This report describes a case of a 55-year-old woman with an incidental leiomyoma arising from her left adrenal gland. Leiomyoma may occur in any part of the body where smooth muscular layers exist; however, the uterus and gastrointestinal tract are the most commonly affected sites. Adrenal leiomyomas are however rarely found in routine clinical examinations or during postmortem examinations. In addition, most leiomyomas are extremely rare, asymptomatic, nonfunctioning adrenal tumors, which are discovered fortuitously during computed tomography scanning (CT) or magnetic resonance imaging (MRI). A laparoscopic operation has been performed in numerous adrenal surgeries; however, laparoscopic resections of adrenal benign leiomyomas are not often reported. We diagnosed a case of a nonfunctional adrenal tumor which was histologically confirmed as a benign leiomyoma. We successfully resected the adrenal tumor using a laparoscopic approach. Moreover, we report this case along with a review of the recent literature.
Adrenal Glands* ; Autopsy ; Female ; Gastrointestinal Tract ; Humans ; Leiomyoma* ; Magnetic Resonance Imaging ; Middle Aged ; Uterus

Ultrasound-guided fine needle aspiration biopsy (USFNA) is a very useful procedure for the diagnosis and management of thyroid diseases. It is very safe procedure and complications have been rarely reported. We experienced a case of an extensive hemorrhage after USFNA of the thyroid nodule in a patient undergoing long-term aspirin therapy. We emphasize that it is very important to obtain a patient history carefully before performing a USFNA.
Aspirin* ; Biopsy* ; Biopsy, Fine-Needle* ; Diagnosis ; Hemorrhage* ; Humans ; Thyroid Diseases ; Thyroid Gland* ; Thyroid Nodule*

In contrast to the intrinsic feedback inhibition defect of primary hyperparathyroidism (HPT), secondary HPT is caused by chronic extrinsic overstimulation of otherwise normal parathyroid glands. This condition is very common in patients with end stage renal disease (ESRD), and secondary HPT develops as a complex sequence of interactions. As the glomerular filtration rate falls, the renal production of 1,23- dihydroxy-vitamin D3 decreases. Moreover, this causes a reduction in intestinal calcium absorption, which creates the parathyroid hormone (PTH) secretion. This secretion increases serum calcium levels by mobilizing calcium from bones. Lastly, the PTH secretion is further stimulated by hyperphosphatemia (via a phosphorous-specific receptor) and a decrease in ionized calcium (from reduced solubility caused by hyperphosphatemia). Intact PTH levels of 500 to 1,500 pg/ml are common (normal: 10~65 pg/ml) in ESRD patients. Long-standing hyperphosphatemia contributes to the alteration of the parathyroid cells, which affect feedback inhibition, due to an increase in ionized calcium. Secondary HPT is mainly controlled by the restriction of phosphate, the inhibition of phosphorous absorption and the supplementation of calcitriol. Secondary HPT, which is unresponsive to medical treatment, it is well known that a total parathyroidectomy and autotransplantation has good results. This report documents our experience with secondary HPT, treated with a total parathyroidectomy and autotransplantation.
Absorption ; Accidental Falls ; Autografts ; Calcitriol ; Calcium ; Glomerular Filtration Rate ; Humans ; Hyperparathyroidism, Primary ; Hyperparathyroidism, Secondary* ; Hyperphosphatemia ; Kidney Failure, Chronic* ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroidectomy ; Solubility ; Transplantation, Autologous

PURPOSE: With an accumulation of surgical experience for endoscopic or video-assisted thyroidectomy and improvements in surgical techniques and endoscopic instruments, these procedures have become a valid option for patients with benign thyroid nodules. These applications are now being expanded even to selected patients with low risk thyroid carcinomas. This study was performed to suggest new modified methods of approach on the use of a gasless endoscopic thyroidectomy via an axillary approach and to evaluate the short-term outcomes. METHODS: Between May 2004 and March 2007, 66 female patients underwent a gasless endoscopic thyroidectomy via an axillary approach. Surgical outcomes were evaluated in terms of surgical time, length of hospital stay, the incidence of perioperative complications, and patient opinion at two and four months after surgery. RESULTS: No cases required conversion to open surgery. The mean surgical time was 136.5±31.8 minutes, and the mean length of hospital stay was 4.2±1.1 days. There were two transient recurrent laryngeal nerve palsies, two minor tracheal injuries without air leakage, and two postoperative hemorrhages that required a second surgery. Only one patient (1.9%) and five patients (9.4%) complained of slight hypesthesia or paresthesia in the neck and anterior chest wall, respectively, and only three patients (5.7%) complained of discomfort while swallowing 4 months after surgery. CONCLUSION: Gasless endoscopic thyroidectomy via an axillary approach is a feasible and safe procedure and providesa minimal degree of postoperative complaints. This procedure is now a valid option for the surgical treatment of benign thyroid disease and its applications will broaden in the near future.
Conversion to Open Surgery ; Deglutition ; Female ; Humans ; Hypesthesia ; Incidence ; Length of Stay ; Neck ; Operative Time ; Paralysis ; Paresthesia ; Postoperative Hemorrhage ; Recurrent Laryngeal Nerve ; Thoracic Wall ; Thyroid Diseases ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy*

