"BACKGROUND: Between 80 to 85% of patients with hyperparathyroidsm have a solitary adenoma of the parathyroid glands and another 15% have a parathyroid hyperplasia. Preoperative localization of the parathyoid glands is generally accepted as warranted in patients who have failed an initial attempt at parathyroidectomy, ectopic locations and inexperienced surgeons. Different imaging techniques have been used for detection of abnormal parathyroid glands such as high resolution ultrasonography, computerized tomography, arteriography, venous sampling or magnetic resonance imaging and 201Tl/99mTc subtraction scintigraphy. But these methods have had varying rates of success, with low specificity and low sensitivity. Among the several different techniques available for parathyroid radionuclide imaging, the most common is the use of a dualradioisotope procedure combining of Tl with Tc. However, there are some controversies regarding the optimal technical aspects of this procedure, including the relative amount of injected dose of radiotracers, failed detection for small sized and deeper cervical located parathyroids, and not easy procedures. Recently, double phase Tc-sestamibi scintigraphy would be useful to solve these technical limitations, more convenient and have higher sensitivities. The purpose of this study was to compare the diagnostic accuracy of 99mTc-sestamibi with 201Tl/ 99mTc subtraction scintigraphy in the localization of hyperparathyroidism. METHODS: 9 patients with hyperparathyroidism underwent preoperative evaluation with double phase 99mTc-sestamibi scintigraphy and 201Tl/99mTc subtraction scintigraphy for attempted localization of abnormal parathyroid glands and surgical explorations. Imaging results were compared to surgical findings. RESULTS: Of 9 patients, 7 had a solitary parathyroid adenoma, 1 had a carcinoma and 1 had parathyroid hyperplasia. The 201Tl/99mTc subtraction scintigraphy preoperatively localized 8 of 9 patients(sensitivity: S9%) and 99mTc-sestamibi scintigraphy correctly localized all lesions for a sensitivity of 100%. In one case, 201Tl/99mTc subtraction scan show only a hot uptake at left upper parathyroid area, but 99mTc-sestamibi scan was shown the three site of hot uptake at left upper, both inferior parathyroid area. CONCLUSION: In patients with hyperparathyoridism, 99mTc-sestamibi scintigraphy may be used as the single imaging technique as it show a very high sensitivity and specificity in the preoperative localization of pathological parathyroid glands.
Adenoma ; Angiography ; Humans ; Hyperparathyroidism* ; Hyperplasia ; Magnetic Resonance Imaging ; Parathyroid Glands ; Parathyroid Neoplasms ; Parathyroidectomy ; Radionuclide Imaging* ; Sensitivity and Specificity ; Technetium Tc 99m Sestamibi* ; Ultrasonography

BACKGROUND: Percutaneous ethanol injection(PEI) performed in guidance of ultrasonography has been used in cases of thyroid cyst and autonomous functiong thyroid nodule(AFTN). We performed this study to determine the feasibility of PEI on the various type of benign cold nodules(solid, pure cyst, complex cyst) and AFTN. METHOD: Ninety patients(age 41+12 years; 83 women and 7 men) with hot and cold nodule were included in this study. All cases were subjected to FNAB, and sono-guided in cases of complex cyst, at least twice with results of colloid nodule. T4 suppression treatment was done for cold solid nodules for at least 6 months and cases which had partial response(50% or more volume reduction but no further volume decrease on T4 suppression) were included in this study. After PEI, we classified AFTN into three different response groups; complete response (normali- zation of TFT and thyroid scan finding), partial response(normalized freeT4 but suppressed TSH or persistently suppressed scan), or failure group. Each subtypes(solid, pure cyst, complex cyst) of cold nodules were also classified into three groups in accordance with volume reduction; complete response(above 90% of volume reduction), partial response(50-90%), and failure(below 50% or increase in size) group. RESULTS: Overall responses rate of PEI for benign thyroid nodule were complete; 70(78%), partial; 18(20%), and failure; 2(2%). In 27 cold solid nodules, complete response was observed in 23(85%) and partial response in 4(15%). In 11 pure cysts, complete response was observed in 7(64%), partial response in 3(27%), and 1 case(9%) of failure was lost after 1 trial of PEI. In 45 cases of complex cyst, complete response was observed in 36(80%), partial response in 8 (18%), and 1 case(2%) of failure was subjected to operation with pathology report of Hiirthle cell adenoma. In 7 cases of AFTN, complete response was observed in 4(57%) and partial response in 3(43%). We observed complications during PEI therapy such as transient neck pain(n=10), transient unilateral vocal cord palsy(n=l), and intracavitary hemorrhage(n=2), transient hypotension during ethanol injection(n 1). CONCLUSION: Our data suggest that efficacy of PEI(57%) in AFTN is inferior to conventional therapies like surgery and radioiodine, but still can be an alternative therapeutic modality in selected cases. In cold nodules, especially of solid type and complex cyst, PEI may have feasibility as a therapeutic modality in restricted cases. Further studies of prolonged follow-up for the possibility of neglecting occult malignancy are warranted.
Adenoma ; Colloids ; Ethanol* ; Female ; Follow-Up Studies ; Humans ; Hypotension ; Neck ; Pathology ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography ; Vocal Cords

