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Vascular Endothelial Growth Factor in Cystic Fluid of Degenerative Cysts of Thyroid and Its Significance of Reaccumulation of Cystic Fluid Following Aspiration.

Eun Ho CHO ; Hee Boong PARK ; Hyun Man KIM ; Kwan Woo LEE ; Yun Suk JUNG ; Euy Young SOH

Korean Journal of Endocrine Surgery.2002;2(1):25-30. doi:10.16956/kjes.2002.2.1.25

PURPOSE: VEGF, a potent angiogenic factor, increases vascular permeability and induces the fluid accumulation in the peritoneal and pleural cavities. This study is designed to know whether the VEGF concentration are associated with the formation of cystic fluid of thyroid nodules and the results of treatment. METHODS: To know whether thyroid follicular cells produce VEGF, we measured the VEGF concentration in the conditioned medium after primary culture of the normal thyroid follicular cells (NT 1.0). Thirty seven patients, who had visited Ajou University Medical Center, were divided into two groups; group A (n=19) is patients whose cystic nodules disappeared completely with 1 or 2 times fine needle aspirations. In Group B (n=18), the cystic nodules recurred rapidly and required aspiration more than 3 times. Clinical records of patients were analyzed and compared with TSH and VEGF levels in cystic fluids. RESULTS: The VEGF concentration in basal conditioned medium were 8.2±1.2 ng/ml in NT 1.0 and 8.2±0.6 ng/ml in thyroid cancer cell line (FTC-133). NT 1.0 was not affected by TSH stimulation. Mean concentration of TSH of all cystic fluids was 4.36µIU/ml (0.13~21.7) and there was no difference between 2 groups. Mean concentration of VEGF of all cystic fluids was 140.7 ng/ml (11.1~688.8). The VEGF concentration (287.9±289.6 ng/ml) in group B was significantly higher than that (104.2±97.1 ng/ml) in group A (P<0.05). CONCLUSION: This study suggests that thyroid follicular cells produce and secrete VEGF, and VEGF is related with the accumulation of cystic fluid in degenerative cysts of thyroid. Cysts with high VEGF concentration promote rapid reaccumulation of the cystic fluid and possibly necessitate operation in selected patients.

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A Clinical Analysis of Differentiated Thyroid Cancer.

Sung Hoo JUNG

Korean Journal of Endocrine Surgery.2002;2(1):19-24. doi:10.16956/kjes.2002.2.1.19

PURPOSE: Thyroid cancer is the most common endocrine malignancy, and it has a wide spectrum of biologic behavior, histologic appearance, and management. This study reviewed various aspects of the clinical features of differentiated thyroid cancer. METHODS: We retrospectively reviewed the clinical characteristics of 114 patients who had undergone surgical management for differentiated thyroid cancer at the Chonbuk National University Hospital from September 1989 to December 1997. RESULTS: The most prevalent age group was in the 5th decade (29 cases, 25.4%). The male-to-female ratio was 1 to 5.7. The most common initial symptom was a palpable mass on the anterior or the lateral portion of the neck (110 cases, 96.5%). The most common duration of illness from the appearance of the symptom to the treatment was below 3 months (38 cases, 34.5%). The primary tumors were located on the right lobe (49 cases, 43.0%), the left lobe (38 cases, 33.3%), both lobes (22 cases, 19.3%), and the isthmus (5 cases, 4.4%). In the histopathologic study, the common type was a papillary carcinoma (102 cases, 89.5%). The common surgical procedures were a total thyroidectomy (66 cases, 57.8%) and a near total thyroidectomy (24 cases, 21.0%). Seventy-five patients (65.8%) received a lymph-noe dissection, and there was cervical lymph-node metastasis in 43 cases (57.3%) of this group. Postoperative complications occurred in 11 cases (9.3%). The common complications were hemorrhage or seroma (5 cases, 4.4%), hoarseness (5 cases, 4.4%) and wound infection (1 cases, 0.9%). Although hypoparathyroidism was predicted, the predominant symptoms did not appear. Regional recurrence or distant metastases were present in 13 cases (11.4%) during four years. CONCLUSION: Thyroid cancer has a wide sectrum of biological behavior and also problems including the lack of reliable prognostic factors and objective assessments of therapeutic modalities. Appropriate and aggressive management should be recommended because most of differentiated thyroid cancer has a favorable prognosis.

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Differentiation of Parathyroid and Thyroid Nodule by Tc-99m Sestamibi Scintigraphy.

Seung Won SEO ; Jae Kyun JOO ; Jung Han YOON ; Young Jong JAEGAL ; Hee Seung BOM

Korean Journal of Endocrine Surgery.2002;2(1):15-18. doi:10.16956/kjes.2002.2.1.15

PURPOSE: Differentiation of parathyroid and thyroid nodule is often difficult even with aids of ultrasonography and computed tomography. Tc-9m sestamibi (MIBI) scintigraphy is useful in the detection of hyperfuntioning parathyroid nodules. However, its role in the differentiation between parathyroid and thyroid nodules including malignancies is not well studied. Therefore, the purpose of this study is to evlauate the role of Tc-99m MIBI imaing in the differentiation of parathyroid adenoma from thyroid malignancy. METHODS: Six patients (4 women, 2 men, mean age 43 years) with parathyroid adenoma and 4 patients (2 women, 2 men, mean age 56 years) with thyroid papillary cancer were enrolled. Ten and 180 minutes after injection of 740 MBq Tc-99m MIBI, pinhole image of the anterior neck was obtained. Nodule-to-thyroid ratio (N:T) was measured from same sized region of interests over nodule and normal thyroid bed. Retention Index (RI) was calculated as N:T 10 minus N:T 180 divided by N:T 10. RESULTS: as those with thyroid cancer (1.09 ± 0.35, 1.24 ± 0.36, respectively, P>0.05 ). However, RI of parathyroid patients was higher than thyroid cancer patients (0.64 ± 0.29, -0.12 ± 0.20, respectively, P<0.05). CONCLUSION: Parathyroid adenoma showed higher retention rate of Tc-99m MIBI than thyroid cancer. Therefore, differntiation of parathyroid and thyroid nodule could be possible using Tc-99m MIBI scintigraphy.

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Operative Indications for Hashimoto's Thyroiditis in Consideration of the Risk of Concurrent Thyroid Carcinoma.

Sung Lim CHOI ; Bong Ok YOO ; In Soo KIM ; Yoon Kyoo KIM

Korean Journal of Endocrine Surgery.2002;2(1):10-14. doi:10.16956/kjes.2002.2.1.10

PURPOSE: This study was performed to further refine the indications for operative treatment of patients with Hashimoto's thyroiditis, and also to present the better histopathologic diagnosis method for Hashimoto's thyroiditis. METHODS: The authors evaluated retrospectively 130 patients with surgically proven Hashimoto's thyroiditis at presbyterian medical center in Chonju and Yonsei hospital in Masan from Jan. 1995 to Feb. 2002. RESULTS: The sensitivity of gun biopsy for the diagnosis of Hashimoto's thyroiditis was significantly higher than the one of fine needle aspiration (83.3% vs 46..2%, P<0.001). There were 26 cases (13.8%) of coexistent carcinoma of 130 patients. The incidence of carcinoma in men (6 in 9, 66.6%) was significantly higher than in women (20 in 121, 16.5%, P<0.05). The incidence of carcinoma in antithyroglobulin antibody negative group (8 in 10, 80%) was significantly higher than in antibody positive guoup (16 in 111, 14.4%, P<0.001). There was no significant difference in the incidence of carcinoma between positive and negative lymphadenopathy groups (22.6% vs 20.0%, P=0.681). As for ultrasonographic findings, patients with irregular-marginated dominant nodule or calcification had significantly higher incidence of carcinoma than those without so findings had (P<0.001). As for the distribution patterns of lymphocytes infiltration, the incidence of carcinoma in nodular or localized pattern groups is significantly higher than in diffuse group (24.5% vs 8.3%, P<0.05). CONCLUSION: For histopathologic diagnosis of Hashimoto's thyroiditis, gun biopsy is more sensitive than fine needle aspiration. And the incidence of concurrent carcinoma in patients with Hashimoto's thyroiditis is increased under the circumstances as follows: men, negative antithyroglobulin antibody results on serologic test, ultrasonographic findings such as irregular-marginated dominant nodule, increased vascularity or calcification, and nodular or localized patterns of lymphocytes infiltration on histopathologic examination.

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Implication of Angiogenesis in Thyroid Cancer.

Euy Young SOH

Korean Journal of Endocrine Surgery.2002;2(1):1-4. doi:10.16956/kjes.2002.2.1.1

No abstract available.

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Significance of ¹⁸F FDG PET-CT for Preoperative Diagnosis of Cervical Lymph Nodes Metastasis in Papillary Thyroid Carinoma.

Su Ran KIM ; Hyun Jong KANG ; Kyoung Sik PARK ; Nam Sun PAIK ; Young Bum YOO

Korean Journal of Endocrine Surgery.2010;10(4):235-239. doi:10.16956/kjes.2010.10.4.235

PURPOSE: To compare the diagnostic accuracy of US/CT with US/CT/¹⁸F-FDG PET-CT in the diagnosis of cervical lymph nodes metastasis in papillary thyroid carcinoma. METHODS: From July 2008 to May 2010, 36 patients with papillary thyroid carcinoma, confirmed by aspiration cytology analysis, underwent neck US, neck CT and ¹⁸F-FDG PET-CT preoperatively. The sensitivity, specificity and diagnostic accuracy of the US/CT, US/CT/PET-CT was analyzed according to lymph node level (all: levels I~VI, central: level VI, lateral: levels I~V). RESULTS: At all lymph nodes group (level I~VI), US/CT/ PET-CT showed a sensitivity of 66.6%, a specificity of 61.9% and a diagnostic accuracy of 63.8%. The corresponding values for US/CT were 60.0%, 85.7%, 75.0% respectively. Considering the central cervical nodes group (level VI), US/CT/PET-CT showed a sensitivity of 57.1%, a specificity of 68.1%, and a diagnostic accuracy of 63.8%. The corresponding values of US/CT were 57.1%, 90.9%, 77.7% respectively. Considering the lateral cervical nodes group (level I~V), US/CT/PET-CT showed a sensitivity of 100%, a specificity of 84.3%, and a diagnostic accuracy of 86.1%. The corresponding values of US/CT were 75.0%, 84.3%, 83.3% respectively. The diagnostic results of US/ CT, US/CT/PET-CT in initial evaluation of the cervical nodes metastasis did not differ significantly. CONCLUSION: Our preliminary results suggest that additional PET-CT evaluation in US/CT does not provide statistically significant benefit for initial diagnosis of cervical lymph nodes metastasis in papillary thyroid carcinoma.
Diagnosis* ; Humans ; Lymph Nodes* ; Neck ; Neoplasm Metastasis* ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Neoplasms

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Preoperative Thyroid-stimulating Hormone Levels as a Predictor of Thyroid Carcinoma.

Sung Yup JOUNG ; Hoon Yub KIM ; Woo Sang RYU ; Sang Uk WOO ; Gil Soo SON ; Jae Bok LEE ; Jeoung Won BAE

Korean Journal of Endocrine Surgery.2010;10(4):220-223. doi:10.16956/kjes.2010.10.4.220

PURPOSE: This study investigated the effects of serum thyroid-stimulating hormone (TSH) levels in predicting malignancy-associated differentiated thyroid cancer (DTC) and benign thyroid nodules. METHODS: Between January 2005 and December 2007, 346 patients underwent thyroid surgery at one hospital. Their records were retrospectively reviewed. RESULTS: Sixty-nine percent (237 of 346) of the patients had DTC. The mean preoperative TSH level was higher than in the malignant group (5 uIU/ml vs 0.4 uIU/ml). The rate of malignancy was the 71% in patients with TSH levels >5 uIU/ml. The TSH level of DTC with metastasis of the lymph node was higher than that with non-metastasis (3.08 uIU/ml vs 2.09 uIU/ml, P<0.01) CONCLUSION: The likelihood of DTC increases with higher serum TSH concentration. Serum TSH level might be useful in predicting malignant nodular thyroid lesion.
Humans ; Lymph Nodes ; Neoplasm Metastasis ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule ; Thyrotropin*

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Changes of Thyroid Function in Patients Undergoing Partial Thyroidectomy for Benign Thyroid Tumors.

Yoon Sun HWANG ; Soo Youn BAE ; Dong Hui CHO ; Min Young CHOI ; Jun Ho CHOE ; Jeong Eon LEE ; Jee Soo KIM ; Seok Jin NAM ; Jung Hyun YANG ; Jung Han KIM

Korean Journal of Endocrine Surgery.2010;10(4):213-219. doi:10.16956/kjes.2010.10.4.213

PURPOSE: Lobectomy or subtotal thyroidectomy in patients with a benign thyroid tumor or goiter can give rise to hypothyroidism due to the reduced volume of the hormone-secreting thyroid gland. This study investigated the incidence of hypothyroidism in such patients and the clinical risk factors. METHODS: One hundred seven patients who underwent partial thyroidectomy for benign thyroid tumor or goiter from January 2003 to February 2005 in our institution were reviewed retrospectively. Patients who had been preoperatively diagnosed with hyper- or hypothyroidism preoperatively were excluded. Postoperative hypothyroidism was defined as an elevated serum thyroid stimulating hormone (TSH) level >6.5 µIU/L at about 6 months postthyroidectomy. RESULTS: The mean age of the 107 patients was 42.2 years. Ninety patients (84.1%) were female. Subtotal thyroidectomy was performed in 20 patients, lobectomy in 83 patients and enucleation in four patients. The most common pathologic diagnosis was nodular hyperplasia (86.0%). Postoperative hypothyroidism developed after surgery in 19 (21.8%) patients. Patients were evaluated for age, gender, preoperative TSH level, tumor size, tumor number, extent of the resection, thickness of thyroid isthmus and the presence of pathologic thyroiditis or thyroid autoantibody. Advanced age, elevated preoperative TSH level and extensive resection of the thyroid gland were significantly associated with postoperative hypothyroidism. CONCLUSION: Since many patients with a benign thyroid nodule can maintain a normal thyroid function even after thyroidectomy, preservation of more thyroid tissue during the operation is desirable, especially in young patients with a low-normal TSH level, unless the possibility of disease recurrence is high.
Diagnosis ; Female ; Goiter ; Humans ; Hyperplasia ; Hypothyroidism ; Incidence ; Recurrence ; Retrospective Studies ; Risk Factors ; Thyroid Gland* ; Thyroid Nodule ; Thyroidectomy* ; Thyroiditis ; Thyrotropin

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Occult Papillary Thyroid Carcinoma Presenting as a Cystic Neck Mass.

Eun Sin LEE ; Hye Kyung LEE ; Seong Woo HONG ; Woo Yong LEE ; Yeo Goo CHANG ; In Wook PAIK ; Hyucksang LEE

Korean Journal of Endocrine Surgery.2009;9(4):228-231. doi:10.16956/kjes.2009.9.4.228

The majority of cystic masses in the lateral neck are benign entities, and these entities include branchial cyst. Occult papillary thyroid carcinoma can occasionally present with regional lymph node metastasis. However, cystic metastasis from occult papillary thyroid carcinoma is a very rare condition. We present here a case of a cystic neck mass as the sole initial clinical manifestation of metastatic occult papillary thyroid carcionoma.
Branchioma ; Lymph Nodes ; Neck* ; Neoplasm Metastasis ; Thyroid Gland* ; Thyroid Neoplasms*

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The Correlation between the Fine Needle Aspiration Cytology and Histology of Patients Who Have Undergone Thyroidectomy.

Jong Beom BAEK ; Sung Chul KIM ; Keum Seok BAE ; Seong Joon KANG

Korean Journal of Endocrine Surgery.2009;9(4):223-227. doi:10.16956/kjes.2009.9.4.223

PURPOSE: Fine needle aspiration cytology (FNAC) has become a standard diagnostic tool for thyroid nodules. The purpose of this study is to analyze the correlation between FNAC and the final histology to improve the diagnostic value. METHODS: We collected 792 patients who had undergone thyroidectomy, and we selected 549 patients who had undergone preoperative FNAC. The FNAC results were classified as non-diagnostic, malignancy, indeterminate and benign. The final pathologic reports were classified into two categories: malignant or benign. The individual histology was also identified. We retrospectively analyzed the pathologic result, the sensitivity, the specificity and the predictive value of the FNAC. RESULTS: Among 549 patients, their FNACs showed 47 non diagnostic results, 189 malignancies,136 indeterminate results and 177 benign results. The false positive rate was 1.1% and the false negative rate was 12.9%. The final pathology reports were 262 malignancies and 287 benign lesions. There were 42 (30.9%) malignancies among the 136 indeterminate cases. Adenomatous hyperplasia was the most common benign lesion and papillary carcinoma (containing micropapillary carcinoma) was the most common benign lesion. CONCLUSION: FNAC is an easy and safe diagnostic tool, but it still has many limitations. It is necessary to reduce the number of non diagnostic results. Technical advances, classification of the advanced categories of cytology and other staining methods can provide more specific results, and this can reduce the rate of performing unnecessary surgery.
Biopsy, Fine-Needle* ; Carcinoma, Papillary ; Classification ; Humans ; Hyperplasia ; Pathology ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Nodule ; Thyroidectomy* ; Unnecessary Procedures

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