• 대한두경부종양학회지
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• 제30권2호
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• pp.74-78
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• 2014

갑상선 암 진단과 치료기술이 발전하면서 최근 그 수술 건 수가 급격하게 증가하고 있다. 하지만이와 관련된 합병증과 부작용을 면밀하게 평가해야 할 필요 역시 점차 늘어나고 있다. 갑상선 암 수술 후 발생할 수 있는 드문 합병증의 하나로 횡격막 신경마비(phrenic nerve paralysis)가 있다. 이러한 횡격막신경마비는 대부분 증상이 경미하고 쉽게 호전되어 임상적으로 크게 중요하게 다루어지지 않았다. 하지만, 갑상선 수술 후 갑작스런 호흡곤란이 발생한다면 횡격막 신경마비에 의한 횡격막 마비(diaphragmatic paralysis)와 관련되었을 가능성을 놓치지 말아야 한다. 저자들은 최근 갑상선암 수술 후 발생한 호흡곤란으로 2년 동안 심각한 호흡곤란을 호소하던 73세 여자환자에서 투시촬영(fluoroscopy) 상 편측으로 상승되고 운동성이 저하된 횡격막을 확인하여 일측성 횡격막신경마비(Unilateral phrenic nerve paralysis)를 확진 하였다. 갑상선수술 후 발생하는 일측 횡경막 신경마비는 임상에서 드물게 관찰되는 수술 합병증이기에 환자는 상당기간 이에 대한 감별이 제대로 이루어지지 않았다. 우리는 횡격막 마비의 조기 진단과 적극적인 치료를 통하여 심한 호흡곤란을 호소하는 환자의 증상 및 병의 경과를 호전 시킬 수 있었다.

• 대한두경부종양학회지
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• 제27권2호
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• pp.198-203
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• 2011

Background and Objectives : Distinguishing benign from malignant lesion in thyroid noddex is important but clinically difficult. FNAB is the first investigation of choice. However, cytologic results are often indeterminable. In those cases, additional molecular biologic tests are helpful. If serologic tests are available to predict malignancy, it can be useful to fortify accurate diagnosis. We analyzed whether TSH or FreeT4 level could be used as a predictor of malignancy. Materials and Methods : From January 2008 to March 2009, 540 patients received one of thyroidectomy in a single center. We only included 167 patients from 18 to 65 years old without cardiopulmonary or renal disorders. All the patients were in euthyroid state and took no medications, which affect the thyroid function. We reviewed charts retrospectively to find out differences in TSH level and FreeT4 level between the benign and malignant groups. Results : In this study, all the patients with malignancy had the papillary cancer. In benign group, average TSH level came out to be 1.48mU/L, whereas the average TSH level of malignant group was 1.98 mU/L. Moreover, the higher the cancer stage was, the higher the TSH level was. Although we have adjusted factors that can affect TSH level(age, sex, race, goiter type), we still received the same result. The risk of malignant cancer increased in proportion with TSH level within the normal range. In free T4 level, there was no difference between benign and malignant group. Conclusion : We propose that TSH level can play a role as one of the predictors for thyroid cancer. However, there is limitation because all the patients with malignancy in this study have papillary cancer. Thus, we can apply this result only in papillary cancer, and we need more study for other types of thyroid cancer.

• 대한두경부종양학회지
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• 제24권1호
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• pp.47-52
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• 2008

Purpose：The incidence of papillary thyroid microcarcinoma(PTMC) has increased due to the widespread use of high resolution ultrasonography and fine-needle aspiration biopsy. However, the clinical and biologic behaviors of PTMC is debatable. The aim of this study was to describe clinicopathologic features of PTMC and to suggest whether tumor size(5mm) might prove the useful parameter for determining the surgical strategy in PTMC. Material and Methods：From Jan. 2000 to Dec. 2005, 1355 of 2678 patients with papillary thyroid carcinoma were identified as having PTMC, based on tumor size${\leq}$10mm(50.6%). Among patients with PTMC, we further separated tumors<5mm(minute group：group M) from those 5 to 10mm(tiny group：group T). We compared the clinicopathological characteristics and the TNM stagings between two groups. Results：There were 114(8.4%) men and 1241(91.6%) women with a median age of 47 years(range；13-79). During a mean follow-up of 47.3(range；22-93), 13 patients(1.0%) developed locoregional recurrences and 3 patients(0.2%) showed distant metastases at initial presentation. Statistical analysis revealed that the presence of extracapsular invasion(p<0.0001), invasion to adjacent structure(p<0.0001), multifocality(p<0.0001), central lymph node metastasis(p<0.0001), and lateral lymph node metastasis(p<0.0001) were all significantly higher in tiny group(tumor${\geq}$5mm). Furthermore, minute group demonstrated a significantly lower tumor stage(AJCC TNM classification) compared with tiny group(p<0.0001). Conclusion：Patients with PTMC have a favorable treatment outcomes, although the distinction needs to be made with reference to the clinicopathologic behaviors. It would be reasonable to consider that tumor size(5mm) would be useful parameter for the treatment strategy of PTMC.

• 대한두경부종양학회지
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• 제31권2호
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• pp.16-20
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• 2015

Background and Objectives : In papillary thyroid carcinoma (PTC), multiplicity and central or lateral lymph node metastases significantly affect the recurrence. This study was carried out to evaluate the clinical and histological characteristics of PTC according to the tumor size. Materials and Method : Between January 1, 2009 and December 31, 2014, 12,269 PTC patients underwent thyroid surgery at the Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Korea. We analyzed pathologic findings and clinical features according to the size of tumor Results : The mean size of tumor was $0.89{\pm}0.70cm$. The Central and lateral compartment metastases were observed 64.7% and 37.6% on the range that the primary tumor size is 1cm. There was a significant association between the PTC primary tumor size and multiplicity and cervical neck metastasis (p<0.001). Conclusion : The PTC primary tumor size for prediction of multiplicity and neck node metastasis can be helpful in optimization of the surgical extent for each patient.

• 대한두경부종양학회지
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• 제31권2호
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• pp.11-15
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• 2015

Background and Objectives: This study aimed to analyze the features of patients with papillary thyroid carcinoma (PTC) recurred as distant metastases (DM). Materials and Method: We retrospectively reviewed and analyzed clinical records of 63 patients who were treated for PTC recurred as DM between 2000 and 2006. Univariate and multivariate analyses of various clinical factors were performed. Results: Male patients were 12, and female patients were 51. The 5- and 10-year survival rates for PTC recurred as DM were 85% and 73%, respectively. Size of tumor, multiplicity of tumor, lateral neck node metastasis, and RAI ablation therapy with other treatments such as surgery were associated with survival rate (p < 0.005) in univariate analysis. The lateral neck node metastasis[p =0.039, hazard ratio=2.2(95% CI. 1.18~3.24)] and multiple organ DM[p =0.041, hazard ratio=2.18(95% CI. 1.03~2.89)] were related to the survival in multivariate analysis. Conclusion: PTC recurred as DM is uncommon (2.2%). The size of tumor, the multiplicity of tumor, lateral neck node metastasis and RAI ablation therapy with other treatments for DM were revealed as associated factors for the survival. Evaluation of DM should be considered in patients with PTC during long-term follow-up.

• 대한두경부종양학회지
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• 제26권2호
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• pp.183-186
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• 2010

Purpose : Papillary thyroid carcinoma (PTC) is known for malignant tumor which has a favorable prognosis and long-term survival. Although the prognosis for patients with PTC is generally good, PTC tends to have highly metastatic property. The purpose of this study was to analyze the central compartment lymph node in papillary thyroid cancer with no lymph node metastasis clinically and to assess the significance of prophylactic node dissection. Methods : A retrospective review was carried out in 394 patients with PTC who underwent surgery for the period from January 2004 to December 2006. The positive rate of the lymph node metastasis was analyzed. The relations between the central compartment lymph nodes and the patients' age, gender, tumor size, exrathyroidal extension(ETE), multifocality, and bilaterality were comparatively analyzed in PTC patients with preoperative no lymph node metastasis. Results : The enrolled patients were 40 male and 354 female cases. The 118 cases of them were found to have cervical lymph node metastasis. The mean age was 46 years(range, 15-77years). Tumor size(p=0.000), ETE(p=0.001), multifocality(p=0.014), and bilaterality(p=0.001) were significantly related factors for cervical lymph node metastasis clinically in papillary thyroid cancer. However, age and gender were not significantly related with lymph node metastasis. Conclusion : Although no lymph node metastasis clinically, prophylactic neck node dissection can be performed to avoid risks of local recurrence and reoperation in the light of PTC nature. The pathological status and high positive rate of central compartment lymph node relate to tumor size and extrathyroidal extension. Close surveillance for nodal status is required in follow-up.

