suggest that some reproductive factors associated with BC differ across ethnicities and time trends, perhaps due to the prevalence of reproductive factors and the baseline hazard of BC.

Background: Active surveillance (AS) has emerged as a viable management strategy for low-risk papillary thyroid microcarcinoma (PTMC), following pioneering trials at Kuma Hospital and the Cancer Institute Hospital in Japan. Numerous prospective cohort studies have since validated AS as a management option for low-risk PTMC, leading to its inclusion in thyroid cancer guidelines across various countries. From 2016 to 2020, the Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) enrolled 1,177 patients, providing comprehensive data on PTMC progression, sonographic predictors of progression, quality of life, surgical outcomes, and cost-effectiveness when comparing AS to immediate surgery. The second phase of MAeSTro (MAeSTro-EXP) expands AS to low-risk papillary thyroid carcinoma (PTC) tumors larger than 1 cm, driven by the hypothesis that overall risk assessment outweighs absolute tumor size in surgical decision-making. Methods: This protocol aims to address whether limiting AS to tumors smaller than 1 cm may result in unnecessary surgeries for low-risk PTCs detected during their rapid initial growth phase. By expanding the AS criteria to include tumors up to 1.5 cm, while simultaneously refining and standardizing the criteria for risk assessment and disease progression, we aim to minimize overtreatment and maintain rigorous monitoring to improve patient outcomes. Conclusion This study will contribute to optimizing AS guidelines and enhance our understanding of the natural course and appropriate management of low-risk PTCs. Additionally, MAeSTro-EXP involves a multinational collaboration between South Korea and Australia. This cross-country study aims to identify cultural and racial differences in the management of low-risk PTC, thereby enriching the global understanding of AS practices and their applicability across diverse populations.

Background: Active surveillance (AS) has emerged as a viable management strategy for low-risk papillary thyroid microcarcinoma (PTMC), following pioneering trials at Kuma Hospital and the Cancer Institute Hospital in Japan. Numerous prospective cohort studies have since validated AS as a management option for low-risk PTMC, leading to its inclusion in thyroid cancer guidelines across various countries. From 2016 to 2020, the Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) enrolled 1,177 patients, providing comprehensive data on PTMC progression, sonographic predictors of progression, quality of life, surgical outcomes, and cost-effectiveness when comparing AS to immediate surgery. The second phase of MAeSTro (MAeSTro-EXP) expands AS to low-risk papillary thyroid carcinoma (PTC) tumors larger than 1 cm, driven by the hypothesis that overall risk assessment outweighs absolute tumor size in surgical decision-making. Methods: This protocol aims to address whether limiting AS to tumors smaller than 1 cm may result in unnecessary surgeries for low-risk PTCs detected during their rapid initial growth phase. By expanding the AS criteria to include tumors up to 1.5 cm, while simultaneously refining and standardizing the criteria for risk assessment and disease progression, we aim to minimize overtreatment and maintain rigorous monitoring to improve patient outcomes. Conclusion This study will contribute to optimizing AS guidelines and enhance our understanding of the natural course and appropriate management of low-risk PTCs. Additionally, MAeSTro-EXP involves a multinational collaboration between South Korea and Australia. This cross-country study aims to identify cultural and racial differences in the management of low-risk PTC, thereby enriching the global understanding of AS practices and their applicability across diverse populations.

Background: Active surveillance (AS) has emerged as a viable management strategy for low-risk papillary thyroid microcarcinoma (PTMC), following pioneering trials at Kuma Hospital and the Cancer Institute Hospital in Japan. Numerous prospective cohort studies have since validated AS as a management option for low-risk PTMC, leading to its inclusion in thyroid cancer guidelines across various countries. From 2016 to 2020, the Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) enrolled 1,177 patients, providing comprehensive data on PTMC progression, sonographic predictors of progression, quality of life, surgical outcomes, and cost-effectiveness when comparing AS to immediate surgery. The second phase of MAeSTro (MAeSTro-EXP) expands AS to low-risk papillary thyroid carcinoma (PTC) tumors larger than 1 cm, driven by the hypothesis that overall risk assessment outweighs absolute tumor size in surgical decision-making. Methods: This protocol aims to address whether limiting AS to tumors smaller than 1 cm may result in unnecessary surgeries for low-risk PTCs detected during their rapid initial growth phase. By expanding the AS criteria to include tumors up to 1.5 cm, while simultaneously refining and standardizing the criteria for risk assessment and disease progression, we aim to minimize overtreatment and maintain rigorous monitoring to improve patient outcomes. Conclusion This study will contribute to optimizing AS guidelines and enhance our understanding of the natural course and appropriate management of low-risk PTCs. Additionally, MAeSTro-EXP involves a multinational collaboration between South Korea and Australia. This cross-country study aims to identify cultural and racial differences in the management of low-risk PTC, thereby enriching the global understanding of AS practices and their applicability across diverse populations.

