{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T06:26:12Z","timestamp":1787293572711,"version":"build-2736575974"},"reference-count":56,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100015800","name":"Universidade Federal De Sergipe","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100015800","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Endocrinol Invest"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Acromegaly is associated with increased risk of diffuse or nodular goiter and possibly of thyroid cancer. The aim of this study was to verify whether these findings persist in the current scenario of improved disease control.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A two-steps protocol was carried out:. In the first (retrospective), clinical and laboratory data (including 969 IGF-I measurements), and the frequency of thyroid cancer were recorded for 92 acromegaly patients over a 28-year period. The annual control percentage was defined as the average of the ratios between each of the 969 IGF-I measurements over the total follow-up period and the respective upper age limit (IGF-I\/ULN) less than 1.Acromegaly activity was determined at the last visit. In the second step (cross-sectional), 74 of the 92 acromegaly patients underwent thyroid ultrasound and were subjected to a two-stage cluster analysis, with the aim of grouping them into homogeneous clusters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      70% of the 92 patients had inactive disease, with a median control rate of 50%, with four cases of thyroid cancer (4.3%), only one in a patient with active disease. Two-thirds of the 74 patients (evaluated by ultrasound) had nodules, and 27% had diffuse thyroid hyperplasia. Three clusters were segregated with high significant differences in sex and echotextural alterations (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001 in both cases). Age, number of nodules, thyroid volume and follow-up time were similar between the clusters.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>No inherent thyroid changes were apparently identified in a large cohort of acromegaly patients. Better control during follow-up may attenuate thyroid manifestations in acromegaly.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s40618-026-02919-y","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T04:53:11Z","timestamp":1779425591000},"page":"2245-2253","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Thyroid abnormalities in acromegaly in the era of improved disease control: a two-stage study"],"prefix":"10.1007","volume":"49","author":[{"given":"Luciana P. S.","family":"Diniz Leite","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz S. Soares","family":"da Rocha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo A. P.","family":"Diniz Leite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel A. P.","family":"Diniz Leite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana Beaudette","family":"Drumond","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas G.","family":"de O Freitas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Izabella S.","family":"Freitas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c2ngela C.","family":"Leal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie O.","family":"Santana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana M.","family":"Lamego Rezende","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enaldo V.","family":"Melo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur M.","family":"Pereira Oliveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elenilde