A randomized controlled trial conducted by Ruijin Hospital, Shanghai Jiao Tong University School of Medicine showed that adding methotrexate 10 mg/week to standard thiamazole treatment significantly improved the remission rate off medication in patients with Graves’ disease (GD) at 15–18 months (55.6% vs. 38.9%) and accelerated the reduction of TSH receptor antibody (TRAb) levels, with no significant differences in the speed of thyroid function recovery or adverse reaction rates compared with the monotherapy group.
The phase 3 clinical trial of teprotumumab—the first IGF‑1R antibody in China and the second worldwide for thyroid‑associated ophthalmopathy (TED)—was published. It confirmed that the drug markedly improved exophthalmos (response rate 85.8% at week 24 vs. 3.8% in the placebo group). The improvement rate of clinical activity score and overall response rate were far superior to placebo, with favorable safety, providing an effective and affordable targeted option for Chinese TED patients. In addition, case reports noted that two patients with refractory TED achieved rapid and sustained clinical remission after treatment with the Janus kinase (JAK) inhibitor tofacitinib.
Regarding the management of congenital hypothyroidism (CH), a team from the Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine reported the clinical outcomes of 28 children with CH caused by biallelic DUOX2 mutations who discontinued levothyroxine (LT4) at age 3. Only 25% developed permanent hypothyroidism, and 44.4% of children with isolated hyperthyrotropinemia had normalized TSH one year after stopping treatment. The study indicated that long‑term follow‑up is necessary because most children, especially those with elevated TSH, show increased serum thyroglobulin (Tg) and enlarged thyroid volume for several months after LT4 withdrawal.
In 2025, two more studies supported de‑escalation strategies for low‑risk differentiated thyroid carcinoma (DTC). The UK multicenter randomized controlled IoN study showed that in low‑risk DTC patients (especially pT1/T2, N0/Nx), total thyroidectomy alone was non‑inferior to total thyroidectomy plus radioactive iodine remnant ablation in 5‑year recurrence‑free survival. Another Canadian long‑term follow‑up study confirmed that active surveillance (AS) is suitable for low‑risk papillary thyroid carcinoma (PTC) < 2 cm, particularly in elderly patients. Among 155 low‑risk patients managed with AS over a median follow‑up of 66 months, none had PTC‑related death or distant metastasis; 24% later underwent surgery, with oncologic outcomes and surgical complications similar to the immediate surgery group. The 5‑year continuous AS rate in patients ≥65 years reached 95%. Furthermore, a team from Fudan University Shanghai Cancer Center challenged traditional approaches for medullary thyroid carcinoma (MTC). For unilateral sporadic MTC ≤ 2 cm, they concluded that thyroid lobectomy is comparable to total thyroidectomy in cure rate and prognosis, with a lower risk of complications. The team also updated thresholds for preoperative calcitonin levels (measured by electrochemiluminescence or chemiluminescence) that predict the extent of lymph node metastasis:central compartment metastasis 241.9 pg/ml,ipsilateral lateral neck metastasis 693.9 pg/ml,superior mediastinum metastasis 2787.1 pg/ml,contralateral/bilateral lateral neck metastasis 2378.5 pg/ml [32]. The impact of thyroid diseases on long‑term health has drawn attention. A large Korean population‑based survey found that patients with GD had a 13% higher risk of new‑onset diabetes than the general population, with the highest risk within 6 months after diagnosis (HR=3.21), independent of treatment modality [33]. Varner et al. performed long‑term follow‑up of patients with untreated subclinical hypothyroidism (SCH) diagnosed during pregnancy and found a 23.1% risk of progression to overt hypothyroidism within 5 years postpartum. The risk was further increased in those with baseline thyroid peroxidase antibody (TPOAb) >50 IU/ml and TSH >10 mU/L, highlighting the need for continued postpartum thyroid function monitoring in pregnant women with SCH, especially those with positive TPOAb.
Most thyroid cancer patients achieve long‑term survival, so comorbidities, rehabilitation, and quality of life during post‑treatment or survivorship should be emphasized. An et al. found that the risk of second primary malignancies after radioactive iodine therapy for DTC varies by age: an increased risk of hematologic malignancies in the young group (15–44 years); higher risks of prostate, salivary gland, and lymphoma in the middle‑aged group (45–64 years); and elevated risks of gastric, esophageal, skin, and leukemia in the elderly group (≥65 years). Age should therefore be considered in clinical surveillance.
A multicenter survey (n=1316) led by West China Hospital, Sichuan University showed that among low‑risk micro‑PTC patients, 24.2% of the surgery group reported high decision regret, mainly related to reduced postoperative quality of life and insufficient preoperative disease information. A study from the First Affiliated Hospital, Sun Yat‑sen University reported that reproductive concerns in Chinese women of childbearing age with DTC were significantly higher within 2 years after surgery than in those with benign lesions, accompanied by lower fertility desire, most prominent at 1 year postoperatively. This suggests that medical teams should provide more psychological support and scientific pregnancy guidance for women of childbearing age after thyroid cancer surgery.