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Axillary Lymph Node Metastasis of Papillary Thyroid Carcinoma: A Case Report.

Journal of Korean Thyroid Association.2014;7(2):194-200. doi:10.11106/cet.2014.7.2.194

We report a case of axillary lymph node metastasis (LNM) as a recurrence of papillary thyroid carcinoma (PTC) in a 68-year-old male. The patient initially presented in 2009 with a 3.4x5.4 cm sized neck swelling and left cervical lymphadenopathy. He underwent total thyroidectomy and central compartment neck dissection (CCND) with left modified radical neck dissection (MRND). The pathological report confirmed PTC with metastasis of neck lymph node. On a regular follow up of positron emission tomography (PET), LNM was found on the right supraclavicular area and on the left axillary area. It was 17 months after the initial thyroid cancer had been diagnosed. The right MRND and left axillary lymph node dissections were performed in April of 2012. Pathological result confirmed metastatic PTC of left axillary lymph nodes. After recovery from the surgery, the patient got radioactive iodine therapy with I-131 180 mCi.
Aged ; Follow-Up Studies ; Humans ; Iodine ; Lymph Node Excision ; Lymph Nodes* ; Lymphatic Diseases ; Male ; Neck ; Neck Dissection ; Neoplasm Metastasis* ; Positron-Emission Tomography ; Recurrence ; Thyroid Neoplasms* ; Thyroidectomy

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Primary Thyroid Lymphoma Associated with Dyspnea in an Old Age Patient: A Case Report.

Dae Jin SAH ; Joon Yeon HWANG ; Choon Dong KIM

Journal of Korean Thyroid Association.2014;7(2):190-193. doi:10.11106/cet.2014.7.2.190

Primary thyroid lymphoma is a rare tumor which patients usually present an enlarging neck mass, often causing local obstructive symptoms. Hypothyroidism is seen in 30-40% of the patients with primary thyroid lymphoma. We report a 77-year-old man with history of hypothyroidism, presenting enlarging anterior neck mass which pathologically confirmed as thyroid lymphoma with literature review.
Aged ; Dyspnea* ; Humans ; Hypothyroidism ; Lymphoma* ; Neck ; Thyroid Gland*

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A Case of Severe Thyrotoxicosis Caused by Graves' Disease Presenting with Myasthenic Crisis.

Sun Hee KIM ; Tae Sun PARK ; Hong Sun BAEK ; Heung Yong JIN

Journal of Korean Thyroid Association.2014;7(2):185-189. doi:10.11106/cet.2014.7.2.185

Thyrotoxicosis due to autoimmune thyroid disease occurs in approximately 5% to 10% of patients with myasthenia gravis (MG), whereas the incidence of MG in patients with Graves' disease is much less at approximately 0.2%. Recently, we experienced a 40-year-old male patient diagnosed with thyroid storm with severe respiratory failure and lower extremity weakness. At first, he was diagnosed with Graves' disease and critical illness neuropathy. His thyroid function was improved by anti-thyroid drug, but his neurologic function aggravated at the same time. He accordingly diagnosed with myasthenia gravis. We studied that when we should examine the neurologic function from this case. Our case highlights the importance of investigating muscle weakness or other neurologic problems in the thyrotoxic patient during their management.
Adult ; Critical Illness ; Graves Disease* ; Humans ; Incidence ; Lower Extremity ; Male ; Muscle Weakness ; Myasthenia Gravis ; Respiratory Insufficiency ; Thyroid Crisis ; Thyroid Diseases ; Thyroid Gland ; Thyrotoxicosis*

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Insulin Autoimmune Syndrome in a Patient with Hashimoto's Thyroiditis.

In Wook SONG ; Eugene HAN ; Nan Hee CHO ; Ho Chan CHO

Journal of Korean Thyroid Association.2014;7(2):180-184. doi:10.11106/cet.2014.7.2.180

Insulin autoimmune syndrome (IAS) is characterized by fasting hypoglycemia, endogenous hyperinsulinemia, and the presence of autoantibodies to insulin or insulin receptor in patients that have never been exposed to exogenous insulin. This syndrome is occasionally accompanied by several autoimmune disorders. There is no reported case of concurrent IAS with Hashimoto's thyroiditis. A 52-year-old female was diagnosed with Hashimoto's thyroiditis and was treated with 25 microg/d levothyroxine for 3 years. Recently, she experienced recurrent fasting hypoglycemic symptoms that disappeared rapidly with a carbohydrate-rich diet, although she had no history of diabetes or insulin use. Blood analysis showed hypoglycemia and elevated serum levels of insulin and C-peptide. Imaging studies did not reveal a mass lesion in the pancreas, and selective calcium-stimulated venous sampling also gave a negative result. However, anti-insulin antibody titer was high and assay for anti-insulin receptor antibody was positive. Here, we report a case of IAS concomitant with Hashimoto's thyroiditis.
Autoantibodies ; C-Peptide ; Diet ; Fasting ; Female ; Humans ; Hyperinsulinism ; Hypoglycemia ; Insulin* ; Middle Aged ; Pancreas ; Receptor, Insulin ; Thyroid Gland* ; Thyroiditis* ; Thyroxine

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Concurrent Presence of Sjogren's Syndrome, Warthin Tumor, and MALT Lymphoma in a Parotid Gland and Hashimoto's Thyroiditis.