G.","family":"Santps","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviane C.","family":"Campos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Salvatori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel H.","family":"Aguiar-Oliveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"2919_CR1","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1210\/er.2018-00216","volume":"40","author":"MH Aguiar-Oliveira","year":"2019","unstructured":"Aguiar-Oliveira MH, Bartke A (2019) Growth hormone deficiency: health and longevity. Endocr Rev 40:575\u2013601. https:\/\/doi.org\/10.1210\/er.2018-00216","journal-title":"Endocr Rev"},{"key":"2919_CR2","doi-asserted-by":"publisher","first-page":"0","DOI":"10.1152\/physiol.00009.2025","volume":"41","author":"MH Aguiar-Oliveira","year":"2026","unstructured":"Aguiar-Oliveira MH, Boguszewski MCS, Rovaris DL, Donato J Jr (2026) Growth hormone and IGF-1 actions in the brain and neuropsychiatric diseases. Physiol (Bethesda) 41:0. https:\/\/doi.org\/10.1152\/physiol.00009.2025","journal-title":"Physiol (Bethesda)"},{"key":"2919_CR3","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1051\/rnd:19890401","volume":"29","author":"G Cabello","year":"1989","unstructured":"Cabello G, Wrutniak C (1989) Thyroid hormone and growth: relationships with growth hormone effects and regulation. Reprod Nutr Dev 29:387\u2013402","journal-title":"Reprod Nutr Dev"},{"key":"2919_CR4","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1203\/00006450-200208000-00003","volume":"52","author":"H Robson","year":"2002","unstructured":"Robson H, Siebler T, Shalet SM, Williams GR (2002) Interactions between GH, IGF-I, glucocorticoids, and thyroid hormones during skeletal growth. Pediatr Res 52:137\u2013147. https:\/\/doi.org\/10.1203\/00006450-200208000-00003","journal-title":"Pediatr Res"},{"key":"2919_CR5","doi-asserted-by":"publisher","first-page":"99","DOI":"10.3109\/08977199009071497","volume":"2","author":"MC Eggo","year":"1990","unstructured":"Eggo MC, Bachrach LK, Burrow GN (1990) Interaction of TSH, insulin and insulin-like growth factors in regulating thyroid growth and function. Growth Factors 2:99\u2013109","journal-title":"Growth Factors"},{"key":"2919_CR6","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1210\/endo-119-2-940","volume":"119","author":"D Tramontano","year":"1986","unstructured":"Tramontano D, Cushing GW, Moses AC, Ingbar SH (1986) Insulin-like growth factor-I stimulates the growth of rat thyroid cells in culture and synergizes the stimulation of DNA synthesis induced by TSH and Graves\u2019-IgG. Endocrinology 119:940\u2013942","journal-title":"Endocrinology"},{"key":"2919_CR7","doi-asserted-by":"publisher","first-page":"1158","DOI":"10.1210\/jcem-66-6-1158","volume":"66","author":"P Roger","year":"1988","unstructured":"Roger P, Taton M, Van Sande J, Dumont JE (1988) Mitogenic effect of thyrotropin and adenosine 3,5-monophosphate in differentiated normal human thyroid cells in vitro. J Clin Endocrinol Metab 66:1158\u20131165","journal-title":"J Clin Endocrinol Metab"},{"key":"2919_CR8","doi-asserted-by":"publisher","first-page":"1546","DOI":"10.1172\/JCI113764","volume":"82","author":"RB Maciel","year":"1988","unstructured":"Maciel RB, Moses AC, Villone G, Tramontano D, Ingbar SH (1988) Demonstration of the production and physiological role of insulin-like growth factor II in rat thyroid follicular cells in culture. J Clin Invest 82:1546\u20131553","journal-title":"J Clin Invest"},{"key":"2919_CR9","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1210\/jcem-69-3-639","volume":"69","author":"B Tode","year":"1989","unstructured":"Tode