Yi-Jing Sheen Taiwan

• Advancement in AI Applications to Thyroid Nodule Detection and Evaluation
  Argon ChenTaiwan Speaker Advancement in AI Applications to Thyroid Nodule Detection and EvaluationDiagnosing thyroid cancer remains challenging due to overlapping imaging features between benign and malignant nodules, inherent limitations of current diagnostic tools, and substantial interobserver variability among clinicians. Although ultrasound is the first-line modality for thyroid nodule evaluation, interpretations of the same images often differ across physicians. The Thyroid Imaging Reporting and Data System (TI-RADS) was developed to standardize malignancy risk assessment; however, considerable variability in its application persists in clinical practice. Artificial intelligence (AI) is increasingly transforming thyroid cancer diagnosis by enhancing accuracy, efficiency, and consistency in clinical decision-making. By leveraging machine learning and deep learning techniques, AI-based systems offer new opportunities to reduce subjectivity in ultrasound interpretation and support more personalized patient care. This talk will focus on recent advances in AI-assisted ultrasonographic detection and characterization of thyroid nodules. Specifically, we will present evidence from Multi-Reader Multi-Case (MRMC) performance studies demonstrating how AI can improve diagnostic accuracy and inter-reader consistency across different TI-RADS guidelines. We will also compare the consistency of nodule interpretation across ultrasound systems between AI algorithms and human readers. Finally, a live demonstration of the AI software will illustrate its performance using ultrasound images from a wide spectrum of benign and malignant thyroid nodules.
• Electronic Dashboard-Based Remote Glycemic Management Program Reduces Length of Stay and Readmission Rate among Hospitalized Adults
  Yi-Jing SheenTaiwan Speaker Electronic Dashboard-Based Remote Glycemic Management Program Reduces Length of Stay and Readmission Rate among Hospitalized AdultsBackground: Inpatient dysglycemia is strongly associated with prolonged length of stay (LOS), increased readmission rates, and higher healthcare costs. Traditional consultation-based models are often insufficient for institution-wide glycemic quality improvement. With advances in electronic medical records (EMRs), real-time digital surveillance offers a scalable solution. We implemented a hospital-wide remote glycemic management program to evaluate its impact on glycemic control and clinical outcomes. Methods: Building on our previously published framework, this institution-wide before-and-after study was conducted in a 1,500-bed tertiary medical center using data from 2016 to 2019 (106,528 hospitalized adults; 878,159 glucose measurements). The core intervention utilized an EMR-integrated dashboard to identify hyper-/hypoglycemia in real-time, enabling endocrinologists to provide daily virtual recommendations without formal consultation. Key components included automated risk stratification, real-time alerts, and department-specific performance feedback. Primary outcomes were LOS and 30-day readmission rates. Analyses were performed using Poisson and joinpoint regression with multivariable adjustment. Results: Program implementation resulted in consistent and clinically significant improvements in hospital-wide glycemic metrics. Rapid improvement in treat-to-target rates was observed within 3–6 months of initiating virtual recommendations. Clinical Outcomes: The program was associated with a significant reduction in LOS, independent of age, sex, and admission department. Notably, patients with high glucose variability exhibited the longest LOS, identifying glycemic instability as a key driver of resource utilization. Furthermore, 30-day readmission rates decreased significantly, particularly among patients achieving stable euglycemia. Operational Efficiency & Pandemic Resilience: As glycemic quality improved, the time required for daily virtual recommendations decreased from ~2 hours to <1 hour. The program significantly reduced the need for formal consultations. Crucially, this established remote workflow proved vital during the COVID-19 pandemic, minimizing clinician exposure and preserving personal protective equipment (PPE) while maintaining high-quality glycemic care without disruption. Conclusion: Integrating real-time EMR-based surveillance with remote endocrinologist-led intervention significantly improves inpatient glycemic control, translating into measurable reductions in LOS and 30-day readmission rates. This model has demonstrated sustained efficacy extending into the COVID-19 era and beyond, proving that an electronic dashboard-based system is a scalable, resilient, and resource-efficient strategy for modern hospital care.
• A New Era of Managing Thyroid Eye Disease
  Jae Hoon MoonSouth Korea Speaker A New Era of Managing Thyroid Eye Disease: AI-Based Quantitative Monitoring and Precision CareThyroid Eye Disease (TED) is the most common extrathyroidal manifestation of autoimmune thyroid dysfunction, occurring in approximately 30% to 50% of patients with Graves’ disease. While endocrinologists primarily manage thyroid dysfunction, TED can severely impact a patient’s quality of life through vision loss, diplopia, and cosmetic concerns, necessitating active early intervention. Consequently, it is crucial for clinicians to be proficient in basic TED assessments for early diagnosis; however, many endocrinologists remain unfamiliar with these evaluations, which often leads to delayed treatment. To usher in a new era of managing TED, a paradigm shift toward AI-based quantitative monitoring and precision care is explored in this session. Fundamental assessment methods, including the Clinical Activity Score (CAS), exophthalmos, and Margin-Reflex-Distance 1 (MRD1), will be introduced alongside clinical cases where AI-driven solutions provide objective and reproducible data. These cutting-edge tools go beyond simple diagnostic assistance by quantitatively tracking disease progression and treatment response, thereby facilitating highly personalized treatment plans. By integrating these innovative AI solutions, a comprehensive approach to TED management is presented, demonstrating how technology and innovation converge to solve long-standing clinical challenges and improve patient outcomes.

