Optimal Thyroid Health for All

This transcript has been edited for clarity.

Hi. My name is Dr Maria Papaleontiou. I'm one of the 2022 American Thyroid Association (ATA) annual meeting co-chairs. It is my pleasure and honor today to provide some highlights from the recently concluded ATA annual meeting that took place in Montreal.

The stimulating in-person meeting delivered an engaging program, which highlighted the most recent advances in basic, clinical, and translational thyroidology. The exciting spectrum of topics and speakers centered on diversity, equity, and inclusion while amplifying participation from early-career faculty.

I would like to thank my co-chair Dr McCabe, the ATA leadership, the program committee, and the ATA staff, led by Ms Amanda Perl, the executive director, without whom this meeting would not have been so successful and possible.

I'd like to start by discussing one of the most anticipated sessions every year, Year in Thyroidology, which provides a summary of impactful articles that were published in the past year in both benign thyroid disease and thyroid cancer.

This session included three talks. The first, on basic thyroidology, was delivered by Dr Alexandra Dumitrescu from the University of Chicago, Chicago, Illinois. The clinical science review was delivered by Dr Angela Leung from UCLA, Los Angeles, California. The surgical review was delivered by Dr Kepal Patel, an endocrine surgeon at NYU Langone Health, New York.

Our keynote plenary lecture was delivered by the director of the Division of Cancer Epidemiology and Genetics from the National Cancer Institute, Dr Stephen Chanock. Dr Chanock delivered a timely lecture, "Radiation-related Genomic Profile of Papillary Thyroid Cancer After the Chernobyl Accident." His talk addressed important issues affecting the survivors of Chernobyl, including points on the epidemiology of papillary thyroid cancer following radiation exposure.

He described the landscape analysis that his team led that was published in Science last year, which focused on the importance of radiation, age, and fusion drivers in thyroid cancer in Chernobyl survivors. He discussed the key features of how radiation actually causes driver mutations and events in these patients. He also presented unpublished data that dealt with metastasis in 440 patients and the role of age and RNA analysis in these patients, and how the landscape genomic analysis compared and revealed exciting findings.

Subsequently, we had another exciting plenary lecture delivered by Dr Michael Tuttle. This was also very timely, considering how the pendulum has swung from "too much" to "less is more" in thyroid cancer care. Dr Tuttle talked about how to avoid over- and undertreatment of thyroid cancer and talked about the right patient, the right treatment, and the right time.

He discussed how medical decision-making in the context of medical mindsets occurs nowadays. And how that may have changed over the last few decades, focusing on facts such as some of us being maximalists vs minimalists, some of us pursuing naturalism vs technology, and some of us being believers vs doubters.

Another exciting lecture this year was the inaugural plenary lecture sponsored by Women in Thyroidology. As incoming chair of Women in Thyroidology, I'm very excited at how well received this lecture was. Delivered by Dr Jennifer Sipos, professor of medicine and vice chair for diversity and inclusion at The Ohio State University, her scientific talk was titled, "Correlation of Cytology, Molecular Profiles, and Sonographic Appearance of Thyroid Nodules."

Following this plenary lecture, we had an interactive panel discussion to celebrate the 20th anniversary of the ATA Women in Thyroidology group. Moderated by Drs Eve Bloomgarden and David Cooper, the discussion featured several women within the ATA from different career paths and backgrounds. They talked about how women have grown in prominence in recent years in leadership roles at the ATA, while highlighting that work needs to continue. Discussion centered on leadership, mentorship, and sponsorship; barriers to career advancement; and brainstorming on advancing gender equity as we go forward.

We had several symposia, all well attended with positive feedback. These were carefully selected by the program committee to highlight topics that we thought interesting to the ATA membership and that may provide some food for thought going forward.

One of the symposia I'd like to highlight focused on disparities in access to care for patients with thyroid disease and thyroid cancer. Given the high prevalence of thyroid disease in the United States and documented worse outcomes for racial and ethnic minorities, the endocrinology community now faces an imperative reason to examine factors contributing to these disparities and to address how we can improve equal access to care for all.