B, Serio M, Rotella CM (1989) Insulin-like growth factor I: autocrine secretion by human thyroid follicular cells in primary culture. J Clin Endocrinol Metab 69:639\u2013647","journal-title":"J Clin Endocrinol Metab"},{"key":"2919_CR10","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1210\/jc.2005-2555","volume":"91","author":"MR Alc\u00e2ntara","year":"2006","unstructured":"Alc\u00e2ntara MR, Salvatori R, Alc\u00e2ntara PR, N\u00f3brega LM, Campos VS, Oliveira EC, Oliveira MH, Souza AH, Aguiar-Oliveira MH (2006) Thyroid morphology and function in adults with untreated isolated growth hormone deficiency. J Clin Endocrinol Metab 91:860\u2013864. https:\/\/doi.org\/10.1210\/jc.2005-2555","journal-title":"J Clin Endocrinol Metab"},{"key":"2919_CR11","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1210\/er.2018-00115","volume":"40","author":"MR Gadelha","year":"2019","unstructured":"Gadelha MR, Kasuki L, Lim DST, Fleseriu M (2019) Systemic complications of acromegaly and the impact of the current treatment landscape: an update. Endocr Rev 40:268\u2013332. https:\/\/doi.org\/10.1210\/er.2018-00115","journal-title":"Endocr Rev"},{"key":"2919_CR12","doi-asserted-by":"publisher","first-page":"1926","DOI":"10.1056\/NEJMra2409076","volume":"393","author":"A Giustina","year":"2025","unstructured":"Giustina A, Colao A (2025) Acromegaly. N Engl J Med 393:1926\u20131939. https:\/\/doi.org\/10.1056\/NEJMra2409076","journal-title":"N Engl J Med"},{"key":"2919_CR13","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.1507\/endocrj.EJ23-0356","volume":"70","author":"C Mo","year":"2023","unstructured":"Mo C, Zhong L (2023) The effect of acromegaly on thyroid disease. Endocr J 70:1051\u20131060. https:\/\/doi.org\/10.1507\/endocrj.EJ23-0356","journal-title":"Endocr J"},{"key":"2919_CR14","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1016\/S2213-8587(22)00244-3","volume":"10","author":"M Fleseriu","year":"2022","unstructured":"Fleseriu M, Langlois F, Lim DST, Varlamov E, Melmed S (2022) Acromegaly: pathogenesis, diagnosis, and management. Lancet Diabetes Endocrinol 10:804\u2013826. https:\/\/doi.org\/10.1016\/S2213-8587(22)00244-3","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2919_CR15","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1038\/nrendo.2010.171","volume":"7","author":"PE Clayton","year":"2011","unstructured":"Clayton PE, Banerjee I, Murray PG, Renehan AG (2011) Growth hormone, the insulin-like growth factor axis, insulin and cancer risk. Nat Rev Endocrinol 7:11\u201324","journal-title":"Nat Rev Endocrinol"},{"key":"2919_CR16","doi-asserted-by":"publisher","first-page":"837","DOI":"10.5114\/aoms.2013.36924","volume":"10","author":"AM D\u0105browska","year":"2014","unstructured":"D\u0105browska AM, Tarach JS, Kurowska M, Nowakowski A (2014) Thyroid diseases in patients with acromegaly. Arch Med Sci 10:837\u2013845. https:\/\/doi.org\/10.5114\/aoms.2013.36924","journal-title":"Arch Med Sci"},{"key":"2919_CR17","doi-asserted-by":"publisher","first-page":"269","DOI":"10.20945\/2359-3997000000247","volume":"64","author":"E Natchev","year":"2020","unstructured":"Natchev E, Vandeva S, Kovatcheva R, Kirilov G, Kalinov K, Zacharieva S (2020) Thyroid gland changes in patients with acromegaly. Arch Endocrinol Metab 64:269\u2013275. https:\/\/doi.org\/10.20945\/2359-3997000000247","journal-title":"Arch Endocrinol Metab"},{"key":"2919_CR18","doi-asserted-by":"publisher","unstructured":"Guevara-Aguirre J, Pe\u00f1a G, Acosta W, Pazmi\u00f1o G, Saavedra J, Soto L, Lescano D, Guevara A, Gavilanes AWD (2023) Cancer in growth hormone excess and growth hormone deficit. Endocr