• The Efficacy and Safety of RFA for PTMC in Long-Term Cohort Study: Do Above and Beyond
  Jung Hwan BaekSouth Korea Speaker Standard and Advanced Techniques for Thyroid RFAThermal ablation, especially radiofrequency ablation (RFA), is promising technique not only for benign thyroid nodules but also for thyroid cancers. In various thyroid tumors, RFA effectively improves tumor-related symptoms and cosmetic problems by reducing tumor volume. RFA is recently adopted to recurrent and primary thyroid cancers. In terms of complication, major complication rate was reported as 1.4% - 8% according to the types, locations and size of the thyroid tumors. Therefore, proper techniques and experience of operators are key factors to achieve effective and safe RFA. To maximize efficacy and to minimize complications, the Korean Society of Thyroid Radiology Guidelines (KSThR Guidelines 2012, 2017, and 2025) recommend the use of standard techniques; the perithyroidal lidocaine injection to control pain, trans-isthmic approach, moving-shot technique and hydrodissection (HD) technique. Furthermore, KSThR Guidelines recommend advanced techniques, such as vascular ablation, bolus injection of cold water (to manage nerve damage problems) or tracheal stent assisted RFA. In this lecture, therefore I will introduce various standard and advanced techniques to maximize the ablation zone and to minimize injury of surrounding critical structures. Furthermore, I will briefly touch “how to combine proper device and techniques” for thyroid RFA.The Efficacy and Safety of RFA for PTMC in Long-Term Cohort Study: Do Above and BeyondThe incidence of thyroid cancer has increased not only in Korea, but in worldwide. This situation is mainly due to an increase in the over detection of small papillary thyroid carcinomas (PTCs) using high-resolution ultrasonography (US). Almost all newly detected thyroid cancers are small papillary thyroid cancers (PTCs), while the incidence of large PTCs and aggressive histological types has remained stable. In addition, mortality of thyroid cancer has remained stable in Korea. Therefore, several studies have suggested over-diagnosis of small thyroid cancers, especially papillary thyroid microcarcinomas (PTMC). Since the majority of PTMCs progress slowly and show excellent outcome and considering the drawbacks of surgery including voice change or hypoparathyroidism, it is time to re-evaluate the role of surgery (especially immediate surgery) for all biopsy proven PTMCs. According to publications from South Korea and other countries, the incidence of thyroid carcinoma had increased 15-fold between 1993 and 2011; however, its mortality rate did not decrease. Moreover, the number of patients who suffered from surgical complications increased significantly. Considering the exceedingly low disease-specific mortality rate of PTMCs and the potential complications of thyroidectomy, it is imperative to consider alternative management strategies for PTMC management. Therefore, this lecture will review the current oncologic outcome (in both short and long-term follow-up studies) of thermal ablation in PTMC and compare it with the results of active surveillance and surgery.

• Update in Primary Aldosteronism
  Mitsuhide NaruseJapan Speaker Update in Primary AldosteronismPrimary aldosteronism (PA) is linked to significantly greater cardiovascular morbidity and mortality than essential hypertension, yet it offers a more favorable prognosis when appropriately treated. Early detection and targeted therapy are therefore essential for achieving optimal long-term outcomes and preserving quality of life. Since the release of the Endocrine Society’s guidelines in 2010, several countries—including Japan—have developed national recommendations (e.g., Endocrine Journal, 2021). This reflects growing awareness and research momentum, with over 3,500 publications in the past decade. In Japan, we have established a national PA registry and conducted multicenter studies under the Japan Primary Aldosteronism Study (JPAS), supported by AMED, resulting in more than 40 publications as Japan-originated evidence. Diagnostic protocols have become increasingly standardized, encompassing initial screening, confirmatory testing, subtype classification via adrenal venous sampling (AVS), and tailored treatment—mineralocorticoid receptor (MR) antagonists for bilateral PA and adrenalectomy for unilateral PA. The integration of PA screening into routine hypertension care, alongside the standardization of diagnostic methods, has led to substantial improvements in clinical practice. However, key challenges remain. These include variability in assay methods (e.g., PRA vs. ARC for renin; CLEIA vs. RIA for aldosterone), which affects diagnostic thresholds; uncertainty regarding optimal cutoffs for screening and confirmatory tests; lack of consensus on AVS protocols (with or without cosyntropin); and ongoing debates over the role of non-invasive imaging and advanced surgical approaches (laparoscopic vs. robot-assisted adrenalectomy). These unresolved issues warrant evaluation through a cost-effectiveness lens. As PA diagnostics become increasingly integrated into hypertension management, a fundamental question emerges: How far should we go in diagnosing PA? This presentation will provide an updated overview of clinical practice and address these critical challenges in PA management.Do We Still Need Confirmatory Testing?

• History of Asia Oceania Congress of Endocrinology
  Takashi AkamizuJapan Speaker History of AOCEThe 1st Asian-Oceanian Congress of Endocrinology (AOCE) was held in Kyoto in 1959, one year prior to the 1st International Congress of Endocrinology (ICE). Subsequently, the AOCE was held every four years until the 16th Congress in Yogyakarta, Indonesia, in 2018. Subsequently, AOCE shifted to a biennial schedule, with the 17th AOCE scheduled for Seoul, South Korea in 2020. However, the 18th AOCE was inevitably held online due to the COVID-19 pandemic. Now is an opportune moment to reflect on AOCE's history and move forward toward future development.

