Thyrotoxic periodic paralysis is not a rare complication of hyperthyroidism in Asian people, but the cases of paralysis with normal serum potassium levels are very rare. A 36-year-old Korean man who had been diagnosed with Graves' disease had experienced recurrent paralysis for 9 months in spite of normokalemia. We measured the patient's serum potassium levels nine times at the time of paralysis. All measurements fell in the range 3.3~4.7 mmol/L. We treated the patient with methimazole, Lugol's solution, beta-blockers, and radioactive iodine. Thyroid function was normalized after anti-thyroid treatment and then no further paralytic attacks have occurred.
Adult ; Asian Continental Ancestry Group ; Graves Disease ; Humans ; Hyperthyroidism ; Iodides ; Iodine ; Methimazole ; Paralysis ; Potassium ; Thyroid Gland ; Thyrotoxicosis

BACKGROUND AND OBJECTIVES: Little has been known for factors predicting improvement of proptosis in patients with thyroid-associated ophthalmopathy (TAO) after intravenous (IV) glucocorticoid therapy. This study aimed to evaluate the efficacy of IV glucocorticoid therapy and to find factor predicting treatment outcomes in patients with TAO. MATERIALS AND METHODS: Forty-two consecutive patients with TAO treated by IV glucocorticoid from 2000 to 2009 were retrospectively analyzed. They received IV methylprednisolone of 7.0 g over 18 weeks. Before and after treatment, patients underwent orbital CT for assessment of proptosis and extraocular muscle hypertrophy, and physical examination for clinical activity score (CAS). RESULTS: Thirteen patients (31%) showed improvement in proptosis after therapy. High extraocular muscle diameter index was an independent predictor for improvement in proptosis (odds ratio=1.25, p=0.03). Smoking, age, gender and initial CAS did not predict improvement. Seven of 16 patients with initial CAS<3 (43%) and 13 of 17 with initial CAS> or =3 (77%) showed improvement in diplopia after treatment (p=0.002). Of patients with CAS> or =3, patients with intermittent, inconstant and constant diplopia showed improvement in diplopia in 100%, 80% and 63%, respectively. Of patients with CAS<3, patients showed improvement in 80%, 33% and 20%, respectively. CONCLUSION: Presence of extraocular muscle hypertrophy was the only factor predicting improvement in proptosis after IV glucocorticoid therapy. In patients with TAO, IV glucocorticoid therapy could be considered to improve proptosis when they present with increased extraocular muscle diameter, or to improve diplopia especially when they also have high initial CAS.
Diplopia ; Exophthalmos ; Graves Disease ; Graves Ophthalmopathy ; Humans ; Hypertrophy ; Methylprednisolone ; Muscles ; Orbit ; Physical Examination ; Retrospective Studies ; Smoke ; Smoking ; Troleandomycin

BACKGROUND AND OBJECTIVES: Thyroid ultrasonography (US) is a useful diagnostic tool for the evaluation of thyroid cancer. And US elastography is a newly developed dynamic technique that can provide an estimation of thyroid nodule stiffness. The aim of this study was to evaluate the role of conventional US and shear wave elastography in the diagnosis of thyroid cancer. MATERIALS AND METHODS: Eighty one patients who underwent both conventional US and shear wave elastography were included in this study. Patients were classified into benign and malignant groups according to the cytopathologic results. We evaluated and compared the diagnostic performances of conventional US, shear wave elastography, and combination of conventional US with shear wave elastography. RESULTS: Of 81 nodules, 58 were benign and 23 were malignant. All diagnostic performances of conventional US were higher than those of shear wave elastography. The area under the receiver operating characteristic curve (Az) of conventional US was superior (Az=0.792) to that of shear wave elastography (Az=0.609) (p=0.049) and that of combination of conventional US with shear wave elastography (Az=0.72) (p=0.118). CONCLUSION: Conventional US was good diagnostic modality for diagnosing thyroid cancer. Shear wave elastography itself or a combination of conventional US with shear wave elastography was not as useful as the use of conventional US alone for predicting thyroid malignancy.
Elasticity Imaging Techniques ; Humans ; ROC Curve ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule

BACKGROUND AND OBJECTIVES: Recent studies have reported that vascular endothelial growth factor (VEGF) and hypoxia-inducible factor (HIF)-1alpha are up-regulated in BRAF(V600E)-positive papillary thyroid carcinoma (PTC). We investigated whether papillary thyroid microcarcinomas (PTMCs) also exhibited increased expression of VEGF and HIF-1alpha. In addition, we analyzed the relationship between BRAF(V600E) mutation and clinicopathological parameters, as well as HIF-1alpha expression in PTMC. MATERIALS AND METHODS: We retrospectively selected 225 patients with PTMC. Immunohistochemical staining for HIF-1alpha and VEGF was performed using paraffinembedded PTMC tissue microarrays. BRAF(V600E) mutation status was analyzed by dideoxy sequencing. RESULTS: PTMCs larger than 0.5 cm tend to be related to aggressive clinicopathological features such as thyroid capsular invasion (p=0.023) and bilaterality (p=0.047). Immunoreactivity to HIF-1alpha (20.7%) and VEGF (30.2%) was more prominent in PTMCs as compared to normal follicular cells. However, HIF-1alpha and VEGF expression was not correlated with clinicopathological features. BRAF(V600E) mutation was found in 70.7% (159/225) of the PTMC cases. PTMCs harboring the BRAF(V600E) mutation exhibited larger tumor sizes as compared to PTMCs without the BRAF(V600E) mutation (p=0.038). However, BRAF(V600E) mutation status did not correlate with the expression of HIF-1alpha (p=0.623) or VEGF (p=0.990). CONCLUSION: HIF-1alpha and VEGF were more frequently detected in PTMCs as compared to normal thyroid tissues. However, BRAF(V600E) mutation status was not correlated with the expression of HIF-1alpha or VEGF in PTMCs.
Carcinoma ; Carcinoma, Papillary ; Humans ; Hypoxia-Inducible Factor 1 ; Proto-Oncogene Proteins B-raf ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Vascular Endothelial Growth Factor A

Clinical guidelines for initial management and long-term follow-up of thyroid cancer have been published from many societies world-widely, but there are still many unanswered clinical situation by conventional approach. The prognostic role of BRAF V600E mutation status in patients with papillary thyroid microcarcinoma has been reported and surgical extent could be guided by preoperative assessment of BRAF V600E status from fine needle aspirates. The most important prognostic parameters thyroid cancer after total thyroidectomy and radioactive iodine treatment is measurement of serum thyroglobulin (Tg). Thyrolgobulin autoantiboies (TgAb) is detected up to 25 percent of thyroid cancer patients and may be potential cause of false negative Tg. To overcome this caveat, measurement of transcript of thyroid tissue specific gene could be a substitute for Tg. Serum Tg measurement is also not helpful for thyroid cancer patients who received partial thyroidectomy. Because Tg is tissue specific marker, not cancer specific marker, i.e. normal remnant thyroid tissue could be potential source of Tg. Recent approach to measure BRAF V600E mutation from peripheral blood could be a good candidate tumor marker in patients with normal remnant thyroid tissue. Recent introduction of novel molecular markers for thyroid cancer could be a promising answer to previous guideline for individualize follow-up of thyroid cancer patients.
Carcinoma, Papillary ; Follow-Up Studies ; Humans ; Iodine ; Needles ; Thyroglobulin ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Biomarkers, Tumor

The diagnosis and treatment of recurrent or persistent thyroid cancer can pose significant clinical dilemmas. The tumor generally has a relatively indolent biology; however, recurrent or persistent disease is not uncommon, although tumor-specific mortality is infrequent. Treatment options include 131I, surgical resection, and ethanol or radiofrequency ablation. Neck recurrences are common in papillary thyroid carcinoma (PTC). Surgical removal decreases the need for additional therapy and can minimize complications from local recurrence. Therefore, any patient with a local recurrence should be offered surgical resection. Since reoperations in the central neck can be difficult, it is essential that a surgeon have accurate preoperative imaging and extensive experience in thyroid surgery.
Carcinoma ; Ethanol ; Humans ; Neck ; Recurrence ; Thyroid Gland ; Thyroid Neoplasms

Poorly differentiated thyroid cancer (PDTC) and anaplastic thyroid cancer (ATC) have poor prognosis and rare incidence compared to well differentiate thyroid cancer. Since the original description of PDTC in 1983, PDTC was introduced as a separate entity in the 2004 WHO Classification of Endocrine Tumors. PDTC was defined as a thyroid cancer with thyroglobulin-producing non-follicular non-papillary growth pattern and high-grade features, having an intermediate behavior between well differentiated thyroid cancer (WDTC) and ATC. But the criteria of PDTC are still controversial and heterogeneously applied in the diagnostic practice. Also the modalities of treatment, such as the extent of thyroid surgery, the use of radioiodine therapy and external radiation therapy are still controversial. ATC is rapidly progressing human carcinoma with a median survival of 4 to 12 months after diagnosis. Although the complete resection combined with external radiation therapy was reported to be effective recently and multimodality treatment has been recommended, current treatment of ATC has not been adequate for controlling the diseases. Therefore there are new attempts for treatment, such as chemotherapy with paclitaxel, clinical trials of combretastatin 4 phosphate and CS-7107 and multitargeted therapy of bevacizumab with doxorubicin, sorafenib, sunitinib etc. PDTC and ATC are an unexplored field like this, therefore, the studies for molecular pathology and therapeutic approach are necessary for improving survival and quality of life of patients.
Antibodies, Monoclonal, Humanized ; Bevacizumab ; Bibenzyls ; Doxorubicin ; Humans ; Incidence ; Indoles ; Niacinamide ; Paclitaxel ; Pathology, Molecular ; Phenylurea Compounds ; Prognosis ; Proline ; Pyrroles ; Quality of Life ; Thiocarbamates ; Thyroid Gland ; Thyroid Neoplasms