Relat Cancer 30. https:\/\/doi.org\/10.1530\/ERC-22-0402","DOI":"10.1530\/ERC-22-0402"},{"key":"2919_CR19","doi-asserted-by":"publisher","first-page":"e0285335","DOI":"10.1371\/journal.pone.0285335","volume":"18","author":"Z Xiao","year":"2023","unstructured":"Xiao Z, Xiao P, Wang Y, Fang C, Li Y (2023) Risk of cancer in acromegaly patients: an updated meta-analysis and systematic review. PLoS ONE 18:e0285335. https:\/\/doi.org\/10.1371\/journal.pone.0285335","journal-title":"PLoS ONE"},{"key":"2919_CR20","doi-asserted-by":"publisher","first-page":"130","DOI":"10.23736\/S2724-6507.21.03363-7","volume":"48","author":"Y Cankurtaran","year":"2023","unstructured":"Cankurtaran Y, \u00d6r\u00fck GG, Tozduman B (2023) Evaluation of thyroid disease and thyroid malignancy in acromegalic patients. Minerva Endocrinol (Torino) 48:130\u2013139. https:\/\/doi.org\/10.23736\/S2724-6507.21.03363-7","journal-title":"Minerva Endocrinol (Torino)"},{"key":"2919_CR21","doi-asserted-by":"publisher","first-page":"2","DOI":"10.5603\/EP.2017.0001","volume":"68","author":"K Woli\u0144ski","year":"2017","unstructured":"Woli\u0144ski K, Stangierski A, Gurgul E, Bromi\u0144ska B, Czarnywojtek A, Lodyga M, Rucha\u0142a M (2017) Thyroid lesions in patients with acromegaly - case-control study and update to the meta-analysis. Endokrynol Pol 68:2\u20136. https:\/\/doi.org\/10.5603\/EP.2017.0001","journal-title":"Endokrynol Pol"},{"key":"2919_CR22","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1530\/ERC-16-0553","volume":"24","author":"M Terzolo","year":"2017","unstructured":"Terzolo M, Reimondo G, Berchialla P et al (2017) Acromegaly is associated with increased cancer risk: a survey in Italy. Endocr Relat Cancer 24:495\u2013504","journal-title":"Endocr Relat Cancer"},{"key":"2919_CR23","doi-asserted-by":"publisher","first-page":"2182","DOI":"10.1210\/jc.2017-02457","volume":"103","author":"J Dal","year":"2018","unstructured":"Dal J, Leisner MZ, Hermansen K, Farkas DK, Bengtsen M, Kistorp C, Nielsen EH, Andersen M, Feldt-Rasmussen U, Dekkers OM et al (2018) Cancer incidence in patients with acromegaly: a cohort study and meta-analysis of the literature. J Clin Endocrinol Metab 103:2182\u20132188. https:\/\/doi.org\/10.1210\/jc.2017-02457","journal-title":"J Clin Endocrinol Metab"},{"key":"2919_CR24","doi-asserted-by":"publisher","first-page":"2929","DOI":"10.1210\/jcem.86.7.7635","volume":"86","author":"S Melmed","year":"2001","unstructured":"Melmed S (2001) Acromegaly and cancer: not a problem? J Clin Endocrinol Metab 86:2929\u20132934","journal-title":"J Clin Endocrinol Metab"},{"key":"2919_CR25","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1007\/s11102-010-0224-9","volume":"13","author":"BE Gullu","year":"2010","unstructured":"Gullu BE, Celik O, Gazioglu N, Kadioglu P (2010) Thyroid cancer is the most common cancer associated with acromegaly. Pituitary 13:242\u2013248. https:\/\/doi.org\/10.1007\/s11102-010-0224-9","journal-title":"Pituitary"},{"key":"2919_CR26","doi-asserted-by":"publisher","first-page":"e88787","DOI":"10.1371\/journal.pone.0088787","volume":"9","author":"K Wolinski","year":"2014","unstructured":"Wolinski K, Czarnywojtek A, Ruchala M (2014) Risk of thyroid nodular disease and thyroid cancer in patients with acromegaly - meta-analysis and systematic review. PLoS ONE 9:e88787. https:\/\/doi.org\/10.1371\/journal.pone.0088787","journal-title":"PLoS ONE"},{"key":"2919_CR27","doi-asserted-by":"publisher","first-page":"3487","DOI":"10.1210\/CLINEM\/DGAB560","volume":"106","author":"D Esposito","year":"2021","unstructured":"Esposito D, Ragnarsson O, Johannsson G, Olsson DS (2021) Incidence of benign and malignant tumors in patients with acromegaly is increased: a nationwide population-based study. J Clin Endocrinol Metab 106:3487\u20133496. https:\/\/doi.org\/10.1210\/CLINEM\/DGAB560","journal-title":"J Clin Endocrinol Metab"},{"key":"2919_CR28","doi-asserted-by":"publisher","DOI":"10.1007\/s11154-024-09875-z","author":"C Rosendal","year":"2024","unstructured":"Rosendal C, Arlien-Soborg MC, Nielsen EH, Andersen MS, Feltoft CL, Kistorp C et al (2024) The changing landscape of acromegaly - an epidemiological perspective. Rev Endocr Metab Disord. https:\/\/doi.org\/10.1007\/s11154-024-09875-z","journal-title":"Rev Endocr Metab Disord"},{"key":"2919_CR29","doi-asserted-by":"publisher","first-page":"R147","DOI":"10.1530\/EJE-16-0178","volume":"175","author":"CL Boguszewski","year":"2016","unstructured":"Boguszewski CL, Ayuk J (2016) Management of endocrine disease: acromegaly and cancer: an old debate revisited. Eur J Endocrinol 175:R147\u2013R156. https:\/\/doi.org\/10.1530\/EJE-16-0178","journal-title":"Eur J Endocrinol"},{"key":"2919_CR30","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1590\/s0004-27302013000900003","volume":"57","author":"HB Uchoa","year":"2013","unstructured":"Uchoa HB, Lima GA, Corr\u00eaa LL et al (2013) Prevalence of thyroid diseases in patients with acromegaly: experience of a Brazilian center. Arq Bras Endocrinol Metabol 57:685\u2013690. https:\/\/doi.org\/10.1590\/s0004-27302013000900003","journal-title":"Arq Bras Endocrinol Metabol"},{"key":"2919_CR31","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1007\/s11102-012-0383-y","volume":"16","author":"MC dos Santos","year":"2013","unstructured":"dos Santos MC, Nascimento GC, Nascimento AG et al (2013) Thyroid cancer in patients with acromegaly: a case-control study. Pituitary 16:109\u2013114. https:\/\/doi.org\/10.1007\/s11102-012-0383-y","journal-title":"Pituitary"},{"key":"2919_CR32","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1016\/j.jacr.2017.01.046","volume":"14","author":"FN Tessler","year":"2017","unstructured":"Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, Cronan JJ, Beland MD, Desser TS, Frates MC, Hammers LW, Hamper UM, Langer JE, Reading CC, Scoutt LM, Stavros AT (2017) ACR Thyroid Imaging, Reporting and Data System (TI-RADS): white paper of the ACR TI-RADS Committee. J Am Coll Radiol 14:587\u2013595. https:\/\/doi.org\/10.1016\/j.jacr.2017.01.046","journal-title":"J Am Coll Radiol"},{"key":"2919_CR33","doi-asserted-by":"publisher","DOI":"10.1002\/9780470316801","volume-title":"Finding groups in data: an introduction to cluster analysis","author":"L Kaufman","year":"1990","unstructured":"Kaufman L, Rousseeuw PJ (1990) Finding groups in data: an introduction to cluster analysis. Wiley, New York. https:\/\/doi.org\/10.1002\/9780470316801"},{"key":"2919_CR34","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1159\/000371808","volume":"103","author":"WW de Herder","year":"2016","unstructured":"de Herder WW (2016) The history of acromegaly. Neuroendocrinology 103:7\u201317. https:\/\/doi.org\/10.1159\/000371808","journal-title":"Neuroendocrinology"},{"key":"2919_CR35","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1210\/er.2002-0022","volume":"25","author":"A Colao","year":"2004","unstructured":"Colao A, Ferone D, Marzullo P, Lombardi G (2004) Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev 25:102\u2013152. https:\/\/doi.org\/10.1210\/er.2002-0022","journal-title":"Endocr Rev"},{"key":"2919_CR36","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.ecl.2007.10.002","volume":"37","author":"A Ben-Shlomo","year":"2008","unstructured":"Ben-Shlomo