Practical Guidelines for Diagnosing and Treating Thyroid Disease Based on the WOMED Metabolic Model of Disease Focusing on Glycolysis and Coenzyme Q10 Deficiency—A Clinical Alternative to the 2021 Retired Clinical Practice Guidelines of the Endocrine Society

This review aims to provide a functional, metabolic view of the pathogenesis of benign thyroid disease. Here, we summarize the features of our previous publications on the “WOMED model of benign thyroid disease”. As of 2021, the current state of art indicates that the basic alteration in benign thyroid disease is a metabolic switch to glycolysis, which can be recognized using 3D-power Doppler ultrasound. A specific perfusion pattern showing enlarged vessels can be found using this technology. This switch originates from an altered function of Complex I due to acquired coenzyme Q10 deficiency, which leads to a glycolytic state of metabolism together with increased angiogenesis. Implementing a combined supplementation strategy that includes magnesium, selenium, and CoQ10, the morphological and perfusion changes of the thyroid can be reverted, i.e., the metabolic state returns to oxidative phosphorylation. Normalization of iron levels when ferritin is lower than 50 ng/mL is also imperative. We propose that a modern investigation of probable thyroid disease requires the use of 3D-power Doppler sonography to recognize the true metabolic situation of the gland. Blood levels of magnesium, selenium, CoQ10, and ferritin should be monitored. Thyroid function tests are complementary so that hypo- or hyperthyroidism can be recognized. Single TSH determinations do not reflect the glycolytic state.

Association between Uterine Fibroid and Benign Thyroid Disease: Nationwide Population-Based Cohort Study

Background Uterine fibroid and benign thyroid disease are common diseases in women. Objective This study aims to evaluate both diseases are related. Study Design: We established the uterine fibroid group according to diagnosis codes and surgery codes using the Korea National Health Insurance data from 2007 to 2020. All women from 20 to 50 years old with uterine myomectomy from 2007 to 2020 were identified (uterine fibroids group). For controls, 1:1 propensity score matching was performed on age at 5-year intervals, socio-economic status (SES), region, Charlson comorbidity index (CCI), and menopause (control group). Thyroid disease cases were selected using the thyroid disease diagnosis code and thyroid-associated laboratory examination. Results A total of 21,246 patients were extracted from the uterine fibroid and control groups, respectively. The median ages of each group were 40 (range, 35 ~ 44) years and 40 (range, 35 ~ 44) years old. Benign thyroid disease was 469 (2.2%) in the uterine fibroid group and 246 (1.2%) in the control group. Among benign thyroid diseases, hypothyroidism was the largest in both groups. A non-toxic single thyroid nodule followed it. The uterine fibroid group had a higher incidence of hypothyroidism {relative risk (RR) 1.943, 95% CI 1.5-2.516), autoimmune thyroid disease (RR 1.59, 95% CI 1.065–2.373), goiter (RR 1.773, 95% CI 1.051–2.99), nontoxic single thyroid nodule (RR 2.213, 95% CI 1.685–2.907), other thyroid disease (RR 2.31, 95% CI 1.608–3.317), and total thyroid disease (RR 1.905, 95% CI 1.63–2.226) in logistic regression analysis adjusted for age, SES, region, CCI, and menopause compared than the control group. The uterine fibroid group had a higher risk of hypothyroidism (HR 1.431, 95% CI 1.023–2.001) and nontoxic single thyroid nodule (HR 1.511, 95% CI) in cox regression adjusted for age, SES, region, CCI, and menopause. Conclusions Uterine fibroid might be associated with hypothyroidism and thyroid nodule.

The circumstances in which recurrent laryngeal nerve palsy occurs after surgery for benign thyroid disease: a retrospective study of 1026 patients

Objective To evaluate the circumstances in which recurrent laryngeal nerve palsy occurs after thyroid surgery. Methods This study assessed 1026 patients who underwent surgery for benign thyroid disease over a seven-year period in a retrospective, single-centre study. Results With a total of 1835 recurrent laryngeal nerves at risk, there were 38 cases (2.07 per cent) of transient recurrent laryngeal nerve palsy and 8 (0.44 per cent) of permanent recurrent laryngeal nerve palsy. No explanation was found for 10 of the 46 cases of recurrent laryngeal nerve palsy. Among the 38 other cases, the probable causes included poor identification of the recurrent laryngeal nerve during surgery, involuntary resection of the nerve and several other factors. Conclusion Apart from accidental resection of the recurrent laryngeal nerve during thyroid surgery, the causes of post-operative recurrent laryngeal nerve palsy are often unclear and likely multifactorial. Poor identification of the recurrent laryngeal nerve during surgery is still the main cause of post-operative recurrent laryngeal nerve palsy, even when intra-operative neuromonitoring is used.

Gender differences in estimating I-131 thyroid uptake from Tc-99m thyroid uptake for benign thyroid disease

Objective: For radioactive Iodine-131 (131I) treatments of thyroid diseases, increased efficacy has been reported for personalized dosimetry treatments. The measurement of Iodine-131 thyroid uptake (131IU) is required in these cases. This study aims to investigate whether 99mTc thyroid uptake (99mTcU) may be used in place of 131IU for implementing personalised treatments. Methods: A retrospective study of 152 benign thyroid disease 131I treatments was carried out during 2012–2020; 117 treatments were for female patients while 35 were for male patients diagnosed with either Graves’ disease, multinodular goitre or toxic nodules. Results: A statistically significant correlation was found between 131IU and 99mTcU data, with the data more correlated for male than female patients (r = 0.71 vs 0.38, p-value < 0.001). Patient age and time difference between the two respective uptake measurements significantly influenced the uptake correlation in females but not for the male cohort, although there was no significant difference between the parameters across gender. Thyroid diagnosis and hormone levels showed a significant correlation with uptakes in both genders. Estimating 131IU based on 99mTcU was shown to be predictive for male but not in female patients (R2 = 91% vs 16%). Conclusion: Estimating 131IU based on 99mTcU is not recommended for females at our centre. Males reported good correlation, but a larger sample would be needed for validation. Advances in knowledge: The initial findings showed a significant gender difference in benign thyroid uptake parameters at our centre, highlighting the potential need for gender consideration when planning 131IU patient management and when reporting studies results.