• 대한수의학회지
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• 제64권2호
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• pp.10.1-10.9
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• 2024

Hyperthyroidism, characterized by elevated thyroid hormone levels and thyroid gland hyperplasia or adenoma, is a prevalent endocrinopathy in older cats. Treatment options include antithyroid drugs, surgical thyroidectomy, and radioiodine therapy (RAIT), which is non-invasive treatment option that can achieve complete remission. However, efficacy and safety of RAIT in hyperthyroid cats have not been investigated in South Korea. This study includes 10 hyperthyroid cats with RAIT. Initial assessments comprised history, physical examination, blood analysis, and serum total T4 (tT4) concentration. Thyroid scintigraphy revealed hyperactivity and enlargement of thyroid gland at 24 hours before the RAIT. Radioiodine (RAI) was injected subcutaneously with 2 to 6 mCi, determined by the fixed dose or the scoring system based on severity of clinical signs, tT4 concentration, and thyroid size individually. After RAIT, the concentration of serum tT4 and liver enzymes were significantly decreased at discharge. However, no significant differences were noted in blood urea nitrogen, creatinine, symmetric dimethylarginine, hematocrits, and white blood cell counts pre- and post-treatment. Although 4 cats received RAI twice, clinical signs disappeared and tT4 levels decreased following the RAIT. All 10 cats achieved complete remission after 6 months without critical adverse effect. The safety and the effectiveness of RAIT was confirmed based on protocols reported other countries. Therefore, RAIT could be considered the treatment option and prevent adverse effects from medication or surgery. This preliminary study presents the first evaluation of RAIT for hyperthyroid cats using locally produced RAI in South Korea and provide valuable insight for clinicians and further studies.

• 농업과학연구
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• 제51권2호
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• pp.109-121
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• 2024

Mancozeb is a manganese and zinc-containing fungicide that belongs to the ethylene bisdithiocarbamate group and produces ethylene thiourea (ETU) after biotransformation or environmental degradation, which has toxicological hazard owing to its known antithyroid properties. Although mancozeb leads to negative changes in fertility capacity, the effects of ETU are less known. Therefore, this study examined the alteration of fertilization competence in boar spermatozoa exposed to ETU. The sperm motility, motion kinematics, viability, acrosome integrity, chromatin stability, and intracellular reactive oxygen species (ROS) production of sperm subjected to various ETU concentrations (10, 50, 100, and 200 µM) were evaluated after two different incubation times (30 min and 2 hrs). In addition, the relative mRNA expression of the sperm functional proteins was analyzed after exposure to ETU. A dose-dependent motility reduction was observed in sperm exposed to ETU during both incubation periods compared to the controls. The motion kinematics were reduced significantly in sperm incubated with ETU. Higher percentages of viable sperm were observed in the controls, while such viability was decreased significantly in sperm with 10 - 200 µM ETU. The acrosome integrity was particularly damaged on sperm incubated with 10 - 200 µM ETU for 30 min. Higher intracellular ROS levels were produced in sperm exposed to 200 µM ETU. In addition, lower relative levels of AKAP3, AKAP4, ODF2, and ZPBP2 expression were observed in sperm exposed to ETU compared to the controls. Mancozeb and ETU could adversely affect the reproductive functions of mammals. Hence, the effects of ETU on the reproductive system should be examined further.

• 대한핵의학회지
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• 제8권1_2호
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• pp.29-37
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• 1974