A, Melmed S (2008) Acromegaly. Endocrinol Metab Clin North Am 37:101\u2013122. https:\/\/doi.org\/10.1016\/j.ecl.2007.10.002","journal-title":"Endocrinol Metab Clin North Am"},{"key":"2919_CR37","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1530\/EC-21-0035","volume":"10","author":"E Varlamov","year":"2021","unstructured":"Varlamov E, Niculescu DA, Banskota S, Galoiu SA, Poiana C, Fleseriu M (2021) Clinical features and complications of acromegaly at diagnosis are not all the same: data from two large referral centers. Endocr Connect 10:731\u2013741. https:\/\/doi.org\/10.1530\/EC-21-0035","journal-title":"Endocr Connect"},{"issue":"6","key":"2919_CR38","doi-asserted-by":"publisher","first-page":"808","DOI":"10.1007\/s11102-015-0657-2","volume":"18","author":"TJ Reid","year":"2015","unstructured":"Reid TJ, Jin Z, Shen W, Reyes-Vidal CM, Fernandez JC, Bruce JN, Kostadinov J, Post KD, Freda PU (2015) IGF-1 levels across the spectrum of normal to elevated in acromegaly: relationship to insulin sensitivity, markers of cardiovascular risk and body composition. Pituitary 18(6):808\u2013819. https:\/\/doi.org\/10.1007\/s11102-015-0657-2. (PMID: 25907335; PMCID: PMC4619193)","journal-title":"Pituitary"},{"key":"2919_CR39","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1007\/s11102-023-01360-1","volume":"27","author":"A Giustina","year":"2024","unstructured":"Giustina A, Biermasz N, Casanueva FF, Fleseriu M, Mortini P, Strasburger C, van der Lely AJ, Wass J, Melmed S, Banfi G, Barkan A, Beckers A, Bidlingmaier M, Boguszewski C, Brue T, Buchfelder M, Chanson P, Chiloiro S, Colao A, Zatelli MC (2024) Consensus on criteria for acromegaly diagnosis and remission. Pituitary 27:7\u201322. https:\/\/doi.org\/10.1007\/s11102-023-01360-1","journal-title":"Pituitary"},{"key":"2919_CR40","doi-asserted-by":"publisher","first-page":"D1","DOI":"10.1530\/eje-19-1009","volume":"183","author":"M Terzolo","year":"2020","unstructured":"Terzolo M, Puglisi S, Reimondo G, Dimopoulou C, Stalla GK (2020) Thyroid and colorectal cancer screening in acromegaly patients: should it be different from that in the general population? Eur J Endocrinol 183:D1\u2013D13. https:\/\/doi.org\/10.1530\/eje-19-1009","journal-title":"Eur J Endocrinol"},{"key":"2919_CR41","doi-asserted-by":"publisher","first-page":"729","DOI":"10.2174\/138161207780249209","volume":"13","author":"A Ciampolillo","year":"2007","unstructured":"Ciampolillo A, de Tullio C, Perlino E, Maiorano E (2007) The IGF-I axis in thyroid carcinoma. Curr Pharm Des 13:729\u2013735. https:\/\/doi.org\/10.2174\/138161207780249209","journal-title":"Curr Pharm Des"},{"key":"2919_CR42","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1007\/s11102-016-0744-z","volume":"20","author":"A Tirosh","year":"2017","unstructured":"Tirosh A, Shimon I (2017) Complications of acromegaly: thyroid and colon. Pituitary 20:70\u201375. https:\/\/doi.org\/10.1007\/s11102-016-0744-z","journal-title":"Pituitary"},{"key":"2919_CR43","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1046\/j.1365-2265.1997.1680985.x","volume":"46","author":"NW Cheung","year":"1997","unstructured":"Cheung NW, Boyages SC (1997) The thyroid gland in acromegaly: an ultrasonographic study. Clin Endocrinol (Oxf) 46:545\u2013549","journal-title":"Clin Endocrinol (Oxf)"},{"key":"2919_CR44","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1210\/jcem-67-5-973","volume":"67","author":"M Miyakawa","year":"1988","unstructured":"Miyakawa M, Saji M, Tsushima T, Wakai K, Shizume K (1988) Thyroid volume and serum thyroglobulin levels in patients with acromegaly: correlation with plasma insulin-like