• Sex-Specific Approaches in Precision Medicine: Advancing Endocrinology Care
  Shih-Li SuTaiwan Speaker Sex-Specific Approaches in Precision Medicine: Advancing Endocrinology CareSex differences are fundamental determinants of endocrine physiology and disease. Conventional approaches that treat men and women as biologically equivalent overlook variations in hormonal regulation, immune response, organ function, and pharmacologic metabolism. Precision medicine in endocrinology integrates these sex-specific biological and environmental factors to achieve individualized care. Emerging evidence shows that women are more prone to autoimmune thyroid disease, prolactinoma, and osteoporosis, largely due to estrogen-enhanced immune activity and X-chromosome dosage effects. Men, by contrast, experience higher rates of hypogonadism, visceral obesity, and aggressive endocrine tumors, reflecting androgen decline and single X-chromosome vulnerability. Hormonal effects, such as menopause-related bone loss, are often reversible, whereas chromosomal influences—such as those seen in Turner and Klinefelter syndromes—are irreversible and genetically determined. Pharmacokinetic and pharmacodynamic disparities further highlight the need for sex-informed dosing. Women generally have higher CYP3A4 activity and altered drug binding via increased sex hormone–binding globulin. In Asian populations, genetic polymorphisms, including the high prevalence of BRAF^V600E^ mutations in papillary thyroid cancer and variable androgen receptor CAG repeats, demand region-specific precision strategies. Sex-specific precision endocrinology moves beyond a uniform model of care by recognizing biological sex as a key variable in disease risk and treatment response. Incorporating sex-stratified analyses, adjusted diagnostic thresholds, and personalized pharmacotherapy can enhance diagnostic accuracy and therapeutic safety. For Asia, integrating genetic and environmental diversity is essential to advance equitable, individualized endocrine care.
• From the Bedside to the Digital World: Precision Medicine in Endocrinology with Al and ICT
  Miyuki KataiJapan Speaker From the Bedside to the Digital World: Precision Medicine in Endocrinology with Al and ICTPrecision medicine in endocrinology must account for biological variability, life-course hormonal transitions, and sociocultural determinants of health. However, in routine clinical practice, endocrine disorders are often detected only after prolonged symptomatic periods, particularly when symptoms are nonspecific or overlap with normal physiological transitions. Our work originates from bedside clinical challenges. In developing and operating a comprehensive women’s specialty clinic grounded in sex-specific medicine—representing an innovative clinical model in Japan—we evaluated more than 5,000 women. Among patients who presented to our clinic with a prior diagnosis of menopausal disorders, organic diseases were identified in 27%. Thyroid dysfunction accounted for approximately 15% of cases initially attributed to menopausal disorders. These findings suggest that menopausal diagnoses may contribute to delayed recognition of underlying diseases. Among conditions masked by such symptoms, endocrine disorders were frequently identified, likely because many endocrine diseases require additional targeted laboratory testing for definitive diagnosis. Within endocrine disorders, thyroid dysfunction was particularly prevalent in women. To address this unmet need, we developed the Women’s AI Symptom Evaluator (WaiSE), a digital platform designed to visualize multidimensional symptom patterns using AI-assisted structured questionnaires. WaiSE was developed to support detection of a broad spectrum of underrecognized conditions in women, including endocrine disorders such as thyroid disease. Importantly, these digital tools help women recognize and articulate complex autonomic symptom patterns commonly experienced during menopausal transitions, thereby enabling clinicians to better interpret symptom presentations and facilitating earlier detection of endocrine disorders. The platform is supported by a gender-specific clinical database derived from over 5,000 patients and more than 60,000 consultations, enabling symptom–diagnosis correlation modeling and development of sex-informed diagnostic algorithms. Building upon this clinical and digital foundation, we have recently initiated an integrated endocrine screening strategy through collaboration with the AI-based Thyroid Screening (AITS) platform. We collaborated with Cosmic Corporation, the developer of the AI-based Thyroid Screening (AITS) system. AITS is an AI-based screening system that analyzes routine blood test results obtained in general screening programs, including health checkups, to estimate the likelihood of thyroid dysfunction. The integrated WaiSE–AITS system combines patient-reported symptom assessment through WaiSE with objective clinical indicators derived from AITS to assist in identifying individuals who may require additional thyroid function testing. The integrated system is being developed with the aim of future regulatory approval as Software as a Medical Device (SaMD). This integrated platform can be utilized in clinical practice settings as well as in health screening programs and occupational health settings, demonstrating feasibility in capturing real-world symptom data beyond hospital-centered care. The combined system is designed as a physician-supervised clinical decision-support tool intended to assist healthcare professionals in identifying patients who may benefit from further thyroid evaluation, while maintaining physician responsibility for final diagnostic decisions. This presentation highlights the clinical background, digital innovation process, and emerging collaborative screening strategies, demonstrating how bedside endocrinology can evolve into digitally supported precision care incorporating a life-course approach for women. Acknowledgements:This research was supported by AMED (Grant Number: JP21gk0210024h9903) and by grants from METI, Japan.
• Precision Medicine in Diabetes: Perspectives from Asia
  Ronald MaHong Kong, China Speaker Precision Medicine in Diabetes: Perspectives from AsiaPrecision Medicine in Diabetes: Perspectives from Asia Abstract Diabetes is traditionally classified into type 1 diabetes, type 2 diabetes and gestational diabetes as the main forms of diabetes. However, there is increasing recognition that there is significant hidden heterogeneity within diabetes. Resolving this heterogeneity of diabetes can help facilitate personalized treatment and precision medicine in diabetes. For example, identification of specific monogenic forms of diabetes may facilitate tailored choices of diabetes medications. Precision diagnosis also includes the use of biomarkers to correctly identify adults presenting with autoimmune diabetes for appropriate treatment. Recent advances have included the use of clinical characteristics to empower subtyping of adult-onset diabetes through different clustering strategies. Regardless of the approach of subclassification, the essence of diabetes subtyping is to differentiate between individuals with diabetes due to different underlying pathophysiological defects, and hence have different prognosis towards complications or response to treatment. Recent advances in precision prognostics have also highlighted strategies that can identify high-risk individuals for more intensive treatment. An international consortium initiated by the American Diabetes Association and European Association for the Study of Diabetes (EASD) has reviewed the landscape for precision medicine in diabetes to map our current understanding, as well as outline future directions. The ability to resolve the heterogeneity in diabetes, and thereby provide treatment that is best tailored to the underlying pathophysiology, provides exciting opportunities to realize precision medicine in diabetes towards better patient outcomes. References 1. Leslie RD, Ma RCW, Franks PW, Nadeau KJ, Pearson ER, Redondo MJ. Understanding diabetes heterogeneity: key steps towards precision medicine in diabetes. Lancet Diabetes Endocrinol. 2023 Nov;11(11):848-860. 2. Tobias D, Merino J et al, Second International Consensus report on gaps and opportunities for the clinical translation of precision diabetes medicine. Nature Medicine 2023; 29: 2438-2457. Challenging Cases in EndocrinologyIn this meet the professor session, we will use 4-5 case scenarios to illustrate diagnostic challenges around clinical endocrinology and diabetes and discuss management strategies.

