• Journal of Yeungnam Medical Science
• /
• 제28권2호
• /
• pp.206-210
• /
• 2011

The occurrence of a mixed tumor containing papillary thyroid carcinoma (PTC) and primary squamous-cell carcinoma (SCC) is rare because there is no squamous epithelium in the thyroid gland. Reported herein is a 30-year-old female with mixed PTC and primary sec of the thyroid presented as thyroid incidentaloma. Fine-needle aspiration biopsy of the thyroid nodule revealed the presence of malignant thyroid cells. The histopathological examination following total thyroidectomy yielded two mixed, morphologically distinct histotypes that included PTC and sec. After total thyroidectomy, the patient underwent radioactive iodine therapy. No recurrence or metastasis occurred during the 20-month follow-up period after the operation.

• International journal of thyroidology
• /
• 제11권2호
• /
• pp.137-142
• /
• 2018

Background and Objectives: Radioactive iodine therapy (RAI) is an important treatment modality of Graves' disease (GD), but there is still not a consensus on the optimal dosage regimen. We studied the treatment success rate of different RAI doses, and examined which clinical markers were useful for determining the optimal RAI dosage for successful therapy in Korean patients. Materials and Methods: We retrospectively studied 123 patients with GD treated with RAI between 2004 and 2014 at Chonnam National University Hwasun Hospital. The responder group was defined as patients who developed hypothyroidism requiring levothyroxine replacement following RAI, regardless of the RAI dosage. Results: A total of 54 patients (43.9%) became hypothyroid after the first dose, and 31 needed two to four additional doses to achieve hypothyroidism. In the responder group as a whole (85 patients), the mean total dose of RAI was $15.5{\pm}7.0mCi$ and the mean thyroid volume (TV) was $35.4{\pm}23.4mL$. When divided into low dose (<15 mCi, n=46) and high dose (${\geq}15mCi$, n=39) responder groups, TV was significantly lower in the low-dose responder group ($25.7{\pm}11.4$ vs. $48.4{\pm}31.3$, p<0.001). The optimal cut-off TV for the low-dose responder group was <32.37 mL (sensitivity 80.9%, specificity 76.7%). Conclusion: TV had significant effects on the outcome of RAI in GD patients. The optimal fixed RAI dose for Korean GD patients with a large goiter (${\geq}33mL$) should be at least 15 mCi to achieve the best outcome.

• 대한두경부종양학회지
• /
• 제23권1호
• /
• pp.50-53
• /
• 2007

Adrenal metastasis from papillary thyroid carcinoma is extremely rare. We present herein a patient with adrenal metastases from recurrent papillary carcinoma of the thyroid. A 54 year-old woman had received a total thyroidectomy and postoperative radioactive iodine therapy for locally advanced papillary thyroid carcinoma. One year after initial surgery, distant metastases to multiple organs including right cervical lymph nodes, left upper lung, left 2nd and 3rd ribs, 2nd thoracic vertebra and left adrenal gland were found by 18-FDG-PET-CT whole body scan. She underwent right modified neck dissection, partial resection of left 2nd and 3rd ribs, posterior arch of 2nd thoracic vertebra, left upper lobectomy of lung, and left adrenalectomy. On histologic examination, metastases to the left adrenal gland and cervical lymph nodes were papillary thyroid carcinomas, while other metastatic sites turned out to be anaplastic thyroid carcinomas. Despite aggressive surgery and postoperative adjuvant therapy, her general clinical conditions were getting worse day by day due to regrowing of the anaplastic thyroid carcinomas. To our knowledge, this is the first case reported in Korea.