growth factor I levels. J Clin Endocrinol Metab 67:973\u2013978. https:\/\/doi.org\/10.1210\/jcem-67-5-973","journal-title":"J Clin Endocrinol Metab"},{"key":"2919_CR45","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1007\/BF03343997","volume":"25","author":"M Gasperi","year":"2002","unstructured":"Gasperi M, Martino E, Manetti L et al (2002) Prevalence of thyroid diseases in patients with acromegaly: results of an Italian multi-center study. J Endocrinol Invest 25:240\u2013245. https:\/\/doi.org\/10.1007\/BF03343997","journal-title":"J Endocrinol Invest"},{"key":"2919_CR46","doi-asserted-by":"publisher","first-page":"e104174","DOI":"10.1371\/journal.pone.0104174","volume":"9","author":"JL Reverter","year":"2014","unstructured":"Reverter JL, Fajardo C, Resmini E et al (2014) Benign and malignant nodular thyroid disease in acromegaly. Is a routine thyroid ultrasound evaluation advisable? PLoS ONE 9:e104174. https:\/\/doi.org\/10.1371\/journal.pone.0104174","journal-title":"PLoS ONE"},{"key":"2919_CR47","doi-asserted-by":"publisher","first-page":"1029926","DOI":"10.3389\/fonc.2022.1029926","volume":"12","author":"C Mu","year":"2022","unstructured":"Mu C, Ming X, Tian Y, Liu Y, Yao M, Ni Y, Liu Y, Li Z (2022) Mapping global epidemiology of thyroid nodules among general population: A systematic review and meta-analysis. Front Oncol 12:1029926. https:\/\/doi.org\/10.3389\/fonc.2022.1029926","journal-title":"Front Oncol"},{"issue":"4","key":"2919_CR48","doi-asserted-by":"publisher","first-page":"369","DOI":"10.4158\/EP-2019-0353","volume":"26","author":"Z Chen","year":"2020","unstructured":"Chen Z, Jiang X, Feng Y, Li X, Chen D, Mao Z, He D, Zhu Y, Wang H (2020) Decrease in acromegaly-associated thyroid enlargement after normalization of igf-1 levels: a prospective observation and in vitro study. Endocr Pract 26(4):369\u2013377 (Epub 2019 Dec 20. PMID: 31859554)","journal-title":"Endocr Pract"},{"issue":"Suppl 1","key":"2919_CR49","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/s12963-020-00215-2","volume":"18","author":"DC Malta","year":"2020","unstructured":"Malta DC, Flor LS, Machado \u00cdE, Felisbino-Mendes MS, Brant LCC, Ribeiro ALP, Teixeira RA, Mac\u00e1rio EM, Reitsma MB, Glenn S, Naghavi M, Gakidou E (2020) Trends in prevalence and mortality burden attributable to smoking, Brazil and federated units, 1990 and 2017. Popul Health Metr 18(Suppl 1):24. https:\/\/doi.org\/10.1186\/s12963-020-00215-2. (PMID: 32993660; PMCID: PMC7526090)","journal-title":"Popul Health Metr"},{"key":"2919_CR50","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1186\/1471-2407-13-550","volume":"13","author":"M Park","year":"2013","unstructured":"Park M, Park SH, Kim EK, Yoon JH, Moon HJ, Lee HS, Kwak JY (2013) Heterogeneous echogenicity of the underlying thyroid parenchyma: how does this affect the analysis of a thyroid nodule? BMC Cancer 13:550. https:\/\/doi.org\/10.1186\/1471-2407-13-550","journal-title":"BMC Cancer"},{"key":"2919_CR51","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1055\/s-2007-1003632","volume":"23","author":"C Wuster","year":"1991","unstructured":"Wuster C, Steger G, Schmelzle A et al (1991) Increased incidence of euthyroid and hyperthyroid goiters independently of thyrotropin in patients with acromegaly. Horm Metab Res 23:131\u2013134. https:\/\/doi.org\/10.1055\/s-2007-1003632","journal-title":"Horm Metab Res"},{"key":"2919_CR52","doi-asserted-by":"publisher","first-page":"1426","DOI":"10.1210\/jc.85.4.1426","volume":"85","author":"P Marzullo","year":"2000","unstructured":"Marzullo P, Cuocolo A, Ferone D et al (2000) Cardiac effect of thyrotoxicosis in