Abstract
Regular Call Oral Abstracts
Oral 0001
Thyroid Hormone Action, Metabolism and Regulation, Basic, Oral
Thyroid hormone promotes upper layer neuron specification in human cerebral organoids
Robert Opitz*1,2, Benedikt Obermayer3, Audrey Bresser2, Matthias Megges2, Valeria Fernandez Vallone4, Harald Stachelscheid4, Peter Kühnen2, 1Institute of Experimental Pediatric Endocrinology, Charité Universitätsmedizin, Germany, 2Department of Pediatric Endocrinology and Diabetology, Charité Universitätsmedizin, Germany, 3Core Unit Bioinformatics, Berlin Institute of Health, Germany, 4Core Unit pluripotent Stem Cells and Organoids (CUSCO), Berlin Institute of Health, Germany
Human nervous system development depends on normal thyroid hormone (TH) function. This is evident from the various neurological phenotypes in pediatric patients following TH deficiency or perturbed local TH signaling during early human brain development. However, scarcity and inaccessibility of human fetal brain tissue have been major roadblocks for experimental approaches to decipher mechanistic aspects of TH function during early stages of human brain development. In this study, we generated human cerebral organoids (hCOs) from induced pluripotent stem cell lines and assessed neuronal development in response to varying T3 media levels (0.002 – 20 nM). Immunofluorescence (IF) staining of hCOs cultured for up to 10 weeks verified successful differentiation of dorsal telencephalic tissue including a sequential appearance of deep and upper layer neurons consistent with the inside-out manner of fetal cortical layer emergence. However, quantitative image analyses of IF-stained organoid sections revealed a number of T3 concentration-dependent differences in cell type abundance including a strong stimulatory T3 effect on the abundance of SATB2+ upper layer neurons. Single cell RNA-seq of differentially treated hCOs confirmed an increased abundance of SATB2-expressing neurons in hCOs treated with increasing T3 concentrations. Notably, our single cell analyses also revealed a concurrent decrease in the abundance of TLE4-expressing deep layer neurons in hCOs treated with high T3 concentrations. We next exploited the conceptual power of single cell transcriptomics to impute T3 effects on gene-regulatory networks driving upper layer neuron generation. These analyses identified up-regulation of several key transcription factors implicated in upper layer neuron specification (CUX2, POU3F2, POU3F3, ZBTB20) already at early stages of neuronal differentiation whereas transcription factors regulating deep layer neuron programs (FEZF2) were down-regulated by T3. In conclusion, our organoid studies demonstrate that the molecular processes of upper layer neuron specification are very sensitive to changes in TH levels. In this respect, it is of note that the expansion of the upper layer neuron population is a key hallmark of human cortical evolution.
Oral 0002
Disorders of Thyroid Function, Basic, Oral
Hypothyroidism with Defective Thyroglobulin Co-opts the Machinery of Thyroid Hormone Synthesis to Drive Thyroid Cell Death
Crystal Young1, Xiaohan Zhang*1, Helmut Grasberger1, Xiao-Hui Liao2, Samuel Refetoff2, Aaron Kellogg1, Xiaofan Wang1, PETER ARVAN1 , 1University of Michigan, USA, 2University of Chicago, USA
Oral 0003
Disorders of Thyroid Function, Translational, Oral
Severe osteoporotic phenotype in Secisbp2 deficient mice
Haruki Fujisawa1, Marie Pereira2, Natalie Butterfield2, Manassawee Korwutthikulrangsri1, Jiao Fu1, Xiao-Hui Liao1, Graham Williams2, Duncan Bassett2, Alexandra Dumitrescu*1 , 1Univ of Chicago, USA, 2Imperial College London, United Kingdom
Oral 0005
Thyroid Cancer, Clinical, Oral
ChatGPT-4's Accuracy in Estimating Thyroid Nodule Cancer Risk from Ultrasound Images
Esteban Cabezas*1, David Toro-Tobon1, Thomas Johnson2, Marco Alvarez3, Javad Azadi4, Camilo Gonzalez-Velasquez5, Naykky Singh Ospina6, Juan Brito1 , 1Mayo Clinic, USA, 2Mercy Hospital, USA, 3Universidad Politécnica de Sinaloa en Mazatlán, Mexico, 4Johns Hopkins University School of Medicine, USA, 5Hospital Universitario “Dr. José E. González”, Universidad Autónoma de Nuevo León, Mexico, 6University of Florida, USA
Oral 0006
Thyroid Imaging, Clinical, Oral
Artificial Intelligence-Enhanced Infrared Thermography as a Diagnostic Tool for Thyroid Malignancy Detection
Panpicha Chantasartrassamee, Boonsong Ongphiphadhanakul, Ronnarat Suvikapakornkul, Panus Binsirawanich, Chutintorn Sriphrapradang*, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
Oral 0009
Thyroid Cancer, Clinical, Oral
Efficacy, Safety, and Genomic Data in Patients With TRK Fusion Thyroid Carcinoma (TC) Treated With Larotrectinib
Steven Waguespack*1, Jessica Lin2,3, Marcia Brose4, Ray McDermott5, Mohammed Almubarak6, Jessica Bauman7, Michela Casanova8, Shivaani Kummar9, Se-Hoon Lee10, Serge Leyvraz11, Do-Youn Oh12, Lin Shen13, Natascha Neu14, Vadim Bernard-Gauthier15, Shalini Chaturvedi16, Hong Zheng15, Chiara Mussi17, David Hong1, Alexander Drilon18,19, Maria Cabanillas1 , 1The University of Texas MD Anderson Cancer Center, USA, 2Massachusetts General Hospital, USA, 3Harvard Medical School, USA, 4Department of Medical Oncology, Sidney Kimmel Cancer Center of Jefferson University, USA, 5St Vincent's University Hospital and Cancer Trials Ireland, Ireland, 6West Virginia University, USA, 7Fox Chase Cancer Center, USA, 8Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy, 9Oregon Health & Science University, USA, 10Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea, Republic of, 11Charité – Universitätsmedizin Berlin, Germany, 12Seoul National University Hospital, Cancer Research Institute, National University College of Medicine, Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Korea, Republic of, 13Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, China, 14Chrestos Concept GmbH & Co. KG, Germany, 15Bayer Pharmaceuticals, Inc., Canada, 16Bayer HealthCare Pharmaceuticals, USA, 17Bayer S.p.A., Italy, 18Memorial Sloan Kettering Cancer Center, USA, 19Weill Cornell Medical College, USA
Baseline genomic data derived from circulating tumor DNA (ctDNA; n=17) and/or tissue DNA (n=23) were available for 27 patients. Baseline ctDNA analysis detected NTRK gene fusions in 5 patients. Additional baseline known/likely oncogenic variants were identified in 8 tumors (5 ATC). Six tumors had acquired potential larotrectinib-resistance mutations: 4 off-target and 2 with both on- and off-target pathogenic variants.
Oral 0010
Thyroid Cancer, Clinical, Oral
GLP-1RA Use and Thyroid Cancer Risk: Retrospective Emulation of a Target Trial
Juan Brito*1, Jeph Herrin2, Kavya Swarna1, Naykky Singh Ospina3, Victor Montori1, David Toro-Tobon1, Guillermo Umpierrez4, Rodolfo Galindo5, Yihong Deng6, Mindy Mickelson1, Eric Polley7, Rozalina McCoy8 , 1Mayo Clinic, USA, 2Yale School of Medicine, USA, 3University of Florida, USA, 4Emory University School of Medicine, USA, 5University of Miami Miller School of Medicine, USA, 6Optum labs, USA, 7University of Chicago, USA, 8University of Maryland, USA
Oral 0011
Thyroid Cancer, Clinical, Oral
Efficacy of Selpercatinib by RET mutation in RET-mutant Medullary Thyroid Cancer: A combined analysis of LIBRETTO-001 and LIBRETTO-531 trials
Julien Hadoux*1, Rossella Elisei2, Ana Hoff3, Bruce Robinson4, Lori Wirth5, Christine Spitzweg6,7, Francis Worden8, Tyler Marquart9, Patrick Peterson9, Anna Szpurka9, Patricia Maeda9, Jennifer Wright9, Olivera Grbovic-Huezo9, Hyunseok Kang10, Mimi Hu11 , 1Gustave-Roussy, Département d’imagerie, service d'oncologie endocrinienne, Villejuif, France, France, 2Department of Clinical and Experimental Medicine, University of Pisa, Italy, 3Instituto do Cancer do Estado de Sao Paulo, ICESP, Brazil, 4Kolling Institute of Medical Research, The University of Sydney, Australia, 5Department of Medicine, Massachusetts General Hospital, USA, 6Department of Medicine IV, LMU University Hospital, LMU Munich, Germany, 7Division of Endocrinology, Diabetes, Metabolism and Nutrition, Adjunct Academic Appointment, Mayo Clinic Rochester, USA, 8Comprehensive Cancer Center, University of Michigan, USA, 9Eli Lilly and Company, USA, 10Department of Medicine, University of California San Francisco, USA, 11University of Texas M. D. Anderson Cancer Center, USA
Among LIBRETTO-531 patients, ORR was 71.9% (95%CI, 63.0-79.7) with selpercatinib versus 45.9% (95%CI, 33.1-59.2) with control for M918T; 62.5% (95%CI, 45.8-77.3) versus 30.0% (95%CI, 11.9-54.3) for EC; and 68.8% (95%CI, 50.0-83.9) versus 23.5% (95%CI, 6.8-49.9) for Other.
Oral 0012
Thyroid Nodules and Goiter, Clinical, Oral
Thyroid Nodules with Indeterminate Cytology and Negative Molecular Testing: Prevalence of Malignancy and Practice Paradigms for Surveillance
Sapir Goldberg*1, Isabella Tondi Resta1, Zubair Balcoh2, Susan Mandel1 , 1Perelman School of Medicine, Hospital of the University of Pennsylvania, USA, 2University of Pennsylvania Medical Center, USA
Clinical management varied based on TSv3 negative subtype, with more nodules with TSCN (20%) and TSNBL (18%) undergoing immediate surgical resection as compared to TSN (7%) (p<0.001). Surveillance ultrasound was done for 319 (64%) nodules, of which 76 (24%) grew. Rates of subsequent surgical resection performed after ultrasound surveillance did not differ based on TSv3 results (p 0.65) or nodule growth (p 0.11). FNA was repeated for 23 nodules (16% of growing and 4.5% of stable nodules, p<0.01), with benign cytology in 6. Repeat TSv3 results remained a negative subtype in 15 nodules but became positive in 2 nodules (1 adenoma, 1 ATA low risk cancer).
Oral 0013
Health Disparities/Health Equity, Clinical, Oral
The Influence of Safety-Net Burden on Outcomes for High-Volume Thyroid Cancer Surgeons
Hattie Huston-Paterson*1, Yifan Mao2, Chi-Hong Tseng3, Jiyoon Kim4, Debbie Chen5, James Wu6, Michael Yeh6 , 1Department of Surgery, University of California Los Angeles, USA, 2David Geffen School of Medicine, University of California Los Angeles, USA, 3Department of Medicine, University of California Los Angeles, USA, 4Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, USA, 5Division of Endocrinology, Department of Internal Medicine, University of Michigan, USA, 6Section of Endocrine Surgery, Department of Surgery, University of California Los Angeles, USA
The performance of high-volume thyroid cancer surgeons differs by a hospital’s safety net burden, with patients treated at high SNB hospitals experiencing higher rates of operative complications, disease-specific mortality, and all-cause mortality. Having a HV surgeon alone may be insufficient to provide optimal short- and long-term outcomes for thyroid cancer patients.
Oral 0014
Health Disparities/Health Equity, Clinical, Oral
Multilevel Associations of Food Environment and Papillary Thyroid Cancer Outcomes in the United States
David Fei-Zhang1, Eric Pan*2, Jean-Nicolas Gallant3, Andrés Bur4, Ryan Belcher3 , 1Northwestern University Feinberg School of Medicine, USA, 2Medical College of Georgia, USA, 3Vanderbilt University Medical Center, USA, 4University of Kansas Medical Center, USA
Oral 0015
Health Disparities/Health Equity, Clinical, Oral
Factors Influencing the Time Interval to Thyroid Biopsy and Cancer Diagnosis Post-Thyroid Ultrasound
Sanaa Badour*1, Xingke Liu1, Kylie Harrall1, Yi Guo1, Ramzi Salloum1, Juan Brito Campana2, Dejana Braithwaite1, Naykky Singh Ospina1 , 1University of Florida, USA, 2Mayo Clinic, USA
Oral 0017
Autoimmunity, Clinical, Oral
Reduced Proptosis and Muscle/Fat Volume by MRI/CT in a Proof-of-Concept Study in TED Shows Potential for Disease-Modifying Effects of VRDN-001, a Targeted TED Therapy
Shoaib Ugradar*1, Andrea Kossler2, Roger Turbin3, Kimberly Cockerham4, Navdeep Nijhawan5, Rosa Tang6, Michael Yen7, Chantal Boisvert8, David Kaufman9, Wendy Lee10, Michael Yoon11, Cathy Michalsky12, Thomas Ciulla12 , 1Department of Orbital and Oculoplastic Surgery, Private Practice, USA, 2Stanford University Department of Ophthalmology at Byers Eye Institute, USA, 3Rutgers New Jersey Medical School, Dept of Ophthalmology, USA, 4Senta Clinic, USA, 5Oshawa Clinic, Canada, 6Eye Wellness Center–Neuro-Eye Clinical Trials, Inc., USA, 7Baylor College of Medicine, Alkek Eye Center, USA, 8University of Vermont Medical Center, USA, 9Michigan State University Department of Neurology & Ophthalmology, USA, 10Bascom Palmer Eye Institute, USA, 11Harvard Medical School, Massachusetts Eye and Ear Infirmary, USA, 12Viridian Therapeutics, Inc, USA
Oral 0018
Disorders of Thyroid Function, Translational, Oral
Severe Neurodevelopmental Phenotype, Diagnostic and Treatment Challenges in Patients with SECISBP2 (SBP2) Deficiency
Athanasia Stoupa1, Monica Malheiros Franca*2, Maha Abdulhadi-Atwan3, Haruki Fujisawa2, Manassawee Korwutthikulrangsri2, Isis Marchand4, Gabrielle Polak5, Jacques Beltrand1, Michel Polak1, Dulanjalee Kariyawasam1, Xiao-Hui Liao2, Chantalle Raimondi6, Connolly Steigerwald7, Nicolas Abreu7, Andrew Bauer8, Aurore Carré9, Charit Taneja10, Allison Bauman Mekhoubad11, Alexandra Dumitrescu12 , 1Hôpital Universitaire Necker-Enfants Malades, France, 2Univ of Chicago, USA, 3Crescent Society Hospital, Palestine, 4Hôpital Intercommunal de Créteil, France, 5Faculté de Médecine, Université Paris Cité, France, 611Advocate Children’s Hospital, USA, 7NYU Grossman School of Medicine, USA, 8Children’s Hospital of Philadelphia, USA, 9Assistance Publique Hôpitaux de Paris, France, 10Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA, 11Cohen Children’s Medical Center/Northwell, USA, 12Univ of Chicago, USA
Oral 0021
Autoimmunity, Clinical, Oral
Glandy EXO: A Deep Learning Approach for Proptosis Measurement in Thyroid Eye Disease
Joon Hyeon Park*1, Kyubo Shin1, Jongchan Kim1, Jaemin Park1, JaeSang Ko2, Jin Sook Yoon2, Jae Hoon Moon1,3,4 , 1THYROSCOPE INC., Korea, Republic of, 2Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Korea, Republic of, 3Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Korea, Republic of, 4Center for Artificial Intelligence in Healthcare, Seoul National University Bundang Hospital, Korea, Republic of
Oral 0022
Thyroid Nodules and Goiter, Clinical, Oral
Enhanced performance of the new optimized version (v2) of the microRNA and DNA-based molecular classifier test: Insights from a Latin American Multicenter Study
Marcos Santos*1, Andrei de Oliveira1, Diego Vilela1, Bruna Rodrigues1, Miriane Oliveira1, Bruna Rabelo1, Thamiris Gatti Deo1, Eduardo da Silva2, Cristiano Oliveira3, Rozany Dufloth4, Fernando Soares4, Leandra Schneider5, Mario Montemór Netto5, Milena Kozonoe6, Sérgio Ioshii6, Ricardo Gama7, Acklei Viana8, Daniel Ortellado8, Gustavo de los Santos8, Jalmir Aust8, Giulianno de Melo9, Rubens Adão10, David Figueiredo11, Miluska Huachín Soto12, Mauro Saieg13, Fabiano Callegari14, Léa Maciel15, Gláucia Mazeto16, Gabriela Brenta17, Edna Kimura18 , 1ONKOS Molecular Diagnostics, Brazil, 2Department of Pathology, Barretos Cancer Hospital, Brazil, 3Department of Pathology Medicine, Botucatu Medical School, São Paulo State University (Unesp), Brazil, 4Pathology Division, Rede D’Or Hospitals Network, Brazil, 5Department of Pathology, State University of Ponta Grossa (UEPG), Brazil, 6Pathology Division, Erasto Gaertner Hospital, Brazil, 7Department of Head and Neck Surgery, Barretos Cancer Hospital, Brazil, 8Integrated Center for Head and Neck Surgery (NICAP), Brazil, 9Head and Neck Surgery, The Portuguese Beneficence of São Paulo (BP), Brazil, 10Surgical Cancerology, Complexo ISPON, Brazil, 11Head and Neck, Midwestern State University (UNICENTRO), Brazil, 12Peruvian University Cayetano Heredia, Peru, 13Pathology Division, Santa Casa de São Paulo School of Medical Sciences, Brazil, 14Department of Pathology, São Paulo Federal University (Unifesp/EPM), Brazil, 15Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (USP/RP), Brazil, 16Department of Internal Medicine, Botucatu Medical School, São Paulo State University (Unesp), Brazil, 17Division of Endocrinology, Dr. Cesar Milstein Hospital, Argentina, 18Department of Cell and Developmental Biology, Institute of Biomedical Sciences, University of São Paulo (USP), Brazil
Oral 0023
Autoimmunity, Clinical, Oral
Validation of Glandy CASTM Software as Medical Device for Thyroid Eye Disease Activity Assessment: A Confirmatory Clinical Trial for Ministry of Food and Drug Safety Approval
Kyubo Shin*1, Jongchan Kim1, Jaemin Park1, Namju Kim2, JaeSang Ko3, Jin Sook Yoon3, Jae Hoon Moon1,4,5 , 1THYROSCOPE INC., Korea, Republic of, 2Department of Ophthalmology, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Korea, Republic of, 3Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Korea, Republic of, 4Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Korea, Republic of, 5Center for Artificial Intelligence in Healthcare, Seoul National University Bundang Hospital, Korea, Republic of
Oral 0024
Surgery, Clinical, Oral
Factors Increasing the Likelihood of Postoperative Hematomas Following Thyroid Surgery
Emily Ajit-Roger*1, Jessica Hier2, Marco Mascarella3,4,5, Koorosh Semsar-Kazerooni2, Sabrina Silva Wurzba3,6, Véronique-Isabelle Forest3,4, Michael Hier3, Alex Mlynarek3, Richard Payne3,4 , 1Faculty of Medicine and Health Sciences - McGill University, Canada, 2Department of Otolaryngology – Head and Neck Surgery, Faculty of Medicine, McGill University, Canada, 3Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, McGill University, Canada, 4Department of Otolaryngology – Head and Neck Surgery, Royal Victoria Hospital, McGill University, Canada, 5Centre for Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Canada, 6Segal Cancer Centre and Lady Davis Institute for Medical Research, Departments of Medicine and Oncology, Sir Mortimer B. Davis-Jewish General Hospital, Faculty of Medicine, McGill University, Canada
Oral 0025
Surgery, Clinical, Oral
Prospective Implementation of Thyroid Lobectomy Guidelines and Preoperative ThyroSPEC Molecular Testing: Impact on Rates of Lobectomy and Completion Thyroidectomy
Caitlin Yeo*, Jiahui Wu, Paul Stewardson, Markus Eszlinger, Sana Ghaznavi, Ralf Paschke, University of Calgary, Canada
Oral 0026
Surgery, Clinical, Oral
Patient-Reported Outcomes after Thyroid Surgery for Differentiated Thyroid Cancer: A Crucial Consideration for Personalized Treatment Decisions
Anthony Saxton*, Samantha Thomas, Alberto Monreal, Randall Scheri, Carly Kelley, Hadiza Kazaure, Duke University, USA
Among core symptoms, distress and sadness were similar for the TL and TT cohorts at all time points. However, both distress and sadness were improved after surgery in the short-term and long-term after TT (both p<0.01). No differences in distress or sadness were observed following TL (p=0.74 & 0.96, respectively).
Oral 0028
Thyroid Cancer, Basic, Oral
Characterization and targeting of synthetic lethal vulnerabilities uncovered by inhibition of one carbon metabolism in anaplastic thyroid cancer
Sara Zirpoli1,2, Alexander Forrest1, Antonio Di Cristofano*1 , 1Albert Einstein College of Medicine, USA, 2University of Naples Federico II, Italy
Anaplastic thyroid cancer (ATC) has a median survival of less than 9 months when patients are treated with multimodal therapy. Cytotoxic chemotherapy and external beam radiation are ineffective in prolonging survival of ATC patients. The recent approval of a BRAF/MEK inhibitors combination for BRAF V600E–positive ATC has improved the progression-free survival of eligible patients. However, this therapy only benefits a subset of patients, and only for a short period of time. Thus, ATC remains a paradigmatic model for those aggressive tumors that need novel, rationally designed therapeutic approaches that overcome or bypass critical roadblocks to cell death and effectively induce rapid demise of tumor cells.
We have found that ATCs display a significant upregulation of genes involved in the one-carbon metabolic pathway (1CM), and have shown that inhibition of SHMT2, a key enzyme of the mitochondrial arm of the 1CM, leads to significant reduction of ATC cell proliferation in the short term, and a dramatic impairment of colony forming ability, both primarily caused by depletion of the purine pool and cell cycle arrest.
The nucleotide shortage induced by inhibition of 1CM is predicted to induce replicative stress and activation of the ATM/Chk2/TP53 (G1/S phase) and ATR/Chk1 (S-phase) checkpoints. Due to the very frequent loss or mutation of TP53, we posited that ATC cells are primarily dependent on the ATR/Chk1 S-phase checkpoint to cope with replication stress, and that inhibition of this checkpoint in G1/S checkpoint-deficient ATC cells would result in improper progression of 1CM-impaired ATC cells through the cell cycle, with mitotic catastrophe and cell death as the endpoint.
We show that non-cytotoxic concentrations of ATR and Chk1 inhibitors, combined with either tool compounds or clinic-ready inhibitors of 1CM, induce massive death of TP53 mutant ATC cells, but have no combinatorial effect in TP53 wt cells. Exogenous hypoxanthine rescues the lethal effect of these combinations, supporting the critical role of purine depletion in this synthetic lethal relationship.
Thus, inhibition of one-carbon metabolism generates metabolic and functional vulnerabilities that can be harnessed in synthetic lethal strategies that represent a compelling foundation for the clinical development of novel, rationally designed therapeutic approaches.
Oral 0029
Thyroid Cancer, Translational, Oral
Integrated Genomic Analysis Identifies Tumor Differentiation Status as a Crucial Determinant of Immune Infiltration and Potential Combinatorial Therapeutic Targets with Immunotherapy in Papillary Thyroid Carcinoma Patients
Chia-Chin Wu1, Sarah Hamidi*1, Maxime Tarabichi1, Aatish Thennavan1, Jeffrey Jiang1, Albert Han2, Lauren Erasmus3, Xiao Zhao1, Mark Zafereo1, Ying Henderson1, Stephen Lai1, Wenyi Wang1, Maria Cabanillas1, Jennifer Wang1 , 1The University of Texas MD Anderson Cancer Center, USA, 2University of Southern California, USA, 3Baylor College of Medicine, USA
Oral 0030
Thyroid Cancer, Translational, Oral
Metabolomic pathways associated with timing to thyroid cancer diagnosis
Maaike van Gerwen*1, Haibin Guan1, Elena Colicino1, Georgia Dolios1, Mathilda Monaghan1, Girish Nadkarni1, Roel Vermeulen2, Eric Genden1, Lauren Petrick1,3 , 1Icahn School of Medicine at Mount Sinai, USA, 2Utrecht University, Netherlands, 3Sheba Medical Center, Israel
Oral 0032
Thyroid Nodules and Goiter, Basic, Oral
Development of a nomogram—a visually intuitive tool—that illustrates the contribution of molecular testing in addition to all diagnostic components in an optimized integrated interdisciplinary thyroid nodule diagnostic pathway facilitating integrated malignancy risk assessment and clinical decision-making for indeterminate thyroid nodules
Jiahui Wu, Paul Stewardson, Markus Eszlinger, Moosa Khalil, Sana Ghaznavi, Erik Nohr, Adrian Box, Ralf Paschke*, University of Calgary, Canada
Thursday, October 31, 2024
Poster 0100
Autoimmunity, Case Study, Poster
Subacute Thyroiditis Secondary to Chikungunya Virus: A Case Report
Laila Daibes Rachid*1, Marianna Daibes2, Monica Thimoteo1 , 1Clínica Daibes Diagnósticos, Brazil, 2Brigham and Women's Hospital, USA
Poster 0101
Poster 0102
Disorders of Thyroid Function, Case Study, Poster
Recurrent Cardiac Tamponade: A Rare And Critical Manifestation Of Untreated Hypothyroidism Leading To Myxedema Coma
Adriana Luzuriaga*1, Patricia Guia2, Hery Mejia3, Susana Barreiro3, Silvia Gra Menendez3 , 1Rutgers Health/Community Medical Center, USA, 2Montefiore New Rochelle Medical Center/Albert Einstein College of Medicine, USA, 3University of Miami/Jackson Health System Program, USA
Myxedema coma, a rare but potentially life-threatening complication of hypothyroidism, is characterized by severe hypothyroidism leading to altered mental status and multiorgan dysfunction. Despite its name, patients may present with varying degrees of consciousness alongside severe systemic manifestations. Cardiovascular emergencies, including large volume pleural effusions, significantly contribute to the mortality rate associated with this condition.
A 49-year-old male with a history of untreated hypothyroidism presented to the emergency department after a syncopal episode and one week of progressive weakness. The patient reported no additional symptoms and was able to participate in the medical interview. Upon evaluation, chest X-ray revealed cardiomegaly, prompting further investigation with echocardiography, which revealed a large pericardial effusion causing cardiac tamponade. Concurrently, thyroid function tests demonstrated a markedly elevated thyroid-stimulating hormone (TSH) level of 500 mIU/L and undetectable free thyroxine (T4). Prompt recognition of the association between hypothyroidism and cardiac tamponade led to an emergent pericardial window, along with the initiation of high-dose corticosteroids and intravenous levothyroxine and liothyronine. Following thyroid hormone replacement therapy and pericardial intervention, the patient exhibited significant clinical improvement, with normalization of TSH levels within one week.
Myxedema coma is seen in 0.1% of patients with hypothyroidism. The magnitude of the clinical impact depends on the severity of hormone deficiency. Widespread and early use of thyroid-stimulating hormone assays has led to a progressive reduction in the complications associated with hypothyroidism. However, if myxedema is present, mortality despite treatment ranges between 20 to 40%.
Our case highlights the clinical variability of myxedema coma, as patients may present with minor alterations in mental status despite experiencing life-threatening complications such as pericardial effusion and cardiac tamponade. Timely diagnosis and intervention, including aggressive thyroid hormone replacement and pericardial decompression, are crucial in decreasing mortality associated with this rare but critical illness. Clinicians should have a high index of suspicion for hypothyroidism-related complications, even in patients with preserved consciousness, as it can be the determinant factor in avoiding fatal outcomes.
Poster 0103
Disorders of Thyroid Function, Case Study, Poster
Roller Coaster Ride: Thyroid Function Rises and Dives; A Case of Competing Autoantibodies and Medication-Induced Thyroid Dysfunction
Nicole Chan*, Grace Kim,Albany Medical Center, USA
Thyroid function varies depending on the patient’s underlying risk factors. Medications and underlying autoimmunity have been well documented to cause dysfunction due to numerous mechanisms. We present a case in which a patient’s fluctuating thyroid function due to different etiologies contributing to this interesting circumstance.
This is a 60-year-old female with a history of Graves’ disease (GD) during teenage years with spontaneous remission in one year and a longstanding history of multiple sclerosis (MS). For her MS, she was treated with alemtuzumab and carbamazepine. Her thyroid function was, therefore, monitored during her therapy. She was referred to the endocrine clinic for TSH 0.16 uIU/mL (nl. 0.27-4.2) and free T4 0.55 ng/dL (nl. 0.93-1.7), suggestive of central hypothyroidism. She started thyroid hormone replacement therapy. Repeat TSH in 2 months showed elevated TSH of 21.76, at which time TPO antibody and TSI were checked, and both were strongly positive. Levothyroxine dose was increased. Subsequently, she was noted to have thyrotoxicosis requiring a decrease in her levothyroxine dose. Despite a significant decrease in levothyroxine dose, she remained biochemically hyperthyroid with eventual discontinuation of the medication. During thyrotoxic state, both thyrotropin receptor stimulating antibody and inhibiting antibody were elevated at 14.8 (nl. 0-1.75 IU/L) and 12.9 (nl. 0-1.75 IU/L), respectively. She had been off levothyroxine for 2 years with periodic monitoring of thyroid function tests. After 2 years, TSH was again low at 0.008 and low free T4 0.89, suggestive of central hypothyroidism. She started low dose levothyroxine (25 mcg) daily with subsequent free T4 normalization.
Carbamazepine, an antiepileptic drug, has been well-known to cause central hypothyroidism. Alemtuzumab, a monoclonal antibody that targets CD52 used in treating relapsing MS, is also known to increase the risk of autoimmune pathologies such as GD or Hashimoto’s thyroiditis in up to 30% of patients. This patient had fluctuating thyroid function due to her underlying autoimmunity and medication regimen. This case presents a unique situation in which careful follow up of thyroid function is necessary as the thyroid function depends on the balance between these autoantibodies.
Poster 0104
Thyroid Cancer, Clinical, Poster
“Metastatic Odyssey: Renal Cell Carcinoma's Journey to the Thyroid – A Case Study”
Bhavika Agrawal*, Vidhi Mehta, Feruze Cavdar, Edward Ruby,Mercy Fitzgerald hospital, USA
Poster 0105
Disorders of Thyroid Function, Case Study, Poster
“Hoffman Syndrome: Thyroid dysfunction silent impact on Neuromuscular health”
Bhavika Agrawal*1, Piyush Agrawal2, Vidhi Mehta1, Feruze Cavdar1, Rabia Naseem1, 1Mercy Fitzgerald hospital, USA, 2Sri Aurobindo Institute of Medical Science, India
Poster 0106
Autoimmunity, Case Study, Poster
Nivolumab’s Thyroid Tale: Immunotherapy induced thyroiditis
bhavika agrawal*1, hardik Jain2, Feruze Cavdar1, Vidhi Mehta1, Rabia Naseem1, 1Mercy Fitzgerald hospital, USA, 2allegheny general hospital, USA
Poster 0107
Thyroid Cancer, Case Study, Poster
“When worlds collide: Diffuse large B cell lymphoma in patient of hypothyroidism”
Feruze Cavdar, Bhavika Agrawal*, Vidhi Mehta, Edward Ruby,Mercy Fitzgerald hospital, USA
Poster 0108
Thyroid Nodules and Goiter, Case Study, Poster
The Great Imitator: A thyroid nodule mimicking Medullary thyroid carcinoma
Hardik jain1, Bhavika Agrawal*2, Joshika Agarwal2, Harshil Patel2, 1Allegheny general hospital, USA, 2Mercy Fitzgerald hospital, USA
Poster 0109
Thyroid Hormone Action, Metabolism and Regulation, Case Study, Poster
Demystifying Hashitoxicosis- Autoimmune assault on thyroid function
Bhavika Agrawal*1, Hardik Jain2, Rabia Naseem1, Vidhi Mehta1, Feruze Cadvar1, 1Mercy Fitzgerald hospital, USA, 2Allegheny Hospital, USA
Poster 0110
Disorders of Thyroid Function, Case Study, Poster
Recurrent Thyrotoxic Periodic Paralysis – A Rare Complication of Uncontrolled Graves’ Disease
Brihant Sharma*, Mariya Khan, Ajaykumar Rao,Temple University Hospital, USA
Poster 0111
Disorders of Thyroid Function, Case Study, Poster
Thyrotoxicosis in a Post Heart Transplant Patient - A Diagnostic Dilemma
Brihant Sharma*, Mariya Khan, Ajaykumar Rao, Paul Guido,Temple University Hospital, USA
Poster 0112
Disorders of Thyroid Function, Case Study, Poster
Thyrotoxic Cardiomyopathy Leading to Acute Heart Failure: A Case Report
Harshita Marasandra Ramesh*, Rashmi Subramani, Ferrol Lee,Guthrie Robert Packer Hospital, USA
Poster 0113
Disorders of Thyroid Function, Case Study, Poster
Painful Thyroiditis: Subacute Thyroiditis or Painful Hashimoto's Thyroiditis
Harshita Marasandra Ramesh*1, FNU Manas1, Sundas Zahra2, Sneha Singh2, Ferrol Lee2, 1Guthrie Robert Packer Hospital, USA, 2GuthrieRobert Packer Hospital, USA
Subacute thyroiditis is the most common cause of painful thyroiditis. It is usually preceded by upper respiratory tract infection and associated with fever, leukocytosis, elevated inflammatory markers and transient hyperthyroidism. The thyroid gland can be of normal size or enlarged with diffuse or focal hypoechogenicity on ultrasonography. The treatment is pain control with NSAIDs or steroids and symptoms management of hyperthyroidism. Rarely Hashimoto’s can present as painful thyroiditis which can be challenging to differentiate from subacute thyroiditis without histopathological evidence. Less than half of the patients with painful Hashimoto's thyroiditis can have fever with elevated inflammatory markers. The thyroid function can vary from hypothyroid, euthyroid or hyperthyroid state but the thyroid auto-antibodies (anti-thyroid peroxidase and anti-thyroglobulin) are always positive. Ultrasonography shows diffuse heterogeneous hypoechoic thyroid gland. Patients usually do not respond well to NSAIDs or steroids and thyroidectomy is recommended in patients with recurrent painful episodes.
Poster 0114
Disorders of Thyroid Function, Case Study, Poster
Myxedema Coma With Dangerously Elevated TSH: A rare presentation of an even rarer disease
Abdullah Masood*, Fareeha Abid, Sohail Sodhi, Gamal Musleh, Niranjana Kesavamoorthy, Vaishnavi Gurumurthy, Manthan Pandya,Rutgers NJMS-Trinitas Regional Medical Center, USA
Poster 0115
Disorders of Thyroid Function, Case Study, Poster
Prolonged sub-acute thyroiditis - A perfect storm
Neha Varanasi1, Abigail Foster*2, 1Berkeley preparatory School, USA, 2Nova Southeastern University, USA
Poster 0116
Disorders of Thyroid Function, Case Study, Poster
A Rare Case of Central Hypothyroidism and Secondary Adrenal Insufficiency in Moyamoya Disease
Ashlee Sidhu*1, Neha Meda1, Dieula John1, Hilda Merino-Chavez2, 1UCF/HCA Florida Healthcare, USA, 2VA Medical Center, USA
Poster 0117
Disorders of Thyroid Function, Case Study, Poster
A Rare Case of Graves’ Disease Induced Cardiomyopathy
Christina Marchese*, David Felske, Matthew Gilbert,University of Vermont Medical Center, USA
Poster 0118
Disorders of Thyroid Function, Case Study, Poster
Silent Storm - Apathetic hyperthyroidism: case report
Claudia Guillen1, Sarah Lahud1, Aesha Patel*1, Mounika Allam1, Chloe Arima1, Shweta Mahesh1, Daisy Buenaventura-Collazos2, 1Loyola Medicine MacNeal Hospital, USA, 2Hospital Universitario del Valle, Colombia
Apathetic hyperthyroidism (AH), initially described by Dr. Frank H. Lahey in 1931, presents a challenge due to its subtle or absent symptoms, especially in older patients. Unlike classic hyperthyroidism with prominent adrenergic symptoms, AH often manifests as fatigue, weakness, weight loss, insomnia, depression, and apathy. The deficiency or unresponsiveness to brain catecholamines contributes to these symptoms, sometimes leading to bilateral ptosis. However, conditions like atrial fibrillation and congestive heart failure can hint at underlying hyperthyroidism. The etiology of AH remains unclear but is associated with factors like age-related changes in adrenergic tone, tissue resistance to thyroid hormone, comorbidities, immune response variations, or hypomagnesemia. Despite its subtle presentation, AH can lead to complications such as cardiovascular and bone diseases and even thyroid eye disease. AH has been related to malignancy, mainly lung cancer, where symptoms could be masked by either one. The importance of the unique presentation of AH is that it may lead to underdiagnosis and delayed treatment.
A 77-year-old male with a medical history of hypertension, type 1 diabetes mellitus, and Graves' disease experienced symptom exacerbation after discontinuing methimazole due to elevated TSH levels. He presented with swallowing difficulties, weakness, sadness, weight loss, bilateral ptosis, and skin lesions. TSH was 0.02 mIU/mL, FT3 >2000 pg/dl, and FT4 >5.0 ng/dl. CT neck and chest showed thyromegaly and para mediastinal left upper lobe mass with pleural contact with the superior mediastinum, suggesting mild invasion. Skin biopsy showed basal cell carcinoma. However, lung biopsy results were negative for malignancy, necessitating continued surveillance. Treatment with methimazole led to symptom improvement and normalization of thyroid function tests. The patient denies dysphagia, dysphonia, neck pain, or dyspnea.
In older patients with thyrotoxicosis, atypical symptoms or their absence complicate the identification of this condition. Understanding demographic patterns and risk factors associated with AH is crucial for targeted screening and prompt diagnosis. This case highlights the potential for both benign and malignant conditions to coexist in elderly patients with AH-like symptoms. Early diagnosis of AH is essential for effective treatment and reducing morbidity and mortality. However, the overlap of symptoms with malignancies underscores the importance of considering a broad range of differential diagnoses, particularly in elderly patients with nonspecific clinical presentations.
Poster 0119
Disorders of Thyroid Function, Case Study, Poster
The Mind Behind The Thyroid: Exploring Psychiatric Manifestations Of Hypothyroidism
Dania Kaur*, Abhinav Vyas, Mina Iskander, Bhargavi Nagendra, Sunpil Hwang, Rachna Valvani, North Alabama Medical Center, USA
Poster 0120
Disorders of Thyroid Function, Case Study, Poster
Thyroid Function Test Dilemma: A Case of Misleading Pattern
Farris Sabir*1, Katalina Funke2, Malek Mushref3, 1Medical College of Georgia, USA, 2Palmetto Endocrinology, USA, 3Piedmont Athens Endocrinology, AU/UGA medical partnership, USA
Discordant thyroid function test results highlight the need to heed caution interpreting such tests. Atypical patterns such as hyperthyroxinemia with non-suppressed TSH warrant considering a broad differential diagnosis including assay interference, TSH secreting adenoma and resistance to thyroid hormone. Here we present a patient with hypothyroidism who was taken off thyroid hormone treatment due to unusual thyroid function pattern requiring an extensive work-up.
