Age may be one of the important factors which influence the decision for treatment of thyroid cancer in elderly patients. In addition, although thyroid surgery is generally considered as the procedure with low morbidity, a variety of complications can occur with serious consequences in patients with huge thyroid cancer. We report a case of giant thyroid cancer in elderly patient.
Aged ; Humans ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

As the prevalence of thyroid carcinoma is rapidly increasing, coexisting subtypes of thyroid carcinomas are often found. However, concurrent papillary and medullary carcinomas in the thyroid gland are extremely rare. We report the case of a 50-year-old man with co-occurrence of multiple papillary and medullary thyroid carcinomas; the latter were undetected at initial diagnosis. Sixty-three months after the initial operation performed because of papillary carcinoma diagnosis, a metastatic lymph node was detected in the left level IV region, which was revealed as medullary carcinoma. The histopathologic results from initial surgery were reviewed, and we found multiple coexisting medullary carcinomas that were not identified initially. The incidence of concurrent papillary and medullary thyroid carcinomas will continue to increase as rates of diagnosis of and surgery for thyroid carcinoma increase. Therefore, surgeons and pathologists should be aware of the possible coexistence of subtypes of thyroid carcinomas to avoid missing concurrent lesions.
Carcinoma, Medullary ; Carcinoma, Papillary ; Incidence ; Lymph Nodes ; Prevalence ; Thyroid Gland ; Thyroid Neoplasms

The most common thyroid dysfunctions that occur after delivery are postpartum thyroiditis (PPT) and Graves' disease (GD). PPT is more likely to occur among patients who had a history of PPT or GD. For that reason, it is possible to assume that both PPT and GD occur concomitantly after delivery. Here we report two cases of atypical postpartum thyroid dysfunctions presenting the simultaneous occurrence of PPT and GD. A 31-year-old woman with history of PPT had thyrotoxicosis and hypothyroidism of PPT followed by GD with mild symptoms. The patient recovered quickly afterwards. In the second case, a 28-year-old woman with a history of GD presented with thyrotoxicosis of PPT followed by severe GD. The patient required long-term antithyroid treatment.
Female ; Graves Disease ; Humans ; Hypothyroidism ; Postpartum Period ; Postpartum Thyroiditis ; Thyroid Gland ; Thyrotoxicosis

The incidence of thyroid cancer has been increasing in Korea as well as in many countries. This is mainly due to the early detection of papillary thyroid microcarcinoma less than 1 cm in diameter with a high-resolution ultrasonography. Because of the unique Korean medical environment, its incidence is abruptly increasing in Korea. Many experts have emphasized that the early detection cannot completely explain the observed increase in thyroid cancer. Therefore, other possible explanations should be explored. Unnecessary diagnosis and excessive treatment should be avoided. If unreasonable regulations are applied, they could do more harm than good. In terms of screening efficacy, the National Evidence-based Healthcare Collaborating Agency in conjunction with Korean Thyroid Association concluded in 2013 that evidence was insufficient to recommend for or against ultrasonography screening for thyroid cancer. If a patient incidentally finds a tumor on the thyroid, a physician should manage the patient according to the guidelines. The guidelines should be developed based on evidence-based medical decisions for patients, not on economic efficacy.
Delivery of Health Care ; Diagnosis ; Humans ; Incidence ; Korea ; Mass Screening ; Social Control, Formal ; Thyroid Gland ; Thyroid Neoplasms* ; Ultrasonography