acromegaly. J Clin Endocrinol Metab 85:1426\u20131432. https:\/\/doi.org\/10.1210\/jc.85.4.1426","journal-title":"J Clin Endocrinol Metab"},{"key":"2919_CR53","doi-asserted-by":"publisher","first-page":"7","DOI":"10.17648\/RBUS-V29N31-1","volume":"31","author":"VHR Barros","year":"2021","unstructured":"Barros VHR, Parente AMV (2021) Ultrasonographic Thyroid Findings. Brazilian J Ultrasonography 31:7\u20139. https:\/\/doi.org\/10.17648\/RBUS-V29N31-1","journal-title":"Brazilian J Ultrasonography"},{"issue":"6","key":"2919_CR54","doi-asserted-by":"publisher","first-page":"779","DOI":"10.20945\/2359-3997000000294","volume":"64","author":"APFE Goulart","year":"2021","unstructured":"Goulart APFE, Batista ERM, Figueira MG, Magalh\u00e3es PKR, Maciel LMZ (2021) Evaluation of thyroid nodules in the Brazilian Public Health Care System, Supplementary Health System, and Private Health System in the northeastern region of the State of S\u00e3o Paulo. Arch Endocrinol Metab 64(6):779\u2013786. https:\/\/doi.org\/10.20945\/2359-3997000000294","journal-title":"Arch Endocrinol Metab"},{"key":"2919_CR55","doi-asserted-by":"publisher","first-page":"79","DOI":"10.11152\/mu-980","volume":"19","author":"M Dighe","year":"2017","unstructured":"Dighe M, Barr R, Bojunga J et al (2017) Thyroid ultrasound: state of the art part 1 - thyroid ultrasound reporting and diffuse thyroid diseases. Med Ultrason 19:79\u201393. https:\/\/doi.org\/10.11152\/mu-980","journal-title":"Med Ultrason"},{"key":"2919_CR56","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1089\/thy.2023.0141","volume":"33","author":"SZ Ali","year":"2023","unstructured":"Ali SZ, Baloch ZW, Cochand-Priollet B, Schmitt FC, Vielh P, VanderLaan PA (2023) The 2023 Bethesda system for reporting thyroid cytopathology. Thyroid 33:1039\u20131044. https:\/\/doi.org\/10.1089\/thy.2023.0141","journal-title":"Thyroid"}],"container-title":["Journal of Endocrinological Investigation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40618-026-02919-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40618-026-02919-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40618-026-02919-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T06:08:40Z","timestamp":1787292520000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40618-026-02919-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,22]]},"references-count":56,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["2919"],"URL":"https:\/\/doi.org\/10.1007\/s40618-026-02919-y","relation":{},"ISSN":["1720-8386"],"issn-type":[{"value":"1720-8386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,22]]},"assertion":[{"value":"2 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethics approval and consent to participate This research protocol and the statement of consent were approved by the Institutional Review Board of the Federal University of Sergipe and Federal University of Minas Gerais. All participants were informed about the purpose of this study.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All authors have reviewed the contents of the manuscript being submitted, approve of its contents, and validate the accuracy of the data.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"R. Salvatori has served on the Camurus, Chiesi, and Crinetics advisory boards.","order":3,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from the subjects for anonymous publication of their individual details. The consent form is held by the authors and is available for review as requested.","order":4,"name":"Ethics","label":"Consent to publish","group":{"name":"EthicsHeading","label":"Declarations"}}]}}