This report discusses a 40-year-old man with history of hypothyroidism treated with levothyroxine presenting with mixed symptoms including fatigue, insomnia, anxiety, weight loss, and constipation. He was recently taken off levothyroxine due to abnormal thyroid labs: TSH 5.97 uIU/mLm (0.456-4.68), free T4 1.94 ng/dL (0.78-2.19), and free T3 >22.8 pg/mL (2.8-5.3). Thyroid function tests repeated several times showed similar findings. Physical exam showed no overt signs of hypo- or hyperthyroidism. TSI and TPO were negative while thyroglobulin antibody was positive. Thyroid ultrasound and uptake/scan were normal. SHBG was 64 nmol/L (16-55), alpha-subunit:TSH ratio <1. Other pituitary labs were unremarkable. MRI showed no evidence of pituitary adenoma. The patient denied any family history of abnormal thyroid function tests. Human anti-mouse antibodies were negative. However, thyroid function tests repeated with equilibrium dialysis showed TSH of 20.4 uIU/mLm, free T4 0.7 ng/dL (0.9-2.2), and free T3 of 3.0 (1.81-4.06) pg/mL, consistent with hypothyroidism. Further evaluation showed positive heterophile antibody falsely elevating free T3 and T4. The patient was restarted on levothyroxine with plans to monitor TSH and avoid checking T4 and T3 by direct immunoassays.
Heterophile antibodies illustrate an example of how assay interference produces unusual thyroid function test results. Atypical thyroid function patterns can result from various forms of assay interference and from less common thyroid-related conditions. This patient’s heterophile antibodies, or antibodies not specific to distinct antigens, affected T4 and T3 levels unless corrected for. Since diseases like thyroid hormone resistance and TSH-producing pituitary adenomas are rare, considering the assay’s methodology provides essential context in interpreting atypical patterns. Identifying the etiology of discordant results helps optimize management of patients’ thyroid function, including limiting unnecessary diagnostics and improper therapeutic intervention.
Poster 0121
Disorders of Thyroid Function, Case Study, Poster
Severe Thyrotoxicosis as a Precipitant for Diabetic Ketoacidosis
Leslie Ha*, Prasanth Surampudi, Joaquin Lado, UC Davis Medical Center, USA
In individuals with Graves and T1DM, one should evaluate for DKA in cases of thyrotoxicosis and vice-versa as excessive thyroid hormone can cause imbalances in glucose homeostasis through synergistic effects on carbohydrate and fatty acid metabolism. In rare cases of concomitant presentation, we recommend early initiation of anti-thyroid therapy and empiric DKA treatment due to risk of rapid decompensation and high associated mortality rates.
Poster 0122
Disorders of Thyroid Function, Case Study, Poster
Case Report: A Rare Presentation of Complete Molar Pregnancy Complicated by Concurring Severe Hyperthyroidism and Preeclampsia with Severe Features in a Perimenopausal Woman
Mounika Lakshmi Allam*1, Suresh Duvvada1, Claudia Guillén-López1, Chloe Arima1, Shweta Mahesh1, Madalina Ionescu2, Hong Lee1, Priyanka Sultania-Dudani1, 1Loyola Medicine-MacNeal Hospital, USA, 2Cook County, USA
Poster 0123
Disorders of Thyroid Function, Case Study, Poster
Navigating the Intersection of Graves' Disease and Severe Thrombocytopenia: A Case Report and Management Approach
Paola Reyes-Torres*, Neshma Román-Velez,San Juan City Hospital, USA
Poster 0124
Disorders of Thyroid Function, Case Study, Poster
Sexual Dysfunction, Hypertestosteronemia, and Surprising Thyrotoxicosis!
Sarah Makadsi, Ranim Chamseddin*, Julie Samantray,Wayne State University, USA
The relation of sex hormone binding globulin (SHBG) and thyroid hormone is well documented in the literature. The serum concentration of SHBG is elevated in hyperthyroid state and has been used in the past as a marker of thyroid hormone effect at the peripheral tissue. Sexual dysfunction has been reported in males with thyroid dysfunction. Here we highlight a case of thyrotoxicosis presenting with hypertestosteronemia.
A 64-year-old man with history of well controlled type 2 diabetes presented to his primary care physician with multiple complaints. He reported a 6 month history of poor energy, weight loss and erectile dysfunction. He attributed the weight loss to lifestyle changes for diabetes and obesity.
He was found to have a resting HR of 120/min and was in atrial fibrillation at that visit. Laboratory results revealed Total Testosterone 1,115 (350-720 NG/dL), FSH 30.1 mIU/mL and LH 46.3 mIU/mL. Calculated free testosterone level was low normal. Prolactin, IGF1, Cortisol levels were normal. CT of the pituitary, abdomen and pelvis were normal. Due to persistent symptoms, he was referred to endocrinology. Thyroid function testing was done and showed TSH <0.005 (0.45-4.5 uIU/mL) and Free T4 of >7.7 (0.82-1.77 NG/dL) with a total T3 of 587 (71-180 NG/dL). Methimazole and a beta blocker were started. SHBG level was 239 (19.3-76.4 nmol/L). 12 weeks after starting methimazole he reported improved energy, weight gain, and resolution of erectile dysfunction. Labs showed normalization of Free T4, SHBG, gonadotropins and total testosterone levels.
Thyroid hormones act indirectly to increase the hepatic synthesis of SHBG. SHBG binds testosterone with high affinity and positively correlates with testosterone levels. The testosterone bound to SHBG is biologically inactive and therefore, not a true reflection of androgen status. Elevated LH and FSH with high total testosterone but normal free testosterone levels can be explained by age related dysregulation of feedback. Elevated SHBG should prompt an evaluation for hyperthyroidism. In this case, early diagnosis and treatment would have prevented unnecessary laboratory and imaging studies.
Poster 0125
Disorders of Thyroid Function, Case Study, Poster
Battling the Perfect Storm – A Case Report of Unyielding Treatment Challenges in Refractory Thyroid Storm
Sahar Bhai*1, Anahita Mahmoudabadi1, Shashank Nuguru2, 1Wellstar Kennestone Internal Medicine Residency, USA, 2Wellstar Kennestone Internal Medicine Residency Faculty, USA
Poster 0126
Disorders of Thyroid Function, Case Study, Poster
A Rare Case of Acute Infectious Thyroiditis Masquerading As Subacute Thyroiditis - A Diagnostic Dilemma
Todd Lavine*1, Shreya Bhandari1, Yu-Han Chen1, Ross Lavine1, Christian Kim2, 1Englewood Health, USA, 2Hackensack Meridian Medical School, USA
Poster 0127
Iodine Uptake and Metabolism, Case Study, Poster
A rude awakening: Atrial Fibrillation because of IV Contrast Administration
Sai Narra, Kristal Pereira*, Madhulika Kakarla,Mercy Catholic Medical Center, USA
Poster 0128
Pediatrics, Case Study, Poster
Metastatic Oncocytic Thyroid Carcinoma Presenting as Back Pain: An Autobiographical Case Report
Kathleen Modder*1, Jason Wexler2, Andrew Bauer3, Jina Kim4, 1Rhodes College, USA, 2Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, USA, 3Division of Endocrinology and Diabetes, Department of Pediatrics, The Children’s Hospital of Philadelphia, The Perelman School of Medicine, The University of Pennsylvania, USA, 4Department of Surgery, Inova Health System, USA
Poster 0129
Pediatrics, Case Study, Poster
The Effectiveness of Teprotumumab in Treating Graves' Dermopathy in an Adolescent
Mostafa Salama*, Matthew Basiaga, Dawn Davis, Siobhan Pittock, Ana Creo,Mayo Clinic, USA
Poster 0130
Surgery, Case Study, Poster
Metastatic Lower Extremity Leiomyosarcoma with Thyroid Metastasis
Amy Li*, Dong Ren, Kiarash Mashayekhi, Warren Chow, Beverly Wang, Melissa Mao,University of California, Irvine, USA
Poster 0131
Surgery, Case Study, Poster
Delayed, Recurrent Post Thyroidectomy Seroma: Case Report and Literature Review
Hannah Seo*1, Nadia Tello2, Tam Nguyen2, 1Texas Tech University Health Sciences Center School of Medicine, USA, 2Texas Tech University Health Sciences Center, USA
Poster 0132
Thyroid Hormone Action, Metabolism and Regulation, Case Study, Poster
Thyroid Associated Ophthalmopathy; A Rare Presentation of Hypothryroidism
Marcos Chacon*, Jorge Soto,Mayaguez Medical Center, Puerto Rico
Thyroid-associated ophthalmopathy (TAO) is an ocular condition that frequently manifests with thyroid dysfunction, and is the most common extrathyroidal manifestation of Graves’ disease. A systematic review of prevalence of thyroid function in patients already diagnosed with thyroid-associated ophthalmopathy, found 86.2% prevalence with hyperthyroidism; 10.36% prevalence with hypothyroidism; and 7.9% with euthyroid states. Thyroid associated ophthalmopathy is rare in patients with Hashimoto’s thyroiditis, and only few cases have been reported.
Case of 90 y/o female patient with Past medical history of diabetes mellitus type 2, hypertension, atrial fibrillation, hypothyroidism and osteopenia who was brought to ER after suffering a fall from her bed, earlier today over her left side; since then, she reefers Left hip pain associated with limited active and passive range of motion. Orthopedic surgeon consulted who performed a Left hip hemiarthroplasty w/o complication. Upon evaluation, patient was found with exosphthalmos bilaterally. The patient received 4/7 points in the Clinical Activity Scale (CAS) due to the eyelid edema, redness, conjunctival injection, and inflammation of left caruncle. Laboratory work up revealed TSH in 7.14 uIU/mL, FT4 0.79 ng/dl, Thyroid peroxide antibody <9 IU/mL, Thyroglobulin <0.1 IU/mL, Thyroid Stimulating Immunoglobulin <0.10. Also, orbital CT was performed and found with bilateral orbital proptosis of up to 28 mm. Imaging findings correlate with clinical presentation of exophthalmus.
This case illustrates a rare presentation of Hyporthryrodism, due to Thyroid opthalmopathy prevalence with hypothyroidism is 10.36% and is more described in a patient with Graves Disease. As a Doctor, no matter what medical specialty we have, a good clinical history and physical examination is always an essential part of making a correct diagnosis. This Thyroid associated ophthalmopathy can sometimes occur in Hashimoto’s thyroiditis and awareness of this atypical form is important. Prompt recognition and treatment can prevent corneal involvement and blindness due to optic nerve compression. Patient was discharged home with home care and endocrinologist follow up.
Poster 0133
Thyroid Nodules and Goiter, Case Study, Poster
Not So Benign: A Case of Thyroid Nodule Regrowth
Karen Jong*1, Muddasir Fariduddin2, Daniel Toft1, 1University of Illinois Chicago, USA, 2Ayaan Institute of Medical Sciences, India
A benign thyroid fine needle biopsy result is almost always great news. It becomes concerning when these benign nodules behave unexpectedly and aggressively. We present a case of recurrent thyroid tissue regrowth and discuss the role of genetic testing.
A 33 year-old female with history of multinodular goiter status-post total thyroidectomy with benign pathology in 2006 presented to clinic in 2019 with recurrent bilateral thyroid nodules causing compressive symptoms. Fine-needle aspiration revealed two Bethesda II and one Bethesda III nodule. In 2020, CT neck showed increasing size of the nodules now extending into the superior mediastinum. She underwent revision thyroidectomy requiring partial sternotomy in July 2021 to remove recurrent thyroid tissue in the right and left thyroid bed, a suprasternal nodule, and a level 5 thyroid mass. Some residual left thyroid bed tissue remained due to proximity to the recurrent laryngeal nerve. Pathology of the suprasternal nodule was follicular adenoma and the rest was thyroid follicular nodular disease. Ultrasound in May 2022 showed tissue regrowth in the right and left thyroid beds, 4.9cm and 5.7cm, respectively. Her levothyroxine was increased for TSH suppression. Ultrasound in March 2024 showed slightly increased growth in both thyroid bed masses. GeneAssure testing showed no BRAF or RAS mutations, but Tier III variants BRCA1 p.K619E and MYC p.V185I, copy number variant gain in NF1, RAD51D CDK12, BRCA1, and RNF43, and hemizygous loss of TP53.
Follicular thyroid adenomas (FTA) and follicular thyroid carcinomas (FTC) may constitute a continuum of disease, given similarities in their genetic backgrounds. TP53 mutations have been found in both follicular thyroid adenoma and carcinoma, and some even suggest that TP53-mutant FTA is a precursor to FTC and anaplastic thyroid carcinoma. We suspect that hemizygous loss of TP53 may have conveyed aggressive growth potential in this patient’s tumor. There are also several other mutations present which are of uncertain clinical significance. We are not aware of any reported case series regarding somatic mutations in “benign,” but aggressive, follicular adenomas. There is also no expert consensus on treatment of these entities, causing a clinical challenge for the clinician and the patient.
Poster 0134
Thyroid Nodules and Goiter, Clinical, Poster
Training Programs for Thyroid Biopsy and Ablation: A Systematic Review and Meta-Analysis
Sharon Bridgemohan*1, Andrea Ortiz Rocha1, Gilberto Perez Rodriguez Garcia1, Sannidhi Kolukula1, Gonzalo Acosta Garcia1, Juan Brito Campana2, Naykky Singh Ospina1, 1University of Florida, USA, 2Mayo Clinic, USA
Poster 0135
Thyroid Cancer, Case Study, Poster
Cytologically Indeterminate Thyroid Nodules with 3 or More High-Grade Genetic Mutations Have Poor Outcomes
Alexander Goldberg*1, Cheng Liu1, Gary Rothberger2, Rong Xia1, Steven Hodak1, Sumedha Chablani1, 1NYU Grossman School of Medicine, USA, 2NYU Grossman Long Island School of Medicine, USA
While thyroid carcinomas with multiple genetic alterations have been shown to have poor prognosis, there is limited data on cytologically indeterminate tumors with 3 or more mutations. We present a series of 6 such cases with outcomes.
Of 6 thyroid tumors at our institution identified between 2016 and 2023 with 3 or more potent oncogenic driver mutations, 5 were malignant and 1 was benign, with sizes ranging from 1.7 to 7.2 cm. The average age at diagnosis was 63 years, and 5 cases were female. Despite the genetically high-grade profiles, all cases had benign or indeterminate cytology.
The primary driver mutation was an isoform of RAS in all 6 cases. All cases had TERT mutations. Additional mutations included EIF1AX, DICER1, and PIK3CA. Based on initial surgical pathology, 3 patients were ATA high-risk, including a follicular thyroid carcinoma (FTC) with extensive angioinvasion, poorly differentiated thyroid carcinoma with extensive angioinvasion, and a follicular variant of papillary thyroid carcinoma (PTC) with extensive angioinvasion. An FTC with minimal capsular invasion was ATA low-risk; however, follow-up to date has only been 12 months. The remaining 2 cases were benign follicular adenomas (FA) on initial surgical pathology. However, one of these “benign” FAs developed sternal metastases 7 years later. Genomic analyses of the metastasis and retrospective analysis of the original benign FA confirmed that both had an identical high-grade genetic profile suggesting that the “benign” FA was in fact a metastatic carcinoma.
Although this series includes only 6 patients, it is the largest to date reporting cytologically indeterminate thyroid tumors with 3 or more potent genetic driver mutations, of which 4 demonstrated aggressive clinical features. The majority of these tumors presented with benign or indeterminate cytology, likely because primarily RAS-driven tumors have histologically follicular architecture and lack nuclear changes typical of PTC, whereas BRAF-driven tumors generally have overtly malignant cytology for which genetic testing is typically not done. Given the clinically aggressive behavior of these tumors with indeterminate cytology and 3 or more potent oncogenic driver mutations, primary surgical management with total thyroidectomy should be considered, even though the initial cytology is not highly suspicious.
Poster 0136
Pregnancy and Development, Case Study, Poster
Transient Hypoparathyroidism in Pregnancy
Alexander Goldberg*1, Loren Greene2, 1NYU Grossman School of Medicine, USA, 2NYU Langone Health, USA
Hypoparathyroidism in pregnancy can be difficult to diagnose given the changes in calcium homeostasis. Complications include seizures, miscarriage, preterm delivery, and in utero fractures. We present a case of a pregnant woman who developed transient hypoparathyroidism resulting in seizures.
A 44-year-old G2P1 woman with a history of hypothyroidism presented with numbness and tingling during her second pregnancy. During her first pregnancy she developed mild asymptomatic hypocalcemia in the 3rd trimester. Between her first and second pregnancy she had normal calcium levels. Initially in her second pregnancy, her corrected calcium was normal and PTH levels decreased, as is expected in pregnancy. At 24 weeks of gestation, she presented again with numbness and tingling. Labs were notable for an ionized calcium of 5.0 mg/dL (range 4.8-5.6), PTH 13.1 ng/mL (range 10-65), 25-OH vitamin D 39 ng/mL, and an undetectable 1,25-OH vitamin D. Although started on calcitriol 0.5 mcg daily, she experienced a focal seizure. Labs showed ionized calcium of 4.4 mg/dL (range 4.8-5.6), Mg 1.8 mg/dL (range 1.5-2.5), PTH of 3.3 ng/mL (range 10-65), PTHrP 15 pg/mL (range 14-27). She had no prior history of neck surgery or radiation. Her calcium and calcitriol supplements were increased and she remained stable. Delivery was complicated by a pneumothorax in the baby, but was otherwise unremarkable. She was followed for 3 years postpartum with normal calcium, vitamin D, and PTH levels without supplementation.
During pregnancy, the placenta and breast tissue produce PTHrP, leading the maternal kidneys and placenta to increase calcitriol production. The PTH level correspondingly decreases, so that the corrected calcium and ionized calcium levels remain normal throughout. The patient presented here developed symptomatic hypocalcemia in the 3rd trimester and was found to have a low PTH, but the PTHrP did not rise as would be expected. The etiology of this patient’s transient and clinically significant hypoparathyroidism remains unclear, but it is hypothesized that she may have failed to manifest the appropriate PTHrP elevation of pregnancy or perhaps she developed calcium sensing receptor (CaSR) antibodies leading to decreased PTH release. Fortunately, her infant was not affected.
Poster 0137
Thyroid Cancer, Case Study, Poster
Follow-up of radiofrequency ablation for papillary thyroid microcarcinoma: is the fine needle aspiration biopsy a good strategy?
Cristhian Garcia*1, Andrea Solis2, Michelle Ojeda1, Ana Perez1, Kevin Carrillo1, Eduardo Pilatuna3, 1Instituto de Tiroides y Enfermedades de Cabeza y Cuello, Ecuador, 2Santa Casa de Misericordia, Brazil, 3Universidad San Francisco de Quito, Ecuador
Poster 0138
Thyroid Nodules and Goiter, Case Study, Poster
Outcomes of patients who underwent hemithyroidectomy: A first retrospective cohort study in Ecuador
Cristhian Garcia*1, Andrea Solis2, Eduardo Pilatuna3, Kevin Carrillo1, Andrea Cho1, Camila Pazmino3, Ana Perez1, Michelle Ojeda1, 1Instituto de la Tiroides y Enfermedades de Cabeza y Cuello, Ecuador, 2Santa Casa de Misericordia, Brazil, 3Universidad San Francisco de Quito, Ecuador
Poster 0139
Thyroid Cancer, Case Study, Poster
Diffuse Parenchymal Micro-calcifications in the Thyroid Gland with or without Thyroid Nodule: Clinical Significance
FNU Manas*, Sharon Lahiri,Henry Ford Hospital, USA
Poster 0140
Thyroid Nodules and Goiter, Case Study, Poster
Concurrent Thyroid and Lung Nodules: Unveiling Rare Pathways in Malignancy
FNU Manas*, Andrea Costris, Rebecca Simon, Arti Bhan, Henry Ford Hospital, USA
Poster 0141
Thyroid Cancer, Case Study, Poster
SNOWGLOBE APPEARENCE ON CECT NECK AS A PREDICTOR OF LOCALLY ADVANCED PAILLARY THYROID CARCINOMA WITH PHARYNGEAL INFILTRATION-A CASE STUDY AND SERIES FROM A TERTIARY HOSPITAL IN SOUTH INDIA
KARTHIKEYAN MURALIDHARAN*, PAUL JACOB,CHRISTIAN MEDICAL COLLEGE, India
Poster 0142
Thyroid Nodules and Goiter, Case Study, Poster
MALIGNANCY VEILING IN AUTONOMOUSLY FUNCTIONING THYROID NODULES(AFTN)-IS ROUTINE CYTOLOGY REPORTING OF HOT NODULES NECESSARY?-RETROSPECTIVE CASE STUDY AND LITERATURE REVIEW FROM A TERTIARY HOSPITAL IN SOUTH INDIA
KARTHIKEYAN MURALIDHARAN*, PAUL JACOB, Christian Medical College, India
Poster 0143
Thyroid Cancer, Case Study, Poster
Elevation of Thyroglobulin Antibodies Induced by IVIG in a Lung Transplant Recipient with Papillary Thyroid Cancer: A Case Report
Mercedes Martinez Gil*1, Javier Munoz1, Kajalben Buddhdev2, 1Creighton University, USA, 2St. Joseph's Hospital and Medical Center, USA
Intravenous immunoglobulin (IVIG), which is a pooled human serum product, contains Tgab. Commercially available Tgab assays may detect the Tgabs contained within the administered intravenous immunoglobulin, leading to alarm and further imaging to exclude progressive malignancy. We present a unique case with differentiated micropapillary thyroid cancer (MPTC) who received lung transplant and was treated with IVIG.
The absence of established sensitivity and specificity parameters for TgAb as a tumor marker in patients receiving IVIG might result in unnecessary diagnostic procedures. It's crucial to increase awareness of this issue and approach evaluations with caution in such cases, taking into account additional clinical and imaging data. Alternative diagnostic techniques, such as mass spectrometry-based assays unaffected by TgAb interference, are suggested to improve diagnostic precision in these scenarios.
Poster 0144
Disorders of Thyroid Function, Case Study, Poster
METHAMPHETAMINE ABUSE AS A TRIGGER FOR MYXEDEMA COMA IN A PATIENT WITH AN UNKNOWN DIAGNOSIS OF HASHIMOTO’S THYROIDITIS: A CASE REPORT
Mercedes MArtinez Gil*1, Fernanda Fonseca2, Marina Rudin3, David Wisinger3, 1Creighton University, USA, 2Anahuac University, Mexico, 3Valleywise, USA
Poster 0145
Thyroid Cancer, Case Study, Poster
NTRK Fusion Genes in Thyroid Cancer and Implications for Treatment – A Case Report
Mona Vahidi Rad*, Samir Ahmed, Joseph Arguinchona, Bithika Thompson,Mayo Clinic, USA
Due to the increased risk of more aggressive thyroid cancer and multifocality linked with NTRK fusion-positive tumors, a total thyroidectomy was performed. This involved removing the entire thyroid gland and conducting bilateral central neck dissection.
Pathology revealed a multifocal classic subtype papillary thyroid carcinoma with a predominant follicular growth pattern affecting both lobes and the isthmus, with the largest focus measuring 0.7 cm. Two lymph nodes in the bilateral central neck dissection showed signs of metastatic papillary carcinoma, with one exhibiting extracapsular extension. The patient also underwent radioactive iodine (RAI) treatment as part of her management.
If a thyroid nodule contains the NTRK fusion gene, it may be recommended to undergo a total thyroidectomy because of the heightened probability of multifocality and malignancy, potentially necessitating subsequent treatment with RAI. For NTRK fusion-positive tumors resistant to RAI, larotrectinib, a tyrosine receptor kinase inhibitor, can be utilized in treatment.
Our case emphasizes the role of molecular testing in guiding treatment decisions in thyroid cancer. However, additional research is required to fully comprehend and assess the broader effects of molecular testing and genomic profiling in thyroid cancer.
Poster 0146
Disorders of Thyroid Function, Case Study, Poster
Ashwagandha Induced Hyperthyroidism
Mona Vahidi Rad*, Samir Ahmed, Joseph Arguinchona, Aditi Kumar, Mayo Clinic, USA
This case highlights the potential risk of Ashwagandha-induced hyperthyroidism, emphasizing the importance of awareness among healthcare providers and patients regarding the potential adverse effects of herbal supplements. It underscores the need for cautious use and monitoring of Ashwagandha, especially in individuals with underlying thyroid conditions. Further research is warranted to understand the exact mechanism of Ashwagandha's effect on thyroid function and to establish safe dosing guidelines.
Poster 0147
Thyroid Cancer, Case Study, Poster
Oncocytic Carcinoma of the Thyroid with Extensive Tumor Thrombus in the Innominate Vein: A Case Report
Suedeh Ranjbar*1, Helen Liu1, Rajam Raghunathan2, Yesha Maniar1, Matthew Krell1, Alec Vaezi1, Scott Schubach1, Reese Wain1, Mala Gupta1, John Allendorf1, 1NYU, USA, 2NYU, USA
The patient underwent a left thyroid lobectomy, isthmusectomy, central and modified left radical neck dissections. Thrombectomy and innominate vein repair with pericardial bovine patch required median sternotomy and resection of the clavicular head for safe access.
Surgical pathology confirmed differentiated high-grade thyroid carcinoma, oncocytic type, Stage IVA T4bN1bMX. Tumor profiling showed microsatellite-stability, with ATM, NF1 (5727 and Q97) and PTEN (517DR and D24V) biomarkers. Recovery was uneventful and there was no evidence of metastases at two-month follow-up. Patient will continue close observational surveillance with no planned adjuvant therapy.
Poster 0148
Thyroid Cancer, Case Study, Poster
Poorly Differentiated Thyroid Carcinoma in the Second Trimester of Pregnancy: A Diagnostic and Clinical Challenge
Suedeh Ranjbar*1, Rajam Raghunathan2, Michael Weintraub2, Steven Hodak2, Cheng Liu2, Bruce Wenig3, Kepal Patel2, Insoo Suh2, John Allendorf1, 1NYU, USA, 2NYU, USA, 3Moffitt Cancer Center, USA
Poster 0149
Thyroid Cancer, Clinical, Poster
Age but not tumor size modifies the association between extrathyroidal extension and long-term outcomes in patients with follicular cell-derived thyroid carcinoma
Saad Samargandy*1, Shaza Samargandy1, Hani Marzouki1, Raghad Alotaibi1, Rahaf Alotaibi1, Hanan Faruqui2, Ahad Alsuwat3, Marwan Alhajeili1, Asala Baharoon1, 1King Abdulaziz University, Saudi Arabia, 2Dr.Soliman Fakeeh Medical Center, Saudi Arabia, 3King Faisal specialist hospital & Research center, Saudi Arabia
Poster 0150
Thyroid Cancer, Clinical, Poster
PD-L1 Expression Varies Across Thyroid Cancer Types and Histological Subtypes
Deema Al-Souri*1, Illiam Kuenstner1, Jennifer Rosen1, Gretchen Hubbard2, Leonared Wartofsky1, Vasyl Vasko3, Kenneth Burman1, Leila Shobab1, 1MedStar Washington Hospital Center, USA, 2CARIS Molecular Intelligence, USA, 3Uniformed Services University of the Health Sciences, USA
Poster 0151
Thyroid Cancer, Case Study, Poster
Deleterious Co-Mutation: A Case of Co-existent BRAF and TERT Mutations in a Patient with Metastatic PTC
Aastha Sehgal*1, Dmitriy Stasishin1, Ruben Alberto Hiraldo1, Jacqueline Jonklaas2, 1MedStar Washington Hospital center, USA, 2Georgetown University Hospital, USA
Poster 0152
Thyroid Cancer, Case Study, Poster
Medullary Thyroid Carcinoma Associated with a Rare RET Proto-Oncogene Mutation: p.K666N
Adam Davis*1,2, Robert Kennedy1,2, Diana Bigler1,2, Matthew Nicholson1, Forest Weir1, 1Wellstar MCG Health, USA, 2Charlie Norwood Veterans Affairs Medical Center, USA
Poster 0153
Thyroid Cancer, Case Study, Poster
Not so Minimally Invasive, Minimally Invasive Follicular Thyroid Carcinoma: A Case without Capsular Breakthrough Presenting with Multiple Metastases
Diego Moreno Watashi*, Kenneth Burman,MedStar Washington Hospital Center/Georgetown University, USA
The patient was asymptomatic from a thyroid standpoint, with normal thyroid function tests TSH 3.5 uUI/ml, T4 8.6ng/dL, elevated thyroglobulin levels 44.6 ng/mL but no thyroglobulin antibodies.
Thyroid ultrasound identified an isoechoic solid nodule, taller than wide, located at the mid lobe measuring 1.1 x 0.7 x 1.3 cm (TI-RADS 4) without local pathologic adenopathy, and fine needle aspiration yielded an undiagnostic result.
Total thyroidectomy was performed, revealing a microfollicular lesions with singular focal capsular invasion without loss of capsular continuity, consistent with minimally invasive follicular carcinoma.
Post-thyroidectomy, the patient received radioactive iodine therapy with 303 mCi of I-131. Tg decreased to 0.4. and antibodies continued negative. Molecular profiling revealed TERT and HRAS Q61K mutations. Subsequent scans demonstrating iodine uptake in the right scapular area indicative of additional metastatic disease.
Management is based on the likelihood of metastasis, through risk stratification after thyroid lobectomy or thyroidectomy. Most guidelines do not routinely recommend radioactive iodine ablation in patients with low-risk disease, but to consider in the setting of a primary tumor size ≥4 cm, multiple vascular invasion sites or distant metastasis.
The existence of severe metastatic disease with deemed “low-risk” primary cancer can point that the nomenclature of minimally invasive may not mirror the tumor’s behavior.
Poster 0154
Thyroid Cancer, Case Study, Poster
Unusual Metastatic Journey: Benign Thyroid Nodule to Lung Metastasis
Eman Alhussain*, Julie Samantry,Wayne state university, USA
The patient underwent a total thyroidectomy. Post-surgical pathology revealed a benign hyperplastic nodule with extensive cystic degeneration. Approximately two years following total thyroidectomy, a biopsy of a growing right lung nodule revealed metastatic thyroid cancer, confirmed by immunohistochemical staining for TTF-1 (positive), PAP (negative), NKX3.1 (negative), PAX8 (positive), and thyroglobulin (positive). Thyroglobulin was more than 450. The initial thyroid pathology was reviewed again; no evidence of capsular or vascular invasion was found. A nuclear medicine thyroid scan showed residual post-operative thyroid tissue in the thyroid bed and increased uptake of functioning lung metastases. Consequently, the patient underwent radioactive iodine therapy. Repeated thyroglobulin went down from 450 to 5.
Poster 0155
Thyroid Cancer, Case Study, Poster
An Unresectable Papillary Thyroid Cancer Presenting with Extensive Cervical Lymphadenopathy and Miliary Pulmonary Metastasis Treated Successfully with Both Neoadjuvant and Adjuvant Tyrosine Kinase Inhibitors (TKI)
Haley Niu*1, Shriya Kundranda2, Amanda Edmond3, Chafeek Tomeh3, Iram Ahmad4, Jiaxin Niu3, 1Basis Scottsdale, USA, 2Desert Mountain High School, USA, 3Banner MD Anderson Cancer Center, USA, 4Virginia Mason Franciscan Health, USA
The case was discussed on a multidisciplinary tumor board; he was deemed medically inoperable due to severe hypoxia. Lenvatinib 24 mg daily was started to reduce tumor burden and oxygen requirement. He responded rapidly and underwent total thyroidectomy with bilateral and central neck dissection. NGS disclosed NCOA4-RET fusion. He received RAI ablation, TSH suppression, and was able to discontinue Lenvatinib 2 months later.
The patient was doing well for 2 years before he started to experience dyspnea on exertion, his thyroglobulin level was also rising. Given his significant disease burden in the lung and concerns for long-term toxicity of high-dose RAI, the decision was made to treat him with a specific RET inhibitor, pralsetinib, first to cytoreduce the lung metastases before the second RAI ablation optimally. He had a remarkable response in 6 months and underwent the second RAI ablation. Clinically he responded well to both Pralsetinib and RAI. His dyspnea on exertion resolved quickly and he has been progression-free for 3 years with declining thyroglobulin level over time (5436 to 62) despite the discontinuation of pralsetinib after RAI.
Poster 0156
Thyroid Cancer, Case Study, Poster
Somatic BRAF V600E Mutation Found in Sporadic Medullary Thyroid Carcinoma
Henri Sasseville*1,2, Michael Tamilia1,3, 1Jewish General Hospital, Canada, 2McGill University, Canada, 3McGIll University, Canada
The patient underwent total thyroidectomy with central and ipsilateral lateral neck dissection. Histology revealed a low-grade MTC, with an infiltrative growth pattern, focal positive margins, microscopic extrathyroidal extension into skeletal muscle and only one of the four positive (2.3mm) lymph nodes. Notably, a BRAF V600E mutation was identified by immunohistochemistry and later by next-generation sequencing (NGS). Furthermore, one of the blocks was retested using real-time PCR-based biocartis Idylla, yielding the same result of a BRAF V600E mutation. Histological review of tumor blocks did not reveal any incidental admixed papillary carcinoma. MTC cells stained diffusely, as expected, with calcitonin, CEA, and INSM-1, confirming the diagnosis.
Poster 0157
Thyroid Cancer, Case Study, Poster
Rare Case of Multiple Endocrine Neoplasia Type 2A Diagnosis in a Geriatric Patient Emphasizes Importance of Early Genetic Testing
Jack Miller*, Kaare Weber,Department of General Surgery, White Plains Hospital, USA
MEN-2A is a rare familial cancer syndrome that affects multiple endocrine organs, typically the thyroid, adrenal glands, and parathyroid. The age of onset for MEN-2A is early adulthood. Physiologically, MEN-2A is a hereditary syndrome typically indicated by the presence of two or more specific endocrine tumors. Genetically, MEN-2A is caused by a missense gain-of-function mutation of the REarranged during Transfection (RET) proto-oncogene. We present a case of an 81-year-old woman diagnosed with multiple endocrine neoplasia 2A (MEN-2A). The patient underwent genetic testing with a positive detection of C1859G>A (p.Cys620Tyr) showing an increased risk of endocrine cancer. Previously, diagnosis of MEN-2A across all phenotypes has only been shown to occur from adolescence to middle age. This report emphasizes the importance of preliminary screenings and genetic testing due to the oddity of this unexpected diagnosis in a geriatric patient typically diagnosed in young adulthood.
Poster 0158
Thyroid Cancer, Case Study, Poster
Diagnostic Conundrum: Pulmonary Metastasis from Thyroid Cancer Masquerading as Benign Adenomatoid Nodules on Pathology
Kajol Manglani*, Priya Kundra,Georgetown University/MedStar Washington Hospital Center, USA
Multinodular goiter (MNG) represents a common thyroid disorder characterized by enlargement of the thyroid gland and presence of multiple nodules. While most nodules are benign, a subset may harbor malignant potential, posing diagnostic challenges for clinicians. Fine needle aspiration (FNA) and molecular testing have emerged as valuable tools in evaluating thyroid nodules, aiding in risk stratification and guiding management decisions.
We present a case of a 78-year-old female, without prior radiation exposure or family history of thyroid cancer, who presented to the Endocrine clinic for postsurgical hypothyroidism. She had a history of MNG and neck ultrasound showed a solid, isoechoic nodule with smooth margins measuring 6.6cm in the left lobe and two nodules measuring 3.4cm and 2.1cm in the right lobe, without associated lymphadenopathy. Thyroid-stimulating hormone (TSH) was 2.8 mcIU/mL. FNA of the left nodule yielded findings of atypia of undetermined significance, and molecular analysis using Thyroseq demonstrated the presence of NRAS and EIF1AX mutations, raising suspicion for malignancy. However, subsequent total thyroidectomy pathology reported benign adenomatoid nodules with some areas of hypercellularity without evidence of malignancy, corroborated by two independent pathologists. Several months later, the patient underwent chest computed tomography (CT) to investigate chronic dyspnea on exertion, which revealed numerous bilateral metastatic lung nodules, with the largest measuring 1.8cm. A positron emission tomography (PET) scan demonstrated mild activity in the nodules (SUV 2.3) however, no primary fluorodeoxyglucose (FDG) avid tumor was identified. The thyroglobulin level measured at this juncture was elevated at 1025.2ng/mL. Subsequent radioactive iodine (RAI) scan revealed diffuse uptake in the bilateral lung fields, confirming metastatic thyroid cancer. The patient underwent dosimetry-based RAI therapy, resulting in a decrease in thyroglobulin level to 170.9ng/mL two months post-RAI.
Multifocal pulmonary metastasis of thyroid cancer, devoid of primary intrathyroidal cancer or metastases elsewhere, is exceedingly rare, with very few cases reported in literature. This case highlights the need for accurate diagnostic techniques in scenarios lacking pathological confirmation yet exhibiting malignant clinical characteristics. Based on the mutations detected in our patient, it is probable that she had metastatic follicular or hurthle cell thyroid carcinoma despite a benign pathology report.
Poster 0159
Thyroid Cancer, Case Study, Poster
A Novel Case of Redifferentiation of Anaplastic Thyroid Cancer Followed by Surgery and Treatment with Radioactive Iodine
Kayle Lowe*1, Omar Abdel-Rahman2, Julinor Bacani1, Jeffrey Harris1, Jennifer Jacquier1, 1University of Alberta, Canada, 2Cross Cancer Institute, Canada
Anaplastic thyroid cancer (ATC) is a rare and aggressive thyroid tumor which usually develops from dedifferentiation of papillary thyroid cancer (PTC) secondary to the accumulation of somatic mutations. The BRAF V600E mutation is found in 40-50% of ATC. Treatment with dabrafenib and trametinib in a non-randomized study demonstrated an overall survival (OS) of 14.5 months, with neoadjuvant treatment resulting in a one year survival of 83% in a small case series. The efficacy of radioactive iodine (RAI) following BRAF-directed therapy and surgery is unclear.
A 64-year-old male presented with cough, dyspnea, and dysphagia. PET/CT showed a 7.5 cm thyroid mass, with cervical, hilar and mediastinal lymphadenopathy, as well as multiple pulmonary and bone metastases. Endobronchial biopsy of his lung metastases was diagnostic of ATC with a BRAF V600E mutation, therefore initial treatment was non-surgical with external beam radiation, and systemic therapy with dabrafenib and trametinib. Follow-up imaging showed a mixed response, and treatment was complicated by multiple hospitalizations and treatment interruptions. After ten months of systemic therapy, fine needle aspiration biopsy of neck nodal disease revealed differentiated thyroid cancer. Four months later he underwent total thyroidectomy, left neck dissection, and mediastinal dissection, with histopathology showing a mix of classical PTC, poorly differentiated thyroid carcinoma, high grade differentiated follicular cell derived thyroid carcinoma, and anaplastic thyroid cancer. He received 150 mCi of RAI two months after surgery and his post-treatment I-131 scan with SPECT CT showed a mix of RAI-avid and non-RAI-avid metastases. There was further disease progression and he died 6 weeks later, with an overall survival of 20 months from the time of diagnosis.