The $^{99m}Tc$-pertechnetate thyroid uptake rates(20 min) were measured in 24 healthy normal subjects, 140 patients with nontoxic goiter and 98 patients with thyrotoxicosis who were treated at the Thyroid Clinic, Seoul National University Hospital, from August 1972 to August 1973. Diagnostic reliabilities and correlations between $^{99m}TcO_4$-thyroid uptake rate (20 min) and other thyroid function tests were evaluated. The observed results were as follows 1. The $^{99m}TcO_4$-thyroid uptake rates (20 min) in normal subjects, euthyroid group and hyperthyroid group were $4.1{\pm}0.9%,\;5.2{\pm}1.8%\;and\;29.7{\pm}10.6%$. There was a significant difference between the mean of the euthyroid group and the mean of the hyperthyroid group and so differentiation between them can be easy. 2. In the diagnosis of hyperthyroidism, the reliabilities of $^{99m}TcO_4$- thyroid uptake rate(20 min), $^{131}I$ thyroid uptake rate(24hrs), serum $T_3$ resin uptake rate, serum $T_4\;and\;T_7\;were\;87.9{\sim}97.9%,\;81.2{\sim}94.4%,\;87.9{\sim}97.9%,\;90.5{\sim}99.3%\;and\;93.7{\sim}100%$. $^{99m}TcO_4$-thyroid uptake rate(20 min) is more accurate than $^{131}I$ thyroid uptake rate (24 hrs) in the diagnosis of hyperthyroidism. 3. $^{99m}TcO_4$-thyroid uptake rate (20 min) was well correlated with $^{131}I$ thyroid uptake rate (24 hrs), serum $T_3$ resin uptake rate, serum $T_4\;and\;T_7$. Points in favor of $^{99m}Tc$ are that it gives a small radiation dose to the thyroid, that tests can be repeated at the short interval, the study can be completed at a single patient visit and it is particularly well suited for the assessment of thyroid function in patients being treated with an antithyroid drug.

• 대한두경부종양학회지
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• 제18권1호
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• pp.60-64
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• 2002

Objectives: Three classic treatment modalities have been used to treat Graves' disease: antithyroid medication, radioiodine ablation, and subtotal thyroidectomy. Postoperative thyroid functions were studied in patients with Graves' disease treated by subtotal thyroidectomy to evaluate the superiority of surgical treatment. Materials and Methods: One hundred fourty patients of Graves' disease were analysed retrospectively in follow-up for more than three years following subtotal thyroidectomy. Postoperative serum levels of $T_3,\;T_4, TSH, TSH-R Ab, free $T_4$, were evaluated to watch hypo- or hyperthyroidsm. Results: In the evaluation of preop- and postoperative thyroid function after three years of subtotal thyroidectomy, $T_3$ was changed from $464.10{\pm}196.16ng/dl$ to $140.41{\pm}76.56ng/dl$ in mean value, $T_4$ was changed from $20.76{\pm}7.98{\mu}g/dl$ to $9.54{\pm}4.02{\mu}g/dl$, $TSHT_3$ was changed from $0.55{\pm}4.42{\mu}u/ml$ to $4.96{\pm}7.20{\mu}u/ml$, TSH-R Ab was changed from $41.6{\pm}28.27%$ to $28.7{\pm}28.79%$ and free $T_4$ was changed from $4.45{\pm}2.33ng/dl$ to $1.44{\pm}0.69ng/dl$ in mean value. Euthyroidism was noted in 118 patients(84.3%), overt hyperthyroidism in 6 patiens(4.3%), latent hyperthyroidism in 8 patients(5.7%), overt hypothyroidism in 2 patint(1.4%), and latent hypothyroidism in 6 patients(4.3%). Of surgical complications, permanant hypoparathyroidism was found in one patient, recurrent laryngeal nerve injury in two patients, postoprative bleeding with reoperation in two patients, and death in one patient. Conclusion: The thyroid function after subtotal thyroidectomy in diffuse toxic goiter is normal level (euthyroidism) in 84.3% and low recurrence rate of hyperthyroidism is showed with rare surgical complication. Therefore, subtotal thyroidectomy in diffuse toxic goiter is more effective and safe than RI or longterm ATD treatment, if the operation is performed by skillful surgeon.