• 대한두경부종양학회지
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• 제14권2호
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• pp.253-259
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• 1998

The increasing risk of subsequent malignancy after treatment of malignant lymphoma is well known, which is mainly due to longer survival of these patients. Radiotherapy at an early stage of Hodgkin's disease or non-Hodgkin's lymphoma is accepted to be associated with future occurrence of secondary thyroid cancer. Nevertheless, the synchronous presentation of these malignancies is extremely rare. Well differentiated thyroid cancer, a slow-growing tumor that responds to therapy with surgery and radioactive iodine, is associated with prolonged survival. therefore, it is important to make this diagnosis in patients who show evidence of malignant lymphoma. Furthermore, appropriate treatment must be considered for thyroid cancer to improve the prognosis of these patients. We herein reported 4 cases of synchronous thyroid cancer and malignant lymphoma in patients who had not previously recieved radiotherapy or chemotherapy.

• 대한한방부인과학회지
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• 제31권3호
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• pp.141-151
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• 2018

Objectives: This paper aims to report the effects of Korean medical treatment on three patients who underwent thyroid lobectomy for thyroid cancer. Methods: Three patients were hospitalized at hospital to treat pain and general weakness after thyroid lobectomy. The patients took Korean medical treatment including herbal medicine and acupuncture. Numerical Rating Scale (NRS) of symptoms was measured every morning. Results: After the treatment, the pain and general weakness following surgery decreased, and general conditions improved. Conclusions: This cases show that Korean medical treatment is effective for a patients who underwent thyroid lobectomy for thyroid cancer.

• 대한두경부종양학회지
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• 제21권2호
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• pp.174-177
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• 2005

Skin metastasis from papillary thyroid carcinoma is extremely rare. Due to similar histopathologic features, it is difficult to differentiate skin metastatic papillary thyroid carcinoma and some primary skin neoplasms without a clinical history. However, most of metastatic skin lesions showed a strong reactivity to the antithyroglobulin antibodies unlike primary skin neoplasms. Metastatic skin lesions must be completely removed and radiotherapy can be added. Investigators reported that prognosis of skin metastases from thyroid carcinoma is dismal and the average survival after it's diagnosis was only 19 months because distant metastases were often discovered at diagnosis of skin metastasis or during follow-up period. We report a case of skin metastasis from tall cell variant of papillary thyroid carcinoma. In our case, the anti thyroglobulin antibodies measured from cystic fluid from a skin lesion was more than 2000 IU/ml. Skin metastasis was diagnosed at 20 months after primary surgery for thyroid cancer and brain metastasis at 12 months after diagnosis of skin metastasis. Although skin metastasis is an ominous prognostic indicator in patients with thyroid carcinoma, a radical treatment for skin lesions and early diagnosis of distant metastasis could provide a chance to the patients to improve their survival.

• 한국산학기술학회논문지
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• 제11권3호
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• pp.1133-1138
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• 2010

이 연구는 갑상샘 유두암 환자에서 VEGF, HIF-$1{\alpha}$, E-cadherin, p53의 발현 정도와 병기와의 상관관계를 알아보고자 하였다. 2000년부터 2007년까지 갑상샘 절제술을 시행받은 101명의 환자의 의무기록을 후향적으로 검토하였다. VEGF, HIF-$1{\alpha}$, E-cadherin, p53의 발현은 면역학적으로 조사되었다. 갑상샘 유두암으로 진단된 45세 이상의 환자 중 54명을 대상으로 하여 VEGF, HIF-$1{\alpha}$, E-cadherin, p53의 발현이 분석되었다. E-cadherin의 발현소실과 병기 사이에는 유의한 상관관계가 있었다. VEGF의 발현과 HIF-$1{\alpha}$의 과발현 사이에는 유의한 관련성이 관찰되었다(p<0.05). E-cadherin의 발현소실은 통계적인 유의성은 없었다. HIF-$1{\alpha}$의 높은 발현이 HIF-VEGF 경로를 통해 종양간 맥관형성과 관련된 것으로 여겨진다.