Recent advances in the treatment of ATC have resulted in improved overall survival rates, particularly in patients who are candidates for BRAF-directed therapy. A retrospective cohort study reported improved survival in patients with ATC treated with neoadjuvant BRAF-directed therapy followed by surgery. Our case is the first report of the use of RAI following redifferentiation with BRAF-directed therapy and surgery, with RAI uptake into some of the metastases.
Poster 0160
Thyroid Cancer, Case Study, Poster
Rare Case Of Cutaneous Metastasis In Medullary Thyroid Cancer
Maria Fariduddin*1, Asifa Bilgi2, Muddasir Fariduddin2, Daniel Toft1, 1UIC Chicago, USA, 2Ayaan Institute of Medical Sciences, India
Cutaneous metastases are rare in any type of thyroid malignancies, and of those reported, majority are seen in papillary cancers. We report a case of cutaneous metastasis in medullary carcinoma of the thyroid.
44 y/o male presented with left ear pain and swelling in the neck. CT scan showed enlarged thyroid gland with infiltrating features concerning for thyroid malignancy with enlarged cervical lymph nodes. Fine Needle Aspiration of the left thyroid nodule and cervical lymph node showed Medullary Thyroid Carcinoma (MTC). Patient did not have any family history of MTC or Multiple Endocrine Neoplasia syndromes. Parathyroid hormone, Calcium and Metanephrine levels were in normal range. He underwent total thyroidectomy with left neck dissection. Pathology showed 5.2 cm MTC, 4/12 lymph nodes involved, largest focus of 3.8 cm with extranodal extension and positive tumor margins. Pre-operative calcitonin levels were 133 pg/mL which improved to 6.5 post-operatively. RET M918T mutation was seen.
3 months after completion of radiation therapy, he presented with severe scalp pain and a red exophytic indurated nodule on the right parieto-occipital scalp which was unresponsive to topical steroids and oral antibiotics. Suspecting cutaneous metastatic disease, further evaluation for recurrence was undertaken. Calcitonin levels returned elevated at 1405 pg/mL and CT imaging revealed multiple lesions in liver and lung consistent with metastatic disease. A liver biopsy showed metastatic MTC and biopsy of the skin lesion was deferred to avoid worsening the pain in that site as it would not alter management in that time. He started on Selpercatinib treatment and imaging 3 months later showed response to treatment with decrease in the size of liver and lung metastases. Calcitonin levels were also undetectable. His scalp lesion also reduced in size and scalp pain had resolved, proving that this was a cutaneous metastasis of MTC.
Medullary thyroid cancer is a rare thyroid malignancy and cutaneous metastasis are even rarely reported in this disease or any other type of thyroid cancer. Most of reported cutaneous metastasis in thyroid cancer are seen in papillary and follicular types. Scalp is the most common site of cutaneous metastasis from any type of thyroid cancer and indicates poor prognosis. This highlights the importance of awareness of this rare site of metastasis of MTC which needs a high index of suspicion. His diagnosis of progressive systemic disease perhaps could have been delayed without this suspicion of cutaneous metastasis.
Poster 0161
Thyroid Cancer, Case Study, Poster
Significant Clinical Response to Crizotinib in Recurrent, Metastatic Papillary Thyroid Cancer with CCDC30-ROS1 Fusion Mutation
Miguel De La Torre Avitia*1,2, Jorge Nieva3, Amitha Kapyur1,2, Caroline Nguyen4, 1Los Angeles General Medical Center, USA, 2Keck School of Medicine of USC, USA, 3Keck School of Medicine of USC, Department of Oncology, USA, 4Keck School of Medicine of USC, Department of Medicine and Obstetrics and Gynecology, Division of Endocrinology, USA
Poster 0162
Thyroid Cancer, Case Study, Poster
Diagnostic Discrepancy: A Case of Coexisting Papillary and Anaplastic Thyroid Carcinoma
Minju Kim*, Manasi Shah, Eastern Virginia Medical School, USA
Anaplastic thyroid cancer is known for its aggressive nature that leads to poor prognosis and is not uncommon to find coexisting differentiated thyroid cancer. Here we present a case initially diagnosed with papillary thyroid cancer, later turned out to have anaplastic thyroid carcinoma too, which could have approached differently if known earlier.
A 77-year-old female was admitted for a large left papillary thyroid cancer which was diagnosed from a fine needle aspiration (FNA) 8 months before the admission. CT chest and neck demonstrated solid, lobulated heterogeneously enhancing 5.0 x 4.1 cm mass in the left side of the neck involving the left thyroid, causing mild deviation of nearby structure. She underwent left hemithyroidectomy and neck dissection. The tumor involved the trachea, tracheal-esophageal groove, and skeletal muscles. Two lymph nodes out of 27 were positive for metastatic thyroid carcinoma. Interestingly, pathology from surgical biopsy revealed three different types of thyroid carcinoma: 5% of anaplastic, mainly in the extrathyroid area, 25% of differentiated high-grade papillary, and 70% of clear cell type papillary carcinoma. The patient's hospital course was complicated with an acute left middle cerebral artery infarct postoperatively. She developed hypothyroidism, so started levothyroxine 25 mcg. The patient was discharged to a long-term care facility for hospice care.
There was a significant delay between the onset, first diagnosis, and surgery of her thyroid mass as the patient lost follow-ups a few times, which might have caused cancer transformation in the meantime. The mean interval between the FNA and surgery was 52 days per Yuan F. Liu et al. Also, it was less likely to get the tissue sample of anaplastic carcinoma from FNA as it only consisted of 5% of the mass. In addition, there has been research showing relatively large false negative results from FNA for large nodules. We can argue that the patient would have benefited from core needle biopsy rather than FNA for its large size. We can also consider developing a scoring system for patients who have a higher chance of having coexisting anaplastic thyroid cancer to get further diagnostic tests before considering treatment.
Poster 0163
Thyroid Cancer, Case Study, Poster
The Enigma of Distant Metastases in Medullary Thyroid Cancer: Low Calcitonin Levels as a Deceptive Indicator
Nazanene Esfandiari*, Sima Saberi, Maria Papaleontiou,University of Michigan, USA
Calcitonin levels can be used as an indicator for regional neck metastasis versus distant metastasis in patients with medullary thyroid cancer (MTC).
A 61-year-old man with hypertension was diagnosed with a 0.6 cm left lobe medullary thyroid cancer with central and left lateral neck metastases with extranodal extension at age 53. He had no germline mutation. Prior to surgery his calcitonin was 255 pg/mL and CEA was 5 ng/mL. Post-operatively these calcitonin and CEA levels decreased to 5 pg/mL and <1 ng/mL, respectively. The year following his initial surgery, he underwent a repeat left neck dissection for cervical node metastases. Two years after the repeat neck dissection, he was found to have recurrence in a left submandibular node, left periauricular mass, neck scar on the left, and liver. Next generation sequencing in the liver tissue was positive for RET p.M918T. Despite these extensive distant metastases his calcitonin level was only 36 pg/mL and CEA level was 1 ng/mL. Due to distant metastases, he was enrolled into the LOXO study but was disenrolled three months later due to elevated liver enzymes. He then enrolled in the BLU study during which time his calcitonin and CEA levels became undetectable and his liver and lungs metastases remained stable in size. Following completion of the BLU study, he started Pralsetinib 100 mg three tablets daily. His current calcitonin and CEA levels remain undetectable and imaging studies show no progression of distant metastases.
Distant metastases can rarely occur in patients with MTC with a calcitonin level less than 150 pg/mL. Physicians should pursue additional imaging studies even if calcitonin level is less than 150 pg/ml if there is clinical suspicion for distant progression of disease.
Poster 0164
Thyroid Cancer, Case Study, Poster
A Rare Presentation: Papillary Thyroid Cancer Initially Identified As Left Hip Pathological Fracture
Renu Thomas*1, Anam Zara1, Ashley Charales1, Syed Haider1, Srinivas Panja2, Zuhair Ali1, 1HCA Houston Healthcare, USA, 2Greater Houston Diabetes and Endocrinology Center, USA
Poster 0165
Thyroid Cancer, Case Study, Poster
Redifferentiation Effect of Larotrectinib: A case report of a 19 y/o male with an NTRK1 pathogenic fusion
Sebastian Vallejo*1, Gustavo Fernandez Castro2, Russ Kuker2, Silvia Gra Menendez2, Regina Young1, 1Jackson Memorial Hospital/University of Miami, USA, 2University of Miami, USA
Papillary Thyroid Carcinoma (PTC) is the most common cause of thyroid malignancy, and the most common metastatic site is the lung. Metastatic thyroid cancers may dedifferentiate and become radioactive-iodine (RAI) resistant. A redifferentiation effect can be observed with inhibitors of the mitogen-activated protein kinase pathway in thyroid cancers with point mutation in oncogenes and inhibitors targeting oncogenic fusion genes. Neurotropic Tyrosine Receptor Kinase 1 (NTRK1) represents a minority of oncogenes causing PTC. We report the case of a patient with metastatic RAI-refractory NTRK-rearranged thyroid cancer who received Larotrectinib for redifferentiation therapy.
We present a case of a 19 y/o man with no family history of thyroid cancer or history of radiation to the neck or chest area. He was incidentally found with abnormal cervical lymph nodes (LN). The Neck US showed an ill-defined left lobe nodule, measuring 3.0 cm with microcalcifications. It also showed LNs that were completely replaced by tumors on Left cervical levels 3 and 4. The abnormal LN were solid and had chaotic blood flow and calcifications. The FNA of the Left lobe nodule and the dominant LN were positive for PTC. He underwent a total thyroidectomy with a left neck dissection. The pathology showed papillary thyroid cancer, a classical variant extending into the strap muscles, with negative angiovascular invasion. He had LN metastasis to 13/72 with positive ENE.
The appropriately suppressed post-op thyroglobulin was 112.4 ng/ml, with a low concentration of thyroglobulin Ab, 11 IU/ml. The CT chest showed scattered subcentimeter pulmonary nodules, which were too small for biopsy.
Molecular analysis by DNA and RNA next-generation sequencing identified a pathogenic NTRK1 fusion. Whole Body Dosimetry did not show RAI avid disease. The patient received Larotrectinib for three months with the goal of cancer differentiation and subsequent RAI therapy. The repeated diagnostic Whole-Body scan after the therapy showed RAI avid disease.
The patient underwent RAI therapy with a therapeutic activity of 200 mCi. The stimulated thyroglobulin was 126 ng/ml, and the thyroglobulin Ab was 15 IU/ml. The post-treatment scan showed diffuse uptake throughout the bilateral lungs. A CT chest after RAI therapy showed a significant decrease in the size and number of the bilateral punctate pulmonary nodules.
Larotrectinib-induced a remarkable RAI reuptake in the lungs. The patient tolerated the therapy well, with no reported side effects, and experienced a significant reduction in the size and number of bilateral pulmonary nodules.
Poster 0166
Thyroid Cancer, Case Study, Poster
Anaplastic Thyroid Cancer Presenting as Cranial Nerve Palsies
Shea-Lee Godin*, Kristin Ek,University of Connecticut, USA
PET scan showed a 2cm intensely FDG avid nodule in the right thyroid lobe and nonspecific increased uptake around the right carotid artery, impacting the carotid artery and cranial nerves X and XII. Because of the location, a needle biopsy nor an open biopsy was feasible. Total thyroidectomy revealed papillary thyroid carcinoma progressing to ATC with a significant squamous component with extrathyroidal extension, perineural invasion, and lymph vascular invasion. One central compartment lymph node contained a tumour with no extracapsular disease. A high-dose iodine scan showed no uptake in the carotid mass, suggesting a squamous cell component. External beam radiation targeted the carotid lesion, and targeted therapy with anti-BRAF plus anti-MEK was initiated.
Poster 0167
Thyroid Cancer, Case Study, Poster
Follicular Thyroid Neoplasm with Aggressive Bone Metastasis
Sandhya Shanthosh kumar*, Liane Cali, Karen Selk,UPMC Mercy, USA
We present an extremely rare case of a follicular thyroid carcinoma presenting with aggressive bone metastasis.
52-year-old female with no known medical history initially presented for evaluation of a left scalp mass and enlarging anterior neck mass. The neck mass was present for the past 6 years, but progressively enlarged causing mild dyspnea when supine and dysphagia to solids for the past one year. A CT of the neck revealed a goiter with substernal extension and invasion of the right internal jugular vein. A subsequent thyroid ultrasound demonstrated goitrous enlargement of the right thyroid lobe with heterogeneous nodules, hypervascularity and scattered marginal calcifications. Thyroid function tests revealed a normal TSH and a borderline low FT4. Cytology from a FNA was consistent with a follicular thyroid neoplasm.
A CT Head revealed a 5 cm x 4 cm lytic mass along the posterior midline and another 3.3 cm x 2 cm lytic mass along the left calvarial cortex with invasion of the scalp soft tissue. Subsequent imaging revealed an incidental 10.1 cm x 6 cm x 8 cm lytic sacral mass and a 3.6 x 3.2 x 5.2 cm lytic left iliac lesion invading the left gluteal musculature. There was no clear evidence of another primary lesion on other lab testing or imaging. A core biopsy of the sacral mass had pathology with positive stains for TTF, galectin 3, HBME1, and thyroglobulin supporting a diagnosis of metastatic thyroid carcinoma.
Follicular thyroid carcinoma is more common in women and usually appears in the fifth and sixth decades. Chronic iodine deficiency may also increase individual risk. Metastasis occurs via vascular invasion with rate of distant hematogenous dissemination reported as 6-20%. The most common sites involved are spine (33.9%), pelvis (30. 5%) and skull (27.1%). In some cases, widespread metastasis has already occurred at the time of diagnosis. Sacral metastases are extremely rare, with literature consisting of only a few case reports. All patients presenting with thyroid mass should be thoroughly evaluated for any evidence of metastasis and disease burden, as in this case, the patient’s sacral and iliac masses were incidental findings given absence of symptoms.
Thursday, October 31, 2024
Poster 0168
Autoimmunity, Basic, Poster
The TSH Receptor Interacts Directly With The IGF-1 Receptor Complex
Mihaly Mezei*1, Rauf Latif1,2, Syed Morshed1,2, Terry Davies1,2, 1Icahn School of Medicine at Mount Sinai, USA, 2James J. Peters VA Medical Center, USA
In order to validate our modelling data, we next performed co-immunoprecipitation studies with anti-TSHR and anti-IGF-1R mAbs using cells expressing the TSHR and the IGF1R and compared them with cells that expressed only the TSHR-ECD (which is unable to bind β-arrestin) and the IGF1R complex. We detected a 362kD complex protein in the immunoprecipitation positive for both antibodies, and which was clearly present in the full length TSHR and the TSHR-ECD-only expressing cells and absent from controls. Furthermore, we also found co-localization of TSHR and IGF1R in the TSHR-ECD-only cells again evidencing direct interaction.
Poster 0169
Autoimmunity, Translational, Poster
IFNα shapes thyroglobulin peptide repertoire into an immunogenic repertoire triggering autoimmune thyroiditis
Nicola Viola*1,2, Larissa Costa Faustino1, Olga Meshcheryakova1, Aizhan Kozhakhmetova1, Mihaela Stefan-Lifshitz1, Yaron Tomer1, 1Division of Endocrinology, Department of Medicine, Albert Einstein College of Medicine, USA, 2University of Pisa, Italy
Poster 0170
Autoimmunity, Translational, Poster
Effect on Th1 and Th2 Chemokines Secretion by Rapamycin, Mycophenolic Acid, or Glucocorticoids in Primary Retro-Orbital Cells Obtained from Patients with Graves’ Ophthalmopathy
Silvia Martina Ferrari1, Giusy Elia2, Francesca Ragusa2, Eugenia Balestri2, Chiara Botrini2, Licia Rugani2, Valeria Mazzi2, Armando Patrizio3, Alessandro Antonelli2, Poupak Fallahi*4, 1University of Pisa, Department of Clinical and Experimental Medicine, Italy, 2University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area, Italy, 3Azienda Ospedaliero-Universitaria Pisana, Department of Emergency Medicine, Italy, 4University of Pisa, Department of Translational Research of New Technologies in Medicine and Surgery, Italy
Differently, a low level of CCL2 were found in basal condition, and it was induced in a dose-dependent manner by TNF-alpha (but not by IFN-gamma alone), while the combination of TNF-alpha+IFN-gamma had a significant synergistic effect on CCL2 release.
The co-treatment with mycophenolic acid, rapamycin, or glucocorticoids (in a pharmacological range), in the presence of TNF-alpha+IFN-gamma, led to a dose-dependent inhibitory effect on the chemokines release.
Moreover, a synergistic inhibitory effect on the chemokines release was observed by combining mycophenolic acid or rapamycin and/or with glucocorticoids.
Poster 0171
Autoimmunity, Translational, Poster
Targeting CD4+ T cell IL21 Signaling to Halt Hashimoto's Thyroiditis Progression
Kyleigh Kimbrell*1, Jarod Olay1, Trevor Angell2, Willy Hugo1, Melissa Lechner1, 1UCLA Geffen School of Medicine, USA, 2USC Keck School of Medicine, USA
Hashimoto’s thyroiditis is one of the most common autoimmune endocrinopathies, affecting 15% of the U.S. population. However, no treatments exist to halt disease progression or address the underlying immunopathogenesis, as has become the standard of care for many other autoimmune diseases. We used single cell and spatial RNA sequencing of human thyroid specimens to delineate key immune interactions and signaling pathways in HT. We identified T-follicular helper (Tfh, CD4+IL21+ICOS+PD1+BCL6+CXCR5+) cells as early mediators of HT, orchestrating the formation of tertiary lymphoid structures (TLS). Cellchat analysis showed significant interleukin 21 (IL21) – IL21R, CXCL13 – CXCR5/3, and CD40LG – CD40 signaling from CD4+ Tfh cells to B and effector T cells in inflamed thyroid tissues. In addition, Tfh cells appeared early in disease progression (euthyroid TPO antibody positive patients with HT), while CD8+ T cells were increased in later disease (hypothyroid TPO antibody positive patients). Spatial transcriptomics confirmed that Tfh CD4+ cells expressing IL21 and CXCL13 were central to TLS in early stage HT. We then turned to our unique mouse model of HT, in which mice with a dominant negative mutation in the AIRE (autoimmune regulator) gene develop spontaneous thyroiditis due to altered negative selection of self-reactive T cells. Importantly, thyroiditis in NOD.AIREGW mice recapitulates key features of human HT, including lymphocytic infiltration, hypothyroidism, TPO antibody positivity, and female sex bias, but does not require excess iodine for disease development. As in patients, scRNAseq of thyroid immune infiltrates in NOD.AIREGW mice revealed T, B, and myeloid cells, with a prominent IL21+ CD4+ T cell population. Flow cytometry analyses confirmed increased Tfh cells in thyroid infiltrates of NOD.AIREGW mice compared to age and sex matched NOD wildtype controls. Furthermore, deletion of CD4+ T cells and genetic deletion of IL21 signaling in NOD.AIREGW mice prevented thyroiditis development. Based upon these data, we tested the effect of ruxolitinib, a clinically-approved janus kinase (JAK) inhibitor that prevents downstream JAK/STAT activation in immune cells following IL21 stimulation, on thyroiditis development in our mouse model. Indeed, ruxolitinib effectively halted thyroiditis and presents a potential near-term therapeutic approach to stop autoimmune disease progression in patients with HT.
Poster 0172
Autoimmunity, Translational, Poster
Memory Stem-like Progenitor Exhausted CD8+ T cells Drive Chronicity in Hashimoto's Autoimmune Thyroid Disease
Jarod Olay*, Rachelle Le, Jaden Nuyen, Willy Hugo, Melissa Lechner,UCLA Geffen School of Medicine, USA
Hashimoto’s thyroiditis (HT) is an autoimmune disease affecting up to 15% of the population and the most common cause of thyroid gland dysfunction. While HT is clinically defined by chronic lymphocytic infiltration, the mechanisms driving continued propagation of self-reactive immune effectors remains elusive. Memory progenitor exhausted T cells (Tpex) are antigen experienced CD8+ T cells that uniquely possess a capacity for self-renewal and differentiation to cytotoxic CD8+ effectors. Such Tpex cells have been implicated in chronic viral infection and cancer immune responses. We hypothesize that these cells are also seen in HT and potentiate the chronic, progressive autoimmunity that defines HT.
We evaluated thyroid immune infiltrates in patients with no thyroid disease, early HT (+immune infiltrate, +TPO antibody positive, but euthyroid) or late HT (+immune infiltrate, +TPO antibody, with hypothyroidism) using single nuclei RNA sequencing (snRNAseq) of benign thyroid surgical specimens and flow cytometry of fresh tissue from thyroid fine needle aspirates. SnRNAseq revealed thyroid follicular cells and diverse immune infiltrates comprised of CD4+ and CD8+ T cells, B cells, and myeloid cells. Notably, we found increased CD8+ T cells in HT compared to healthy controls, with increased absolute counts and relative percentages correlating with progression from early (euthyroid) to late stage (hypothyroid) HT. This suggested that differences in the CD8+ T cell population may distinguish individuals who have progression of their autoimmunity compared with those who remain euthyroid.
Subclustering of CD8+ T cells identified clusters of Tpex (IL7R+ CD44+ TCF7+ SLAMF6+ SELL+ TOX+ ) and effectors (IFNG+ FAS+ PRF1+ ), as well as a terminally exhausted subset (LAG3+ HAVCR2+ PDCD1 +). Furthermore, trajectory analysis showed that progression from Tpex to effector CD8+ T cells expressing cytotoxicity genes (IFNG, PRF1) was significantly increased in thyroid immune infiltrates from subjects with late stage HT but not early HT or healthy controls. We then confirmed Tpex and effector CD8+ populations using flow cytometry in patients with HT and healthy controls. In summary, we now extend a role for memory Tpex cells, key drivers of immune chronicity in viral infections and cancer, to thyroid autoimmunity and propose them as a potential therapeutic target in autoimmune endocrinopathies.
Poster 0173
Autoimmunity, Translational, Poster
Serum Proteomic Analysis Reveals Insights into the Mechanism of Action of Teprotumumab, an Insulin-Like Growth Factor-1 Receptor Inhibitor, in Patients with Chronic, Low Disease Activity Thyroid Eye Disease (TED)
Peng Li, Michael Karon, Monica Gavala*, Amgen Inc, USA
Poster 0174
Autoimmunity, Translational, Poster
GenSci098-a potent TSHR antagonistic antibody for the treatment of TED
Peipei Wei, Mengyao An, Qian Zhou, Zhenyu Shao, Yamin Gao, Xiang Xu, Shanshan Wang, Haijun Tong*, Gao Sun,GenSci Pharmaceutical Co., Ltd, China
Poster 0175
Autoimmunity, Translational, Poster
Single-cell transcriptomics defines disease-specific cellular heat shock response states in autoimmune thyroid diseases and thyroid cancer
Jin Zhou*1, Fangyi Han2, Xicheng Song3, 1Department of Endocrinology, Yantai Yuhuangding Hospital of Qingdao University, China, 2Yue Bei People's Hospital Postdoctoral Innovation Practice Base, Southern Medical University, China, 3Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital of Qingdao University, China
Poster 0177
Disorders of Thyroid Function, Basic, Poster
Transcriptome Analysis of a Novel Hyperthyroid Mouse Induced by TSH Overexpression
Taku Sugawa*1, Ichiro Yamauchi1, Takuro Hakata1, Akira Yoshizawa2, Tomoko Kita2, Yo Kishimoto2, Sadahito Kimura1, Daisuke Kosugi1, Haruka Fujita1, Kentaro Okamoto1, Yohei Ueda1, Toshihito Fujii1, Daisuke Taura1, Yoriko Sakane3, Akihiro Yasoda4, Nobuya Inagaki5, 1Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Japan, 2Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan, 3Sugawa Clinic, Japan, 4Clinical Research Center, National Hospital Organization Kyoto Medical Center, Japan, 5Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Japan
Thereafter, we obtained thyroid transcriptome dataset from control mice, hyperthyroid mice, and MMI-treated hyperthyroid mice. Unexpectedly, MMI treatment caused slight changes in clustering and principal component analyses, which resulted in a small number of differentially expressed genes. On the other hand, clear changes in thyroid transcriptome were observed between control mice and hyperthyroid mice. The enrichment analyses shed light on cell cycle, PI3K/Akt pathway, and Rap1 pathway that could associate with goiter development.
In addition, among genes crucial to thyroid hormone secretion, Slc26a4 was exclusively upregulated in hyperthyroid mice at 1 week and 4 weeks after TSH overexpression. We performed TSH overexpression for Slc26a4 knockout mice to investigate its pathophysiological significance, which revealed that Slc26a4 knockout mice developed hyperthyroidism and goiter in a similar manner.
Poster 0178
Disorders of Thyroid Function, Basic, Poster
Improvement of Free Thyroxine Measurement Quality Through CDC Clinical Standardization Programs
Uliana Danilenko*1, Ashley Ribera1, Otoe Sugahara1, Norma Vazquez2, Samantha Knoblock3, Tatiana Buchannan1, Lynn Collins4, David Spector3, Li Zhang1, Hubert Vesper1, 1CDC, USA, 2Battelle, USA, 3ak Ridge Institute for Science and Education (ORISE), USA, 4Cherokee Nation Operational Solutions, USA
Poster 0179
Disorders of Thyroid Function, Basic, Poster
Incidence and Prevalence of Graves’ Disease: Analysis of a United States Commercial Insurance Claims Database
Lesley-Ann Miller-Wilson*1, Joel Arackal2, Paola Mina-Osorio1, Ruby Grewal2, Brett Venker2, 1Immunovant, Inc., USA, 2Roivant Sciences, Ltd., USA
Poster 0180
Thyroid Hormone Action, Metabolism and Regulation, Basic, Poster
Exploring the Effects of Thyroid Hormones on Oligodendrocyte Progenitor Cell Differentiation for Potential Therapeutic Use in Myelin Repair
Ziyu Zhu*, Achala Dharmasiri, Matt Zupan, Meredith Hartley,University of Kansas, USA
Poster 0181
Thyroid Hormone Action, Metabolism and Regulation, Basic, Poster
Investigating the Effect of Sob-AM2 on the Central Nervous System Lipid Turnover for Successful Remyelination
Nishama Mohotti*, Rashmi Binjawadagi, Disni Dedunupitiya, Meredith Hartley,University of Kansas, USA
Poster 0182
Thyroid Hormone Action, Metabolism and Regulation, Basic, Poster
The loss of silencing mediator of retinoid and thyroid hormone receptors (SMRT) in cerebellar Purkinje cells results in developmental disorder
Izuki Amano*1,2, Ayane Ninomiya1, Shinnosuke Masuda1, Kisho Obi-Nagata1, Megan Ritter2, Anthony Hollenberg2, Noriyuki Koibuchi1, 1Department of Integrative Physiology, Gunma University Graduate School of Medicine, Japan, 2Boston University Chobanian & Avedisian School of Medicine, Department of Medicine, USA
Poster 0183
Thyroid Hormone Action, Metabolism and Regulation, Basic, Poster
Thyrocyte-specific Bmal1 Deletion induces metabolic alterations in mice
Jinrong Fu*, Qiting Ye, Shili Zhang, Haixia Guan,Guangdong Provincial People’s Hospital, China
Poster 0184
Thyroid Hormone Action, Metabolism and Regulation, Basic, Poster
Molecular Effects of Thyroid Hormone and Histone Methyltransferase Dot1L during X. tropicalis Metamorphosis
Emeric LOUIS*1,2, Liezhen FU1, Nga LUU1, Yun-Bo SHI1, 1National Institutes of Health (NIH), USA, 2Muséum national d'Histoire naturelle (MNHN), France
Epigenetic modifications play a pivotal role in embryonic development. Among histones regulations, H3K79 methylation is performed by the highly conserved protein known from yeast to human: Disruptor of Telomeric Silencing-1 like (Dot1L). Despite its association with childhood leukemia and adult cancer, Dot1L’s function remains enigmatic. Dot1L gene is regulated by thyroid hormone (T3) during metamorphosis in Xenopus tropicalis, a quintessential model for post-embryonic development.
Our previous findings have revealed that Dot1L is a co-activator of thyroid receptor (TR). Moreover, Dot1L expression is directly regulated by T3 at the transcription level. Notably, Dot1L knockdown inhibits tadpole development, leading to premature death before metamorphosis. My project aims to understand the role of endogenous Dot1L and the associated molecular mechanisms during Xenopus metamorphosis.
To address this issue, we generated Dot1L mutant animals using CRISPR/Cas9 gene-editing approach and obtained a frog line with an 18 bp in-frame deletion in the coding methyltransferase domain. We observed that homozygous mutant tadpoles lacked any H3K79 methylation, demonstrating that the mutation inactivates the enzyme and confirms Dot1L as the exclusive methyltransferase for H3K79 methylation. Importantly, mutant tadpoles died before the initiating metamorphosis, similarly to our earlier observation with Dot1L knockdown animals, suggesting that H3K79 methylation is essential for tadpole development prior to metamorphosis.
We are currently investigating if Dot1L deficiency affect T3 signaling and metamorphosis by treating wild type and mutant pre-metamorphic tadpoles with exogenous T3, focusing on intestinal remodeling and hindlimb development. Furthermore, employing ChIP-seq assays, I am identifying Dot1L methylation targets in the genome to determine if and how Dot1L affects T3-signaling globally during Xenopus development.
These studies should deepen our understanding of Dot1L's multifaceted functions and its contribution to metamorphosis in Xenopus tropicalis and mammals post-embryonic development.
Poster 0185
Thyroid Hormone Action, Metabolism and Regulation, Basic, Poster
Quantification of mouse brain cholesterol esters in a demyelinating mouse model upon Sob-AM2 treatment
Disni Dedunupitiya*, Eden Go, Nishama Mohotti, Jenna Williams, Hiroko Kobayashi, Rashmi Binjawadagi, Heather Desaire, Meredith Hartley,University of Kansas, USA
Poster 0186
Thyroid Hormone Action, Metabolism and Regulation, Basic, Poster
Thyroid Hormone Dosage Effects on Oligodendrocyte Progenitor Cell Differentiation and Remyelination
Esther Holt*, Ziyu Zhu, Rashmi Binjawadagi, Jenna Williams, Hiroko Kobayashi, Meredith Hartley,University of Kansas, USA
Poster 0187
Thyroid Hormone Action, Metabolism and Regulation, Basic, Poster
The Thyroid Increases the T3/T4 Ratio in Response to Short-Term Overnutrition to Mitigate Hypothyroidism
Jessica Rampy*1,2, Alejandra Paola Torres Manzo2, Kendra Hoffsmith2, Matthew Loberg3, Huiying Wang3, Vivian Weiss3, Nancy Carrasco2, 1Yale University, USA, 2Vanderbilt University, USA, 3Vanderbilt University Medical Center, USA
Obesity, which affects >40% of the U.S. population, is increasingly understood as an endocrine disorder. The field has long focused on the effects of thyroid status on obesity, but much less is known about obesity’s effects on thyroid function, though we have known for decades that thyroid hormones (THs) are regulated by nutrient sensing to modulate energy expenditure to match energy intake. One would expect strong TH upregulation to counteract diet-induced weight gain, but this is not consistently reported in obesity studies. Thus, we
Poster 0188
Thyroid Hormone Action, Metabolism and Regulation, Basic, Poster
Thyroid Hormone Action on Microglia in Mechanisms of Myelin Repair
Matthew Zupan*, Nishama Mohotti, Meredith Hartley,University of Kansas, USA
Poster 0189
Thyroid Hormone Action, Metabolism and Regulation, Basic, Poster
Comprehensive Evaluation of Thyroid Hormone Action Using Hypothyroid Mice
Ichiro Yamauchi*1, Sadahito Kimura1, Taku Sugawa1, Takuro Hakata1, Daisuke Kosugi1, Kentaro Okamoto1, Yohei Ueda1, Daisuke Taura1, Daisuke Nakajima2, Takuya Kubo3,4, Daisuke Yabe1, 1Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Japan, 2Health and Environmental Risk Division, National Institute for Environmental Studies, Japan, 3Division of Applied Life Sciences, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Japan, 4Department of Material Chemistry, Graduate School of Engineering, Kyoto University, Japan
Thus, we could evaluate TH actions in various organs via detailed analyzes of hypothyroid mice. Furthermore, we improved this model through following experiments. To shorten the induction period of hypothyroidism, we treated mice with sodium iodide as well as PTU for either 1 week or 2 weeks. We found that PTU monotreatment for 2 weeks was enough to induce hypothyroidism and significant changes in phenotypes. To search more sensitive TH-responsive genes, we performed RNA sequencing for the liver, the heart, the cerebrum, and the gastrocnemius muscle of hypothyroid mice generated by this regimen.
Poster 0190
Disorders of Thyroid Function, Clinical, Poster
Management of Thyroid Dysfunction Due to Immune Checkpoint Inhibitors: Lessons from the Real-World Experience
Ichiro Yamauchi*, Takuro Hakata, Taku Sugawa, Sadahito Kimura, Daisuke Kosugi, Kentaro Okamoto, Yohei Ueda, Daisuke Taura, Daisuke Yabe,Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Japan
According to these results, we predicted that patients with positive TgAbs who developed severe thyrotoxicosis within 4 weeks after the first ICI administration would develop subsequent severe hypothyroidism. We treated 4 such patients with prompt LT4 replacement, characterized by LT4 initiation after thyrotoxicosis improvement and quick dose titration. Their euthyroid state was successfully maintained, in contrast with patients receiving conventional replacement.
Poster 0191
Thyroid Hormone Action, Metabolism and Regulation, Translational, Poster
LASN01 is a novel, clinical stage antibody that blocks inflammatory cytokine and chemokine release in in vitro studies using orbital fibroblasts from thyroid eye disease (TED) patients
James Swaney*1, Shira Geller1, Yasmin Vasquez1, Andrea Kossler2, Rona Silkiss3, Deborah Witherden1, David King1, 1Lassen Therapeutics, USA, 2Byers Eye Institute, Stanford University School of Medicine, USA, 3Silkiss Eye Surgery, USA
Poster 0192
Thyroid Hormone Action, Metabolism and Regulation, Translational, Poster
Thermogenic Gene Expression in Human Neck Adipose Tissue in Relation to Circulating and Local Thyroid Hormone Levels
Laura Salej*1, Sean Kodani2, Henrique Camara2, Natalia Chaves1, Aaron Cypess3, Yu-Hua Tseng2, Benjamin James1, Alina Gavrila1, 1Beth Israel Deaconess Medical Center, USA, 2Joslin Diabetes Center, USA, 3National Institute of Health, USA
Poster 0193
Thyroid Hormone Action, Metabolism and Regulation, Basic, Poster
Adiponectin receptors agonist, AdipoRon, regulates cardiac lipid metabolism via thyroid hormone dependent mechanism
Adam Olichwier*1, Agnieszka Bińczak2, Monika Duda2, Tomasz Bednarski3, 1UNL, USA, 2Centre of Postgraduate Medical Education, Department of Clinical Physiology, Poland, 3Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, USA
Hypothyroidism is one of the key risk factors for developing cardiovascular diseases (CVDs) such as atherosclerosis, ischemic heart, or heart failure. Hypothyroidism treatment involves constant thyroid hormone (TH) supplementation, usually triiodothyronine (T3) or thyroxine (T4). TH action in the cell is facilitated by TH transporters, such as monocarboxylate transporter 8 (MCT8), and TH receptors (TR). These proteins were also shown to regulate metabolism by controlling the expression of enzymes involved in such processes as lipid trafficking, synthesis, and utilization. Furthermore, obese patients with hypothyroidism have been shown to have lower level of adiponectin, an adipokine secreted by adipocytes, that regulates insulin sensitivity as well as balances glucose and lipid metabolism. Therefore, the aim of this project is to determine if adiponectin receptors agonist, AdipoRon, is involved in lipid metabolism regulation in hypothyroid cardiomyocytes in TH-dependent manner. To accomplish that, we have used left ventricles from 3-month-old female Wistar-Kyoto rats that underwent thyroidectomies to develop hypothyroidism. Additionally, some animals were given T4 (2µg/100g body weight/day) or simultaneously T4 and AdipoRon (25µg/100g body weight/day) intraperitonially for 4 weeks after thyroidectomy. AdipoRon treatment elevated MCT8 protein level and gene expression, but at the same time decreased TRα and did not affect TRβ protein levels in cardiomyocytes compared to T4 only treated group. No changes in TR-dependent lipogenic genes expression, such as transcription factor sterol regulatory element binding transcription factor 1 (Srebpf1) or Cd36 transporter, were detected, that corresponds with constant TRβ level. On the other hand, AdipoRon supplementation decreased gene expression and protein level of adipose triglyceride lipase (ATGL), a rate-limiting enzyme of triglyceride (TAG) lipolysis, and elevated gene expression of G0s2, a protein inhibitor of ATGL. Moreover, gene expression and protein level of diglyceride acyltransferases (DGAT1 and 2), involved in last step of TAG synthesis, were also downregulated by AdipoRon action compared to T4 treatment alone, leading to a conclusion that observed changes are TRα dependent. Taking together, obtained results suggest that AdipoRon, through activation of different TR isoforms, can modulate lipogenesis and lipolysis in cardiomyocytes during hypothyroidism.
Poster 0194
Thyroid Hormone Action, Metabolism and Regulation, Basic, Poster
Menopause is Associated With Disc Degeneration in the Lumbar Spine. Can PRP and 8-Prenylnaringenin (phytoestrogen) be a Disease Modifying Treatment?
Claudia Grigorov*1, Alin Pandea2, 1Heka Hospital, Romania, 2Regina Maria, Romania
Several studies have demonstrated the clinical significance of estrogen as it relates to intervertebral disc degeneration.
Degenerative disc disease (DDD) remains a leading cause of chronic back pain.
The intervertebral disc is composed of an annulus fibrosus that surrounds a nucleus pulposus, anchored to each other by cartilage endplates. The nucleus pulposus, composed primarily of water, proteoglycans such as aggrecan, and type II collagen, provides vertebrae with the elasticity and stability .
Various explanations have been offered to the origins of disc degeneration, including progressive deterioration, nutritional deficiencies, genetic predispositions, and hormone-related processes.
Women who are estrogen-replete are more likely to maintain intervertebral disc height than estrogen deficient women.
The aim of this study is to evaluate the efficacy of PRP treatment in patients with low back pain and menopause versus patients with low back pain that received intradiscal PRP and 8-prenylnaringenin treatment.
We evaluated 40 menopausal female patients who presented non specific low back pain that had no relief after physiotherapy (ESWT, MLS) and nsaids medication and we divided them in two groups of 20 patients (group 1 that had only intradiscal PRP) and a second group of 20 patients that had intradiscal PRP and 8-prenylnaringenin treatment for 6 months.
Patient were injected with 2 mls of PRP (48 mls of venous blood, obtained under aseptic technique, centrifuged for 2 minutes at 3450 rpm. From the resulting 25 mL PRP, there was another spin at 3550 rpm, 5 minutes and the resulting 2 mls were administered intradiscal, using echographic guidance.