• 대한핵의학회지
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• 제11권1호
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• pp.49-58
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• 1977

For the assessment of antithyroid effect of lithium carbonate, it was administered to the 17 hyperthyroid and 5 euthyroid patients, who visited the Seoul National University Hospital from Jan. to Aug., 1977. Thyroid function tests were performed just before the administration of Lithium carbonate, 2 weeks and 2 months after lithium treatment. The results were as follows; 1) In the 5 euthyroid patients, no significant changes in thyroid function tests were obtained before and after lithium treatment. 2) In the 17 hyperthyroid patients, the values of the $T_3RIA$ were $370{\pm}121ng/dl$ 2 weeks after lithium treatment as compared with $506{\pm}121ng/dl$ before the administration, of which the mean percentage fall was 26.9%. $T_3RU$ was varied from $56.8{\pm}8.0%\;to\;47.3{\pm}8.1%$ (16.7% in mean percentage fall), $T_4$ was changed from $24.2{\pm}2.4ug/dl\;to\;22.0{\pm}4.2ug/dl$ (9.1% in mean fall), and $T_7$, from $13.82{\pm}2.25\;to\;10.55{\pm}3.12$ (23.7% in mean fall). 3) In the 5 hyperthyroid patients, serial thyroid function tests were performed 2 weeks and 2 months later. The mean percentage falls of $T_3RIA$ were 36.6 and 61.3%, 2 weeks and 2 months after lithium treatment respectively. Those of $T_3RU$ were 17.5 and 35.1%, those of $T_4$ were 20.4 and 44.0%, $T_7$, 35.0 and 60.7%. 4) Approximately $45{\sim}60%$ of mean fall in thyroid function tests were obtained within the second week. Normal thyroid function tests were observed in 2 among 17 patients within the second week, and 2 among 5 patients within the second month. 18 patients, however, became clinically euthyroid within the 4th week. 5) Single case of hypothyroidism was experienced, and 5 patients (29.4%) complained mild side effects. Lithium salts could be safely administered to hyperthyroid patients who are allergic to thioamides or iodine. Its use is indicated in cases of acute thyrotoxicosis in which it's necessary to reduce hormone levels very rapidly, and lithium-thioamides drug combination is a highly effective and safe means of initial routine control of hyperthyroidism.

• 대한핵의학회지
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• 제21권2호
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• pp.133-141
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• 1987

To evaluate the values of the thyroid autoantibody measured by radioimmunoassay (RIA) and compare it with hemagglutination method (HA) in the normal and the thyroid disease, data were obtained from total 618 persons; 236 healthy persons, 217 patients with Graves' disease (including 113 patients with undertreated Graves' disease), 100 Hashimoto's disease, 31 thyroid nodule, and 34 simple goiter. RSR kit made in England was used and could be detected to at least 3 U/ml. The positive rates of normal group were antimicrosomal antibody (AMA) 31.8%, antithyroglobulin antibody (ATA) 44.5% by RIA and there was no considerable change in sex and age distribution. In Graves' disease, the positive rates of AMA and ATA were 90.4, 76.9% by RIA, 85, 39% by HA. In Hashimoto's disease, 94,91 % by RIA, and 87,48% by HA, respectively. The autoantibody titer by RIA in thyroid autoimmune disease as well as in normal group was more senisitive than that by HA, especially in ATA. There were linear relationships between the titer of RIA and that of HA in AMA of Graves' disease and AMA and ATA of Hashimoto's disease. There was no relationship among thyroid autoantibody, free $T_4$ index, TBII, and TSH. The titers of AMA and ATA were found to decrease in patients with Graves' disease during the course of antithyroid drug therapy. Of the 236 normal subjects, thirty-seven (15.7%) had concentrations of above 7.5 U/ml in AMA, forty. four (18.6%) above 9 U/ml in ATA. These values were considered as the upper limit for the normal range. In Graves' disease, 82.7, 53.8% were above 7.5, 9 U/ml, respectively; In Hashimoto's disease, 82, 79% were positive. We conclude that RIA was more sensitve than HA in measuring the thyoird autoantibody, but we will study further more for determining the normal range and its interpretation.