• Update in Osteoporosis
  Dolores ShobackUnited States Speaker Update in OsteoporosisMany issues in osteoporosis management are challenging in clinical practice. Factors in fracture risk assessment include those in the FRAX algorithm as well as imminent fracture risk in the next 1-5 years. Highest risk individuals benefit most from aggressive therapies targeted to increase bone mineral density (BMD) and reduce fracture rates as rapidly as possible to enhance bone strength. Sequential therapeutic strategies with repeated courses of both anabolic and antiresorptive treatments are becoming the norm for highest risk patients. Yet clinicians are often without trial data to predict clinical outcomes. Bisphosphonate treatment holidays are often employed to allow for a return of bone remodeling with the goal of microdamage repair and avoiding oversuppression of turnover. Yet the duration and monitoring of such treatment interruptions have not been rigorously established. The safety and efficacy of repeated courses of anabolic agents in the lifespan of a patient have not been well studied. The biologic basis for achieving effective BMD responses in sequential therapy is not known. Despite the long use of denosumab and bisphosphonates in clinical care, how to interrupt safely, and how to sequence these therapies most effectively are not known. Rebound increases in bone remodeling after stopping treatment with the RANK-ligand inhibitor denosumab and the challenges of treating patients with advanced chronic kidney disease with denosumab remain unsolved. The bifunctional monoclonal antibody to sclerostin romosozumab, while potent at increasing BMD due to its anabolic and antiresorptive actions, may have off-target cardiovascular adverse effects. Patients who are obese or with diabetes using GLP1 receptor agonists and SGLT2 inhibitors have risks to bone health with rapid weight loss and or direct effects on bone. Ultimately, clinicians must make decisions on patient management based on individual risk assessment and anticipated pathophysiology of the low BMD and risk in that patient.Challenging Parathyroid CasesThis session will review cases of primary, secondary and tertiary hyperparathyoidism and their management. The recommendations for screening patients with possible MEN1 and its manifestations will be reviewed. The role for parathyroid autotransplantation in the management of MEN1 hyperparathyroidism and in postsurgical hypoparathyroidism will be reviewed. A newly released form of parathyroid hormone (PTH) replacement will be discussed in the setting of chronic hypoparathyroidism in adults. Palopegteriparatide has been released for the treatment of chronic hypoparathyroidism and has shown strong efficacy on the control of the biochemical parameters (serum and urine calcium levels, serum phosphate, the Ca x phosphate product) as well as on the quality of life. Updated guidance on considering the use of PTH replacement is being developed and will be discussed. Additionally, the role combined functional and structural localization of parathyroid tissue(s) in the setting of recurrent primary hyperparathyroidism will be reviewed.

• Exploring the World of Autoimmune Disease: from Genetic Manipulation to Disease Reversal
  Huey-Kang SytwuTaiwan Speaker Exploring the World of Autoimmune Disease: from Genetic Manipulation to Disease ReversalAbstract for Asia Oceania Congress of Endocrinology 2026 Huey-Kang Sytwu1 2 1 National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Taiwan 2 Department of Microbiology and Immunology, National Defense Medical University, Taiwan TITLE: Exploring the world of autoimmune disease: From genetic manipulation to disease reversal Abstract: Insulin-dependent diabetes mellitus (IDDM) is a T cell-mediated autoimmune disease. To delineate the protective roles of some immune modulatory molecules, such as soluble decoy receptor 3 (DcR3), cytotoxic T lymphocyte antigen 4 (CTLA4), program death ligand 1 and 2 (PD-L1 and 2), heme oxygenase 1 (HO-1), and chemokine receptor D6 in the autoimmune process and to search for potential preventive and/or therapeutic targets in this disease, we have generated (a) insulin promoter (pIns)-sDcR3 transgenic non-obese diabetic (NOD) mice, (b) pIns-single chain anti-CTLA4 transgenic NOD mice, (c) pIns-single chain anti-4-1BB transgenic NOD mice, (d) pIns-PD-L1 transgenic NOD mice, (e) pIns-HO-1 transgenic NOD mice, and (f) pIns-D6 transgenic NOD mice and demonstrated their immunomodulatory potential and underlying mechanisms. Meanwhile, to explore the modulatory potential of interleukin-12, 23 and 27 on autoimmune diabetes, we have generated following transgenic, knockout and knockdown NOD mice: (1) Th1 and Th2 doubly transgenic (2) IL-12 knockout (3) IL-23 knockdown (4) IL-27 knockdown NOD mice. Our results revealed that 20% IL-12-deficient NOD mice still developed autoimmune diabetes, the diabetic incidence of IL-23 knockdown NOD mice is lower than that of control littermates, and the number and percentage of Th1 cells are dramatically decreased and Th17 cells are increased in IL-27 knockdown mice, indicating a differential role of IL-12 cytokine family in modulating Th1 and Th17 cell development during autoimmune diabetogenic process. Previously, we demonstrated that overexpression of B lymphocyte-induced maturation protein-1 (Blimp-1) in T cells decreases IL-21 expression and suppresses autoimmune diabetes, whereas, lacking Blimp-1 in T cells upregulates IL-21 and results in severe colitis and autoimmune encephalomyelitis in NOD mice. Here, we further illustrated that Blimp-1 represses IL-21 by reducing chromatin accessibility and evicting an IL-21 activator, c-Maf on its promoter. Moreover, an IL-21-accelerating autoimmune diabetogenesis in SUMO-defective c-Maf transgenic mice can be overridden by Blimp-1 overexpression-mediated reduction of permissive chromatin structures at Il21 locus. We also explored the fundamental mechanisms by which a high-salt diet (HSD) affects susceptibility to or modifies autoimmune diseases. we generated T-cell–specific STE20/SPS1-related proline/alanine–rich kinase (SPAK) knockout NOD mice and demonstrated that SPAK deficiency in T cells significantly attenuated diabetes development in NOD mice by downregulating IL-21 expression in CD4+ T cells. Furthermore, HSD-triggered diabetes acceleration was abolished in HSD-fed SPAK knockout mice when compared with HSD-fed NOD mice, suggesting an essential role of SPAK in salt-exacerbated T-cell pathogenicity. Finally, by using gain- and loss-of-function approaches, we demonstrated that T cell-specific Mgat5 overexpression-induced higher tetra-antennary N-glycans exacerbate autoimmune diabetes, whereas mutant Mgat5L188R-associated tetra-antenna deficiency completely prevents disease in a CD8+ T cell-dependent manner. Making full use of these unique mouse strains, we are quantitatively and qualitatively investigating the immunopathogenic mechanisms of autoimmune diabetes and providing valuable information for the development of novel immunotherapies.