For group 2 patients were administered 8-prenylnaringenin 1 tablet a day for 6 months (Menovert - SWP).
Patients who had received PRP injection and Menovert medication showed improvement in their scores at the 6 months follow up with no complications.
The study showed improve of symptoms in terms of NRS and ODI. Only one patient had pain above 5 in NRS and there was no value > 20% on ODI after 6 months. One patient complained of nausea.
MRI was used to analyse 25 discs, height was recorded, disc degeneration was evaluated using Pfirmann grading system.
Menopause is associated with disc degeneration
PRP injection and Menovert is a good treatment for the management of the patient with menopause and low back pain.
Limitations of this study: small number of patients involved, patients who would like to have hormone therapy and many patients are reluctant to spinal injection.
Poster 0195
Thyroid Nodules and Goiter, Basic, Poster
Association Between Shoulder Calcification Tendinophaty and Benign Thyroid Cysts
Claudia Grigorov*1, Alin Pandea2, 1Heka Hospital, Romania, 2Regina Maria, Romania
All of the participants answered the questionnaire on the following variables: age, gender, body mass index (BMI), occupation, physical activity, presence of thyroid disorders, shoulder disorders, smoking and alcohol.
All patients had ultrasound of the shoulder and the thyroid.
Group 1 consisted of 18 female patients between 20-65 years old, of whom 3 presented bilateral symptoms, and 10 had the non dominant side affected and 2 male patients.
Out of the 18 female patients, 2 (11,11%) had benign thyroid cysts (ultrasound appearance), 4 had thyroid nodules (22,22%) and 1 one had thyroiditis (5,55%).
Group 2 consisted of 18 female patients between 20-80 years old, without any shoulder complaints, of whom
None had thyroid cysts, 1 had nodules (5,55%) and none had thyroiditis.
Group 3 consisted of 20 female patients, aged from 20-65 years old, know with benign thyroid cysts (5 patients), hypothyroidism (10 patients) and nodules (5 patients).
Of these patients 3 patients had supraspinatus calcific tendinopathy (thyroid cysts), 2 had joint pain (1 benign thyroid nodules and 1 patient with thyroiditis).
Thyroid cysts are common findings but whenever a shoulder calcific tendinopathy is diagnosed without an obvious overuse cause, thyroid should be considered.
Patients with thyroid dysfunction should be questioned for musculoskeletal complaints and referred to a specialist if necessary.
Poster 0196
Thyroid Nodules and Goiter, Basic, Poster
Behavior of the Genes CLDN1, TIMP1 and KRT19 Among the Different Categories of the Bethesda System in Thyroid Nodules
Andrea Ross Orozco*1,2, Marco Álvarez Arrazola3, Anette Gastelum Quiroz1,2, Hanna Tolosa Lerma1,2, Eliakym Arámula Meraz1, Fred Luque Ortega1, Karla Morales Hernández1,2, Noemí García Magallanes2,4, 1Universidad Autónoma de Sinaloa, Mexico, 2Laboratorio de Biomedicina y Biología Molecular, Mexico, 3Álvarez y Arrazola Radiólogos, Mexico, 4Universidad Politécnica de Sinaloa, Mexico
The Bethesda System for Reporting Thyroid Cytopathology allows for the categorization of thyroid nodules based on cytology. Although approximately 90% of detected nodules are benign lesions, thyroid cancer might be present in around 5% of cases. From 20 to 25% of thyroid nodules submitted to fine-needle aspiration (FNA) result in an indeterminate diagnosis, with a risk of malignancy ranging between 5% and 30%. Uncovering the molecular patterns hidden behind nodules from the different Bethesda System categories could help guide diagnosis and treatment options for patients.
Poster 0197
Disorders of Thyroid Function, Translational, Poster
Transmission of different deletions in the SLC16A2 gene
Monica Malheiros França*1, Xiao-Hui Liao1, Michael Bamshad2, Jessica Chong2, Samuel Refetoff1, Alexandra Dumitrescu1, 1Univ of Chicago, USA, 2Univ of Washington, USA
Poster 0198
Iodine Uptake and Metabolism, Basic, Poster
Urinary Iodine Concentration And Thyroid Status In 880 Patients From The Longitudinal Adult Health Study (Elsa-Brasil)
Laís Fraga1, Isabela Benseñor2, Adriano Cury1, Nilza Scalissi1, Carmen Baptista1, Carolina Silva1, Rosalia Padovani*1, 1Irmandade Santa Casa de Misericórdia de São Paulo, Brazil, 2Faculdade de Medicina da USP, Brazil
Poster 0199
Iodine Uptake and Metabolism, Translational, Poster
Imaging-guided mesenchymal Stem Cell-mediated Sodium Iodide Symporter (NIS) Gene Transfer targeting Hypoxia in Glioblastoma
Carolin Kitzberger1,2, Martin Grashei2, Sandra Sühnel2, Sybille Reder2, Rebekka Spellerberg1, Katja Steiger3, Rainer Glass4, Wolfgang Weber2, Peter Nelson1, Franz Schilling2, Christine Spitzweg*1,5, 1Department of Internal Medicine IV, University Hospital, LMU Munich, Germany, 2Department of Nuclear Medicine, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Germany, 3Institute of Pathology, TUM School of Medicine and Health, Technical University of Munich, Germany, 4Neurosurgical Research, Department of Neurosurgery University Hospital, LMU Munich, Germany, 5Division Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, USA
Glioblastoma multiforme (GBM) is characterized by significant tumor heterogeneity at cellular and molecular levels – a central phenomenon linked to treatment failure and tumor recurrence. Hypoxia is a predominant feature of GBM, promoting its aggressiveness, chemo- and radioresistance, and is known to support GBM stem cell survival. Hypoxia and related signaling pathways are therefore important therapeutic targets in GBM. As central part of the tumor microenvironment, mesenchymal stem cells (MSC) have emerged as cellular-based vehicles for the delivery of therapeutic genes, such as the sodium iodide symporter (NIS), in cancer therapy due to their inherent migratory and tumor homing capabilities. As theranostic gene, NIS represents one of the oldest and most successful targets for non-invasive radionuclide-based molecular imaging and therapy. In our recent work we showed NIS to be highly effective as reporter and therapy gene, allowing therapeutic application of 131I or alternative radionuclides 188Re or 211At as well as detailed non-invasive in vivo tracking of MSCs by 123I-scintigraphy/SPECT and 124I- or 18F-TFB-PET.
Based on the important role of hypoxia and hypoxia-related HIF signaling in the pathogenesis of GBM, in the present study we have used multiparametric imaging to characterize regions of tumor hypoxia by 18F-FMISO-PET and its correlation with 124I-PET-monitored recruitment of MSCs genetically engineered to express NIS under control of a synthetic hypoxia-inducible promoter (HIF-NIS-MSC).
Subcutaneous GBM xenograft mouse models were established by implantation of patient-derived GBM cells. Areas of hypoxia were characterized in vivo by 18F-FMISO-PET and correlated with ex vivo pimonidazole staining. HIF-NIS-MSCs were labelled with CMFDA and injected i.v., wild-type-MSC or NIS-specific inhibitor perchlorate served as controls. Coregistration of 18F-FMISO-PET imaging with 124I-PET imaging 48 h after HIF-NIS-MSC injection demonstrated significant induction of NIS-mediated 124I-accumulation in hypoxic areas showing effective MSC recruitment into these sites. This was confirmed by fluorescence microscopy as well as ex vivo NIS immunostaining and 124I-autoradiography.
In conclusion, we have shown the potential to therapeutically target the critical areas of hypoxia in GBM by MSC-based NIS gene delivery under the control of a hypoxia-responsive promoter guided by PET-based imaging of hypoxic regions.
Poster 0200
Disorders of Thyroid Function, Clinical, Poster
Risk of Mortality Associated with Anti-thyroid Drugs, Radioactive Iodine, and Surgery for Hyperthyroidism: A Systematic Review and Network Meta-analysis
Brianna Spiegel*1, Carol Chiung-Hui Peng2,3,4, Peter Pin-Sung Liu5,6, David Flynn7, Cheng Han2,8, Xin-Ning Ng9,4, Ching-Hui Loh3,5, Huei-Kai Huang4,10,11, Elizabeth Pearce2, 1Boston University Chobanian and Avedisian School of Medicine, USA, 2Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University Chobanian and Avedisian School of Medicine, USA, 3Diabetes Technology Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan, 4School of Medicine, Tzu Chi University, Taiwan, 5Center for Healthy Longevity, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan, 6Institute of Medical Sciences, Tzu Chi University, Taiwan, 7Department of Medical Sciences & Education, Boston University Chobanian and Avedisian School of Medicine, USA, 8Department of Clinical Nutrition and Metabolism, Affiliated Zhongshan Hospital of Dalian University, China, 9Division of Endocrinology and Metabolism, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan, 10Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan, 11Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan
Poster 0201
Iodine Uptake and Metabolism, Translational, Poster
Transcriptional Reprogramming Using a New Dual NIS Agonist Enhances Radioiodide Uptake and Facilitates Greater Predictive Utility for Thyroid Cancer Recurrence
Martin Read*1, Katie Brookes1, Ling Zha1, Jana Kim2, Jessica Fear1, Sarinya Wongsanit1, Benjamin Small3,4, Hannah Nieto1, Vinodh Kannappan3,4, Weiguang Wang3,4, Sissy Jhiang5, Matthew Ringel5, Moray Campbell6, Kavitha Sunassee2, Philip Blower2, Kristien Boelaert7, Vicki Smith1, Christopher McCabe1, 1Metabolism and Systems Science (MSS), and Centre of Endocrinology, Diabetes and Metabolism (CEDAM), University of Birmingham, United Kingdom, 2School of Biomedical Engineering & Imaging Sciences, King’s College London, United Kingdom, 3Research Institute in Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, United Kingdom, 4Disulfican Ltd, University of Wolverhampton Science Park, United Kingdom, 5Division of Endocrinology, Diabetes, and Metabolism and Cancer Biology Program, The Ohio State University College of Medicine and Comprehensive Cancer Center, USA, 6Division of Cancer Biology, Cedars Sinai Cancer, USA, 7Institute of Applied Health Research, University of Birmingham, United Kingdom
Poster 0202
Thyroid Cancer, Basic, Poster
Thyroid Cancer is Associated with Sex-Specific Spatial Molecular Immune Responses
Leila Shobab*1, Matthew McCoyy2, Jennifer Simpson3, Serenity Budd4, Hui Zheng1, Sonam Kumari3, Jennifer Rosen1, Wen Lee5, Brent Harris6, Ruzong Fan7, Leonard Wartofsky5, Joanna Klubo-Gwiezdzinska3, Jason Brenchley3, Kenneth Burman5, 1Georgetown University/MedStar Washington Hospital Center, USA, 2Georgetown Innovation Center for Biomedical Informatics, USA, 3National Institutes of Health, USA, 4MedStar Research Institutes, USA, 5MedStar Washington Hospital Center, USA, 6MedStar Georgetown University Hospital, USA, 7Georgetown University Hospital, USA
Poster 0203
Thyroid Cancer, Basic, Poster
The crosstalk between SPP1+ macrophages and FAP+ fibroblasts participating in the sensitivity of post-radiotherapeutic immunotherapy for anaplastic thyroid cancer
Pei-Heng Li*, Xiangyu Kong, Hancong Li, Yue Zhao, Qiang Miao, Gongshuang Zhang, Liting You, Juan Zhou, Han Luo,West China Hospital, Sichuan University, China
Poster 0204
Thyroid Cancer, Basic, Poster
Breaking Resistance to Immune Checkpoint Inhibitor Therapy in Papillary Thyroid Cancer
Jaden Nguyen*1, Jarod Olay1, Aime Franco2, Melissa Lechner1, 1UCLA Geffen School of Medicine, USA, 2Perelman School of Medicine at the University of Pennsylvania, USA
Poster 0205
Thyroid Cancer, Basic, Poster
Exposure to Bisphenol A Promotes the Proliferation and Tumourigenesis of Papillary Thyroid Carcinoma by producing ROS and Activating NOX4/MAPK and NOX4/PI3K/AKT Axises
Yi Wang, Xinpei Wang, Qianqian Wang, Likun Zhang, Yiwei Zhao, Zhiyan Liu*, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China
Poster 0206
Thyroid Cancer, Basic, Poster
Low Bisphenol A doses produce diverse pleiotropic effects on anaplastic-derived thyroid cells and control follicular epithelial thyroid cells
Elisangela Teixeira, Larissa Rabi, Karina Peres, Natassia Bufalo, Laura Ward*, University of Campinas (UNICAMP), Brazil
Bisphenol A (BPA), a ubiquitous synthetic endocrine-disrupting chemical, may increase susceptibility to thyroid cancer. However, little is known about the effects of BPA on thyroid cells, particularly malignant cells. Our aim was to evaluate the effects of low doses (0.1–1.0 µg/ml) on the TP53-mutated cell line derived from anaplastic thyroid carcinoma (8505-C) and on the normal thyroid follicular epithelial cell line (Nthy-ori-3-1). Different concentrations, including the Specific Migration Limit (SML) = 1.0 µg/ml (the maximum allowed amount of a substance in food), were tested in technical and biological triplicates after 24h, 48h, and 72h of exposure. The Trypan Blue assay, which assesses cell membrane integrity, and the CCK-8 assay, based on metabolic activity, were used to analyze cell viability. Apoptosis rates were cytologically determined using Hoechst 33342 and propidium iodide double staining. The BRDU assay was used to determine cell proliferation rates. Migration and invasion analyses were performed using a wound healing assay in monoculture. BPA produced non-monotonic cytotoxic effects in both thyroid cell lines. However, while an SML dose of 1.0 µg/ml decreased Nthy-ori-3-1 viability by 50% at the 24h and 48h time points, the same concentration reduced the viability of 8505-C cells by 80% after 48h of exposure. The CCK-8 assay confirmed the sensitivity of 8505-C to BPA, with only 33% and 39% of viable cells remaining after 24h and 48h of exposure to 1.0 µg/ml, respectively. The rate of apoptotic cell death was more pronounced in 8505-C cells than in control cells at all tested BPA concentrations. Surprisingly, BPA promoted the proliferation of 8505-C cells. Doses of 0.8 µg/ml and 0.1 µg/ml produced increases in absorbance of 143% and 113%, respectively, at 24h; 1.0 µg/ml produced an increase of 151% after 48h. The SML dose of BPA increased the wound healing rates of Nthy-ori-3-1 (62%) and 8505-C (33%) after 48h. This increase persisted in 8505-C cells after 72h but disappeared in Nthy-ori-3-1 cells. We suggest that the pleiotropic effects of low-dose BPA exposure, especially in mutated cells, may be related to the incidence and clinical characteristics of thyroid cancer, contributing to the selection of more harmful cells.
Poster 0207
Thyroid Cancer, Basic, Poster
GPT-4 Accuracy and Completeness of American Thyroid Association Guidelines for Management of Thyroid Cancer
Hannah Luk*1, Nishat Momin2, Kassandra Corona1, Brian McKinnon2, Sepehr Shabani2, 1John Sealy School of Medicine, University of Texas Medical Branch, USA, 2Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, USA
Poster 0208
Thyroid Cancer, Basic, Poster
Proto-oncogene regulation of thyroid cancer cell motility through altered focal adhesions
Selvambigai Manivannan*, Merve Kocbiyik, Davina Banga, Hannah Nieto, Steve Thomas, Martin Read, Chris McCabe, Vicki Smith,University of Birmingham, United Kingdom
Poster 0209
Thyroid Cancer, Basic, Poster
Site-Specific HRAS Q61R Activation Promotes Cell Proliferation via Activation of the PI3kinase/AKT/mTOR Pathway and TP53 Inactivation in Medullary Thyroid Cancer
Andrea Ruiz- Jurado, Montserrat Olaya Herrera, Joseph Kidd, Theresa Guise, Marie-Claude Hofmann, Mimi HU, Rozita Bagheri-Yarmand*,The University of Texas MD Anderson Cancer Center, USA
Poster 0210
Thyroid Cancer, Basic, Poster
Metabolic Reprogramming Contributes to Resistance Towards Lenvatinib in Thyroid Cancer
Sonam Kumari*, Shilpa Thakur, Stephanie Cardenas, Andrew Makarewicz, Joanna Klubo-Gwiezdzinska, National Institutes of Health, USA
Poster 0211
Thyroid Cancer, Basic, Poster
Differential activity of specific inhibitors of transcription regulating cyclin-dependent kinases in thyroid cancer cells
Tilak Khanal*, Neel Rajan, Amy Adik, Anisley Valenciaga, Akanksha Nigam, Sandya Liyanarachchi, Matthew Ringel, The Ohio State University, USA
Poster 0212
Thyroid Cancer, Translational, Poster
Unique Molecular Landscape of Thyroid Cancer in African Americans: A Cross-Institutional Large-Cohort Genomic Analysis
Matthew Loberg*1, Mozibur Rahman1, Tina O’Grady2, Ellen Jaeger2, Melissa Stoppler2, Fei Ye1, Vivian Weiss1, 1Vanderbilt University Medical Center, USA, 2Tempus, USA
Poster 0213
Thyroid Cancer, Translational, Poster
Role of the ETV5/p38 Signaling Axis in BRAF-Mutated Anaplastic Thyroid Cancers
Jerry Houl1, Rozita Bagheri-Yarmand1, Paola Miranda-Mendez1, Nikhil Chari2, Ying Henderson2, Jennifer Wang2, Sarah Hamidi1, Anastasios Maniakas2, Priyanka Iyer1, Stephen Lai2, Maria Cabanillas1, Naifa Busaidy1, Ramona Dadu1, Mark Zafereo2, Marie-Claude Hofmann*1, 1Department of Endocrine Neoplasia and Hormonal Disorders, UT MD Anderson Cancer Center, USA, 2Department of Head and Neck Surgery, UT MD Anderson Cancer Center, USA
Funded by the Petrick/MDA Anaplastic Thyroid Cancer Funds and DOD #HT9425-23-1-0675.
Poster 0214
Thyroid Cancer, Translational, Poster
Targeting the MAPK and DNA Repair Pathways in Poorly Differentiated and Anaplastic Thyroid Cancer Cells
Jerry Houl1, Paola Miranda-Mendez1, Jennifer Wang2, Sarah Hamidi1, Anastasios Maniakas2, Priyanka Iyer1, Stephen Lai2, Maria Cabanillas1, Naifa Busaidy1, Ramona Dadu1, Mark Zafereo2, Marie-Claude Hofmann*1, 1Department of Endocrine Neoplasia and Hormonal Disorders UT MD Anderson Cancer Center, USA, 2Department of Head and Neck Surgery, UT MD Anderson Cancer Center, USA
Funded by the Petrick/MDA Anaplastic Thyroid Cancer Funds.
Poster 0215
Thyroid Cancer, Translational, Poster
Association Between Polygenic Risk Score and Clinical Outcomes in Papillary Thyroid Cancer
Sophie Li*1,2, Guibin Zheng1, Li Xu1, Maitrayee Goswami1, Mark Zafereo1, Steven Sherman1, Guojun Li1, Erich Sturgis2, Jennifer Wang1, 1The University of Texas MD Anderson Cancer Center, USA, 2Baylor College of Medicine, USA
Poster 0216
Thyroid Cancer, Translational, Poster
Metabolomic Profiling of Paraffin-Embedded Thyroid Tumors Identifies Hallmarks of Cancer Progression
Athanasios Bikas*1, Anirudh Chellappa2, Theodora Pappa1, Kristine Wong1, Justine Barletta1, Erik Alexander1, Ed Reznik2, Iñigo Landa1, 1Brigham and Women's Hospital, USA, 2Memorial Sloan Kettering Cancer Center, USA
Poster 0217
Thyroid Cancer, Translational, Poster
A Novel Approach for the Study of Anaplastic Thyroid Carcinoma via Generation of Patient-Derived Thyroid Tumor Organoids
Stephanie Wong1, Michelle Koh*2, Hua Zhao3, Niels Kokot1, Uttam Sinha1, Dechen Lin3, Albert Han1, 1USC Caruso Department of Otolaryngology-Head and Neck Surgery, USA, 2Keck School of Medicine or USC, USA, 3Center for Craniofacial Molecular Biology, Herman Ostrow School of Dentistry of USC, USA
Poster 0218
Thyroid Cancer, Translational, Poster
Redox State of Serum Albumin Cys34 and Its Influence on Ferroptosis in Differentiated Thyroid Cancer
Minoru Inoue*1,2, Yusuke Iizuka1, Kiyonal Nakamura1, Genki Sato1, Takashi Mizowaki1, 1Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Japan, 2Radiation and Proton Therapy Center, Shizuoka Cancer Center Hospital, Japan
Poster 0219
Thyroid Cancer, Translational, Poster
Exposomic Analysis of Thyroid Cancer: Correlating histopathological characteristics with persistent environmental organic pollutants
Thomas Szabo Yamashita*, Joshua Preston, Yongliang Lang, Sami Teenny, Zachary Jarrell, Susan Safley, Jennifer Robertson, Anee Jackson, Adil Malek, Snehal Patel, Matthew Smith, Jyotirmay Sharma, Collin Weber, Dean Jones, Neila Saunders, Emory, USA
Poster 0220
Thyroid Cancer, Translational, Poster
Routine Mutation Analysis Reveals Germline and Somatic Variants Associated with Altered Risk: Results in 265 Thyroid Cancers
Benjamin Greenspun*1, Zachary Whaley2, Teagan Marshall2, Abhinay Tumati2, Theresa Scognamiglio2, Rasa Zarnegar2, Brendan Finnerty2, Thomas Fahey III2, 1Weill Cornell Medicine, USA, 2Weill Cornell Medicine, USA
Poster 0221
Thyroid Cancer, Translational, Poster
Tumor Cell Origin of Anaplastic Thyroid Cancer Squamous Subtype and Novel Targeted Therapy Options Revealed by Patient-derived Xenografting
Mikael Nilsson*1, Elin Schoultz1, Jakob Dahlberg2, Andreas Muth2, Erik Elias2, Henrik Fagman3, Lisa Nilsson2, Jonas Nilsson2, Volkan Sayin2, 1Sahlgrenska Center for Cancer Research and Department of Medical Chemistry and Cell Biology, Institute of Biomedicine, University of Gothenburg, Sweden, 2Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Sweden, 3Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg, Sweden
Only one out of eight engrafed advanced-stage TC (3 PTC, 2 FTC, 1 PDTC, 2 ATC) was successfully established and propagated as PDX. The primary tumor was an invasive TSCC (T3N1bM0) with no signs of differentiated TC. Driver mutations comprised PIK3CA, CDKN2A and NFE2L2. PDX recapitulated the tumor phenotype. Combined treatment with cabozantinib and GDC-0326, a PI3K inhibitor, significantly reduced PDX growth whereas single drugs were inefficient. Remarkably, monotherapy with glutaminase inhibitor CB-839 (telaglenastat) had the best therapeutic effect of all drugs. CB-839 suppressed NQO1 and CDH2/N-cadherin overexpression in SCC tumor cells.
Poster 0222
Thyroid Cancer, Translational, Poster
EpCAM Signaling Regulates Tumor Progression, Metastasis, and Stemness in Anaplastic Thyroid Cancer
Chi-Chiu Lee1, Yi-Jen Su1, Sushree Panda1, Chiung-Yi Chiu2, Chung-Hsuan Wu2, Pi-Chun Li2, Yen-Lin Huang3, Ruey-Long Hong3, Shao-Hsi Hung4, Ying Henderson4, Cassian Yee4, Stephen Lai*4, Han-Chung Wu1, 1Academia Sinica, Taiwan, 2AcadeMab Biomedical Inc, Taiwan, 3National Taiwan University Cancer Center, Taiwan, 4The University of Texas MD Anderson Cancer Center, USA
Poster 0223
Thyroid Cancer, Translational, Poster
Transcriptome analysis of FNA to identify candidate genes related to prognosis of papillary thyroid microcarcinoma
Luying Gao*, Yu Xia, Yuxin Jiang, Xiaoyi Li, Yuang An, Peking union medical college hospital, China
Poster 0224
Thyroid Cancer, Translational, Poster
Thyroid Cancer: Role of Neutrophil Extracellular Traps and Neutrophil-Related Mediators
Francesca Ragusa1, Luca Modestino2,3,4, Leonardo Cristinziano2,3,4, Remo Poto2,3,4, Annagioia Ventrici2,3,4, Marialuisa Trocchia2,3,4, Silvia Martina Ferrari5, Giusy Elia1, Poupak Fallahi6, Gianni Marone2,3,4,7, Alessandro Antonelli*1, Gilda Varricchi2,3,4,7, Maria Rosaria Galdiero2,3,4 , 1University of Pisa, Department of Surgical, Medical and Molecular Pathology and Critical Area, Italy, 2University of Naples Federico II, Department of Translational Medical Sciences (DiSMeT), Italy, 3University of Naples Federico II, Center for Basic and Clinical Immunology Research (CISI), Italy, 4University of Naples, Federico II, World Allergy Organization Center of Excellence, Italy, 5University of Pisa, Department of Clinical and Experimental Medicine, Italy, 6University of Pisa, Department of Translational Research & New Technologies in Medicine and Surgery, Italy, 7Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Italy
The serum levels of all subjects have been investigated for: free DNA (dsDNA), nucleosomes, citrullinated histone H3 (CitH3), and MPO-DNA complexes (NETs indicators), and MPO, PTX3, MMP-9 and granulocyte-monocyte colony-stimulating factor (GM-CSF) (as neutrophil-related mediators).
Poster 0225
Thyroid Cancer, Translational, Poster
Role of cGAS-STING pathway in anaplastic thyroid cancer progression
Xuguang Zhu*, Manju Acharya, Sheue-yann Cheng, CCR/NCI/NIH, USA
Poster 0226
Thyroid Cancer, Translational, Poster
Novel Approach for Study of Thyroid Carcinogenesis via BRAFV600E Transduction of Patient-Derived Normal Thyroid Organoids
Michelle Koh*1, Hua Zhao2, Stephanie Wong3, Daniel Kwon3, Niels Kokot3, Uttam Sinha3, Dechen Lin2, Albert Han3, 1Keck School of Medicine of USC, USA, 2Center for Craniofacial Molecular Biology, Herman Ostrow School of Dentistry of USC, USA, 3USC Caruso Department of Otolaryngology-Head and Neck Surgery, USA
BRAF V600E is the predominant genetic mutation implicated in thyroid carcinomas. However, more than 50% patients do not respond to BRAF/MEK inhibition. Furthermore, a comprehensive understanding of the pathways involved in BRAF-driven tumorigenesis has not yet been characterized that would allow for effective alternatives for treatment. Three-dimensional culture systems, also known as organoid models, recapitulate tissue heterogeneity. We hypothesized that patient-derived thyroid organoids can be an effective platform for studying early events in thyroid carcinogenesis. We report a proof-of-concept protocol as a novel approach to model thyroid carcinogenesis through BRAFV600E transduction of patient-derived thyroid organoids.
Three normal thyroid specimens were collected from adult patients undergoing thyroidectomy for papillary thyroid cancer (mean age = 32.3, range 22.9 – 48.2). The surgical specimens underwent mechanical and enzymatic dissociation. We compared the growth of the thyroid organoids in Wnt 3a, Wnt surrogate, and CHIR99021 in addition to other growth factors mentioned in the previous literature. Our results show that the thyroid organoids faithfully express TTF-1 and other related markers of thyroid differentiation. These organoids have been observed to be capable of being passaged at least 4 times and grown in culture for at least 3 months. To induce tumorigenesis, we performed lentiviral transduction of the BRAFV600E mutation. BRAF-induced thyroid organoids show an increased rate of growth and viability compared to control. The hyperproliferation and abnormal morphology in these organoids are suggestive of follicular thyroid neoplasm.
Our platform provides a novel framework to study early events in papillary thyroid carcinogenesis related to BRAF mutation. We will report the single-cell transcriptomic analyses and metabolomic analyses to determine the key metabolic pathways involved in tumorigenesis. Ultimately, we hope to leverage the unique advantages provided by our organoid platform to identify therapeutic targets and perform drug screening, which is critical for discovering novel targets for BRAF inhibition-resistant thyroid cancers.
Poster 0227
Thyroid Cancer, Translational, Poster
Cabozantinib in Primary Human Cell Cultures from Anaplastic Thyroid Carcinoma
Giusy Elia1, Silvia Martina Ferrari2, Francesca Ragusa1, Eugenia Balestri1, Chiara Botrini1, Licia Rugani1, Valeria Mazzi1, Poupak Fallahi3, Alessandro Antonelli*1, 1University of Pisa, Department of Surgical, Medical and Molecular Pathology and Critical Area, Italy, 2University of Pisa, Department of Clinical and Experimental Medicine, Italy, 3University of Pisa, Department of Translational Research and of New Technologies in Medicine and Surgery, Italy
We aimed to test the antineoplastic effect of the multikinase inhibitor cabozantinib, that acts against tyrosine kinase receptors involved in growth, angiogenesis and metastatic progression of tumour. Cabozantinb was recently approved for the treatment of adult patients with locally advanced or metastatic differentiated thyroid carcinoma, not eligible or refractory to radioactive iodine who have progressed during or after prior systemic therapy.
Friday, November 1, 2024
Poster 0228
Surgery, Basic, Poster
OCCULT LYMPH NODE MICROMETASTASES AND RELATED FACTORS IN PATIENTS WITH cT1aN0M0 PAPILLARY THYROID CARCINOMA UNDERWENT TOETVA PROCEDURE: FROM GUIDELINES TO CLINICAL PRACTICE
Hien Nguyen*1,2, Hau Nguyen1,2, Duong Pham1, Tan Nguyen1, Quang Le1,2, 1Hanoi Medical University, Vietnam, 2Hanoi Medical University Hospital, Vietnam
Poster 0229
Surgery, Case Study, Poster
Primary Thyroid Epithelioid Angiosarcoma of Non-Alpine Origin: A Case Report
Emery Boudreau*1, Darcy Kerr1, Theodora Pappa2, Thierry Alcindor3, Meredith Sorensen1, 1Dartmouth Hitchcock Medical Center, USA, 2Brigham and Women's Hospital, USA, 3Brigham and Women's, USA
She underwent a total thyroidectomy; a 6cm nodule occupied the left thyroid lobe with rightward tracheal shift and no extrathyroidal extension. Final pathology resulted as epithelioid angiosarcoma with negative margins. An ARID1A nonsense mutation was found on genetic testing. By analogy with other high-grade sarcomas, adjuvant radiotherapy was recommended by a multidisciplinary tumor board for a potential cure of her locally advanced malignancy. The patient ultimately chose to continue with surveillance only, with no evidence of recurrence on most recent imaging.
Poster 0230
Surgery, Clinical, Poster
Impact of the COVID-19 Pandemic on Thyroid Surgery for Medicare Beneficiaries
Anthony Saxton*, Alberto Monreal, Hadiza Kazaure, Randall Scheri, Duke University, USA
During the first year of the COVID-19 pandemic in the United States in 2020, Medicare claims for thyroid surgeries decreased by -18.8% (22,866 cases), with a -20.5% decrease in utilization rate to 3.64. In the subsequent two years, case volumes remained stagnant with 22,958 cases in 2022 and a utilization rate of 3.53. Procedures with the largest annual decline from 2019 to 2022 included unilateral lobectomy with contralateral subtotal lobectomy (-15.3%), total thyroidectomy (-9.4%), and thyroidectomy with radial neck dissection (-7.4%).
Between 2020-22, an estimated 7,150 thyroid surgery case deficit was incurred for Medicare beneficiaries, leading to $5,906,109 in decreased Medicare provider revenues (p <0.001). Case volumes have not yet caught up to expected demand, with 96% of expected cases for Medicare beneficiaries performed in 2022.
Poster 0231
Surgery, Clinical, Poster
The Role of Pre-Operative Vitamin D Levels on Post-Operative Symptomatic Hypocalcemia in Patients with Hyperthyroidism
Chad Griesbach*1, Jhon Martinez-Paredes1, Kristina Nikolova1, Ginger Coleman2, Sahi Puvvala3, Stacey Milan1,3, 1Baylor Scott & White Medical Center, USA, 2South Texas VA Medical Center, USA, 3Baylor College of Medicine, USA
Poster 0232
Surgery, Clinical, Poster
Comparative Efficacy, Safety, and Oncological Outcomes of Percutaneous Thermal and Chemical Ablation Modalities for Recurrent Metastatic Cervical Lymphadenopathy in Thyroid Cancer
Hassan Malik*1, Humza Pirzadah1, Eman Toraih2, Emad Kandil3, 1Louisiana State University Health Sciences Center, USA, 2Tulane University School of Medicine, USA, 3Tulane University, USA
Poster 0233
Surgery, Clinical, Poster
Implementation of Scarless Robotic Thyroid Surgery in the United States: The Initial 10-year Experience
Hyunsuk Suh*, Hospital for Endocrine Surgery, USA
Poster 0234
Surgery, Clinical, Poster
Limited Thyroidectomy Achieves Equivalent Survival to Total Thyroidectomy for Localized T1 Medullary Thyroid Cancer
Jessan Jishu*, Mohammad Hussein, Salmanfaizee Sadakkadulla, Solomon Baah, Yaser Bashumeel, Eman Toraih, Emad Kandil,Tulane University School of Medicine, USA
The optimal surgical approach for localized T1 medullary thyroid cancer remains unclear. Total thyroidectomy is standard, but limited thyroidectomy may minimize morbidity while maintaining oncologic control. This retrospective analysis utilized the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry to identify 2,702 MTC patients including 398 patients with T1N0/1M0 MTC treated with total thyroidectomy or lobectomy/subtotal thyroidectomy from 2010-2019. Cox regression analyses assessed thyroid cancer-specific and overall mortality. The majority (89.7%) underwent total thyroidectomy, while 10.3% had lobectomy/subtotal thyroidectomy. Nodal metastases were present in 29.6%. Over a median follow-up of 8.75 years, no significant difference was observed in cancer-specific mortality (5.7% vs 8.1%, p=0.47) or overall mortality (13.2% vs 12.8%, p=0.95). On multivariate analysis, undergoing cancer-directed surgery was associated with significantly improved overall survival (HR 0.18, p<0.001) and cancer-specific survival (HR 0.17, p<0.001) compared to no surgery. However, no significant survival difference was seen between total thyroidectomy and lobectomy/subtotal thyroidectomy for overall mortality (HR 0.77, p=0.60) or cancer-specific mortality (HR 0.44, p=0.23). Extent of surgery also did not impact outcomes within subgroups stratified by age, gender, T stage, or nodal status. Delayed surgery >1 month after diagnosis was associated with worse overall survival (p=0.012). For localized T1 MTC, lobectomy/subtotal thyroidectomy appears to achieve comparable long-term survival to total thyroidectomy in this population-based analysis. Delayed surgery is associated with worse survival and additional neck dissection showed no benefit for this select group of patients. Selective use of limited thyroidectomy may allow avoidance of morbidity from total thyroidectomy while maintaining oncologic efficacy. A personalized approach weighing potential risks and benefits of lobectomy versus total thyroidectomy is warranted.
Poster 0235
Surgery, Clinical,
Evaluation of two different treatment strategies of inferior parathyroid gland during central neck dissection of thyroid cancer: active autotransplantation or preservation in situ
Jianbiao Wang*, Lei Xie, Lei Jin, Department of Head and Neck Surgery, Institute of Micro-Invasive Surgery of Zhejiang University, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
Poster 0236
Surgery, Clinical, Poster
The Effect of Perioperative Education of Neck, Oropharyngeal and Laryngeal Rehabilitation Exercises on Quality of Life in Patients Undergoing Thyroidectomy
Jiayong Huang*, Wanna Chen, Jinyao Huang, Weiming Lv, The First Affiliated Hospital of Sun Yat sen University, China
Poster 0237
Surgery, Clinical,
Assessing the Correlation Between 18F-Choline PET/CT and Surgical Outcomes for Parathyroid Adenoma Localization in Primary Hyperparathyroidism Patients with Negative or Inconclusive Conventional Imaging: A Retrospective Study of 70 Cases at a High-Complexity Hospital in Bogotá, Colombia (2023)
Juan Santivañez*, Fundacion santa fe de Bogota, Colombia
Poster 0238
Surgery, Clinical, Poster
Radiofrequency Ablation of Benign Thyroid Nodules: Risk of Progression to Indeterminate or Malignant Cytology
Kavin Sugumar*, Eman Toraih, Mohammad Hussein, Emad Kandil,Department of Surgery, Tulane University School of Medicine, USA
Poster 0239
Poster 0240
Surgery, Clinical, Poster
Gasless Trans-axillary Endoscopic versus Conventional Open Thyroidectomy for Thyroid Cancer patients: a Propensity Score-matched Analysis of Quality of Life, Functions, Cosmetic and Oncological Outcomes
Nan Huang*, Qiaofei Liu, Surong Hua, Yuze Hua, Mengyi Wang, Jiayi Li, Huaijin Zheng, Ge Chen, Quan Liao, Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, and Peking Union Medical College, China
Poster 0241
Surgery, Clinical, Poster
Saving Parathyroids during Trans Oral Endoscopic Thyroidectomy Vestibular Approach – TOETVA
Narendra Lohokare*, Siddhakala Hospital, India
Poster 0242
Surgery, Clinical, Poster
Extent of Thyroidectomy for Solitary Papillary Thyroid Carcinoma Confined in the Isthmus
Seungho Lee*1, Hye Lim Bae1, Woochul Kim Kim1, Hyeong Won Yu2, Su-jin Kim3, Young Jun Chai4, June Young Choi2, Kyu Eun Lee3, 1Seoul National University Hospital, Korea, Republic of, 2Seoul National University Bundang Hospital and College of Medicine, Korea, Republic of, 3Seoul National University Hospital and College of Medicine, Korea, Republic of, 4Seoul National University Boramae Medical Center and College of Medicine, Korea, Republic of
Poster 0243
Surgery, Clinical, Poster
Chylous Leak after a Modified Radical Neck Dissection for Thyroid Cancer – A Single Institution Experience
Nikola Besic*, Institute of Oncology, Slovenia
Poster 0244
Surgery, Clinical, Poster
Hypocalcemia Post Total Thyroidectomy: A Ten-Year, Single Institution Experience with a PTH-Guided Calcium and Calcitriol Supplementation Protocol
Rockey Dahiya*, Victor Bernet, Ejigayehu Abate, Sarika Rao, Jeffrey Janus, Michael Heckman, Hannah Sledge, John Casler, Ana-Maria Chindris, Mayo Clinic, USA
Poster 0245
Surgery, Clinical,
Bilateral Superficial cervical plexus block for conduct of thyroidectomy and parathyroidectomy surgeries: A prospective randomised clinical study
Ashutosh Chaurasia, Ashish Kannaujia, Rudrashish Haldar*,SGPGIMS, India
Poster 0246
Surgery, Clinical, Poster
NON RECURRENT LARYNGEAL NERVE – A SERIES OF 9 CASES IN OUR TERTIARY CENTER
Sunil Unnithan*, Kerala ENT Research Foundation, India
Recurrent laryngeal nerve (RLN) is a branch of the vagus, that recurs around the subclavian artery on the right and the arch of aorta on the left. It innervates all the laryngeal muscles except the cricothyroid. Nonrecurrent laryngeal nerve (NRLN) is a rare entity with a reported incidence of 0.3–0.8% on the right side and 0.004% on the left side. It was first reported by Steadman in 1823. It’s intraoperative diagnosis is a challenge and hence we present a series of 9 cases of NRLN in our tertiary center.