• Endocrinology and Metabolism
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• 제33권4호
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• pp.466-472
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• 2018

Background: Thyroid dysfunction is associated with negative neonatal and obstetric outcomes. Large differences in thyroid function reference intervals exist across different populations. These differences can be explained by population-specific factors, such as iodine status. Many countries in Latin America report iodine sufficiency, but relatively few countries have published up-to-date data on iodine levels and thyroid function in the overall population, and especially in pregnant women. We evaluated the iodine status of pregnant women in Chile and determined thyroid hormone reference ranges in this population. Methods: This was a prospective observational study of healthy Chilean women at their first prenatal visit before week 14. Thyroid-stimulating hormone (TSH), total thyroxine ($T_4$), free $T_4$, antithyroid peroxidase antibody (TPOAb), and iodine levels from spot urine samples were measured. Iodine status and the reference ranges for TSH were calculated. Results: A total of 1,022 pregnant women in the first trimester were selected. Urinary iodine levels were measured in 302 randomly-selected women. The median urinary iodine concentration was $173.45{\mu}g/L$ (interquartile range, 108.11 to 249.35).The reference ranges of TSH were calculated in 670 patients selected according to the National Academy of Clinical Biochemistry guidelines. The median TSH level was $1.88{\mu}IU/mL$ (2.5th percentile: 0.13 to 97.5th percentile: 5.37). Using the reference range in the 1,022 women, the prevalence of clinical hypothyroidism was 1.76%, and that of subclinical hypothyroidism was 3.92%. TPOAb positivity was more common in women with TSH levels above $3.5{\mu}IU/mL$. Conclusion: We found adequate iodine intake and a right-shifted distribution of serum TSH levels in pregnant women in Chile. The prevalence of hypothyroidism in our sample of pregnant women was higher than has been described in the literature.

• Clinical and Experimental Pediatrics
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• 제52권9호
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• pp.1021-1028
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• 2009

목 적:저자들은 그레이브스병으로 인한 갑상샘기능항진증을 가진 소아나 청소년에게 항갑상샘 약물 치료 전, 치료 중, 그리고 치료 종료 시에 관해를 예측할 수 있는 예측인자를 각각 찾아보고 그레이브스병의 관해율을 알아보고자 하였다. 방 법:그레이브스병으로 인한 갑상샘기능항진증으로 진단받고 3년 이상 외래 추적 관찰이 가능했던 64명의 환자를 관해를 획득한 군과 관해를 획득하지 못한 군으로 나누어 후향적으로 진단 당시의 갑상선 기능 검사와 TBII, 진단 당시 Tanner stage, 갑상샘 질환 가족력, 발현시의 증상, TBII가 정상화되는 시기와 TRH 자극 검사 시행 여부 등을 조사 분석하였다. 결 과:총 64명의 환아 중 관해가 온 환아는 37명(57.8%), 마지막 외래 추적 관찰 때 까지 관해가 오지 않은 환아는 27명(42.2%)이었다. 관해를 획득한 군과 관해를 획득하지 못한 군에서 성별이나, 발병 당시 나이, 안구돌출 여부나 진단 당시 갑상샘종의 크기, 갑상샘 질환의 가족력, 그리고 진단 당시 갑상샘 기능 검사나 TBII 수치도 차이가 없었다. 약물 치료 후 TBII가 정상화되기까지 걸리는 기간은 관해를 획득한 군은 평균 $15.5{\pm}12.07$개월, 관해를 획득하지 못한 군은 $41.69{\pm}35.70$개월로 관해를 획득한 군에서 관해를 획득하지 못한 군에 비해 유의하게 짧았다(P<0.05). 관해에 도달 한 후 TRH 자극 검사를 시행한 28명의 환아 중 정상 또는 과도한 반응을 보인 26명 중 24명(92.8%)은 마지막 외래 추적 관찰 시까지 관해를 유지하고 있었고 오직 2명(7.7%)에서만 재발하였다. 로지스틱 회귀 분석을 통해 약물 치료 후 TBII가 빨리 정상화 되는 경우 관해가 올 가능성이 높음을 알 수 있었다. 그리고 본 연구에서의 관해율은 3년에 6.3%, 6년에 55.8%로 나타났다. 결 론:치료 중 TBII가 빨리 정상화되는 것은 소아 및 청소년 그레이브스병 환자의 관해여부를 예측할 수 있는 인자가 될 수 있을 것으로 생각되며 약물 중단 시에는 TRH 자극 검사가 그레이브스병이 재발 없이 관해를 유지할 수 있는지 예측 하는데 도움을 줄 수 있을 것으로 생각된다.

