• Annals of Occupational and Environmental Medicine
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• v.35
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• pp.14.1-14.10
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• 2023

Background: Shift work is known to cause changes in the circadian rhythm of the human body and adversely affect not only physical health but also mental health. Some studies have demonstrated the correlation between shift work and thyroid stimulating hormone (TSH), a hormone that changes according to the diurnal rhythm, but few studies have reported the different TSH levels according to the shift work type. This study aimed to investigate changes in TSH according to the shift work type. Methods: This study included 1,318 female workers who had a medical checkup at a university hospital in Changwon from 2015 to 2019. Shift work types were classified as non-shift work, regular 2 shifts, and irregular three shifts, and a TSH ≥ 4.2 mIU/L was defined as abnormal. A general linear model (GLM) was used to compare the TSH levels and the risk of subclinical hypothyroidism in each year, and a binary logistic analysis was performed using a generalized estimation equation (GEE) to compare the risk of subclinical hypothyroidism over the 5-year period. Results: Of the 1,318 participants included in this study, 363, 711, and 244 were non-shift, two-shift, and irregular three-shift workers, respectively. In the GEE analysis, after adjusting for age, body mass index, smoking, and alcohol consumption, the odds ratios (ORs) were 1.81 (95% confidence interval [CI]: 1.15-2.86; p = 0.011) in 2 shifts and 2.02 (95% CI: 1.23-3.32; p = 0.006) in irregular three shifts, compared to non-shift. Conclusions: Our results showed that shift work had a higher risk of subclinical hypothyroidism than non-shift work and that there was a significant difference in the risk of subclinical hypothyroidism according to the shift work type. These findings suggest that the shift work type can be considered in future thyroid function tests and evaluations.

• The Korean Journal of Nuclear Medicine
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• v.28 no.3
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• pp.343-349
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• 1994

The study was taken to analyze the laboratory findings of the 161 patients with autoimmune thyroiditis treated at Kyungpook University Hospital from January 1992 to July 1993. They were all female and mean age was 33 years ranging from 10 to 73 years. Mean radioactive iodine uptake(RAIU) of the thyroid was $30.90{\pm}21.80(mean{\pm}SD)%$ at 6 hours and $37.97{\pm}23.25%$ at 24 hours. Mean serum levels of thyroid hormones were $1.41{\pm}0.48$(ng/ml) of T3, $7.26{\pm}3.23$(ug/dl) of T4, and $1.11{\pm}0.66$(ng/dl) of free T4, while mean serum level of TSH was $17.99{\pm}30.72$(uIU/ml). Mean levels of serum autoantibodies were 24. $43{\pm}31.91$(U/ml) of antithyroglobulin antibody and $55.32{\pm}41.97$(U/ml) of antimicrosomal antibody. The correlation between RAIU and serum thyroid hormone levels was significantly negative, but the positive correlation between RAIU and serum TSH was noted. The correlation between thyroid hormones and TSH was significantly negative, but the positive correlation between RAIU and serum TSH was noted. The correlation between thyroid hormones and TSH was significantly negative, while antimicrosomal antibody titer revealed significantly positive correlation with TSH. The RAIU and free T4 showed negatively correlated with the increasing age. The Initial clinical findings of the patients with autoimmune thyroiditis revealed euthyroidism in 83.2%, hypothyroidism in 14.9%, and hyperthyroidism in 1.9%. The incidence of abnormally increased serum thyroglobulin, antithyroglobulin antibody, and antimicrosomal antibody were 21.3%, 97.5%, and 87.6%, respectively and these abnormalities were more frequent in the patients with documented clinical thyroid functional disturbances.

