin and TPOAb are closely related to the occurrence of hypothyroidism during pregnancy,and the combination of them has high diagnostic value for hypothyroid-ism during pregnancy.