{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T04:58:18Z","timestamp":1758776298840,"version":"3.44.0"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,6,28]],"date-time":"2025-06-28T00:00:00Z","timestamp":1751068800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,28]],"date-time":"2025-06-28T00:00:00Z","timestamp":1751068800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Endocrine"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>Thyrotoxicosis results from either thyroid hyperfunction, as seen in Graves\u2019 disease, or tissue destruction, as in subacute thyroiditis (SAT). Differential diagnosis is essential but can be challenging, with thyroid scintigraphy traditionally used to distinguish between these types. This study investigates the potential of Contrast-Enhanced Ultrasound (CEUS) to provide a non-invasive alternative for differentiating hyperfunction and destructive thyroid disease.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>In a prospective study, 42 patients with untreated thyrotoxicosis were evaluated using CEUS to analyze both qualitative and quantitative perfusion parameters.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Group 1 included 20 patients with Graves\u2019 disease, while Group 2 comprised 22 patients with destructive thyrotoxicosis (SAT, Hashitoxicosis, postpartum thyroiditis, and iatrogenic cases). Significant differences were observed in CEUS parameters between the two groups. Hyperfunction cases showed higher Peak Intensity (PKI), Area Under Curve (AUC), Wash-in AUC (WiAUC), Wash-out AUC (WoAUC), and Mean Time-Intensity Curve (mTIC), while Rise Time (RT) and Time to Peak (TTP) were prolonged in the destruction group. Strong correlations with hyperfunction were observed for PKI, AUC, WoAUC, and mTIC. Optimal cut-off values of AUC\u2009&gt;\u20091991, WoAUC\u2009&gt;\u20091876, and mTIC\u2009&gt;\u200910 achieved 100% sensitivity and specificity for identifying hyperfunction.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>This preliminary study suggests that CEUS, with its quantitative and qualitative assessments, could be a valuable tool in the non-invasive differential diagnosis of thyrotoxicosis, potentially reducing the need for scintigraphy and enabling rapid and accurate treatment decisions.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s12020-025-04324-6","type":"journal-article","created":{"date-parts":[[2025,6,28]],"date-time":"2025-06-28T10:31:33Z","timestamp":1751106693000},"page":"199-207","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Qualitative and quantitative CEUS assessment for differential diagnosis in thyrotoxicosis: destruction vs. hyperfunction"],"prefix":"10.1007","volume":"90","author":[{"given":"Dana","family":"Stoian","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luciana","family":"Moisa-Luca","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreea","family":"Bena","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,6,28]]},"reference":[{"key":"4324_CR1","doi-asserted-by":"publisher","first-page":"737","DOI":"10.3389\/FENDO.2018.00737","volume":"9","author":"VA LiVolsi","year":"2018","unstructured":"V.A. LiVolsi, Z.W. Baloch, The pathology of hyperthyroidism. Front. Endocrinol. 9, 737 (2018). https:\/\/doi.org\/10.3389\/FENDO.2018.00737.","journal-title":"Front. Endocrinol."},{"key":"4324_CR2","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1111\/cei.12980","volume":"189","author":"T Diana","year":"2017","unstructured":"T. Diana, J. Krause, P.D. Olivo, J. K\u00f6nig, M. Kanitz, B. Decallonne, G.J. Kahaly, Prevalence and clinical relevance of thyroid stimulating hormone receptor-blocking antibodies in autoimmune thyroid disease. Clin. Exp. Immunol. 189, 304\u2013309 (2017). https:\/\/doi.org\/10.1111\/cei.12980.","journal-title":"Clin. Exp. Immunol."