• Clinics in Shoulder and Elbow
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• v.21 no.2
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• pp.82-86
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• 2018

Background: Although a common shoulder disease, there are no accepted classification criteria for frozen shoulder (FS). This study therefore aimed to evaluate the accuracy of the conventionally used FS classification system. Methods: Primary FS patients (n=168) who visited our clinic from January 2010 to July 2015 were included in the study. After confirming restrictions of the glenohumeral joint motion and absence of history of systemic disease, trauma, shoulder surgery, shoulder muscle weakness, or specific x-ray abnormalities, the Zuckerman and Rokito's classification was employed for diagnosing primary FS. Following clinical diagnosis, each patient underwent a shoulder magnetic resonance imaging (MRI) and blood tests (lipid profile, glucose, hemoglobin A1c, and thyroid function). Based on the results of the blood tests and MRIs, the patients were reclassified, using the criteria proposed by Zuckerman and Rokito. Results: New diagnoses were ascertained including blood test results (16 patients with diabetes, 43 with thyroid abnormalities, and 149 with dyslipidemia), and MRI revealed intra-articular lesions in 81 patients (48.2%). After re-categorization based on the above findings, only 5 patients (3.0%) were classified having primary FS. The remaining 163 patients (97.0%) had either undiagnosed systemic or intrinsic abnormalities (89 patients), whereas 74 patients had both. Conclusions: These findings demonstrate that most patients clinically diagnosed with primary FS had undiagnosed systemic abnormalities and/or intra-articular pathologies. Therefore, a modification of the Zuckerman and Rokito's classification system for FS may be required to include the frequent combinations, rather than having a separate representation of systemic abnormalities and intrinsic causes.

• Radiation Oncology Journal
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• v.15 no.3
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• pp.225-231
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• 1997

Purpose : Radiation therapy in combination with surgery has an important role in the therapy of the head and neck cancer We conducted a prospective study for patients with head and neck cancer treated with surgery and radiation to evaluate the effect of therapies on the thyroid gland, and to identify the factors that might influence the development of hypothyroidism. Materials and Methods : From September 1986 through December 1994, 71 patients with head and cancer treated with surgery and radiation were included in this prospective study. Patients' age ranged from 32 to 73 years with a median age of 58 years. There were 12 women and 59 men. The primary tumor sites were larynx in 34 patients, hypopharynx in 13 patients, oral cavity in 12 patients, unknown primary of the neck in 6 patients, salivary gland in 3 patients, maxillary sinus in 2 patients, and oropharynx in 1 patient. Total laryngectomy with neck dissection was carried out in 45 patients and neck dissection alone in 26 patients. All patients were serially monitored for thyroid function (T3, T4, free T4, TSH, antithyroglobulin antibody and antimicrosomal antibody) before and after radiation therapy. Radiation dose to the thyroid gland ranged from 40.6Gy to 60Gy with a median dose of 50Gy The follow-up duration was 3 to 80 months. Results :The overall incidence of hypothyroidism was 56.3\%$);7 out of 71 patients $(9.9\%)$ developed clinical hypothyroidism and 33 patients $(46.4\%)$ developed subclinical hypothyroidism. No thyroid nodules, thyroid cancers, or hyperthyroidism was detected. Hypothyroidism developed earlier in patients who underwent total laryngectomy with neck dissection than in patients with neck dissection alone (P<0.05). The risk factor that significantly influenced the incidence of hypothyroidism was a combination of surgery (total laryngectomy with neck dissection) and radiation therapy (P=0.0000), Four of 26 patients $(15.4\%)$ with neck dissection alone developed hypothyroidism while 36 of 45 patients $(80\%)$ with laryngectomy and neck dissection developed hypothyroidism. Conclusion : The hypothyroidism following surgery and radiation therapy was a relatively common complication. The factor that significantly influenced theincidence of hypothyroidism was combination of surgery and radiation therapy. Evaluation of thyroid function before and after radiation therapy with periodic thyroid function tests is recommended for an early detection of hypothyroidism and thyroid hormone replacement therapy is recommended whenever hypothyroidism develops.

• The Korean Journal of Nuclear Medicine
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• v.9 no.2
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• pp.13-22
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• 1975

The purpose of the present study is to evaluate the diagnostic value of the ETR test as compared to other thyroid function tests in normal persons, patients with thyroid disorders and patients with alterations of thyroxine-binding proteins. The ETR values were obtained from 35 cases as normal control, 63 hyperthyroid patients, 56 euthyroid patients, 23 hypothyroid patients, 10 pregnant women, 5 women taking oral contraceptive medication, 8 liver cirrhosis patients and 4 nephrotic syndrome patients. The results obtained were as follows. 1. The mean value of ETR obtained from the normal controls was $0.99{\pm}0.06$. 2. The mean ETR values of various thyroid states were $1.25{\pm}0.16$ in hyperthyroidism, $0.99{\pm}0.08$ in euthyroidism and $0.82{\pm}0.05$ in hypothyroidism and significant difference was found between these groups. 3. Seven out of 63 hyperthyroid patients(11.1%) and 2 out of 23 hypothyroid patients(8.7%) had ETR values within normal range and among the 56 euthyroid patients 6(10.7%) had ETR values outside normal range, so the diagnostic compatibility of ETR was 89.4% in thyroid diseases. 4. Even though the ETR value was well correlated with $^{131}I$-thyroid uptake rate, serum $T_3$ resin uptake rate and serum $T_4$, a high positive correlation was found (r=0.79) between ETR and $T_7$. 5. The mean ETR values from patients with alteration in TBG binding capacity were $0.99{\pm}0.05$ in pregnant women, $0.98{\pm}0.04$ in women with oral contraceptive medication, $1.04{\pm}0.09$ in liver cirrhosis patients and $0.94{\pm}0.02$ in nephrotic syndrome patients and most of them (85.2%) had ETR values within normal range. Our results, therefore, suggests that the ETR estimation does offer the simplest and most reliable single procedure for the screening and diagnosis of various thyroid diseases as a indirect indicator of serum-free thyroxine concentration without essential influence of changes in the thyroxine-binding proteins in serum.

• Tuberculosis and Respiratory Diseases
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• v.62 no.5
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• pp.417-420
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• 2007

Sarcoidosis is a multisystemic granulomatous disease with an of unknown etiology, involving bilateral hilar lymphadenopathy, pulmonary, skin and eye lesions. However, involvement of the endocrine system in sarcoidosis is quite rare, and the coexistence of both diseases is extremely unusual. We describe a 60-year-old woman presenting with sarcoidosis and Graves' disease. She was admitted for evaluation of dry cough, dyspnea, palpitation and general weakness. Both thyroid glands were enlarged diffusely. The thyroid function tests showed suppressed serum thyrotropin and an increased thyroid hormone level. The levels of the TSH receptor antibody, anti-thyroglobulin antibody and anti-microsomal antibody were higher than normal. The radionuclide scan($^{131}I$) showed increased iodine uptake. The chest X-ray revealed pulmonary hilar enlargement and high resolution CT showed both hilar lymph nodes enlargement and tiny parenchymal nodules. The transbronchial lung biopsy showed a noncaseating granuloma without necrosis. We report this case of pulmonary sarcoidosis plus Graves' disease with a review of the relevant literatures.

• Annals of Pediatric Endocrinology and Metabolism
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• v.23 no.4
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• pp.235-239
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• 2018

Most cases of congenital hyperthyroidism are autoimmune forms caused by maternal thyroid stimulating antibodies. Nonautoimmune forms of congenital hyperthyroidism caused by activating mutations of the thyrotropin receptor (TSHR) gene are rare. A woman gave birth to a boy during an emergency cesarean section at 33 weeks of gestation due to fetal tachycardia. On the 24th day of life, thyroid function tests were performed due to persistent tachycardia, and hyperthyroidism was confirmed. Auto-antibodies to TSHR, thyroid peroxidase, and thyroglobulin were not found. The patient was treated with propylthiouracil and propranolol, but hyperthyroidism was not well controlled. At 3 months of age, the patient had craniosynostosis and hydrocephalus, and underwent a ventriculoperitoneal shunt operation. Direct sequencing of the TSHR gene showed a heterozygous mutation of c.1899C>A (p.Asp633Glu) in exon 10. No mutations were discovered in any of the parents in a familial genetic study. We have reported a case of sporadic nonautoimmune congenital hyperthyroidism, by a missense mutation of the TSHR gene, for the first time in South Korea.