BACKGROUND AND OBJECTIVES: The relationship between short-term hypothyroidism due to levothyroxine (LT4) withdrawal for radioactive iodine (RI) therapy in patients with differentiated thyroid cancer (DTC) and risk of cardiovascular disease is not clear. In this study, we evaluated the impact of short-term overt hypothyroidism on lipid profiles and cardiovascular parameters in patients with DTC. MATERIALS AND METHODS: We recruited 195 patients with DTC who were preparing RI therapy from March 2008 to February 2012. We analyzed the effect of thyroid stimulating hormone (TSH) level on the clinical, biochemical, and cardiovascular risk markers at the end of LT4 withdrawal protocol (P2). RESULTS: After LT4 withdrawal (P2), TSH and total cholesterol (TC) levels were significantly increased (p<0.005). After adjustment for multiple factors such as age, sex, body mass index (BMI), hypertension and diabetes mellitus (DM), the positive relationship between TSH and TC remained significant (p=0.04). Mean levels of homocysteine, low density lipoprotein-cholesterol, triglyceride were increased. However, levels of high density lipoprotein-cholesterol, cystatin C, C-reactive protein, apolipoprotein B (ApoB), apolipoprotein A1 (Apo A1), lipoprotein (a) (Lp[a]), aspartate transaminase, alanine aminotransferase, total bilirubin, uric acid remained within normal range. Splitting the whole cohort into the three different age groups, serum Apo B, Lp(a) levels and BMI increased with increasing age (p<0.05). And splitting into three different TSH level groups (1st group; <79 microIU/mL, 2nd group; 79-121 microIU/mL, 3rd group; >121 microIU/mL), all values did not have a statistical significant meaning except Apo A1. CONCLUSION: Short-term hypothyroidism induced worsening of lipid metabolic parameters, but not enough to induce the cardiovascular risk in patients with thyroid cancer.
Alanine Transaminase ; Apolipoprotein A-I ; Apolipoproteins ; Apolipoproteins B ; Aspartate Aminotransferases ; Bilirubin ; Body Mass Index ; C-Reactive Protein ; Cardiovascular Diseases ; Cholesterol ; Cohort Studies ; Cystatin C ; Diabetes Mellitus ; Homocysteine ; Humans ; Hypertension ; Hypothyroidism ; Iodine* ; Lipoprotein(a) ; Reference Values ; Thyroid Neoplasms ; Thyrotropin ; Thyroxine ; Triglycerides ; Uric Acid

BACKGROUND AND OBJECTIVES: The incidence of thyroid cancer has been increasing in Korea as well as in other countries. The majority of thyroid cancers are papillary thyroid carcinomas and follicular thyroid carcinomas, both of which are classified as differentiated thyroid carcinoma (DTC). Total or near-total thyroidectomy followed by administration of radioactive iodine (RAI) constitutes the initial treatment for DTC. This study was conducted to investigate the therapeutic modalities of surgery and RAI for the treatment of DTC in Korea using claims data provided by the Health Insurance Review and Assessment Service. MATERIALS AND METHODS: This study was performed in 170,131 (men 29,002, women 141,129) Korean patients with thyroid cancer treated from January 2008 to December 2012. Patients with past history of thyroid cancer prior to 2008 were not included. RESULTS: Total or near total thyroidectomy was done in 83.4%, lobectomy in 14.4%, and subtotal thyroidectomy in 2.2%. Postoperative RAI treatment was performed in 52.7%. Median 100 mCi of RAI was administered at median 89 days after operation, and it was completed with one dose in 66.0%. Thirty mCi was mostly preferred as an initial dose in 35.6%, and subsequently 150 mCi in 25.7%, 100 mCi in 17.5%, and more than 150 mCi in 10.1%. Median cumulative RAI dose was 130 mCi. RAI treatment rate was decreasing during recent 5 years. CONCLUSION: This is the first nationwide report to investigate the therapeutic modalities of surgery and RAI for the treatment of DTC in Korea.
Adenocarcinoma, Follicular ; Female ; Humans ; Incidence ; Insurance, Health ; Iodine ; Korea ; Thyroid Gland ; Thyroid Neoplasms* ; Thyroidectomy

BACKGROUND AND OBJECTIVES: The incidence of thyroid cancer is increasing worldwide. The increase in the frequency of screening tests may have led to an over-detection of small thyroid cancers. The Korean Thyroid Association (KTA) discourages the find needle aspiration of thyroid nodules < or =0.5 cm. The aim of this study was to evaluate time trends of characteristics of thyroid cancer patients in a single medical center. MATERIALS AND METHODS: This study included 15,465 patients who underwent operation due to thyroid cancer from 1995 to 2012. Data on age, gender of patients and histology, clinical stage of the thyroid cancer were reviewed retrospectively. RESULTS: New thyroid cancer cases have dramatically increased and papillary thyroid carcinoma (PTC) accounted for a major part of this increase. PTCs were accounted for 98% of all thyroid cancer surgeries in 2012 and 79% in 1995. The proportion of PTCs < or =0.5 cm has increased from 1% in 1995 to 32% in 2009 and then slightly decreased afterward. The peak age of patients with PTC has increased from 40 years in 1995-2000 to 55 years in 2006-2012. The proportion of small follicular thyroid carcinomas and medullary thyroid carcinomas (< or =1.0 cm) also steadily increased during study periods. CONCLUSION: Thyroid cancers became smaller but, increase of very small PTCs stopped after 2010, in which the KTA guidelines were introduced. These findings suggest that the increasing incidence of thyroid cancer in Korea might be due to the over-detection of small thyroid cancers.
Adenocarcinoma, Follicular ; Epidemiology ; Humans ; Incidence ; Korea ; Mass Screening ; Needles ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms* ; Thyroid Nodule