},{"key":"4324_CR3","doi-asserted-by":"publisher","first-page":"bcr0420114163","DOI":"10.1136\/BCR.04.2011.4163","volume":"2011","author":"S Kohler","year":"2011","unstructured":"S. Kohler, O. Tschopp, E. Jacky, C. Schmid, Paraneoplastic hyperthyroidism. BMJ Case Rep. 2011, bcr0420114163 (2011). https:\/\/doi.org\/10.1136\/BCR.04.2011.4163.","journal-title":"BMJ Case Rep."},{"key":"4324_CR4","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1001\/ARCHINTE.1977.03630200005005","volume":"137","author":"SG Dorfman","year":"1977","unstructured":"S.G. Dorfman, Hyperthyroidism: usual and unusual causes. Arch. Intern. Med. 137, 995\u2013996 (1977). https:\/\/doi.org\/10.1001\/ARCHINTE.1977.03630200005005.","journal-title":"Arch. Intern. Med."},{"key":"4324_CR5","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1016\/J.AUTREV.2014.10.016","volume":"14","author":"A Antonelli","year":"2015","unstructured":"A. Antonelli, S.M. Ferrari, A. Corrado, A. Di Domenicantonio, P. Fallahi, Autoimmune thyroid disorders. Autoimmun. Rev. 14, 174\u2013180 (2015). https:\/\/doi.org\/10.1016\/J.AUTREV.2014.10.016.","journal-title":"Autoimmun. Rev."},{"key":"4324_CR6","doi-asserted-by":"publisher","first-page":"2646","DOI":"10.1056\/NEJMRA021194","volume":"348","author":"EN Pearce","year":"2003","unstructured":"E.N. Pearce, A.P. Farwell, L.E. Braverman, Thyroiditis. N. Engl. J. Med. 348, 2646\u20132655 (2003). https:\/\/doi.org\/10.1056\/NEJMRA021194.","journal-title":"N. Engl. J. Med."},{"key":"4324_CR7","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.1089\/THY.2016.0229","volume":"26","author":"DS Ross","year":"2016","unstructured":"D.S. Ross, H.B. Burch, D.S. Cooper, M.C. Greenlee, P. Laurberg, A.L. Maia, S.A. Rivkees, M. Samuels, J.A. Sosa, M.N. Stan et al., 2016 American thyroid association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 26, 1343\u20131421 (2016). https:\/\/doi.org\/10.1089\/THY.2016.0229.","journal-title":"Thyroid"},{"key":"4324_CR8","doi-asserted-by":"publisher","first-page":"178","DOI":"10.4329\/WJR.V5.I4.178","volume":"5","author":"RH Donkol","year":"2013","unstructured":"R.H. Donkol, A.M. Nada, S. Boughattas, Role of color doppler in differentiation of Graves\u2019 disease and thyroiditis in thyrotoxicosis. World J. Radiol. 5, 178 (2013). https:\/\/doi.org\/10.4329\/WJR.V5.I4.178.","journal-title":"World J. Radiol."},{"key":"4324_CR9","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/J.JCTE.2019.01.001","volume":"15","author":"R Vita","year":"2019","unstructured":"R. Vita, F. Di Bari, S. Perelli, G. Capodicasa, S. Benvenga, Thyroid vascularization is an important ultrasonographic parameter in untreated Graves\u2019 disease patients. J. Clin. Transl. Endocrinol. 15, 65\u201369 (2019). https:\/\/doi.org\/10.1016\/J.JCTE.2019.01.001.","journal-title":"J. Clin. Transl. Endocrinol."},{"key":"4324_CR10","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1530\/EJE-11-0736","volume":"166","author":"M Ruchala","year":"2012","unstructured":"M. Ruchala, E. Szczepanek-Parulska, A. Zybek, J. Moczko, A. Czarnywojtek, G. Kaminski, J. Sowinski, The role of sonoelastography in acute, subacute and chronic thyroiditis: a novel application of the method. Eur. J. Endocrinol. 166, 425\u2013432 (2012). https:\/\/doi.org\/10.1530\/EJE-11-0736.","journal-title":"Eur. J. Endocrinol."},{"key":"4324_CR11","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1111\/CEN.14130","volume":"92","author":"L Scappaticcio","year":"2020","unstructured":"L. Scappaticcio, P. Trimboli, F. Keller, M. Imperiali, A. Piccardo, L. Giovanella, Diagnostic testing for Graves\u2019 or non-Graves\u2019 hyperthyroidism: a comparison of two thyrotropin receptor antibody immunoassays with thyroid scintigraphy and ultrasonography. Clin. Endocrinol. 92, 169\u2013178 (2020). https:\/\/doi.org\/10.1111\/CEN.14130.","journal-title":"Clin. Endocrinol."},{"key":"4324_CR12","doi-asserted-by":"publisher","first-page":"1300447","DOI":"10.3389\/FENDO.2023.1300447\/BIBTEX","volume":"14","author":"D Stoian","year":"2023","unstructured":"D. Stoian, A. Borlea, L. Moisa-Luca, C. Paul, Multiparametric ultrasound-based assessment of overt hyperthyroid diffuse thyroid disease. Front. Endocrinol. 14, 1300447 (2023). https:\/\/doi.org\/10.3389\/FENDO.2023.1300447\/BIBTEX.","journal-title":"Front. Endocrinol."},{"key":"4324_CR13","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1016\/J.RCL.2020.07.003","volume":"58","author":"LF Alexander","year":"2020","unstructured":"L.F. Alexander, N.J. Patel, M.P. Caserta, M.L. Robbin, Thyroid ultrasound: diffuse and nodular disease. Radiol. Clin. North. Am. 58, 1041\u20131057 (2020). https:\/\/doi.org\/10.1016\/J.RCL.2020.07.003.","journal-title":"Radiol. Clin. North. Am."},{"key":"4324_CR14","doi-asserted-by":"publisher","first-page":"79","DOI":"10.11152\/mu-980","volume":"19","author":"M Dighe","year":"2017","unstructured":"M. Dighe, R. Barr, J. Bojunga, V. Cantisani, M. Cristina Chammas, D. Cosgrove, X.-W. Cui, Y. Dong, F. Fenner, M. Radzina et al., Thyroid ultrasound: state of the art part 1 \u2013 thyroid ultrasound reporting and diffuse thyroid diseases. Med. Ultrason. 19, 79\u201393 (2017). https:\/\/doi.org\/10.11152\/mu-980.","journal-title":"Med. Ultrason."},{"key":"4324_CR15","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.crad.2017.08.003","volume":"73","author":"AS Mcqueen","year":"2018","unstructured":"A.S. Mcqueen, K.S. Bhatia, Head and neck ultrasound: technical advances, novel applications and the role of elastography. Clin. Radiol. 73, 81\u201393 (2018). https:\/\/doi.org\/10.1016\/j.crad.2017.08.003.","journal-title":"Clin. Radiol."},{"key":"4324_CR16","doi-asserted-by":"publisher","first-page":"1319","DOI":"10.7863\/ultra.32.7.1319","volume":"32","author":"RD Harris","year":"2013","unstructured":"R.D. Harris, J.E. Langer, R.A. Levine, S. Sheth, S.J. Abramson, H. Gabriel, M.D. Patel, J.A. Craychee, C.R. Miller, H.K. Rosenberg et al., AIUM thyroid and parathyroid ultrasound examination. J. Ultrasound Med. 32, 1319\u20131329 (2013). https:\/\/doi.org\/10.7863\/ultra.32.7.1319.","journal-title":"J. Ultrasound Med."},{"key":"4324_CR17","doi-asserted-by":"publisher","DOI":"10.1186\/S12967-018-1765-3","volume":"17","author":"Z Cui","year":"2019","unstructured":"Z. Cui, Z. Wang, X. Liu, Y. Cai, X. Xu, T. Yang, Establishment of clinical diagnosis model of Graves\u2019 disease and Hashimoto\u2019s thyroiditis. J. Transl. Med. 17, 11 (2019). https:\/\/doi.org\/10.1186\/S12967-018-1765-3.","journal-title":"J. Transl. Med."},{"key":"4324_CR18","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1055\/S-0041-1734360","volume":"31","author":"PK Sarangi","year":"2021","unstructured":"P.K. Sarangi, S. Parida, S. Mangaraj, B.K. Mohanty, J. Mohanty, B.M. Swain, Diagnostic utility of mean peak systolic velocity of superior thyroid artery in differentiating Graves\u2019 disease from thyroiditis. Indian. J. Radiol. Imaging 31, 311\u2013317 (2021). https:\/\/doi.org\/10.1055\/S-0041-1734360.","journal-title":"Indian. J. Radiol. Imaging"},{"key":"4324_CR19","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/S0929-8266(02)00072-1","volume":"16","author":"SL Schulz","year":"2003","unstructured":"S.L. Schulz, U. Seeberger, J.H. Hengstmann, Color doppler sonography in hypothyroidism. Eur. J. Ultrasound 16, 183\u2013189 (2003). https:\/\/doi.org\/10.1016\/S0929-8266(02)00072-1.","journal-title":"Eur. J. Ultrasound"},{"key":"4324_CR20","doi-asserted-by":"publisher","first-page":"1621","DOI":"10.1016\/j.ejrad.2015.05.028","volume":"84","author":"V Cantisani","year":"2015","unstructured":"V. Cantisani, S.R. Wilson, CEUS: where are we in 2015?. Eur. J. Radiol. 84, 1621\u20131622 (2015). https:\/\/doi.org\/10.1016\/j.ejrad.2015.05.028.","journal-title":"Eur. J. Radiol."