Staging is the process of determining how much cancer there is in the body and where it is located. Correct staging helps the oncologist to plan a treatment and determine a prognosis. For the surgeon's perspective, planning of surgical treatment is the main concern in preoperative staging. Preoperative staging would be synonym of "preoperative planning" or "preoperative localization" in this context. Extent of primary tumor and lymph node status is the main factor to decide initial surgical treatment of well-differentiated thyroid carcinomas (WDTC). Precise description of lymph node status is also important in the planning of surgery for WDTC. Surgeon performed preoperative ultrasound is highly recommended in the planning of surgery, especially in recurrent cases. There have been debates for what the best imaging modality is in the preoperative staging of WDTC. Surgeon should understand pros and cons of each modality and should communicate with radiologist to decide surgical plan. In this article, we will discuss importance of radiological imaging in preoperative staging of WDTC.
Lymph Nodes ; Prognosis ; Thyroid Gland ; Thyroid Neoplasms

Papillary thyroid carcinoma (PTC) is the most representative carcinoma among thyroid malignancies. The treatment strategy, especially surgery, in Japan traditionally differs from that in other countries, including Korea. Total thyroidectomy has been less frequently adopted, but lymph node dissection has been more actively performed in Japan than in other countries. Based on our data, total thyroidectomy is not necessary for low-risk patients, while it is, of course, mandatory for patients with high-risk features. Prophylactic central node dissection may not prolong patients' survival, but we routinely perform it because reoperation for recurrence to this compartment is troublesome. In the past, Japanese endocrine surgeons actively performed prophylactic lateral node dissection, but indications are narrowing. However, it may be better to perform prophylactic modified radical neck dissection for patients exhibiting certain characteristics to reduce the rate of lymph node recurrence. I hope that surgical strategies in Japan and other countries will fuse with each other in order to identify the best treatments for PTC patients throughout the world.
Asian Continental Ancestry Group ; Carcinoma ; Factor IX ; Humans ; Japan ; Korea ; Lymph Node Excision ; Lymph Nodes ; Neck Dissection ; Prognosis ; Recurrence ; Reoperation ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

BACKGROUND AND OBJECTIVES: Older patients show more aggressive features in papillary thyroid carcinoma (PTC). However, data about clinicopathologic features of older patients in papillary thyroid microcarcinoma (PTMC) are limited. Presently, we investigated the difference of clinicopathologic features in PTMC according to age. MATERIALS AND METHODS: A total of 820 PTMC patients (82 males, 10%; 738 females, 90%) who underwent total thyroidectomy at Pusan National University Hospital were enrolled. The patients were divided into three age groups: group 1 (44 years or younger, n=230), group 2 (45-64 years, n=513), and group 3 (65 years or older, n=77). RESULTS: Extrathyroidal extension was 33% in group 1, 32.2% in group 2, and 31.2% in group 3 (p=0.948). There was no significant difference of lymph node metastasis between the groups: N0 (59.1% vs. 67.8% vs. 70.1%), N1a (37.4% vs. 28.8% vs. 26%), and N1b (3.5% vs. 3.3% vs. 3.9%) (p=0.159). Of the 820 patients, 526 (64.1%) were diagnosed as early stage (stage I, II) PTMC and 294 (35.9%) were diagnosed as advanced stage (stage III, IV) PTMC. The proportion of patients with each stage was significantly different between the groups (p<0.001). However, there was no significantly difference in the stage over 45 years old. Of the 820 patients, 517 were evaluated BRAF(V600E) mutation. There was no difference in prevalence between each group. CONCLUSION: There was no statistically significant difference of clinicopathologic features between the groups, indicating that old age itself was not associated with unfavorable clinicopathologic features in PTMC.
Aged ; Carcinoma ; Carcinoma, Papillary ; Female ; Humans ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Prevalence ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy