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Milk-Alkali Syndrome in a Patient with Postoperative Hypoparathyroidism During Long-Term Maintenance of Calcium Supplementation.

Cheol Su KIM ; Bukyung KIM ; Young Sik CHOI ; Yo Han PARK ; Su Kyoung KWON

Korean Journal of Endocrine Surgery.2014;14(2):85-88. doi:10.16956/kjes.2014.14.2.85

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

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Clinical Characteristics of Papillary Carcinomas with Other Benign Pathologies.

Sungyi KANG ; Jin Woo PARK ; Dongju KIM

Korean Journal of Endocrine Surgery.2014;14(2):81-84. doi:10.16956/kjes.2014.14.2.81

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

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In Thyroid Cancer Patients, Is Preoperative FNAB-C Reliable for Prediction of Lateral Cervical LN Metastasis?.

Su Han SEO ; Jung Hun LEE ; Euy Young SOH

Korean Journal of Endocrine Surgery.2014;14(2):76-80. doi:10.16956/kjes.2014.14.2.76

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*

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The Present and Future of Intraoperative Neuromonitoring in Thyroid Surgery.

Hee Yong KWAK ; Hoon Yub KIM

Korean Journal of Endocrine Surgery.2014;14(2):67-75. doi:10.16956/kjes.2014.14.2.67

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

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Primary Ectopic Mediastinal Goiter Combined with Papillary Microcarcinoma of the Cervical Thyroid Gland.

Sa Min HONG ; Jin Gu BONG ; Cheong Hyun BANG ; Mi Jeong SHIN ; Hyun Ok KIM

Korean Journal of Endocrine Surgery.2006;6(1):50-54. doi:10.16956/kjes.2006.6.1.50

True primary mediastinal ectopic goiters are quite rare, and they occur in less than 1% of all goiters. We report here on a case in which a primary mediastinal ectopic goiter was accompanied with papillary microcarcinoma of the cervical thyroid. The mediastinal ectopic goiter was not connected to the cervical thyroid and its blood was supplied from intrathoracic vessels, which necessitated a thoracotomy or sternotomy for removal rather than a standard cervical collar incision. We performed total thyroidectomy for the papillary microcarcinoma of the cervical thyroid gland and transsternal removal for the mediastinal goiter; this resulted in a favorable outcome.
Goiter* ; Sternotomy ; Thoracotomy ; Thyroid Gland* ; Thyroidectomy

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Spine Metastases as the Initial Sign of Differentiated Thyroid Carcinoma: Two Case Reports.

Kuk Jin KIM ; Jandee LEE ; Ji Sup YUN ; Chi Young LIM ; Kee Hyun NAM ; Hang Seok CHANG ; Woong Youn CHUNG ; Cheong Soo PARK

Korean Journal of Endocrine Surgery.2006;6(1):46-49. doi:10.16956/kjes.2006.6.1.46

Bone metastases as the first manifestation of thyroid carcinoma are extremely rare. Interestingly, evaluation at appropriate initials and proper treatment will lead to satisfactory long-term survival. We report here on two such cases; the patients presented with back pain and fine needle aspiration cytology of spine lesion revealed a metastatic carcinoma. A wide excision of the bone lesion was carried out and the histopathology was consistent with features of metastatic carcinoma of the thyroid. The management of thyroid carcinoma and the subsequent bone metastases is reviewed and the controversial points are highlighted.
Back Pain ; Biopsy, Fine-Needle ; Humans ; Neoplasm Metastasis* ; Spine* ; Thyroid Gland* ; Thyroid Neoplasms*

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A Case of Thyroid Hematoma Complicated with Unexpected Airway Obstruction by Blunt Cervical Trauma.

Yu Mi RA ; Sang Eok LEE ; In Seok CHOI ; Won Jun CHOI ; Hyun Sik MIN ; Dae Sung YOON

Korean Journal of Endocrine Surgery.2010;10(1):39-41. doi:10.16956/kjes.2010.10.1.39

Traumatic thyroid hematoma is a rare problem in cases of blunt trauma, but it can be a life-threatening condition. We report here on a case of thyroid hematoma that was complicated with unexpected airway obstruction due to blunt trauma on the anterior neck. A 23-year-old man who developed neck painful swelling and dyspnea was admitted to the emergency room with a blunt neck injury after motor-bicycle accident, and he hit his anterior neck against the handle-bar. He had no previous thyroid pathology and other medical problems. On the initial examination, his vital signs were stable and the oxygen saturation was 97.8%. A computed tomography (CT) scan of the neck showed fragmentation and extensive hematoma within the right thyroid gland and dislocation of the trachea. No definite bleeding focus was identified on the angiography that was done through the carotid artery. Two hours later, the patient experienced sudden respiratory distress and the oxygen saturation dropped rapidly. The patient needed emerg encyendotracheal intubation and surgical intervention. He successfully underwent right lobectomy of the thyroid gland, and was discharged on the 6th hospital day without any complications. The thyroid function was normal after 3 months.
Airway Obstruction* ; Angiography ; Carotid Arteries ; Dislocations ; Dyspnea ; Emergency Service, Hospital ; Hematoma* ; Hemorrhage ; Humans ; Intubation ; Neck ; Neck Injuries ; Neck Pain ; Oxygen ; Pathology ; Thyroid Gland* ; Trachea ; Vital Signs ; Young Adult

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Fifteen Years or Greater Follow-Up of Pediatric Differentiated Thyroid Cancer.

A Ram KIM ; Chi Won SUNG ; Young Sam PARK ; Cheol Seung KIM ; Kab Tae KIM

Korean Journal of Endocrine Surgery.2010;10(1):34-38. doi:10.16956/kjes.2010.10.1.34

PURPOSE: Thyroid cancer is rare in childhood. Although thyroid cancer is biologically more aggressive in children because of the high incidence of lymph node metastasis and distant metastasis when compared with that of adults, the prognosis is better. This study investigated the prognosis of pediatric differentiated thyroid cancer with 15 years or greater follow-up and we consider the proper treatment of pediatric differentiated thyroid cancer. METHODS: From January, 1979 to December, 1994 during 16 years, 17 patients younger than 17 years old and who underwent thyroid surgery for well differentiated thyroid cancer at the Department of Surgery at Presbyterian Medical Center were retrospectively reviewed by the medical records and they were interviewed by telephone. RESULTS: Total thyroidectomy was performed in 4 patients (23.5%), subtotal thyroidectomy was performed in 10 patients (58.8%) and lobectomy was performed in 3 patients (17.7%). The mean follow-up period was 23.5 years (range: 15~28.2 years) and recurrence was found in 7 cases (41.3%). Five cases (29.5%) showed locoregional recurrence and 2 cases (11.8%) showed distant metastasis. Postoperative radioiodine (¹³¹I) therapy was done in 6 cases (35%) and 6 cases (35%) underwent radioiodine therapy as a therapeutic modality for metastasis. CONCLUSION: The pediatric well differentiated thyroid cancer in this study showed high rates of lymph node metastasis at the time of diagnosis and a high recurrence rate, but the prognosis was good (100% overall survival rate during the follow-up period). Therefore, total thyroidectomy, radical lymph node dissection and postoperative radioiodine therapy are considered the initial patient management. This aggressive therapeutic management can decrease of the recurrence rate and increase the therapeutic effect. A radioiodine scan and thyroglobulin can used for follow-up.
Adult ; Child ; Diagnosis ; Follow-Up Studies* ; Humans ; Incidence ; Lymph Node Excision ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Protestantism ; Recurrence ; Retrospective Studies ; Survival Rate ; Telephone ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

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Is Hashimoto's Thyroiditis Associated with the Prognostic Factors of Papillary Thyroid Carcinoma?.

Min Joo LEE ; Byoung Kil LEE ; Hyun Jo YOUN ; Sung Hoo JUNG

Korean Journal of Endocrine Surgery.2010;10(1):29-33. doi:10.16956/kjes.2010.10.1.29

PURPOSE: In recent studies, the presence of lymphocytic infiltration in patients with papillary thyroid carcinoma (PTC) was reported to be associated with a favorable prognosis. The prognostic significance of Hashimoto's thyroiditis (HT) in patients with PTC remains unclear. The aim of our study was to determine the frequency and prognostic significance of HT in patients with PTC. METHODS: From January 2005 to December 2007, 367 patients who underwent thyroid surgery for PTC were included in this study. They were divided into two groups: Group A (n=71; 19.4%) included the patients diagnosed as having PTC with HT and Group B (n=296; 80.6%) included the patients who had PTC without HT. The clinicopathologic features between Groups A and B were retrospectively reviewed via the medical records. RESULTS: Lymph node metastasis was less frequent in Group A than that in Group B (25.5% versus 41.0%, respectively, P=0.033). However, both groups had similar clinicopathologic features in terms of age, gender, the tumor size, multifocality, extrathyroidal invasion, the TNM stage and the AMES and MACIS scores. Also, the operative method did not differ significantly between the two groups. CONCLUSION: These results suggest that the presence of HT is not associated with the prognostic factors of PTC.
Humans ; Lymph Nodes ; Medical Records ; Methods ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroiditis*

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Analysis of the Clinicopathologic Characteristics of Multifocal Papillary Thyroid Carcinoma.

Min Wuk LEE ; Tae Kwun HA ; Sung Mock RYU ; Sang Hyo KIM

Korean Journal of Endocrine Surgery.2010;10(1):24-28. doi:10.16956/kjes.2010.10.1.24

PURPOSE: Papillary thyroid carcinoma (PTC) is the most common malignancy that develops from the thyroid gland and its prognosis is quite excellent. One of the characteristic behaviors of PTC is that it often occurs at multiple foci. The purpose of this study was to investigate the clinicopathologic features and risk factors of multifocal papillary thyroid cancer. METHODS: A retrospective review was carried out on 624 patients with PTC and who underwent surgery from January 2005 to December 2007. Two hundred twenty-nine of them were found to have multiple tumor foci (≥2 foci). The risk factors that included gender, age at diagnosis, tumor size, capsular invasion, extrathyroidal extension (ETE), cervical lymph node (LN) involvement, the TNM classification, local recurrence and distant metastasis were comparatively analyzed between the solitary PTC and multifocal PTC groups. RESULTS: The enrolled patients were 59 male and 565 females. The mean age was 46 years (range: 15~77 years). Age (P=0.025), tumor size (P=0.027), capsular invasion (P<0.001), ETE (P<0.001) and cervical LN metastasis (P=0.002) were the significantly related factors for multifocal papillary thyroid cancer. However, gender was not significantly related with multifocality. CONCLUSION: The results of this study showed that multifocal tumors were significantly associated with age, tumors size, capsular invasion, ETE and cervical LN metastasis in patients with PTC. LN metastasis was mostly influenced by multifocality in the PTC patients. It seems certain that total thyroidectomy and formal central node dissection with postoperative adjuvant therapy are essential treatment for these patients, and closely surveying the nodal status is needed on the follow up of patients with multifocal PTC.
Classification ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

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