BACKGROUND: We evaluated the prevalence of thyroid cancer in patients with cold thyroid nodules and the impact of sex, age, hardness of nodule, and multinodularity as factors able to predict the probability of malignancy in patients with nodular thyroid diseases. METHODS: We examined a 728 patients who visited Seoul National University Hospital with one or more cold thyroid nodules between Jan. 1996 and Dec. 1997. After clinical evaluations including medical history, physical examinations(size, hardness and multiplicity of nodule), fine needle aspiration biopsies and cytologic examinations were carried out. RESULTS: Among the 728 cases, 76 cases(10.4%) were diagnosed as cancer and 602 cases (82.6%) were diagnosed as benign nodule. The prevalence of cancer was significantly lower in female patients with cold nodules(9.4%, 62/662) than in males(17.5%, 11/63)(p=0.041). Age was an important factor in both sexes. The proportion of nodules that were malignant was lower in patients of 20-60 years old(8,9%, 56/632) than patients younger than 20 years old(1S.1%, 2/11) or older than 60 years old(18.3%, 15/82)(p=0.019). The prevalence of cancer was significantly higher in hard nodules(36.3%, 41/113) than firm(5.2%, 30/574) or soft nodules(5.3%, 2/38)(p= 0.001). There was no size difference between malignant(25.2 +- 13.7mm) and benign nodules(25.3 +- 8.9mm)(p=0.9425). The prevalence of thyroid cancer in solitary nodule(10.6%, 63/593) was not different from that in multiple nodules(7.6%, 10/132)(p=0.293). CONCLUSION: Our data suggest that thyroid nodules of the patients who are younger than 20 years old or older than 60 years old, male, as well as hard nodule require more careful evaluation for the risk of thyroid malignancies.
Biopsy ; Biopsy, Fine-Needle ; Female ; Hardness ; Humans ; Male ; Middle Aged ; Prevalence* ; Seoul ; Thyroid Diseases ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule* ; Young Adult

BACKGROUND: Proteins of the Bcl-2 family are intracellular membrane-associated proteins that regulate programmed cell death either positively or negatively by as yet unknown mechanism. Bcl-2 family proteins have an antiapoptotic function, such as the Bcl-2, the long form of Bcl-x and Mcl-l, or a proapoptotic function, like the short form of Bcl-x and Bax. To investigate the potential role of Bcl-2 family proteins in thyroid tumorigenesis, the authors examined the pattern of expression of the Bel-2 family proteins in various thyroid neoplasms. METHODS: Bcl-2 family proteins, including Bcl-2, Bcl-x, Mcl-1 and Bax proteins were immunohistochemically stained in 57 cases of various thyroid neoplasms using formalin-fixed and paraffin embedded tissues; 18 cases of papillary carcinoma, 6 cases of medullary carcinoma, 4 cases of anaplastic carcinoma, 10 cases of follicular adenoma, 9 cases of adenomatous goiter, and 10 autopsy cases of fetal thyroid galnd. The intensity and frequency of the immunostaining were evaluated with the program of Image-Pro Plus Version 3.0 for image analysis. RESULT: Consistent expression of Bcl-2, Mcl-1, and Bax proteins were present in the surrounding normal thyroid tissue, however the expression of Bcl-x protein was not observed. Compare to the expression patterns of adenomatous goiter, and fetal and surrounding normal thyroid tissues, papillary and anaplastic carcinomas showed the decreased Bcl-2 and increased Bcl-x protein expressions(p (0.05). Medullary carcinoma revealed the increased Bcl-x protein expression only(p 0.05). CONCLUSION: These data suggest that combined patterns of decreased Bcl-2 and increased Bcl-x protein expressions may eontribute to the carcinogenesis of thyroid cancers originated from thyroid follicular cells, and an increased expression of Bcl-x protein may be related to the pathogenesis of medullary carcinoma from parafollicular C cells.
Adenoma ; Autopsy ; bcl-2-Associated X Protein ; bcl-X Protein ; Carcinogenesis ; Carcinoma ; Carcinoma, Medullary ; Carcinoma, Papillary ; Cell Death ; Goiter ; Humans ; Membrane Proteins ; Paraffin ; Thyroid Gland* ; Thyroid Neoplasms*