},{"key":"4324_CR21","doi-asserted-by":"publisher","first-page":"2579","DOI":"10.1016\/J.ULTRASMEDBIO.2020.04.030","volume":"46","author":"CF Dietrich","year":"2020","unstructured":"C.F. Dietrich, C.P. Nols\u00f8e, R.G. Barr, A. Berzigotti, P.N. Burns, V. Cantisani, M.C. Chammas, N. Chaubal, B.I. Choi, D.A. Clevert et al., Guidelines and good clinical practice recommendations for contrast-enhanced ultrasound (CEUS) in the liver-update 2020 WFUMB in cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. Ultrasound Med. Biol. 46, 2579\u20132604 (2020). https:\/\/doi.org\/10.1016\/J.ULTRASMEDBIO.2020.04.030.","journal-title":"Ultrasound Med. Biol."},{"key":"4324_CR22","doi-asserted-by":"publisher","first-page":"e2","DOI":"10.1055\/A-0586-1107","volume":"39","author":"PS Sidhu","year":"2018","unstructured":"P.S. Sidhu, V. Cantisani, C.F. Dietrich, O.H. Gilja, A. Saftoiu, E. Bartels, M. Bertolotto, F. Calliada, D.A. Clevert, D. Cosgrove et al., The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: update 2017 (long version). Ultraschall Med. 39, e2\u2013e44 (2018). https:\/\/doi.org\/10.1055\/A-0586-1107.","journal-title":"Ultraschall Med."},{"key":"4324_CR23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/S12880-023-00966-Y\/TABLES\/2","volume":"23","author":"XJ Chen","year":"2023","unstructured":"X.J. Chen, L.J. Huang, F. Mao, H.X. Yuan, X. Wang, Q. Lu, C.H. Dong, Value of CEUS features in diagnosing thyroid nodules with halo sign on B-mode ultrasound. BMC Med. Imaging 23, 1\u20138 (2023). https:\/\/doi.org\/10.1186\/S12880-023-00966-Y\/TABLES\/2.","journal-title":"BMC Med. Imaging"},{"key":"4324_CR24","doi-asserted-by":"publisher","first-page":"4559","DOI":"10.3390\/jcm10194559","volume":"10","author":"S Sorrenti","year":"2021","unstructured":"S. Sorrenti, V. Dolcetti, D. Fresilli, G. Del Gaudio, P. Pacini, P. Huang, C. Camponovo, A. Leoncini, V. D\u2019andrea, D. Pironi et al., Clinical medicine the role of CEUS in the evaluation of thyroid cancer: from diagnosis to local staging. J. Clin. Med. 10, 4559 (2021). https:\/\/doi.org\/10.3390\/jcm10194559.","journal-title":"J. Clin. Med."},{"key":"4324_CR25","doi-asserted-by":"publisher","first-page":"8229445","DOI":"10.1155\/2022\/8229445","volume":"2022","author":"H Petrasova","year":"2022","unstructured":"H. Petrasova, R. Slaisova, T. Rohan, K. Stary, J. Kyclova, T. Pavlik, P. Kovalcikova, T. Kazda, V. Valek, Contrast-enhanced ultrasonography for differential diagnosis of benign and malignant thyroid lesions: single-institutional prospective study of qualitative and quantitative CEUS characteristics. Contrast Media Mol. Imaging 2022, 8229445 (2022). https:\/\/doi.org\/10.1155\/2022\/8229445.","journal-title":"Contrast Media Mol. Imaging"},{"key":"4324_CR26","unstructured":"Zuo Q. New CEUS Quantification Analysis Demo Guide, (Ultrasound Technology Operation Instructions, 2024)"},{"key":"4324_CR27","doi-asserted-by":"publisher","first-page":"6","DOI":"10.4158\/EP.15.1.6","volume":"15","author":"KV Hari Kumar","year":"2009","unstructured":"K.V. Hari Kumar, V. Pasupuleti, M. Jayaraman, V. Abhyuday, B.R. Rayudu, K.D. Modi, Role of thyroid doppler in differential diagnosis of thyrotoxicosis. Endocr. Pract. 15, 6\u20139 (2009). https:\/\/doi.org\/10.4158\/EP.15.1.6.","journal-title":"Endocr. Pract."},{"key":"4324_CR28","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1177\/147323001204000226","volume":"40","author":"X Zhao","year":"2012","unstructured":"X. Zhao, L. Chen, H. Liu, Y. Wang, L. Li, B. Lu, Y. Li, R. Hu, Mean peak systolic velocity of the superior thyroid artery is correlated with radioactive iodine uptake in untreated thyrotoxicosis. J. Int. Med. Res. 40, 640\u2013647 (2012). https:\/\/doi.org\/10.1177\/147323001204000226.","journal-title":"J. Int. Med. Res."