• The Journal of Internal Korean Medicine
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• v.44 no.2
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• pp.277-284
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• 2023

Objective: This study investigated the effects of Guibiondam-tang-gamibang on patients in the thyrotoxic phase of painless thyroiditis. Methods: A patient in the thyrotoxic phase of painless thyroiditis was treated with Guibiondam-tang-gamibang combined with Western medicine (i.e., beta blockers). The effect of treatment was evaluated according to the pulse rate, NRS, the frequency of subjective symptoms, and sleep time. In addition, the thyroid function was evaluated with TSH, Free T4, and T3 using blood tests. Results: After treatment, the pulse rate decreased, and the NRS and frequency of subjective symptoms disappeared after improvement. Sleep time increased. In the thyroid function test, a significant normalization of each value was observed. Conclusion: This study suggests that Guibiondam-tang-gamibang can be effectively treated in patients with painless thyroiditis in the thyrotoxic phase. However, further studies should be conducted.

• The Journal of Internal Korean Medicine
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• v.29 no.4
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• pp.1000-1010
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• 2008

Objective : Hypothyroidism is a syndrome characterized by symptoms such as cold intolerance, or weight gain. Because of side effects of Western medicine treatment, interest in oriental medicine has been increasing. In this study, we examined the therapeutic effects of Evodiae fructus and histological modification in hypothyroidism rat model induced by PTU(6-propyl, 2-thiouracil). Methods : After inducing hypothyroidism in the rats by PTU injections, we divided the rats into four groups, the Evodiae fructus 100 500, control, and $LT_4$ (levothyroxine) groups. After 2 weeks Evodiae fructus and $LT_4$ were administered, respectively. The weight was measured once a week. After sampling the blood for biochemical analysis to check the levels of $T_3$, $T_4$ and TSH, the thyroid tissue was removed, stained with H&E, and an image was obtained using an optical microscope. Results : Compared with normals, controls showed low $T_4$ and high TSH. The Evodiae fructus group showed a statistically meaningful $T_3$ increase to be dose related. But the levels of TSH showed no meaningful difference between the Evodiae fructus group and normals. About the biochemical tests(liver, kidney etc) and weight change, there was no meaningful difference between the Evodiae fructus group and controls. In the biopsy, the Evodiae fructus group showed thyroid tissue improvement compared to controls. Conclusions : These results show that Evodiae fructus stimulates the decreased functions of the thyroid, and also has thyroid cell protecting effects. The lab results also showed that Evodiae fructus is a safe substance that doesn't cause hepatotoxicity or nephrotoxicity. Therefore it is an effective substance in the treatment of hypothyroidism.

• Clinical and Experimental Pediatrics
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• v.58 no.2
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• pp.73-76
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• 2015

Isolated sphenoid sinusitis is a rare disease in children, and its symptoms are often nonspecific and confusing. Rarely, severe headache can be the first or only symptom of isolated sphenoid sinusitis. New daily persistent headache (NDPH) is a form of chronic daily headache that may have features of both migraines and tension-type headaches. NDPH is difficult to diagnose and requires a multifaceted approach. Here, we report on a 10-year-old boy and an 11-year-old girl who both presented with typical NDPH symptoms. These patients had no nasal symptoms or signs of infection. Neither nonsteroidal anti-inflammatory drugs nor topiramate had any effect on the headaches. Their neurological and ophthalmological examinations were normal. The results of routine blood work, including thyroid function tests, inflammatory markers, complete blood count, tests for viral infection, and a metabolic panel, were normal. A brain magnetic resonance imaging scan showed isolated sphenoid sinusitis. Both patients' symptoms resolved completely after approximately 1 month of oral antibiotics for sinusitis.