Background Thyroid papillary microcarcinoma (TPMC) is an incidentally discovered papillary carcinoma that is ≤ 1.0 cm in size. Most TPMCs are indolent, whereas some behave aggressively. The aim of the study was to evaluate whether the combination of BRAF mutation and specific histopathological features allows risk stratification of TPMC. Methods A group of aggressive TPMC was selected based on the presence of lymph node metastasis or tumor recurrence. A group of non-aggressive tumors included TPMCs matched for age, gender, and tumor size, but with no extrathyroidal spread. Molecular analysis was performed and histological slides were scored for multiple histopathological criteria. A separate validation cohort of 40 TPMC was evaluated. Results BRAF mutation was detected in 77% of aggressive TPMC and 32% of non-aggressive tumors (p=0.001). Several histopathological features showed significant difference between the groups. Using multivariate regression analysis, a molecular-pathological (MP) score was developed that included BRAF status and three histopathological features: superficial tumor location, intraglandular tumor spread/multifocality, and tumor fibrosis. By adding the histologic criteria to BRAF status, sensitivity was increased from 77% to 96% and specificity from 68% to 80%. In the independent validation cohort, the MP score stratified tumors into low, moderate, and high risk groups, with the probability of lymph node metastases or tumor recurrence of 0, 20%, and 60%, respectively. Conclusions BRAF status together with several histopathological features allow clinical risk stratification of TPMC. The combined molecular-pathological risk stratification model is a better predictor of extrathyroidal tumor spread than either mutational or histopathological findings alone.

An ultrasound finding of a hypoechoic thyroidectomy bed lesion with internal vascularity and size greater than 6 mm is highly sensitive in predicting recurrence. Serum Tg levels were less sensitive than ultrasound in detection of recurrence in the thyroidectomy bed.

BackgroundThe incidence of Papillary thyroid carcinoma (PTC), the most common type of thyroid malignancy, has risen rapidly worldwide. PTC usually has an excellent prognosis. However, the rising incidence of PTC, due at least partially to widespread use of neck imaging studies with increased detection of small cancers, has created a clinical issue of overdiagnosis, and consequential overtreatment. We investigated how molecular data can be used to develop a prognostics signature for PTC.MethodsThe Cancer Genome Atlas (TCGA) recently reported on the genomic landscape of a large cohort of PTC cases. In order to decrease unnecessary morbidity associated with over diagnosing PTC patient with good prognosis, we used TCGA data to develop a gene expression signature to distinguish between patients with good and poor prognosis. We selected a set of clinical phenotypes to define an ‘extreme poor’ prognosis group and an ‘extreme good’ prognosis group and developed a gene signature that characterized these.ResultsWe discovered a gene expression signature that distinguished the extreme good from extreme poor prognosis patients. Next, we applied this signature to the remaining intermediate risk patients, and show that they can be classified in clinically meaningful risk groups, characterized by established prognostic disease phenotypes. Analysis of the genes in the signature shows many known and novel genes involved in PTC prognosis.ConclusionsThis work demonstrates that using a selection of clinical phenotypes and treatment variables, it is possible to develop a statistically useful and biologically meaningful gene signature of PTC prognosis, which may be developed as a biomarker to help prevent overdiagnosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2771-6) contains supplementary material, which is available to authorized users.

Objective To determine the association between thyroid hormone levels and sleep quality in community-dwelling men. Methods Among 5,994 men aged ≥65 years in the Osteoporotic Fractures in Men (MrOS) study, 682 had baseline thyroid function data, normal free thyroxine (FT4) (0.70 ≤ FT4 ≤ 1.85 ng/dL), actigraphy measurements, and were not using thyroid-related medications. Three categories of thyroid function were defined: subclinical hyperthyroid, thyroid-stimulating hormone (TSH) <0.55 mIU/L; euthyroid (TSH, 0.55 to 4.78 mIU/L); and subclinical hypothyroid (TSH >4.78 mIU/L). Objective (total hours of nighttime sleep [TST], sleep efficiency [SE], wake after sleep onset [WASO], sleep latency [SL], number of long wake episodes [LWEP]) and subjective (TST, Pittsburgh Sleep Quality Index score, Epworth Sleepiness Scale score) sleep quality were measured. The association between TSH and sleep quality was examined using linear regression (continuous sleep outcomes) and log-binomial regression (categorical sleep outcomes). Results Among the 682 men examined, 15 had subclinical hyperthyroidism and 38 had subclinical hypothyroidism. There was no difference in sleep quality between subclinical hypothyroid and euthyroid men. Compared to euthyroid men, subclinical hyperthyroid men had lower mean actigraphy TST (adjusted mean difference [95% confidence interval (CI)], −27.4 [−63.7 to 8.9] minutes) and lower mean SE (−4.5% [−10.3% to 1.3%]), higher mean WASO (13.5 [−8.0 to 35.0] minutes]), whereas 41% had increased risk of actigraphy-measured TST <6 hours (relative risk [RR], 1.41; 95% CI, 0.83 to 2.39), and 83% had increased risk of SL ≥60 minutes (RR, 1.83; 95% CI, 0.65 to 5.14) (all P>0.05). Conclusion Neither subclinical hypothyroidism nor hyperthyroidism is significantly associated with decreased sleep quality.