},{"key":"4324_CR29","doi-asserted-by":"publisher","first-page":"e50051","DOI":"10.1371\/JOURNAL.PONE.0050051","volume":"7","author":"X Zhao","year":"2012","unstructured":"X. Zhao, L. Chen, L. Li, Y. Wang, Y. Wang, L. Zhou, F. Zeng, Y. Li, R. Hu, H. Liu, Peak systolic velocity of superior thyroid artery for the differential diagnosis of thyrotoxicosis. PLoS One 7, e50051 (2012). https:\/\/doi.org\/10.1371\/JOURNAL.PONE.0050051.","journal-title":"PLoS One"},{"key":"4324_CR30","unstructured":"D. Stoian, T. Bogdan, M. Craina, M. Craciunescu, R. Timar, A. Schiller, Elastography: a new ultrasound technique in nodular thyroid pathology. In Thyroid Cancer - Advances in Diagnosis and Therapy, (2007)"},{"key":"4324_CR31","doi-asserted-by":"publisher","first-page":"2917","DOI":"10.1210\/jc.2007-0641","volume":"92","author":"T Rago","year":"2007","unstructured":"T. Rago, F. Santini, M. Scutari, A. Pinchera, P. Vitti, Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules. J. Clin. Endocrinol. Metab. 92, 2917\u20132922 (2007).","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"4324_CR32","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1530\/EJE-12-0936","volume":"168","author":"G Russ","year":"2013","unstructured":"G. Russ, B. Royer, C. Bigorgne, A. Rouxel, M. Bienvenu-Perrard, L. Leenhardt, Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography. Eur. J. Endocrinol. 168, 649\u2013655 (2013). https:\/\/doi.org\/10.1530\/EJE-12-0936.","journal-title":"Eur. J. Endocrinol."},{"key":"4324_CR33","doi-asserted-by":"publisher","first-page":"874","DOI":"10.3390\/diagnostics10110874","volume":"10","author":"CM Cepeha","year":"2020","unstructured":"C.M. Cepeha, C. Paul, A. Borlea, F. Borcan, R. Fofiu, C.A. Dehelean, D. Stoian, The value of strain elastography in predicting autoimmune thyroiditis. Diagnostics 10, 874 (2020). https:\/\/doi.org\/10.3390\/diagnostics10110874.","journal-title":"Diagnostics"},{"key":"4324_CR34","doi-asserted-by":"publisher","first-page":"520","DOI":"10.5603\/EP.2014.0071","volume":"65","author":"M Rucha\u0142a","year":"2014","unstructured":"M. Rucha\u0142a, K. Szmyt, S. S\u0142awek, A. Zybek, E. Szczepanek-Parulska, Ultrasound sonoelastography in the evaluation of thyroiditis and autoimmune thyroid disease. Endokrynol. Pol. 65, 520\u2013531 (2014). https:\/\/doi.org\/10.5603\/EP.2014.0071.","journal-title":"Endokrynol. Pol."},{"key":"4324_CR35","doi-asserted-by":"publisher","unstructured":"H. Ayca Ata Korkmaz, G. Baki, M. Kose, B. Yaldiz Cobanoglu, Value of real-time and strain ratio elastography in differential diagnosis of Graves\u2019 disease and subacute and hashimoto\u2019s thyroiditis. Iran. J. Radiol. 14, (2017), https:\/\/doi.org\/10.5812\/IRANJRADIOL.22019","DOI":"10.5812\/IRANJRADIOL.22019"},{"key":"4324_CR36","doi-asserted-by":"publisher","DOI":"10.1186\/S13104-020-05164-5","volume":"13","author":"K Alswat","year":"2020","unstructured":"K. Alswat, S.A. Assiri, R.M.M. Althaqafi, A. Alsufyani, A. Althagafi, S. Alrebaiee, N. Alsukhayri, Scintigraphy evaluation of hyperthyroidism and its correlation with clinical and biochemical profiles. BMC Res. Notes 13, 324 (2020). https:\/\/doi.org\/10.1186\/S13104-020-05164-5.","journal-title":"BMC Res. Notes"}],"container-title":["Endocrine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12020-025-04324-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12020-025-04324-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12020-025-04324-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T04:00:15Z","timestamp":1758772815000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12020-025-04324-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,28]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["4324"],"URL":"https:\/\/doi.org\/10.1007\/s12020-025-04324-6","relation":{},"ISSN":["1559-0100"],"issn-type":[{"type":"electronic","value":"1559-0100"}],"subject":[],"published":{"date-parts":[[2025,6,28]]},"assertion":[{"value":"22 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}