PURPOSE: The extent of prophylactic lateral neck lymph node dissection is very controversial in medullary thyroid cancer. This retrospective study was undertaken to evaluate the efficacy of prophylactic lateral neck lymph node dissection. METHODS: A total of 29 patients underwent curative operation for medullary thyroid carcinoma at our institution. Of these 29 patients, 13 patients had prophylactic lateral neck dissection and 16 patients had non-prophylactic lateral neck dissection. Among 13 patients, one-compartment prophylactic lymph node dissection was performed in 10 patients and two-compartment prophylactic lymph node dissection was performed in 3 patients. Postoperative calcitonin level was evaluated between these groups. RESULTS: A normalized calcitonin level was detected after surgery in 74% of patients without lateral neck lymph node metastases, and in 10% of patients with lateral neck lymph node metastases. In comparison of prophylactic node dissection group and non-prophylactic node dissection group, the rate of normalized calcitonin level after surgery is 100%, 66.7% in stage 1, 100%, 50% in stage 2, 0%, 80% in stage 3, 14.3%, 0% in stage 4. In the patients who one-compartment prophylactic lymph node dissection was performed, 40% of patients had positive lymph node metastasis, and 70% had persistent hypercalcitoninemia. However, there was no postoperative hypercalcitoninemia in the patients with twocompartment prophylactic lymph node dissection although lymph node metastasis was not identified with pathologic examination. CONCLUSION: Prophylactic lymph node dissection was more effective in the early stage of medullary thyroid carcinoma than late stage. The two or more compartment lymph node dissection is more effective than just one-compartment dissection for the normalization of serum calcitonin level.
Calcitonin ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neck Dissection* ; Neck* ; Neoplasm Metastasis ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms*

PURPOSE: Heat shock proteins (hsps) are synthesized by cells in response to various stress conditions, including carcinogenesis. The expression of hsps in neoplasia has been implicated in the regulation of cell signaling pathway such as cell survival and apoptosis. This study aimed to determine whether hsps expression in various thyroid neoplasia are significant and to identify the possibility as a therapeutic molecular target. METHODS: We examined the expression of the hsp70 and hsp90 on tissue section from 53 thyroid tissues (16 normal tissues; 11 nodular hyperplasia; 12 follicular adenomas; 14 papillary carcinomas) using immunohistochemistry. Hsps expression was scored according to the percentage of positively stained cells (grade 0 to grade III). RESULTS: For hsp70, all of the 53 tissues showed overexpression. 100% (16/16) of normal thyroid tissue and 87.0% (20/23) of benign tissue were categorized as grade I or II. In comparison, the carcinoma tissues showed expression in 64.3% with grade III. For hsp90, almost of normal thyroid tissue and benign tumors showed no expression (87.5% in normal tissues, 91.3% in benign tumors). However, all of carcinoma tissues showed expression and 78.6% (11/14) of carcinoma were in grade II or III. CONCLUSION: In current study, the pattern of expression for hsp70 and hsp90 in normal, benign, malignant thyroid tissues suggests that heat shock proteins might have some role in tumorigenesis in thyroid. Since there have been no reports on heat shock proteins and thyroid, further study is necessary and could give us clinically significant clue for diagnosis and treatment.
Adenoma ; Apoptosis ; Carcinogenesis ; Cell Survival ; Diagnosis ; Heat-Shock Proteins* ; Hot Temperature* ; Hyperplasia ; Immunohistochemistry ; Thyroid Gland* ; Thyroid Neoplasms*