• 대한핵의학회지
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• 제30권1호
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• pp.77-85
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• 1996

목적 : 그레이브스 갑상선기능항진증 환자에서 개개인마다 유효반감기가 차이가 있기 때문에, 방사성옥소 치료시 용량산출법에서, 고정된 유효반감기를 사용하는 경우에는 환자에 따라 과용량 뿐만아니라, 부족한 용량을 투여하게 되는 문제점이 있다. 저자들은 환자마다 다양하게 나타나는, 유효반감기를 $^{131}I$ 치료의 효과를 결정하는 가능한 한 인자로서 평가하고, 방사성옥소 투여후에 실제 유효반감기를 추정하고, 이를 기준으로 환자에게 실제 흡수된 방사선 흡수선량을 구하고 예정 흡수선량에 도달하기 위해 필요한 조사선량을 추정하기 위해서 본 연구를 시작했다. 대상 및 방법 : 대상은 1995년 4월부터 본원의 갑상선 클리닉을 방문한 환자중 그레이브스병 갑상선기능항진증으로 진단받았으나 항갑상선제를 장기간 복용에도 불구하고 관해를 유도하지 못했던 경우와, 항갑상선제에 대한 부작용으로 복용할 수 없는 환자 및 환자가 수술적 치료를 거부한 12명의 환자를 대상으로 방사성옥소 치료를 실시하였다. 수정된 Quimby-Marrinelli[투여량(MBq)=$absorbed\;dose(100Gy){\times}thyroid\;weight(g){\times}25{\div}T_{1/2}(day){\div}24hr$ $^{131}I$ uptake(%)]공식에 의해서 계산된 용량을 기준으로 방사성옥소를 투여한 후에 24, 48, 72, 96, 120시간당 방사성 옥소의 갑상선흡수율을 구한후 생물학적반감기, 유효반감기, 흡수선량을 구하였다. 결과: 1) 환자들에서 방사성옥소 투여시 실제 생물학적반감기는 9.5일에서 67.2일까지 다양하게 나타났고 평균 $21{\pm}13.0$(S.D.)일 이었다. 유효반감기는 평균 $5.3{\pm}0.88$(S.D.)일 이었으며 4.3일에서 7.1일까지였다. 2) 평균 방사성옥소 투여량은 532MBq(S.D.=${\pm}254$), 이때 실제 흡수선량은 112Gy(S.D.=${\pm}50.9$)였고, 갑상선조직 1그람당 100Gy의 흡수선량의 도달에 필요한량은 평균 583MBq(S.D.=${\pm}385$)였으며 평균 51MBq의 추가 용량투여가 필요하였다. 3) 방사성옥소의 추적자용량과 치료량에서의 갑상선 옥소섭취율의 변화는 t 값이 3.85, p<0.001로서 유의수준 0.01에서 유의한 차가 인정되었다. 4) 갑상선 중량측정에 있어서 갑상선스캔과 초음파사이에 유의한 차이를 보이지 않았다. 5) 유효반감기, 갑상선중량, 치료전과 치료후의 방사성옥소섭취율은, 40세 이전과 40세 이후의 양군에 있어서 유의한 차이를 보이지 않았다. 결론 : 그레이브스병 환자의 방사성옥소 치료시 용량결정 방법에서 실제 유효반감기를 이용한 방법은, 치료자가 목표로 한 흡수선량을 환자들에게 되도록 정확하게 투여하여, 방사성옥소 투여 후 잦은 빈도로 발생하는 갑상선기능저하증과, 치료실패의 빈도를 줄일 수 있을 것으로 생각한다.

• Clinical and Experimental Pediatrics
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• 제46권1호
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• pp.76-82
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• 2003

목 적 : 소아 Graves병의 진단 시 발병 연령에 따른 갑상선 기능, 임상 양상, 갑상선 항체가 및 치료 기간 등이 어떻게 다른지 알아보고자 본 연구를 시도하였다. 방 법 : 1989년 1월 1일부터 1995년 12월 31일까지 7년간 가톨릭대학교 의과대학 성모병원과 강남성모병원 소아과에서 Graves병으로 진단 받고 3년 이상 추적관찰이 가능하였던 환아 52명을 대상으로 Tanner의 성 성숙도를 기준으로 사춘기 이전에 발병한 군(사춘기전군)과 사춘기 시작 후 발병한 군(사춘기군)으로 나누어 갑상선 기능상태, 갑상선 항체, TSH 수용체 항체, 치료 후 갑상선 기능검사치가 정상화되는 시기 및 치료 기간 등을 조사하였다. 결 과 : 1) 전체 52명 중 남녀간의 성비는 1 : 12로 주로 여아에서 발병하였다. 2) 사춘기전군은 14명(남아 2명), 사춘기군은 38명(남아 2명)으로 각각 평균연령은 $7.2{\pm}0.9$세, $12.4{\pm}1.5$세이었다. 3) 치료 전 사춘기전군과 사춘기군에서 $T_3$는 $3.98{\pm}1.70$과 $3.82{\pm}1.63ng/mL$, $T_4$는 $17.49{\pm}5.56$과 $19.23{\pm}6.01{\mu}g/dL$, TSH는 $0.07{\pm}0.11$과 $0.07{\pm}0.24mIU/L$ 등으로 서로 유의한 차이가 없었다. 4) 치료 전 사춘기전군과 사춘기군에서 AMA 양성률은 85%와 89%이었고, 평균 항체가는 사춘기군이 사춘기전군보다 유의하게 높았다(P<0.01). ATA 양성율은 각각 57.1%와 72.2%였으나 평균 항체가의 차이는 없었으며 TBII의 양성율은 각각 92.9%와 84.2%였고 평균 항체가는 사춘기전군에서 사춘기군보다 유의하게 높았다(P<0.05). 5) 치료 후 사춘기전군과 사춘기군에서 $T_3$, $T_4$, TSH, TBII가 정상화되는 소요되는 기간은 $T_3$는 각각 $6.8{\pm}5.0$과 $5.4{\pm}13.2$개월, $T_4$는 각각 $2.3{\pm}1.9$와 $2.1{\pm}2.2$개월, TSH는 각각 $14.6{\pm}11.0$과 $6.8{\pm}7.8$개월, TBII는 각각 $26.7{\pm}24.0$과 $20.8{\pm}12.1$개월로 사춘기전군에서 TSH가 정상화되는 기간이 사춘기군보다 더 길었다(P<0.05). 두 군 모두 $T_4$, $T_3$, TSH, TBII 순으로 정상화되었다. 6) 치료 기간은 사춘기전군($53.3{\pm}19.3$개월)이 사춘기군($37.9{\pm}16.3$개월)보다 유의하게 길었다(P<0.01). 7) 약물 치료 3년 동안 관해는 사춘기전군에서 8례(57.1%), 사춘기군에서 26례(68.4%)였고 재발율은 각각 6례(75%) 및 17례(65.3%)였다. 8) Graves병의 진단 시 연령과 치료 기간 사이에는 역상관관계가 있었다(P=0.03). 결 론 : 소아에서 사춘기 이전에 발병하는 Graves병은 사춘기 이후에 발병하는 경우보다 항갑상선제 치료기간이 더 필요하다는 사실을 알 수 있었으며 앞으로 더 많은 환자를 대상으로 장기간의 연구가 필요하다고 생각된다.