BACKGROUND: Hypothyroidism is a treatable cause of secondary hyperlipidemia. The lipid profile usually seen is an increased total and low density lipoprotein(LDL) cholesterol, and the plasma triglyceride may also be increased. Hypercholesterolemia associated with hypothyroidism is an important factor in the pathogenesis of coronary artery disease(CAD). And the hyperchole-sterolemia caused by hypothyroidism is potentially reversible by thyroid hormone replacement therapy. Hypothyroidism should be ruled out by routine laboratory screening as a treatable cause of secondary hyperlipidemia and increased CAD risk. We carried out this study aimed at evaluating the frequency of hypothyroidism and its relationship with serum cholesterol concentration in Koreans. METHODS: We investigated 15028(men 8273, women 6755) Korean subjects who visited our hospital center for health promotion during an one year period(from January 1, 1996, to December 31, 1996). Among them, we analyzed 6756 hypercholesterolemic subjects whose serum cholesterol levels were greater than 200 mg/dL. They performed thyroid function tests(total T, T4, and TSH) and lipid profiles(total cholesterol, triglyceride and HDL-cholesterol) were measured by enzyme assay. We defined hypothyroidism by serum thyrotropin values greater than 5 U/mL. RESULTS: The observed prevalence of hypothyroidism was 2.4%(163/6756). Among those with high TSH levels, 17(10.4%) had overt hypothyroidism with a low T4 (below 6 g/dL) level. As we analyzed the frequency of hypothyroidism according to cholesterol range by 20 mg/dL, the frequency was significantly increased in the group whose serum cholesterol levels were greater than 300 mg/dL, especially in women over 50 years of age. Analysis of lipid parameters showed that hypertriglyceridemia was frequent and hyperHDLaemia was observed in hypothyroidic populations. CONCLUSION: Screening for hypothyroidism by measurement of thyrotropin values is of particular importance in patients with hypercholesterolemia. And the frequency of hypothyroidism was more significantly increased in whose serum cholesterol levels were greater than 300 mg/dL, especially in the group of women over 50 years of age.
Cholesterol ; Coronary Vessels ; Enzyme Assays ; Female ; Health Promotion ; Hormone Replacement Therapy ; Humans ; Hypercholesterolemia ; Hyperlipidemias ; Hypertriglyceridemia ; Hypothyroidism* ; Mass Screening ; Plasma ; Prevalence ; Thyroid Gland ; Thyrotropin ; Triglycerides

BACKGROUND: Postpartum thyroiditis(PPT) is one of syndromes of thyroid dysfunction that occurs in the first year after parturition. Reported incidence of PPT is 3.9-8.2% of postpartum women in several studies from different countries. The fact that 52-100% of patients with PPT have thyroid autoantibodies, and that lymphocytic infiltration of thyroid gland is the characteristic pathological feature of PPT suggest that PPT is an autoimmune disease. High iodine intake in short term period is known to aggrevate the experimental autoimmune thyroiditis. This study was performed to investigate the incidence and clinical features of PPT in Korean postpartum women who usually ingest excessive amount of idine in immediate postpartum period and to investigate the predictive value of thyroid autoantibodies in the development of PPT in them. METHOD: Between March 1996 and February 1997, 99 women without previous history of any thyroid disease who delivered babies at Boramae hospital were enrolled. Thyroid function parameters(T3, T4, free T4, TSH), thyroid autoantibodies(anti-microsomal antibody, anti-thyroglobulin antibody) and urinary iodine excretion were measured prospectively before and 1, 3 months after delivery. Dietary iodine intake during postpartum period was evaluated by questionnaire, and clinical parameters were followed up. RESULTS: During 3 months of observation, PPT developed in 8.1%(8/99) of postpartum women. Five cases had typical course having thyrotoxic phase and the other 3 cases had hypothyroid phase without toxic phase. However, only one of those required thyroid hormone replacement therapy in the latter group. There were no differences in age, baseline thyroid function parameters, parity, percent cases with family history of thyroid disease between those developed PPT (n=8) and those did not develop PPT(n=91). Duration of high iodine intake(3.8 +- 0.5 wk. vs. 3.7 +- 0.8 wk., p>0.05), total ingested amount of high iodine diet(77 +- 28 vs. 79 +- 24 bowels of miyokguk, p)0.05), and the urinary iodine excretion(1.9 +- 1.4 mg/g creatinine vs. 3.7 +- 3.7mg/g creatinine, p0.05) at 1 month postpartum were not different between two groups. Of 99 total subjects, anti-microsomal antibody(AMA) was present in 13.1%(13/99) before delivery in their sera. Positive predictive value of the presence of AMA before delivery in predicting the development of PPT was 30.8%. CONCLUSION: The fact that incidence of PPT in normal Korean postpartum women who usually have high iodine intake in immediate postpartum period is not higher than those of other countries, and that there was no difference in the amount of iodine intake between those developed PPT and those did not suggest that high iodine intake in immediate postpartum period do not influence on the incidence of PPT. The presence of AMA before delivery had low specificity in prediction of development of PPT, so the measurement of AMA seems not to be a useful screening test.
Autoantibodies ; Autoimmune Diseases ; Creatinine ; Female ; Hormone Replacement Therapy ; Humans ; Incidence* ; Iodine* ; Mass Screening ; Parity ; Parturition ; Postpartum Period* ; Postpartum Thyroiditis* ; Prospective Studies ; Surveys and Questionnaires ; Sensitivity and Specificity ; Thyroid Diseases ; Thyroid Gland ; Thyroiditis, Autoimmune

BACKGROUND: Some of the deficiencies in anterior pituitary function identified in subjects with macroadenomas appear to represent irrevemible necrosis of normal pituitary cells, and in addition reversible damage to viable glandular tissue and/or incomplete interruption of local circulation by compression of pituitary stalk may also contribute significantly to hypopituitarism. So anterior pituitary function may actually improve in some patients undergoing successful tumor resection or reduction in tumor size. Although direct comparisons of pituitary function among the various pituitary tumors are not presently available it was reported that there is some difference in the degree of pituitary impairment between patients with nonfunctioning macroadenoma(NFMA) and those with GH-secreting macroadenoma(GHMA).In this study, to investigate the difference in the degree of hypopituitarism we compared anterior pituitary function in subjects with NFMA to that in patients with GHMA. METHODS: In this retrospective study, preoperative and postoperative anterior pituitary function was assessed by clinical findings, basal hormone levels and/or combined pituitary stimulation test in 29 subjects with NFMA and in 24 subjects with GHMA. RESULTS: 1. There was no difference in age, sex, tumor size distribution between the two groups. 2. Preoperatively, NFMA patients had a higher prevalence of secondary hypothyroidism(34% vs. 5%; p(0.02) compared to subjects with GHMA. Patients with NFMA also had a higher prevalence of more severe pituitary failure compared with acromegalic patients; 48% of the patients in this group had more than one pituitary hormone axis impaired compared to 17% in the acromegalic group(p0.03). 3. Postoperatively, NFMA patients also had a higher prevalence of secondary hypoadrenalism (52% vs. 11%; p 0.01) compared with acromegalic patients. Additionally, the prevalence who had more than one pituitary hormone axis impaired was still greater in NFMA patients than in the acromegalic group(57% vs. 22%; p=0.054). 4. No correlation was found between the severity of pituitary failure and tumor size or extension in both groups before and after surgery. CONCLUSION: These findings suggest that anterior pituitary function is relatively better preserved in patients with GHMA than those with NFMA and that this difference is independent of tumor size and extension. The mechanism underlying the lower rate of hypopituitarism in acromegalics with macroadenoma remains to be elucidated.
Adrenal Insufficiency ; Axis, Cervical Vertebra ; Humans ; Hypopituitarism ; Necrosis ; Pituitary Gland ; Pituitary Neoplasms ; Prevalence ; Retrospective Studies

