Reviews & Analysis

Thyroid cancer is the most common malignancy of the endocrine system and well-differentiated thyroid cancers (DTCs) represent >90% of thyroid malignancies. This Review outlines the current surgical management of DTC and provides an overview of the controversies surrounding the optimal surgical scheme. The recent advances in thyroid surgery, the arguments for and against each surgical approach, and the authors’ personal opinions are also presented.

Preclinical models have shown that inhibition of kinases in mitogenic and angiogenic signaling pathways can have antitumoral effects. Starting with a brief synopsis of a malignancy that responds well to kinase inhibition (chronic myeloid leukemia) compared with one with less durable responses as yet (melanoma), this Review highlights challenges that must be overcome in order to successfully translate small-molecule therapies to thyroid cancer in the future.

Estrogens regulate physiological and pathological processes in both women and men. Traditionally, the actions of 17β-estradiol, the predominant and most potent endogenous estrogen, were ascribed to two nuclear estrogen receptors (ERs), ERα and ERβ; however, transmembrane ERs, such as G-protein-coupled ER 1 (GPER), have been implicated in rapid estrogen signaling. This Review provides an overview of estrogen signaling and its receptors, with particular emphasis on GPER. It also highlights the importance of GPER in health and disease, such as cancer, for which GPER is a potential therapeutic target and prognostic indicator.

The increasing diversity of patient groups and rising prevalence of vitamin D deficiency highlight a pressing need for consensus-based guidance in terms of the evaluation, treatment and prevention of this condition. Following the Institute of Medicine's population-based recommendations, the Endocrine Society attempts to provide clear guidelines for clinicians but runs the risk of adding to the confusion.

This Perspectives re-evaluates the role of radioiodine treatment following surgery in low-risk patients with undetectable serum thyroglobulin levels after TSH stimulation and without evidence of disease. Moreover, the authors discuss the methods used for preparing low-risk patients for the administration of radioiodine after surgery and the activity of radioiodine that should be administered.

Gut microbes act as an environmental factor that affects an individual's physiology and metabolism, particularly in the context of obesity and its related metabolic disorders. This Review highlights how gut microbes alter the expression of genes involved in the development of obesity and inflammation and focuses on the potential role of specific nutrients that target the gut microbiota.

Many questions remain about the efficacy of radioiodine treatment for thyroid remnant ablation and therapy of advanced differentiated thyroid cancer. This Review intends to answer some of these questions taking into account novel insights into the treatment and (re)staging of patients with metastatic disease.

A recent study of selenium supplementation in patients with mild Graves ophthalmopathy (GO) has demonstrated improvements in associated soft-tissue manifestations of the disease. The findings of this multicenter trial reveal a potential treatment option for the mild form of this vexing disease, which affects the majority of patients with GO.

Epidemiological data show a worldwide increase in the prevalence and incidence of neuroendocrine neoplasms of the digestive tract and pancreas in the past few decades, which is probably due to improved methods of detection of these tumors. This Review provides a state-of-the-art discussion of the current diagnostic procedures and treatment options for these neuroendocrine neoplasms.

Bone turnover markers are the Cinderella of osteoporosis medicine: despite their great potential, they live a life of neglect and disdain under their glamorous but wicked sister, BMD. With a new position statement, Vasikaran and colleagues are inviting Cinderella to the Prince's ball, for her true worth to be acknowledged. Will it work? Doubts are justified.

The anterior pituitary gland secretes hormones that regulate developmental and physiological processes, such as growth, the stress response, and reproduction. This Review summarizes the gene regulatory pathways that control anterior pituitary development, with emphasis on the role of the homeodomain transcription factors in normal pituitary organogenesis and heritable pituitary disease.

The cellular origin of thyroid cancer has not been fully elucidated. The author of this Review discusses the different mechanisms by which thyroid cancer stem cells might contribute to the development of thyroid cancer and the potential of stem-cell-based diagnostic and therapeutic strategies to improve the management of patients with thyroid cancer.

Osteoporosis is characterized by a decrease in bone mass and alterations in bone architecture that increase bone fragility and risk of fracture. Therapy with recombinant human PTH analogues increases BMD and bone mass and improves the microarchitecture of the skeleton. This Review summarizes the mechanism of action of PTH and discusses pharmacological data as well as the clinical uses of PTH analogues.

Many individuals with prediabetes have been shown to have neuropathy and vice versa. This Review summarizes the current evidence on the association between prediabetes and neuropathy and discusses the assessment of glucose metabolism as part of the diagnostic work-up for neuropathy.

Treatment options for osteoporosis are limited for older individuals with chronic kidney disease. A secondary analysis of the FREEDOM trial sheds light on the efficacy and safety of denosumab in patients with impaired kidney function, but underlines that challenges remain in the treatment of osteoporosis in patients with severe chronic kidney disease.

Isolated studies have suggested that thyroid antibodies may signal an increased risk of miscarriage and/or preterm birth in pregnant women. A recent meta-analysis by Thangaratinam and colleagues concludes that a clear association appears evident. Less certain, however, is whether this pregnancy risk can be reduced with any treatment intervention.

The correct diagnosis of a child with a disorder of sex development (DSD) is crucial and can be life-saving. The most challenging situation for the pediatric endocrinologist and for the parents occurs when the sex cannot be determined at birth. A UK task force has now published novel guidelines that delineate the complex program needed for an initial diagnosis.

Diabetes insipidus is a clinical syndrome characterized by the excretion of abnormally large volumes of dilute urine (polyuria) and increased fluid intake (polydipsia). This Review focuses on the clinical presentation, genetic basis and molecular mechanisms of the currently known familial forms of diabetes insipidus.

Diabetes mellitus is an established risk factor for periodontitis, and periodontitis can adversely affect glycemic control. This Review discusses the complex relationship between these two conditions and the implications of this association for patients and health-care professionals.

This Review provides a brief overview of the prevalence, clinical effect and management of endocrine incidentalomas with a focus on data regarding the diagnostic and therapeutic challenges imposed by incidentally discovered adrenal lesions.