These guidelines aim to establish the standard practice for diagnosing and treating patients with differentiated thyroid cancer (DTC). Based on the Korean Thyroid Association (KTA) Guidelines on DTC management, the “Treatment of Advanced DTC” section was revised in 2024 and has been provided through this chapter. Especially, this chapter covers surgical and nonsurgical treatments for the local (previous surgery site) or regional (cervical lymph node metastasis) recurrences. After drafting the guidelines, it was finalized by collecting opinions from KTA members and related societies. Surgical resection is the preferred treatment for local or regional recurrence of advanced DTC. If surgical resection is not possible, nonsurgical resection treatment under ultrasonography guidance may be considered as an alternative treatment for local or regional recurrence of DTC. Furthermore, if residual lesions are suspected even after surgical resection or respiratory-digestive organ invasion, additional radioactive iodine and external radiation treatments are considered.

Differentiated thyroid cancer demonstrates a wide range of clinical presentations, from very indolent cases to those with an aggressive prognosis. Therefore, diagnosing and treating each cancer appropriately based on its risk status is important. The Korean Thyroid Association (KTA) has provided and amended the clinical guidelines for thyroid cancer management since 2007. The main changes in this revised 2024 guideline include 1) individualization of surgical extent according to pathological tests and clinical findings, 2) application of active surveillance in low-risk papillary thyroid microcarcinoma, 3) indications for minimally invasive surgery, 4) adoption of World Health Organization pathological diagnostic criteria and definition of terminology in Korean, 5) update on literature evidence of recurrence risk for initial risk stratification, 6) addition of the role of molecular testing, 7) addition of definition of initial risk stratification and targeting thyroid stimulating hormone (TSH) concentrations according to ongoing risk stratification (ORS), 8) addition of treatment of perioperative hypoparathyroidism, 9) update on systemic chemotherapy, and 10) addition of treatment for pediatric patients with thyroid cancer.

The primary objective of initial treatment for thyroid cancer is minimizing treatment-related side effects and unnecessary interventions while improving patients’ overall and disease-specific survival rates, reducing the risk of disease persistence or recurrence, and conducting accurate staging and recurrence risk analysis. Appropriate surgical treatment is the most important requirement for this purpose, and additional treatments including radioactive iodine therapy and thyroid-stimulating hormone suppression therapy are performed depending on the patients’ staging and recurrence risk. Diagnostic surgery may be considered when repeated pathologic tests yield nondiagnostic results (Bethesda category 1) or atypia of unknown significance (Bethesda category 3), depending on clinical risk factors, nodule size, ultrasound findings, and patient preference. If a follicular neoplasm (Bethesda category 4) is diagnosed pathologically, surgery is the preferred option. For suspicious papillary carcinoma (suspicious for malignancy, Bethesda category 5), surgery is considered similar to a diagnosis of malignancy (Bethesda category 6). As for the extent of surgery, if the cancer is ≤1 cm in size and clinically free of extrathyroidal extension (ETE) (cT1a), without evidence of cervical lymph node (LN) metastasis (cN0), and without obvious reason to resect the contralateral lobe, a lobectomy can be performed. If the cancer is 1-2 cm in size, clinically free of ETE (cT1b), and without evidence of cervical LN metastasis (cN0), lobectomy is the preferred option. For patients with clinically evident ETE to major organs (cT4) or with cervical LN metastasis (cN1) or distant metastasis (M1), regardless of the cancer size, total thyroidectomy and complete cancer removal should be performed at the time of initial surgery. Active surveillance may be considered for adult patients diagnosed with low-risk thyroid papillary microcarcinoma. Endoscopic and robotic thyroidectomy may be performed for low-risk differentiated thyroid cancer when indicated, based on patient preference.