Citing the motto of the ATA, "Optimal thyroid health for all," three esteemed speakers talked about disparities. Dr Elizabeth Pearce, Boston University, Boston, Massachusetts, spoke about barriers to optimal thyroid disease management in pregnancy. Dr Michael Yeh, an endocrine surgeon and division chief at UCLA, spoke about disparities in access to high-volume or expert surgeons in specialized care. Dr Meghan Haymart from the University of Michigan talked about strategies for overcoming barriers to specialty care for thyroid disease and cancer.

A highly anticipated symposium that did not disappoint was the Arthur Bauman Clinical Symposium, which gave a glimpse into what's to come in the upcoming ATA differentiated thyroid cancer and nodule guidelines. The co-chairs of the thyroid nodule guidelines, Drs Susan Mandel, University of Pennsylvania, and Lisa Orloff, Stanford Medicine, gave an overview of the updates regarding the thyroid nodule atlas to assist with nodule risk stratification that will come in the new guidelines and provided some background in terms of recent studies that would inform recommendations.

Drs Matthew Ringel, The Ohio State University, and Julie Ann Sosa, University of California, San Francisco, provided insight into what's to come on the horizon for thyroid cancer guidelines and outlined that less is more, highlighting two recent systematic reviews that were performed by the group to inform the guidelines. One of these reviews was on active surveillance vs surgery for differentiated thyroid cancer, and the other focused on serum thyroglobulin measurement following surgery without radioactive iodine for differentiated thyroid cancer.

In keeping with our focus on women, another symposium that I want to highlight focused on thyroid disease in women and how we could understand sex-based differences. Dr Robin Peeters from the Erasmus Medical Center in the Netherlands discussed women and biological risk for thyroid disease, focusing on autoimmunity. Dr Louise Davies from Dartmouth discussed overdetection of thyroid cancer in women. The symposium concluded with the talk by Dr Erik Alexander, Brigham and Women's Hospital, Boston, on fertility issues with thyroid disorders.

In keeping with our inclusion of basic science in the symposia of the ATA, we also highlighted a session on novel animal models for thyroid disease. These talks provided some insight in terms of thyroid hormone action and signaling, using different animal models.

Dr Heike Hauer from the University of Essen talked about novel mouse models of thyroid hormone function in the brain. Dr Luca Persani from Italy spoke about zebrafish bioassay from human thyroid hormone signaling defects. Dr Daniel Buchholz from the University of Cincinnati spoke about TR-GR crosstalk in regulation of frog development.

A topic that's near and dear to my heart is improving thyroid cancer survivorship for our patients. As we know, most thyroid cancer patients have excellent survival and prognosis; however, living beyond thyroid cancer and improving thyroid cancer survivorship should be in all of our minds.

Understanding how to help our patients navigate through survivorship has become an increasingly important issue. This symposium focused on understanding how we can emotionally support our patients at thyroid cancer diagnosis, as discussed by Dr Susan Pitt, University of Michigan. Dr Anna Sawka, University of Toronto, discussed the quality-of-life implications of living with thyroid cancer. The challenges in terms of financial toxicity and hardship, particularly in the United States, for patients who have thyroid cancer were discussed by Dr Cord Sturgeon, Northwestern University, Chicago, who also highlighted the fact that bankruptcy is not as uncommon as we think in thyroid cancer survivors.

A well-attended symposium focused on the tumor/immune environment in thyroid cancer and how we can exploit this environment in immunotherapy for patients with thyroid cancer. We had three esteemed speakers. Dr Melissa Lechner, from UCLA, focused on immune profiles of thyroid cancer and implications for immunotherapeutic approaches. Dr Alan Ho, from Memorial Sloan Kettering, talked about targeting immune suppressive microenvironment in anaplastic thyroid cancer. Dr Mabel Ryder, from the Mayo Clinic, discussed application of immunotherapy to the spectrum of aggressive thyroid cancers.

Finally, we had a symposium that came together based on current events. This was focused on endocrine disruptors in thyroid disease and how this influences human health. We had a very multidisciplinary group of speakers for this symposium.

Dr Maaike Van Gerwen, Mount Sinai, New York, spoke about endocrine disruptors, heavy metals, and thyroid cancer. Dr Mary Gilbert, who is the principal investigator in the US Environmental Protection Agency, spoke about thyroid-disrupting chemicals in the developing brain. Dr Akhgar Ghassabian, professor of environmental pediatrics at NYU Langone Health, discussed environmental chemicals, contaminants, and their effects on maternal and child health.

