Daily Endocrinology Research Analysis

BACKGROUND: Total thyroidectomy requires lifelong levothyroxine (LT4) therapy. Achieving optimal thyroid hormone replacement at the first postoperative follow-up might be harder than expected. Despite the various LT4 dose-choosing strategies tested, there is no consensus on the most effective approach to achieve early euthyroidism. MATERIALS AND METHODS: We performed a systematic review and meta-analysis, including studies published between 2000 and 2024 that reported the proportion of patients achieving euthyroidism at first follow-up after total thyroidectomy. Data from 11 studies comprising 2577 patients were analyzed. LT4 dosing strategies included fixed-dose, weight-based (dose/kg), and individualized algorithm-based methods. Meta-regression and subgroup analyses were used to explore sources of heterogeneity. RESULTS: The pooled euthyroidism rate at first follow-up was 33.9%, with high heterogeneity across studies (I2 = 82.68%). No dosing strategy consistently outperformed others: dose/kg methods achieved 29% euthyroidism, while fixed or algorithm-based approaches achieved 40%, though without statistical significance. Meta-regression analysis did not identify any statistically significant predictor. No significant differences emerged between patients treated for benign or malignant thyroid diseases or between retrospective and prospective study designs. CONCLUSION: Only about one-third of patients achieve euthyroidism at first follow-up after thyroidectomy, regardless of LT4 dosing strategy. The current guidelines recommendation of applying a pro/kg dose may not be adequate, and even personalized algorithms yield inconsistent results. Future prospective studies are needed to refine individualized dosing protocols and identify additional factors influencing LT4 requirements.

BACKGROUND: Insulin resistance (IR) is a key metabolic abnormality associated with adverse health outcomes, including increased cancer risk. The triglyceride-glucose (TyG) index, a validated surrogate marker of IR, has been linked to metabolic dysfunction; however, its association with cancer risk in large population-based cohorts remains unclear. This study aimed to evaluate the relationship between TyG index and cancer risk in Taiwanese population. METHODS: We analyzed 150,592 participants from the Taiwan Biobank, among whom 148,809 were linked to the Taiwan Cancer Registry (2011-2022) for cancer incidence tracking. Cancer risk was assessed across TyG quartiles over a median follow-up of 5.7 years (IQR: 3.4-7.6). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, adjusting for key covariates. RESULTS: Higher TyG index levels were associated with increased risks of digestive system cancer (adjusted HR [aHR]: 1.17, 95% CI: 1.05-1.29), colorectal cancer (aHR: 1.25, 95% CI: 1.08-1.44), and urinary tract cancer (aHR: 1.47, 95% CI: 1.18-1.85). While subgroup trends suggested numerically higher risks in males, individuals aged ≥ 50 years, and those with overweight or obesity for these cancer types, formal interaction tests did not support statistically significant effect modification in these groups. Significant interactions were observed for overall cancers by age (P < 0.001) and BMI (P = 0.012), and for urinary tract cancer by drinking status (P = 0.047). In a subset of 19,808 participants with follow-up data, higher TyG quartiles were also linked to fatty liver, carotid plaques, and persistent IR over time (r = 0.75). CONCLUSIONS: Higher TyG index levels, indicative of greater IR, are associated with an elevated risk of digestive system, colorectal, and urinary tract cancers. Evaluating TyG index levels could assist in risk stratification for these cancers among individuals with persistent IR, supporting targeted prevention strategies.

BACKGROUND: Diabetic neuropathy is the most prevalent complication of diabetes mellitus, affecting up to 50% of patients with type 2 diabetes mellitus (T2DM). Among the various types of diabetic neuropathy, diabetic peripheral neuropathy (DPN) is the most common. Numerous animal studies have highlighted a strong association between the improvement of DPN and curcumin supplementation, particularly due to curcumin's anti-inflammatory and antioxidant properties. However, the effects of curcumin on DPN have been evaluated in only one randomized controlled trial. In our study, we assessed the efficacy and safety of a 16-week supplementation with nanocurcumin in T2DM patients suffering from DPN. METHODS: This randomized, double-blind, placebo-controlled trial was conducted at a diabetes clinic within the Endocrinology and Metabolism Research Center in Tehran, Iran. The study aimed to evaluate the effects of nanocurcumin (40 mg taken twice daily) compared to a placebo in patients with DPN over a 16-week period. The primary endpoint of the study was the reduction of pain severity, measured by the Numerical Rating Scale (NRS). Additionally, we assessed neuropathic outcomes by monitoring changes in the Michigan Neuropathy Screening Instrument examination (MNSIE) and the Neuropathy Disability Score (NDS). Secondary endpoints included improvements in metabolic and cardiovascular parameters from baseline to the end of the treatment. RESULTS: Ninety-seven patients were randomized, with 41 in the nanocurcumin group and 45 in the placebo group completing the study. No significant differences were found between the groups in terms of NRS (P = 0.787), NDS (P = 0.576), or MNSIE (P = 0.405) after 16 weeks. Nanocurcumin supplementation did not alter the metabolic profile or cardiovascular parameters and was well-tolerated, without major adverse events. CONCLUSION: Nanocurcumin supplementation over 16 weeks did not improve pain, neuropathic outcomes, or metabolic/cardiovascular parameters in patients with T2DM suffering from DPN.