After thyroid surgery, voice change occurs very frequently, in more than 30% of cases. In addition to injury to the recurrent laryngeal nerve (RLN) or the external branch of superior laryngeal nerve (EBSLN), vocal fold edema due to excessive tracheal traction or disrupted laryngeal venous drainage, and laryngotracheal fixation following injury to extralaryngeal musculature can cause post-thyroidectomy voice change. Although complete recovery can be expected mostly in 3 months, dysphonic patients should be evaluated pre and postoperatively by laryngoscopy or laryngeal stroboscopy. The present review discusses the evaluation of voice change, the anatomy of RLN and EBSLN and common cause of voice change after thyroid surgery. Furthermore, we represent how to preserve RLN, SLN including intraoperative nerve monitoring.
Drainage ; Edema ; Humans ; Laryngeal Nerves* ; Laryngoscopy ; Recurrent Laryngeal Nerve ; Stroboscopy ; Thyroid Gland ; Thyroidectomy ; Traction ; Vocal Cords ; Voice*

Hypoparathyroidism after thyroidectomy occurs as a result of devascularization or unintentional resection of the parathyroid glands. To preserve parathyroid glands, surgeons have to know well about their embryology and anatomy. The parathyroid glands vary in number, size, shape, and color. Because of more variable migration path in the neck, the inferior parathyroid glands are more widely distributed than the superior glands. The upper parathyroid glands are dorsal and the lower parathyroid glands are ventral to the coronal plane of recurrent laryngeal nerve path. Positional symmetry of superior or inferior parathyroid glands is found in approximately 70-80%. Each parathyroid gland has its own end-artery. Both the superior and inferior parathyroid glands most frequently receive blood supply from the inferior thyroid artery. Parathyroid exploration requires a meticulous and bloodless dissection with help of surgical loupes. During the superior pole dissection, every attempt should be made to dissect the gland posteriorly off the thyroid with preserving the posterior branch of the superior thyroid artery. Dissection of the lateral lobe is best achieved by capsular dissection. The tertiary branches of the inferior thyroid artery lying on the thyroid capsule are individually ligated and divided. The surgeon can also utilize positional symmetry of the parathyroid glands. If the parathyroid gland is clearly devascularized or turns deep black, it should be biopsied, confirmed as normal parathyroid tissue, and reimplanted. It is useful to search for unintentionally resected parathyroid tissue in the surgical specimen for autotransplantation at the end of the operation.
Arteries ; Autografts ; Deception ; Embryology ; Hypoparathyroidism ; Neck ; Parathyroid Glands* ; Recurrent Laryngeal Nerve ; Thyroid Gland* ; Thyroidectomy

Considering the relatively good prognosis of papillary thyroid carcinoma, surgical treatment should be conducted with an adequate method and extent of surgery with minimal complications. The optimal indications and extent of central neck dissection in papillary thyroid carcinoma has been introduced by variable guidelines. However, there have been controversies in several aspects regarding central neck dissection (i.e., prophylactic versus therapeutic, unilateral versus bilateral), which will remain until a large prospective study is completed. Successful management of cervical lymph node metastasis in papillary thyroid carcinoma requires thorough preoperative evaluation, knowledge on adequate indications and extent of surgery and considerations on surgical anatomy. In this article, we reviewed the rationales for optimal central neck dissection in papillary thyroid carcinoma based on recent studies and presented the surgical strategy and skills based on personal experience of a single surgeon.
Humans ; Lymph Nodes ; Neck Dissection* ; Neoplasm Metastasis ; Prognosis ; Thyroid Neoplasms*