• Key Highlights of the American Thyroid Association Thyroid and Pregnancy Guidelines
  Angela M. LeungUnited States Speaker Key Highlights of the American Thyroid Association Thyroid and Pregnancy GuidelinesThis session will present the key highlights of the American Thyroid Association 2026 guidelines for thyroid disease in preconception, pregnancy, and postpartum that have been published by a multidisciplinary group of experts with global perspective. The discussion will provide an overview of the methodology used to prepare these updated guidelines in partnership with and endorsed by several other collaborating societies. The presentation will cover the most notable changes and new recommendations surrounding thyroid function testing, iodine nutrition, infertility and assisted reproductive techniques, hypothyroidism, hyperthyroidism (including Graves’ disease), thyroid nodules, and thyroid cancers for women planning pregnancy, are pregnant, or seen for postpartum care.Thyroid Risks of Iodine ExcessIodine is a micronutrient that is required for the production of thyroid hormone. Iodine is commonly obtained from consuming an iodine-rich diet or iodine-fortified foods, amiodarone use, iodine-containing supplements, and iodinated contrast media. This session will review the potential forms of thyroid dysfunction arising from an acute iodine load, due to the failure to escape from the Wolff-Chaikoff effect and to the Jod-Basedow phenomenon. The risks of iodine excess in vulnerable populations, and current guidelines regarding the screening and monitoring of iodinated contrast-induced thyroid dysfunction, will be summarized.
• Precision Medicine in Gestational Thyroid Disease: Taking Care of Mother and Baby
  Marjorie A. RamosPhilippines Speaker Precision Medicine in Gestational Thyroid Disease: Taking Care of Mother and BabyPrecision medicine is revolutionizing the management of thyroid disorders in pregnancy by emphasizing individualized diagnosis, trimester-specific reference ranges, and tailored treatment strategies. Thyroid dysfunction is the second most common endocrine abnormality during gestation which poses significant risks to both maternal and fetal health, including miscarriage, preterm delivery, and impaired neurodevelopment. Guidelines now emphasize routine screening in high-risk populations, with tailored management protocols based on trimester-specific TSH and free T4 targets. For hypothyroidism, levothyroxine therapy is initiated early and titrated to maintain TSH in the lower half of the trimester-specific reference range, while hyperthyroidism is managed with antithyroid drugs at the lowest effective dose to minimize fetal risks. Recent updates to clinical guidelines highlight recommendations, including the importance of shared decision-making for women with Graves’ disease, and a shift from antibody-based to timing-based criteria for the treatment of subclinical hypothyroidism. These updates reflect evolving evidence from large randomized trials and systematic reviews, underscoring the need for flexibility and individualization in clinical practice. Future directions in precision medicine include the integration of genetic and molecular profiling to predict disease risk, response to therapy, and long-term outcomes. Machine learning and artificial intelligence are also being explored to enhance diagnostic accuracy and personalize prevention strategies for high-risk subgroups. By combining cutting-edge diagnostics with tailored therapeutic interventions, precision medicine aims to maximize maternal and fetal well-being, reduce adverse outcomes, and improve the overall quality of care for pregnant women with thyroid disorders. This presentation will review the latest evidence, guideline updates, and future innovations in precision medicine for gestational thyroid disease, providing clinicians with practical tools and insights for optimizing patient management in clinical practice and research settings
• Iodine Status in Pregnant Women in Taiwan
  Fan-Fen WangTaiwan Speaker Iodine Status in Pregnant Women in TaiwanIn the 1940’s, endemic goiter was the fifth most common disease in Taiwan. Then, in 1967, an island-wide salt-iodization campaign using 33 ppm potassium iodate was started. Four years after implementation of the campaign, goiter rates among schoolchildren had decreased from 21.6% to 4.3%, suggesting successful elimination of iodine deficiency. However, the mandatory salt iodization policy was discontinued in 2002. In recent surveys, the iodine nutrition status of the overall Taiwanese population has been found to be sufficient, but is at borderline level in pregnant women. Socioeconomic, environmental factors contribute to the incident iodine deficiency in subgroups. While about 92% of pregnant women in Taiwan take nutritional supplements, only about 49% take iodine-containing multi-vitamins. The iodine content of daily meals in Taiwan is currently under investigation, to support targeted dietary education and food fortification programs, which are indicated to improve the iodine status of pregnant women in Taiwan.

• PitNET in Multiple Endocrine Neoplasm
  Sang Ouk ChinCanada Speaker PitNET in Multiple Endocrine NeoplasmMultiple endocrine neoplasia type 1 (MEN1) is a hereditary autosomal-dominant syndrome involving neoplasms of the parathyroid glands, pituitary gland, and endocrine components of the gastrointestinal system. Pituitary neuroendocrine tumors (PitNETs) develop in roughly 40% of individuals with MEN1 and constitute the initial clinical presentation in approximately 10% of cases. Recent epidemiological data indicate a modest female predominance, with tumors smaller than 1 cm occurring more frequently than larger lesions. Hormone-secreting PitNETs are observed more often than non-functioning tumors, representing nearly 36–48% of cases, and prolactin-secreting adenomas remain the most prevalent subtype. In comparison with sporadic PitNETs, those associated with MEN1 are more likely to exhibit plurihormonal secretion, greater tumor size, and locally aggressive behavior, while age at diagnosis and the relative frequency of functional tumors appear comparable. Patients lacking detectable MEN1 gene mutations often present with larger and more clinically apparent PitNETs at diagnosis. Although rare, pituitary carcinoma has been documented in six patients with MEN1, including one individual without an identifiable MEN1 mutation. Current evidence suggests that management strategies for MEN1-related PitNETs largely parallel those used for sporadic tumors. PitNETs have also been described in multiple endocrine neoplasia type 4 (MEN4), though comprehensive epidemiologic characterization remains limited, and MEN4 should be considered in patients with MEN1-like clinical features and negative MEN1 genetic testing.
• Oncologist Perspective of NET Management
  Stephen ChanHong Kong, China Speaker Oncologist Perspective of NET Management
• The impact of mutational status on the heterogeneity of MEN1
  Shyang-Rong ShihTaiwan Speaker The impact of mutational status on the heterogeneity of MEN1Multiple Endocrine Neoplasia type 1 (MEN1) is a rare syndromic disease primarily characterized by parathyroid adenomas, duodenopancreatic neuroendocrine neoplasms (dpNENs), and pituitary neuroendocrine tumors (pitNETs). Although over 750 germline MEN1 mutations have been identified, there is no definitive genotype-phenotype correlation, and specific mutations cannot reliably predict clinical presentations. However, the overall presence or absence of a germline mutation fundamentally alters the disease trajectory. This presentation investigates the clinical heterogeneity between germline mutation-positive (GP-MEN1) and mutation-negative (GN-MEN1) patients. Approximately 10-30% of patients meeting clinical MEN1 criteria are GN-MEN1, which may represent phenocopies (e.g., MEN4, MEN5) or sporadic co-occurrences. Distinct clinical disparities exist between the two cohorts. GP-MEN1 patients exhibit an earlier median onset (33-35 years), aggressive and multiglandular disease, and a high probability of developing a third cardinal tumor, leading to a poorer prognosis. Conversely, GN-MEN1 patients present significantly later (46-52 years), rarely develop a third cardinal tumor, and experience a more indolent course with a life expectancy comparable to the general population. In a cohort analysis from National Taiwan University Hospital (NTUH), the paradigm of pitNETs in MEN1 has shifted towards non-functioning microadenomas due to modern screening. GP-MEN1 patients with pitNETs were diagnosed at a younger age, showed higher sellar floor involvement, and had a higher prevalence of adrenal tumors and non-functioning GEP-NENs. In contrast, GN-MEN1 patients were older and more frequently presented with insulinomas. In conclusion, germline mutational status is a critical determinant of MEN1 clinical heterogeneity. Genetic testing is essential not only for confirming diagnoses and facilitating targeted therapies but also for exonerating non-carriers. Although current guidelines recommend uniform surveillance for all MEN1 diagnostic categories, the distinctively indolent phenotype of GN-MEN1 suggests that a modified, de-escalated surveillance approach may be more appropriate and warrants further formal investigation.