Background: Active surveillance (AS) has emerged as a viable management strategy for low-risk papillary thyroid microcarcinoma (PTMC), following pioneering trials at Kuma Hospital and the Cancer Institute Hospital in Japan. Numerous prospective cohort studies have since validated AS as a management option for low-risk PTMC, leading to its inclusion in thyroid cancer guidelines across various countries. From 2016 to 2020, the Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) enrolled 1,177 patients, providing comprehensive data on PTMC progression, sonographic predictors of progression, quality of life, surgical outcomes, and cost-effectiveness when comparing AS to immediate surgery. The second phase of MAeSTro (MAeSTro-EXP) expands AS to low-risk papillary thyroid carcinoma (PTC) tumors larger than 1 cm, driven by the hypothesis that overall risk assessment outweighs absolute tumor size in surgical decision-making. Methods: This protocol aims to address whether limiting AS to tumors smaller than 1 cm may result in unnecessary surgeries for low-risk PTCs detected during their rapid initial growth phase. By expanding the AS criteria to include tumors up to 1.5 cm, while simultaneously refining and standardizing the criteria for risk assessment and disease progression, we aim to minimize overtreatment and maintain rigorous monitoring to improve patient outcomes. Conclusion This study will contribute to optimizing AS guidelines and enhance our understanding of the natural course and appropriate management of low-risk PTCs. Additionally, MAeSTro-EXP involves a multinational collaboration between South Korea and Australia. This cross-country study aims to identify cultural and racial differences in the management of low-risk PTC, thereby enriching the global understanding of AS practices and their applicability across diverse populations.

This study investigated the effects of radioiodine (RAI) therapy on fertility-related hormones, particularly anti-Müllerian hormone (AMH), and menopause in women with differentiated thyroid cancer (DTC). Materials and Methods: We recruited 46 women with regular menstrual cycles who underwent total thyroidectomy for DTC. After excluding those who were menopausal before surgery, 35 patients in the RAI group and seven in the control group were analyzed. AMH levels were measured at baseline, 6 months, 9 months, and 1 year post-operation. Statistical analyses included Kruskal–Wallis tests and linear mixed model. Results: The Kruskal–Wallis test showed no significant difference in AMH changes between RAI doses (p=0.62). Age was significantly associated with AMH levels, with corresponding to a decrease of 0.18 ng/mL per year (p＜0.001).No significant difference in AMH levels was observed between the RAI and control groups after adjusting for age and baseline AMH (p=0.62). At 6 months after surgery or RAI, AMH declined in 57.1% (4/7), 60.0% (9/15), and 50.0% (9/18) in the control, 30 mCi, and 50 mCi groups, respectively. Among single RAI-treated patients with long-term follow-up, AMH levels recovered to baseline or higher in 50.0% (2/4), 0.0% (0/1), and 42.9% (9/19) in the control, 30 mCi, and 50 mCi groups, respectively. Conclusion: RAI therapy in patients with DTC showed no significant impact on AMH levels compared to controls. Larger studies with longer follow-ups are needed to assess its long-term effects on fertility.

Purpose: Papillary thyroid cancer (PTC), a common malignancy among women of reproductive age, is increasingly common during pregnancy because of routine prenatal imaging. However, the optimal timing for surgical treatment remains controversial. This study aimed to assess the safety and practicality of performing thyroid surgery during pregnancy through a comparative analysis of perioperative and pathological outcomes between pregnant and nonpregnant women. Methods: We conducted a retrospective case-control study of 100 female patients aged 20–39 years who underwent thyroid surgery for PTC between January 2019 and December 2024. Patients were grouped into pregnant (n = 14) and nonpregnant (n = 86) cohorts. Clinical, surgical, and pathological data were compared. Results: Most pregnant patients underwent surgery during the second trimester. The operative duration was significantly shorter in the pregnant group than in the nonpregnant group (71.4 ± 26.35 minutes vs. 87.2 ± 5.17 minutes, P = 0.025), and there was a trend towards a lower drain volume on postoperative day 1 (25.2 ± 15.23 mL vs. 32.7 ± 0.18 mL, P = 0.077).No significant differences were observed in terms of complication rates. Despite a higher frequency of extrathyroidal extension (P = 0.003) and advanced T stage (P = 0.038) in the pregnant group, the surgical outcomes were favorable. One neonate experienced mild intraventricular hemorrhage that resolved without sequelae. Conclusion Thyroid surgery during pregnancy, particularly in the second trimester, appears feasible in selected patients.Given the small sample and retrospective nature of this study, larger prospective studies are needed to validate these findings.