PURPOSE: The purpose of this study was to compare mechanical and physical properties of injection-molded thermoplastic denture base resins. MATERIALS AND METHODS: In this study, six commercially available products (VA; Valplast, LC; Lucitone, ST; Smiltone, ES; Estheshot-Bright, AC; Acrytone, WE; Weldenz) were selected from four types of thermoplastic denture base materials (Polyamide, Polyester, Acrylic resin and Polypropylene). The flexural properties and shore D hardness have been investigated and water sorption and solubility, and color stability have evaluated. RESULTS: For the flexural modulus value, ES showed the highest value and WE showed significantly lower value than all other groups (P < .05). Most of experimental groups showed weak color stability beyond the clinically acceptable range. CONCLUSION: Within the limits of this study, thermoplastic denture base resin did not show sufficient modulus to function as a denture base. In addition, all resins showed discoloration with clinical significance, and especially polyamides showed the lowest color stability.
Denture Bases ; Dentures ; Hardness ; Nylons ; Polyesters ; Solubility ; Water

OBJECTIVE: To compare the results of electrodiagnostic studies with the severity of disc herniation, measured digitally by picture archiving and communication system (PACS) from the images of magnetic resonance imaging (MRI). METHOD: MRI images were reviewed from thirty two patients who were diagnosed electrodiagnostically as unilateral S1 radiculopathy. Areas of herniated disc and spinal canal were measured and the ratio of disc herniation was calculated from the axial images stored and analyzed by PACS. The radiologic measurements were compared with the results of electrodiagnostic studies. RESULTS: The presence of abnormal spontaneous activities in needle EMG and no response in H reflex were associated with larger disc herniation (p<0.05). There was no other single electrodiagnostic study that showed correlation with any of radiologic measurements. With increasing number of abnormal electrodiagnostic tests, area of disc herniation grew larger (p<0.05). Area of spinal canal and the ratio of disc herniation did not show difference between normal and abnormal groups in most of electrodiagnostic studies. CONCLUSION: There were limited correlations between electrodiagnostic results and severity of disc herniation. The size of disc herniation, regardless of the size of spinal canal, was associated with abnormal results of electrodiagnostic tests.
Electromyography ; H-Reflex ; Humans ; Intervertebral Disc ; Intervertebral Disc Displacement ; Magnetic Resonance Imaging ; Needles ; Radiculopathy ; Spinal Canal

OBJECTIVE: To know whether nerve conduction study (NCS) could predict later development of carpal tunnel syndrome (CTS) in asymptomatic hands of the patients with unilateral CTS. METHOD: Thirty four patients with unilateral CTS were studied. Subjects were divided into groups with or without the delay of latency, based on the results of initial NCS of asymptomatic hands. After follow up for more than 6 months clinically and electrodiagnostically, the development of CTS in initially asymptomatic hands was compared between groups. RESULTS: At follow up, CTS was diagnosed in 83% of the subjects in the group with motor latency delay at first study, while it was diagnosed in 32% of the subjects in the group without motor latency delay. In the group with sensory latency delay at first study, CTS was diagnosed in 78% of subjects at follow up, whereas only 19% of the subjects developed CTS in the group without sensory latency delay. The incidence of CTS at follow up was significantly higher in the group with motor or sensory latency delay at first study. CONCLUSION: In unilateral CTS, latency delay in motor or sensory NCS of asymptomatic hands may suggest a greater risk of later development of CTS.
Carpal Tunnel Syndrome* ; Follow-Up Studies* ; Hand* ; Humans ; Incidence ; Neural Conduction

Pharyngeal involvement of tuberculosis is rare and is seen only in massive sputum positive patients with cavitating pulmonary tuberculosis. The pharyngeal lesions are secondary to aspiration of heavily infected sputum from lung and consist of painful shallow ulcers in pharynx. Chronic sore throat and unexplained dysphagia should alert the clinician to possibility of tuberculosis, especially in the countries where tuberculosis is endemic. We report two cases of pharyngeal tuberculosis with pulmonary tuberculosis, one of which has concurrent laryngeal and intestinal tuberculosis. Histological and bacteriological examinations established the diagnosis of pharyngeal tuberculosis associated with pulmonary focus.
Deglutition Disorders ; Diagnosis ; Humans ; Lung ; Pharyngitis ; Pharynx ; Sputum ; Tuberculosis* ; Tuberculosis, Pulmonary* ; Ulcer