Adrenal medullary hyperplasia is an increase in the mass of the adrenal medullary cells. We report a case of a 38-year-old man presenting with pheochromocytoma-like symptoms who was preoperatively misdiagnosed with pheochromocytoma. Hypertension was associated with an intracranial hemorrhage evident in a brain computed tomography scan, in which no obvious pituitary gland enlargement was detected. An abdominopelvic CT revealed a solitary tumor in the right adrenal gland with no obvious enlargement of the contralateral adrenal gland or sympathetic chains. Lab results showed increased levels of urinary metanephrines. Based on clinical data, the patient underwent a laparoscopic right adrenalectomy bases on a diagnosis of pheochromocytoma. The patient was finally diagnosed with adrenal medullary hyperplasia with coexisting ipsilateral non-functioning adrenal cortical adenoma. Postoperatively, blood pressure and lab results were maintained in the normal range and the patient was symptomatically free during the follow-up period.
Adrenal Glands ; Adrenalectomy ; Adrenocortical Adenoma* ; Adult ; Blood Pressure ; Brain ; Diagnosis ; Follow-Up Studies ; Humans ; Hyperplasia* ; Hypertension ; Intracranial Hemorrhages ; Pheochromocytoma ; Pituitary Gland ; Reference Values

Thyroid cancer is the most common endocrine malignancy and it is increasing throughout the world, but metastasis to the thyroid gland is uncommon. The overall incidence varies from 1.25% in unselected autopsy series to 24% in autopsy of patients with widespread malignant neoplasms. Although detection of metastasis to the thyroid gland often indicates a poor prognosis, aggressive surgical and medical therapy may be effective for a small percentage of patients. There are many reports that have described a secondary thyroid cancer arising from other primary sites. The kidney is the most common site, followed by lung, breast, esophagus and uterus. Although some patients with metastatic disease to the thyroid present with symptoms such as dysphagia, stridor, hoarseness or a palpable neck mass, most of the patients are asymptomatic at presentation. In this paper, we report on a female patient with thyroid metastasis from pulmonary adenocarcinoma and we review the relevant literature.
Adenocarcinoma* ; Autopsy ; Breast ; Deglutition Disorders ; Esophagus ; Female ; Hoarseness ; Humans ; Incidence ; Kidney ; Lung ; Lung Neoplasms ; Neck ; Neoplasm Metastasis* ; Prognosis ; Respiratory Sounds ; Thyroid Gland* ; Thyroid Neoplasms ; Uterus

PURPOSE: Vocal symptoms have been reported after thyroidectomy and even in the absence of injury to the recurrent laryngeal nerve or the external branch of the superior laryngeal nerve. The aim of this prospective study was to evaluate the subjective and objective voice changes in patients without laryngeal nerve injury after thyroidectomy. METHODS: The subjects had undergone total thyroidectomy for differentiated thyroid carcinoma from November 2007 to December 2008. Twenty-eight subjects (males: 8, females: 20) were selected for this study. Voice analysis was prospectively evaluated in the subjects at the time of preoperation and postoperation (10.8 months for the males and 11.7 months for the females). A subjective analysis was done using the visual analogue scale (VAS, 0: no symptom, 10: severe symptoms) and objective analyses were determined by several parameters such as the fundamental frequency (Fo), jitter, shimmer and the noise to harmonic ratio (NHR) using the multi-dimensional voice program. Maximum phonation time (MPT)was performed as an aerodynamic test. RESULTS: 3 patients (37.5%) among the males and 14 patients (70%) among the females had subjective postoperative voice change. The VAS showed a significant difference for the females (0 to 1.25±0.97, P<0.001), whereas no changes were shown for the males (0 to 0.88±1.25, P>0.05). The vocal parameters (Fo, jitter, shimmer, NHR) and MPT showed no significant changes for both the males and females (P>0.05). CONCLUSION: Subjective voice changes may occur after thyroidectomy without laryngeal nerve injury. Surgeons should take possible voice changes into consideration when informing patients before thyroidectomy.
Female ; Humans ; Laryngeal Nerve Injuries ; Laryngeal Nerves ; Male ; Noise ; Phonation ; Prospective Studies ; Recurrent Laryngeal Nerve ; Surgeons ; Thyroid Neoplasms ; Thyroidectomy* ; Voice

