What Is the Most Commonly Cited Paper on Thyroid Cancer in the Last Decade?

with commentary by David S. Cooper, MD and John C. Morris, III, MD

Stack of colorful magazines against a white backgroundResearch in the field of thyroid disease is thriving with a third of all papers on this topic being published in the last 10 years,1 according to an analysis in the journal, Thyroid. Thyroid cancer, while not the most common thyroid disease, was the topic of the most commonly cited paper found in this review.

“There has been a tremendous surge in papers being written in the past 10 years about thyroid problems in general,” said lead author David S. Cooper, MD, professor of medicine andradiology in the Division of Endocrinology, Diabetes, and Metabolism at The Johns Hopkins University School of Medicine in Baltimore, Maryland.

When asked to determine the most impactful papers in the last decade on thyroid disease, Dr. Cooper took an analytical approach and examined trends in the number of papers published on thyroid disease in general and specifically in six topic areas (ie, iodine deficiency/iodine nutrition, hypothyroidism, hyperthyroidism/ thyrotoxicosis, thyroiditis/ autoimmune thyroid disease, thyroid nodules/ multinodular goiter, and thyroid cancer). Dr. Cooper conducted the analysis with co-author Blair Anton, MLIS, MS.1

One-Third of All Thyroid Disease Papers Focus on Thyroid Cancer

In the last century, more than 58,000 articles on clinical thyroidology were published; 19,055 of these articles (33%) were published between 2006 and 2015.1 Dr. Cooper noted that the exponential increase in papers on thyroid disease published in the last decade may not be unique to this topic, and may also apply to other areas of endocrinology or other fields of medicine.

Thyroid cancer was the most common of the topic areas reported (31% of the total). “While thyroid cancer isn’t the most common type of thyroid disease, researchers are writing about it more than any other topic,” Dr. Cooper said.                                               

“It is really interesting to see how much thyroid research has grown, and especially in the last 10 to 15 years,” commented John C. Morris, III, MD, president-elect of the American Thyroid Association, and professor of medicine and endocrinology at Mayo Clinic Rochester.  “There has been an explosion of new research and papers on thyroid disease research in that interval, especially in thyroid cancer.”

Most Highly Cited Paper Warns of Thyroid Cancer Overdiagnosis

The most highly cited paper in the past decade was on the topic of thyroid cancer. The study, which was published by Davies et al described the increase in thyroid cancer incidence in the United States, which was predominately due to increased detection of small papillary cancers (< 2 cm).2

The JAMA study “is a cautionary paper about the overdiagnosis of thyroid cancer in the United States,” Dr. Cooper said. Davies et al were the first authors to demonstrate this epidemic of overscreening and overdiagnosing small thyroid cancers that are probably of little clinical significance, a phenomenon that continues to this day, he said.

“Most of the growth in research has been in thyroid cancer, as we have learned more about the pathogenesis and nature of thyroid cancer,” Dr. Morris said. “There are a number of reasons for this growth in knowledge about thyroid cancer, including an increase in the incidence of thyroid cancer and the appearance of new therapies, especially chemotherapy agents, to treat advanced thyroid cancer that were not available before.”

The United States was the most common country of origin for clinical thyroid cancer research.

Anticipating Thyroid Disease Research in the Years Ahead

While most of the highly cited papers were case series or cohort studies, the number of randomized controlled trials published on thyroid disease is beginning to grow, “portending a bright future for clinical thyroidology,” Dr. Cooper wrote.

Dr. Morris hopes to see new drugs in the pipeline for thyroid cancer reach the clinical arena in the near future. In addition, he hopes that research will elucidate how to manage the increased diagnosis of low-risk thyroid cancers, and how to better identify which nodules are low risk versus high risk, possibly using molecular markers.

Furthermore, Dr. Morris tells EndocrineWeb: precision medicine will become the norm in treating patients with thyroid cancer and endocrinopathies to " better individualize therapies based upon genomics, genetic alterations, or other yet to be determined individualization parameters, and to help us to fine tune their treatments.”

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