Chronic venous disease (CVD) presents a major public-health burden and is frequently managed via minimally invasive endovenous ablation techniques. Although these modalities have replaced traditional open surgery due to favorable safety and recovery profiles, early complications remain under-reported and may compromise patient outcomes and practitioner trust. In this review we define “early complications” as those occurring intra-operatively or within 24 hours of the procedure and provide a structured overview of the incidence, mechanisms, risk-factors and management strategies across thermal (laser, radiofrequency) and non-thermal (mechanochemical, cyanoacrylate) ablation methods. Thermal ablation carries inherent risks such as skin burns, nerve injury, and hemorrhage/hematoma. Non-thermal technologies reduce thermal damage but introduce distinct complications including adhesive hypersensitivity, phlebitis and thrombotic events. We summarize reported incidence rates, highlight anatomical and procedural risk-factors, and propose a framework for prevention and management of these events. Key practical implications include the need for standardized reporting of early adverse events, informed consent addressing realistic risk profiles, protocolized peri-procedural pathways in venous centers, and close monitoring for postoperative complications is essential. Early complications may be uncommon but are clinically significant—recognition, stratification of risk, prompt diagnosis and intervention are essential to preserve the safety profile of endovenous ablation.

Purpose: Although Korea’s medical care uses advanced technology, there are not enough doctors working in rural areas, and fewer doctors are working in challenging fields such as surgery. Medical care in Türkiye is very cost-effective for patients, but doctors have too many patients and too much work. This study compared the healthcare systems of the 2 countries and the gaps felt by surgeons. Methods: A comparative analysis was conducted using a comprehensive literature review and a questionnaire involving medical professionals from various working positions in both countries. Results: Doctors in both countries felt that there was a large medical gap between regions and reported that the number of doctors was small. Turkish doctors experience excessive patient overload, contributing to high stress and feelings of overwork. They also showed lower job satisfaction than in Korea. The common reasons for the low preference for general surgery residencies include intense training, excessive workload, and high risk in both countries. Conclusion This study identified the key challenges in medical and surgical training in Korea and Türkiye. In Korea, shortages can be addressed by reforms in general surgery residency, the development of a balanced residency selection system, and the provision of work opportunities for non-Korean professionals. In Türkiye, improving remuneration and alleviating unsafe work environments is urgent. Both countries should incentivize rural services to ensure balanced doctor distribution. Collaborative initiatives informed by these findings can enhance medical education and healthcare delivery in both countries.

Purpose: Relative energy deficiency in sport (REDs) is a syndrome of physiological and/or psychological functioning experienced by female and male athletes that is caused by exposure to problematic low energy availability. For the prevention and intervention of REDs, awareness of REDs among sports physicians is important, but it is largely unknown. This study aimed to survey the awareness and clinical treatment experience of REDs in sports physicians. Methods: We conducted an online survey to assess awareness of the triad and REDs among sports physicians and members of The Korean Society of Sports Medicine. Results: A total of 69 members (62.2% male, including sports physicians) to this survey. Most participants (84.1%) were aware of the triad compared to fewer with awareness regarding REDs (23.2%). People who knew about the difference between REDs and triad was 33.3%, which was lower than those who did not (66.6%). Only 10.1% of the study subjects had experience treating REDs patients, and the biggest difficulty in treating patients was a lack of information and education (50.7%). It appeared that the most information about REDs was obtained from academic conferences (59.4%). Conclusion This survey found relatively low awareness of REDs among physicians treating athletes and sports professionals. Considering the various negative effects of REDs on athlete health and performance, education and promotion are needed to increase awareness among sports physicians and sports professionals.