Context Molecular tests have improved the accuracy of preoperative diagnosis of indeterminate thyroid nodules. The Afirma Gene Sequencing Classifier (GSC) was developed to improve the specificity of the Gene Expression Classifier (GEC). Independent studies are needed to assess the performance of GSC. Objective The aim was to compare the performance of GEC and GSC in the assessment of indeterminate nodules. Design, Settings, and Participants Retrospective analysis of Bethesda III and IV nodules tested with GEC or GSC in an academic center between December 2011 and September 2018. Benign call rates (BCRs) and surgical outcomes were compared. Histopathologic data were collected on nodules that were surgically resected to calculate measures of test performance. Results The BCR was 41% (73/178) for GEC and 67.8% (82/121) for GSC (P < .001). Among specimens with dominant Hürthle cell cytology, the BCR was 22% (6/27) for GEC and 63.2% (12/19) for GSC (P = .005). The overall surgery rate decreased from 47.8% in the GEC group to 34.7% in the GSC group (P = .025). One GEC-benign and 3 GSC-benign nodules proved to be malignant on surgical excision. GSC had a statistically significant higher specificity (94% vs 60%, P < .001) and positive predictive value (PPV) (85.3% vs 40%, P < .001) than GEC. While sensitivity and negative predictive value (NPV) dropped with GSC (97.0% vs 90.6% and 98.6% vs 96.3%, respectively), these differences were not significant. Conclusions GSC reclassified more indeterminate nodules as benign and improved the specificity and PPV of the test. These enhancements appear to be resulting in fewer diagnostic surgeries.

Recruitment of peripheral monocytes to the liver is a key contributor to the response to injury. MIF can act as a chemokine and cytokine, regulating innate immune responses in many tissues and cell types. We hypothesized that MIF contributes to the progression of CCl4-induced hepatic fibrosis by regulating recruitment of SAM. SAMs dynamically regulate HSC activation and ECM degradation. To gain insight into the role of MIF in progression of liver fibrosis, we investigated markers of fibrosis and immune responses after chronic CCl4 administration to female C57BL/6 and MIF(-/-) mice. Chronic CCl4 exposure increased activation of HSC in WT mice, indicated by increased expression of αSMA mRNA and protein, as well as mRNA for collagen 1α1; these responses were blunted in female MIF(-/-) mice. Despite lower activation of HSC in MIF(-/-) mice, accumulation of ECM was similar in WT and MIF(-/-)mice, suggesting a decreased rate of ECM degradation. Recruitment of SAMs was lower in MIF(-/-) mice compared with WT mice, both in their initial inflammatory phenotype, as well as in the later phase as proresolution macrophages. The decreased presence of resolution macrophages was associated with lower expression of MMP13 in MIF(-/-) mice. Taken together, these data indicate that MIF-dependent recruitment of SAMs contributes to degradation of ECM via MMP13, highlighting the importance of appropriate recruitment and phenotypic profile of macrophages in the resolution of fibrosis.

Objective To assess hormonal outcomes and thyroid hormone (TH) replacement after hemithyroidectomy (HT). Study Design Retrospective chart review. Setting Quaternary care hospital system. Methods A retrospective analysis was performed on patients who had an HT at Cleveland Clinic between 2000 and 2010 with outcomes assessed up to 5 years post-HT. Patients with overt hypothyroidism (OH; thyroid-stimulating hormone [TSH] >10 mIU/L, TSH >4.2 mIU/L on thyroid hormone [TH]), subclinical hypothyroidism (SH; TSH >4.2-10 mIU/L, no TH), or euthyroidism (EU; TSH 0.4-4.2 mIU/L, no TH) were compared. Patients with SH who returned to EU were compared to those who continued to have SH. For immediate start on TH, a receiver operating characteristic analysis was performed to determine dosage of TH above which suppression of TSH <0.4 mIU/L was predicted. Results We identified 335 patients (average age 51 years, 78% female, median follow-up of 50 months). Of the 210 not immediately started on TH, 32.4% were OH, 13.3% were SH, and 54.3% were EU. EU patients were younger (48 years), had more remaining gland, were less likely to have lymphocytic infiltrate, and had a lower preoperative TSH (1.2 mIU/L). In the SH group, 58.3% of patients normalized their TSH. With immediate TH start, 45% developed suppressed TSH. Those on LT4 >1.05 mcg/kg/d were more likely to suppress (sensitivity 89%). Conclusion Most patients post-HT will remain EU, and immediate start of TH may lead to TSH suppression. Those with SH may ultimately normalize TSH. These findings together suggest that observation may be a better option than TH replacement after HT.

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Objective: To identify issues surrounding discharge from hospitalization in patients newly prescribed insulin or oral hypoglycemic agents. Methods: We conducted telephone surveys and retrospective chart reviews on adult patients satisfying the aforementioned conditions one week after they were discharged from an academic medical center. Data gathered included glucose levels, logistical issues in obtaining medications or testing supplies, and barriers for testing and treating DM. We compared A1c during and after admission, and identified factors associated with change in A1c. Results: We attempted to contact 141 eligible patients phone, and reached 98. Of 98 patients, 85 were scheduled with a follow-up with PCP or endocrinology within 60 days of discharge, 13 patients were discharged without follow-up scheduled; 76 were discharged with enough supplies and medication to last until next follow-up. Regarding overall glucose control after discharge, 69 patients were completely to very satisfied, 18 were somewhat satisfied, 11 were slightly to not at all satisfied. Fifty patients had repeat A1c available after admission (median 116 days, IQR 92, 196). There was a significant decrease in A1c (admission mean 9.5% ± SD 2.7 vs. follow-up 7.0% ± 1.5, p &lt;0.0001). There was no statistically significant change in percentage A1c reduction whether patient received bedside delivery (-22.3% ± 18.8) or not (-23.5% ± 22.0; p = 0.825), or between medical (-25.4% ± 20.4) and surgical services (-16.2% ± 18.7, p = 0.134). Patients utilizing bedside delivery program (pharmacy bringing discharge medications to patient’s room) were more likely to receive the correct diabetes testing supplies and medications (95.2%) than those who did not use the service (71.1%) (p=0.003). Conclusion: Most patients were satisfied with DM education and readiness upon discharge. Bedside delivery may help improve percentage of discharge with correct supplies and medications. Disclosure N.Z. Madhun: None. E. Calogeras: None. S. Niwattisaiwong: None. M. Lansang: None.