• 대한방사선기술학회지:방사선기술과학
• /
• 제39권4호
• /
• pp.565-570
• /
• 2016

방사성 요오드($^{131}I$) 치료는 분화성 갑상선암 환자에서 재발을 감소시키고 생존률을 증가시키나, 환자에서 방출되는 방사능으로 인하여 피폭을 야기시킬 수 있으므로 환자로부터 발생되는 방사선량률을 측정하는 것이 방사선안전관리 측면에서 중요하다. 방사성 요오드($^{131}I$) 치료시 널리 사용되는 측정기 중 전리함과 GM계수관으로 측정된 방사선량률의 감도와 측정효율을 구하였다. 방사성 요오드($^{131}I$)를 150mCi 경구투여 받은 분화성 갑상선암 환자의 상복부로부터 1 m거리에서 경과 시간에 따라 방사선량률을 측정하였다. 시간에 따른 변화를 직접적으로 비교한 결과, 고선량률에서의 감도와 측정효율은 GM계수관보다 전리함이 높게 나타났고, 통계적으로 유의하였다(p<0.05). 저선량률에서의 감도와 측정효율은 GM계수관보다 전리함이 낮게 나타났지만 통계적으로 유의한 차이를 나타내지 않았다(p>0.05). 방사성 요오드($^{131}I$) 치료시에 검 교정이 완료된 전리함과 GM계수관으로 정확하고 신속한 방사선량률을 측정하여 환자에게 설명함으로써 방사성 요오드 치료 후 퇴원하는 환자에게 환자가족 또는 주변 사람들에게 미칠 수 있는 방사선피폭을 예측하고, 불필요한 예단을 줄여줄 수 있을 것이다.

• 대한핵의학회지
• /
• 제16권2호
• /
• pp.1-24
• /
• 1982

Several recent advances in our knowledge of thyroid physiology have broad application to the diagnosis and management of thyroid disorders. For in the thyroid, more than other endocrine organs, pathophysiology can be translated directly into the diagnosis and management of thyroid disease. Graves' disease is a syndrome including goiter with hyperthyroidism, exophthalmos and dermopathy. The pathogenesis of Graves' disease is not yet clearly identified, but various autoantibodies to the thyroid gland and immunopathologic studies indicate that autoimmune processes are involved in the pathogenesis of the disease. The diagnosis and management of Graves' disease are largely dependent on radionuclide techniques as radioimmunoassay, radioactive iodine therapy and so on. Several laboratory tests are also developed to determine the remission of this disase including TRH stimulation test, $T_3$ suppression test and detection of thyroid stimulating immunoglobulins. Autoimmune thyroiditis is almost certainly a primary immunologic disease and the incidence tends to increase recently, mainly due to the application of biopsy technique in thyroid diseases. Thyroid nodules have been a great challenge to physicians because of the possibility of malignancy. But recently, cytologic examination of thyroid aspirate provides a very simple and also reliable diagnostic method in patients with thyroid nodules. In 163 patients with thyroid nodules, only 19.3% was revealed to be malignant. Therefore cytologic examination of thyroid aspirate and thyroid biopsy should be included in the diagnosis of nodular patients prior to surgical intervention. In this paper, a comprehensive review is presented on the pathogenesis, clinical features, laboratory findings and therapeutic modalities of various thyroid diseases on the basis of over 80 researches performed during the past 20 years at radioisotope clinic, Seoul National University Hospital.

• 대한핵의학회지
• /
• 제38권3호
• /
• pp.272-273
• /
• 2004

We experienced a case with meningioma showing false positive I-131 uptake. A 55-years old female patient underwent high dose (150 mCi) radioactive iodine therapy to ablate remnant tissue after total thyroidectomy for papillary thyroid cancer. in addition to intense tracer uptake in thyroid bed, there was mild but focal abnormal uptake in left frontal lobe of the brain on post-therapy I-131 whole body scan. Subsequent brain MR imaging showed single mass lesion in left frontal lobe and the mass was resected under the impression of brain metastasis of thyroid carcinoma. Pathologic report confirmed meningioma from the surgical specimen.

• Journal of Yeungnam Medical Science
• /
• 제40권1호
• /
• pp.12-22
• /
• 2023

Graves disease (GD) is the most common cause of hyperthyroidism, accounting for more than 90% of cases in Korea. Patients with GD are treated with any of the following: antithyroid drugs (ATDs), radioactive iodine (RAI) therapy, or thyroidectomy. Most patients begin treatment with ATDs, and clinical guidelines suggest that the appropriate treatment period is 12 to 18 months. While RAI treatment and surgery manage thyrotoxicosis by destroying or removing thyroid tissue, ATDs control thyrotoxicosis by inhibiting thyroid hormone synthesis and preserving the thyroid gland. Although ATDs efficiently control thyrotoxicosis symptoms, they do not correct the main etiology of GD; therefore, frequent relapses can follow. Recently, a large amount of data has been collected on long-term ATDs for GD, and low-dose methimazole (MMZ) is expected to be a good option for remission. For the long-term management of recurrent GD, it is important to induce remission by evaluating the patient's drug response, stopping ATDs at an appropriate time, and actively switching to surgery or RAI therapy, if indicated. Continuing drug treatment for an extended time is now encouraged in patients with a high possibility of remission with low-dose MMZ. It is also important to pay attention to the quality of life of the patients. This review aimed to summarize the appropriate treatment methods and timing of treatment transition in patients who relapsed several times while receiving treatment for GD.

