For the distant metastasis of differentiated thyroid cancers, such as papillary thyroid carcinoma, follicular thyroid carcinoma, and Hurthle cell carcinoma, radioiodine therapy is one of the standard treatment methods after total thyroidectomy. Radioiodine is accumulated in thyroid cells and thyroid cancer cells through sodium iodide symporter which is located in the membrane of cells. This molecular target specific therapy renders a better prognosis and less adverse effects. Radioiodine 131I emits gamma ray for imaging and beta ray for treatment at the same time, we can monitor patients' specific distribution of radioiodine, which let us know unexpected metastasis lesions or differentiated status of thyroid cancer cells. In this article, I reviewed practical points of view about radioiodine therapy for distant metastasis of thyroid cancers such as methods for administration of radioiodine, patients' preparation before radioiodine treatment, follow up of patients, adverse effects, and radiation safety issues.
Adenocarcinoma, Follicular ; Beta Particles ; Carcinoma ; Enzyme Multiplied Immunoassay Technique ; Follow-Up Studies ; Gamma Rays ; Humans ; Ion Transport ; Linear Energy Transfer ; Membranes ; Neoplasm Metastasis ; Organothiophosphorus Compounds ; Prognosis ; Sodium Iodide ; Symporters ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

Radioiodine (RI) therapy is one of the key factors for the good prognosis of differentiated thyroid cancers. Currently, most of RI treatments are performed with predetermined fixed dose of RI, whereas strict dose adjustment is made in chemotherapy or external radiotherapy for cancer treatment. Although fixed dose methods have been practically effective in RI therapy hitherto, dose determination with individual radiation dosimetry is theoretically superior to use of empirical fixed dose, for maximization of treatment effect and minimization of adverse events. The theoretical superiority of dosimetry-based dose determination is not yet directly supported by clinical data of real world; however, indirect results support the use of dosimetry-based dose determination in several specific patient groups. In this review, the basis of dosimetry is briefly discussed with regard to necessity and practical methods. Additionally, the efficacy of dosimetry is also discussed through the data of clinical studies so far.
Humans ; Prognosis ; Radiometry ; Thyroid Gland ; Thyroid Neoplasms

Empiric fixed dose approach is commonly adopted in the radioiodine therapy (RIT) for thyroid cancer, and considered to be a reasonably safe, simple, and easy practice. Recent clinical guidelines and articles suggested that RIT should be more selectively applied, based on risk stratification and individual treatment. However, there was no specific dose of RIT for each risk group. Application of empiric fixed dose can be needed, based on the guidelines, to improve therapeutic prognosis and radiation safety in the selected patients. In Korea, for the low risk group according to some prognostic factors, such as histology and genetic mutation, RIT can be selected, preferably using higher dose. To minimize any side effects, on the other hand, radioiodine dose can be decreased and optimized for patient's body weight, age, and kidney function. For the advanced thyroid cancer, higher fixed dose of radioiodine could be administered to improve survival and to reduce recurrence.
Body Weight ; Hand ; Humans ; Kidney ; Korea ; Prognosis ; Recurrence ; Thyroid Neoplasms

Radionuclide therapies have been applied in the diverse fields of medicine, and it has been demonstrated the usefulness of it, especially in the field of oncology. Accurate dosimetric assessment is imperative during radionuclide therapy, in order to optimize the treatment efficacy for target sites and to minimize the radiation exposure for normal organ. Recent advancement in imaging technology permits the precise determination of the absorbed dose non-invasively. This imaging based dosimetry can be routinely applicable to the bedside in the near future.
Treatment Outcome