PURPOSE: Medullary thyroid cancer (MTC) is a rare disease and the clinical course of MTC many vary. In this study, we analyzed the factors influencing the prognosis of MTC. METHODS: The study group consisted of 37 patients with MTC seen at KNUH between July 1985 and July 2003. We analyzed the medical records of MTC surgical cases in a retrospective study to analyze treatment results and utilized the Kaplan-Meier and chi-squred tests to determine the correlation of prognosis and recurrence. RESULTS: The median age of patients was 39 years and 7 patients had a family history and accompanying disease. No metastases were detected at the time of diagnosis. The majority of the sizes of tumors were under 4 cm in 22 cases and 24 cases (64.9%) showed unilateral tumor locations. Twenty cases (48.6%) showed lymph node metastasis, and invasion of the surrounding organs was seen in 5 cases (13.5%) of these cases. A total thyroidectomy and central neck dissection was performed in all cases. In 17 cases, a modified radical neck dissection was performed initially. Recurrence was detected in 13 out of 37 cases. The most common site of recurrence was the neck, followed by the lung and liver. We analyzed the factors that affected recurrence and it was found that lymph node metastasis and the TNM stage had a statistically significant relationship. No factor showed relevance to prognosis by multivariate analysis. The survival rates were 89.2% for 5 years and 83.8% for 10 years. CONCLUSION: We could not find any statistical significance for a factor relevant to the prognosis of the patients by multivariate analysis. However, as the 10 year-survival rate was 83.8%, we can expect improvement in the treatment of MTC with surgical management (total thyroidectomy and central neck dissection) and constant follow-up.
Diagnosis ; Follow-Up Studies ; Humans ; Liver ; Lung ; Lymph Nodes ; Medical Records ; Multivariate Analysis ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Prognosis ; Rare Diseases ; Recurrence ; Retrospective Studies ; Survival Rate ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

Thyroid nodules are frequently diagnosed today, mainly due to the wide use of neck ultrasonography (US). The majority of these lesions are benign; suspicion for malignancy is an indication for surgery, while benign thyroid nodules may be managed conservatively. There is evidence that a large percentage of patients with thyroid nodules are over-treated. Careful and accurate identification of patients with thyroid nodules that are highly suspicious for an underlying malignancy would allow for a more reasonable therapeutic approach and would result in a reduction of the number of unnecessary thyroidectomies. Fine needle aspiration cytology is currently the most accurate and cost effective diagnostic approach for the evaluation of patients with nodular thyroid disease. Completely asymptomatic nodules require follow-up without treatment. Cosmetic problems or compression related symptoms may be indications for surgery. When surgery is contraindicated or refused, several non-surgical approaches are available. These include levothyroxine therapy, radioiodine treatment, injection of percutaneous ethanol and laser photocoagulation. Levothyroxine therapy is the most widely used approach, but its clinical efficacy and safety are controversial. Treatment with radioiodine is the therapy of choice for toxic nodules or for symptomatic nodular goiters when surgery is not possible. Percutaneous ethanol injection should be used as the first-line therapy for recurrent symptomatic cystic nodules. Laser therapy should be reserved only for selected patients treated in experienced centers. With these options, clinicians can personalize the management of nodular thyroid disease according to a careful cost benefit analysis.
Biopsy, Fine-Needle ; Cost-Benefit Analysis ; Ethanol ; Follow-Up Studies ; Goiter, Nodular ; Humans ; Laser Therapy ; Light Coagulation ; Neck ; Thyroid Diseases ; Thyroid Gland* ; Thyroid Nodule* ; Thyroidectomy ; Thyroxine ; Treatment Outcome ; Ultrasonography