Ho Su KIM ; Jong Ryeal HAHM ; Tae Sik JUNG ; Soo Kyoung KIM ; Sungsu KIM ; Kyong Young KIM ; Jung Hwa JUNG

Journal of Korean Thyroid Association.2013;6(2):126-130. doi:10.11106/jkta.2013.6.2.126

A 54-year-old female patient was referred due to a mass in the left salivary gland. A neck CT was performed and surgery was agreed due to a suspected Warthin tumor. The patient was also diagnosed with Sjogren's syndrome and Hashimoto's thyroiditis and treated. Warthin tumor and extranodal marginal zone B-cell lymphoma were also diagnosed after parotidectomy. The coexistence of the two autoimmune diseases, Hashimoto's thyroiditis and Sjogren's syndrome, has been reported, as has the coexistence of Warthin tumor and malignant tumor within a single salivary gland. However, these four diseases have not previously been reported in an individual patient. The authors treated a patient who was first diagnosed with Sjogren's syndrome and Hashimoto's thyroiditis, and subsequently also with Warthin tumor and extranodal marginal zone B-cell lymphoma after superficial parotidectomy. Therefore, this case is reported together with a related literature review.
Adenolymphoma* ; Autoimmune Diseases ; Female ; Humans ; Lymphoma, B-Cell, Marginal Zone* ; Middle Aged ; Neck ; Parotid Gland* ; Salivary Glands ; Sjogren's Syndrome* ; Thyroid Gland* ; Thyroiditis*

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Subclinical Central Lymph Node Metastasis in Papillary Thyroid Microcarcinoma Evaluated as cT1aN0 by Preoperative Imaging Study.

Seung Tae KIM ; Bong Kwon CHEON ; Hyoung Shin LEE ; Sung Won KIM ; Hyo Sang PARK ; Kang Dae LEE

Journal of Korean Thyroid Association.2013;6(2):121-125. doi:10.11106/jkta.2013.6.2.121

BACKGROUND AND OBJECTIVES: Papillary thyroid microcarcinoma (PTMC) generally has a highly favorable prognosis, however reports show a 30-65% prevalence of subclinical central lymph node metastasis. Therefore, the role of elective central neck dissection in PTMC treatment remains controversial. Our study focused on preoperative features of clinically lymph node negative and intracapsular (cT1aN0) PTMC and the correlation of these features with subclinical central lymph node metastasis. MATERIALS AND METHODS: Of 584 PTC patients who underwent thyroidectomy at the Kosin University Gospel Hospital from January 2009 to July 2011, 219 patients with cT1aN0 PTMC were reviewed retrospectively. Pathologic results were reviewed and various clinicopathologic prognostic factors were investigated. RESULTS: Postoperative pathology report revealed capsular invasion of primary tumor in 77 patients (35.2%) and subclinical central lymph node metastasis in 62 patients (28.3%). Tumor of the isthmic location was an independent predictor of subclinical central lymph node metastasis by multivariate analysis while multifocality showed borderline significance. The presence of extrathyroidal extension (ETE), multifocality, and cervical lymph node metastasis were significantly related to PTMC of isthmus. Seven of the 14 subjects with PTMC of the isthmus (50%) had pretracheal lymph node metastasis showing significant correlation (p=0.001). CONCLUSION: Despite the absence of ETE and lymph node metastasis in the preoperative imaging studies, higher risk of subclinical central lymph node metastasis should be considered in PTMC with multifocality and tumor of the isthmus.
Carcinoma, Papillary ; Humans ; Lymph Nodes* ; Multivariate Analysis ; Neck Dissection ; Neoplasm Metastasis* ; Pathology ; Prevalence ; Prognosis ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy

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What Are Patients with Thyroid Cancer Surgery Concerned about?.

Hanna KIM ; Yoon Hee PARK ; Young Ja OH ; Kyung Ah PARK ; In Sook KIM ; Kum Myoung WOO ; Bup Woo KIM ; Yong Sang LEE ; Hang Seok CHANG ; Cheong Soo PARK

Journal of Korean Thyroid Association.2013;6(2):115-120. doi:10.11106/jkta.2013.6.2.115