• Mechanistic Insights into the Gut–Liver–Brain Axis in MASLD: Metabolic Crosstalk and Neuroinflammation
  Lee-Ling LimMalaysia Speaker Mechanistic Insights into the Gut–Liver–Brain Axis in MASLD: Metabolic Crosstalk and NeuroinflammationThe gut–liver–brain axis plays an important role in the pathogenesis and progression of metabolic dysfunction-associated steatotic liver disease (MASLD). Disruptions in gut microbiota, increased intestinal permeability, and microbial metabolites drive hepatic lipotoxicity and systemic inflammation. These hepatic signals, together with other metabolic dysfunctions, worsen neuroinflammatory responses and metabolic dysregulation. This lecture will discuss mechanistic links across the axis, and understanding these interconnected mechanisms offers opportunities to refine risk stratification and develop targeted interventions that address MASLD as a multisystem disease.Early-Onset Diabetes: Expanding the Spectrum of ComplicationsEarly-onset diabetes is increasing globally and is characterized by an accelerated trajectory of metabolic dysfunction. People diagnosed at a younger age experience a longer lifetime exposure to hyperglycaemia, adiposopathy, and inflammation, leading to an expanded spectrum of complications. Emerging evidence highlights earlier onset of kidney disease, heart failure, fatty liver disease, cognitive decline, and mental health disorders in this high-risk population. This lecture will synthesize current epidemiology, mechanistic insights, and evolving phenotypes, underscoring the urgent need for precision prevention, aggressive risk-factor modification, and integrated care models to reduce premature morbidity and mortality.
• MASLD and Cognitive Impairment Correlate with Diabetic Management
  Noriko Satoh-AsaharaJapan Speaker MASLD and Cognitive Impairment Correlate with Diabetic ManagementIn recent years, the coexistence of metabolic dysfunction–associated steatotic liver disease (MASLD) and cognitive decline in patients with diabetes has attracted growing attention. These conditions are not merely concurrent comorbidities but share common pathophysiological mechanisms involving insulin resistance, chronic inflammation, and gut dysbiosis. Using a large health checkup database, we reported that a body weight gain of more than 10 kg since the age of 20 is a significant risk factor for the development of MASLD (Nutrients, 2025). Moreover, we found that subsequent weight reduction markedly attenuated this risk, emphasizing the importance of appropriate weight management. In our multicenter diabetic cohort studies of the National Hospital Organization (JOMS/J-DOS2), we reported that circulating soluble TREM2 (sTREM2) —a receptor specifically expressed in monocytes and microglia—was significantly associated with cognitive decline in patients with diabetes, suggesting its potential as a predictive biomarker for dementia (Diabetes Metab, 2019; Front Endocrinol, 2022). Furthermore, our network meta-analysis in patients with type 2 diabetes revealed that SGLT2 inhibitors, GLP-1 receptor agonists, and thiazolidinediones may reduce the risk of cognitive impairment (Diabetes Obes Metab, 2025). Novel antidiabetic agents, particularly GLP-1 receptor agonists, have been shown to improve hepatic function and preserve cognitive performance. Collectively, these findings suggest that optimized diabetic management may hold the key to preventing both MASLD and dementia. In this presentation, I would like to summarize recent evidence and discuss optimal therapeutic strategies for MASLD and cognitive impairment in patients with diabetes.
• Diabetes Mellitus-Dementia Correlate with Diabetic Management
  Chaur-Jong HuTaiwan Speaker Diabetes Mellitus-Dementia Correlate with Diabetic ManagementDiabetes mellitus (DM) is a major metabolic disorder that substantially increases the risk of cognitive decline and dementia, including Alzheimer’s disease (AD) and vascular dementia. Growing evidence indicates that chronic hyperglycemia, insulin resistance, vascular injury, oxidative stress, and neuroinflammation are key mechanisms linking DM to neurodegeneration. Insulin resistance in the brain disrupts neuronal glucose utilization, enhances tau phosphorylation, and accelerates amyloid-β accumulation, while advanced glycation end-products (AGEs) and diabetes-related microvascular dysfunction further exacerbate neuronal injury. Effective diabetic management plays a critical role in mitigating dementia risk. Antidiabetic agents such as metformin, thiazolidinediones, and particularly glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated neuroprotective effects beyond glycemic control. GLP-1RAs improve insulin signaling, reduce neuroinflammation, enhance mitochondrial function, promote autophagy, and inhibit apoptosis, leading to preserved cognitive functions in preclinical models. Clinical studies show that GLP-1RAs may improve specific cognitive domains in patients with type 2 DM and reduce the incidence of cognitive impairment. However, the recent phase 3 trials, Eoke and Evoke+ failed to show the beneficial effects on AD. Overall, the strong interplay between DM and dementia highlights the necessity of optimal glycemic control and strategic use of antidiabetic therapies with neuroprotective potential. Integrating metabolic management into dementia prevention frameworks may offer an effective approach to reducing the global burden of cognitive disorders.