Our center has done over 1500 total thyroidectomy cases over last 10 years (2012-2012). Non Recurrent Laryngeal nerve was identified in 9 out of 1500 cases, 0.6% incidence. Of the 9 cases, 8 were females. All the above cases had NRLN on the right with four being Type 2b and three Type 2a (Avisse’s types of NRLN). All the above patients underwent doppler study post-op but none had any vascular anomaly. All were intraoperative diagnoses and had uneventful post operative period.
Poster 0247
Surgery, Clinical, Poster
Enhanced Parathyroid Identification in Endoscopic Thyroidectomy: A Comparative Analysis of AI Models Across Different Surgical Approaches
Chenyi Wang*1,2, Jian Cao1, Xiaodong Yang1, Kewei Jiang1, Shan Wang1, 1Peking University People's hospital, China, 2Stanford University, USA
Poster 0248
Thyroid Cancer, Basic, Poster
Identification and Validation of a Necroptosis-related Prognostic Signature in Thyroid Cancer via Single-Cell Sequencing
Chenyi Wang*1,2, Kewei Jiang3, Shan Wang3, 1Peking University People's Hospital Peking University People's Hospital, China, 2Stanford University, USA, 3Peking University People's Hospital, China
Poster 0249
Surgery, Clinical, Poster
Uncontrolled Hyperthyroidism During Total Thyroidectomy: A Systematic Review and Meta-analysis
Eddy Lincango*1, Luis Figueroa2, Cristina Arias3, Domenica Herrera Hernandez4, Emily Rivadeneira5, Francisco Rivadeneira Proano5, Pedro Torres5, Domenica Brito5, Bryan Vallejo6, Luis Serrano1, Adela Casas-Melley1, Dustin Huynh1, Julie Sosa7, Benzon Dy8, Minerva Romero9, Sophie Dream10, Carmen Solorzano11, Juan Brito6, 1Department of Surgery, University of Central Florida/HCA Healthcare, USA, 2CaTaLiNA Research: Cancer de tiroides en Latinoamerica, Ecuador, 3Medical school, Universidad del Azuay, Ecuador, 4Medical school, Universidad Católica del Ecuador, Ecuador, 5Medical school, Universidad Central del Ecuador, Ecuador, 6Knowledge and Evaluation Research Unit, Mayo Clinic, USA, 7Department of Surgery, University of California San Francisco (UCSF), USA, 8Department of Surgery, Mayo Clinic, USA, 9Department of Surgery, Weill Cornell Medicine New York Presbyterian Brooklyn Methodist Hospital, USA, 10Surgical Oncology, Department of Surgery, Medical College of Wisconsin, USA, 11Department of Surgery, Vanderbilt University Medical Center, USA
There was one case of thyroid storm after surgery but no mortalities. No significant differences emerged in any postoperative complications including, temporary hypocalcemia (OR:0.50, 95%CI:0.20 - 1.29, I2: 42.7%, n=521), permanent hypocalcemia (OR:0.46, 95%CI:0.11 - 1.96, I2: 0.0%, n=727), temporary hoarseness (OR: 1.46, 95%CI: 0.59 - 3.64, I2:0.0%, n=541) permanent hoarseness (OR:0.74, 95%CI: 0.13-4.34, I2:0.0%, n=727), hematoma risks (OR:0.27, 95%CI: 0.06-1.28, I2:0.0%, n=541), length of stay (MD:-0.0, 95%CI: -0.2-0.2, n=379), and operative time (MD: -5.6, 95%CI:-15.4 - 4.3, n=674). The risk of bias was moderate in six studies and high in two.
Poster 0250
Thyroid Cancer, Clinical, Poster
Quality of Life in Patients with Differentiated Thyroid Cancer Undergoing Total Thyroidectomy in Ecuador
Eddy Lincango*, Martin Lescano Ruiz, Wladimir Lescano Silva, Ana Ortiz Burbano, Juan Iglesias, Jorge Salazar, CaTaLiNA Research: Cancer de tiroides en Latinoamerica, Ecuador
Poster 0251
Surgery, Clinical, Poster
Pectoral Nerve II Block after Robot-Assisted Transaxillary Thyroidectomy: A Prospective, Randomized Controlled Trial
JA SUNG BAE*, Kwangsoon Kim, The Catholic University of Korea, Seoul St. Mary's Hospital, Korea, Republic of
Poster 0252
Thyroid Cancer, Clinical, Poster
Redefining T3b (Strap Muscle Invasion): Tumor Size as a Key Factor in Differentiated Thyroid Carcinoma Prognosis
JA SUNG BAE*, Joonseon Park, The Catholic University of Korea, Seoul St. Mary's Hospital, Republic of Korea
Poster 0253
Thyroid Nodules and Goiter, Case Study, Poster
Resolution of Sleep Apnea After Radiofrequency Ablation of Goiter: A Case Report
Kamran Ali1,2, Daniel Ma*2, Lindsay McCullough2,3, James Herdegen2,3, Sean Wrenn1,2, 1Rush University Medical Center, Department of Surgery, USA, 2Rush Medical College of Rush University, USA, 3Rush University Medical Center, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, USA
Poster 0254
Thyroid Nodules and Goiter, Case Study, Poster
Follicular Epithelial Dysplasia with RET/PTC1 Rearrangement in Hashimoto’s Thyroiditis
Kristina Kuklova*, Tarunya Vedere, Faripour Forouhar, Giao Phan,UConn Health, USA
Poster 0255
Thyroid Nodules and Goiter, Case Study, Poster
Thyroid Nodule Hematoma Following Fine Needle Aspiration in a Thrombocytopenic Patient Causing Respiratory Distress and Thyrotoxicosis: A Cautionary Tale
Soumya Kurnool*, Jessica Hansen, Niharika Vennelaganti, Charles Choe, Karen McCowen,University of California, San Diego, USA
In conclusion, transfusion-dependent patients may warrant a higher minimum platelet count of 50,000/mm3 prior to thyroid FNA to reduce bleeding risk.
Poster 0256
Thyroid Nodules and Goiter, Case Study, Poster
Posterior substernal goiter as a rare cause of pleural effusion
Sualeha Khalid*, Emily Japp, University of Maryland School of Medicine, USA
Substernal goiters typically follow the path of least resistance and preferentially extend into the anterior mediastinum; only 10-15% extend into the posterior mediastinum. We present a rare case of a posterior mediastinal goiter causing pleural effusion.
A 73-year-old female was referred to the emergency department by her pulmonologist after she was found to have recurrent pleural effusion and increased dyspnea. She had a history of multinodular goiter with mediastinal extension and subclinical hyperthyroidism, for which she took methimazole 5 mg daily. Her goiter had been slowly growing since 1990, however she remained asymptomatic for about 30 years. Prior evaluation included radioactive iodine uptake scans showing increased metabolic activity in the right thyroid extending into the chest, and a cold nodule in the left inferior pole with subsequent negative fine needle aspiration. On physical exam, both cervical thyromegaly, and Pemberton’s sign were negative. Laboratory evaluation showed low free T4 of 0.66 (0.9-1.7 ng/dL) and normal TSH 1.14 (0.27-4.2 mcIU/mL). CT scan revealed substernal extension of a lobulated, partially calcified left lobe of the thyroid measuring 3.5 x 4 cm, and intrathoracic extension of a heterogenous and calcified right lobe measuring 11 x 10 x 14 cm, with distortion of the right hilum, atelectasis of the right lung and large right pleural effusion. Subsequent PET scan confirmed inferior right thyroid gland extending into chest and displacing lung parenchyma however did not demonstrate significantly increased metabolic activity. Thoracentesis removed 1.5 liters of transudative fluid with cytology negative for malignancy. Patient is planned for future surgical resection via thoracotomy with possible sternotomy, and total thyroidectomy, since radioactive iodine would not significantly reduce the volume of substernal goiter.
Differential diagnosis of posterior mediastinal mass is broad and includes conditions such as neurogenic tumors, non-neurogenic tumors like lymphoma and sarcoma, and vascular conditions like aortic aneurysm. Posterior mediastinal goiter can be differentiated from other mediastinal masses with radioactive iodine uptake scan (using I-123 vs pertechnetate) and CT imaging. Substernal goiter is an important clinical entity to be aware of and monitor, as it can progress and impinge on vital organs.
Poster 0257
Thyroid Nodules and Goiter, Clinical, Poster
Radiofrequency Ablation as the First-Line treatment for Autonomously functioning thyroid nodules: A Latin American Experience
Juan Dueñas*1, Nathalia Buitrago-Gómez2, Antonio Rahal3, Higinio Steck4, Cristhian García5, Rafael De Cicco6, Leonardo Rangel7, Ana Voogd8, Lorena Savluk9, Erivelto Volpi10, 1Integral Endocrine Surgery Clinic, Colombia, 2Universidad Pontificia Bolivariana, Colombia, 3Hospital Israelita Albert Einstein, Brazil, 4University of Campinas, Brazil, 5Institute of Thyroid and Head and Neck Diseases, Ecuador, 6AC Camargo Cancer Center, Brazil, 7State University of Rio de Janeiro, Brazil, 8Hospital Universitario Austral, Argentina, 9Hospital Italiano, Argentina, 10Oswaldo Cruz German Hospital, Brazil
Poster 0258
Poster 0259
Thyroid Nodules and Goiter, Clinical, Poster
Comparison of Sedation and Non-Sedation Approaches in Patients Undergoing Radiofrequency Ablation for Thyroid Nodules: A Retrospective Cohort Study
Alexandra LaForteza*, Eman Toraih, Mohammad Hussein, Ahmed Abdelmaksoud, Jessan Jishu, Emad Kandil,Tulane University School of Medicine, USA
Poster 0260
Thyroid Nodules and Goiter, Clinical, Poster
Polyamine and Methionine Metabolism Gene Expression Analysis in Thyroid Tumors
Cody Huffman*1, Allan Golding2, David Bimston2, Mohammed Alshalalfa3, Yangyang Hao3, Joshua Klopper3, Richard Kloos3, Ryan Jackson1, Patrik Pipkorn1, Paul Zolkind1, Jason Rich1, Salma Ramadan1, Wade Thorstad1, Douglas Adkins1, Peter Oppelt1, Nikhil Rammohan1, Anthony Apicelli1, Michael Moravan1, Guangyong Peng1, Sidharth Puram1, Sina Jasim1, R. Harbison1, 1Washington University School of Medicine in St. Louis, USA, 2Memorial Healthcare System, USA, 3Veracyte, USA
Poster 0261
Thyroid Nodules and Goiter, Clinical, Poster
External Validation of a Natural Language Processing Enhanced Algorithm to Identify Appropriateness of Thyroid Ultrasound
Gilberto Perez Rodriguez Garcia*1, Andrea Ortiz Rocha1, Aman Pathak1, Ricardo Loor-Torres2, Yonghui Wu1, Juan Brito2, Naykky Singh Ospina1, 1University of Florida, USA, 2Mayo Clinic, USA
The rule-based NLP algorithm, developed at Mayo Clinic and focusing solely on visit diagnoses and reasons for the exam sections, was subsequently deployed in our UF-annotated cohort to categorize the appropriateness of the TUS. Performance metrics were calculated, including Sensitivity, Specificity, Positive Predictive Value (PPV), and Accuracy. We conducted a quality assessment of the potentially misclassified iTUS cases by the NLP algorithm.
Poster 0262
Thyroid Nodules and Goiter, Clinical, Poster
Systematic Assessment of Thyroid Biopsy Appropriateness In Clinical Practice
Saad Habib1, Gilberto Rodriguez Garcia*1, Juan Brito2, Naykky Singh Ospina1, 1University of Florida, USA, 2Mayo Clinic, USA
Following thyroid biopsy appropriateness assessment using ultrasound criteria by ACR-TIRADS, 83% (193/232) were deemed likely appropriate, while 17% (39/232) were classified as likely inappropriate.
Upon incorporating additional factors, the distribution of appropriateness shifted. Among the 39 likely inappropriate biopsies, 1 was classified as extremely inappropriate due to factors associated with limited life expectancy. Additionally, 16 were reclassified as likely appropriate due to clinical factors, leaving 23/232 as likely inappropriate (10%).
A total of 178/232 (77%) were considered likely appropriate based on ultrasound features and clinical factors, while 13% (30/232) were classified as possibly inappropriate as they were deemed appropriate by ultrasound features but occurred in patients with limited life expectancy.
Poster 0263
Thyroid Nodules and Goiter, Clinical, Poster
Distinct Molecular Profiles of Thyroid Nodules in Patients Under 21 Years of Age
Julio Ricarte-Filho*1, J. Iorgulescu2, Luz Castellanos2, Steven Waguespack2, Mohammed Alshalalfa3, Joshua Klopper3, Richard Kloos3, Amie Franco1, 1Children's Hospital of Philadelphia, USA, 2The University of Texas MD Anderson Cancer Center, USA, 3Veracyte, USA
Sequence variants were also enriched in < 21 yrs (44.8% vs 37.0%, p<0.001), notably of DICER1 (10.0% vs 1.5%, p<0.001) including those associated with poorly differentiated thyroid histology (codons 1709/1705/1813; 7.2% vs 0.7%, p<0.001).
Transcriptionally, < 21 yrs TN expressed higher ERK and MYC activity and cell cycle-related pathways (adjusted p<0.05). DGE identified overexpression of genes associated with cell cycle-related gene sets (e.g. KEGG cell cycle, G2-M). Among the subset of thyroid nodules with NTRK, RET, or ALK fusions, < 21 yrs was associated with higher expression of angiogenesis, epithelial-mesenchymal transition, and cell cycle gene sets (adjusted p<0.05).
Poster 0264
Thyroid Nodules and Goiter, Clinical, Poster
Radionuclide Therapy With I-131 In Patients With Autonomously Functioning Thyroid Nodules And Normal FT4 Blood Level
MIODRAG LACIC*, Polyclinic Lacic, Croatia
Poster 0265
Thyroid Nodules and Goiter, Clinical, Poster
Shared decision making for patients with thyroid nodules considering biopsy: a pilot multicenter randomized trial
Naykky Singh Ospina*1, Sandra Algarin Perneth,2, Andrea Ortiz Rocha1, Urja Patel1, Diana Barb1, Gonzalo Acosta1, Ashok Srihari1, Peter Dziegielewski1, M. Regina Castro2, Diana Dean2, John Morris2, Mabel Ryder2, Ian Hargraves2, Carma Bylund1, Victor Montori2, Roy Arkaprava1, Zhongyue Zhang1, Juan Brito2, 1University of Florida, USA, 2Mayo Clinic, USA
In the SDM tool group, the average thyroid nodule knowledge correct response rate was 72% vs 65% in the UC group (p=0.215). Thyroid cancer risk perception was accurate for 70% of participants in the SDM group vs 54% in UC (p=0.101). Furthermore, 60% of SDM participants reported reduced worry about thyroid cancer after the visit, compared to 44% in UC (p=0.179).
Patient involvement in decision-making, assessed via video recordings using the OPTION Scale (1-100 scale, higher levels indicate higher patient involvement), was greater in the SDM group (34) than in UC (27) (p<0.001). Choice awareness, indicating discussion of alternative diagnostic options, occurred in 91% of SDM recordings versus 65% of UC (p=0.008).
Immediate biopsy was chosen by 40% of patients in the SDM group, compared to 51% in UC (p=0.386). Patient satisfaction was high, decisional conflict moderate and clinician satisfaction moderate in both groups. Encounter duration averaged 22 minutes, in both groups.
Poster 0266
Poster 0267
Thyroid Nodules and Goiter, Clinical, Poster
A Scoping Review of Patient Quality of Life Following Molecular testing or Surgery for Individuals with Indeterminate Thyroid Nodules
Raisa Chowdhury*1, Khadija Brouillette1, Kayle Payne2, Veronique-Isabelle Forest3, Richard Payne3, 1McGill University Faculty of Medicine and Health Sciences, Canada, 2McGill University Department of Psychology, Canada, 3McGill University Department of Otolaryngology-Head and Neck Surgery, Canada
Poster 0268
Thyroid Nodules and Goiter, Clinical, Poster
Consensus Radiofrequency Ablation Reporting Guidelines for Thyroid Nodules Using a Delphi Approach
Kendyl Carlisle1, Rebecca Kowalski*1, Q. Hu2, Sophie Dream3, Jonathan Russell4, Steven Hodak5, Yinin Hu1, 1University of Maryland Baltimore, Department of Surgery, USA, 2Beth Israel Deaconess Medical Center, Department of Surgery, USA, 3Medical College of Wisconsin, Department of Surgery, USA, 4Johns Hopkins University, Department of Otolaryngology, USA, 5NYU Langone Health, Department of Medicine, USA
Poster 0269
Thyroid Nodules and Goiter, Clinical, Poster
Trends, risk factors and outcomes of the diagnostic work of patients with thyroid nodules
Sanaa Badour*1, Xingke Liu1, Kylie Harrall1, Yi Guo1, Ramzi Salloum1, Juan Brito Campana2, Dejana Braithwaite1, Naykky Singh Ospina1, 1University of Florida, USA, 2Mayo Clinic, USA
Poster 0270
Thyroid Cancer, Clinical, Poster
Medullary Thyroid Cancer: Clinicopathological Profile of a Cross-Sectional Study at a Single Center, 2000–2024, Imbanaco Clinic, Cali – Colombia
Alin Abreu Lomba*1,2, David Vernaza Trujillo2, Thomas Acosta Perez2, Paola Osorio Escorcia3, Harold Cuello Bueno4, 1Imbanaco Clinic, Colombia, 2Universidad Libre, GIMI1 (Interinstitutional Group of Internal Medicine, Colombia, 3New Clinic of Cali, Colombia, 4Imbanaco clinic, Colombia
Histopathological findings showed amyloid production, calcifications, nodular cell proliferation, and lymphocytic thyroiditis. Immunohistochemical markers, including thyroglobulin (52.4%), calcitonin (95%), chromogranin (90.5%), and synaptophysin (66.7%), were positive in significant portions of patients. The T-student analysis revealed a significant difference in age between patients with tumors larger than 2 cm and those with tumors between 1-2 cm (mean difference: -15.2 years, P < 0.05). No significant difference was observed in the Ki67 proliferation index. The overall mortality rate was 19%, while the survival rate was 71.4%.
Poster 0271
Thyroid Cancer, Clinical, Poster
Outcomes in Thyroid Cancer Patients According to 7th and 8th Edition AJCC/TNM Classifications: A Retrospective Cohort Study in a Single Center. Imbanaco clinic. Cali, Colombia
Alin Abreu Lomba*1,2, Andres Delgado Truque3, Juan Muñoz Acosta1, Rodrigo Cardenas Perilla1, David Vernaza Trujillo4, Paola Osorio Escorcia5, 1Clínica Imbanaco, Colombia, 2Universidad Libre, Colombia, 3Universidad Nacional de Colombia, Colombia, 4Universidad Libre - Grupo Interinstitucional de Medicina Interna, Colombia, 5Clinica Nueva de Cali, Colombia
Poster 0272
Poster 0273
Poster 0274
Thyroid Cancer, Clinical, Poster
Selpercatinib Dose Adjustments and Associated Exposure-Response in Patients with Advanced RET-mutant Medullary Thyroid Cancer
Laura Fugazzola*1, Jaume Capdevila2, Samantha Bowyer3, Fernanda Vaisman4, Patrice Rodien5, Yu Wang6, Kate Newbold7, Jolanta Krajewska8, Matthias Kroiss9, Matthias Weber10, Patrick Peterson11, Patricia Maeda11, Ashish Massey11, Dan Liu11, Ayman Akil12, Marcia Brose13, Mimi Hu14, 1Endocrine Oncology Unit, Istituto Auxologico Italiano IRCCS and Department of Pathophysiology and Transplantation, University of Milan, Italy, 2Medical Oncology Department, Vall Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Spain, 3Medical Oncology Department, Sir Charles Gairdner Hospital, Australia, 4Endocrinologia Oncológica - Instituto Nacional do Cancer, Brazil, 5Service d'Endocrinologie-Diabétologie-Nutrition Centre de référence des maladies rares de la Thyroïde et des récepteurs hormonaux CHU d'Angers, France, 6Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, China, 7Thyroid Unit, The Royal Marsden NHS Foundation Trust, United Kingdom, 8Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska Curie National Research Institute of Oncology, Gliwice Branch, Poland, 9Department of Endocrinology and Diabetology, Ludwig-Maximilians-University of Munich, LMU Hospital Munich, Germany, 10Unit of Endocrinology, 1. Medical Department, University Hospital, Universitätsmedizin Mainz, der Johannes Gutenberg-Universität, Germany, 11Eli Lilly and Company, USA, 12Certara USA, Inc., USA, 13Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, USA, 14Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M. D. Anderson Cancer Center, USA
In the 494 patients included in the ORR exposure-response analysis, the response rate was 74% (364 responders); the probability of response increased with increasing selpercatinib exposure (AUC24) (P<0.05). Exploratory analysis of PFS in 495 patients (145 events) by exposure metrics showed no significant relationship with PFS probability across exposure quartiles.
Poster 0275
Thyroid Cancer, Translational, Poster
A Sensitive Liquid Chromatography Tandem Mass Spectrometry Method (LC-MS/MS) for Plasmatic Lenvatinib Measurement Allows Drug Monitoring in Patients with Thyroid Cancer
Carla Colombo1,2, Roberta Ottria3, Matteo Trevisan1, Sara Casati4, Simone De Leo2, Marica Orioli4, Pierangela Ciuffrida3, Laura Fugazzola*1,2, 1University of Milan, Italy, 2Istituto Auxologico Italiano IRCCS, Italy, 3Department of Biomedical and Clinical Sciences, Italy, 4Department of Biomedica, Surgical, and Dental Sciences, Italy
This preliminary retrospective study aims to evaluate the PK profile of Lenvatinib in a real-life scenario, in order to validate the clinical application of the method.
Lenvatinib was taken by all patients between 8.00 pm and 11.00 pm and the plasma samples were collected the following morning within 9.00 am at multiple time points for each patient, for a total of 51 samples. Samples were collected using sodium heparinized tubes and plasma was stored at -80°C until assay. Detection of Lenvatinib was performed by liquid chromatography-tandem mass spectrometry (LC–MS/MS) using 250 μL of plasma, after analytical validation of the assay.
Poster 0276
Thyroid Cancer, Clinical, Poster
RAF Family Fusions in Thyroid Carcinomas: Clinicopathological Analysis of 16 Patients
Luz Castellanos*, Sarah Hamidi, Naifa Busaidy, Maria Cabanillas, Ramona Dadu, Mimi Hu, Priyanka Iyer, Sinchita Roy-Chowdhuri, Steven Sherman, Gloria Sura, Jennifer Wang, Michelle Williams, J. Bryan Iorgulescu, Steven Waguespack, University of Texas MD Anderson Cancer Center, USA
Median age at diagnosis was 50 years (range 13-86) and 50% were female. PTCs presented with stage I (n=4) or II (n=7) disease. ATCs presented with stage IVB (n=1) or IVC (n=1). All primary tumors were surgically resected. At initial resection of cervical lymph nodes, pN status was: 1/11 N0, 2/11 N1a, and 8/11 N1b. Distant metastases developed in 9/14 PTCs and 1/2 ATCs, including 3/9 PTCs and 1/1 ATC at initial presentation, most frequently involving lungs (8/10) and mediastinal lymph nodes (5/10). Median time to distant metastasis for PTCs was 43 months (range 0-254).
All PTCs received I131 (median cumulative activity 196 mCi). Neck-directed radiotherapy was administered to 4/14 PTCs and 1/2 ATCs. 7/14 PTCs and 2/2 ATCs received systemic therapy, including: MEK inhibitors (n=2), BRAF+MEK inhibitors (n=1), pan-RAF then MEK inhibitors (n=1), pan-RAF inhibitor (n=1), and multi-targeted TKI(s) (n=5). In 1 PTC with neck recurrence invading sternocleidomastoid muscle, 1 month of neoadjuvant trametinib facilitated a less morbid surgery. 11/14 PTCs (median follow-up: 94 months) and 2/2 ATCs (15 and 25 months follow-up) patients were still alive.
Poster 0277
Thyroid Nodules and Goiter, Clinical, Poster
Clinical Performance of the Afirma Genomic Sequencing Classifier (GSC) in Pediatric Patients With Cytologically Indeterminate Thyroid Nodules
Luz Castellanos*1, J. Iorgulescu1, Julio Ricarte-Filho2, Amie Franco2, Mohammed Alshalalfa3, Joshua Klopper3, Richard Kloos3, Steven Waguespack1, 1The University of Texas MD Anderson Cancer Center, USA, 2Children's Hospital of Philadelphia, USA, 3Veracyte, USA
Poster 0278
Thyroid Cancer, Clinical, Poster
Overcoming Thyroid Overdiagnosis: Developing and Deploying Large Language Models for Incidental Thyroid Nodule Identification
Ricardo Loor-Torres*1, Mariana Borras-Osorio1, Yuqi Wu1, Esteban Cabezas1, Maria Mateo Chavez1, David Toro Tobon1, Misk Al Zahidy1, Jungwei Fan1, Naykky Singh Ospina2, Yonghui Wu2, Felipe Larios1, Kerly Guevara1, Juan Brito1, 1Mayo Clinic, USA, 2University of Florida, USA
Poster 0279
Thyroid Nodules and Goiter, Clinical, Poster
Leveraging artificial intelligence to categorize thyroid cytology results from fine-needle aspiration biopsy reports within a large healthcare system
Ricardo Loor-Torres*1, Yuqi Wu1, Esteban Cabezas1, David Toro-Tobon1, Misk Al Zahidy1, Maria Mateo Chavez1, Mariana Borras Osorio1, Jungwei Fav1, Naykky Singh Ospina2, Yonghui Wu2, Felipe Larios1, Kerly Guevara1, Juan Brito1, 1Mayo Clinic, USA, 2University of Florida, USA
Poster 0280
Thyroid Cancer, Clinical, Poster
Thyroid Cancer Invading the Airway: Common Features and Outcomes of Surgical Treatment in a Single Center Experience
Anna Zolotoukho*, Arseny Semenov, Roman Chernikov, Ilya Sleptsov, Anna Uspenskaya, St. Petersburg State University Hospital, Russian Federation
11 patients (50%) had primary surgery, each case involving circular resection of the trachea. 6 of the 11 primary patients were first diagnosed with thyroid nodules by ultrasound imaging a number of years prior (range 2-29 years), none of them had FNA performed at the time of diagnosis and most did not undergo regular ultrasound scans. Among the 11 patients with repeat surgery 4 underwent laryngectomy and 7 had circular tracheal resection. For 3 of the 11 patients primary thyroid surgery was performed 11, 14, and 40 years prior and no records of primary treatment or histological examination results were available.
18 patients were available for follow up. 6 patients with PTC are disease-free. 2 patients with local recurrence of PTC undergo regular ultrasound and CT scans and show no signs of disease progression. 3 patients are presently receiving thyrosine kinase inhibitors (1 MTC, 1 PTC, 1 poorly differentiated TC). 6 patients have died (4 PTC, 1 ATC, 1 poorly differentiated TC), 1 of them of unrelated causes.
Poster 0281
Thyroid Cancer, Clinical, Poster
How response to therapy status changed over 5 years of follow-up in a German collective of differentiated thyroid cancer patients after surgery and radioiodine therapy (RAIT)
Friederike Eilsberger*1, Robert Tuttle2, Benedikt Palmedo1, Wadim Bowl1, Damiano Librizzi1, Markus Luster1, Andreas Pfestroff1, 1University Marburg, Department of Nuclear Medicine, Germany, 2Memorial Sloan Kettering Cancer Center, Department of Endocrinology, USA
39/49 (80%) ATA low risk patients and 6/10 (60%) intermediate risk patients showed an excellent response 5 years after therapy. None of the indeterminant responses or biochemical incomplete responses developed a structural incomplete response. In the 5 patients with structural incomplete response to initial therapy, who receive additional therapies, 2 patients (40%) transitioned to biochemical incomplete response.
Poster 0282
Thyroid Cancer, Clinical, Poster
Could quantitative superb microvascular imaging or shear wave elastography help to identify grown suspicious thyroid nodules measuring ≤10 mm? A cross-sectional study
Yuang An*, Xinlong Shi, Luying Gao, Yu Xia, Xiaoyi Li, Yuxin Jiang, Department of Ultrasound, Peking Union Medical College Hospital, China
Poster 0283
Thyroid Cancer, Clinical, Poster
Diagnostic Value of Molecular Testing for Evaluating Thyroid Nodules Greater Than 4 Centimeters
Zhixing Song*, Christopher Wu, Ramsha Akhund, Jessica Fazendin, Herbert Chen, Brenessa Lindeman, Andrea Gillis, University of Alabama at Birmingham, USA
Poster 0284
Thyroid Cancer, Clinical, Poster
The Absence of TPO Antibodies Marks the Role of Immune Evasion in the Development of Aggressive Thyroid Cancers of Follicular Origin: An International Surgical Series
Rodis Paparodis*1,2,3, Evangelos Karvounis4,1, Aikaterin Kapezanou4, Dimitra Bantouna1, Sarantis Livadas1,5,6, Georgios Simeakis7, Dimitrios Askitis8,1, Ioannis Androulakis1,9, Nicholas Angelopoulos1,10, Dimitra Zianni1,11, Anastasios Boniakos1,12, Shahnawaz Imam13, Juan Jaume3, 1Hellenic Endocrine Network, Greece, 2Endocrinology, Diabetes and Metabolism Clinics, Greece, 3Loyola University Medical Center and Edward Hines Jr VA Hospital, USA, 4Euroclinic Hospital Center of Excellence in Endocrine Surgery, Greece, 5Endocrinology, Diabetes and Metabolism Clinics, Greece, 6Athens Medical Center, Greece, 7401 General Military Hospital of Athens, Greece, 8Endocrinology, Diabetes and Metabolism Clinics, Greece, 9Endocrinology, Diabetes and Metabolism Clinics, Greece, 10Endocrinology, Diabetes and Metabolism Clinics, Greece, 11Endocrinology, Diabetes and Metabolism Clinics, Greece, 12Endocrinology, Diabetes and Metabolism Clinics, Greece, 13University of Toledo College of Medicine and Life Sciences, USA
Poster 0285
Thyroid Cancer, Clinical, Poster
DESCRIPTION OF FIFTY YEARS OF EXPERIENCE IN THE MANAGEMENT OF THYROID DIFFERENTIATED CARCINOMA IN CHILDREN AND ADOLESCENTS IN THE REAL WORLD
Mariana de Oliveira1, Laura Ward2, Adriano Cury1, Nilza Scalissi1, Marilia Marone1, Carlos Longui1, Cristiane Kochi1, Osmar Monte1, Carolina Ferraz1, Rosália Padovani*1, 1Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil, 2Universidade de Campinas (Unicamp), Brazil
Distinguishing patients who require closer monitoring and rigorous therapeutic measures from those who should be spared from excessive treatment is crucial in the management of thyroid cancer. However, limitations of the current initial risk stratification (IRS) and dynamic risk stratification (DRS) methods challenge the management of pediatric patients with thyroid cancer (pDTC), where this issue is particularly important. To improve the monitoring parameters, we retrospectively evaluated the predictive markers for persistent disease in a consecutive series of patients with pDCT treated at a single institution.
We reviewed the records of 178 patients with pDTC who underwent the same standard management protocol to establish their risk using the stratification system of the 2015 American Thyroid Association pDTC guidelines (IRS) and DRS guidelines for adults. We characterized the early outcome risk (EDRS) after 1–3 years and a late outcome (LDRS) after ≥10 years of follow-up.
125 patients had sufficient recorded data to permit IRS. The mean age at diagnosis was 14 years, 98 (78.4%) were female, and 114 (91.2%) had papillary thyroid carcinomas. The tumor size was 2.4±1.41 cm, 80 (64%) had cervical metastases, and 21 (16.8%) had distant metastases at diagnosis. IRS classified the majority of patients (108, 86.4%) as intermediate- or high-risk. EDRS was closely associated with IRS, with favorable responses predominating in the low- and intermediate-risk groups and unfavorable responses predominating in the high-risk group (p=0.0001). We observed that 86.11% of the 36 patients evaluated for LDRS maintained this response (p=0.074). A serum post operative Tg (sPOTg) level of 12.5 ng/mL predicted persistent disease with a sensitivity of 73.3% and specificity of 81.1%, along with tumor margins (p=0.007) and the number of affected lymph nodes (p=0.032).
In conclusion, we confirmed a positive relationship between IRS and disease persistence, demonstrating that EDSR is a good predictor of LDSR and pDTC patient outcomes, in addition to the number of affected lymph nodes, resected tumor margins, and sPOTg levels.
Poster 0286
Thyroid Cancer, Clinical, Poster
Metabolic Parameters on PET/CT Correlate with Biochemical Response to Selpercatinib in Patients with Advanced Medullary Thyroid Cancer
Eline Jager1,2,3, James McNeil1, Alex Papachristos4,5, Mark Sywak4,5, Stanley Sidhu4,5, Rhonda Siddall1, Jeremy Hoang6, Geoffrey Schembri6, Venessa Tsang1,4, Ayanthi Wijewardene1,7, Lyndall Tacon1,4, Bruce Robinson1,4,7, Roderick Clifton-Bligh1,4,7, Martyn Bullock4,7, Thera Links2, Schelto Kruijff3, Anthony Glover4, Matti Gild*1,4,7, 1Department of Endocrinology and Diabetes, Royal North Shore Hospital, Australia, 2Department of Internal Medicine, Division of Endocrinology, University Medical Centre Groningen, Groningen, Netherlands, 3Department of Surgery, Division of Surgical Oncology, University Medical Centre Groningen, Netherlands, 4Faculty of Medicine and Health, University of Sydney, Australia, 5Department of Endocrine Surgery, Royal North Shore Hospital, Australia, 6Department of Nuclear Medicine, Royal North Shore Hospital, Australia, 7Cancer Genetics Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, Australia
Poster 0287
Thyroid Cancer, Clinical, Poster
Evaluating the Prognostic Significance of Cyfra 21-1 Changes and Genetic Mutations in Thyroid Cancer Patients
Jaekyung Lee*1,2, Jeongmin Lee3,2, Chaiho Jeong4,2, Han-Sang Baek4,2, Dong-Jun Lim1,2, 1Department of Internal Medicine, Division of Endocrinology and Metabolism, Seoul St. Mary’s Hospital, Korea, Republic of, 2College of Medicine, The Catholic University of Korea, Korea, Republic of, 3Department of Internal Medicine, Division of Endocrinology and Metabolism, Eunpyeong St. Mary’s Hospital, Korea, Republic of, 4Department of Internal Medicine, Division of Endocrinology and Metabolism, Uijeongbu St. Mary's Hospital, Korea, Republic of
Poster 0288
Thyroid Cancer, Case Study, Poster
A Rare Case Of Mixed PTC Sub-Types: An Evolving New Entity
Zinnia Al-Najjar, Tala Abu-Hijleh*, McMaster University, Canada
Poster 0289
Thyroid Cancer, Case Study, Poster
Monoallelic Pathogenic c.5712dup Mutation in the Ataxia Telangiectasia Mutated (ATM) Gene as a Risk Factor for Metachronous Thyroid and Breast Cancer - A First Report
Tiffany Gan*1,2, Han Boon Oh1,2, 1Division of Breast & Endocrine Surgery, Department of General Surgery, Ng Teng Fong General Hospital, Singapore, Singapore, 2Division of Thyroid & Endocrine Surgery, Department of General Surgery, National University Hospital, Singapore, Singapore
The Ataxia Telangiectasia Mutated (ATM) gene is an oncosuppressor located on chromosome 11q23 involved in DNA repair by activating DNA damage response pathways. Pathogenic ATM gene variants are common and have a prevalence of approximately 1%. There is a strong association between ATM variants and the risk of malignancy development. The c.7271 mutation was found to have the highest association with breast cancer while other variants have been found to be associated with thyroid but not increased breast cancer risk.
We describe the first case report of a c.5712dup monoallelic pathogenic mutation in the ATM gene as a risk factor for metachronous thyroid and breast cancer.
The patient was a young female who underwent total mastectomy at age 35 for a Grade 1 ER PR Positive Her 2 Negative Invasive Mucinous Carcinoma of the right breast. She underwent 49-gene testing (Invitae) and was found to be a heterozygous carrier of a pathogenic monoallelic ATM gene mutation (c.5712dup (p.Ser1905Ilefs*25)). She was hence followed up more closely with surveillance PET-CT which found an FDG-avid focus in the right thyroid. Ultrasound thyroid showed a 0.6cm indeterminate right lower pole nodule and Fine Needle Aspiration Cytology was Atypia of Undetermined Significance (AUS). She was counselled for right hemithyroidectomy and final histology showed papillary microcarcinoma. She was the index case and there was no history of radiation exposure in her family.
Unlike the more common BRCA1 and PTEN mutations, ATM represents a rarer mutation. This is the first case of a c.5712dup variant predisposing to the development of metachronous papillary thyroid and breast cancer. This case demonstrates the importance of genetic testing in young patients with a first primary breast malignancy. Detection of an ATM gene mutation like the c.5712dup variant necessitates a high index of suspicion for a secondary thyroid malignancy and carries screening implications for the offspring of these individuals. Further studies would be valuable to establish precise and comprehensive estimates of cancer risks associated with ATM gene mutations as this can facilitate recommendations for the identification, surveillance, and potential preventive treatment of high-risk individuals with a first primary malignancy.
Poster 0290
Thyroid Cancer, Case Study, Poster
A Rare and Difficult Diagnosis: Primary Fibrosarcoma Masquerading as Riedel's Thyroiditis and Anaplastic Carcinoma
Ying Chen*1, Katie Tai2, Andrew Turk3, Anuraag Parikh2, Susana Ebner1, 1Department of Endocrinology, Columbia University Irving Medical Center, USA, 2Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, USA, 3Department of Pathology and Cell Biology, Columbia University Irving Medical Center, USA
Poster 0291
Thyroid Cancer, Case Study,
Papillary Thyroid Cancer Presenting As Thyroid Abscess
Yisihak Debodina*1, Fitsum Asfaw2, Tsion Gebrekidan3, 1Saint Paul's Hospital Millennium Medical College, Ethiopia, 2Yekatit 12 Medical College, Ethiopia, 3Saint Paul's Hospital Millennium Medical College, Ethiopia
Thyroid cancer is most frequently detected in females (3:1) and makes up about 1% of all newly diagnosed malignant disorders. Papillary carcinomas are considered “well-differentiated” and are responsible for between 80-85% of all thyroid malignancies.
A 43 years old female years patient presented to our Emergency department with a compliant of a sudden anterior neck swelling with difficulty of breathing of 10days duration. The patient couldn’t maintain her saturation with atmospheric air. Progressively she couldn’t breath by herself.
Neck ultrasound shows markedly enlarged right thyroid lobe with multiple different sized nodules largest >5cm in AP diameter and there is surrounding collection with internal echo debris . The left lobe appears normal.
FNAC from the mass showed impression of suppurative inflammation.
With an impression of thyroiditis with abscess collection and rule out anaplastic thyroid cancer, an initial dose of Hydrocortisone 200 mg IV shot given.
The intraoperative finding was: Adhesion between the platysma muscle and external layer of deep fascia, around 400 ml of super infected hematoma, both lobes were necrotic except small thyroid tissue remnant over bilateral upper lobes.
The hematoma drained, necrotic tissue removed, the trachea was free especially centrally. She was extubated on the next day of surgery.
The patient was seen after 12days of the surgery, the wound was getting better.
She was put on suppressive dose of levothyroxine.
She is now on her 11th post surgery month with no sign regrowth or metastasis.
The patient didn’t took radio-iodine ablation therapy because it is not available in the country.
Given the relative resistance of the thyroid gland to infection, acute suppurative thyroiditis/thyroid abscess is an exceptionally rare condition. Due to its protective capsule, abundant blood supply, extensive lymphatic drainage, and high iodine content, the thyroid gland is naturally resistant to infection. The most prevalent malignant thyroid tumor with respect to age at presentation is papillary thyroid carcinoma (PTC). Patients are typically diagnosed with this tumor during the third and fifth decades of life. Most patients with this tumor present with painless anterior neck mass. High index of sudspicion for thyroid cancer presenting as an abscess is import to act early in this gropu of patients.
Still if timely apptroapriate actions are taken the patinets life could be saved and leave long as this cancer is differentiated one and grows slowly.
Poster 0292
Thyroid Cancer, Case Study, Poster
Successful Redifferentiation of Radioactive Iodine Resistant Papillary Thyroid Cancer with BRAF/MEK Inhibition: A Case Report
Esra Sari*, Jacqueline Kung, Tufts University School of Medicine, USA
Surveillance imaging with neck US and CT chest in 2017 showed cervical and mediastinal lymphadenopathy and bilateral pulmonary nodules, the largest 1.1 cm in the left lingula. PET scan showed avidity in the lingula nodule and lymph nodes. Biopsy of the lingula lesion confirmed metastatic papillary thyroid cancer. He underwent repeat neck dissections and received additional I-131. Post-RAI WBS showed uptake in the neck without mediastinal or lung uptake.
Molecular analysis showed BRAF V600E and TERT promoter mutations. Treatment with dabrafenib/trametinib (BRAF/TERT inhibition) started in 2022. 6 week follow-up I-123 WBS showed new uptake in the superior mediastinum although no lung uptake, which led to the administration of the third course of I-131 RAI. Tg levels increased from <1 to 22, interpreted as re-differentiation. CT showed a decrease in the neck and lung lesions, with the most recent CT showing only subcentimeter lung nodules and lymph nodes.
Poster 0293
Thyroid Cancer, Case Study, Poster
Neoadjuvant Selective RET Inhibitor for Medullary Thyroid Cancer: A Case Report
Miriam Steinschneider*1,2, Efrat Markus1, Rutie Mamlok Sherf1, Regev Landau1, Limor Muallem Kalmovich1,2, Raya Leibowitz1,2, Shlomit Koren1,2, 1Shamir Medical Center, Israel, 2Sackler Faculty of Medicine, Tel-Aviv Universitysity, Israel
Further clinical trials are required to establish the safety, efficacy, and long-term outcomes with this approach.
Poster 0294
Thyroid Cancer, Case Study, Poster
A Unique Presentation of Unilateral Thyroid Lymphoma
John Woodley*,UCSF Fresno, USA
Primary Thyroid Lymphoma (PTL) is a rare malignancy of the thyroid gland that accounts for less than 5% of all thyroid malignancies. A large majority of PTL cases are of B-cell origin with approximately 98% of all cases being Non-Hodgkin’s Lymphoma. In a retrospective analysis between 2004 and 2015 by Vardell et al., 68% of diagnosed PTL cases were histologically diffuse large B-cell lymphoma (DLBCL) with 10% being follicular lymphoma, 10% being marginal zone or mucosa-associated lymphoma tissue (MALT) lymphoma and 3% being small lymphocytic lymphoma. On clinical presentation, PTLs traditionally present as a rapidly enlarging, uniform neck mass with possible symptoms of compression such as dysphagia, hoarseness, or dyspnea. Occasionally, B symptoms and peripheral lymphadenopathy may also be present. In this case report, we highlight the clinical course of a patient who initially presented to the clinic with a rapidly enlarging unilateral neck mass that ultimately revealed MALT lymphoma of the right thyroid without evidence of malignancy on the left.
Poster 0295
Thyroid Cancer, Case Study, Poster
METASTATIC PAPILLARY THYROID CANCER PRESENTING AS CAUDA EQUINA SYNDROME: A CASE REPORT
Samantha Patricia Go-Soco*, Kurt Bryan Tolentino, Roy Raoul Felipe, Mikhail Lew Ver, St. Luke's Medical Center - Global, Philippines
Papillary thyroid cancer is the most common type of thyroid malignancy worldwide and usually presents as a painless enlarging nodule or mass. Metastatic disease is rare at the onset of diagnosis, only present in about 1-2% of diagnosed thyroid cancers.
A 49 year old male with no comorbidities complained of lower back pain with initial workup revealing vertebral body compression with spinal canal stenosis, with an anterior paraspinal soft tissue at the T2 and L5 along with a positive TB quantiferon result favoring tuberculous spondylodiscitis. He denied fever, cough, or weight loss; eventually managed as Pott's disease and was started on Anti-Koch’s regimen. Despite treatment for 4 months, the patient noted worsening of lower back pain now with difficulty ambulating, constipation and urinary urgency. He was advised admission for emergent surgery due to symptoms of cauda equina syndrome. Lateral rectus palsy was noted during physical exam, hence a brain scan was requested which revealed a skull base lesion. Now entertaining the possibility of malignancy, cancer markers were requested (TSH, CEA and AFP all normal, with elevation of PSA at 5.46) and PET scan was done with attenuation of the thyroid gland and the soft tissue paraspinal mass. During laminectomy, specimens were sent for cultures which returned negative, with histopathology showed metastatic carcinoma. Anti-Koch’s regimen was discontinued, and patient was referred to Endocrinology. Thyroid ultrasound done showed multiple TIRADS 4 nodules, and IHC stains positive CK7, Thyroglobulin, PAX8, TTF-1, favoring thyroid as the primary carcinoma. Patient underwent total thyroidectomy with a final histopathology of papillary thyroid cancer, encapsulated follicular variant. On follow up, patient underwent RAI therapy, with post-RAI scan showing no iodine-avid thyroid tissue, but with uptake on the skull base, pelvis and right femur and was subsequently started on levothyroxine therapy.
We report an unusual case of papillary thyroid cancer initially presenting as severe back pain leading to cauda equina syndrome. Although metastasis is the most common cause of tumors in the spine, having it as the initial presentation of thyroid cancer is rare, and metastatic workup of spinal lesions should include the thyroid.
Friday, November 1, 2024
Poster 0296
Autoimmunity, Case Study, Poster
Conversion of Hashimoto’s thyroiditis to Graves’ disease; a rare phenomenon
Nayan Shrestha*1, Qasim Iqbal2, 1Indiana University School of Medicine, Ball Memorial Hospital, USA, 2Indiana University School of Medicine, Department of Endocrinology, Diabetes and Metabolism, USA
Hashimoto’s thyroiditis and Graves’ disease are autoimmune diseases with potential for interconversion. Conversion from Graves’ disease to Hashimoto’s thyroiditis is more common than the vice versa. We are presenting a case of a patient in whom Hashimoto’s thyroiditis shifted to Graves’ disease.
A 63-year-old female was diagnosed with HT 10 years ago and was treated with levothyroxine 112 mcg daily, however, the dose of levothyroxine was tapered down to 50 mcg daily. She was referred to an endocrinologist for excessive eye tearing, fatigue, muscle weakness, and palpitations.
On examination, she had periorbital edema along with conjunctival injection, and inflammation of the caruncle. Her TSH was suppressed at 0.010 mcU/ml (0.4-4.2), free T4 elevated to 2.8 ng/dl (0.6 – 1.5) and had elevated antibodies including TRAb at 32.20 IU/L and thyroid stimulating immunoglobulin Antibody (TSI Ab) at 7.5 IU/L. CT scan of the orbit showed proptosis secondary to thyroid orbitopathy and her Doppler imaging of the thyroid was consistent with hyperemia. Consequently, levothyroxine was discontinued, and she was started on methimazole.
Conversion from HT to GD is very rare. The reason behind this conversion remains debatable. More than 50% - 70% of patients with GD also have TPOAb and TgAb, [1], similarly, TRAb is detected in 10% of HT cases.[2] Patient who had conversion form HT to GD have both TSAb and TRAb that cause thyroid in a push and pull state and favors the antibody which is higher in concentration. [3] Thyroid gland recovery from HT injury and start responding to TSAb leading to the conversion to GD. Given, TSAb has higher affinity to TSH receptor than as compared to TSH. [3] Studies have reported a positive correlation between levothyroxine dose and the appearance of de novo TSAb or an increase in TSAb. [4,5]
A high index of suspicion should be raised in patients with HT, especially if levothyroxine demand is decreasing. Further testing for GD autoantibodies and meticulous clinical examination should help in the early diagnosis of the conversion.
Poster 0297
Autoimmunity, Clinical, Poster
Improvements in Quality of Life with Teprotumumab in Patients with Chronic, Low Disease Activity TED With a Proptosis Response
George J. Kahaly1, Michael Karon2, Qianhong Fu2, Robert J. Holt2 and Sara T. Wester3, 1Johannes Gutenberg University (JGU) Medical Center, Department of Medicine I, Mainz, Germany, 2Amgen Inc, Thousand Oaks, CA, 3Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
At baseline, 20 and 22 patients were categorized as higher and lower QoL groups, respectively. Those with lower baseline GO-QoL had greater improvements than those with higher baseline GO-QoL, although differences between the groups were only significant for VF: total, mean (SD) 14.1 (21.8) vs 3.6 (10.1), p=0.06; VF, 14.9 (24.5) vs 0.1 (6.7), p <0.02; AP, 12.8 (32.5) vs 6.9 (17.4), p=0.48.
Poster 0298
Autoimmunity, Clinical, Poster
Increasing Incidence of Pediatric Graves' Disease in the U.S.: An Epidemiological Analysis of 2007-2022 Outpatient Insurance Claims
Akash Halagur*, Julia Donner, Allen Green, Eric Wei, Jason Qian, Hilary Seeley, Kara Meister, Stanford University, USA
Poster 0299
Autoimmunity, Clinical, Poster
University of Pittsburgh Real World Experience with Teprotumumab: Outcomes and Side Effects
Sahana Parthasarathy*, Esra Karslioglu French, UPMC, USA
Poster 0300
Thyroid Cancer, Case Study, Poster
Malignant Struma Ovarii: A Rare Malignancy
Sahana Parthasarathy*, Esra Karslioglu French, UPMC, USA
Poster 0301
Autoimmunity, Clinical, Poster
Clinical characteristics of serum IgG4 elevated Hashimoto's thyroiditis
Chenxu Zhao*, Liyuan Liu, Yang Yu, Yang Zhang, Ying Gao,Department of Endocrinology, Peking University First Hospital, China
Poster 0302
Autoimmunity, Basic, Poster
LDHA Mediated Glycolysis Promotes Fibrosis in IgG4 Hashimoto’s thyroiditis Through Facilitating Epithelial–Mesenchymal Transition
Chenxu Zhao*1, Zhiming Sun1, Jumei Liu2, Yang Zhang1, Lei Chen2, Ying Gao1, 1Department of Endocrinology, Peking University First Hospital, China, 2Department of Ultrasound, Peking University First Hospital, China
Poster 0303
Autoimmunity, Clinical,
Prognostic Factors and Outcomes of Intravenous Glucocorticoid Pulse Therapy in Moderate-to-Severe Thyroid Eye Disease
Anna Giannakogeorgou*1, Thomas Bobbert1, Daniel Salchow2, 1Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Germany, 2Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Germany
Poster 0304
Autoimmunity, Clinical, Poster
Subcutaneous Efgartigimod PH20 for the Treatment of Thyroid Eye Disease in Adults (UplighTED): Study Design for Two Identical, Parallel, Phase 3, Randomized, Placebo-Controlled Studies
Mario Salvi1, Lelio Baldeschi2, Erika Brutsaert*3, Estefanía Urdániz3, Yelena Vainilovich3, Ivaylo Stoykov3, Daniel Rootman4, 1Fondazione IRCCS Cà Granda, Italy, 2Catholic University of Louvain, Academic Hospital Saint Luc, Belgium, 3argenx, Belgium, 4Doheny and Stein Eye Institutes, University of California, USA
Multiple secondary endpoints will assess speed of response onset, changes in diplopia Gorman score and clinical activity score, adverse events, PK parameters, development of antibodies against efgartigimod PH20 SC, effect on total binding TSHR autoantibodies, and participant-reported QoL and treatment satisfaction.
Poster 0305
Autoimmunity, Clinical, Poster
Clinical Outcomes in Pediatric Graves' Disease Treated with Anti-thyroid Drugs and Radioactive Iodine
FERNANDA LOPES*1, Julia Thomaz1, Renata Oliveira1, Luiz Claudio Castro1,2, 1University Hospital of Brasília, Brazil, 2University of Brasília, Brazil
Poster 0306
Thyroid Cancer, Clinical, Poster
Characteristics and Outcomes of Pediatric Differentiated Thyroid Carcinoma: A Single-Center Experience
FERNANDA LOPES*1, Cristiane Jeyce Lima2, 1University Hospital of Brasília, Brazil, 2Hospital de Base do Distrito Federal - IGESDF, Brazil
Poster 0307
Autoimmunity, Clinical, Poster
Subcutaneous Administration of VRDN-003, a Next-Generation Full Antagonist Antibody to IGF-1R, in Patients With Thyroid Eye Disease (TED): Two Randomized Placebo-Controlled Clinical Studies (REVEAL-1 and REVEAL-2)
Steven Leibowitz*1, Thomas Ciulla2, Abhijit Narvekar2, Antonio Garrido Hermosilla3,4, 1Jules Stein Eye Insitute, UCLA, USA, 2Viridian Therapeutics, Inc, USA, 3Virgen Macarena University Hospital, Spain, 4University of Seville, Spain
Poster 0308
Disorders of Thyroid Function, Clinical, Poster
Comparative Efficacy of Corticosteroids and Teprotumumab in Thyroid Eye Disease Management
Suyoung Choi*1, Patcharaporn Chandraparnik2, Karen Wai1, Prithvi Mruthyunjaya1, Chrysoula Dosiou1, Benyam Kinde1, Andrea Kossler1, 1Stanford, USA, 2Phramongkutklao Hospital, Thailand
Poster 0309
Disorders of Thyroid Function, Poster
Restoration of Bone Health in Hyperthyroid-Induced Osteoporosis: Insights from a Postmenopausal Case Study
Niharika Vennelaganti*, Soumya Kurnool, Jessica Hansen, Charles Choe, Karen Mccowen, UC San Diego, USA
Osteoporosis is a feature of untreated thyrotoxicosis secondary to an accelerated rate of bone turnover. Numerous reports describe a consistent decrease in bone mineral density (BMD) and increase in fracture risk in overt hyperthyroidism. A TSH level of <0.1 uIU/mL has been associated with a 4.5-fold risk of vertebral fracture. However, antithyroid treatment and achieving a euthyroid state can reverse osteoporosis caused by hyperthyroidism.
We present a 59-year-old woman who presented with weight loss, atrial fibrillation, and congestive heart failure in 2020, and was diagnosed with Graves' disease. On admission, her TSH was undetectable, with fT4 level of 7 ng/dL (0.93-1.7 ng/dL); serum calcium was 9.7 mg/dL, and vitamin D 34 ng/dL. Given hyperthyroidism and postmenopausal status, she underwent a dual-energy X-ray absorptiometry (DXA) scan in 10/20. The results indicated T scores of -2.7 at the lumbar spine (LS) and -2.4 at the femoral neck (FN) with Z scores of -1.9 and -1.4 respectively. Subsequently, an elevated fractionated bone alkaline phosphatase of 249 U/L (0- 55 U/L) was noted. She started on treatment with Methimazole and achieved euthyroidism within 6 months. She also followed recommendations for daily calcium and vitamin D supplementation.
A follow-up DXA scan in 12/21, conducted on the same GE Lunar Prodigy machine, demonstrated marked improvements with persistent euthyroidism: a T score of -1.4 at the FN and -0.7 at the LS with Z scores of -0.3 and 0.2 respectively, corresponding to a 28% increase in BMD at both sites. This was confirmed in 2023: FN T score -0.9. (6.7% further increase) and LS T score -0.2 (6% increase). Her current laboratory results indicate normal levels of bone-fractionated alkaline phosphatase.
This patient achieved complete normalization of bone density; however, there is currently no consensus on the optimal timing for conducting DXA scans, nor are there well-defined treatment strategies for managing osteoporosis in hyperthyroid patients. Specifically, the debate continues over whether to treat with antithyroid drugs alone or in combination with bisphosphonates, particularly in postmenopausal women. Improvements in our patient suggest that immediate implementation of osteoporosis drug therapy might be premature, but appropriate guidelines are wanted.
Poster 0310
Disorders of Thyroid Function, Clinical, Poster
Barriers and Facilitators to Evidence-based Use of Levothyroxine
Spyridoula Maraka*1,2, Micheal Knox1,2, Eva Woodward1,2, Katherine Dishongh1, Naykky Singh Ospina3, Juan Brito4, Richard Owen1,2, Geoffrey Curran2, Sara Landes1,2, 1Central Arkansas Veterans Healthcare System, USA, 2University of Arkansas for Medical Sciences, USA, 3University of Florida, USA, 4Mayo Clinic, USA
Poster 0311
Disorders of Thyroid Function, Clinical, Poster
FLT3 polymorphisms and FLT3 ligand levels in thyroid irAEs
Christopher Muir*1, Venessa Tsang2, Alexander Menzies2, Georgina Long3, Richard Scolyer3, Matthew Law4, Roderick Clifton-Bligh2, 1St. Vincent's Hospital, Australia, 2Royal North Shore Hospital, Australia, 3Melanoma Institute Australia, Australia, 4QIMR Berghofer, Australia
Poster 0312
Disorders of Thyroid Function, Clinical, Poster
Outcome of radioactive iodine therapy for Graves' disease using pretreatment with ether potassium iodide or methimazole
Tetsuya Mizokami*, Katsuhiko Hamada, Tetsushi Maruta, Kiichiro Higashi, Junichi Tajiri, Tajir thyroid clinic, Japan
Poster 0313
Disorders of Thyroid Function, Clinical, Poster
Unilateral Grave’s Disease, A Poorly Understood Entity
Regina Llamosas-Sentíes*, Nicole Iniguez-Ariza, Bernardo Pérez-Enríquez, National Institute of Health Sciences and Nutrition, Mexico
Unilateral Graves’ disease (UGD) it’s an exceedingly rare disease with roughly 25 cases reported thus far, in the medical literature.
Poster 0314
Disorders of Thyroid Function, Clinical, Poster
Hypo Versus Hyperthyroidism in Heart Failure: A Retrospective Population-Based Study to Assess In-Hospital Outcomes
Bosky Modi*1, Godfrey Tabowei1, John Ogedegbe2, Gabriel Alugba3, Samuel Kwame Dadzie4, Anuradha Twayana1, Enakpene Evbu5, 1Texas Tech University Health Sciences Center Permian Basin, USA, 2Trinity, USA, 3Englewood hospital and medical center, USA, 4Piedmont Athens regional center, USA, 5Permian Basin Cardiology, USA
To assess and compare the average length of stay and hospitalization costs for patients admitted for heart failure with hyperthyroidism versus those with hypothyroidism.
To examine and compare the risk of atrial fibrillation among patients admitted for heart failure with hyperthyroidism and those with hypothyroidism.
In-hospital mortality rates were 2.4% for HFHYPER and 2.6% for HFHYPO. While HFHYPO exhibited 3% lower odds of mortality, this difference was statistically insignificant (p=0.856).
The average length of stay was 5.54 days for HFHYPER and 5.62 days for HFHYPO. Multivariate analysis indicated a significant 74% reduction in length of stay for HFHYPO (p=0.028).
The average cost of hospitalization was $64,437 for HFHYPER and $58,541 for HFHYPO, with a statistically insignificant $84 decrease in costs for HFHYPO (p=0.978).
HFHYPO patients had 35% increased odds of AF compared to HFHYPER (p=0.00), along with increased odds of Dyslipidemia (19%, p=0.00), Obesity (42%, p=0.00), and Obstructive Sleep Apnea (16%, p=0.02).
No significant differences were observed in the odds of Coronary Artery Disease, Peripheral Vascular Disease, Acute Kidney Injury, smoking, or hypertension between the groups.
Poster 0315
Disorders of Thyroid Function, Clinical, Poster
Methimazole Can Be Administered on a Weekly Basis
Adelina Priscu*, Michael Morkos, Indiana University, USA
Poster 0316
Disorders of Thyroid Function, Clinical, Poster
Transient Thyrotoxicosis and Hypothyroidism after Combination Therapy with PD-1 and CTLA-4 Inhibitors for Cervical Cancer
Ketevan Lomidze*1,2, Marine Gordeladze2, Nino Kikodze2, Nino Charkviani2, Tinatin Chikovani2, Ketevan Meladze3, 1Israeli-Gerorgian Medical Research Clinic Healthycore, Georgia, 2Tbilisi State Medical University, Georgia, 3Tbilisi State University, Georgia
Poster 0317
Disorders of Thyroid Function, Clinical, Poster
Immune Checkpoint Inhibitor Related Thyroid Dysfunction: A Quality Improvement Project to Improve Access to Endocrine Care and Expedite Normalization of Thyroid Hormone Levels
Anne Brinkman*1, Amori Salami-Henry1, Lori Aaron-Brija2, Faheemah Hannah2, Mimi Hu1, Li-Ling Hwang1, Nupur Kikani1, Rachna Patel1, Johnny Rollins1, Steven Sherman1, Jessica Williams1, Steven Weitzman1, 1The University of Texas MD Anderson Cancer Center, USA, 2Texas Woman's University, USA
Poster 0318
Disorders of Thyroid Function, Clinical, Poster
Changes in Therapeutic Plasma Exchange in Hyperthyroidism Treatment Scenarios
Zirui Zhu1, Xinran Gao2, Ge Bai3, Honghua Wu1, Youyuan Huang1, Junqing Zhang1, Ying Gao1, Yang Zhang*1, 1Department of Endocrinology, Peking University First Hospital, Peking University, China, 2Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Peking University, China, 3Department of Gastroenterology, Peking University First Hospital, Peking University, China
Poster 0319
Disorders of Thyroid Function, Clinical, Poster
Cost-effectiveness of different screening strategies for thyroid indicators during pregnancy based on a real-world cohort
Ning Zhou1, Yang Zhang*1, Ying Gao2, Xun Tang3, 1Department of Endocrinology, Peking University First Hospital, China, 2Department of Endocrinology, Peking University First Hospital, Chile, 3School of Public Health, Peking University, China
Poster 0320
Disorders of Thyroid Function, Clinical, Poster
Adverse Thyroid Reaction Caused by the Combination of Tyrosine Kinase Inhibitors and Immune Checkpoint Inhibitors: A Retrospective Study in Beijing
Wen Shao1, Kaiwei Yang2, Difei Lu1, Ying Gao1, Junqing Zhang1, Yang Zhang*1, 1Department of Endocrinology, Peking University First Hospital, China, 2Department of Urology, Peking University First Hospital, China
Poster 0321
Disorders of Thyroid Function, Clinical, Poster
In-Hospital Outcomes among Hospitalized Thyroid Storm Patients with Comorbid Heart Failure with reduced Ejection Fraction (HFrEF): A United States Population-Based Cohort Study
Carlo Gabriel Casipit*, Bruce Adrian Casipit, Phuuwadith Wattanachayakul, Yajur Arya, Arshi Syal, Simone Wajnsztajn, Maxim Barnett, Sri Ram Sathi, Jefferson-Einstein Hospital, USA
Poster 0322
Disorders of Thyroid Function, Clinical, Poster
Risk for Cardiac Arrhythmia Development among Hospitalized Thyroid Storm Patients with Comorbid Heart Failure: A United States Population-Based Cohort Study
Carlo Gabriel Casipit*, Bruce Adrian Casipit, Maxim Barnett, Phuuwadith Wattanachayakul, Sri Ram Teja Sathi, Arshi Syal, Yajur Arya, Jefferson-Einstein Hospital, USA
Poster 0323
Disorders of Thyroid Function, Clinical, Poster
International Survey of Trends in the Management of Thyroid Eye Disease
Danilo Villagelin*1, David Cooper2, Henry Burch3, 1Pontificia Universidade Católica de Campinas, Brazil, 2Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, USA, 3National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, USA
Sodium selenite would be prescribed by European respondents (66%) almost twice as often compared to those from other regions of the world (38%) (p < 0.0001). Also, respondents younger than age 45 and those who see more than ten new cases of GD per month were more likely to prescribe sodium selenite (p<0.005).
Ophthalmologists would be responsible for prescribing medical therapy for TED in North America (75%) and Oceania (68%), compared to endocrinologists having primary responsibility in the other regions of the globe (Europe (63%), Latin America (63%), Asia (62%)). Considering only respondents from North America, teprotumumab would be almost twice as frequently prescribed as glucocorticoids (42% vs. 23%). There were no differences regarding sex, age, the number of new patients with GD per month, and the likelihood of prescribing teprotumumab.
Poster 0324
Disorders of Thyroid Function, Clinical, Poster
Treatment of Subclinical Hypothyroidism and its Impact on Lipid Metabolism
Rachel Zielinski*, Martha Dillon, Francesco Celi,UConn Health, USA
Poster 0325
Disorders of Thyroid Function, Clinical, Poster
Uncontrolled Hypothyroidism in Pregnancy Increases Risk of Preeclampsia
April Alcantara*1, Christopher Pham2, Shakeela Faulkner3, Intira Sriprasert4, Zoey Agle5, Caroline Nguyen6, 1LA General Medical Center/USC, USA, 2LA General Medical Center, USA, 3Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, Keck School of Medicine, University of Southern California, USA, 4Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, USA, 5Keck School of Medicine, USA, 6Department of Medicine and Obstetrics and Gynecology, Division of Endocrinology, USA
At gestational week 28, most patients’ hypothyroidism was controlled with 72.05% of patients with TSH <2.5 mIU/L. Women with TSH >2.5 mIU/L had a higher incidence of preeclampsia compared to those with TSH <2.5 mIU/L at gestational week 28 (20.31% vs. 9.05%; p = 0.02).
Poster 0326
Disorders of Thyroid Function, Clinical, Poster
Prevalence and the Clinical Features of the Postpartum Thyrotoxicosis in the Patients with Graves’ Disease, a Retrospective Single-Center Study in Japan
Nami Suzuki*, Natsuko Watanabe, Ai Yoshihara, Miho Fukushita, Masako Matsumoto, Masahiro Ichikawa, Masakazu Koshibu, Rei Hirose, Kiminori Sugino, Koichi Ito,Ito Hospital, Japan
Poster 0327
Disorders of Thyroid Function, Clinical, Poster
Spuriously High Free T3 in Clinically and Biochemically Euthyroid Patients
Zainab Nasrallah*, Michael Morkos,Indiana University, USA
Despite being a frequently ordered laboratory test, the reliability and utility of the free triiodothyronine (FT3) is questionable, and its interpretation can be inaccurate. We present a case series of eighteen clinically and biochemically euthyroid patients who were found to have elevated levels of FT3 on routine screening lab tests.
All patients’ data were reviewed retrospectively for this descriptive study. The utilized FT3 assay is a quantitative Electrochemiluminescent immunoassay. We used the Shapiro-Wilk test to assess normality. Normally distributed data is presented as mean ± standard deviation and skewed as median [interquartile range]. Age was 50.3±14.4. Most were white (n=15), and three patients were black. The serum thyrotropin stimulating hormone (TSH) 1.18 [0.74-2.6] mcU/mL (reference range (ref) 0.4-4.2), free thyroxine (FT4) 0.88±0.14 ng/dL (ref 0.6-1.5), and total triiodothyronine (TT3) 112±18.5 (ref 82-179). They were all within the normal range. The FT3 was 3.95 [3.70-4.40] pg/mL (ref 1.5-3.5). All FT3 values for this cohort were falsely elevated.
FT3 is the biologically active thyroid hormone. Although it should theoretically be the best reflection of active thyroid hormone level, its frequent unreliability is becoming more apparent. This is likely secondary to its inherent low serum concentration and affinity. Thus, the blind measurement of FT3 may be of limited utility and can be a pitfall, especially when the results are incongruent with the clinical picture and other thyroid hormone levels. Total T3 may be a better assay currently to assess T3 levels when warranted till the FT3 assay becomes more reliable.
Poster 0328
Disorders of Thyroid Function, Clinical, Poster
Drug Administration as A Factor Affecting Levothyroxine Therapy – Results of the CONTROL Surveillance II Study
Duni Cummings-John*1, Marcela Castano1, Walter Sandulli1, Doreen Amatelli-Clark2, R Heidel3, 1IBSA Pharma, USA, 2Way To Goal, USA, 3Aesculapius Consulting, Inc., USA
Many patients (29%) administer levothyroxine outside of FDA-approved labelling. This includes 18% who take levothyroxine ≤30 minutes before eating, 2% while eating and 9% ≤ 1 hour after eating. Use of vitamins/supplements known to interfere with levothyroxine is high: calcium (30%), and iron (15%). Many patients (39%) take proton pump inhibitors (PPIs) which are classified as “interfering drugs” in FDA-approved levothyroxine labelling.
Most patients recall physician instructions to take levothyroxine in the morning ≥ 30 minutes before breakfast with water (72%). However, 55% do not recall instructions regarding consumption of interfering vitamins/supplements; 60% don’t recall instructions regarding the use of PPIs or certain prescription medications. Patients managed by a primary care physician (PCP), versus those managed by a specialist, are more likely to take their medication after eating (18% vs 10%; p ≤ 0.05). Patients who report difficulty adhering to administration guidance are more likely to report that their hypothyroidism has reduced their quality of life (31% vs 18%; p < 0.05) and more likely to report stopping their prescribed medication for ≥1 month (25% vs 10%; p < 0.05). Many patients (53%) are willing to consider liquid levothyroxine formulations which may be taken closer to mealtime or without regard to the presence of PPIs.
Poster 0329
Disorders of Thyroid Function, Clinical, Poster
Hypokalemic Periodic Paralysis Precipitated by Levothyroxine Replacement in a Patient with Hashimoto’s Hypothyroidism
Anna Betlachin, Chan Ho Shin*,UCI, USA
Periodic paralysis (PP) is a rare skeletal muscle channelopathy leading to recurrent episodes of muscle weakness. Hypokalemic PP is the most common form of PP and may be hereditary or acquired. Acquired hypokalemic PP is sometimes associated with thyrotoxicosis, in a condition called thyrotoxic periodic paralysis (TPP). We present a case of hypokalemic PP in a hypothyroid patient after starting levothyroxine replacement.
A 21-year-old asymptomatic female underwent routine labs with TSH > 150 mlU/L (0.40-4.50 mlU/L) and FT4 0.4 ng/dL (0.8 - 1.8 ng/dL). She was diagnosed with hypothyroidism and was started on levothyroxine 25 mcg daily. One week into treatment, she noticed increased fatigue and muscle weakness. She presented to the emergency department (ED) where she was noted to have a potassium of 2.6 mmol/L. Repeat TSH was 21 mlU/L and thyroid peroxidase antibody level was > 1000 IU/ml (< 9 IU/mL). She was treated with IV and oral potassium and discharged on potassium chloride 10 mEq twice daily. The patient self-discontinued levothyroxine but continued to experience muscle weakness and returned to the ED twice over the following week for potassium repletion. Levothyroxine 25 mcg daily was resumed and she was discharged on a potassium regimen of 40 mEq three times daily, which she weaned to 10 mEq twice daily over the next month. Repeat TSH was 8.7 mlU/L and levothyroxine was increased to 50 mcg with precautions to increase potassium if experiencing muscle weakness. TSH normalized and potassium was discontinued without recurrence of symptoms.
The occurrence of hypokalemic PP in a hypothyroid patient after the initiation of levothyroxine suggests a pathophysiology similar to TPP. In TPP, hypokalemia is caused by intracellular potassium shift due to thyroid hormone sensitization of sodium-potassium ATPase. We hypothesize that in this patient with hypothyroidism, the initiation of levothyroxine may have unmasked an underlying channelopathy and led to similar intracellular potassium shift and hypokalemia. The onset of acute muscle weakness after levothyroxine initiation should prompt consideration of hypokalemic PP and levothyroxine replacement should be managed cautiously with adequate potassium replacement and electrolyte monitoring.
Poster 0330
Disorders of Thyroid Function, Clinical, Poster
The Association Between Hypothyroidism and Cognitive Function Change in Women Across the Menopause Transition: The Study of Women's Health Across the Nation (SWAN)
Matthew Ettleson*1, Kelly Karavolos2, Sherri-Ann Burnett-Bowie3, Lynda Powell2, Imke Janssen2, 1University of Chicago, USA, 2Rush University Medical Centers, USA, 3Massachusetts General Hospital and Harvard Medical School, USA
Poster 0331
Disorders of Thyroid Function, Clinical, Poster
Methimazole for Prevention of Iodinated Contrast Media Induced Exacerbation of Thyrotoxicosis in Susceptible Patients
Irit Ayalon-Dangur1, Einat Magid-Ohayon2, Ilan Shimon1, Eyal Robenshtok*1, 1Rabin Medical Center, Israel, 2Tel Aviv University, Israel
Poster 0332
Thyroid Cancer, Clinical, Poster
Surgery for Papillary Thyroid Carcinoma with Microscopic Extra-Thyroid Extension – Is Lobectomy Enough?
Anner Moskovitz1, Nir Tsur2, Keren Kaminer2, Dean Dudkiewicz2, Eyal Robenshtok*2, 1Tel-Aviv Medical Center, Israel, 2Rabin Medical Center, Israel
Poster 0333
Disorders of Thyroid Function, Clinical, Poster
The First Robust Bioavailability/Bioequivalence (BA/BE) Study of Thyromimetic Tiratricol, a Treatment in Development for MCT8 Deficiency
Christian Sonesson1, Kevin Carroll2, Nand Singh3, John McDermott3, Kristina Nygren*1, Jacques Näsström1, Paul Dickinson4, 1Egetis Therapeutics AB, Sweden, 22KJC Statistics Ireland, Ireland, 3Quotient Sciences, United Kingdom, 4Seda Pharmaceutical Development Services, United Kingdom
The primary objective was to establish bioequivalence between 350μg tiratricol oblong tablets and 350μg tiratricol round tablets. The secondary objectives were to estimate the effect of food by comparing both 175μg and 1050μg tiratricol oblong tablet doses in fasted versus fed states, and to assess dose-proportionality of tiratricol oblong tablets in a fasted state. All subjects received the treatments for the critical assessment of bioequivalence and 3 additional ones. Serum tiratricol, standard PK parameters, and safety were assessed.
Poster 0334
Disorders of Thyroid Function, Clinical, Poster
Association of serum calcium and glucocorticoid-induced hypertension in thyroid-associated ophthalmopathy patients treated with methylprednisolone
Ling Wang*1, Yushi Sun1, Meng Zhang1, Hairong He2, Jingya Wang3, Huayang Xu1, Yang Hao4, Wenqiang Zhang1, Yawen Wang5, Kelvin K. L. CHONG6, Hui Guo1, Bingyin Shi1, Yue Wang1, 1Department of Endocrinology, The First Affiliated Hospital of Xi’an Jiaotong University, China, 2Center of investigator initiated trial, The First Affiliated Hospital of Xi’an Jiaotong University, China, 3Department of gastroenterology, Xi'an Children's Hospital, China, 4Department of Ophthalmology, The First Affiliated Hospital of Xi’an Jiaotong University, China, 5Department of Laboratory Medicine, The first Affiliated Hospital of Xi'an Jiaotong University, China, 6Department of Ophthalmology and Visual Sciences, China
Poster 0335
Disorders of Thyroid Function, Clinical, Poster
Thyroid Hormone resistance syndrome due to thyroid hormone receptor beta (THRB) gene
Alveena Altaf*, Neel Shah, Ayesha Arooj, Esthelory Lopez-Hidalgo,University of Texas Health Science Center, USA
Poster 0336
Disorders of Thyroid Function, Clinical, Poster
Effect of Oral LT3 administration on Thyroid function Tests in Participants with Isolated Low T3 levels and Heart Failure: A Randomized, Placebo-controlled, Crossover Trial
Kristen Kobaly*, Shanelle Mendes, Robert Gallop, Julio Chirinos, Thomas Cappola, Anne Cappola,University of Pennsylvania, USA
Poster 0337
Disorders of Thyroid Function, Clinical, Poster
Sudden Onset T3 Thyrotoxicosis with Low Thyroxin
Mohammed Mahmoodurrahman*, SASAN FAZELI,City of Hope, USA
US thyroid showed bilateral heterogenous thyroid gland without discrete nodule. A thyroid uptake scan showed generalized elevated 24-hour iodine uptake measuring 37.1% (10-35%), without focal hot nodule.
Patient was started on methimazole 10 mg daily, which up-titrated to 30 mg. After 5 months patient’s free T3 normalized and TSH rose to 55.714. Methimazole was down titrated and eventually discontinued. Repeat labs 3 months after stopping methimazole revealed TT3 0.97 (0.60-1.81 pg/mL), FT4 0.83 (0.54-1.24 ng/dL) and TSH 2.332 (0.35-5.5 mIU/L). The patient’s symptoms improved significantly.
Poster 0338
Disorders of Thyroid Function, Clinical,
Morphological and functional changes of the thyroid during pregnancy: Case of Pregnant Women in the District of Gbadolite/DR Congo
Demongawi Richard*,University of Kinshasa, Congo, the Democratic Republic of the
Poster 0339
Disorders of Thyroid Function, Clinical,
Primary hypothyroidism and Ramadan
Ismail Nasri*1, Dany Ait Aissa2, 1Liberal doctor, ANDEL, Algeria, 2Faculty of medicine, Algeria
Objectives are to analyze certain parameters to determine the cause of the imbalance .
Inclusion criteria: Primary hypothyroidism.
Exclusion criteria: Age <18 years, Pregnancy or desire of pregnancy, thyroid cancer.
Note that: Iftar = Evening meal (after sunset) Suhoor = meal right before dawn
Poster 0340
Disorders of Thyroid Function, Case Study, Poster
A Case of Post-Aspiration Thyrotoxicosis and Hematoma in a 48-Year-Old Woman with a Thyroid Nodule
Lauren Lynch*, Magdalena Bogun, Susana Ebner,Division of Endocrinology, Columbia University Irving Medical Center, USA
A 48-year-old woman with a history of benign thyroid nodule presented to the emergency department with neck pain, swelling, dysphagia following thyroid fine needle aspiration (FNA) 2 days prior to admission. A TSH 3 months prior to biopsy was 0.51 mIU/L. A thyroid ultrasound obtained prior to biopsy revealed a 2.0x1.4 cm cyst in the midpole of the right lobe and a 2.0x2.0 cm complex nodule at the lower pole of the right lobe (TR3). She was not taking any NSAIDs, antiplatelet agents, or antithyroid drugs. Both the complex nodule and the cyst were biopsied with 4 passes each, using a 25G needle. Cytology results were benign.
On physical exam, the patient was tachycardic and without signs of thyroid eye disease. She had an enlarged thyroid gland. A CT Angiogram of the neck with contrast showed a heterogeneous 5.3x4x5.8-cm right thyroid nodule with likely hemorrhage with leftward tracheal deviation and splaying of regional structures. There was no obvious active contrast extravasation to suggest active bleed. Laboratory values obtained <12 hours after iodinated contrast administration revealed a TSH <0.01 mIU/L; free T4 2.33 ng/dL and a total T3 of 339 ng/dL. TSH-Receptor antibody and thyroid-stimulating immunoglobulin were negative.
Over the course of her two-day admission, thyroid hematoma improved with compression. Patient represented to ED 1 week after discharge with exertional dyspnea. Laboratory tests revealed TSH <0.01 mIU/L, free T4 4.71 ng/dL, and total T3 345 ng/dL. Methimazole 20 mg daily was initiated. A thyroglobulin value of 4099.7 ng/dL resulted later. A CT Chest with contrast revealed bilateral segmental and subsegmental pulmonary emboli and anticoagulation was initiated. A Thyroid US showed a 5.1x4.6x3.6 cm almost completely solid, hypoechoic thyroid nodule.
Post-aspiration hematoma is uncommon and could be explained by hemorrhage from one of the capsular vessels of the cyst during the procedure. Post-aspiration thyrotoxicosis is an extremely rare complication of thyroid FNA [1-3]. Trauma from aspiration coupled with leakage of cystic fluid contents into surrounding thyroid could lead to thyrotoxicosis [2]. This case supports this hypothesized mechanism and highlights the potential for rare but serious complications following FNA.
Poster 0341
Disorders of Thyroid Function, Case Study, Poster
A Case of Atrial Fibrillation with Rapid Ventricular Response in a 31-year-old Woman with Postpartum Thyrotoxicosis
Lauren Lynch*, Magdalena Bogun, Susana Ebner, Division of Endocrinology, Columbia University Irving Medical Center, USA
A 31-year-old woman with no significant past medical history aside from cesarean section 4 months’ prior presented to the emergency department with palpitations that began the day of presentation. She denied any associated neck pain, shortness of breath, or dizziness. She had no personal history of thyroid disease; her mother was recently diagnosed with hypothyroidism. On arrival, the patient was noted to be in atrial fibrillation with rapid ventricular response with rates up to 220s. Blood pressures were maintained throughout, but she was urgently cardioverted in this setting. Sinus rhythm was subsequently restored with heart rates in 110s. Physical exam showed no goiter, no tenderness to palpation of the thyroid gland, and no thyroid eye disease. Laboratory workup revealed TSH <0.01 mIU/L, free T4 3.51 ng/dL, total T4 15.80 ng/dL, total T3 242.0 ng/dL. TSH level checked at 11 weeks’ gestation was within-normal-limits at 1.27 mIU/L. A thyroid ultrasound was obtained, which showed a heterogeneous, mildly hypervascular thyroid gland. An echocardiogram demonstrated a structurally normal heart. She did not receive anticoagulation or intravenous contrast.
The patient was initially managed with beta-blockade and methimazole 20 mg daily, which was stopped after negative TSH-Receptor antibody and thyroid-stimulating-immunoglobulin resulted 3 days later. Heart rates downtrended to 80s-90s with beta blockade and she was discharged home. She was able to resume breastfeeding once home. Eighteen days after discharge, TSH remained <0.01 mIU/L, free T4 was 1.6 ng/dL, total T3 was 147 ng/dL, thyroglobulin was 37.6 ng/mL. Six weeks later, her TSH rose to 27.01mIU/L, free T4 dropped to 0.7 ng/dL, and total T3 dropped to 97 ng/dL. An anti-TPO antibody was positive at >900 IU/mg.
Although hyperthyroidism is associated with supraventricular ectopic activity and arrythmias, thyrotoxicosis-induced atrial fibrillation is rare in young patients with structurally normal hearts. To our knowledge, atrial fibrillation complicating postpartum thyroiditis has not been previously reported. Resolution of thyrotoxicosis from postpartum thyroiditis occurs over time and is managed symptomatically. This case should raise awareness for this unusual but serious complication.
Poster 0342
Disorders of Thyroid Function, Case Study, Poster
A Unique Patient With Immune Checkpoint Inhibitor-Induced Thyroiditis: What’s the Kidney Have to Do With It?
Jessica Williams*, Anne Brinkman, Amori Salami-Henry, Nupur Kikani, Steven Weitzman,University of Texas MD Anderson Cancer Center, USA
She was prescribed levothyroxine, and the dose was progressively increased. TSH remained elevated (21.28) despite normalization of FT4 on levothyroxine 150 mcg/kg (3mcg/kg, nearly double the expected weight-based dose). She reported taking levothyroxine in the proper manner. She had minimal diarrhea related to lenvatinib. Celiac disease was ruled out by antibody testing. However, a 24-hour urine collection revealed total protein of 3,294 mg/24 hr. Lenvatinib was held by oncology and 2 weeks later TFTs normalized [TSH=2.02, FT4=1.57]. After another week, urinary total protein decreased to 2,147 mg/24 hr and TFTs showed thyrotoxicosis [TSH=0.18, FT4=1.95] requiring a decrease in the levothyroxine dose.
Poster 0343
Disorders of Thyroid Function, Case Study, Poster
Asymmetric Periorbital Edema Due to Delayed Hypersensitivity Reaction to Thyroid Hormone Replacement: A Case Report
Vien Phan*1, Quynh Nguyen2, Hoang Dinh3, Nguyet Nguyen1, Zhenkun Guan4, Quan Nguyen5, Van Phan6, 1Interfaith Medical Center, USA, 2Logan Regional Medical Center, USA, 3University of Medicine and Pharmacy, Vietnam, 4University of Indiana, Department of Familiy Medicine in Jasper, USA, 5Memorial Hospital West, USA, 6MiddleSex Hospital, USA
Poster 0344
Disorders of Thyroid Function, Case Study, Poster
Thyroid Dysfunction Associated with Lenalidomide Therapy: A Case-Series
Hawra Kamal*,Wayne State University, USA
Poster 0345
Iodine Uptake and Metabolism, Case Study, Poster
Beyond the Thyroid: Iododerma as a Rare Dermatological Complication of Radioactive Iodine Ablation in Thyroid Disease
Hawra Kamal*, Julie Samantray,Wayne State University, USA
Poster 0346
Health Disparities/Health Equity, Clinical, Poster
Hispanic Race and Socioeconomic Status as Predictors of Pediatric Thyroid Cancer Presentation
Simo Kraguljac*1, Muhammad Seif2, Hana Seif2, Benjamin Oakes1, Michael Pozin3, Daniel Najafali3, Joseph Lopez4, 1University of Central Florida College of Medicine, USA, 2University of Central Florida, USA, 3Carle Illinois College of Medicine, USA, 4AdventHealth for Children, USA
Poster 0347
Health Disparities/Health Equity, Clinical, Poster
Using Artificial Intelligence To Aid Decision-Making And Improve Standards Of Care In Thyroid Surgery
Victoria Hammond*, Mahsa Javid,University of Louisville, USA
Poster 0348
Pediatrics, Clinical, Poster
Composition and Priorities of Pediatric Thyroid Programs: A Consensus Statement
Ronik Kothari*1, Julia Donner2, Hilary Seeley2, Expert Panel3, Karthik Balakrishnan2, Gary Hartman2, Kara Meister2, 1California University of Science and Medicine, USA, 2Stanford University, USA, 3Variable, USA
Poster 0349
Pediatrics, Clinical, Poster
Combined Levothyroxine and Propylthiouracil Treatment in Children with MCT8 Deficiency: A Retrospective Review of 11 Patients
Roy Weiss*1, Joana Lemos1, Alexandra Dumitrescu2, Mohammad Islam1, Khemraj Hirani1, Samuel Refetoff2, 1University of Miami Miller School of Medicine, USA, 2University of Chicago, USA
Poster 0350
Pediatrics, Clinical, Poster
Safety and feasibility of transoral endoscopic thyroidectomy vestibular approach in pediatric populations
Duy Ngo*1,2, Duong Le1, Quy Ngo1, Quang Le1,2, 1Department of Head and Neck Surgery, Vietnam National Cancer Hospital, 30 Cau Buou Street, Thanh Tri District, Vietnam, 2Hanoi Medical University, 01 Ton That Tung Street, Dong Da District, Vietnam
Poster 0351
Surgery, Clinical, Poster
Transoral endoscopic thyroidectomy vestibular approach: Experience from a single institution with 900 patients
Duy Ngo*1,2, Duong Le1, Quy Ngo1, Quang Le1,2, 1Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Vietnam, 2Hanoi Medical University, 01 Ton That Tung Street, Dong Da District, Vietnam
Poster 0352
Pediatrics, Clinical, Poster
Surgical Outcomes of Endoscopic Thyroidectomies in Pediatric Patient for Thyroid Tumors: Single Surgeon’s Experience from India
Gyan Chand*, Madhu Kumari, Aakriti Yadav,Sanjay Gandhi Post Graduate Institute of Medical Sciences, India
The commonest FNAC includes BETHESDA II (72%), BETHESDA III (08%) and BETHESDA IV (12%). In two patients, FNAC was not done. The endoscopic surgical approach was BABA 64% & TOETVA 36%. The extent of surgery includes Hemithyroidectomy, Total thyroidectomy (TT), and completion total thyroidectomy were applied in 20 cases (80%), 03 cases (12%) and 1 Case (4%), respectively one patient was converted to open thyroidectomy. The mean operative time was 148.96 (±55.73) minutes. The mean hospital stay was 3 (±1.22) days. There were 05 patients (20%) diagnosed with thyroid cancer and 20 patients (80%) diagnosed with benign tumour based on histopathology. There was no case of permanent hypocalcaemia, vocal cord palsy and numbness. One patient developed transient hypocalcaemia after TT and central neck dissection, which were managed with calcium and vitamin D. Focal transient numbness in the Neck and upper chest area was observed only in two patients, and all patients recovered fully after surgery.
Poster 0353
Pregnancy and Development, Translational, Poster
Intraamniotic levothyroxine treatment of fetal goiter caused by synonymous mutation creating a cryptic splice site and nonsense mutation in thyroglobulin
Jeremy Winer*1, Omar Abuzeid2, Monica Malheiros Franca3, Dianne Deplewski3, Samuel Refetoff3, Alexandra Dumitrescu3, 1Univ of Chicago, USA, 2Franciscan, USA, 3Univ of Chicago, USA
Poster 0354
Pregnancy and Development, Clinical, Poster
The association of gestational thyroid function and thyroid autoimmunity with offspring neurodevelopment: an individual participant meta-analysis
Joris Osinga*1,2, Leonie Warringa1,2, Consortium on Thyroid and Pregnancy Working group on offspring neurodevelopment3, Robin Peeters1,2, Tim Korevaar1,2, 1Erasmus MC, Department of Internal Medicine, Netherlands, 2Erasmus MC, Academic Center for Thyroid Diseases, Netherlands, 3Multiple, Netherlands
Poster 0355
Pregnancy and Development, Clinical, Poster
The association of gestational thyroid function with gestational diabetes mellitus: a systematic review and individual participant meta-analysis
Joris Osinga*1,2, Leonie Warringa1,2, Consortium on Thyroid and Pregnancy Working group on GDM3, Arash Derakhshan1,2, Robin Peeters1,2, Tim Korevaar1,2, 1Erasmus MC, Department of Internal Medicine, Netherlands, 2Erasmus MC, Academic Center for Thyroid Diseases, Netherlands, 3Multiple, Netherlands
Poster 0356
Pregnancy and Development, Clinical, Poster
Changes in Thyroid Function during Pregnancy: A Prospective Observational Study to Determine Trimester-specific Reference Intervals
Li-Hsin Pan1, Chang-Ching Yeh2, Chun-Jui Huang*3, 1Division of Endocrinology and Metabolism, Department of Medicine, Taipei City Hospital Zhongxing Branch, Taiwan, 2Department of Obstetrics & Gynecology, Taipei Veterans General Hospital, Taiwan, 3Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taiwan
Poster 0357
Pregnancy and Development, Clinical, Poster
Iodine and Selenium Nutritional Status: a cross-sectional analysis in women with unexplained infertility
Karina Adami1, Fabyan Beltrão2, Lara Torres3, Giulia Carvalhal4, Jessica Cassemiro3, Gabriel Jeferson Machado3, Camila Falcão3, Vanessa Cristina Souza5, Fernando Barbosa Júnior5, Renata Britto6, Paula Navarro7, Sun Lee8, Elizabeth Pearce8, Helton Ramos*3, 1Medicine and Health Post-Graduation Program, School of Medicine, Federal University of Bahia, Brazil, 2Lauro Wanderley Universitary Hospital Department of Internal Medicine, Federal University of Paraíba, Brazil, 3Bioregulation Department Health Science Institute Federal University of Bahia, Brazil, 4Center for Biological Health Science, Federal University of Paraíba, Brazil, 5Toxicology Essentiality Metals Lab, School of Pharmacy Sciences University of São Paulo, Brazil, 6Department of Gynecology and Obstetrics, Faculty of Medicine, Federal University of Bahia, Brazil, 7Sector of Human Reproduction, Department of Gynecology and Obstetrics - Ribeirão Preto Medical School, University of São Paulo, Brazil, 8Section of Endocrinology, Diabetes, and Nutrition, Boston University Chobanian & Avedisian School of Medicine, USA
Poster 0358
Pregnancy and Development, Clinical, Poster
Selenium deficiency is associated with high-risk pregnancy in selenium-rich Brazilian pregnant women population
Luciana de Souza1, Renata Campos2, Bruno Alexsander dos Santos3, Pedro Rende3, Jessica Cassemiro3, Vanessa Cristina Souza4, Fabyan Esberard Beltrão5, Fernando Barbosa Júnior4, Laszlo Hegedüs6, Helton Ramos*3,1, 1Postgraduate Program in Interactive Processes of Organs and Systems, Health & Science Institute, Federal University of Bahia, Brazil, 2Health and Science Center, Federal University Reconcavo of Bahia, Brazil, 3Bioregulation Department, Health and Science Institute, Federal University of Bahia, Brazil, 4Laboratory of Toxicology and Essentiality of Metals, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Brazil, 55 Lauro Wanderley University Hospital, Federal University of Paraíba, Brazil, 6Department of Endocrinology and Metabolism, University of Southern Denmark, Denmark
Poster 0359
Disorders of Thyroid Function, Clinical, Poster
Genomic Ancestry as a Risk Factor for Thyroid Dysfunction: Data from 9372 Individuals Analysed at ELSA-Brasil Longitudinal Study
DIANA MARTINS1, FABYAN BELTRÃO2, MARIA CONCEIÇÃO ALMEIDA3, CAROLINA JANOVSKY4, ISABELA BENSEÑOR4, HELTON RAMOS*1, 1UFBA, Brazil, 2UFPB, Brazil, 3FIOCRUZ, Brazil, 4USP, Brazil
Poster 0360
Thyroid Hormone Action, Metabolism and Regulation, Case Study, Poster
Third Time is the Charm: Persistent Thyroid Stimulating Immunoglobulin Elevation After Two Thyroidectomies
Courtney Clutter*, Rutger Gunther, Darrick Beckman,Brooke Army Medical Center, USA
Total thyroidectomy is considered a definitive treatment for Graves’ disease. Thyroid Stimulating Immunoglobulins (TSI) gradually decline following total thyroidectomy, generally reaching a nadir 6 months post-surgery. We present a case of persistent TSI elevation following total thyroidectomy and subsequent anterior neck mass resection.
A 30-year-old female underwent total thyroidectomy for Graves’ disease in 2012. Following thyroidectomy, she was started on Synthroid 150 mcg. Six years later, she developed a right anterior neck mass. Neck ultrasound noted a hypervascular soft tissue nodule. Cytology from fine needle aspiration was consistent with thyroid tissue. She later developed thyroid eye disease with mild left exophthalmos and bilateral upper eyelid retraction. The patient was referred to endocrinology for further evaluation. Her TSH was <0.01 IU/mL on Synthroid 100 mcg daily. TSI were elevated at 50.7 IU/mL. In September 2023, she was referred to ENT for excision of the anterior neck mass. Surgical pathology demonstrated thyroid tissue with previously treated Graves’ disease. Two months following surgery, her TSI level decreased to 38.2 IU/mL. Six months following surgery, her TSI increased to 51.6 IU/mL, raising concern for residual thyroid tissue. A thyroglobulin level was obtained and resulted as 11.4 ng/dL. An I-123 whole body scan was then performed. Given the patient had post-procedural hypothyroidism requiring Synthroid, 2 doses of Thyrogen were administered in the days preceding the scan. 24 hours following administration of 2.04 mCi of I-123, planar whole body images were performed in addition to SPECT-CT images of the neck and chest. Imaging findings included a 2.1 cm hyperattenuating soft tissue nodule with associated intense iodine uptake in the right thyroid surgical bed and a 0.6 cm x 0.4 cm small hyperattenuating soft tissue nodule in the left surgical bed consistent with residual thyroid tissue. A third neck surgery is planned to resect the residual thyroid tissue with the goal to normalize TSI.
Persistent elevation of TSI following total thyroidectomy should raise suspicion for residual thyroid tissue. In patients with post-thyroidectomy hypothyroidism, I-123 whole body scan with Thyrogen can serve as an imaging modality to locate residual thyroid tissue.
Poster 0361
Thyroid Hormone Action, Metabolism and Regulation, Clinical, Poster
Vital Signs Among Patients With Hypothyroidism Treated for up to 48 Weeks With Armour Thyroid or Synthetic Levothyroxine: ARCH Phase 2 Randomized Double-Blind Study
Antonio Bianco1, Ronald Brazg2, Barry Horowitz3, Gary Pepper4, Stelios Mantis5, Oscar Antunez-Flores5, Richard Leaback5, Alexandra O’Sullivan5, William Ferguson*5, 1The University of Chicago, USA, 2Rainier Clinical Research Center, USA, 3Metabolic Research Institute, Inc., USA, 4Jupiter Medical Center, USA, 5AbbVie, Inc., USA
Poster 0362
Thyroid Hormone Action, Metabolism and Regulation, Clinical, Poster
Exploring the Clinical and Genetic Characteristics of Resistance to Thyroid Hormone β Patients: A Tertiary Center Experience
Karn Wejaphikul*1,2, Kewalee Unachak1, Kanda Fhanchaksai1, Nipawan Waisayanand3, Pattara Wiromrat4, Ouyporn Panamonta4, Tansit Saengkaew5, Somchit Jaruratanasirikul5, W. Edward Visser2, Marcel Meima2, Prapai Dejkhamron1, 1Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Thailand, 2Erasmus MC, Department of Internal Medicine, Academic Center for Thyroid Diseases, Netherlands, 3Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Thailand, 4Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Thailand, 5Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
Poster 0363
Thyroid Hormone Action, Metabolism and Regulation, Clinical, Poster
Effect of bariatric surgery on TSH levels and levothyroxine dosage in patients with thyroid disease: Sleeve gastrectomy vs Roux-en-Y Gastric bypass
Armando Patrizio*1, Marianna Palumbo2, Brenno Astiarraga3, Giacomo Redi4, Carlo Moretto5, Rosario Bellini5, Alessandro Antonelli1, Stefania Camastra2, 1Department of Surgery, Medical and Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy, 2Department of Clinical and Experimental Medicine, University of Pisa, Italy, 3Hospital Universitari Joan XXIII de Tarragona, Institut d'Investigació Sanitària Pere Virgili (IISPV), Spain, 4Neuroscience Institute, National Center for Research (CNR), Italy, 5Bariatric Surgery Unit, Santa Chiara Hospital, Italy
Poster 0364
Thyroid Hormone Action, Metabolism and Regulation, Clinical, Poster
The associations between thyroid hormone state and psychiatric symptoms in hospitalized patients with bipolar disorder or depression
Mariko Hakoshima*, Hisayuki Katsuyama, Hidekatsu Yanai, Sarina Tanida, Koudai Shumiya, Naoko Satake,National Center for Global Health and Medicine Kohnodai Hospital, Japan
Poster 0365
Thyroid Hormone Action, Metabolism and Regulation, Clinical, Poster
Liquid L-T4 Formulation in Hypothyroid Patients with Celiac Diseases or Non-Celiac Gluten Sensitivity
Francesca Ragusa1, Giusy Elia1, Armando Patrizio2, Chiara Botrini1, Valeria Mazzi1, Eugenia Balestri1, Licia Rugani1, Oriana Fabrazzo1, Roberta Pitzus1, Enke Baldini3, Mario Miccoli4, Concettina La Motta5, Gabriella Cavallini6, Silvia Martina Ferrari4, Alessandro Antonelli1, Poupak Fallahi*6, 1University of Pisa, Department of Surgical, Medical and Molecular Pathology and Critical Area, Italy, 2Azienda Ospedaliero-Universitaria Pisana, Department of Emergency Medicine, Italy, 3"Sapienza" University of Rome, Department of Experimental Medicine, Italy, 4University of Pisa, Department of Clinical and Experimental Medicine, Italy, 5University of Pisa, Department of Pharmacy, Italy, 6University of Pisa, Department of Translational Research and New Technologies in Medicine and Surgery, Italy
Poster 0366
Thyroid Hormone Action, Metabolism and Regulation, Clinical, Poster
Treatment with Soft Gel Capsule L-T4 in Hypothyroid Patients with Gastric Diseases Associated with L-T4 Malabsorption
Francesca Ragusa1, Chiara Botrini1, Giusy Elia1, Armando Patrizio2, Eugenia Balestri1, Valeria Mazzi1, Licia Rugani1, Elena Catania Romizi1, Maria Giorgia Martino1, Camilla Virili3, Gilda Varricchi4,5,6, Mario Miccoli7, Silvia Martina Ferrari7, Alessandro Antonelli*1, Poupak Fallahi8, 1University of Pisa, Department of Surgical, Medical and Molecular Pathology and Critical Area, Italy, 2Azienda Ospedaliero-Universitaria Pisana, Department of Emergency Medicine, Italy, 3“Sapienza” University of Rome, Department of Medico-Surgical Sciences and Biotechnologies, Italy, 4University of Naples Federico II, Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), Italy, 5WAO Center of Excellence, Italy, 6National Research Council, Institute of Experimental Endocrinology and Oncology (IEOS), Italy, 7University of Pisa, Department of Clinical and Experimental Medicine, Italy, 8University of Pisa, Department of Translational Research and New Technologies in Medicine and Surgery, Italy
Poster 0367
Thyroid Hormone Action, Metabolism and Regulation, Basic, Poster
ScRNA-seq Analysis Reveals Drastic Epithelial Population Transformation at the Climax of Xenopus Metamorphosis
Liezhen Fu*, Yun-Bo Shi,National Institutes of Health, USA
Abstract: Adult organ/tissue maturation occurs during postembryonic development in vertebrates. This often involves the formation of adult tissue-specific stem cells that play critical roles for organ homeostasis as well as tissue repair and regeneration. However, it has been difficult to study the maturation of adult organs and tissues in mammals due to the difficulty to access uterus-enclosed late-stage embryos. The T3-dependent Xenopus metamorphosis is a process mimicking the postembryonic development in mammals and transforms essentially all tissues, including larval tissue degeneration, de novo adult tissue formation, and remodeling of larval tissues to the adult type. Of particular interest is intestinal metamorphosis, which involves apoptotic degeneration of the larval epithelium, de novo formation of adult stem cells and their subsequent proliferation and differentiation into the adult epithelium. This makes intestine a unique organ for studying adult stem cell development. Toward understanding the cell transformations in the intestinal epithelium during metamorphosis, we perform single cell RNA sequencing (ScRNA-seq) analysis on intestinal epithelial cells isolated from stage 56 (the larval stage) and 61 (the climax of metamorphosis) tadpoles. Our data indicated that the epithelial cells at the stage 61 had very different transcriptome compare to that at stage 56. In addition, we identified the stem cell-like cells and cells likely undergoing epithelial-mesenchymal transition cells at the climax of metamorphosis. Further analyses of the transcriptome changes and the cell types present at the climax of metamorphosis should help to reveal how the molecular mechanism underlying T3-induction of adult epithelial stem cell development.
Acknowledgements: This work was supported by the Intramural Research Program of NICHD, NIH.
Poster 0368
Thyroid Cancer, Case Study, Poster
Tall Cell Variant Papillary Thyroid Cancer with Unexplained TSH and Thyroglobulin Elevation
Mirjana Barjaktarovic, Meredith Sorensen*, Philip Schaner, Sushela Chaidarun,Dartmouth Hitchcock, USA
Saturday, November 2, 2024
Poster 0369
Pregnancy and Development, Case Study, Poster
Delayed Recovery From Gestational Transient Thyrotoxicosis Causing Clinical Hypothyroidism in a Twin Pregnancy
Zoey Agle*1, Caroline Nguyen2, 1Keck School of Medicine, University of Southern California, USA, 2Department of Medicine and Obstetrics &Gynecology, Division of Endocrinology, Keck School of Medicine, University of Southern California, USA
Poster 0370
Surgery, Clinical, Poster
Intraoperative Assessment of Gross Extrathyroidal Extension to Strap Muscle in Differentiated Thyroid Carcinoma: Factors Influencing Accuracy and Association with Recurrence
Solji An*, Joonseon Park, Kwangsoon Kim, Ja Seong Bae, Jeong Soo Kim, Department of Surgery, College of Medicine, The Catholic University of Korea, Korea, Republic of
Poster 0371
Surgery, Clinical, Poster
Pre-operative Calcium and Vitamin D Supplement Can Prevent Postoperative Hypocalcemia Following Total Thyroidectomy: A Randomized Controlled Trial
Waraporn Imruetaicharoenchoke*, Pongthep Pisarnturakit, Mongkol Boonsripitayanon, Pradit Rushatamukayanunt, Suebwong Chuthapisith,Faculty of Medicine Siriraj Hospital, Thailand
To study optimal dosages of calcium and vitamin-D supplement in correction post-thyroidectomy hypocalcemia.
Poster 0372
Thyroid Cancer, Case Study, Poster
No Surgical Resection: Successful Resensitization of Recurrent BRAF Mutated Iodine-Refractory Thyroid Cancer Involving Trachea/Thyroid Cartilage with Dabrafenib and Trametinib
Melissa Papuc*1, Rosemarie Metzger2, Kresimira Milas2, Christian Nasr2, Amanda Edmond2, Monica Camou2, Jiaxin Niu2, 1University of Arizona College of Medicine Phoenix, USA, 2Banner MD Anderson, USA
Recurrent Iodine-refractory thyroid cancer (IRTC) involving trachea/thyroid cartilage remains a formidable clinical challenge. Surgical resection often results in significant impairment of quality of life. Tyrosine kinase inhibitors (TKIs) have become a standard treatment for advanced IRTC. Moreover, targeting BRAF with dabrafenib and trametinib has shown some promise in resensitizing IRTC to radioactive iodine (RAI), thereby potentially expanding treatment options and improving patient outcomes.
Case 1: a 72-year-old male with BRAF positive papillary thyroid cancer presented one year after initial therapy with IRTC involving left tracheoesophageal groove and lung metastasis, requiring tracheal and esophageal resection. He received dabrafenib/trametinib for 16 months, achieving radiographic complete remission and successful RAI ablation. He has now been off treatment without progression of disease for 15 months.
Case 2: a 48-year-old Native American male with BRAF mutated papillary thyroid cancer developed IRTC with extensive cervical and mediastinal lymph node metastases 1 year after initial treatment. He experienced multiple episodes of hemoptysis due to tracheal invasion. The patient was treated with dabrafenib/trametinib. His hemoptysis resolved in 2 weeks and had a near-complete response 6 months later. He received successful RAI therapy with discontinuation of TKIs. He has been progression free for 8 months.
Case 3: a 66-year-old male presented with recurrent BRAF positive IRTC 6 years after initial treatment. Despite a successful central neck dissection removing multiple lymph nodes, total laryngectomy was required for 1-cm metastasis involving thyroid cartilage. Treatment with dabrafenib/trametinib for 7 months was complicated by severe hyponatremia, confusion, and muscle spasm, requiring dose reduction of dabrafenib. With successful resensitization and RAI, he has been treatment-free and event-free for 12 months.
To our knowledge, this is the first report that dabrafenib/trametinib combination therapy was used successfully to treat BRAF mutated IRTC recurrence involving trachea or thyroid cartilage without surgical resection. All three patients continue to enjoy event-free survival with great quality of life. This unique strategy highlights the therapeutic efficacy of TKIs in disease control as well as overcoming iodine refractoriness in this challenging clinical scenario. Further research is warranted to address this unmet clinical need.
Poster 0373
Thyroid Cancer, Clinical, Poster
Leukemia Threats Following Radioactive Ablation Iodine for Thyroid Cancer
Yaser Bashumeel*, Ahmed Abdelmaksoud, Abdulrahman Ghaleb, Mohamed Hussein, Mahmoud Abd Alnaeem, Eman Toraih, Emad Kandil,Tulane University, USA
Poster 0374
Thyroid Cancer, Clinical, Poster
Initial versus Staged Thyroidectomy for Differentiated Thyroid Cancer: A Retrospective Multi-Dimensional Cohort Analysis of Effectiveness and Safety
Yaser Bashumeel*1, Ahmed Abdelmaksoud1,2, eman Toraih1, Mohammed Hussain1, Abdulrahman Ghaleb1, Emad kandil1, 1Tulane University, USA, 2University of California, Riverside, USA
Poster 0375
Thyroid Cancer, Clinical, Poster
Body Mass Index and Sporadic Medullary Thyroid Cancer: insights from a large series of patients
Alessandro Prete*1, Antonio Matrone1, Carla Gambale1, Elisa Minaldi1, Gabriele Materazzi2, Liborio Torregrossa3, Ferruccio Santini1, Alessio Basolo1, Rossella Elisei1, 1Unit of Endocrinology, University of Pisa, Italy, 2Unit of Endocrine Surgery, University of Pisa, Italy, 3Unit of Pathology, University of Pisa, Italy
Poster 0376
Thyroid Cancer, Clinical, Poster
Dissecting the Preoperative Profiles of Oncocytic and Follicular Thyroid Carcinomas
Alicia Belaiche*1, Grégoire Morand2,3,4, Sena Turkdogan5, Esther ShinHyun Kang1, Véronique-Isabelle Forest2, Marc Pusztaszeri6, Michael Hier2, Alex Mlynarek2, Keith Richardson5, Nader Sadeghi5, Marco Mascarella2,5, Sabrina Da Silva2, Richard Payne2,5, 1Faculty of Medicine and Health Sciences, McGill University, Canada, 2Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, McGill University, Canada, 3Department of Otorhinolaryngology – Head and Neck Surgery, University Hospital Zurich, Switzerland, 4Faculty of Medicine, University of Zurich, Switzerland, 5Department of Otolaryngology – Head and Neck Surgery, Royal Victoria Hospital, McGill University, Canada, 6Department of Pathology, Jewish General Hospital, McGill University, Canada
Poster 0377
Thyroid Cancer, Clinical, Poster
Systematic Review & Meta-Narrative of Unmet Care Needs in Adult Thyroid Cancer Survivors
Alisha Das*1, Gilberto Perez Rodriguez Garcia2, Esteban Cabezas3, Carma Bylund4, Juan Brito5, Naykky Singh Ospina2, 1College of Liberal Arts and Sciences, University of Florida, USA, 2Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Florida, USA, 3Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, USA, 4Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, USA, 5Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, USA
Amongst the quantitative studies, 3 studies utilized validated questionnaires to assess unmet needs across multiple domains with unmet psychological needs being the most reported by participants (50-70%). Physical and daily living needs were also significant, with 25-50% reporting unmet needs in each of these domains. Informational needs were frequently assessed using both validated and non-validated instruments, but the extent to which they were considered unmet varied among participants, ranging from 2% to 63%.
Through meta-aggregation of qualitative studies, four synthesized findings were derived: (1) thyroid cancer “good cancer” label driving unmet needs, (2) unmet informational needs through the survivorship process (e.g., diagnosis, treatment, recovery, re-integration), (3) unmet emotional support needs from: family, peers, medical professionals, and co-workers, and (4) unmet practical needs that hinder daily living (e.g. diet, medication management).
Poster 0378
Thyroid Cancer, Clinical, Poster
Development and Validation of the Thyroid Cancer Modified Anxiety Scale (TC-Max)
Amanda Bastien*, Sam Zhang, Sungjin Kim, Evan Walgama, Jon Mallen-St.Clair, Zachary Zumsteg, Allen Ho,Cedars Sinai, USA
Poster 0379
Thyroid Cancer, Clinical, Poster
Superior Re-differentiation of BRAF-Mutated Radioactive Iodine Refractory Differentiated Thyroid Cancer with Longer Duration of Dabrafenib and Trametinib
Amanda Edmond*1, Christian Nasr1, Iram Ahmad2, Monica Camou1, Chafeek Tomeh1, Thomas Shellenberger1, Rosemarie Metzger3, Jon Nelson3, Kresimira Milas3, Jiaxin Niu1, 1Banner MD Anderson, USA, 2Virginia Mason Franciscan Health, USA, 3Banner MD Anderson, USA
Poster 0380
Thyroid Cancer, Clinical, Poster
Reliability of serum thyroglobulin post-total thyroidectomy for detecting structural disease in thyroid cancer patients without radioactive iodine therapy, A prospective trial with median follow up of 7 years
Amani Alarayedh*, Anwar Jammah, Ibrahim Alsadhan, Sarah Alajmi, Alanood Asiri,King Saud university hospital, Saudi Arabia
This cut-off level demonstrates high diagnostic reliability comparable to the established Tg levels of ≤0.2 ng/mL. large sampled studies are needed to consider higher Tg cut-off level in low to intermediate risk DTC post total thyroidectomy with no RAI in monitoring disease recurrence.
Poster 0381
Thyroid Cancer, Basic, Poster
Exploration of Potential Biomarkers in Papillary Thyroid Cancer via RNA-seq Analysis
Anette Gastelum Quiroz*1,2, Noemí García Magallanes2, Andrea Ross Orozco1,2, Fred Luque Ortega3, Eliakym Arambula Meraz4, Marco Álvarez Arrazola5, 1Posgrado en Ciencias Biomédicas, Universidad Autónoma de Sinaloa, Mexico, 2Laboratorio de Biomedicina y Biología Molecular, Universidad Politécnica de Sinaloa, Mexico, 3Laboratorio de Ciencias Básicas, Universidad Autónoma de Sinaloa, Mexico, 4Laboratorio de Genética y Biología Molecular, Universidad Autónoma de Sinaloa, Mexico, 5Álvarez y Arrazola Radiólogos, Mexico
Papillary thyroid cancer (PTC) has experienced an increase in incidence in recent decades. Despite advances in PTC research, challenges such as understanding the molecular mechanisms persist. Thus, increased knowledge on the molecular basis of thyroid neoplasia allows for an improved approach to diagnosis through subclassification of indeterminate thyroid nodules, prognosis and therapeutics by identifying potential new therapeutic targets. Objective. The aim of this study was to identify differentially expressed genes (DEGs) in PTC and their involvement in biological processes. Methods. Six RNA-seq transcriptomic datasets (GSE197443, GSE201365, GSE171011, GSE87410, GSE153659, and GSE165724) from PTC and adjacent normal tissue obtained from NCBI's Gene Expression Omnibus public repository were analyzed. Identification of DEGs was performed with the DESEq2 package in RStudio. Genes with an adjusted p value <0.05 were considered significant and with a logFc value >2 and <-2 were considered overexpressed and underexpressed, respectively. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were performed using ClusterProfiler package in Rstudio. Protein-protein interaction (PPI) network analysis was performed in STRING platform, molecular networks were retrieved in Cytoscape software to identify hub genes and 10 hub genes were screened according to the Maximal Clique Centrality (MCC) score. Finally, 2 genes were selected and their expression was analyzed by qPCR through mRNA isolated from FNA samples from patients with a diagnosis of PTC (Bethesda V and VI) (n=37), benign thyroid disease (Bethesda II) (n=32) and indeterminate cytological diagnosis (Bethesda IV) (n=17). Results. A total of 131 DEGs were identified among the 6 datasets, 3 down-regulated and 128 up-regulated. Among the biological processes in which DEGs participate are skin development, epidermis development, tissue development, wound healing, epithelium development, cell adhesion, animal organ development, and growth development regulation. They were shown to be involved in cellular components at cell-cell junction, basal part of cell, plasma membrane region, integral component of plasma membrane and apical junction complex. The 10 hub genes screened were FN1, MET, KRT19, DPP4, CLDN1, ITGA2, ERBB3, TGFA, CDH3, and SERPINA1. CLDN1 and KRT19 were selected for testing by qPCR and both were found to be significantly overexpressed in Bethesda VI (CLDN1=5.26±4.1 and KRT19=4.11±3.2) compared to Bethesda II (p<0.05). Conclusions. These findings suggest that these DEGs could serve as potential biomarkers for the diagnosis and prognosis of PTC. Furthermore, understanding the molecular mechanisms underlying thyroid neoplasia could facilitate the development of new targeted therapeutic strategies.
Poster 0382
Thyroid Cancer, Clinical, Poster
Unveiling the issues about sporadic apparently non-invasive medullary thyroid cancer
Antonio Matrone*1, Alessandro Prete1, Raffaele Ciampi1, Teresa Ramone1, Cristina Romei1, Carla Gambale1, Eleonora Molinaro1, Gabriele Materazzi2, Liborio Torregrossa3, Rossella Elisei1, 1Unit of Endocrinology, University of Pisa, Italy, 2Unit of Endocrine Surgery, University of Pisa, Italy, 3Unit of Pathology, University of Pisa, Italy
Poster 0383
Thyroid Cancer, Clinical, Poster
Preoperative Thyroglobulin Antibody Status Predicts Histopathological Aggressiveness of Differentiated Thyroid Cancer
Anupam Kotwal*, Patrick Loucks, Fang Qiu, Cheng Zheng, Oleg Shats, Ana Thach, Whitney Goldner,University of Nebraska Medical Center, USA
Poster 0384
Thyroid Cancer, Clinical, Poster
Changes in survival in patients with metastatic thyroid cancer in the era of tyrosine kinase inhibitors
Ashwin Govindan*1, Wei Wei2, Philippos Costa3, Sachin Majumdar4, Avanti Verma3, Saral Mehra3, Ansley Roche3, Priyadarshini Balasubramanian4, Olga Sakharova4, Courtney Gibson4, Manju Prasad4, Patricia Peter4, Henry Park3, Jennifer Ogilvie3, Adriana Ramirez3, Sara Pai3, Zafar Syed4, Barbara Burtness3, Aarti Bhatia3, Michael Chiorazzi3, Kavya Mekala3, Adebowale Adeniran4, Hari Deshpande3, 1Netter School of Medicine, Quinnipiac University, USA, 2Yale Cancer Center, USA, 3Smilow Cancer Hospital, Yale Cancer Center, USA, 4Smilow Cancer Hospital, USA
1992-2003
Papillary number of patients (N): 273 OS 10 months (mo) Confidence Interval (CI) 6.8 - 13.2 mo,
Medullary N 50, OS 8 mo, CI 12.7 – 22.4 mo;
Follicular N 111 OS 11 mo CI 5.6 – 16.4 mo;
Oncocytic N 26 OS 5.5 mo CI 2.6 – 10.4 mo.
2010 – 2017
Papillary N 2155 OS 60 mo CI 58.4 – 61.6 mo; (p<0.001)
Medullary N 226 OS 31 mo CI 26-3 – 35.6 mo; (p=0.004)
Follicular N 299 OS 44 mo CI 40.1 – 47.9 mo; (p<0.001)
Oncocytic N 85 OS 46 mo CI 38.8 – 53.2 mo. (p=0.5)
Poster 0385
Thyroid Cancer, Clinical, Poster
Impact of Physical Activity and its Maintenance in the Efficacy and Safety of Tyrosine Kinase Inhibitors in Advanced Thyroid Carcinoma Patients
Carla Colombo*1,2, Daniele Ceruti2, Fabrizio Cervellini3, Simone De Leo2, Matteo Trevisan1, Massimiliano Succi2, Marina Lugaresi1, Claudia Moneta2, Laura Fugazzola1,2, 1Department of Pathophysiology and Transplantation, University of Milan, Italy, 2Istituto Auxologico Italiano IRCCS, Italy, 3School of Sports Science, university of Milan, Italy
Poster 0386
Thyroid Cancer, Clinical, Poster
Variation in Episode Spending for Thyroidectomy in Thyroid Cancer
Catherine Jensen*1,2, Aayushi Sinha1, Steven Xie1, Hunter Underwood1, Elizabeth Bacon1, Hari Nathan1, Susan Pitt1, 1University of Michigan, USA, 2University of Wisconsin, USA
In the mixed model, patient factors significantly associated with increased spending were age ($61 per year older [95%CI $28-$94], p<0.001 and post-operative length of stay exceeding 2 nights ($14,630 [95%CI $12,879-$16,382], p<0.001). Compared to lobectomy alone, greater extent of surgery was associated with increased spending: total thyroidectomy ($1,229 ([95%CI $321-$2,138]; p=0.008) and lobectomy+completion thyroidectomy ($5,680 ([95%CI $3,384-$7,975]; p<0.001). Patients requiring readmission within 30 days had dramatically higher spending ($17,885 [95%CI $15,362-$20,408]; p<0.001). Factors not significantly associated with spending variation included patient insurance, case volume, bed size, and teaching status.
Poster 0387
Thyroid Cancer, Clinical, Poster
A Revised Perspective on the AJCC Staging System for Medullary Thyroid Cancer: Results from a Chinese Nationwide Multicenter Cohort and the US SEER Database
Cenkai Shen*, Xiao Shi, Yuxin Du, Yu Wang,Fudan University Shanghai Cancer Center, China
Poster 0388
Thyroid Cancer, Clinical, Poster
Identifying Prognostic Thresholds for Lymph Node Metastasis in Medullary Thyroid Cancer
Christina Lindsay*, Samantha Thomas, Frances Wang, Todd Frieze, Randall Scheri, Hadiza Kazaure,Duke University, USA
Poster 0389
Thyroid Cancer, Clinical, Poster
Increased Exposure to Medical Radiation from CT Scans and Other Imaging Procedures in Relation to Increased Risk of Thyroid Cancer
De-Kun Li*, Jeannette Ferber, Roxana Odouli, Division of Research, Kaiser Foundation Research Institute, Kaiser Permanente, USA
Poster 0390
Thyroid Cancer, Clinical, Poster
Germline PPM1D Variant Association with Aggressive Oncocytic Thyroid Carcinoma
Freddy Toloza Bonilla*1, James Welch1, Padma Veeraraghavan1, Irina Veytsman2, Sriram Gubbi1, Joanna Klubo-Gwiezdzinska1, 1National Institutes of Health, USA, 2MedStar Washington Hospital Center’s Cancer Center, USA
Other clinical features included short stature, broad forehead, broad mouth with thin upper lip, and first-degree relatives with short stature and neuro-developmental disorders (epilepsy and learning disability), suggestive of JdVS. While p.Thr483Lysfs*4 variant has uncertain significance as a cause of JdVS, we found it as a rare (0.18%) somatic pathogenic driver in TC (3/1620 TCGA). Different PPM1D pathogenic variants are observed in 1.3% (21/1620) of papillary TC and 1.4% (1/70) of OTC. DFS is significantly lower in TC patients harboring pathogenic PPM1D mutations as compared with patients with non-pathogenic variants (p=0.006).
Poster 0391
Thyroid Cancer, Clinical, Poster
The Role of Molecular Testing for Bethesda V Thyroid Nodule: Clarity or Controversy?
Idit Tessler1, Eran Alon1, Arad Dotan1, Tzahi Yamin1, Nir Gecel1, Grégoire Morand2, Richard Payne2, Galit Avior*1, 1Sheba Medical Center, Israel, 2McGill University, Canada
Poster 0392
Thyroid Cancer, Clinical, Poster
Serum Anti-thyroglobulin Antibody Levels Following Total Thyroidectomy Are Related To The Recurrence Of Papillary Thyroid Carcinoma
Ho Jung JEONG*, Yong Sang Lee, Seok Mo Kim,Gangnam Severance Hospital, Republic of Korea
Poster 0393
Thyroid Cancer, Clinical, Poster
Therapeutic Outcomes and Safety of Radiofrequency Ablation for Primary Papillary Thyroid Carcinoma: Meta-analysis
Humza Pirzadah*1, Hassan Malik1, Eman Toraih2, Emad Kandil2, 1Louisiana State University Health Science Center, USA, 2Tulane University School of Medicine, USA
Poster 0394
Thyroid Cancer, Clinical, Poster
Current status of repeated 100 mCi radioiodine therapy for differentiated thyroid cancer: 86 cases in Japan
Ichiro AKIYAMA*, Tomohiro NOGAMI, Moko TANIGUCHI,NHO Okayama medical center, Japan
Poster 0395
Thyroid Cancer, Clinical, Poster
A Case of a Devious Diffuse Large B-Cell Lymphoma of the Thyroid Gland
Sara Shteyman1, Ipek Alpertunga*2, Vitaly Kantorovich2, Samaneh Rabieihashemi2, 1University of Conneticuc, USA, 2Hartford Hospital, USA
Primary thyroid lymphoma is a rare entity, representing less than 5% of thyroid malignancies and less than 2% of all lymphomas occurring outside the lymph nodes.
A 58-year-old male was admitted with hypercalcemia, AKI, and significant thyromegaly. He had a two month history of new hypothyroidism with rapidly enlarging goiter, leading to progressive dysphagia and a 25 pound weight loss. His labs showed hypercalcemia of 11.5 (8.7-10.5 mg/dL), PTH <6 (16-77 pg/mL), 25-OH Vitamin D 22 (30-100 ng/mL), 1, 25 dihydroxy vitamin D 142 (18-72 pg/mL). Patient received zoledronic acid and intravenous fluids. CT showed enlarged thyroid gland with superior mediastinal extension, completely encircling the trachea with mass effect on the esophagus. Thyroid ultrasound revealed a heterogeneous and hypervascular goiter without distinct thyroid nodules or abnormal lymphadenopathy.
FNA and two core biopsies showed atypical lymphoid infiltration, however due to having a limited sample with necrosis, definitive diagnosis was unable to be made. He subsequently had an excision of the thyroid isthmus and was diagnosed with diffuse aggressive B-cell non-Hodgkin lymphoma.
Molecular testing was positive for C-MYC gene rearrangement (82/200, 41% of nuclei). PET/CT showed substantial enhancement of the thyroid gland without evidence of FDG-avid metastatic lesions. Patient received 5 cycles of chemotherapy with R-CHOP. He had a significant clinical response after cycle one, with improvement in dysphagia and hypercalcemia. Vitamin D 1,25 OH level was used as a tumor marker and normalized to 26 (18-72 pg/mL) at the end of the treatment. PET scan after last chemotherapy cycle showed resolution of the goiter and there was no evidence for FDG avid residual malignancy. Thyroid function tests were monitored and levothyroxine dose adjusted during the duration of treatment.
This is a case of a thyroid lymphoma that took three different tissue sampling modalities to establish the diagnosis. Though primary thyroid lymphoma is rare, the index of suspicion should remain high in patients who have a rapidly enlarging goiter and 1,25-dihydroxy Vitamin D mediated hypercalcemia. If core biopsy results are equivocal, excisional biopsy might be needed.
Poster 0396
Thyroid Cancer, Clinical, Poster
The Prognostic Value of RAS Mutations in Thyroid Cancer: A Meta-Analysis
Isabel Riccio*, Alexandra LaForteza, Mohammad Hussein, Joshua Linhuber, Madeleine Landau, Jonathan Staav, Peter Issa, Eman Toraih, Emad Kandil,Tulane University School of Medicine, USA
Poster 0397
Poster 0398
Thyroid Cancer, Clinical, Poster
Pemetrexed-Carboplatin Salvage Therapy in Advanced Thyroid Cancers
Kenzie Lee*, John Morris, Aditi Kumar, Ashish Chintakuntlawar, Candy Peskey, Crystal Hilger, Keith Bible, Mabel Ryder,Mayo Clinic, USA
Poster 0399
Thyroid Cancer, Clinical, Poster
RAS Mutations as Predictors of Malignancy Status of Thyroid Nodules - a Retrospective Review
Layo Alaga*, Elizabeth Siciliani, Richard Payne, McGill University, Canada
Poster 0400
Thyroid Cancer, Clinical, Poster
Papillary Thyroid MicrocarcinoThyroid Microcarcinoma: Large Case Series and Outcomes Over Up to 45 Years of Follow-Up
Nathalie Sedassari, Patricia Magalhães, Léa Maciel*,Ribeirâo Preto - USP Medical School, Brazil
A significant increase in the incidence of papillary thyroid cancer, especially papillary thyroid microcarcinoma (mPTC), has been reported worldwide. Due to its indolent nature, excellent clinical outcomes have been reported for mPTC patients.
Poster 0401
Thyroid Cancer, Clinical, Poster
The development of a thyroid cancer cohort and biospecimen biorepository at Mount Sinai Hospital: DIRECT-P cohort
Mathilda Monaghan*, Eric Genden, Emanuela Taioli, Elise Brett, Maaike van Gerwen,Icahn School of Medicine at Mount Sinai, USA
Poster 0402
Thyroid Cancer, Clinical, Poster
Consolidative radiotherapy for oligometastatic and oligoprogressive anaplastic thyroid carcinoma: the potential utility of local therapy for limited distant sites
Matthew Ning*, Stephanie Dudzinzski, Naifa Busaidy, Ramona Dadu, Sarah Hamidi, James Welsh, Brandon Gunn, Steven Waguespack, Mimi Hu, Vicente Marczyk, Michael Spiotto, Jack Phan, Jay Reddy, Anna Lee, Ethan Ludmir, Anastasios Maniakas, Priyanka Iyer, Thomas Beckham, Mark Zafereo, Maria Cabanillas,UT MD Anderson Cancer Center, USA
Poster 0403
Thyroid Cancer, Clinical, Poster
Effect of 1 versus 2 week low-iodine diet on urinary iodine levels prior to RAI therapy
Nikhila Janakiram, Tracy Tylee, Mara Roth, Mayumi Endo*,University of Washington, USA
Poster 0404
Thyroid Cancer, Clinical, Poster
The Effect of Age at Diagnosis and Histological Subtype on Survival in Differentiated Thyroid Carcinoma: An International Individual Participant Data Meta-Analysis
Merel Stegenga*1, Arash Derahkshan1, Yanning Xu1, Ali Alzahrani2, Gabriela Brenta3, Alicia Gauna4, Tessa van Ginhoven1, Luca Giovanella5, Omar Hilmi6, Folkert van Kemenade1, Mijin Kim7, Won Kim8, Iain Nixon9, Robin Peeters1, Antonio Prinzi10, Wolfgang Roll11, Ricard Simo12, Roderick Tummers13, Erik Verburg1,14, Wouter Zandee15, Tim Korevaar1, W. Edward Visser1, Evert van Velsen1, 1Erasmus Medical Center, Netherlands, 2King Faisal Specialist Hospital & Research Centre, Saudi Arabia, 3Cesar Milstein Hospital, Argentina, 4Ramos Mejía Hospital, Argentina, 5University Hospital Zürich, Switzerland, 6NHS Greater Glasgow and Clyde, United Kingdom, 7Pusan National University Hospital, Pusan National University School of Medicine, Korea, Republic of, 8Asan Medical Center, University of Ulsan College of Medicine, Korea, Republic of, 9NHS Lothian, University of Edinburgh, United Kingdom, 10Garibaldi-Nesima Medical Center, University of Catania, Italy, 11University Hospital Münster, Germany, 12Guy's and St Thomas’ Hospitals NHS Trust, United Kingdom, 13Zuyd Thyroid Center, Zuyderland Medical Center, Netherlands, 14University of Würzburg, Germany, 15University Medical Center Groningen and University of Groningen, Netherlands
Poster 0405
Thyroid Cancer, Clinical, Poster
The treatment and prognosis in locally advanced and metastatic thyroid cancer: a single center experience of 279 patients
Nai-si Huang*, Jia-ying Chen, Dong-mei Ji, Jia-qian Hu, Yu-jun Wang, Wan-lin Liu, Qing-hai Ji, Yu Wang,Fudan University Shanghai Cancer Center, China
Poster 0406
Thyroid Cancer, Clinical, Poster
Comparative Outcomes Of Synchronous Follicular And Papillary Thyroid Cancers: A Retrospective Analysis
Ho Jung JEONG, Nam Kyung Kim*, Hyeok Jun Yun,Gangnam Severance Hospital, Korea, Republic of
Poster 0407
Thyroid Cancer, Clinical, Poster
Health-related quality of life analysis in a phase 2 study of encorafenib + binimetinib for patients with unresectable or metastatic BRAF V600-mutated thyroid cancer
Naomi Kiyota*1, Makoto Tahara2, Hiroo Imai3, Shunji Takahashi4, Akihiro Nishiyama5, Shingo Tamura6, Yasushi Shimizu7, Shigenori Kadowaki8, Ken-ichi Ito9, Masahiro Toyoshima10, Yoshinori Hirashima10, Shinji Ueno10, Kenji Hiraizumi10, Iwao Sugitani11, 1Kobe University Hospital Cancer Center, Japan, 2National Cancer Center Hospital East, Japan, 3Tohoku University Hospital, Japan, 4The Cancer Institute Hospital of JFCR, Japan, 5Kanazawa University Hospital, Japan, 6NHO Kyushu Medical Center, Japan, 7Hokkaido University Hospital, Japan, 8Aichi Cancer Center Hospital, Japan, 9Shinshu University School of Medicine, Japan, 10Ono Pharmaceutical CO., Ltd, Japan, 11Nippon Medical School Hospital, Japan
Poster 0408
Thyroid Cancer, Clinical, Poster
The Role of Artificial Intelligence in Predicting the Future Burden of Thyroid Cancer in Missouri. A Comparative Analysis
Samuel Kim, Michael Moncure, Patrick Weldon*,University of Missouri-Kansas City, USA
Poster 0409
Thyroid Cancer, Clinical, Poster
Programmed Death-Ligand 1 Expression is Associated with Local Invasion and Distant Metastases in Differentiated Thyroid Cancer: a Systematic Review and Meta-Analysis
Rajan Mediratta*1, Cheng Zheng1, Cindy Schmidt1, Ilia Bernstein2, Apar Ganti1, Anupam Kotwal1, 1University of Nebraska Medical Center, USA, 2Charleston Area Medical Center, USA
Poster 0410
Thyroid Cancer, Clinical, Poster
Ultrasound-guided treatment of cervical metastases from thyroid carcinoma: a prospective clinical trial with cryoablation, laser or radiofrequency ablation
Ricardo Freitas1, Pedro Araujo1, Maria Chammas2, Luiz Kowalski1, Marco Kulcsar1, Debora Danilovic1, Luciana Neves*1, Ana Hoff1, 1Instituto do Cancer do Estado de São Paulo, Brazil, 2Instituto de Radiologia HC-FMUSP, Brazil
Poster 0411
Thyroid Cancer, Clinical, Poster
Back pain masquerading as metastatic papillary thyroid carcinoma
Sadaf Hossain*, Md. Hossain, Bharat Gautam, Bishal Tiwari, David Rosenthal, Salini Kumar, Huijuan Liao,Nassau University Medical Center, USA
CT abdomen showed complex cystic lesions within the right kidney, and a 4 cm x 3 cm soft tissue mass medial to the right kidney, lytic lesion in the T12 vertebra with osseous destruction of the vertebral body, pedicle and right 12th rib. Further evaluation with MRI showed more lytic lesions in the cervical vertebrae, initially suggesting a primary renal neoplasm with metastatic spread to the vertebrae.
Excision biopsy of the soft tissue mass however revealed the tall cell variant of papillary thyroid carcinoma, with extensive necrosis, hemorrhage and areas of psammomatous calcification. CT soft tissue neck obtained afterwards, showed a heterogenous mass in the right thyroid.
The patient underwent total thyroidectomy that confirmed papillary thyroid carcinoma, with pathology revealing a diffuse follicular variant with focal oncocytic features. Molecular testing demonstrated mutations in NRAS and TERT genes, indicative of high-risk thyroid cancer with potential for early distant metastasis. Immunohistochemistry was positive for HBME-1, thyroglobulin, TTF-1 and CK-19 also consistent with papillary thyroid carcinoma.
Her postoperative course was uneventful. Long-term management plans included consideration of targeted therapy, and optimization of bone health.
Poster 0412
Thyroid Cancer, Clinical, Poster
Response to therapy in ATA high risk of recurrence differentiated thyroid cancer patients treated with adjuvant high-dose radioactive iodine
Sana Ghaznavi*, Ralf Paschke, David Twa, Jiahui Wu,University of Calgary, Canada
The rate of SIR during a median 44 months of follow-up was 42% (n=35 patients; 25 had locoregional disease and 13 had distant metastases). Site of distant metastases included: lung n=13 and bone n=2. Twenty-three patients (27%) required additional treatment after initial surgery and adjuvant RAI, which included: observation (n=12, 34%), additional surgery (n=13, 57%), additional RAI (n=7, 30%), and systemic therapy (n=7, 30%).
Poster 0413
Thyroid Cancer, Clinical, Poster
A novel online medullary thyroid cancer (MTC) educational resource: How patients find it, use it, and what they learn
Sophia Williams-Perez*1, Julie Ann Sosa2, Mark Zafereo1, Maria Cabanillas1, Anne Brinkman1, Steven Waguespack1, James Alexander1, Viola Leal1, Robert Volk1, Mimi Hu1, Elizabeth Grubbs1, 1The University of Texas MD Anderson Cancer Center, USA, 2University of California San Francisco, USA
Poster 0414
Thyroid Cancer, Clinical, Poster
Association between Environmental Air Pollution and Thyroid Cancer and Nodules: A Systematic Review
Varun Vohra*1, Lekha Yesantharao1, Rachel Stemme1, Nicole Deziel2, Shyam Biswal3, Lilah Morris-Wiseman1, Murugappan Ramanathan Jr.1, Aarti Mathur1, 1Johns Hopkins School of Medicine, USA, 2Yale University School of Public Health, USA, 3Johns Hopkins Bloomberg School of Public Health, USA
Poster 0415
Thyroid Cancer, Clinical, Poster
Clinicopathologic Characteristics and Outcomes in Early Versus Later-Onset Advanced Thyroid Carcinoma
Vijithan Sugumar*1,2, Peiran Sun1, Yangqing Deng3, Thais Megid1, Aruz Mesci4, Jelena Lukovic4, Ozgur Mete5, Karen Gomez Hernandez6, David Goldstein7, Monika Krzyzanowska8, Carly Barron1, Lucy Ma1,2, 1Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Canada, 2Temerty Faculty of Medicine, University of Toronto, Canada, 3Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Canada, 4Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Canada, 5Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada, 6Endocrine Oncology Site Group, Princess Margaret Cancer Centre, University Health Network, Canada, 7Department of Otolaryngology-Head and Neck Surgery, Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada, 8Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, Canada
Poster 0416
Thyroid Cancer, Clinical,
Study on association Between human plasma Polybrominated Diphenyl Ethers and Thyroid carcinoma
Wang Qianqian*1, Wang Yi1, Chen Chunyan1, Zhang Likun1, Wang Chenglong1, Lou Xinyu2, Chen Dan2, Sui Shaofeng3, Fan Youben1, Jin Jun2, Liu Zhiyan1, 1Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China, 2Minzu University of China, China, 3Shanghai Municipal Center for Disease Control and Prevention, China
Poster 0417
Thyroid Cancer, Clinical, Poster
Reappraisal of BRAFK601E-positive Thyroid Tumors in the NIFTP Era
William Doerfler*1, Alyaksandr Nikitski1, Shannon Keating1, Daniel Spagnolo1,2, Elena Morariu1, Esra Karslioglu French1, Linwah Yip1, Marina Nikiforova1, Abigail Wald1, Yuri Nikiforov1, 1University of Pittsburgh, USA, 2Artios, United Kingdom
Poster 0418
Thyroid Cancer, Basic, Poster
The Role of CREB3L1 in Thyroid Carcinoma Dedifferentiation and Prognosis: Insights from Murine Models and Clinical Specimens
Xiangyu Kong*, Hancong Li, Peiheng Li, Yue Zhao, Gongshuang Zhang, Zhihui Li, Han Luo,West China Hospital, China
Poster 0419
Thyroid Cancer, Clinical, Poster
Combined detection of preoperative serum calcitonin and carcinoembryonic antigen for the diagnosis and prognosis prediction of medullary thyroid cancer: a retrospective multicenter cohort study
Yihao Liu*, Yu Yang,The First Affiliated Hospital of Sun Yat-sen University, China
Poster 0420
Thyroid Cancer, Clinical, Poster
Role of Ultrasound Surveillance for Thyroid Cancer in Setting of Negative Thyroglobulin
Young-Ji Seo*, Ryan Tiu, Katharina Stahl, Elena Hughes, Chi-Hong Tseng, Masha Livhits, Michael Yeh, James wu,University of California, Los Angeles, USA
Poster 0421
Thyroid Cancer, Clinical, Poster
Clinical Characteristics and Prognostic Evaluation of Calcitonin-Negative Medullary Thyroid Carcinoma in a Multicenter Cohort of 1018 Patients
Yuxin Du*, cenkai Shen, Xiao Shi, Wenjun Wei, Yu Wang,Fudan University Shanghai Cancer Center, China
Poster 0422
Thyroid Cancer, Clinical, Poster
Cancer Recurrence in a Cohort of Patients With Differentiated Thyroid Cancer Diagnosed 5 or More Years Ago in Northwest Mexico
Adriana Castillo Jaidar*, Mónica Nieves Viveros, Alberto Murillo Ruiz Esparza, Carlos Jiménez Ricárdez, Juan Román Quevedo,ISSSTE, Mexico
Poster 0423
Thyroid Cancer, Case Study, Poster
Thyroid Collision Tumor: Incidental Detection of Synchronous Medullary Thyroid Carcinoma and Papillary Thyroid Microcarcinoma- A Case Study
Adalberto Gonzalez Pantaleon1, Valery Carrion2, Stephanie Trochez2, Peter Calixte2, Enrique Capellan Lopez*3, 1ImmunoPath Dominicana, Dominican Republic, 2Universidad Iberoamericana, Dominican Republic, 3CEDIMAT, Dominican Republic
Poster 0424
Thyroid Cancer, Clinical, Poster
Use of Natural Language Processing to automate risk of recurrence in patients with papillary thyroid cancer using surgical pathology reports
Esteban Cabezas*1, Ricardo Loor-Torres1, Yuqi Wu1, David Toro-Tobon1, Misk Al Zahidy1, Maria Mateo Chavez1, Mariana Borras Osorio1, Jungwei Fan1, Naykky Singh Ospina2, Yonghui Wu2, Juan Brito1, 1Mayo Clinic, USA, 2University of Florida, USA
Poster 0425
Thyroid Cancer, Clinical, Poster
Exploring Participant Demographics in Studies Addressing Unmet Care Needs of Thyroid Cancer Survivors: A Systematic Review
Esteban Cabezas*1, Gilberto Perez- Rodriguez2, Alisha Das2, Carma Bylund2, Juan Brito1, Naykky Singh Ospina2, 1Mayo Clinic, USA, 2University of Florida, USA
Poster 0426
Thyroid Cancer, Clinical, Poster
Characteristics Assessment Of YouTube Videos On Radioactive Iodine Therapy For Thyroid Cancer For Patient Education
Laura Samson*1, Brandon Chai1, Paris-Ann Ingledew2,3, 1MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Canada, 2BC Cancer – Vancouver; Department of Radiation Oncology, Canada, 3Department of Surgery, University of British Columbia, Canada
Poster 0427
Thyroid Cancer, Clinical, Poster
Characterization of RAS-mutant Anaplastic Thyroid Carcinoma (ATC)
Sarah Hamidi*, Ramona Dadu, Mark Zafereo, Jennifer Wang, Sinchita Roy-Chowdhuri, Michelle Williams, Renata Ferrarotto, Neal Akhave, Luana Sousa, Priyanka Iyer, Vicente Marczyk, Theresa Guise, Marie-Claude Hofmann, Naifa Busaidy, Anastasios Maniakas, Maria Cabanillas,The University of Texas MD Anderson Cancer Center, USA
Poster 0428
Thyroid Cancer, Clinical, Poster
Evaluating How Patients With Thyroid Cancer Use Online Resources And Social Media to Access Health Information
Laura Samson*1, Sarah Hamilton2,3, Eric Berthelet2,3, Eric Tran2,3, Jonn Wu2,3, Paris-Ann Ingledew2,3, 1MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Canada, 2BC Cancer – Vancouver; Department of Radiation Oncology, Canada, 3Department of Surgery, University of British Columbia, Canada
Poster 0429
Thyroid Cancer, Clinical, Poster
Efficacy and Safety of Selective RET Inhibitors in Hereditary Medullary Thyroid Carcinoma
Sarah Hamidi*1, Sireesha Yedururi1, Mimi Hu1, Naifa Busaidy1, Steven Sherman1, Camilo Jimenez1, Elizabeth Grubbs1, Anastasios Maniakas1, Mark Zafereo1, Vivek Subbiah1,2, Steven Waguespack1, 1The University of Texas MD Anderson Cancer Center, USA, 2Sarah Cannon Research Institute, USA
Poster 0430
Thyroid Cancer, Clinical, Poster
Clinicopathological Features of Advanced, RAS-driven Differentiated Thyroid Carcinoma (DTC)
Sarah Hamidi*, Anastasios Maniakas, Sinchita Roy-Chowdhuri, S. Mohsen Hosseini, Ramona Dadu, Steven Waguespack, Mimi Hu, Steven Sherman, Priyanka Iyer, Vicente Marczyk, Theresa Guise, Marie-Claude Hofmann, Naifa Busaidy, Jennifer Wang, Mark Zafereo, Maria Cabanillas,The University of Texas MD Anderson Cancer Center, USA
Poster 0431
Thyroid Cancer, Clinical, Poster
Medullary Thyroid Cancer with Novel Gene Alteration and Novel Management
Shaza Samargandy*,King Abdulaziz University, Saudi Arabia
Medullary thyroid carcinoma (MTC) is one of the potentially aggressive forms of thyroid cancer, with a 5-year survival for stage IV as low as 28%.
A 43-year-old gentleman presented with a left neck mass for six months. No self or family history of thyroid disorders or malignancy. Examination showed thyroid nodules with cervical lymphadenopathy. Investigations showed TSH=2.2mIU/L, and neck ultrasound showed a left thyroid nodule of 2.2 cm (TR4) and Left cervical suspicious lymph nodes (LN). FNA from the thyroid nodule: Bethesda 6 (malignant).Core biopsy from Left cervical LN: MTC.CT neck showed Left thyroid nodules, with suspicious left cervical lymphadenopathy, the largest is 3.6 cm at level III. No invasion of surrounding tissue. RET oncogene: negative. Calcitonin: 243 ng/L. CT chest showed lung metastasis, and MRI liver showed multiple liver metastatic lesions, the largest 1.3cm. Patient underwent total thyroidectomy with central and Left lateral neck dissection.
Histopathology: Unifocal MTC at the left lobe 3.4 x 2 x 2 cm. Mitotic figures <1/2 mm2. Negative margins and no extrathyroidal extension. Malignant LN (4/37) on the Left side, largest (4 cm), with extranodal extension. Three months postoperatively, Calcitonin: 45 ng/L, CEA 19.7. PET scan: Left humeral head and acetabulum metastasis. Known lung metastases were stable. Liver metastasis progressed, reaching 2.7 cm at segment 3, and 3 cm at segment 6. Patient declined medical therapy. He underwent external beam radiation to the affected bone lesions, and also Denosumab was started. Eight months later, there was further progression in the liver and bone. Calcitonin level increased to 251, and CEA 756.
Tumor genetic testing showed SCG-3 ALK-fusion. Therefore, the patient was commenced on Alectinib. Three months later, subsequent images showed a dramatic reduction in the size and number of liver lesions, significant response in the lung lesions, and stability in the bone lesions. Calcitonin level dropped to an undetectable level.
This is an entirely new gene fusion that has never been reported in thyroid cancer or any other cancer listed in the COSMIC or cBioportal database. Advances in genetic testing have transformed the management of thyroid cancer.
Poster 0432
Thyroid Nodules and Goiter, Clinical, Poster
Diagnostic Accuracy of Thyroid Nodules with Indeterminate Cytology when Combined with Ultrasonographic Risk
Shaza Samargandy*, Saad Samargandy, Yousef Khedher, Ghaida Alzahrani, Hesham Nahhas, Mohammed Alshaikh, Khalid Alzahrani,King Abdulaziz University, Saudi Arabia
Poster 0433
Thyroid Cancer, Clinical, Poster
Recombinant Human Thyroid-stimulating Hormone versus Thyroid Hormone Withdrawal in Aiding Postoperative Dynamic Surveillance for Patients with Differentiated Thyroid Cancer
Yan-song Lin*1,2, Qing-Jie Ma3, Wei Fu4, Hui Yang5, Yong-Ju Gao6, Zhi-Yong Li7, Jin-Xiong Huang8, 1Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & PUMC, China, 2Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, China, 3Affiliated China-Japan Union Hospital of Jilin University, China, 4Affiliated Hospital of Guilin Medical University, China, 5Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, China, 6People's Hospital Henan, China, 7The Affiliated Hospital of Xuzhou Medical University, China, 8The First affiliated Hospital of Xiamen University, China
Poster 0434
Thyroid Cancer, Case Study, Poster
A case of thyroid eye disease complicated with radioactive iodine refractory differentiated thyroid cancer under anlotinib therapy
Di Sun1,2, Xin Zhang1,2, Zhuan-Zhuan Mu1,2, Yu-Qing Sun1,2, Cong Shi1,2, Ying-Qiang Zhang1,2, Yan-Song Lin*1,2, 1Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College (PUMC) Hospital, China, 2Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, China
Thyroid eye disease (TED) is an autoimmune disease of the retroorbital tissues. The cross-reaction of thyroid-stimulating hormone receptor antigen in thyroid and ocular fibroblasts is critical to TED pathogenesis. TED after radioactive iodine (RAI) therapy for differentiated thyroid cancer (DTC) is rare, particularly in metastatic patients. We describe a patient with RAI refractory DTC who developed TED after RAI therapy and anlotinib therapy.
A 66-year-old female underwent three times of surgeries for papillary thyroid cancer and lymph node metastasis in 1996, 2011, and 2016 respectively, followed by two RAI therapies of 150 mCi. From August 2017 to June 2022, her suppressed thyroglobulin (Tg) level gradually grew from 0.96 to 248 ng/mL while the Tg antibody was negative. Additionally, her thyrotrophin receptor antibody (TRAb) level increased from negative to 33.43 (<2.5) IU/L. She then started anlotinib therapy for multiple unresectable cervical metastatic lymph nodes and lung metastases. She achieved partial response 6 weeks after anlotinib but soon began to complain of diplopia, periorbital edema, and proptosis. Her Tg level declined to 42.1 ng/mL, whereas TRAb stayed at 34.5 IU/L. Orbital magnetic resonance imaging and ophthalmologic examinations confirmed the diagnosis of TED. Considering the presence of multiple metastases, she received retrobulbar injections of triamcinolone under anlotinib instead of i.v. glucocorticoids. After 8 injections (20 mg per side q.m.), her symptoms were significantly improved, and TRAb dropped remarkably to 5.44 IU/L, therefore she ceased the monthly injections. By March 2024, she had sustained remission, with a Tg level of 5.68 ng/mL and TRAb of 3.07 IU/L.
The inducement of TED after RAI therapy is regarded as thyroid antigen leakage caused by radiation injury. In our patient, TED symptoms occurred shortly after the initiation of anlotinib therapy, which may be further triggered by tumor destruction. While localized glucocorticoid therapy eased the symptoms, continuous anlotinib therapy maintained the tumor burden at a relatively low level and led to the steady reduction of TRAb. In such case, a potent anticancer therapy is the key to treating both TED and disease progression.
Poster 0435
Thyroid Cancer, Clinical, Poster
Thyroid-Stimulating Hormone Suppression for Low-Risk Differentiated Thyroid Cancer: A Large-Scale Real-World Study of Over 10,000 Patients
Yu Wang*, Xiao Shi, Haitao Tang, Tingting Zhang, Cenkai Shen,Fudan University Shanghai Cancer Center, China
Poster 0436
Thyroid Cancer, Clinical, Poster
Hemithyroidectomy versus Total Thyroidectomy for Sporadic Medullary Thyroid Cancer: A Chinese Nationwide Multicenter Large-Scale Retrospective Study
Yu Wang*1, Xiao Shi1, Cenkai Shen1, Zhiyan Liu2, Qinghai Ji1, 1Fudan University Shanghai Cancer Center, China, 2Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China
Poster 0437
Thyroid Cancer, Clinical, Poster
Heterogeneity of genetic characteristics in metastatic thyroid cancer
Zhuan-Zhuan Mu1, Xin Zhang1, Di Sun1, Yu-Qing Sun1, Cong Shi1, Shou-Tai Ding2, Yan-Song Lin*1, 1Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & PUMC, China, 2Zhejiang Shaoxing Topgen Biomedical Technology Co., Ltd, China
Poster 0438
Thyroid Cancer, Clinical, Poster
Prognosis and Risk Factors in Patients With Distant Metastatic Differentiated Thyroid Cancer
Zhuan-Zhuan Mu, Cong Shi, Xin Zhang, Di Sun, Yu-Qing Sun, Yan-Song Lin*,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & PUMC, China
Poster 0439
Thyroid Imaging, Clinical, Poster
Evaluating the Completeness of Thyroid Nodule Ultrasounds Reporting Using Natural Language Processing
Elio Monsour*1, Andrea Rocha2, Aman Pathak3, Yonghui Wu4, JP Brito5, Naykky Singh Ospina6, 1Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, USA, 2Division of Endocrinology, Diabetes & Metabolism, Department of Medicine; University of Florida College of Medicine, USA, 33. Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, USA, 4Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, USA, 5Division of Endocrinology, Mayo Clinic, USA, 6Department of Endocrinology, Diabetes, and Metabolism, University of Florida College of Medicine, USA
Employing a rule-based approach, the information extracted by the NLP was utilized to categorize thyroid ultrasound reports as complete if all six aforementioned features of interest and lymph nodes were reported. Only nodules with a reported size measuring > 1 cm were included. A subgroup analysis of thyroid nodule ultrasound reporting completeness was conducted per year (ACR TIRADS implemented in 2017 in our practice) and for those > 2 cm (clinical relevance).
At the nodule level, 2084 out of 9108 nodules > 1 cm (22%) were considered complete and 827 out of 4312 nodules > 2 cm (19%) across the study period. There was an increasing proportion of completeness in thyroid nodule ultrasound reporting. This ranged from 0% in the years 2013 to 2017, 16% in 2018, 65% in 2019, and 73% in 2020 for nodules > 1 cm.
Poster 0440
Thyroid Imaging, Clinical,
Diagnostic Performance of AI Model for Thyroid Nodules with Initially Nondiagnostic Cytologic Results:
Eun Ju Ha*,Ajou Medical Center, Republic of Korea
Poster 0441
Thyroid Imaging, Clinical, Poster
A randomized controlled trial comparing non-selective vs selective cytology using EU-TIRADS - the Ultracyt study
Jakob Dahlberg*1,2, Jeanette Carlqvist1, Ann Örtoft3, Erik Elias1, Andreas Muth1, 1institution of clinical sciences, University of Gothenburg, Sweden, 2Sahlgrenska Academy, Sweden, 3Norra Älvsborg Hospital, Sweden
Poster 0442
Thyroid Imaging, Clinical, Poster
The Role of Microvascular Patterns Combined with Greyscale Ultrasound in Diagnosis and Recommending Fine-Needle Aspiration Biopsy of Thyroid Nodules
Wanying Li*, Luying Gao, Yahong Wang, Min Zhang, Hongyan Wang, Jianchu Li,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
Poster 0443
Thyroid Imaging, Clinical, Poster
Predicting retreatment after radiofrequency of benign thyroid nodules: pre-treatment nodular growth rate and viable volume at 6 months follow-up are the most accurate factors
Gilles RUSS*, Adrien Ben Hamou, Sylvain Poiree, Jean-Guillaume Marchand, Camille Buffet,La Pitie-Salpetriere Hospital, France
Poster 0444
Thyroid Imaging, Clinical, Poster
Cracking thyroid: report of the first case following radiofrequency ablation of a microcarcinoma
Gilles RUSS*, Adrien Ben Hamou, Sylvain Poiree, Jean-Guillaume Marchand, Camille Buffet,La Pitie-Salpetiere Hospital, France
Poster 0445
Thyroid Imaging, Clinical, Poster
Deciphering the Role of Pre–Ablation Diagnostic I-123 Iodine Scans in Patients with Differentiated Thyroid Cancer
Gayatri Jaiswal, Ashni Dharia*, Jamil Alkhaddo, Michael Grimes, Saira Khan, Nishit Vaghasia, Patricia Bononi,Allegheny General Hospital, USA
Poster 0446
Disorders of Thyroid Function, Case Study, Poster
Pembrolizumab Watch: Spotting Early Red Flags
Ashni Dharia*, Saira Varghese Mammen,ALLEGHENY GENERAL HOSPITAL, USA
Poster 0447
Thyroid Cancer, Clinical, Poster
Brain Metastases from Differentiated Thyroid Cancer in the Era of Targeted Therapies: A Multi-Center Retrospective Cohort
Inbar Finkel*1, Eyal Robenshtok2, Liyona Kampel1, 1Sourasky, Ichilov Tel Aviv Medical Center, Israel, 2Rabin Medical Center, Beilinson, Israel