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Recommended Reading – Key Published Papers from 2016 as chosen by our Scientific Committee Members

Recommended Reading – Key Published Papers from 2016 as chosen by our Scientific Committee Members
  • Endocrinology and metabolism
  • Thyroid disorder

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Practical

The field of thyroid disease research and development is fertile and active. Keeping up to date with the latest findings and studies can be an overwhelming task. To help pinpoint the key papers from 2016, the important papers, those that have made a real impact on the scientific community during the year, we asked our Scientific Committee Members for Manage Thyroid Online, Professor George J Kahaly from Germany and Dr Gabriela Brenta from Argentina to share their top papers from the year and explain why they chose each one.


These papers are in no particular order:

Many guidelines for thyroid disorder treatment were updated during 2015/6, including four of the guidelines from the European and American Thyroid Associations on the management of Graves’ orbitopathy, subclinical hyperthyroidism, thyrotoxicosis and thyroid nodule/cancer. These well-conceived, well-written, thorough and detailed documents are excellent guides for the daily management of patients with both benign thyroid nodular and/or autoimmune disease, as well as malignant disorders

Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1-133.

Bartalena L, Baldeschi L, Boboridis K, et al, European Group on Graves' Orbitopathy (EUGOGO). The 2016 European Thyroid Association/European Group on Graves' Orbitopathy guidelines for the management of Graves' orbitopathy. Eur Thyroid J. 2016;5:9-26.

Biondi B, Bartalena L, Cooper DS, et al. The 2015 European Thyroid Association guidelines on diagnosis and treatment of endogenous subclinical hyperthyroidism. Eur Thyroid J. 2015;4:149-63.

Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26:1343-1421.

These are the first guidelines for thyrotoxicosis that the ATA has published since 2011. There are several interesting findings within these guidelines, including the possibility of continuing antithyroid treatment for a much longer period of time than previously recommended.

Even in autonomous nodular goitre, patients in whom antithyroid drugs do not induce remission and discontinuation of treatment results in a relapse of the disease, long term treatment with antithyroid drugs can sometimes be the best option. This is particularly so in those patients with a short life expectancy and high surgical risk or those who live in homes where the isolation required for radioactive iodine is difficult. The dose of methimazole needed to restore euthyroidism is usually low (5-10 mg/day). In these particular patients, guidelines advise monitoring thyroid function every three months until stable hormonal levels are reached, at which point, monitoring can be more widely spaced.

Nikiforov YE, Seethala RR, Tallini G, et al. Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: a paradigm shift to reduce overtreatment of indolent tumors. JAMA Oncol. 2016;2:1023-9.

The follicular variant of papillary thyroid carcinoma (FVPTC) is composed of thyroid follicles but with the cellular features of papillary carcinoma. It is subdivided into encapsulated or noncapsulated (infiltrative) types.

The incidence of the encapsulated variant of FVPTC (EFVPTC) has increased in the last three decades and is now estimated to account for between 15-20% of cases of papillary carcinoma (PTC). This variant has indolent behaviour and is associated with an excellent prognosis. This large, multidisciplinary, international group of researchers reviewed the clinical outcomes of patients with EFVPTC and, based on their findings, have developed new diagnostic criteria as well as a new nomenclature for these indolent tumours. The new term proposed for the EFVPTC is ‘noninvasive follicular thyroid neoplasm with papillary-like nuclear features’ (NIFTP), which excludes the word ‘cancer’.

The six diagnostic criteria for NIFTP are: 1) encapsulation  2) follicular growth pattern with <1% of papillae, no psammoma bodies, <30% pattern of insular, trabecular or solid growth 3) nuclear features typical of papillary thyroid cancer 4) no capsular or vascular invasion 5) no tumoural necrosis and 6) without high mitotic activity.

According to these authors, the new classification will affect a large number of patients around the world and will result in a significant reduction in the clinical and psychological consequences associated with the diagnosis of cancer.

Ho AS, Davies L, Nixon IJ, et al. Increasing diagnosis of subclinical thyroid cancers leads to spurious improvements in survival rates. Cancer. 2015;121:1793-9.

In this retrospective study, the authors analysed two large databases of thyroid cancer patients (those treated at MSKCC from 1950 to 2005, and the SEER national register from 1975 to 2009). A 3-fold increase in the incidence of neoplasia was revealed (specifically of microcarcinoma), although no changes were found in the incidence of distance metastases or mortality. Anomalously, the whole group 10-year relative survival improved.

These findings could be related to better diagnosis of subclinical thyroid cancer and it could be hypothesized that early detection of these microcarcinomas would result in a lower mortality rate. However, the observed improvement in survival disappears when tumours are stratified by size or by metastatic status, making it unlikely that advanced-stage tumours are being diagnosed at an earlier stage.

As the authors state “this is a phenomenon that could be called an epidemic in diagnosis rather than an epidemic in disease” and they propose an overhaul of the diagnosis and treatment strategies of thyroid cancer.

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