No abstract available.
Humans ; Thyroid Gland

No abstract available.
Consensus ; Hyperthyroidism ; Thyroid Gland

OBJECTIVES: Many epidemiological studies have suggested that a variety of medical illnesses are associated with suicide. Investigating the time-varying pattern of medical care utilization prior to death in suicides motivated by physical illnesses would be helpful for developing suicide prevention programs for patients with physical illnesses. METHODS: Suicides motivated by physical illnesses were identified by the investigator's note from the National Police Agency, which was linked to the data from the Health Insurance Review and Assessment. We investigated the time-varying patterns of medical care utilization during 1 year prior to suicide using repeated-measures data analysis after adjustment for age, gender, area of residence, and socioeconomic status. RESULTS: Among 1994 suicides for physical illness, 1893 (94.9%) suicides contacted any medical care services and 445 (22.3%) suicides contacted mental health care during 1 year prior to suicide. The number of medical care visits and individual medical expenditures increased as the date of suicide approached (p<0.001). The number of medical care visits for psychiatric disorders prior to suicide significantly increased only in 40- to 64-year-old men (p=0.002), women <40 years old (p=0.011) and women 40 to 64 years old (p=0.021) after adjustment for residence, socioeconomic status, and morbidity. CONCLUSIONS: Most of the suicides motivated by physical illnesses contacted medical care during 1 year prior to suicide, but many of them did not undergo psychiatric evaluation. This underscores the need for programs to provide psychosocial support to patients with physical illnesses.
Adult ; Age Factors ; Aged ; Demography ; Fees, Medical ; Female ; Health Services Needs and Demand/*statistics & numerical data/utilization ; Humans ; Male ; Mental Disorders/psychology ; Mental Health/statistics & numerical data ; Middle Aged ; Motivation ; Sex Factors ; Socioeconomic Factors ; Suicide/economics/prevention & control/*statistics & numerical data ; Time Factors

OBJECTIVES: Cigarette smoking prevalence among adolescent males in rural areas of Korea has increased in recent years. The aim of this study was to explore the factors related to increasing trends in cigarette smoking among adolescent males living in rural areas. METHODS: The raw data from the Korea Youth Risk Behavior Web-based Survey from 2006 to 2009 were used. Data were analyzed by using the method of complex survey data analysis considering complex sampling design. Multiple logistic regression models were used to explore the factors affecting cigarette smoking. We evaluated the linear time trends in the prevalence of factors that were related to current smoking status and the linear time trends in cigarette smoking in groups stratified by the exposure to each factor using logistic regression models. Finally, we examined the contributions of the factors to the time trends in cigarette smoking by adjusting for each of those factors in the baseline regression models and changes in the adjusted odds ratio by survey year. RESULTS: A statistically significant increasing trend in smoking was observed after adjusting for the factors affecting cigarette smoking. Significant factors related to cigarette use were perceived stress, experience with depression, current alcohol drinking, exposure to secondhand smoke, and academic performance. The factor related to increasing trends in cigarette smoking was academic performance. CONCLUSIONS: Stress about academic performance is an important factor affecting the increase in cigarette smoking among adolescent males in a rural area of Korea.
Adolescent ; Adolescent Behavior ; Adolescent Psychology ; Alcohol Drinking ; Depression ; Humans ; Internet ; Logistic Models ; Male ; Odds Ratio ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors ; Rural Population ; Smoking/*epidemiology/trends ; Tobacco Smoke Pollution

This road map aims to establish a stable and integrated healthcare system for the Korean Peninsula by improving health conditions and building a foundation for healthcare in North Korea through a series of effective healthcare programs. With a basic time frame extending from the present in stages towards unification, the roadmap is composed of four successive phases. The first and second phases, each expected to last five years, respectively, focus on disease treatment and nutritional treatment. These phases would thereby safeguard the health of the most vulnerable populations in North Korea, while fulfilling the basic health needs of other groups by modernizing existing medical facilities. Based on the gains of the first two phases, the third phase, for ten years, would prepare for unification of the Koreas by promoting the health of all the North Korean people and improving basic infrastructural elements such as health workforce capacity and medical institutions. The fourth phase, assuming that unification will take place, provides fundamental principles and directions for establishing an integrated healthcare system across the Korean Peninsula. We are hoping to increase the consistency of the program and overcome several existing concerns of the current program with this roadmap.
Delivery of Health Care/methods/*organization & administration/standards ; Health Care Sector ; Health Manpower ; Humans ; Nutrition Assessment ; Republic of Korea

This study investigated the German experience in the transition to a unified health care system and suggests the following implications for Korea. First, Germany could have made use of the unification process better if there had been a good road map. Therefore Korea must develop a well prepared road map that considers all possible situations. Second, Germany saw an opportunity for the improvement of the health care system in the early stage of unification but could not take advantage of it because the situation changed dramatically and they had not sufficiently prepared for it. Korea should take into account the opportunity for improvement of the present health care system, such as the roles of public health and traditional medicine. Thirdly, the conditions f North Korea seem to be far worse than those of former East Germany and also worse than even those of other transition countries. Therefore Korea should design a long-term road map taking as many variables into account as possible, including the different rigid way of thinking and the interrelationship among the social sectors. Fourthly, during the German reunification unexpected factors changed the direction of the events. Korea should have a separate plan for the unexpected factors.
Ambulatory Care ; Delivery of Health Care/methods/*organization & administration/standards ; Germany ; Germany, East ; Humans ; Medicine, Traditional ; Public Health ; Republic of Korea