BACKGROUND: It assumed that plurihormonal pituitary adenomas in acromegaly, which were immunohistochemically stained with other pituitary hormones in addition to GH and prolactin, would be originated from poorly differentiated cells. Therefore, we speculated that they might have higher growth rates and worse prognosis than monohormonal adenomas. To verify this speculation, we analyzed the frequency of plurihormonal adenomas and compared the clinical parameters and radiological invasiveness between plurihormonal adenoma and GH-prolactin adenoma in acromegaly. METHODS: We studied 38 patients with acromegaly (22 males and 16 females, mean age 40.7 years) who were underwent surgical removal of pituitary adenomas by TSA from January 1995 to February 1998. We performed immunohistochemical staining in these tumors using avidinbiotin peroxidase complex method. An adenoma was considered as immunoreactive when above 50 percents of tumor cells were stained with anti-hormonal antibodies. Invasiveness of tumors were evaluated by preoperative MRI findings on the basis of Hardys classification. RESULTS: The frequencies of plurihormonal and GH-prolactin adenomas were 42% and 58%, respectively. Plurihormonal adenoma included an adenoma which was not stained with prolactin, but with GH and other hormones. Prolactin immunoreactivity was found in 97%(37/38) of the tumors. Immunoreactivities to FSH, ACTH, LH, and TSH were found in 37.8%, 13.1%, 2.6% and 2.7%, respectively. There were no significant differences in age, basal serum GH and IGF-1 concentrations between plurihormonal and GH-prolactin adenomas. There were also no significant differences in response to TRH & LH stimulation tests and somatostatin & bromocriptine suppression tests between two groups. There were no differences in radiological invasiveness between two groups (plurihormonal adenoma, grade I 2, grade II 3, grade III 7, grade IV 4; GH-prolactin adenoma, grade I 3, grade II 6, grade III 9, grade IV 4). CONCLUSION: Plurihormonal adenomas were 44% and immunoreactivity to prolactin was 97% in pituitary adenomas in acromegaly. There were no significant differences in clinical parameters and radiological invasiveness between plurihormonal and GH-prolactin adenomas in acromegaly.
Acromegaly* ; Adenoma ; Adrenocorticotropic Hormone ; Antibodies ; Bromocriptine ; Classification ; Female ; Humans ; Insulin-Like Growth Factor I ; Magnetic Resonance Imaging ; Male ; Peroxidase ; Pituitary Hormones ; Pituitary Neoplasms* ; Prognosis ; Prolactin ; Somatostatin

BACKGROUNDS: Polyamines are known to be essential for cell growth and differentiation. Recently, possible roles of the polyamine in signal transduction as neurotransmitter, modulator, or second messenger are suggested in many studies. Furthermore, it is widely studied that possible roles of polyamine are involved in the action of hormone. Thus, it was to investigate the effect of polyamines in the cell proliferation and secretion of GH from the GH cells. METHODS: Cells(5*10 cells/mL) were incubated for 3 days in DMEM containing test drugs and labeled with 20pCi/mL of [S]-methionine for 2 hr. Proteins secreted into the medium were separated by 13% SDS-gel electrophoresis, then autoradiography was performed to identify radiolabeled proteins. [S]-methionine labelled GH was identified by radioimmuno-precipitation. Total protein synthesis was determined from the radioactivity of the cell homogenate by liquid scintillation counter. The intracellular polyamine content was determined by HPLC. RESULTS: Externally added polyamines(putrescine, spermidine, spermine) induced cell proliferation in a dose-dependent manner at proper concentrations, specifically 50pM putrescine increased GH secretion, DFMO or MGBG, which is polyamine biosynthetic inhibitor, inhibited GH secretion in a dose-dependent fashion, In the cells treated with 20mM or 0.01mM MGBG, total protein synthesis were decreased only to 90 or 76% of the control levels and cell proliferation was also slightly inhibited. However the secretion of GH was severely blocked to 37% or 35% of the control. Hydrocortisone at 5 pM stimulated the secretion of GH to 153% of basal secretion, also doubled intracellular putrescine content. CONCLUSION: The present data show that externally added polyamines induced cell proliferation and GH secretion. Also, extemally added putrescine stimulated GH secretion significantly. GH secretion was inhibited by polyamine metabolic inhibitor in a dose-dependent manner and polyamine metabolic inhibitors, at proper concentrations, specifically blocked GH secretion without any significant influence on the total protein synthesis. The above results imply the involvement of polyamine in GH secretion.
Autoradiography ; Cell Proliferation ; Chromatography, High Pressure Liquid ; Electrophoresis ; Growth Hormone ; Hydrocortisone ; Mitoguazone ; Neurotransmitter Agents ; Polyamines ; Putrescine ; Radioactivity ; Scintillation Counting ; Second Messenger Systems ; Signal Transduction ; Spermidine

No abstract available.
Hyperparathyroidism*