Calcium plays a critical role in neuromuscular excitement and other cellular functions. Therefore, extracellular calcium concentration is maintained within a very narrow range through interaction of calcium regulating hormones such as parathyroid hormone, calcitonin, and vitamin D. Thus, symptomatic severe hypercalcemia has rarely occurred in a clinical situation, particularly in patients with hypoparathyroidism. In general, a large amount of calcium and vitamin D should be supplied in order to avoid hypocalcemia in hypoparathyroid patients. A 63-year old female patient was admitted suffering from nausea, vomiting, and weakness for two weeks. She had a history of total thyroidectomy and subsequent permanent hypoparathyroidism and long-term calcium and vitamin D supplementation. For over 10 years she had not changed her daily amount of calcium and vitamin D intake. Her initial serum calcium was 17.5 mg/dL, creatinine was 2.57 mg/dL, and total CO2 was 33.1 meq/L. After thorough examination, we concluded that milk-alkali syndrome was the cause of severe hypercalcemia. Therefore, special pay attention should be paid to aged patients on calcium supplementation in situations of increased risk of dehydration and renal insufficiency, even though the usual amount of calcium intake was unchanged for several years.
Calcitonin ; Calcium* ; Creatinine ; Dehydration ; Female ; Humans ; Hypercalcemia* ; Hypocalcemia ; Hypoparathyroidism* ; Nausea ; Parathyroid Hormone ; Renal Insufficiency ; Thyroidectomy ; Vitamin D ; Vomiting

PURPOSE: Thyroid papillary carcinoma is the most common endocrine tumor. There are many known factors affecting the pathophysiology of papillary carcinomas. In this study, we attempted to determine the clinical characteristics of papillary carcinomas with other benign pathologies. METHODS: From May 2007 to December 2012, a total of 994 patients underwent thyroidectomy and were diagnosed as papillary carcinomas. Retrospective study was performed using medical records. We categorized them according to five groups depending on associated benign disease, Papillary carcinoma with Graves disease (Group 1), Multinodular goiter (Group 2), Hashimoto thyroiditis (Group 3), Multinodular goiter and Hashimoto thyroiditis (Group 4), and Papillary carcinoma only (Group 5), and we performed a comparison analysis. RESULTS: T and N stage of group 2 were lower than those of group 5 and T stage of group 3 was lower than that of group 4. T and N stage of group 4 were lower than those of group 5 and extrathyroidal extension rate of group 4 was lower than that of group 5. CONCLUSION: Papillary carcinomas have variable clinical characteristics according to underlying benign thyroid disease. Conduct of advanced research regarding the mechanisms of the effect of benign thyroid disease on papillary carcinomas is needed.
Carcinoma, Papillary* ; Goiter ; Graves Disease ; Hashimoto Disease ; Humans ; Medical Records ; Pathology* ; Retrospective Studies ; Thyroid Diseases ; Thyroid Gland ; Thyroidectomy

PURPOSE: The goal of this study was to evaluate the diagnostic accuracy of preoperative fine needle aspiration biopsy cytology (FNAB-C) in predicting lateral lymph node metastasis in papillary thyroid cancer patients. METHODS: A total of 592 patients who underwent thyroid cancer surgery and intra-operative lateral cervical LN frozen section or RND, from January 2002 to December 2011, were evaluated retrospectively. Among them, 228 cases had suspicious findings in FNAB-C of lateral nodes. We reviewed their radiological and pathological reports. RESULTS: Intra-operative frozen section examination was performed in 540 cases and RND was performed in 314 cases. This study included 534 women (83.4%) and 106 men (16.6%). Patients' ranged in age from 9 to 83 years (mean, 45.65 years). FNAB-C was performed in 228 cases. The sensitivity and specificity of FNAB-C was 71.5% and 78.6%, respectively; 35.9% of cases had a false negative result. The combination of FNAB-C and intra-operative frozen section test sensitivity and specificity was 87.2% and 93.6%, respectively. CONCLUSION: The results for sensitivity in FNAB-C actually appear low, and false negative results were very high. In papillary thyroid cancer in patients with FNAB-C, even if the result is negative, if lymph node metastasis is suspected based on radiologic evidence, frozen section examination should be performed for determination of metastasis.
Biopsy ; Biopsy, Fine-Needle ; Female ; Frozen Sections ; Humans ; Lymph Nodes ; Male ; Neoplasm Metastasis* ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Neoplasms*

Injury to the recurrent laryngeal nerve is the most common and serious complication after thyroid surgery. Many different techniques have been described in the literature and interest in intraoperative neuromonitoring (IONM) has increased in an effort to prevent adverse events. IONM implicated for identification of the nerve and evaluation of its function during the operation. Continuous IONM was recently introduced and looks promising for early recognition and safe operation in the end. This paper describes the role of IONM, and its current and future issues.
Recurrent Laryngeal Nerve ; Thyroid Gland* ; Thyroidectomy