Back by popular demand, we had the surgical and pediatric symposia. These were very exciting topics as well; they covered a variety and range of topics, and there was standing room only. The surgical symposium put together by our surgical colleagues from the program committee included case-based discussions of difficult benign thyroid disease and reoperation for thyroid cancer, followed by a session discussing 5 years of NIFTP.

This was a timely session because in 2017, there was a change in nomenclature for a very low-risk thyroid tumor that was previously known as an encapsulated noninvasive follicular variant papillary thyroid cancer. It was renamed as noninvasive follicular thyroid neoplasm with papillary-like nuclear features, or NIFTP.

There was discussion about how this change in nomenclature has affected the thyroid cancer incidence and patient management over the past 5 years. The pediatric symposium that was put together by our pediatric endocrine colleagues covered topics such as management of Graves disease and thyroid dysfunction in genetic syndromes, as well as some pediatric abstract highlights, and also had a pediatric tumor board discussing interesting and challenging cases.

Another anticipated session at the ATA is the contemporary debates. We had three debates during the 2022 ATA meeting that focused on universal screening for thyroid dysfunction in pregnancy, use of long-term methimazole in Graves disease (yea or nay), and for and against T3/T4 combination therapy in hypothyroidism. All these debates generated very heated and interactive discussions.

We had many meet-the-professor sessions — too many to list here — but these were highly interactive case-based discussions. These were delivered by a variety of speakers on a diverse spectrum of topics. Some highlighted topics included management of thyroid cancer patients after lobectomy, the molecular landscape of pediatric thyroid cancer, iodide prophylaxis and nuclear exposure, a timely session drawing from the current events in Ukraine, surgical approach to thyroid cancer informed by molecular testing, minimally invasive approaches to thyroid nodules and cancer, and many more.

I'd also like to talk briefly about other highlights of our meeting. We had our first diversity, equity, and inclusion networking session at this meeting. This was very well attended, and it was in the form of a world cafe. Dr Sanziana Roman and Amy Chen chaired this session. They were also co-chairs of the DE&I ATA committee. This session took the form of small roundtable discussions, drawing on three focused questions on diversity, equity, and inclusion and how we can move the organization forward by drawing on these principles.

We also had the Clark T. Sawin historical vignette that focused on neonatal screening for congenital hypothyroidism. I'm excited to report that we had a great abstract submission presence. We had 461 abstracts submitted, of which 102 were late-breaking. We were very pleased with this comeback after the 2019 in-person meeting because of the COVID-19 pandemic hiatus.

The meeting would not have been complete without the thyroid cancer tumor board that took place on Sunday, moderated by Dr Laura Boucai, where discussions by a multidisciplinary team of experts took place, looking at interesting and challenging cases of thyroid cancer.

Before I end, I wanted to also highlight the 2022 ATA awardees and congratulate them. We had two awardees of the Women Advancing Thyroid Research Award. These are newer awards that the ATA bestows on early career women conducting outstanding thyroid research.

One of these awards went to Ms Piyasuda Pukkanasut for her work on targeting voltage-gated sodium channels in medullary thyroid cancer using small molecules. The second award went to Dr Elisa Pasqual for her work on the association of obesity and obesity-related conditions with thyroid cancer risk in The Sister Study Cohort.

Finally, I wanted to congratulate our seven recipients of the 2022 ATA awards, including Dr Regina Castro, who received the Woman of the Year award. Dr Nancy Carrasco received the Valerie Anne Galton Distinguished Lectureship Award, which is the first award at the ATA to be named after a woman. Dr David Cooper received the Louise Braverman Award for mentorship.

Dr Julie-Ann Sosa received the Distinguished Service Award. Dr Gregory Brent received the John B. Stanbury Thyroid Pathophysiology Medal. Dr Yun-Bo Shi from the NIH received the Sidney H. Ingbar Distinguished Lectureship Award. Dr Juan Brito from Mayo Clinic received the Van Meter Award.

Thank you again for the opportunity to provide highlights from the 2022 ATA meeting. I look forward to seeing all of you for the 2023 ATA centennial celebration in Washington, DC.

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