PURPOSE: The typical complications after thyroidectomy are bleeding, hematoma, hoarseness, hypocalcemia, chylous fistula, etc. The aim of this study was to determine the incidence and to evaluate risk factors of complication after total thyroidectomy and lymph node dissection (ND) for thyroid cancer. METHODS: We performed a retrospective review of 623 patients with thyroid cancer and who underwent total thyroidectomy and ND and the patients were treated at our hospital from March 2007 to February 2010. The clinical features of complications were reviewed and the incidence and predisposing factors of the complication were analyzed. RESULTS: Postoperative bleeding occurred in 0.2% of the patients. The overall incidence of transient and permanent hypocalcemia was 8.5% and 0.6%, respectively. Graves disease, a decreased number of preserved parathyroid glands and an increased number of removed central lymph nodes constituted the risk factors for postoperative hypocalcemia. On multivariate logistic regression analysis, the presence of Graves disease and a decreased number of preserved parathyroid glands were the independent risk factors for postoperative hypocalcemia. Hoarseness occurred in 1.6% of the patients. The incidence of chylous fistula after lymph node dissection in the central neck and lateral neck was 0.5% and 0.3%, respectively. CONCLUSION: Total thyroidectomy with ND is a safe procedure because the overall incidence of postoperative complications is low. Careful surgery is required for thyroid cancer patients with Graves disease. Parathyroid gland insufficiency is the important cause of hypocalcemia after total thyroidectomy and ND. To reduce voice change, careful dissection is required around the recurrent laryngeal nerve and excessive tracheal traction should be avoided.
Causality ; Fistula ; Graves Disease ; Hematoma ; Hemorrhage ; Hoarseness ; Humans ; Hypocalcemia ; Incidence ; Logistic Models ; Lymph Node Excision ; Lymph Nodes ; Neck ; Parathyroid Glands ; Postoperative Complications ; Recurrent Laryngeal Nerve ; Retrospective Studies ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy* ; Traction ; Voice

PURPOSE: Cervical lymphadenectomy is frequently performed in patients with lateral cervical lymph node metastasis to improve regional control of disease. However, there is controversy regarding appropriate levels of the neck that need to be dissected. In particular, the routine dissection of level V remains an annoying and time consuming procedure due to the injury of the spinal accessory nerve. METHODS: To identify clinical and pathological predictors of cervical node metastases to level V in papillary thyroid carcinoma, we analyzed 42 patients who underwent modified radical neck dissection (MRND), which were separately performed by each strict anatomical level. Five patients underwent both MRND, 29 patients received total thyroidectomy with central neck node dissection and MRND at the time of initial operation. Thirteen patients underwent MRND later when lateral neck metastases were found at the follow-up after total thyroidectomy with central neck node dissection. RESULTS: In our series, 11.9% of neck specimens harbored metastatic thyroid carcinoma at level V. The metastatic rate of level II, III, and IV was 54.7%, 85.7%, and 64.2%, respectively. The presence of level V metastases was not significantly associated with level II, III metastases, age, sex, and histopathologic findings. But, it seemed to be associated with level IV metastases if the proportion of metastasis of level IV exceeded 50%. CONCLUSION: Cervical node metastasis seems to be associated with level IV metastases if the proportion of metastasis of level IV exceeds 50%.
Accessory Nerve ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neck Dissection ; Neck* ; Neoplasm Metastasis* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: The aim of this study was to evaluate the operative feasibility and safety of endoscopic thyroidectomy via bilateral axillo breast approach (BABA) compared to conventional thyroidectomy in papillary thyroid carcinoma (PTC) patients. METHODS: From July 2009 to November 2010, patients underwent BABA endoscopic thyroidectomy (ET group; n=41) or conventional open thyroidectomy (OT group; n=61) for PTC. Clinical and pathologic characteristics of patients, operation time, post-operative complications, cosmetic satisfaction and thyroglobulin (TG) level were analyzed retrospectively. RESULTS: The mean age of the patients was 40.05±9.58 years (range 25~61 years) and 46.21±13.68 years (range 19~79 years) for the ET and OT group, respectively. The operative extent in the ET group did not include advanced thyroid cancer or lateral neck dissection. The size of the tumor was 0.78±0.59 cm (range 0.1~3.00 cm) and 1.54±1.05 cm (range 0.3~6.00 cm) for the ET and OT group, respectively. Extrathyroidal extension and number of retrieved lymph nodes were significantly higher in the OT group. Postoperative radioactive iodine ablation was performed on 25 patients (72.43%) in the ET group and 48 patients (78.69%) in the OT group. There was no abnormal uptake on radioactive iodine scans in the iodine-treated patients and no significant differences in postoperative off-T4 TG levels between the two groups. There were no significant differences in operative time, amount of drainage, postoperative hospitalization period, hypocalcemia, and vocal cord palsy between the two groups. Cosmetic results of ET group were rated as excellent in a 3-month postoperative questionnaire by 25 (72.43%) of 35 patients. CONCLUSION: Endoscopic thyroidectomy via the bilateral axillo breast approach can be a feasible and effective option for PTC in selected cases.
Breast* ; Drainage ; Hospitalization ; Humans ; Hypocalcemia ; Iodine ; Lymph Nodes ; Neck Dissection ; Operative Time ; Retrospective Studies ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy* ; Vocal Cord Paralysis