• Incretin-Based Therapeutics: Bridging Theory and Practice, and Exploring New Horizons
  Daisuke YabeJapan Speaker Advancing toward a Cure for Diabetes: Insights from iPSC-Derived Islet Cell Transplantation TrialType 1 diabetes is characterized by absolute insulin deficiency and marked glycemic variability, creating a constant challenge for individuals who must maintain strict glycemic control to prevent complications and severe hypoglycemia. To address these persistent unmet medical needs, transplantation of pancreatic islet–like cells derived from embryonic stem (ES) or induced pluripotent stem (iPSC) cells has emerged as a promising therapeutic strategy. Encouraging advances have recently been reported from the United States and China. Notably, a world-first autologous transplantation of patient-specific iPSC-derived islet-like cells in China achieved insulin independence with near-normal glycemic control. Despite its promise, concerns remain regarding long-term safety, durability, and broad applicability, underscoring the need for further rigorous clinical evaluation. This lecture will provide an overview of current progress and ongoing challenges in β-cell replacement therapy aimed at curing type 1 diabetes. In addition, I will introduce the study design of our clinical trial at Kyoto University Hospital evaluating allogeneic transplantation of iPSC-derived islet cell sheets (OZTx-410). Through these insights, we aim to highlight both the steady steps already taken and the horizon of possibilities ahead in the pursuit of a functional cure for diabetes.Incretin-Based Therapeutics: Bridging Theory and Practice, and Exploring New HorizonsThe landscape of type 2 diabetes management has been transformed by the advent of incretin-based therapies, including dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. In Japan—where more than 70% of individuals with diabetes are aged 65 years or older and commonly present with a non-obese phenotype and reduced insulin secretory capacity—DPP-4 inhibitors continue to serve as a fundamental treatment option, offering effective glycemic control with minimal risk of hypoglycemia. In contrast, among younger adults with obesity, GLP-1 receptor agonists have emerged as essential agents that not only improve glycemic control but also promote weight reduction and confer cardiovascular and renal benefits. A major advance in 2023 was the approval of tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonist that engages both receptors. Tirzepatide has demonstrated robust glucose-lowering and weight-reducing effects in both clinical trials and real-world practice in Japan, further expanding therapeutic opportunities across the region. However, incretin-based therapies are not without challenges: gastrointestinal adverse events remain common, and potential associations with pancreatic and biliary diseases continue to require caution. In older adults, concerns regarding their impact on frailty and sarcopenia demand careful clinical judgment. Furthermore, inappropriate discontinuation of insulin therapy after initiating incretin treatment has occasionally resulted in severe clinical consequences, highlighting the critical need for decision-making that extends beyond the evidence from controlled trials. In response to these issues, the Japan Diabetes Society (JDS) Committee for the Safe Use of Medications released the Recommendations for the Safe Use of Incretin-Related Agents, Second Edition in 2024. Disseminating these recommendations across East Asia and the broader Asia–Oceania region will be essential to ensure the safe and effective application of incretin-based therapies in diverse clinical settings. In this plenary lecture, I will explore strategies to optimize type 2 diabetes management in Asia by harnessing the therapeutic potential of incretin-based agents while proactively mitigating associated risks. Together, we aim to build a future in which innovation, safety, and patient-centered care advance hand in hand.

• Genomic Alterations in Thyroid Cancer: Biological and Clinical Insights
  Maria E. CabanillasUnited States Speaker Genomic Alterations in Thyroid Cancer: Biological and Clinical InsightsGenomic alterations play a central role in the initiation, progression, and clinical behavior of thyroid cancers, offering critical insights into their underlying biology and therapeutic vulnerabilities. Follicular cell derived thyroid tumors commonly harbor driver mutations that constitutively activate the MAPK signaling pathway, most notably BRAFV600E and RAS mutations. These early events define major molecular subtypes and strongly influence differentiation status, tumor phenotype, and response to therapy. Progression toward aggressive or dedifferentiated forms, such as poorly differentiated and anaplastic thyroid carcinomas, is driven by additional alterations in key genes regulating chromatin remodeling, cell cycle control, and genomic stability, including TERT promoter mutations, TP53, PIK3CA, and EIF1AX. Actionable genomic alterations are increasingly leveraged to personalize treatment strategies in thyroid cancer and underscore the importance of genomic characterization in improving outcomes in thyroid cancer. Anaplastic Thyroid CancerAnaplastic thyroid cancer (ATC) is one of the most aggressive human malignancies, characterized by rapid local invasion, early metastasis, and near‑universal disease‑specific mortality and is considered a medical emergency. Current treatment strategies prioritize rapid assessment of resectability, with surgery pursued only when complete or near‑complete tumor removal is feasible, as partial debulking offers limited benefit. For unresectable disease, localized disease, combined modality therapy—typically external‑beam radiation with concurrent systemic therapy—remains the cornerstone of local control. Recent advances in molecular profiling have transformed systemic management, enabling targeted therapies for tumors harboring BRAFV600E mutations. These agents have demonstrated meaningful responses and, in select cases, have converted unresectable tumors to operable ones, expanding the role of surgery in modern care. However, due to the high risk of relapses, immunotherapy has been added to the treatment strategy. Patients with distant metastatic disease without a BRAFV600E mutation have a more complicated treatment regimen which is still under investigation but require systemic therapy combination strategies involving immunotherapy. These evolving strategies reflect a shift toward precision‑based, time‑critical management aimed at improving outcomes in this highly lethal cancer.

• Diagnosis and Evaluation of Obesity
  Hung-Yuan LiTaiwan Speaker Diagnosis and Evaluation of ObesityObesity is now widely recognized as a chronic, heterogeneous disease rather than a simple consequence of excess body weight. Contemporary perspectives emphasize that obesity-related health risk arises not only from the quantity of adipose tissue, but also from its distribution and functional status. In recent years, major international organizations—including the The Lancet Commission on Obesity, the American Association of Clinical Endocrinology (AACE), the European Association for the Study of Obesity (EASO), the Japan Society for the Study of Obesity (JASSO), and the American Diabetes Association (ADA)—have proposed evolving frameworks for obesity diagnosis that move beyond reliance on body mass index (BMI) alone. This session will review current concepts in the diagnosis and evaluation of obesity, integrating anthropometric measures, adiposity distribution, obesity-related complications, and functional consequences of excess fat. While BMI remains a practical and widely used screening tool, its limitations at the individual level are increasingly recognized. Complementary measures such as waist circumference and waist-to-height ratio provide important additional information, particularly for assessing central adiposity and cardiometabolic risk in Asian populations. A central theme of this lecture is the concept of obesity-related complications and diseases (ORCD), which can be broadly categorized into two interrelated entities. Fat mass disease refers to conditions driven predominantly by excessive fat mass and its mechanical or quantitative burden, whereas sick fat disease reflects adipose tissue dysfunction characterized by abnormal endocrine, inflammatory, and metabolic signaling. Both entities contribute to ORCD, either independently or in combination, and together account for the heterogeneous clinical manifestations of obesity. According to the definitions proposed by the Lancet Commission on Obesity, obesity can be conceptualized along a continuum from preclinical obesity to clinical obesity. Preclinical obesity is characterized by excess adiposity without established ORCD and corresponds conceptually to AACE stage 1, representing a key opportunity for primary prevention. In contrast, clinical obesity is defined by the presence of ORCD and aligns with AACE stage 2 and stage 3, in which clinical management focuses on secondary prevention, risk reduction, and complication management. This integration of Lancet Commission concepts with AACE staging provides a disease-oriented framework for risk stratification and therapeutic decision-making. Comprehensive obesity evaluation must also address psychological, behavioral, and socio-cultural factors. Mental health conditions such as binge-eating disorder, depression, and anxiety may both contribute to and result from obesity, forming bidirectional relationships that influence disease trajectory. In addition, weight stigma, health literacy, and environmental and cultural contexts significantly affect treatment acceptance, adherence, and long-term outcomes, and should be incorporated into routine clinical assessment. In conclusion, this session will propose a pragmatic, stepwise approach to obesity diagnosis and evaluation that integrates ORCD phenotyping with AACE stage 1–3 classification and the conceptual framework of the Lancet Commission. This approach is intended not only to inform clinical decision-making, but also to serve as the foundation for the forthcoming obesity-related clinical practice guidelines of the Diabetes Association of the Republic of China, bridging global concepts with local implementation.

• Revisiting the β-cell: The Key to the Type 2 Diabetes Puzzle
  Steven KahnUnited States Speaker Revisiting the β-cell: The Key to the Type 2 Diabetes PuzzleIncretin-Based Therapies: Lessons Learned Beyond Diabetes

• Paraneoplastic Autoimmune Hypophysitis: A Novel Form Paraneoplastic Endocrine Syndrome
  Yutaka TakahashiJapan Speaker Paraneoplastic Autoimmune Hypophysitis: A Novel Form Paraneoplastic Endocrine SyndromeThe story begins with a fascinating case we encountered in 2003. It was an outlier of hypopituitarism that presented with acquired deficiencies in GH, PRL, and TSH. We subsequently accumulated similar cases and reported them as a novel disease entity named "anti-PIT-1 hypophysitis." We clarified that this condition represents a paraneoplastic syndrome associated with thymoma or malignancies. The mechanism of onset involves ectopic expression of PIT-1 in the tumor, leading to a breakdown of immune tolerance. As a result, anti-PIT-1 antibodies are produced in the blood, and PIT-1–expressing cells (those producing GH, PRL, and TSH) in the pituitary are damaged by cytotoxic T lymphocytes (CTLs). Recently, we have succeeded in establishing a disease model using co-culture of CTLs and patient-derived iPS cell–generated pituitary cells, demonstrating that CTLs are indeed the causatively involved. Interestingly, we found that a similar mechanism underlies some cases of isolated ACTH deficiency and immune checkpoint inhibitor–related hypophysitis (PD-1/PDL-1-related hypophysitis). Based on this, we proposed a broader new disease concept: “paraneoplastic autoimmune hypophysitis.” Very recently, we discovered a case of “immune checkpoint inhibitor–related anti–PIT-1 hypophysitis,” which clearly supports this concept. To elucidate the pathophysiology of such novel diseases, we emphasize the importance of a cross-disciplinary academic framework—beyond organ-specific medical practice and beyond endocrinology alone—which we refer to as "onco-immuno-endocrinology." In this lecture, I will introduce our research journey and share key insights and lessons for young physician-scientists aiming to reshape the textbooks of the future.Hypophysitis: Difficult CasesHypophysitis is defined as inflammation of the hypothalamo-pituitary region and is classified into primary and secondary forms. Primary hypophysitis refers to autoimmune hypophysitis (lymphocytic hypophysitis) and is essentially a diagnosis by exclusion of other diseases. Secondary hypophysitis can be classified into those associated with local lesions, systemic diseases, or drug-induced causes. Therefore, differential diagnosis from other conditions presenting with similar findings is crucial. Among the secondary forms, immune checkpoint inhibitor–related hypophysitis has emerged. In addition, the newly proposed entity paraneoplastic autoimmune hypophysitis have recently drawn considerable attention. That includes anti-PIT-1 hypophysitis, a component of isolated ACTH deficiency and PD-1/PDL-1-related hypophysitis, in which common mechanism underlies. Ectopic expression of pituitary antigens such as POMC and PIT-1 causes breakdown of immune tolerance and specific cytotoxic T cells injure anterior pituitary cells, results in a specific defect in ACTH or GH, PRL, and TSH, respectively. For systemic diseases, diagnosis proceeds by examining specific disease markers and searching for involvement of other organs. On the other hand, it is often difficult to differentiate lesions confined to the hypothalamo-pituitary region. In atypical cases, pituitary biopsy should be considered. When performing a biopsy, appropriate selection of the biopsy site is essential. If possible, the decision should be made before administering pharmacologic doses of glucocorticoids. In this Meet the Professor session, I would like to provide up-to-date information and foster discussion with audience on key points in the differential diagnosis of hypophysitis, with a focus on immune checkpoint inhibitor–related hypophysitis and paraneoplastic autoimmune hypophysitis, which represent emerging disease concepts.