Objective: Conventional cervical lymph node dissection often leaves large surgical scars, which seriously compromises the postoperative aesthetic effect and can affect the quality of life of patients. In this study, the safety and feasibility of robotic-assisted endoscopic thyroidectomy with central neck dissection (CND) and lateral neck dissection (LND) via a combined transoral and breast approach are discussed in detail. Materials and methods: A retrospective analysis was made of the data of 26 patients with stage cN1b papillary thyroid carcinoma who were admitted to the Thyroid Surgery Department of the Hunan Cancer Hospital from March 2021 to September 2022 and who underwent robotic-assisted endoscopic thyroidectomy with LND via a combined transoral and breast approach. The demographic data, surgical indicators, postoperative data, and the postoperative complication rate of the patients were analyzed, and the learning curve was analyzed by cumulative summation. Results: All the patients underwent endoscopic surgery without any conversion to open surgery. The mean operation time was 313.7±50.3 min and the mean number of total positive/retrieved lymph nodes was 11.2±8.1/36.8±13.7. Two patients developed temporary laryngeal recurrent nerve palsy and three patients developed temporary hypoparathyroidism, all of whom recovered within 3 months postoperatively. No tumor recurrence occurred during follow-ups that ranged from 6 to 24 months. The mean postoperative quality of life (QOL) score was 189.1±118.2, test results ranging from 0 to 1300 with a lower score indicating a higher QOL, and the aesthetic satisfaction score was 4.2±0.7, test scores ranging from 0 to 5 with higher scores indicate higher satisfaction. The turning point of the learning curve was in the 11th case. Conclusions: The robotic-assisted endoscopic thyroidectomy with CND and LND via a combined transoral and breast approach is safe and feasible, and the improved cosmetic effect is remarkable, which is conducive to improving the postoperative QOL of patients. It provides a new surgical option for patients.

Objective: While previous studies have explored the relationship between obesity and levels of thyroid autoantibodies, research using novel indicators such as weight-adjusted waist index (WWI) remains limited. This study aimed to evaluate the potential relationship between WWI and thyroid autoantibody levels, with the objective of improving our understanding of the links between central obesity and Hashimoto’s thyroiditis (HT).Methods: We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) cycles from 2007 to 2012. We analyzed the relationship between WWI and levels of thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb) through multivariate linear regression and subgroup analyses.Results: The study included 7,056 participants with an average age of 49.71 ± 17.66 years, comprising 49.18% females. Mean WWI across the cohort was 11.04 ± 0.84. Analysis revealed a significant positive association between WWI and TPOAb levels (β: 4.78, 95% CI: 1.52, 8.05, p = 0.0041), which remained consistent across all multivariate linear regression models. In contrast, no significant correlation was found between WWI and TgAb levels after adjusting for covariates. Subgroup analysis stratified by gender demonstrated a notable gender-specific effect, where the positive correlation between WWI and TPOAb levels was evident only in females (β: 8.13, 95% CI: 4.14, 12.12, p < 0.0001).Conclusion: This study used WWI as a novel indicator of central obesity and identified a strong association with HT, particularly notable in females. However, further high-quality studies are needed to confirm these findings and explore the underlying biological mechanisms.