BACKGROUND AND OBJECTIVES: To prevent getting wrong information and improve high quality of life, it is necessary to provide accurate information and patient education. This study aimed to collect basic data and develop educational program for thyroid cancer patient by understanding their educational needs. MATERIALS AND METHODS: Between April 16 and June 15, 2012, 159 patients who underwent thyroid cancer surgery were enrolled. This survey consisted of 5 areas including management of the symptom and the complication after surgery, postoperative wound and dietary management, treatment plan after discharge, medication management, and daily life. RESULTS: The most common way for the patients to acquire information about the disease was Internet and the patients who used INTERNET as their information source were 54.7%. Doctors (76.1%) and nurses (21.4%) were the preferred educators for the patients, and small group education was the preferred education method. Specifically the need for "management of the symptom and the complication after surgery" was the highest (3.33), followed by "treatment plan after discharge" (3.31), "medication management" (3.19), "postoperative wound and dietary management" (3.17). CONCLUSION: Medical team including doctors and nurses should be the center to activate small group education for patients. Professional and individualized education program should be developed to give the proper education to patients and their family.
Education ; Health Surveys ; Humans ; Internet ; Methods ; Patient Education as Topic ; Quality of Life ; Thyroid Gland* ; Thyroid Neoplasms* ; Wounds and Injuries

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Otolaryngologist-Performed Ultrasound and Ultrasound-Guided Fine Needle Aspiration for Thyroid Nodule and Meaningful Ultrasound Finding.

Seung Young HA ; Young Chan LEE ; Yong Gi JUNG ; Myung Gu KIM ; Young Gyu EUN

Journal of Korean Thyroid Association.2013;6(2):110-114. doi:10.11106/jkta.2013.6.2.110

BACKGROUND AND OBJECTIVES: Ultrasonography is a safe and noninvasive imaging modality with high sensitivity that can be used to identify the presence, location, and size of thyroid nodules. Fine-needle aspiration (FNA) biopsy of thyroid nodules is a minimally invasive and safe procedure that is usually performed on an outpatient basis. The purpose of this study was to investigate the diagnostic efficacy of ultrasonography performed by an otolaryngologist (OUS) and OUS-guided FNA for the thyroid and determine the clinical value of OUS in predicting the presence of malignancy in thyroid nodules. MATERIALS AND METHODS: A single otolaryngologist examined 151 consecutive patients referred to our institution and performed OUS or OUS-guided FNA biopsies on all of them in an office setting. Final diagnosis was based on the FNA biopsy or pathological result of operation. We used the following parameters to assess the relevance of the sonographic findings in the prediction of thyroid malignancy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and relative risk (RR). RESULTS: In total, 12.9% of all the patients showed malignancy. The PPVs for the sonographic features were as follows: a taller-than-wide shape, 63.6%; marked hypoechogenicity, 61.5%; microcalcification, 46.7%; microcalcification or macrocalcification, 44.0%; and spiculated margin, 38.2%. The RR values showed that microcalcification or macrocalcification (p<0.05, RR=7.2) and marked hypoechogenicity (p<0.05, RR=6.7) are significant findings that indicate thyroid malignancy. CONCLUSION: Microcalcification or macrocalcification and marked hypoechogenicity observed on OUS are significant finding that indicate thyroid malignancy, and the most reliable finding are microcalcification or macrocalcification.
Biopsy ; Biopsy, Fine-Needle* ; Diagnosis ; Humans ; Outpatients ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*

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Thyroid Imaging Reporting and Data System (TIRADS).

Jin Young KWAK

Journal of Korean Thyroid Association.2013;6(2):106-109. doi:10.11106/jkta.2013.6.2.106

Ultrasound (US) is the best diagnostic choice for thyroid nodules. Recently, the thyroid imaging reporting and data system (TIRADS) has been developed for risk stratification of thyroid nodules using various US features, similar to Breast Imaging Reporting and Data System (BI-RADS) for evaluating breast lesions. The reporting system can allow effective communication between the reporting doctors, such as radiologists, cytologists, and clinicians using standardization and simplification of the reports. In this review, I discuss several TIRADS systems developed.
Biopsy, Fine-Needle ; Breast ; Information Systems* ; Thyroid Gland* ; Thyroid Nodule ; Ultrasonography

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Hypothyroidism and Metabolic Syndrome.

Jae Hoon MOON

Journal of Korean Thyroid Association.2013;6(2):101-105. doi:10.11106/jkta.2013.6.2.101

Metabolic syndrome is a cluster of diseases that include central obesity, hyperglycemia, dyslipidemia, and hypertension. Metabolic syndrome is a risk factor for type 2 diabetes and cardiovascular disease and the key pathophysiology is insulin resistance. Thyroid hormone has been known to play an important role in lipid and glucose metabolism and hypothyroidism causes atherosclerosis and insulin resistance. A number of clinical studies reported overt or subclinical hypothyroidism is associated with metabolic syndrome, and there has been the efforts elucidating a link between these two diseases. Recently, thyroid hormone analogue or thyromimetics has been developed to improve metabolic syndrome including dyslipidemia. I reviewed recently reported mechanisms explaining the association between hypothyroidism and metabolic syndrome, and current status of the development of thyromimetics was also reviewed.
Atherosclerosis ; Cardiovascular Diseases ; Dyslipidemias ; Glucose ; Hyperglycemia ; Hypertension ; Hypothyroidism* ; Insulin Resistance ; Metabolism ; Obesity, Abdominal ; Risk Factors ; Thyroid Gland

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