Pharyngeal involvement of tuberculosis is rare and is seen only in massive sputum positive patients with cavitating pulmonary tuberculosis. The pharyngeal lesions are secondary to aspiration of heavily infected sputum from lung and consist of painful shallow ulcers in pharynx. Chronic sore throat and unexplained dysphagia should alert the clinician to possibility of tuberculosis, especially in the countries where tuberculosis is endemic. We report two cases of pharyngeal tuberculosis with pulmonary tuberculosis, one of which has concurrent laryngeal and intestinal tuberculosis. Histological and bacteriological examinations established the diagnosis of pharyngeal tuberculosis associated with pulmonary focus.
Deglutition Disorders ; Diagnosis ; Humans ; Lung ; Pharyngitis ; Pharynx ; Sputum ; Tuberculosis* ; Tuberculosis, Pulmonary* ; Ulcer

An 82-year-old female non-smoker with a history of hypertension presented with increasing dyspnea, cough and some purulent sputum without fever. Upon admission, the patient was in a distressed condition. Auscultation revealed diminished breath sounds with no rales over the right lung. An examination of the heart revealed a regular rhythm and a systolic murmur radiating from the apex of the heart. There was no pitting edema in the lower extremities. The blood tests showed mild leukocytosis and an increased C-reactive protein level. The O2 saturation was 98 % whilst breathing room air. The electrocardiogram demonstrated sinus tachycardia. The chest radiograph showed a moderate cardiomegaly, right lobe infiltrates, and blunting of the both costophrenic sulcus suggesting a small pleural effusion. Three days after admission, the symptoms became slightly aggravated despite being treated with empirical antibiotics for presumed community-acquired pneumonia. Transthoracic color Doppler echocardiography indicated an ejection fraction of 48 %, mild left ventricular enlargement, and moderate left atrial enlargement resulting in severe mitral regurgitation. The clinical symptoms and right pulmonary edema resolved quickly with intravenous furosemide treatment.
Aged, 80 and over ; Anti-Bacterial Agents ; Auscultation ; C-Reactive Protein ; Cardiomegaly ; Cough ; Dyspnea ; Echocardiography, Doppler, Color ; Edema ; Electrocardiography ; Female ; Fever ; Furosemide ; Heart ; Hematologic Tests ; Humans ; Hypertension ; Leukocytosis ; Lower Extremity ; Lung ; Mitral Valve Insufficiency* ; Pleural Effusion ; Pneumonia ; Pulmonary Edema* ; Radiography, Thoracic ; Respiration ; Respiratory Sounds ; Sputum ; Systolic Murmurs ; Tachycardia, Sinus

OBJECTIVE: To provide more useful guidelines for methotrexate (MTX) treatment in ectopic pregnancy, including patient selection, therapeutic dose, and reproductive outcome. METHODS: Retrospectively, records of 54 patients treated for ectopic pregnancy with systemic MTX were reviewed. MTX was administered 1.0 mg/kg intramuscularly, alternatively with leucovorin 0.1 mg/kg intramuscularly for up to four daily doses of each drug. Samples for beta-hCG detection were obtained on days +3, +7 after beginning of the therapy and then weekly until values were undetectable. RESULTS: 50 patients (92.6%) were treated successfully. 4 patients (7.4%) for whom MTX therapy failed, were treated surgically. The endometrial thickness significantly increased in the failed group, compared to the successful group (14.3+/-4.0 mm vs 7.0+/-2.8 mm, P=0.0001). The serum hemoglobin levels significantly changed in the failed group, compared to the successful group (2.1+/-0.9 g/dL vs 1.0+/-0.8 g/dL, P=0.044). Patients were divided into increasing group and decreasing group according to beta-hCG levels on day 0, that were higher or lower than day -2 level. The resolution time of beta-hCG between increasing group and decreasing group was significantly different (27.6+/-14.0 days vs 17.7+/-8.6 days, p=0.016). In 8 patients (15.1%), an immediate rise of beta-hCG was recorded on day 3 after MTX treatment, but on day 7, a rapid decrease was recorded. Women were treated with significantly different therapeutic dose of MTX according to initial level of serum beta-hCG (p=0.021). There were mild complications (12%). MTX treatment preserved the fallopian tube and thus preserved fertility (70%). CONCLUSION: Systemic MTX use with the dose according to initial level of serum beta-hCG is a safe and highly effective treatment in clinically stable ectopic pregnancy.
Fallopian Tubes ; Female ; Fertility ; Humans ; Leucovorin ; Methotrexate* ; Patient Selection ; Pregnancy ; Pregnancy, Ectopic* ; Retrospective Studies