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The central reasons (repeatable pattern across literature): Comparator sensitivity: DPP-4i vs sulfonylureas vs SGLT2i changes results Ascertainment differences: Who gets ultrasounds, when, and why Outcome definition: "Thyroid cancer," "tumors," "neoplasm," and "MTC" aren't interchangeable Short follow-up: Better at capturing diagnostic workups than long-term carcinogenesis Residual confounding: Obesity, diabetes duration, smoking, iodine status, healthcare access When Studies Disagree: It's often because they used different comparison drugs, definitions, and populations watched more closely

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