In the past 30 years, the incidence of differentiated thyroid cancer (DTC) has been increasing rapidly and has become one of the most common malignant tumors in females. Currently, the main surgical treatment for DTC is standard open thyroidectomy (SOT) via a traditional Kocher mid-cervical incision, but postoperative neck scarring was associated with significantly worse health-related quality of life (HRQOL) scores. To offer better cosmesis, robotic/endoscopic thyroidectomy via cervical, axillary, anterior chest, breast, postauricular, or transoral approaches have been developed over the past 20 years. In general, gasless transaxillary endoscopic thyroidectomy (GTET) has advantages in terms of convenience, clarity of vision, and aesthetic incision. The current work aims to provide a step-by-step description of GTET, supported by a high-quality, pictorial guide.

Thyroid cancer (TC) represents one of the most prevalent endocrine malignancies, with a rising incidence worldwide. Epigenetic alterations, which modify gene expression without altering the underlying DNA sequence, have garnered significant attention in recent years. Increasing evidence underscores the pivotal role of epigenetic modifications, including DNA methylation, RNA methylation, and histone methylation, in the pathogenesis of TC. This review provides a comprehensive overview of these reversible and environmentally influenced epigenetic modifications, highlighting their molecular mechanisms and functional roles in TC. Additionally, the clinical implications, challenges associated with studying these epigenetic modifications, and potential future research directions are explored.

Background: The rising incidence of thyroid cancer (TC) underscores the need to identify modifiable risk factors for malignancy in patients with thyroid nodules. The role of circadian rhythm disruption (CRD), a pervasive modern lifestyle factor, in TC is poorly understood. We aimed to investigate the association between cumulative CRD and the risk of malignancy and aggressiveness in patients with thyroid nodules. Methods: We conducted a hospital-based, propensity score-matched study involving 2,541 patients who underwent thyroidectomy for thyroid nodules between 2016 and 2019. A novel cumulative circadian rhythm disruption index (cCRDI), integrating sleep insufficiency, shift work history, chronotype/mid-sleep timing, and dietary irregularity, was calculated from preoperative questionnaires. The primary outcome was the definitive postoperative histopathological diagnosis (benign vs. malignant). Propensity score matching (PSM) (1:1) was performed to balance baseline confounders (e.g., age, sex, BMI, TSH levels, and autoimmune status), yielding a cohort of 850 matched pairs (1,700 patients). Conditional logistic regression was used to assess the association between cCRDI and malignancy. Results: In the matched cohort, a strong, dose-dependent relationship was observed. Compared to the No CRD group, the adjusted odds ratios (aOR) for malignancy were 1.58 (95% CI: 1.15–2.15) for Low CRD, 1.85 (95% CI: 1.30–2.62) for Moderate CRD, and 2.95 (95% CI: 2.05–4.25) for High CRD ( P for trend < 0.001). Restricted cubic splines confirmed a non-linear association with accelerating risk at higher cCRDI scores ( P for non-linearity = 0.008). Crucially, increasing CRD severity was independently associated with aggressive clinicopathological features, including multifocality, extrathyroidal extension (ETE), and a dramatic increase in lymph node metastasis (LNM) (69.4% in High CRD vs. 29.3% in No CRD, P < 0.001). High CRD remained the strongest independent predictor for LNM in multivariable analysis (aOR = 4.21, 95% CI: 2.90–6.10, P < 0.001). Conclusion: Cumulative CRD is independently associated with both the presence of malignancy and the aggressive progression of TC in patients with thyroid nodules. Assessing a patient’s circadian health might have potential utility as a novel, modifiable factor for risk stratification and may underscore the importance of lifestyle interventions in the clinical management of thyroid nodules.