• International journal of thyroidology
• /
• 제11권2호
• /
• pp.78-81
• /
• 2018

Lenvatinib, an oral multi-kinase inhibitor, is a valuable treatment option for advanced differentiated thyroid carcinoma. However, severe treatment-related adverse events occur up to 30% of the patients receiving lenvatinib, making it a challenge for clinicians to maintain this drug and therefore affecting the outcome of therapy. Blood vessel related events, such as hypertension or proteinuria, are among the most frequent adverse events. We present a case of 65-year-old man with radioactive iodine refractory papillary thyroid carcinoma with cervical lymph node metastasis and tracheal invasion receiving lenvatinib who developed proteinuria and worsening of hypertension. Management with repeated dose reductions and using supportive medications allowed this patient to continue lenvatinib with his disease stably controlled. Early detection of patients at risk for these adverse events and cautious administration of lenvatinib at appropriate level are crucial in managing patients receiving lenvatinib.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권4호
• /
• pp.1859-1862
• /
• 2014

Recently, the main therapy of medullary thyroid cancer (MTC) is surgical, but by which way there is a poor prognosis with a mean survival of only 5 years. In some cases, some researchers found that it is the medullary thyroid cancer stem cells (MTCSCs) that cause metastasis and recurrence. This study aimed to eradicate MTCSCs through administration of all-trans-retinoic acid (ATRA). Here we demonstrate that MTCSCs possess stemlike properties in serum-free medium. The ABCG2, OCT4 and sodium iodide symporter (NIS) were changed by ATRA. Additionally, we found that ATRA can increase the expression of NIS in vivo. All the data suggested that ATRA could increase the iodine uptake of MTCSCs through NIS.

• 대한핵의학회지
• /
• 제29권3호
• /
• pp.343-349
• /
• 1995

배경 : 방사선 외부 피폭에 대한 생물학적 선량측정방법에는 혈액학적 지표인 림프구 변화와 세포유전학적 지표인 염색체 분석을 통한 Ydr값이 가장 많이 사용되고 있다. 방사성 옥소 투여시와 같은 방사선 내부 피폭에 대해서는 생물학적 선량측정 방법에 대한 연구가 미흡하여 피폭정도는 물론 방사성 옥소 투여용량을 반영할 수 있는지의 여부도 알려져 있지 못하다. 목적 : 갑상선 질환자에게 방사성 옥소 투여후 림프구 변화와 Ydr값을 추적관찰하여 이들을 방사선 내부 피폭에 대한 지표로 이용할 수 있는지 알아보고자 하였다. 방법 : 갑상선 기능항진증 5명과 갑상선암 수술을 받은 35명의 환자를 대상으로 방사성 옥소 투여후 말초혈액 림프구 수를 2개원이상 추적검사 하였고, 림프구의 염색체 분석을 통해 Ydr값을 구했다. 결과: 1) 림프구 수는 방사성 옥소 투여 2주후 부터 감소되기 시작하여 6주와 8주후에 최대로 감소된후 점차 회복되었다. 2) 방사성 옥소량이 증가할 수록 림프구 수는 감소했다 (P<0.01) 3) Ydr값은 2주-8주 사이에는 대체로 일정하였다. 4) 방사성옥소 투여량에 따른 최대 Ydr값의 변화는 유의한 상관관계를 보였다 (p<0.00) 5) 2주째 Ydr값은 방사성옥소 투여량이 증가할 수록 증가하였다 (p<0.00) 6) 2주째 Ydr값은 2주째 림프구 수의 감소정도와 비례관계를 보였다 (p<0.00) 결론: 1) 방사성 옥소의 통상적 치료용량은 일시적 골수부전과 경도의 염색체이상을 초래하므로 8주 이상의 면밀한 추적관찰이 요구된다. 2) 생물학적 선량측정 방법으로서의 최대 림프구 감소치와 2주째 Ydr값과 최대 Ydr값은 방사성옥소 투여용량을 반영하는 지표로 사용할 수 있다.