Objective: Subclinical hypothyroidism (SCH) is a prevalent endocrine disorder associated with metabolic and cardiovascular risks. While physical activity (PA) is well recognized for its benefits on metabolic and cardiovascular health, its relationship with SCH remains unclear. This study aimed to examine the associations between different types, intensities, and frequencies of PA and SCH prevalence using nationally representative data from the U. S. National Health and Nutrition Examination Survey (NHANES).Methods: Data from the 2007–2012 NHANES cycles were analyzed. Weighted univariate and multivariate logistic regression models were employed to assess the associations between PA and SCH prevalence. Curve fitting and threshold effect analyses were conducted to explore potential non-linear relationships, while subgroup analyses examined effect modifications by demographic and clinical factors.Results: Among 6,133 participants included in the final analysis (approximately 20.15% of the total NHANES sample), the prevalence of SCH was 2.5%. Individuals without SCH exhibited significantly higher total PA duration, particularly in occupational physical activity (OPA), vigorous physical activity (VPA), moderate-to-vigorous physical activity (MVPA), MVPA intensity, and weekly frequency of vigorous occupational physical activity (VOPA). In the fully adjusted model, each 10-h/week increase in VPA and MVPA was associated with 33% (OR = 0.67, 95% CI: 0.49–0.91) and 11% (OR = 0.89, 95% CI: 0.81–0.98) lower odds of SCH, respectively. A 10% increase in MVPA intensity was linked to an 8% reduction (OR = 0.92, 95% CI: 0.87–0.97). Similar inverse associations were found for PA and OPA (PA: OR = 0.90, 95% CI: 0.82–0.98; OPA: OR = 0.90, 95% CI: 0.81–0.99). Among PA frequency measures, only VOPA frequency was significant, with each additional session per week associated with a 17% reduction in odds (OR = 0.83, 95% CI: 0.74–0.94). Curve fitting analysis revealed a non-linear relationship between MVPA intensity and SCH prevalence, with a threshold at 57.14%. Below this threshold, higher MVPA intensity was associated with lower SCH prevalence (p = 0.001), whereas above this threshold, the association became non-significant. Subgroup analyses identified a significant interaction with age, where the protective effects of PA and OPA were significant only in individuals aged <60 years.Conclusion: This study suggests that higher PA levels, particularly at greater intensities and frequencies, are associated with a lower prevalence of SCH, especially in individuals aged <60 years. These findings highlight the potential role of regular, high-intensity PA in reducing SCH risk.

Lymph node metastasis in papillary thyroid carcinoma (PTC) has become an area of great interest in the study of thyroid diseases. The aim of this study was to elucidate the research trends and impact of lymph node metastasis of PTC in the study of thyroid diseases through a comprehensive bibliometric analysis. We conducted an extensive bibliometric review of the literature on lymph node metastasis in PTC using the Web of Science Core Database (WOSCC), which included approximately 3292 publications from 2012 to 2022. Data analysis and visualization were performed, using advanced bibliometric tools including VOSviewer, CiteSpace, and bibliometrix R software packages. A total of 3292 publications from 81 one countries were identified. The analysis showed a pattern of growth in the number of publications per year from 2012 to 2022, with China having the highest number of papers. Outstanding contributions were made by China, Korea, USA, Italy and Japan, with Thyroid being the most important journal. The author who published the most papers was Jingqiang Zhu. The institutions that published the most papers were Shanghai Jiao Tong University and Yonsei University. The analysis found that prognosis, recurrence, and ultrasound were the keywords with the highest frequency of occurrence in addition to those related to the title of this article. Our bibliometric analysis outlines the current state of research on lymph node metastasis in PTC, highlighting significant contributions, trends, and future research directions.

Objective: To overcome certain anatomical limitations of transoral vestibular thyroidectomy, we introduced endoscopic thyroidectomy via the submental approach. During subsequent clinical practice, additional advantages of the submental approach were identified, further enhancing its feasibility and clinical applicability. This study aimed to evaluate the safety, efficacy, and postoperative outcomes of this technique in thyroid surgery. Methods: We retrospectively analyzed patients who underwent endoscopic thyroidectomy via the submental approach at Hunan Cancer Hospital between March and September 2023. Perioperative outcomes, complications, and postoperative quality of life were assessed using validated clinical indicators and the Thyroid Cancer-Specific Quality of Life questionnaire. Results: A total of 50 patients (27 males, 23 females; mean age 41.66 ± 9.70 years) were included. The mean operative time was 93.61 ± 21.78 minutes for unilateral thyroidectomy and 137.39 ± 27.76 minutes for total thyroidectomy. The mean pain score at 48 hours postoperatively was 1.56 ± 0.61, and the mean postoperative hospital stay was 2.84 ± 0.81 days. The mean aesthetic satisfaction score was 4.28 ± 0.67 (1–5, with higher scores indicating better satisfaction). The mean quality-of-life score was 10.23 ± 5.33 (0–130, with lower scores indicating better quality of life). No surgical site infections occurred. Transient hypoparathyroidism occurred in 14.8% of patients, and transient recurrent laryngeal nerve palsy occurred in 4.00%. The mean follow-up duration was 22 months, and no cases of recurrence or distant metastasis were observed during the follow-up period. Conclusions: Endoscopic thyroidectomy via the submental approach effectively balances cosmetic outcomes, surgical trauma, oncological integrity, and surgical feasibility, providing a promising alternative for endoscopic thyroidectomy. Further prospective, multicenter studies are needed to validate its long-term safety and broader clinical applicability. Clinical trial registration: https://www.chictr.org.cn , identifier ChiCTR2400089684.