There are three compartments of regional lymph node to which metastases from thyroid cancers can occur: central, lateral, and mediastinal compartment. The mediastinal metastases from thyroid cancers are extremely rare, comparing the relatively common forms of metastases to central or lateral compartments. The importance of complete surgical lymph node dissection of central or lateral compartment for thyroid cancer has been well described, but mediastinal lymph node dissection has been sporadically reported. For mediastinal compartment metastases, operation techniques consist of sternal split, thoracoscopic surgery, or VATS (Video-assisted thoracoscopic surgery). Robotic surgery system was introduced recently with the objective of enhancing the dexterity and view during procedure that uses a videoscope. Many institutions report the experience with minimally invasive resection of mediastinal mass using robotic surgery system. We report that one case of robot-assisted mediastinal lymph node dissection for metastatic papillary thyroid cancer.
Carcinoma, Papillary ; Lymph Node Excision* ; Lymph Nodes* ; Neoplasm Metastasis ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thyroid Gland* ; Thyroid Neoplasms*

PURPOSE: The extent of the initial surgical treatment for patients with papillary thyroid carcinoma (PTC) is controversial. Many surgeons think thattotal thyroidectomy is the most optimal treatment for PTC because of its potential bilaterality. Therefore, bilaterality is an important factor for determining the extent of surgical resection. The aim of this retrospective study is to analyze the relationship between tumor bilaterality and the other clinicopathological factors. METHODS: We conducted a retrospective analysis of 140 patients with PTC and who underwent total thyroidectomy with central lymph node dissection from January to December 2007 at our institution. RESULTS: Among 140 patients, 50 patients (35.7%) had PTC in the bilateral lobes. Of these 50 patients, only 17 patients (34.0%) were operated on under the preoperative diagnosis of bilateral PTC. Two factors, 1) presence of the capsular invasion (P=0.007) and 2) an increase of the tumor size (P=0.023), were statistically correlated with bilaterality. There were no significant associations between bilaterality and the other clinicopathological factors,including age, extrathyroidal invasion and lymph node metastasis. CONCLUSION: For the surgical care of PTC, bilaterality must always be considered even though the tumor is diagnosed preoperatively as unilateral PTC. Furthermore, thorough preoperative evaluation is mandatory if unilateral lobectomy is regarded as a therapeutic option for PTC patients.
Diagnosis ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Retrospective Studies ; Surgeons ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy